Factors affecting compliance and resistance to auditory command hallucinations: perceptions of a clinical population

Abstract

Background: 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.

Aims: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords:

• Mental health
• command hallucinations
• psychosis
• schizophrenia
• compliance

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Note

1. Zisook et al. (1995) reported a significant proportion of patients with commanding aspects to their auditory hallucinations did not have such details recorded by their clinical team, either due to fears of disclosure in a clinical setting or due to not being asked. On this basis it was considered important to screen independently for commanding aspects where auditory hallucinations were reported.