A young woman starts to become suspicious of her cellphone. She notices it listing Wi-Fi networks she does not recognize, and the photos on her contact cards seem to mysteriously change at random times. One day she tries to make a call and just hears static on the line. She begins to think that someone – or an entire organization – has hacked her phone or placed spyware in it, and she wonders what crime she is being framed for.

Built-in laptop webcams, unfamiliar Wi-Fi networks, targeted ads on search engines and personalized algorithms on social media sites: Most people have come to accept and ignore the quirks and drawbacks of daily contact with the internet and devices such as cellphones and computers. But for people with severe mental illness, new technologies are fertile ground for the start of false ideas that can lead eventually to a break with reality.

Psychiatrists like me help people who are bothered by their thoughts, behaviors or emotional states. For the past 10 years I’ve been working closely with people who have schizophrenia.

Schizophrenia, sometimes referred to as a type of thought disorder, is a chronic condition in which alterations in brain function change the way one perceives the world. People with schizophrenia can become hyperaware of their surroundings, often interpreting things they see or hear as being hostile and directed toward them even when there’s no real danger.

Over time, people with schizophrenia can develop delusions: beliefs that are fully held even though they are not based in reality and even when there is evidence to the contrary.

With technology and the internet now such an integral part of daily life, it’s no wonder that people with schizophrenia have incorporated new technologies into their delusional beliefs. In my recent research, my colleagues and I set out to explore the ways modern tech influences the content of delusions for people today.

Old delusional themes expressed in new ways

Most delusions are persecutory, meaning a person believes they are being watched, followed or monitored. Other delusional forms involve the belief that a person has special powers, is being controlled by outside forces, or that a spouse is unfaithful even when they are not.

Prior research has shown that these themes are consistent among people with schizophrenia, but the sociopolitical context in which a person lives shapes the form in which they are expressed.

For example, Americans living during World War II developed persecutory delusions involving Germans, while those living during the Cold War focused on communists. People with thought disorders have incorporated important events such as the fall of the Berlin Wall and the O.J. Simpson trial into delusional frameworks.

The past three decades have seen incredible strides in technological advances and easy access to the internet. How have these old themes become repackaged and expressed in the digital age?

For this research, my colleagues and I reviewed medical records of 228 people with thought disorders who participated in a specialized day treatment program between 2016 and 2024.

We identified any mention of delusional thought content and examined the ways in which these beliefs incorporated new technology. We also analyzed the data to see whether certain people were more likely to express delusions tied to technology, or if there was a change in the frequency of these delusions over time.

Delusions of persecution via common tech

Over half of our study’s participants mentioned new technology or the internet when describing delusional beliefs. Most commonly, people felt they were being persecuted via their electronics – that their Wi-Fi networks, computers or cellphones had been hacked or implanted with tracking devices. One person reported believing that neighbors had access to their Wi-Fi network and were monitoring their activities, while another worried that family members had put tracking devices on their phone.

About a quarter of participants reported delusional beliefs surrounding social media. For example, people believed that celebrities were communicating with them directly through social media posts, that they were receiving encoded messages through suggested playlists, or that social media algorithms were linked directly to their thoughts.

Some participants felt they were being monitored through hidden cameras or microphones implanted in their homes or even in their bodies. Several reported what’s known as the “Truman Show delusion” – the belief that their lives are staged and recorded, their daily activities broadcast as a reality TV show.

With each passing year of the 21st century, we found participants were significantly more likely to express delusions connected to technology.

Stretching the bounds of past realities

Our study confirms that common delusional themes, such as persecution, have become repackaged for the digital age. Interestingly, people often described fears that were based on misunderstanding how technology works – or fails to work. A Wi-Fi router that needed to be reset, a familiar app with a new logo, and text messages that disappeared over time were all cause for suspicion.

The issue that has become hardest for me to grapple with as a psychiatrist is how any of us can distinguish delusional beliefs from reality, given things we never could have imagined would be possible just 10 years ago are now commonplace. Although social media algorithms are not currently linked to our thoughts, is it such a stretch to imagine that in a few short years they may be?

Given recent advances in AI, our collective perception of reality is likely to be further distorted in the years to come. We will all need to find ways to anchor ourselves in a common truth and determine what’s real – and what isn’t.

Alaina Vandervoort Burns does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.