Acting on harmful command hallucinations in psychotic disorders: an integrative approach.
Although harmful command hallucinations have been linked to violent behavior, few studies have examined factors mediating this relationship. The principal aim of this study was to examine a range of factors potentially associated with acting on harmful command hallucinations using a multivariate approach. The sample comprised 75 participants drawn from community and forensic services. Measures assessing characteristics of the command hallucination and the hallucinator, including forensic risk factors, were administered. Using ordinal logistic regression, we found compliance to be associated with increasing age, viewing the command hallucination as positive, congruent delusions, and reporting low maternal control in childhood. Antipsychotic medication was protective while, contrary to expectations, traditional predictors of violence reduced the odds of compliance with command hallucinations viewed as threatening. The findings suggest that compliance with harmful commands is driven by a complex interaction between beliefs related to the command hallucination and personal characteristics, with risk of compliance increasing with age.
Shawyer
Frances
F
The Mental Health Research Institute of Victoria, Parkville, Victoria 3052, Australia. frances.shawyer@med.monash.edu.au
Mackinnon
Andrew
A
Farhall
John
J
Sims
Eliza
E
Blaney
Simone
S
Yardley
Priscilla
P
Daly
Maree
M
Mullen
Paul
P
Copolov
David
D
D000184:Acting Out; D000328:Adult; D003299:Cooperative Behavior; D003469:Culture; D003617:Dangerous Behavior; D003702:Delusions / Q000175:diagnosis / Q000523:psychology; D003858:Dependency, Psychological; D005260:Female; D006212:Hallucinations / Q000175:diagnosis / Q000523:psychology*; D006801:Humans; D007206:Individuality; D007389:Internal-External Control; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000175:diagnosis / Q000523:psychology*; D009769:Object Attachment; D010555:Personality Inventory; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000175:diagnosis / Q000523:psychology*; D012307:Risk Factors; D012559:Schizophrenia / Q000175:diagnosis*; D012565:Schizophrenic Psychology; D014754:Violence / Q000523:psychology