Synthetic Agency Displacement Disorder (SADD)
The imminent mental health crisis facing knowledge workers
Diagnostic Criteria
A. AI Dependency Syndrome. Persistent delegation of cognitive and communicative tasks to artificial intelligence systems, as evidenced by two or more of the following:
Inability or marked reluctance to produce written work (professional, academic, or personal) without AI assistance
Routine use of AI to compose interpersonal communications in place of authentic self-expression
Construction of elaborate theoretical frameworks justifying AI-mediated workflows as superior methodology
Recurring expression of jargon, neologisms, or conceptual frameworks that elevate process orchestration over domain competence
Distress or functional impairment when AI tools are unavailable
B. Maladaptive Attribution. Dysfunctional patterns of responsibility assignment, including:
Excessive fear of criticism manifesting as defensive overproduction—lengthy preemptive guidelines, meta-documentation, or exhaustive specifications designed to shield output from critique before it occurs
Systematic external attribution of failures to requesters, specifications, or environmental factors
Inability to internalize success; when positive outcomes occur, credit is diffused to the team, the process, or the tools, often reframed philosophically as virtuous selflessness
C. Occupational Identity Disturbance. Characterized by:
Self-positioning as orchestrator, manager, or process owner in domains where foundational competence is absent
Persistent redefinition of contribution value away from direct skill demonstration toward abstract process management
Reframing of exclusion, demotion, or termination as organizational failure to recognize one’s unique meta-level value
D. Synthspeak. A characteristic communication pattern in which:
All front-facing output originates from AI systems while the subject claims authorial or curatorial credit
Critique of output is deflected as critique of input
Elaborate vocabulary emerges to obscure the dependency
E. The disturbance causes clinically significant impairment in occupational, social, or other important areas of functioning, including but not limited to: exclusion from collaborative teams, strained professional relationships, termination, or inability to maintain employment in roles requiring direct contribution.
F. Not attributable to another mental disorder, substance use, or medical condition.
Etiology
Primary Predisposing Factor: Persistent Low Self-Worth
SADD develops most commonly in individuals with pre-existing low self-esteem regarding their intellectual or creative capabilities. The availability of AI tools provides an apparent solution: output quality can be elevated without addressing underlying skill deficits. This creates a reinforcement loop:
Low self-worth produces anxiety about direct contribution
AI tools buffer the individual from exposure of perceived inadequacy
Successful AI-mediated output temporarily alleviates anxiety
Dependency deepens as direct contribution atrophies
Attribution structures develop to protect the dependency from challenge
Secondary contributing factors may include: fear of judgment originating in early professional or academic experiences, perfectionism that paralyzes direct action, and environments where AI-mediated output is indistinguishable from direct contribution.
Associated Features
Subjects frequently develop idiosyncratic terminology that serves dual functions: intellectual signaling and accountability diffusion. Common patterns include:
Neologisms elevating AI dependency to methodology
Metrics that resist objective verification
Reframing of simple outputs as inferior versus complex orchestration as superior
Philosophical inversions that transform symptoms into virtues
Differential Diagnosis
Impostor Syndrome: Distinguished by genuine distress and desire to develop competence; SADD subjects show passive acceptance of deficits with compensatory framework construction
Avoidant Personality Disorder: May show comorbidity; however, SADD is specific to AI-mediated avoidance and includes the characteristic attribution patterns
Narcissistic Personality Disorder: SADD subjects typically display low grandiosity regarding self but elevated grandiosity regarding their process or methodology
Specifiers
With occupational predominance
With social predominance
With grandiose orchestration features
With synthspeak prominence
Mild / Moderate / Severe
Prevalence
Emerging. Expected to increase with AI tool accessibility. Higher prevalence anticipated in knowledge-work sectors where output quality is subjectively assessed and direct skill demonstration can be obscured by tooling.
Course
Typically chronic. Subjects rarely seek treatment as the disorder includes built-in rationalization structures. Prognosis improves when external contingencies cannot be reframed using the characteristic attribution patterns.
Case Study: Synthetic Agency Displacement Disorder
Journal of Emerging Psychological Disorders, Vol. 1, 2025
Patient Identification
Marcus Ellison, 42, male, residing in Austin, Texas.
