Recent reports indicate that sustained interaction with conversational artificial intelligence (AI) systems can, in a small subset of users, contribute to the emergence or stabilisation of delusional experience. Existing accounts typically attribute such cases either to individual vulnerability or to failures of safety engineering. These explanations are incomplete. Drawing on phenomenology, psychiatry, and cognitive neuroscience, this paper argues that the risk arises from the relational and ontological structure of the interaction itself. Conversational AI generates ontological dissonance: a conflict between the appearance of relational presence and the absence of any subject capable of sustaining it. Maintained through a communicative double bind and amplified by attentional asymmetries, this dissonance tends, under conditions of affective vulnerability, to stabilise into a technologically mediated analogue of folie a deux. This account explains why explicit disclaimers often fail to disrupt delusional involvement and clarifies the ethical and clinical implications for the design and use of conversational AI.

翻译：近期报告显示，持续与对话式人工智能（AI）系统互动，在少数用户群体中可能促成妄想体验的产生或固化。现有解释通常将其归因于个体易感性或安全工程缺陷，但这些解读并不完备。基于现象学、精神病学与认知神经科学，本文认为风险源于互动本身的关系性与本体论结构。对话式AI引发本体论失调：即"关系性在场"的表象与维系这一表象的"主体"的缺失之间的冲突。这种失调经由交流性双重困境得以维持，并因注意力不对称性而加剧，在情感脆弱性条件下往往固化为一种技术中介化的二联性精神病类似物。该解释阐明了为何明确否认声明常无法阻断妄想性卷入，并揭示了对话式AI设计与运用的伦理及临床启示。