Clinical Correlates of Compliance, Appeasement and Resistance in Command Hallucinations: A Systematic Review
Abstract
ABSTRACT Objective Command hallucinations (CHs) are a subtype of auditory hallucination commonly observed in psychosis and are strongly associated with harmful behaviours towards the self and others. Despite their clinical relevance, no review has synthesised the clinical variables associated with compliance, appeasement and resistance. Method A systematic review was conducted to synthesise the existing evidence regarding the clinical correlates of compliance, appeasement and resistance to CHs. Results Fifty‐six studies were eligible for inclusion. Compliance was associated with cognitive factors (benevolence, omnipotence and omniscience beliefs, perceived consequences of disobedience, perceptions of future compliance and greater attentive awareness), relational factors (social rank, voice identity and voice familiarity), emotional drivers (anger and obligation), behaviours (impulsivity and social isolation), childhood trauma, substance use and overall symptom severity. Appeasement was associated with cognitive factors (perceived dangerousness) and behaviours (avoiding provocation, obeying milder commands or self‐harm to protect others). Resistance was associated with cognitive factors (malevolence and omnipotence beliefs, perceived control over the voice and concurrent suicidal ideation) and voice topography factors (high intrusiveness/frequency/volume and low authoritativeness), alongside childhood trauma factors (interpersonal adversities and fearful attachment).…
How strong is the evidence?
Evidence Hub reads this as a systematic review. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.
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