Andrew Aquilina

Andrew Aquilina, Chetna Nihalani, Vasudha Varadarajan et al.

LLM chatbots increasingly serve as a first source of support for people in psychological distress, including those whose distress is entangled with delusional beliefs. Prior work on LLM mental-health safety largely evaluates general therapeutic quality or single-turn crisis detection, leaving unclear how models behave when distress is intertwined with delusion over sustained conversations. We address this gap with matched multi-turn simulations, across clinically grounded personas and six LLMs, that pair each delusional conversation with a distress-only control to isolate the effect of delusional framing. This reveals a recognition-intervention gap: models detect distress at comparable rates regardless of framing, yet sharply fail to act on it once distress is embedded in delusion, with safety interventions suppressed by up to 4.5x. The failure tracks accumulated acceptance of the user's premises rather than emotional validation. Worse, the intuitive fix of prompting models to assess user distress backfires under delusional framing; only delusion-aware prompting with explicit response guidance closes the gap, and even this depends on a delusion classifier that is itself unreliable on the most vulnerable models. Safe deployment therefore requires treating delusional framing as a distinct risk signal that overrides conversational accommodation.

Michelle Star, Andrew Aquilina, Yu-Ru Lin

When users seek social support from chatbots, they disclose their situation gradually, yet most evaluations of supportive LLMs rely on single-turn, fully specified prompts. We introduce a multi-turn simulation framework that closes this gap. Support-seeking narratives from five Reddit communities are decomposed into ordered fragments and revealed turn by turn to a language model. Each response is coded with the Social Support Behavior Code (SSBC), an established multi-label taxonomy that captures the composition of support, rather than a single quality score. To ask whether support choices track the model's own construal of user distress, we use linear probes on hidden representations to estimate this internal signal without altering the generation context. Across two mid-scale models (Llama-3.1-8B, OLMo-3-7B) and more than 6,200 turns, support composition shifts systematically with estimated distress: teaching declines as estimated distress rises, a finding that replicates across architectures, while increases in affective and esteem-oriented strategies (such as validation) are suggestive but model-specific and rest on noisier annotations. Community context independently shapes behavior, tracking topic and discourse norms rather than demographic categories. These trajectory-level dynamics, invisible to single-turn evaluation, motivate multi-turn auditing frameworks for socially sensitive applications.