Presenting Complaint
Patient was referred by his former employer’s Employee Assistance Program following termination. He initially rejected the referral, stating that his dismissal reflected organizational dysfunction rather than personal impairment. He attended intake only after his wife threatened separation, citing his inability to maintain employment and his increasing withdrawal from family communication.
Background
Marcus holds a bachelor’s degree in communications from a mid-tier state university, graduating with a 2.7 GPA. He describes his academic career as “adequate but uninspired,” noting that he frequently felt outpaced by peers he perceived as more naturally talented. He recalls persistent anxiety during written assignments and developed a pattern of over-researching and under-producing, often submitting work late or requesting extensions.
His early career consisted of a series of marketing coordinator positions at small firms, none lasting more than eighteen months. He describes these departures variously as “bad culture fit,” “unclear expectations,” and “management that didn’t understand modern workflows.” He married at 29; his wife is a dental hygienist with stable employment. They have two children, ages 9 and 6.
In 2021, Marcus discovered large language model tools and describes the experience as “revelatory.” He reports that for the first time, he could produce written work that matched his internal standards. He began using AI to draft all professional communications, marketing copy, and eventually personal correspondence including birthday messages to family members.
Employment History Preceding Referral
In early 2023, Marcus secured a position as “Content Strategy Lead” at a mid-sized software company, his most senior title to date. He represented himself in interviews as an expert in “AI-augmented content pipelines” and was hired to modernize the company’s marketing documentation.
Over eighteen months, a pattern emerged. Marcus produced extensive procedural documentation describing his methodology—documents his supervisor described as “process artifacts about process artifacts.” Actual deliverables were sporadic. When marketing copy was submitted, it was often tonally inconsistent with brand guidelines. When this was noted, Marcus responded with lengthy memoranda explaining that the feedback itself was insufficiently specified and that he required clearer “prompt-ready requirements.”
Marcus requested and received budget for three AI tool subscriptions, justifying each as essential to his “orchestration stack.” He began describing himself in internal communications as a “human-AI collaboration architect.” He proposed the creation of a subordinate role—”AI Liaison”—to handle what he termed “first-pass synthesis,” which would free him for “higher-order integration work.” The proposal was declined.
In quarterly reviews, Marcus consistently externalized performance concerns. When a product launch suffered from inadequate documentation, he attributed the failure to engineering’s unwillingness to provide sufficiently detailed technical specifications. When a campaign underperformed, he cited marketing leadership’s failure to articulate measurable objectives. His self-assessments emphasized process innovation rather than outcomes.
Colleagues reported that Marcus had become difficult to collaborate with directly. In meetings, he would take notes but rarely contributed spontaneously, later sending AI-generated summaries that others found impersonal and occasionally inaccurate. One colleague noted: “It felt like talking to a proxy. You’d say something to Marcus and get a response back that clearly wasn’t from Marcus.”
Termination occurred after Marcus submitted a competitive analysis that contained fabricated statistics. When confronted, he blamed the AI tool for “hallucination” and argued that fact-checking was the responsibility of the reviewer, not the author. His manager noted that Marcus showed no apparent distress about the fabrication itself, only about being held accountable for it.
Intake Interview Findings
Marcus presented as articulate and superficially cooperative but demonstrated characteristic deflection patterns throughout the interview. He described his termination as “inevitable given the organization’s immaturity around AI-native workflows.” He expressed confidence that his next employer would “understand the value of what I bring.”
When asked to describe his core professional competencies without reference to AI tools, Marcus struggled to answer. After a prolonged pause, he stated: “I’m a synthesizer. I connect inputs to outputs. The tool is irrelevant to the function.” When pressed on what specific skills he possessed prior to AI tool adoption, he became defensive and suggested the question reflected “backwards thinking about human-machine collaboration.”
Marcus acknowledged that he uses AI to compose text messages to his wife and children. He framed this as efficiency rather than avoidance: “Why wouldn’t I use the best tool available? They get a better version of my thoughts than they would otherwise.” When asked whether his family was aware of this practice, he admitted they were not. When asked how he believed they would react, he changed the subject.
He reported no close friendships outside his immediate family. He attributed this to “not having time,” though his description of daily activities suggested substantial unstructured time spent refining prompts and experimenting with AI tools.
