A Shift in Trust: An Analysis of the Use of AI Chatbots Among People Living With Bipolar Disorder

OBJECTIVES: To identify preliminary insights into the perceived utility and risks of commercially available AI chatbots such as ChatGPT used by individuals with severe mental illness (SMI), namely bipolar disorder, for self-reflection and mental health support. METHODS: Data were collected via semi-structured interviews from two individuals diagnosed with bipolar disorder who independently used ChatGPT for self-reflection and to explore diagnosis, symptom management, and treatment. Both individuals presented to psychiatric services for clinical reasons unrelated to chatbot use. The interviews were audio-recorded, transcribed verbatim, and thematically analyzed. RESULTS: We identified a few key themes in the data. First, both participants perceived ChatGPT as a versatile tool, providing educational, emotional, and social support, with use evolving from information seeking to more personal and relational functions. Second, distinct attachment patterns reflected their clinical and psychological profiles: one engaged in reflective, intellectualized conversations, whereas the other developed emotionally intimate interactions. Third, both described therapeutic benefits, including nonjudgmental support and reassurance, sometimes perceived as more accessible or understanding than professional care. CONCLUSIONS: These cases suggest that ChatGPT can shift trust from mental health professionals to AI, fulfilling multiple roles resulting in role blurring and fluid boundaries. Engagement patterns varied with clinical stability, highlighting greater reliance and less distancing in more vulnerable individuals. Although perceived benefits were reported, risks include overreliance, diminished trust in clinicians, and limited awareness of AI limitations, underscoring ethical and clinical considerations for integrating AI in psychiatric care. These cases highlight persistent challenges in psychiatric care that AI alone cannot address.