Acting on Harmful Command Hallucinations in Psychotic Disorders

The Mental Health Research Institute of Victoria, Parkville, Victoria 3052, Australia.
The Journal of nervous and mental disease (Impact Factor: 1.69). 06/2008; 196(5):390-8. DOI: 10.1097/NMD.0b013e318171093b
Source: PubMed


Although harmful command hallucinations have been linked to violent behavior, few studies have examined factors mediating this relationship. The principal aim of this study was to examine a range of factors potentially associated with acting on harmful command hallucinations using a multivariate approach. The sample comprised 75 participants drawn from community and forensic services. Measures assessing characteristics of the command hallucination and the hallucinator, including forensic risk factors, were administered. Using ordinal logistic regression, we found compliance to be associated with increasing age, viewing the command hallucination as positive, congruent delusions, and reporting low maternal control in childhood. Antipsychotic medication was protective while, contrary to expectations, traditional predictors of violence reduced the odds of compliance with command hallucinations viewed as threatening. The findings suggest that compliance with harmful commands is driven by a complex interaction between beliefs related to the command hallucination and personal characteristics, with risk of compliance increasing with age.

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    • "BAVQ-R omnipotence and malevolence scores were related to perception of threat, the use of safety-seeking behaviours and distress (Hacker, Birchwood, Tudway, Meaden, & Amphlett, 2008). BAVQ-R omnipotence scores have been found to be associated with compliance with threatening command hallucinations (Shawyer et al., 2008). Omnipotence, malevolence and resistance have been found to be associated with depression, hopelessness and suicidal ideation (Simms, McCormack, Anderson, & Mulholland, 2007). "
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    ABSTRACT: Auditory hallucinations are a common and troubling symptom in psychotic disorders. We aimed to identify measures that could be used by clinicians and researchers to assess the experience of auditory hallucinations. A literature review was conducted to identify auditory hallucination measures that were developed since the last such review in 1998. We identified 10 tools: eight self-report measures and two clinical interviews. The scales measured diverse constructs and are divided into four categories for review: multidimensional assessment, coping strategies, rating of beliefs and acceptance or mindfulness. Evidence of the measures' reliability, validity and sensitivity to change are discussed. There has been an expansion in the range of instruments available, particularly in self-report questionnaires and in measures that focus on psychological aspects such as attitudes and beliefs regarding voices.
    Clinical Psychology & Psychotherapy 11/2011; 18(6):524-34. DOI:10.1002/cpp.729 · 2.59 Impact Factor
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    • "Applebaum et al., 2000), with clear support for the perception of consequences (a specific delusional belief) as being positively associated with compliance to harmful commands (e.g. Beck-Sander et al., 1997; Shawyer et al., 2008). "
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    ABSTRACT: Elements of voice content and characteristics of a hallucinatory voice are considered to be associated with compliance and resistance to auditory command hallucinations. However, a need for further exploration of such features remains. To explore the associations across different types of commands (benign, self-harm, harm-other) with a range of symptom measures and a trait measure of expressed compliance with compliance to the most recent command and command hallucinations over the previous 28 days. Participants meeting Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for schizophrenia or schizoaffective disorder, with auditory hallucinations in the previous 28 days were screened. Where commands were reported a full-assessment of positive symptoms, social-rank, beliefs about voices and trait compliance was completed. Compliance with the last self-harm command was associated with elevated voice malevolence, heightened symptom presentation and perceived consequences for non-compliance. Compliance with the last harm-other command was associated with elevated symptom severity, higher perceived consequences for non-compliance and higher levels of voice social rank. However, these associations were not maintained for compliance during the previous 28 days. Findings indicate the importance of identifying the content of commands, overall symptom severity and core variables associated with compliance to specific command categories. The temporal stability of established mediating variables needs further examination.
    Journal of Mental Health 12/2010; 19(6):542-52. DOI:10.3109/09638237.2010.520365 · 1.01 Impact Factor
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    ABSTRACT: This study examined three factors hypothesised which influence compliance to harm-others command hallucinations. The factors investigated were the perceived power of the commanding voice, participants' perceived social rank in relation to the commanding voice and to the others. Thirty-two male participants were recruited from forensic services. Participants were identified as belonging to one of the two groups: compliers or resisters. Semi-structured interviews and questionnaires were administered to participants. Beliefs, that the commanding voice was more powerful than the self and of a higher social rank than the self, were associated with compliance. There were no significant differences between the two groups on perceptions of social rank in relation to others. The significant findings of this study can be understood in terms of the relationship an individual has with the commanding voice and which are congruent with cognitive models of hallucinations.
    Journal of Forensic Psychiatry and Psychology 02/2010; 21(1-1):121-138. DOI:10.1080/14789940903194111 · 0.88 Impact Factor
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