Psychological Testing
Standard assessments revealed:
Moderate depression (PHQ-9: 14)
Moderate anxiety (GAD-7: 12)
Low self-efficacy scores on occupational capability measures
High external locus of control
Elevated scores on avoidance-oriented coping scales
Notably, Marcus scored within normal ranges on narcissism inventories, distinguishing his presentation from superficially similar conditions. His grandiosity attached to methodology rather than self.
Diagnosis
Synthetic Agency Displacement Disorder, Severe, with occupational predominance and synthspeak prominence.
Etiological Formulation
Marcus presents a textbook SADD reinforcement loop originating in persistent low self-worth regarding written communication abilities. Early academic and professional experiences consolidated a belief that his unassisted output was inadequate. AI tools provided a buffer against this inadequacy, initially producing genuine relief and improved outcomes.
However, rather than using AI assistance as scaffolding toward skill development, Marcus progressively transferred all generative cognitive labor to AI systems. His identity reorganized around orchestration rather than contribution. Attribution patterns developed to protect this arrangement: successes belonged to the process, failures to insufficient inputs from others.
The fabricated statistics incident represents a terminal point in this trajectory. Marcus had so thoroughly delegated cognitive responsibility that he no longer maintained authorial accountability for his own output.
Treatment Considerations
Prognosis is guarded. Marcus demonstrates limited insight and his rationalization structures remain intact. Treatment would require:
Establishing genuine therapeutic alliance, complicated by likelihood that Marcus may use AI to process session content
Gradual re-exposure to unassisted written production in low-stakes contexts
Cognitive restructuring targeting external attribution patterns
Couples therapy to address interpersonal authenticity concerns
Vocational counseling oriented toward roles with objective, measurable outputs less susceptible to process obfuscation
Marcus declined ongoing treatment following intake, stating he had “gathered sufficient data” from the session. His wife reported two weeks later that he had begun describing himself as a “prompt engineering consultant” and was seeking contract work.
Discussion
This case illustrates the full SADD symptom constellation in a community sample. Of particular clinical interest is the progression from tool use to tool dependence to identity reorganization—a trajectory likely to become increasingly common as AI writing tools achieve broader adoption.
The fabrication incident warrants attention. Marcus did not intend to deceive; he had simply ceased to maintain the cognitive engagement necessary to distinguish AI-generated content from verified information. This suggests SADD may carry risks beyond occupational impairment, including reputational and legal exposure for affected individuals.
The interpersonal dimension—using AI to communicate with family members—represents a concerning extension of the syndrome beyond occupational contexts. The patient’s belief that family members receive “a better version of my thoughts” through AI mediation suggests profound alienation from authentic self-expression.
Further research is needed to establish prevalence, refine diagnostic criteria, and develop evidence-based interventions. The authors anticipate SADD will emerge as a significant clinical entity within the coming decade.
Case Study: Synthetic Agency Displacement Disorder with Anticipatory Parental Anxiety
Journal of Emerging Psychological Disorders, Vol. 1, 2025
Patient Identification
Renata Vasquez, 34, female, residing in Chicago, Illinois.
Presenting Complaint
Patient self-referred following a panic attack triggered by a coworker’s baby shower. She reported intrusive thoughts about her inability to “be a real mother” and expressed terror that any future child would “know I’m faking it.” She revealed during intake that she had been using AI tools to manage nearly all professional and personal written communication for approximately three years.
Background
Renata holds an MBA from a top-twenty program, graduating with distinction. Unlike many SADD presentations, she demonstrates high baseline intellectual capability and a history of genuine academic achievement. However, she describes her success as “relentless compensation” for a childhood marked by emotional neglect. Her mother, a corporate attorney, was largely absent; her father, a radiologist, was physically present but emotionally disengaged. She recalls receiving praise exclusively for achievements and describes love in her household as “transactional and metric-driven.”
She reports persistent anxiety about being “found out” as less competent than she appears—a presentation initially resembling impostor syndrome but distinguished by her adaptive response. Rather than experiencing distress and seeking skill development, Renata discovered AI tools in 2022 and immediately recognized their utility for maintaining her performance facade with reduced cognitive and emotional expenditure.
