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.

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