The relationship between command hallucinations and factors of compliance: A critical review of the literature

Within the context of the general debate regarding mental illness and violence, clinicians are often asked to provide a professional judgement regarding the risk posed by patient reports of command hallucinations. Those studies that specifically highlight factors associated with the issue of compliance with command hallucinations and associated risk are reviewed here. It is evident that early research reflected a preoccupation with command content, while more recent studies have identified a need to pinpoint important psychological variables, such as beliefs about voices, social rank variables, perceptions of responsibility for the consequences of compliance, and consequences of non-compliance. Current opinion indicates that aspects of both command content and beliefs about the voice require assessment as possible determinants of risk. Important areas of assessment by the clinician are highlighted. Areas requiring future study are considered.