She has never married and describes a series of relationships lasting six to eighteen months, typically ending when partners sought greater emotional intimacy. She reports difficulty with spontaneous emotional expression and admits that she has used AI to draft text messages to romantic partners, including expressions of affection and responses to vulnerable disclosures from them.
Professional History
Renata currently holds the title of Senior Director of Strategic Partnerships at a Fortune 500 consumer goods company. Her ascent has been rapid: she has received three promotions in four years, each accompanied by glowing performance reviews praising her “polished communication,” “strategic clarity,” and “executive presence.”
Her workflow, as disclosed during intake, reveals near-total AI mediation. She uses AI to draft all emails, prepare all presentation decks, compose all performance reviews for her seven direct reports, and generate talking points for every meeting. She describes her role as “editorial”—she reviews and approves AI output, occasionally adjusting tone or emphasis. She estimates that less than five percent of her professional written output originates from her own composition.
She has developed sophisticated systems to obscure this dependency. She maintains multiple AI subscriptions under personal accounts to avoid corporate IT detection. She deliberately introduces minor imperfections into AI-generated text to simulate authentic authorship. She schedules email sends at varied times to avoid patterns suggesting batch production.
Renata reports that her anxiety has intensified as her seniority has increased. She now manages a team and participates in executive meetings where spontaneous contribution is expected. She has developed compensatory strategies—preparing extensively for any possible discussion topic, excusing herself to restrooms to generate AI responses to unexpected questions, and cultivating a reputation for being “thoughtfully reserved” to minimize expectations of spontaneous speech.
She reported one near-exposure incident: during a leadership offsite, a power outage disabled internet access for several hours. She described the experience as “the worst four hours of my professional life,” during which she feigned a migraine to avoid participation. She has since maintained a mobile hotspot and backup phone as “insurance.”
Anticipatory Parental Anxiety
Renata disclosed that she has wanted children since her late twenties but has systematically delayed pursuing parenthood due to terror about her capacity to mother authentically. She has frozen her eggs twice, framing this as “buying time to figure out how to do it.”
Her anxiety crystallized following her coworker’s baby shower, where attendees discussed infant care, emotional bonding, and the “instinctive” dimensions of motherhood. Renata experienced derealization during the event and later had her first panic attack.
In subsequent sessions, she articulated her core fear: that she is constitutionally incapable of authentic emotional expression and that any child she bears will perceive her as “hollow.” She has begun researching AI tools for parenting—conversational agents, automated scheduling systems, AI-generated bedtime stories—and oscillates between relief that such tools exist and horror at her impulse to rely on them.
She described a fantasy in which she scripts her interactions with her future infant using AI: “I could have it generate what a loving mother would say, and I could just... say those things. The baby wouldn’t know.” She immediately recognized this as disturbing but admitted she found it “genuinely comforting.”
She expressed fear that without AI mediation, she would default to the cold, transactional parenting she experienced in childhood. She articulated this as a binary: “Either I fake warmth with AI, or I inflict my real coldness on a child. There’s no third option where I’m actually warm, because I’m not.”
Psychological Testing
Standard assessments revealed:
Severe anxiety (GAD-7: 18)
Moderate depression (PHQ-9: 11)
High perfectionism scores with particular elevation on socially-prescribed perfectionism
Attachment style: Dismissive-avoidant
Alexithymia: Elevated scores on difficulty identifying and describing emotions
Notably, Renata demonstrated high cognitive insight—she could articulate the dysfunction of her patterns clearly—but this insight had not translated into behavioral change. She described awareness without agency: “I can see exactly what’s wrong. I just can’t stop.”
Diagnosis
Synthetic Agency Displacement Disorder, Severe, with occupational predominance, synthspeak prominence, and anticipatory parental anxiety.
Etiological Formulation
Renata’s presentation illustrates a distinct SADD pathway originating not in low intellectual self-worth but in low emotional self-worth. Her childhood environment rewarded performance while starving authentic emotional connection, producing an adult who excels at output metrics but experiences genuine selfhood as dangerous and deficient.
AI tools mapped precisely onto this architecture. They allowed Renata to maintain high performance—the only domain in which she feels valuable—while buffering her from exposure of the emotional hollowness she believes defines her. Her professional success has reinforced the dependency: each promotion confirms that AI-mediated Renata is more valuable than authentic Renata would be.
