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kalium comments on Post ridiculous munchkin ideas! - Less Wrong
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Fair enough, if I had an imaginary friend I wouldn't want to report it to a shrink. I got hung up on technicalities and the point I should have been focusing on is whether entertaining one specific delusion is likely to result in other symptoms of schizophrenia that are more directly harmful.
See my take on that here.
Many people suffering from hearing voices etc. do realize those "aren't real", which doesn't in itself enable them to turn them off. If I were confident that you can untrain hallucinations (and strictly speaking thus get rid of a psychotic disorder NOS just by choosing to do so), switch them off with little effort, I would find tulpas to be harmless.
Not knowing much of anything about the tulpa community, a priori I would expect that a significant fraction of "imaginary friends" are more of a vivid imagination type of phenomenon, and not an actual visual and auditory hallucination, which may be more of an embellishment for group-identification purposes.