Command Hallucinations and Violence: Implications for Detention and Treatment

Individuals who experience hallucinations that instruct them to follow specific actions (command hallucinations) often feel under a powerful obligation to carry out these actions, sometimes with devastating consequences to themselves or others. There is very little awareness among clinicians about the specific information that needs to be obtained from patients with command hallucinations (CHs) to predict the likelihood of self-harm or harm to others, or point the way to specific therapeutic interventions. We review the evidence for the association between CHs and violence and delineate the factors found to be associated with compliance with CHs. We also propose a new psychological intervention — Treatment for Resistant Command Hallucinations (TORCH). Consideration is given to the implications of this review for the mental health system and beyond.