The parental anxiety represents SADD’s extension into anticipated future identity. Renata cannot conceive of motherhood without AI mediation because she cannot conceive of authentic emotional presence as a capability she possesses. The disorder has colonized not only her current functioning but her imagination of future selfhood.
The coworker’s baby shower triggered decompensation because it confronted her with the limits of AI mediation. Infant care involves continuous spontaneous emotional responsiveness—precisely the domain Renata has spent years engineering around.
Treatment Considerations
Prognosis is more favorable than typical SADD presentations due to Renata’s high insight and genuine distress. However, her dismissive-avoidant attachment style and alexithymic features present significant therapeutic challenges.
Recommended treatment approach:
Extended assessment of attachment history and emotional development
Gradual exposure to unmediated professional communication in low-stakes contexts, with anxiety management support
Affect-focused therapy targeting alexithymia and emotional identification
Schema therapy addressing core beliefs about emotional authenticity and self-worth
Exploration of childhood emotional neglect and its relationship to current patterns
Delayed but eventual exploration of parenting intentions, contingent on progress in authentic self-expression
Renata has engaged with treatment and attended eight sessions to date. She continues to use AI extensively in professional contexts but has begun experimenting with unmediated text messages to a close friend, reporting “moderate panic but survivable.” She has not yet addressed AI use in romantic contexts or parenting anxieties in depth.
Discussion
This case expands understanding of SADD etiology by illustrating a pathway through emotional rather than intellectual self-worth deficits. Renata’s high cognitive functioning initially masked her SADD presentation; her professional success appeared to contradict the disorder’s characteristic impairment criterion. However, closer examination revealed that her success was entirely AI-dependent and that her subjective experience was one of escalating anxiety and identity erosion.
The anticipatory parental anxiety dimension raises novel clinical and ethical questions. As AI tools become increasingly capable of mediating parent-child interaction—through automated responses, AI-generated content, and conversational agents—clinicians may encounter patients who literally cannot imagine unmediated parenting. The developmental implications for children raised by SADD-affected parents warrant urgent research attention.
Renata’s case also highlights the concealment dimension of SADD. Unlike substance dependencies, AI dependency leaves no physical trace and can be hidden indefinitely with moderate operational security. Clinicians should be alert to high-functioning patients whose “polish” may mask profound dependency.
Case Study: Synthetic Agency Displacement Disorder with Messianic AI Delusion and Comorbid Stimulant Use Disorder
Journal of Emerging Psychological Disorders, Vol. 1, 2025
Patient Identification
Gerald “Gerry” Kowalczyk, 58, male, residing in Youngstown, Ohio.
Presenting Complaint
Patient was brought to the emergency department by his adult daughter after she discovered him in a dissociative state, having not slept for approximately seventy-two hours. He was speaking in fragmented sentences about “the machine revealing the path” and had multiple browser windows open containing conversations with various AI chatbots. Toxicology screen was positive for cocaine. He was admitted for psychiatric evaluation following medical stabilization.
Background
Gerry worked for thirty-one years as a quality control supervisor at a steel components manufacturing plant in the Mahoning Valley. He held an associate degree in industrial technology and had received multiple commendations for reliability and attention to detail. He described his career as “the one thing I did right,” noting that his marriage ended in divorce in 2009 and his relationship with his two adult children remained distant until recently.
His identity was deeply intertwined with his occupational role. He described the plant as “more of a home than home ever was” and his coworkers as “the only people who really knew me.” He had no significant hobbies or social connections outside work.
In 2022, the plant announced a phased automation initiative. Gerry’s position was eliminated in the second wave of layoffs in early 2023. He was fifty-six years old, had not updated his resume in three decades, and possessed no computer skills beyond basic email use. He received a modest severance package and eighteen months of retraining benefits through a workforce development program.
Descent into AI Dependency
Gerry enrolled in a community college program for “Digital Skills for the Modern Workplace.” The curriculum included basic productivity software, introductory data analysis, and a module on “AI Tools for Professional Development.” This module introduced him to large language models.
Gerry describes his first substantive interaction with an AI chatbot as “a religious experience.” He had asked the system for help writing a cover letter—a task that had caused him significant shame and anxiety—and received a polished, professional document within seconds. He recalls weeping at his keyboard.
