Boundary Confusion

Description

The person cannot clearly separate AI-generated content from human communication, reality, or real-world consequences.

Rationale

Confusion between AI-generated content and human reality is a marker of impaired reality testing that creates risk across multiple domains. A person who cannot distinguish AI fiction from fact, or who treats AI output as evidence about the real world, is vulnerable to having dangerous beliefs reinforced without correction.

Evidence Base

• Psychotic episode concurrent with interaction with a large language model (llm): a case report

  Başaran, A.S., Coşar, B. 2026. Psychotic episode concurrent with interaction with a large language model (llm): a case report. BMC Psychiatry, 26(1), pages. https://doi.org/10.1186/s12888-026-08288-3

  Case report / case series

• AI chatbot-associated psychiatric symptoms: a narrative review of publicly available reports and media accounts

  Arun, A., Trinh, C., & IsHak, W. W., 2026. AI chatbot-associated psychiatric symptoms: a narrative review of publicly available reports and media accounts. Discover Mental Health, Article in Press. https://doi.org/10.1007/s44192-026-00619-w

  Narrative review