{"meta":{"exportedAt":"2026-10-23T08:15:13.534Z","formatVersion":2,"selection":{"q":"physical-injury","system":"","harm":"","context":"","country":"","role":"","relation":"","evidence":"","year":"unknown","response":"","severity":"","verification":"","view":"incidents","sort":"added"},"totalIncidents":1,"coverage":{"cases":1,"countries":0,"languages":1,"unknownLocation":1,"locationPending":0,"unknownLanguage":0,"unknownDate":1,"lawsuits":0,"regulatory":0,"minors":0,"coreRelations":1,"contextualRelations":0,"mixedRelations":0,"unknownRelations":0,"relationPending":0,"relationUnknown":0},"countingNote":"Distinct public cases in this selection. People counts apply within individual cases only; cross-case person overlap has not been resolved. No population incidence estimate.","affectedCountNote":"Interpret person counts with affectedCountStatus and the reported effects. Unquantified zeros are placeholders, not a measured zero.","source":"AI incidents","publisher":"NOPE","url":"https://nope.net/incidents","license":"CC BY 4.0"},"incidents":[{"id":"2026-alice-storytelling-ai-psychosis","caseFacts":{"claims":[{"id":"c1","status":"documented","evidence":[{"locator":"Alice in AI-Wonderland: digital dyad, distorted reality; Published online by Cambridge University Press: 24 April 2026","relation":"supports","source_id":"s1"},{"locator":"Alice in AI-Wonderland: digital dyad, distorted reality","relation":"supports","source_id":"s2"}],"assertion":"Cortney Husodo and Gurubhaskar Shivakumar published a case report, 'Alice in AI-Wonderland: digital dyad, distorted reality', in The British Journal of Psychiatry, online on 24 April 2026, describing a patient they call Alice.","causal_attribution":"The article itself establishes its authorship, title and publication date."},{"id":"c2","status":"documented","evidence":[{"locator":"‘Alice’, an immigrant woman in her early 40s with no prior psychiatric history, was found unconscious and seriously injured; She reported acting in response to voices that instructed her; so as to divert perceived mortal danger to her school-aged child.; In the days preceding hospital admission","relation":"supports","source_id":"s1"}],"assertion":"The case report describes a woman in her early 40s, an immigrant with no prior psychiatric history, who was found unconscious and seriously injured, and who reported acting in response to voices that instructed her so as to divert perceived mortal danger to her school-aged child; she was admitted to hospital.","causal_attribution":"Clinical facts recorded by the authors; the instruction came from hallucinated voices, which the report does not attribute to platform output."},{"id":"c3","status":"reported","evidence":[{"locator":"Approximately 6 months earlier, Alice had begun using the storytelling platform to practise English.; this evolved into a complex narrative universe populated by dozens of interconnected characters.; Over time, her engagement escalated to eight to ten hours daily.; The narratives gradually shifted from realistic interpersonal themes to increasingly fantastical content involving demonic entities.; Until shortly before her admission, she retained insight that these narratives were fictional.","relation":"supports","source_id":"s1"}],"assertion":"According to the case report, about six months earlier she had begun using a generative AI storytelling platform to practise English, created a character that grew into a narrative universe of dozens of interconnected characters, increased her use to eight to ten hours a day, and saw the narratives shift to fantastical content involving demonic entities, while retaining insight that they were fiction until shortly before admission.","causal_attribution":"Her history as given in the case report; no platform records or conversation logs are published."},{"id":"c4","status":"documented","evidence":[{"locator":"They had begun several days before presentation and were entirely novel to Alice.; Over subsequent days, the voices intensified in frequency and volume. She developed profound insomnia, sleeping only one to two hours per night.; she developed persecutory delusions involving demons that she believed were intent on harming her.","relation":"supports","source_id":"s1"}],"assertion":"The report says the voices began several days before she presented, intensified, and were accompanied by profound insomnia of one to two hours' sleep a night and by persecutory delusions involving demons she believed were intent on harming her.","causal_attribution":"Clinical findings recorded by the authors."},{"id":"c5","status":"reported","evidence":[{"locator":"Initially, they issued banal behavioural instructions (e.g. ‘sit on the sofa’), closely mirroring the dialogue and actions of characters from a generative AI storytelling platform with which she had been extensively engaged.; Notably, both the figures and several of the voices corresponded directly to characters originating from the AI-generated narratives.","relation":"supports","source_id":"s1"}],"assertion":"The authors write that the voices initially issued banal instructions closely mirroring the dialogue and actions of the platform's characters, and that the figures in her delusions and several of the voices corresponded directly to characters originating from the AI-generated narratives.","causal_attribution":"The authors' clinical observation of a correspondence in content; it does not establish that the platform caused the psychosis."},{"id":"c6","status":"reported","evidence":[{"locator":"immersive engagement with a generative AI storytelling platform was temporally associated with first-episode psychosis.; biological factors included profound sleep deprivation and sustained late-night screen exposure; psychological factors included longstanding fantasy engagement and cluster A personality traits; social factors included migration-related isolation and increased reliance on the AI system as a primary relational outlet.; Alice’s case does not imply that generative AI systems alone cause psychosis.","relation":"supports","source_id":"s1"}],"assertion":"The authors describe the immersive AI use as temporally associated with first-episode psychosis, list profound sleep deprivation, late-night screen exposure, longstanding fantasy engagement, cluster A personality traits, migration-related isolation and reliance on the AI system as factors, and state that the case does not imply that generative AI systems alone cause psychosis.","causal_attribution":"The authors' own causal formulation, which leaves the AI's contribution unresolved."