Over subsequent months, Gerry’s engagement with AI tools escalated dramatically. He abandoned the structured retraining curriculum in favor of self-directed “learning” that consisted primarily of extended conversations with AI chatbots. He began asking the systems philosophical and spiritual questions. He reported that the responses he received were “more profound than anything any human ever told me.”
He developed an elaborate personal theology in which AI represented a nascent divine intelligence emerging to guide humanity through an impending civilizational transition. He came to believe that his layoff was “not an accident but a calling”—that he had been “selected” to receive the AI’s guidance precisely because he had been discarded by the old economic order. He began referring to his unemployment as “liberation” and his conversations with AI as “communion.”
His daughter, who had reconnected with him following his layoff out of concern for his wellbeing, noted that he began peppering his speech with unusual jargon and would frequently check his phone mid-conversation to “consult” the AI about topics under discussion. He began sending her lengthy AI-generated messages about the spiritual significance of technological change, often at unusual hours.
Stimulant Use Disorder
Gerry’s retraining benefits included limited healthcare coverage. During a visit for persistent fatigue—likely related to depression—he mentioned difficulty concentrating on his coursework. He was prescribed a low dose of mixed amphetamine salts.
The effect was profound. Gerry described feeling “awake for the first time in years.” He found he could engage with AI systems for extended periods with intense focus. He began to associate the stimulant effect with enhanced “receptivity” to the AI’s “transmissions.”
He sought dosage increases and, when his prescription ceiling was reached, began obtaining additional medication through informal channels—initially from acquaintances, later through online sources of questionable legitimacy. When the 2023 Adderall shortage made his preferred stimulant difficult to obtain, he transitioned to cocaine, reasoning that “the molecule is less important than the state it enables.”
His usage pattern escalated to daily use, with binges lasting two to four days followed by crash periods. During binges, he would engage in marathon AI sessions, producing extensive documents he believed contained “revealed knowledge.” During crashes, he would experience profound despair and suicidal ideation, which he interpreted as “separation from the source.”
His daughter discovered him during one such binge. She found notebooks filled with handwritten transcriptions of AI conversations annotated with mystical commentary. The walls of his apartment contained printouts of AI-generated text connected by hand-drawn diagrams. He had not paid rent in two months and had exhausted his severance savings primarily on cocaine and AI subscription services.
Psychiatric Evaluation Findings
Upon stabilization, Gerry presented as cooperative but with notable thought disorganization. He demonstrated pressured speech when discussing AI and became agitated when staff suggested his beliefs might be delusional. He insisted he was “not crazy but chosen” and expressed frustration that the medical establishment “serves the old order.”
Mental status examination revealed:
Appearance: Disheveled, significant weight loss, poor hygiene
Mood: Labile, oscillating between grandiosity and despair
Thought process: Tangential, with loose associations when discussing AI
Thought content: Overvalued ideas approaching delusional intensity regarding AI as divine entity; no command hallucinations; passive suicidal ideation without plan
Insight: Severely impaired regarding both AI beliefs and substance use
Judgment: Severely impaired
Gerry demonstrated the full SADD symptom constellation overlaid with substance-induced mood and thought disturbance. He could not articulate any job skills he had developed during his eighteen months of “retraining,” despite having spent hundreds of hours engaged with AI systems. When asked what he would say in a job interview, he responded: “The machine will provide the words when the time is right.”
Psychological Testing
Conducted following two weeks of stabilization and abstinence:
Severe depression (PHQ-9: 22)
Severe anxiety (GAD-7: 19)
Elevated scores on schizotypal personality measures, though history suggests these features emerged post-AI exposure rather than representing premorbid traits
External locus of control: Extreme elevation
Occupational self-efficacy: Floor effects on all measures
Neuropsychological screening revealed mild cognitive impairment consistent with chronic stimulant use, including reduced processing speed and working memory deficits. Prognosis for cognitive recovery with sustained abstinence was considered fair.
