Interpersonal complementarity in responses to auditory hallucinations in psychosis

Objectives. Models of interpersonal relating have proposed that people are drawn to respond to others according to a principle of complementarity, whereby perceived hostility elicits reciprocal hostility and perceived dominance elicits submission. This study examined interpersonal appraisals and responses to auditory hallucinations, to determine whether this principle predicts how patients respond to hallucinated voices. Design and methods. Thirty-five participants with schizophrenia or schizoaffective disorder rated their internal 'relationship' with their auditory verbal hallucinations using the Structural Analysis of Social Behaviour, in addition to completing measures of voice-related distress and depression. Results. Participants were able to ascribe almost the full range of interpersonal relating behaviours to their voices reliably, with some notable exceptions for voices' 'responses' to being directly addressed. Appraisals of voice hostility very strongly predicted reciprocal hostile responses, but perceptions of voice control were only weakly associated with submission to voices. Perceived voice hostility was also associated with voice-related distress and perceived voice control was associated with depression. Conclusions. Individual differences in responses to auditory hallucinations appear to reflect normal interpersonal responses to appraisals of voice hostility and affiliation. However, voice hearers do not readily submit to voice control and other factors may be of importance in determining this response