Command Hallucinations, Compliance, and Risk Assessment

K. Hersh, R. Borum, Journal of the American Academy of Psychiatry and the Law, 1998, 26, 353–359.

Abstract: Command hallucinations are auditory hallucinations that instruct a patient to act in specific ways; these commands can range in seriousness from innocuous to life-threatening. This article summarizes two areas of research regarding command hallucinations: rates of compliance with command hallucinations; and factors associated with compliance. Researchers have reported rates of compliance ranging from 39.2 percent to 88.5 percent. Compliance has not been consistently related to dangerousness of commands. Instead, research suggests that individuals are more likely to comply with commands if they recognize the hallucinated voice and if their hallucinations are related to a delusion. Implications for risk assessment are discussed in light of the research.