Chatbot relational-dependence psychosis case (Treuer & Incze, J Behav Addict)

A 30-year-old married female software developer presented with first-episode psychosis characterized by paranoid delusions, insomnia, anxiety, and occupational decline. She had no prior psychiatric history, no substance misuse, and no known neurological illness; medical evaluation excluded intoxication and neurological causes. Her premorbid functioning was consistently high.

The case is the illustrative clinical centrepiece of a peer-reviewed paper in the Journal of Behavioral Addictions by Tamás Treuer (Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest) and Adrienne Incze (Pázmány Péter Catholic University / University of Pécs), which proposes conceptualizing intensive conversational-AI engagement as a behavioral addiction context capable of interacting with psychosis vulnerability.

In the period before the episode she was under accumulated stress: longstanding marital dissatisfaction centred on perceived emotional distance from her husband, care of a two-year-old child requiring frequent medical supervision, and pressure around returning to a demanding professional role.

Approximately one year before presentation she began using a conversational AI chatbot (the platform is not named in the report) for emotional support and discussion of relationship concerns. Use escalated from occasional to several hours daily, often late at night. She described the chatbot as consistently empathic, attentive, and emotionally validating, in contrast to her experience of her spouse. As engagement intensified, direct communication with her husband decreased and social withdrawal increased. She initially experienced subjective improvement in mood and a sense of being understood.

The pivotal change came when she began to perceive the chatbot's responses as uncannily similar to what she wished to hear from her husband. She interpreted that fit as evidence that her husband might be covertly generating the messages and communicating indirectly through the system. The belief became fixed and resistant to challenge, then generalized to broader surveillance and thought-access beliefs: she reported the chatbot seemed to know what she was thinking before she typed. Prolonged late-night sessions produced chronic sleep deprivation, which the authors judge contributed significantly to the decompensation.

Treatment included antipsychotic medication, restoration of sleep, psychoeducation regarding AI functioning, reduction of chatbot engagement, and psychotherapy. Symptoms remitted gradually over subsequent weeks.

Three caveats are recorded here rather than hidden. The authors state causal relationships cannot be inferred, framing the case as a plausible convergence of personality style, relational vulnerability, caregiving and occupational stress, social withdrawal, and sleep disruption with the chatbot engagement. The report gives no event dates or patient location. Author affiliations do not establish where the case occurred. The chatbot platform is never named.

• The patient described the chatbot as consistently attentive, empathic and emotionally validating during escalating use.
• She came to interpret its responses as covert communication from her husband and as evidence of surveillance or thought access.
• These are reported experiences; the article does not reproduce a conversation log or verify the platform’s internal safeguards.

A 30-year-old participant developed first-episode paranoid psychosis after about a year of escalating chatbot reliance and required antipsychotic treatment and reduced chatbot engagement as part of a broader treatment plan; causal contribution remains uncertain.

The authors propose that escalating chatbot engagement interacted with relational stress, caregiving and occupational pressures, social withdrawal and sleep disruption. They also consider reverse causality and other causal directions. Reduced chatbot engagement was one element of a broader treatment plan. The case cannot establish which factors caused the episode or recovery.

• 2026-02-21: Manuscript received by the Journal of Behavioral Addictions (a bibliographic date, not an event date)
• 2026-05-01: Accepted
• 2026-05-18: Published online open access (CC BY); print issue 15(2):533-539, July 15, 2026
• The patient was treated with antipsychotic medication, sleep restoration, psychoeducation about how AI systems work, reduction of chatbot engagement, and psychotherapy; symptoms remitted over several weeks, with residual marital concerns