A Rare Case of Adolescent Suicide with Paraphilia

Suicide continues to be a leading cause of mortality among Indian adolescents, with more than 10,000 deaths reported in individuals under 18 in 2021 alone. Mental health disorders, interpersonal conflicts and academic pressure are major contributors. ¹

We report a clinical case of a 14-year-old boy who survived a suicide attempt using sodium nitrite, which he procured through an online retail platform and used chatbots to find the lethal dose. On evaluation and history taking, he reported low mood, interpersonal conflicts with his mother and stepfather, lack of paternal attachment and severe social withdrawal. The patient disclosed an increased dependence on generative AI chatbots (e.g., ChatGPT, Gemini and DeepSeek) which provides human-like interaction, which he described as his only source of ‘emotional understanding’. His dependency on chatbots extended from asking day-to-day activities, what to do in trivial situations, and added prompts such as ‘Talk to me like a friend’, and actively avoided human-to-human interaction.

The patient also reported that for the past 6-7 months, he started having thoughts of getting attracted to female corpses, which he searched online using the phrase ‘beautiful female corpses’ and masturbated to such images 2–3 times a week. Although these ideations had not led to any criminal behaviour, they raise concern about possible psychosocial vulnerabilities such as poor impulse control, emotional dysregulation, or social withdrawal, which is linked to paraphilic interests. ²

In this case, we observe an overlap between interpersonal conflicts with parents leading to low mood, social isolation, unfiltered digital exposure, suicide risk and paraphilic development. paraphilic ideation in adolescents, when associated with suicidality, should be considered as a potential marker of emotional dysregulation. Recent Indian literature suggests that maladaptive coping mechanisms, disturbed attachments to family and early trauma are key risk factors for such phenomena. ³

We suggest clinicians consider routine digital behaviour screening in adolescent psychiatric evaluations, especially in cases involving sexual themes or suicidal behaviour. Additionally, there is a pressing need to ethically regulate AI-based companionship apps that increasingly function as unmonitored sources of emotional support for vulnerable youth potentially exacerbating their symptoms. ⁴ The chatbots may reduce stigma and are accessible but their lack of clinical oversight, inappropriate or at times even harmful responses raise concerns about their role in mental health problems. ⁵

Early screening and multidisciplinary interventions for atypical sexual development when integrated with digital psychoeducation, play a pivotal role in prevention of mood disorders and suicide risk in adolescents. We need to update our models to the current rapidly evolving digital landscape for psychosexual assessments and adolescent suicide prevention.