Voices in the head not to be ignored

September 25, 2000

A study of 103 patients with major psychiatric disorders found that those who experience command hallucinations to harm others are more than twice as likely to be violent. This study in the October 2000 Psychiatric Services provides information about the relationship between command hallucinations and violence in a group of patients hospitalized in a civil, nonforensic context.

In this study, 31 of 103 psychiatric inpatients reported that they had had heard voices telling them to hurt others in the past year. Twenty-three of the 31 patients said they had complied with these voices. Patients who reported having command hallucinations constitute a subset of patients with hallucinations.

The authors of the study, led by Dale E. McNiel, Ph.D., of Langley Porter Psychiatric Institute, University of California, found that command hallucinations continued to be a significant predictor of violence, even when the analysis took into account other risk factors, such as substance abuse and patients' gender.

The study also accounted accuracy of self-reports by eliminating secondary purposes that may motivate some people to exaggerate or minimize deviant experiences - e.g. in a forensic psychiatric setting, patients may magnify actual hallucinations.

"The results support the clinical usefulness of asking about command hallucinations, in addition to evaluating other risk factors, when assessing the risk of violence in patients with major mental disorders," said Dr. McNiel.
["The Relationship Between Command Hallucinations and Violence," by Dale E. McNiel, Ph.D., et.al., Vol. 51 No.10, Psychiatric Services, October 2000]

American Psychiatric Association

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