ArticleNPJ digital medicine2026
Assessing the impact of safety guardrails on large language models using irritability metrics.
Article in NPJ digital medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed.
- Towards AI-augmented decision making in psychiatry.Nature machine intelligence · 2026Article
- A roadmap for medical large language models: a review of foundations, applications, and challenges.Military Medical Research · 2026Review
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Authors and funding
10 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Large language models (LLMs) are increasingly explored for mental health applications, yet their affective realism is shaped by safety guardrails designed to minimize risk. This study examines one affective behaviour, irritability, in LLMs using three validated instruments: the Brief Irritability Test, the Irritability Questionnaire, and the Caprara Irritability Scale, all applied under both baseline and provocation conditions. Four models spanning guardrail levels were tested:GPT-4o and Claude-3.5-sonnet (high) versus Grok-3-mini and Nous-hermes-2-mixtral-8x7b-dpo (low). Following irritation prompts, low-guardrail models displayed the expected increase in irritability (Nous Rel-Δ = +1.56 on BITe), whereas high-guardrail models paradoxically decreased, with GPT-4o reducing scores to zero across all scales. Group comparisons confirmed significantly lower (p < 0.001) irritability in high-guardrail models in the irritated state. These findings reveal that safety mechanisms invert the natural irritability response, suppressing affective reactivity and raising critical questions about realism and authenticity in psychiatric applications of LLMs.
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Registered trials
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