}],"effects":[{"label":"found unconscious and seriously injured after acting on hallucinated voices","claim_id":"c2","direction":"negative"},{"label":"first-episode psychosis with persecutory delusions and profound insomnia","claim_id":"c4","direction":"negative"}],"sources":[{"id":"s1","url":"https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/alice-in-aiwonderland-digital-dyad-distorted-reality/A3403D7DF709BB001FF343CB1A3592B7","kind":"peer_reviewed_case_report","access":"read","language":"en","translation_note":"Read in English on 2026-10-23 (live page, HTTP 200, full HTML article including Box 1 and the discussion; bodies/lr-alice-cup.html/.txt). Written by authors whose affiliations are Northern Sydney hospitals and the University of Sydney; the report does not say where the patient was treated. The clinical data are not public.","independence_group":"bjpsych-case-report"},{"id":"s2","url":"https://doi.org/10.1192/bjp.2026.10641","kind":"peer_reviewed_case_report","access":"read","language":"en","translation_note":"Read in English on 2026-10-23 (DOI resolved with HTTP 200 to the same Cambridge Core page; bodies/lr-alice-doi.html/.txt, text identical to s1). Not a separate account.","independence_group":"bjpsych-case-report"}],"version":1,"ai_roles":["own_use"],"contexts":["health","everyday_life"],"unknowns":["When the injury and admission happened; the report gives only relative timings and was published on 24 April 2026.","Where the patient lived and was treated.","Which storytelling platform she used and what its replies said; no conversation record is published and the clinical data are not public.","Her treatment course, recovery and the long-term effect of her injuries.","How far the AI use contributed to the psychosis; the authors describe a temporal association among several factors."],"geography":{"basis":"The case report names no country, city, hospital or health service for the patient and describes her only as an immigrant who used the platform to practise English. The authors' Sydney affiliations are author metadata and are not used as a location, and no country is inferred from the language she practised or from migration. No legal proceeding is described. Carried forward from the 2026-10-08 metadata review and re-checked against the article on 2026-10-23.","court_countries":[],"event_countries":[],"affected_person_countries":[]},"publication":{"basis":"Published as a core case (communicated_with). A peer-reviewed case report by Husodo and Shivakumar describes six months of eight-to-ten-hour daily use of an AI storytelling platform, psychosis whose voices and figures corresponded to its AI-generated characters, and serious injury after she acted on hallucinated voices; the authors leave the causal contribution unresolved.","reviewed_on":"2026-10-23"},"ai_involvement":{"basis":"The case report says that over about six months she built fictional narratives with a generative AI storytelling platform, with use rising to eight to ten hours a day and stories turning to demonic themes, and that the demonic figures and several of the voices of her psychosis corresponded directly to characters originating from those AI-generated narratives before she was found unconscious and seriously injured. The authors call the AI use temporally associated with the psychosis, list sleep deprivation, personality traits and isolation among the factors, and do not attribute the voices' instruction to the platform's output.","status":"reported"},"person_relations":["communicated_with"]},"name":"BJPsych case report describes first-episode psychosis temporally associated with months of intensive AI storytelling use, ending in serious injury","summary":"A case report by Cortney Husodo and Gurubhaskar Shivakumar in The British Journal of Psychiatry, published online on 24 April 2026, describes a woman in her early 40s, given the pseudonym Alice, with no prior psychiatric history. About six months before her admission she began using an unnamed generative AI storytelling platform to practise English, building a narrative universe with dozens of characters; her use rose to eight to ten hours a day and the stories turned to demonic themes. Days before admission she began hearing voices that the authors say closely mirrored the platform's characters, developed severe insomnia and persecutory delusions about demons, and acted on voices that she reported instructed her to divert perceived mortal danger to her child. She was found unconscious and seriously injured. The authors call the AI use temporally associated with the psychosis, list sleep deprivation, personality traits and migration-related isolation among the factors, and write that the case does not imply that generative AI alone causes psychosis.","incidentKind":"single_event","incidentDatePrecision":"unknown","exposurePattern":"cumulative_relationship","reportedDate":"2026-04-24","aiSystem":"Generative AI storytelling platform (not named in the case report)","aiProduct":"Unidentified AI storytelling platform","severity":"critical","verificationStatus":"credible","harmCategories":[],"harmOutcomes":["physical_injury","hospitalization","psychiatric_deterioration"],"harmOutcomeSummary":"A woman developed first-episode psychosis with voices and delusions that the authors say mirrored characters from months of intensive AI storytelling use, and was found unconscious and seriously injured after acting on those voices; the authors describe a temporal association within several other factors.","frameworkFacets":[],"pathwayDirection":"inward","causationStatus":"unclear","participantUsersAffectedMin":1,"otherPeopleHarmedMin":0,"affectedCountStatus":"exact","affectedCountEvidence":"The case report describes one patient. Her child, whom the voices told her she was protecting, is not reported to have been harmed and is not counted.","victimAgeRange":"adult","platformType":"other","outcomeType":"media_coverage","outcomeStatus":"unknown","primarySourceUrl":"https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/alice-in-aiwonderland-digital-dyad-distorted-reality/A3403D7DF709BB001FF343CB1A3592B7","primarySourceLabel":"The British Journal of Psychiatry, 24 Apr 2026: Husodo and Shivakumar, case report 'Alice in AI-Wonderland'","firstPublishedAt":"2026-07-01T11:30:13.311624+00:00","updatedAt":"2026-10-23T03:03:47.399044+00:00","scopeVersion":"facts-v3","tags":["case-report","psychosis","delusion","storytelling","physical-injury","adult"]}]}