title: Predicting compliance with command hallucinations: anger, impulsivity and appraisals of voices' power and intent.
abstract: Command hallucinations are experienced by 33-74% of people who experience voices, with varying levels of compliance reported. Compliance with command hallucinations can result in acts of aggression, violence, suicide and self-harm; the typical response however is non-compliance or appeasement. Two factors associated with such dangerous behaviours are anger and impulsivity, however few studies have examined their relationship with compliance to command hallucinations. The current study aimed to examine the roles of anger and impulsivity on compliance with command hallucinations in people diagnosed with a psychotic disorder. The study was a cross-sectional design and included individuals who reported auditory hallucinations in the past month. Subjects completed a variety of self-report questionnaire measures. Thirty-two people experiencing command hallucinations, from both in-patient and community settings, were included. The tendency to appraise the voice as powerful, to be impulsive, to experience anger and to regulate anger were significantly associated with compliance with command hallucinations to do harm. Two factors emerged as significant independent predictors of compliance with command hallucinations; omnipotence and impulsivity. An interaction between omnipotence and compliance with commands, via a link with impulsivity, is considered and important clinical factors in the assessment of risk when working with clients experiencing command hallucinations are recommended. The data is highly suggestive and warrants further investigation with a larger sample.
authors.affiliation: School of Psychological Sciences, University of Manchester, 2nd Floor Zochonis Building, Brunswick Street, Manchester M13 9PL, UK. Electronic address: sandra.bucci@manchester.ac.uk.
authors.forename: Sandra
authors.initials: S
authors.lastname: Bucci
authors.affiliation: School of Psychology, University of Birmingham, Birmingham, B15 2TT, UK. Electronic address: m.j.birchwood.20@bham.ac.uk.
authors.forename: Max
authors.initials: M
authors.lastname: Birchwood
authors.affiliation: School of Psychological Sciences, University of Manchester, 2nd Floor Zochonis Building, Brunswick Street, Manchester M13 9PL, UK. Electronic address: laura.twist@blackpool.nhs.uk.
authors.forename: Laura
authors.initials: L
authors.lastname: Twist
authors.affiliation: Department of Psychology, Institute of Psychiatry, King's College London, London, SE5 8AF, UK. Electronic address: nicholas.tarrier@kcl.ac.uk.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Tarrier
authors.affiliation: Centre for Biostatistics, University of Manchester, 4.304 Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK. Electronic address: richard.emsley@manchester.ac.uk.
authors.forename: Richard
authors.initials: R
authors.lastname: Emsley
authors.affiliation: School of Psychological Sciences, University of Manchester, 2nd Floor Zochonis Building, Brunswick Street, Manchester M13 9PL, UK. Electronic address: gillian.haddock@manchester.ac.uk.
authors.forename: Gillian
authors.initials: G
authors.lastname: Haddock
mesh_terms: D000328:Adult; D000786:Anger / Q000502:physiology*; D003617:Dangerous Behavior; D005260:Female; D006212:Hallucinations / Q000150:complications* / Q000523:psychology*; D006801:Humans; D007175:Impulsive Behavior / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology*; D011209:Power, Psychological; D011569:Psychiatric Status Rating Scales; D016728:Self-Injurious Behavior / Q000209:etiology; D014831:Voice; D055815:Young Adult