Command hallucinations and the risks of violence and self-harm: What distinguishes compliers from non-compliers?

The main aim of this study was to explore and identify the factors associated with compliance with command hallucinations to harm self or others. The theoretical foundations lie in psychological models of auditory hallucinations in general and command hallucinations in particular, and in social models of compliance. Previous research in this area has highlighted the importance of beliefs about self and beliefs about voices in understanding the relationship between the command and the associated behaviour. Seventy four individuals who reported hearing voices were recruited into the study, 76% of these reported currently hearing command hallucinations (CH) 88% of whom reported hearing dangerous commands to either harm others, or harm or kill themselves. CHs were followed up at two intervals over a six month period. In terms of compliance, a good deal of support emerged for the beliefs aspect of the cognitive behavioural model of command hallucinations. All compilers, regardless of the content of the command were more distressed than non-compliers and reported stronger beliefs about malevolence and omnipotence. The findings with regard to beliefs about benevolence were more inconsistent. In addition to beliefs about voices, there were factors that appeared to be specific to compliance with each respective content: those who complied with harm-other commands were significantly more compliant by nature, reported significantly higher levels of guilt, rated their voices as louder and more real, and were significantly more resistant towards the voices those who complied with suicide commands appeared to do so because they believed themselves to be inferior to others and felt that they didn't belong, and because the commands were congruent with their mood and beliefs those that complied with commands to self-harm appeared to do so because they felt physically and emotionally overwhelmed by the commands. The thesis concludes with a discussion of the current findings and the implications for future research into this area and the clinical treatment and management of command hallucinations