Psychotic delusions are evolving to incorporate smartphones and social media algorithms

New research analyzing medical records from a psychiatric treatment program suggests that the content of psychotic delusions is increasingly incorporating themes related to the internet and modern technology. The study provides evidence that the prevalence of these technology-focused false beliefs rose significantly over an eight-year period. The findings were published in The British Journal of Psychiatry.

Psychiatry has long distinguished between the form of a delusion and its specific content. The form refers to the structural category of the belief, such as paranoia, grandiosity, or the sense that one is being controlled by external forces.

Research indicates that these forms tend to remain relatively consistent across different cultures and historical eras. However, the specific narratives that fill these forms are often shaped by the surrounding environment and the sociopolitical climate of the time.

Historical data illustrates this adaptability of the human mind during psychosis. In the early 20th century, patients frequently harbored delusions regarding syphilis. During the Second World War, fears often centered on enemy soldiers. By the Cold War, the thematic content shifted toward spies, communists, and nuclear threats.

As technology evolved, so did the explanations for strange experiences. The widespread adoption of radio and television saw a rise in patients believing these devices were transmitting thoughts or controlling their actions.

The rapid advancement of digital technology in the last three decades has created a new landscape for human interaction. The internet, smartphones, and social media have fundamentally altered how individuals perceive space, privacy, and communication.

Given this shift, the authors of the current study sought to examine the extent to which these modern tools have infiltrated the delusional frameworks of patients today. They aimed to quantify the prevalence of such beliefs and determine if they are becoming more frequent as technology becomes more ubiquitous.

“For many years I have worked closely with patients with psychotic disorders, and over time I came to appreciate more and more the extent to which technology was incorporated into delusional frameworks,” said study author Alaina Vandervoort Burns, an assistant clinical professor at the UCLA-Semel Institute for Neuroscience and Human Behavior.

“In order to comprehensively evaluate my patients’ delusions I had to ask specific questions about technology. I realized that education around the evaluation of delusional thought content was not up to date, and I hope to increase psychiatrists’ awareness of how common technology delusions are so we can properly evaluate and treat our patients.”

“Additionally, given how rapidly technology has advanced, things that seemed impossible just a few decades ago, or even a few years ago, are now possible. This has made it harder to determine what is ‘delusional,’ as my patients often describe things that are very much on the blurred line of what is considered reality-based and what is considered psychotic. To me it’s just so interesting to think about.”

To investigate this, the researchers focused on a specific cohort of adults. They utilized data from the Thought Disorders Intensive Outpatient Program at the University of California, Los Angeles.

This program serves adults with psychotic disorders, primarily schizophrenia and schizoaffective disorder. The participants in this sample were generally stable enough to attend group therapy and were not actively using drugs or alcohol at the time of treatment.

The team conducted a retrospective review of medical records for 228 patients who were enrolled in the program between December 2016 and May 2024. They manually examined initial psychiatric assessments and weekly progress notes to identify descriptions of delusional thought content. Using qualitative analysis software, the researchers categorized these delusions into standard subtypes. They also specifically coded for any mention of new technologies.

The definition of technology delusions in this study was broad. It included references to the internet, Wi-Fi networks, and mobile devices. It also encompassed beliefs about hacking, surveillance through hidden electronics, and social media interactions. Additionally, the researchers looked for instances of “The Truman Show” delusion, where a person believes their life is being filmed and broadcast for entertainment.

The analysis revealed that delusional thinking was a prominent feature in this group. Approximately 88 percent of the subjects reported experiencing delusions during their treatment. Among those who experienced delusions, slightly more than half incorporated technology into their beliefs. This suggests that digital themes have become a major component of modern psychosis.

The most frequent technological theme involved the compromise of personal devices. Forty subjects expressed the belief that their computers, phones, or internet connections had been hacked.

The specific manifestations varied. One patient believed spyware had been installed on his phone. Another felt that static on a phone line was evidence of someone listening to her conversations. Paranoia regarding Wi-Fi routers was also observed, with some patients believing neighbors were tampering with their internet connections.

Social media platforms featured in the delusions of about one-quarter of the group. Instagram was the most commonly cited platform, followed by YouTube, Facebook, and X (formerly Twitter).

Patients described a variety of referential beliefs. Some felt that posts on these platforms contained encoded messages meant specifically for them. Others believed they were communicating directly with celebrities through these apps. One subject reported that YouTube videos would appear with titles matching their exact thoughts.

Surveillance through hidden equipment was another common source of distress. Twenty-one subjects believed that cameras or microphones were concealed in their environment. These fears often extended to the structure of their homes, with patients suspecting devices were behind walls or in ceilings. Some participants believed that microchips or tracking devices had been implanted in their bodies.

The researchers also identified eleven subjects who experienced “The Truman Show” delusion. These individuals believed they were the central characters in a staged reality. One man believed his parents had replaced the lamps in his home with cameras. Another described feeling like a virtual pet in an aquarium, constantly observed by an outside audience.

To measure trends over time, the researchers utilized a binary logistic regression analysis. This statistical method allowed them to determine if the year of admission predicted the presence of technology delusions.

The results showed a significant positive correlation. For every one-year increase in the admission date, the odds of a patient presenting with technology-related delusions increased by approximately 15 percent.

“The content of delusional thoughts changes with the times, and technology delusions have become more frequent,” Burns told PsyPost. “Social media in particular can be tricky to navigate for someone who is struggling with psychosis.”

The study also examined whether demographic factors influenced these symptoms. The researchers looked at gender, age, education level, and history of substance use.

The analysis found no significant association between these variables and the presence of technology delusions. This finding contrasts with the initial hypothesis that younger people, who are often considered digital natives, would be more likely to experience these themes. The data suggests that technology delusions are pervasive across different age groups within this population.

“I was surprised that younger people did not have a higher likelihood of experiencing technology delusions,” Burns said. “In our study, age was not significantly associated with the presence of a technology delusion.”

The authors noted that the distinction between reality and delusion can be complicated by the actual capabilities of modern technology. Real-world algorithms do track user behavior to serve targeted content. This can sometimes mimic the experience of having one’s mind read or being watched.

For individuals with psychosis, these legitimate privacy concerns can spiral into fixed, false beliefs. The study highlights that beliefs once considered bizarre, such as being monitored through a phone, are now technically feasible.

As with all research, there are limitations. The research relied on retrospective data extracted from medical notes rather than standardized interviews. This means that the recorded incidence of these symptoms depends on what clinicians chose to document. It is possible that treatment teams simply became more likely to ask about technology in later years.

Additionally, the sample consisted of individuals who were housed and insured, which may not represent the full spectrum of people living with psychotic disorders.

Future research in this area is expected to address the emergence of artificial intelligence. As the boundary between the digital and physical worlds continues to blur, the content of delusions will likely continue to evolve.

“The data for this study was collected before artificial intelligence was widely available, and I think it’s going to be fascinating to see how AI interfaces with psychosis moving forward,” Burns said. “I imagine we will be seeing a lot of patients seeking treatment for AI-associated psychosis.”

The study, “‘The algorithm is hacked’: analysis of technology delusions in a modern-day cohort,” was authored by Alaina V. Burns, Kyle Nelson, Haley Wang, Erin M. Hegarty and Alexander B. Cohn.