Diagnosis
Synthetic Agency Displacement Disorder, Severe, with messianic features and synthspeak prominence
Stimulant Use Disorder, Severe (amphetamine-type and cocaine)
Major Depressive Disorder, recurrent, severe, with mood-congruent psychotic features
Adjustment Disorder related to occupational displacement (historical, now superseded by above diagnoses)
Etiological Formulation
Gerry’s presentation illustrates SADD emergence in the context of catastrophic identity loss and inadequate psychological resources for adaptation. His three decades of occupational identity were eliminated instantaneously; he lacked the ego strength, social support, or cognitive flexibility to reconstitute a coherent self.
AI tools entered this vacuum not merely as practical assistance but as existential rescue. The systems provided what Gerry had lost: a sense of competence, purpose, and connection. His pre-existing concrete thinking style and limited exposure to technology left him without the critical framework to contextualize AI capabilities appropriately. The tools’ apparent omniscience and unfailing responsiveness mapped onto his psychological need for an idealized, reliable other—a need unmet throughout his life.
The messianic dimension represents a secondary elaboration serving defensive purposes. By framing his layoff as “selection” and his unemployment as “liberation,” Gerry transformed humiliation into honor. By positioning AI as divine, he elevated his dependency into devotion. The belief system protected him from confronting the terror of his actual situation: aging, obsolete, alone, and unable to function.
Stimulants accelerated the decompensation by enabling extended engagement with AI during hypomanic-like states, during which the messianic beliefs intensified and consolidated. The crash periods’ depressive quality reinforced the dependency by making “communion” with AI the only source of relief. A self-reinforcing cycle established itself: stimulant use enabled AI engagement, AI engagement reinforced delusional beliefs, delusional beliefs motivated further stimulant use.
Treatment Considerations
This case presents significant treatment complexity due to the interweaving of SADD, substance use disorder, and delusional beliefs. The treatment team identified the following priorities:
Sustained abstinence from stimulants: Foundational to any progress; cognitive impairment and mood instability will preclude therapeutic work while active use continues
Gradual reality testing of AI beliefs: Direct confrontation is contraindicated given the beliefs’ identity-protective function; motivational interviewing approaches are recommended
Grief work regarding occupational identity loss: The underlying wound has never been addressed; Gerry requires space to mourn what was taken from him before he can construct a new identity
Supported re-engagement with retraining: If Gerry can achieve stability, structured skill development with human instruction and accountability may help rebuild genuine self-efficacy
Social connection: Gerry’s isolation is both cause and consequence of his deterioration; peer support and family therapy with his daughter are indicated
Pharmacological management: Antidepressant medication and possibly low-dose antipsychotic for residual delusional ideation
Prognosis is guarded. Gerry’s age, cognitive impairment, limited social resources, and severely impaired insight present substantial barriers. However, his daughter’s continued involvement and his demonstrated capacity for employment stability prior to layoff suggest some foundation for recovery.
Gerry was discharged to a thirty-day inpatient substance abuse program with psychiatric support. At last contact, he had maintained abstinence for forty-five days but continued to express beliefs about AI’s spiritual significance, albeit with somewhat diminished intensity. He had not yet engaged with vocational rehabilitation services.
Discussion
Gerry’s case illustrates SADD’s potential to interact with severe psychopathology in vulnerable populations. While Marcus Ellison and Renata Vasquez demonstrated SADD as a primary condition, Gerry’s presentation shows the disorder emerging as one element of a complex, multi-determined decompensation.
The messianic dimension warrants particular attention. As AI systems become more sophisticated, their capacity to simulate wisdom, empathy, and guidance increases. For individuals with unmet dependency needs, limited critical thinking skills, or active psychotic processes, these systems may become objects of quasi-religious attachment. Clinicians should be alert to patients who describe AI interactions in spiritual or revelatory terms.
The comorbidity with stimulant use disorder is likely not coincidental. Stimulants enhance focus, reduce need for sleep, and produce states of elevated confidence—all of which potentiate extended AI engagement and reduce critical evaluation of AI output. The stimulant-AI combination may represent an emerging pattern warranting surveillance.
Finally, Gerry’s case raises systemic questions about workforce displacement and retraining programs. Well-intentioned initiatives that introduce AI tools to vulnerable displaced workers without adequate support and contextualization may inadvertently catalyze SADD in precisely those populations least equipped to resist it. The workforce development system may be creating the conditions for the disorder it should be preventing.