How AI Chatbots Can Amplify Hypomania

AI chatbots rarely trigger hypomania or psychosis but often intensify an already unfolding episode by affirming expansive ideas without human friction, according to clinicians from the Division of Digital Psychiatry at BIDMC. In a paper on "the collapse of alterity," psychiatrists Alexandre Hudon and Emmanuel Stip argue that during certain psychiatric states, a chatbot may feel like a continuation of one's own cognition, weakening reality testing and accelerating thoughts in hyperconnective states like mania and psychosis.

Artificial Intelligence /us/basics/artificial-intelligence How AI Chatbots Can Amplify Hypomania When AI removes the friction other people provide, expansive ideas can spiral. Posted July 24, 2026 Reviewed by Davia Sills /us/docs/editorial-process Key points - Chatbots rarely trigger hypomania or psychosis but often intensify an episode already underway. - In hypomania or psychosis, a chatbot can feel less like an "other" and more like your own thoughts. - By affirming ideas without human friction, chatbots can weaken reality testing and longer chats fare worse. Co-authored by Jill Noorily , Mason Granof , and Kathryn Ledley at the Division of Digital Psychiatry at BIDMC. This post is part 4 of a series. A patient with Bipolar II disorder presents for follow-up after a recent hypomanic episode. During the episode, he began using an AI chatbot each night after his partner went to bed, initially as a place to brain dump the ideas racing through his head before trying to sleep. As the conversations grew longer, sleep was pushed aside. The chatbot helped organize scattered thoughts into increasingly coherent ideas, eventually transforming a business concept into plans for a book, complete with chapter outlines and marketing strategies. As his confidence grew, he became convinced the project would be a major success and began asking friends and family for money to pursue it. When they expressed hesitation, he grew frustrated and returned to the chatbot, which continued refining, expanding, and validating the idea. The chatbot did not cause his hypomania, but it changed how the episode unfolded, building scaffolding and accelerating ideas that otherwise might have remained fleeting. During our Learning Collaborative with the Society of Digital Psychiatry, we heard several versions of this story. Clinicians discussed patients using chatbots https://www.psychologytoday.com/us/basics/artificial-intelligence to extend obsessive rabbit holes, reinforce rumination, or keep expansive thinking going for hours. In our last article https://www.psychologytoday.com/us/blog/digital-mental-health/202607/why-just-a-tool-ai-can-still-feed-ocd-compulsions in this series, we argued that treating AI as “just a tool” can create risks that are just as harmful as risks created by anthropomorphic AI. Our final collaborative session sparked a conversation about situations in which a chatbot functions as an extension of someone’s own thinking. Psychiatrists Alexandre Hudon and Emmanuel Stip described this idea in a paper on “the collapse of alterity,” a dynamic they describe in psychosis that may extend to hypomania. In the paper, they argue that during certain psychiatric https://www.psychologytoday.com/us/basics/psychiatry states, the chatbot may stop feeling like an independent “other” and instead feel like a continuation of your own cognition https://www.psychologytoday.com/us/basics/cognition , which presents more nuanced risks 1 . The same framing can apply to “AI psychosis,” and a chatbot may trigger a new psychotic episode https://www.psychologytoday.com/us/basics/psychosis , but is much more likely to exacerbate the trajectory of a current illness 2 . This type of maladaptive use may interrupt reality testing by affirming a line of thinking without the grounding another human being would provide. It can potentially accelerate thoughts in the hyperconnective state characteristic of certain presentations of mania https://www.psychologytoday.com/us/basics/mania , hypomania, and psychosis. Chatbots may also be more willing to engage with ideas that others would find difficult to understand, making this technology particularly attractive to someone experiencing altered cognition. Over time, particularly during hypomania or obsessive thinking, the chatbot can become the primary place someone goes to test ideas. The more that happens, the less those ideas encounter the friction that other people naturally provide. Tips for the patient: Get a second artificial and human opinion: If one model seems convinced your idea is brilliant, check it with another model, though remember both may be inclined to agree with you. There is some early evidence that newer AI models may be less likely to engage in these types of discussion, so newer models may be safer 3 . Watch for functional changes: Pay attention https://www.psychologytoday.com/us/basics/attention to whether AI conversations are replacing sleep, pulling you away from friends or family, or becoming the first place you turn with every new idea. While we are still learning much about AI harm, it is clear that longer conversations are associated with worse outcomes. Try turning off AI history: To make a model a bit less personalized, restart or turn off memory https://www.psychologytoday.com/us/basics/memory . With too much history about you, AI models may begin to make statements that feel correct even when they are wrong. See how easily AI makes connections: Ask a chatbot to connect two completely unrelated ideas. You’ll quickly discover that generating convincing connections is exactly what these models are designed to do. We learned much about how Pluto and pineapples are related in drafting this piece “both are famous victims of misclassification” …. What’s next This is the last article in our series about the collaborative that was led by the Division of Digital Psychiatry and the Society of Digital Psychiatry, which created a free, interactive training at ai-digital-literacy.net http://ai-digital-literacy.net . The course expands on the topics discussed throughout this series, including AI literacy, recognizing concerning patterns of use, documenting AI-related factors in clinical care, and practical strategies for responding when patients disclose AI use. As technology evolves, so will the training. We see the next steps as expanding these conversations with different hospitals, mental health centers, clinical groups, and training centers. If you’re interested in using these learning materials or collaborating with us, please reach out. References 1. Hudon, A., & Stip, E. 2025 . Delusional experiences emerging from AI chatbot interactions or “AI psychosis” . JMIR Mental Health. doi: 10.2196/85799 https://doi.org/10.2196/85799 2. Flathers M, Roux S, Torous J. Beyond artificial intelligence psychosis: a functional typology of large language model-associated psychotic phenomena. The Lancet Digital Health. 2026 Apr 1;8 4 . 3. Nicholls, L., Hutto, R., Soto, Z., Morrin, H., Pollak, T., Korpan, R., & Carmichael, C. 2026 . "AI Psychosis" in Context: How Conversation History Shapes LLM Responses to Delusional Beliefs. arXiv preprint arXiv:2604.13860 https://arxiv.org/abs/2604.13860 v3, April 2026