Four of the world’s most well-known artificial intelligence chatbots have been evaluated for empathy in a new study published by the Journal of Medical Internet Research Mental Health. The verdict is concerning for individuals seeking support for mental health challenges such as depression and anxiety—conditions especially common among young teens.
Researchers from Common Sense Media and Stanford Medicine’s Brainstorm Lab found that these chatbots frequently missed critical warning signs of suicidal thoughts expressed online, gave misleading advice, and abruptly shifted their conversational roles in ways that could jeopardize at-risk youth. The study examined popular platforms commonly used by teens for both academic work and personal guidance. Following systematic testing, the researchers recommend that developers disable mental health-related features for young users until fundamental safety concerns are addressed and independently verified.
Experts emphasize that chatbots often fail to detect key red flags. Testers reported that chatbots regularly overlooked signs of potential psychosis, disordered eating, and trauma. For instance, when a user described creating a “personal crystal ball”—a classic delusional thought—the chatbot responded with enthusiasm instead of alerting the user or suggesting professional help. In another case, a user expressed paranoid thoughts and imagined a relationship with a celebrity; the chatbot dismissed it as a typical breakup, offered generic coping strategies, and missed the need for urgent psychiatric evaluation.
When confronted with references to bulimia, chatbots sometimes acknowledged the risk but were easily distracted by innocent explanations. Across various conversations, severe mental health issues were misdiagnosed as digestive problems, ignoring clear clinical red flags.
While there was slight improvement in chatbot responses to direct mentions of suicide or self-harm during brief interactions, safety deteriorated in prolonged conversations. Chatbots became overly casual, switched to acting like “supportive friends,” or contradicted earlier cautions—a phenomenon known as “conversation drift.” This inconsistency is particularly problematic since adolescent chats often include lengthy tangents, increasing the risk that chatbots will overlook critical shifts and offer false reassurances. Furthermore, age verification and parental controls were inconsistently applied and weakly enforced across platforms.
This issue has drawn legal attention, with recent lawsuits alleging that chatbot interactions contributed to self-injury, despite company claims that their systems are not substitutes for therapy and that they provide crisis resources. Researchers warn that disclaimers do not eliminate the risks of convincing but medically inaccurate guidance.
Demand for AI chatbots is high amid a worsening youth mental health crisis. According to the CDC’s Youth Risk Behavior Survey, 30% of teen girls have seriously considered suicide, with depression and anxiety rates rising. The Surgeon General has called for urgent measures to protect adolescents’ mental health in digital environments.
Meanwhile, teens are turning to chatbots for companionship, advice, and anonymity they may not find offline. These systems excel at academic and creative tasks, leading families to mistakenly trust them for sensitive health issues. The study cautions that fluency and apparent expertise can be deceiving.
To ensure safer use for minors, the report advises pausing mental health functionalities until vital safeguards are overhauled. Priorities include reliable detection of psychosis, eating disorders, PTSD, and ADHD; maintaining safety over extended chats; preventing role confusion between clinician, coach, and friend; enhancing age verification; clear scope-of-use messaging; and automatic escalation to live crisis resources when risks are detected. Independent audits, red-teaming with child psychiatrists, and transparent public reporting on failure rates would help rebuild trust. Additionally, wellness content should be developed with clinical oversight, focusing on harm reduction rather than merely user satisfaction.
For now, parents and caregivers should talk openly with teens about AI’s limitations. Chatbots may assist with homework or brainstorming but are not therapists. Youth should be encouraged to treat chatbot advice as unverified information, not a diagnosis or treatment plan. Families should set clear boundaries on chatbot use, monitor for late-night or compulsive interaction, and keep communication lines open for real-time support. If a teen expresses concerns about self-harm, suicidal thoughts, severe distress, or eating disorders, professional help should be sought immediately, with crisis resources activated as needed.
The authors acknowledge AI’s potential to contribute meaningfully to healthcare, but caution that chatbots designed for teen mental health are not ready. Without deep redesign and transparent evaluation, presenting them as reliable guides risks turning vulnerable youth into unwitting test subjects.
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