Shared Psychotic Disorder in the Digital Age: A Case of Virtual Folie à Trois

Introduction Shared psychotic disorder (SPD), traditionally referred to as folie à deux, is a rare psychiatric syndrome in which delusional beliefs are transmitted from a primary individual (the "inducer") to one or more close associates (the "recipients") through prolonged interpersonal closeness and emotional bonding. While the classic phenotype was first described in 19th-century asylum settings, the syndrome has since evolved conceptually to include variants such as folie à trois and folie à famille, characterized by shared delusions among three or more individuals within closely knit environments.With the exponential rise of digital communication platforms, virtual cohabitation has emerged as a modern analogue of traditional physical proximity. "Digital households"—characterized by emotionally intense and immersive interactions within online gaming guilds, fan communities, or ideologically bonded social media groups—may offer fertile ground for the development of shared psychoses. The digital age has expanded the psychosocial landscape, allowing individuals to form tightly interconnected identities, alliances, and echo chambers without physical co-location. However, despite the ubiquity of online interactions, the psychiatric literature has scarcely examined the potential for delusional transmission across digital-only interfaces.Emerging evidence suggests that social media can contribute to the amplification of conspiracy theories, health-related anxieties, and belief reinforcement, often without critical external appraisal. While these phenomena have been well-documented in the realm of mass psychogenic illness and sociogenic spread of ideas, their role in the crystallization of frank psychotic delusions in digital dyads or triads remains underexplored.To the best of our knowledge, no prior case has been published that describes folie à plusieurs manifesting entirely within virtual relationships. Here, we report a rare and clinically instructive series of three individuals—each residing in different cities within West Bengal—who developed a shared persecutory delusional system within the context of an online gaming guild and daily social media interactions. This report highlights the evolving nature of delusional contagion in the digital era and emphasizes the need for clinicians to remain alert to the psychiatric risks embedded in technologically mediated relationships.