Dangerousness and command hallucinations: an investigation of psychotic inpatients

Forensic consultations with psychotic inpatients frequently include issues of risk management, such as dangerousness and civil commitment. An important dimension of these consultations is the role of command hallucinations in producing an increased risk of aggressive behavior. In the present study, psychotic patients with command hallucinations (N = 27) were compared with patients with other hallucinations (N = 27) and with other psychotic patients (N = 30). The groups did not differ on aggressive behavior or most nonhallucinatory symptoms. However, most patients (84.0%) with command hallucinations had recently obeyed them. Among those with command hallucinations, almost one-half had heard and attempted to obey messages of self-harm during the last month.