Distress, omnipotence, and responsibility beliefs in command hallucinations

Lyn Ellett, Olga Luzon, Max Birchwood, Zarina Abbas, Abi Harris, Paul Chadwick

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Command hallucinations are considered to be one of the most distressing and disturbing symptoms of schizophrenia. Building on earlier studies, we compare key attributes in the symptomatic, affective, and cognitive profiles of people diagnosed with schizophrenia and hearing voices that do (n = 77) or do not (n = 74) give commands.


The study employed a cross-sectional design, in which we assessed voice severity, distress and control (PSYRATs), anxiety and depression (HADS), beliefs about voices (BAVQ-R), and responsibility beliefs (RIQ). Clinical and demographic variables were also collected.


Command hallucinations were found to be more distressing and controlling, perceived as more omnipotent and malevolent, linked to higher anxiety and depression, and resisted more than hallucinations without commands. Commanding voices were also associated with higher conviction ratings for being personally responsible for preventing harm.


The findings suggest key differences in the affective and cognitive profiles of people who hear commanding voices, which have important implications for theory and psychological interventions.

Practitioner points

Command hallucinations are associated with higher distress, malevolence, and omnipotence.
Command hallucinations are associated with higher responsibility beliefs for preventing harm.
Responsibility beliefs are associated with voice-related distress.
Future psychological interventions for command hallucinations might benefit from focussing not only on omnipotence, but also on responsibility beliefs, as is done in psychological therapies for obsessive compulsive disorder.


The cross-sectional design does not assess issues of causality.
We did not measure the presence or severity of delusions.
Original languageEnglish
Pages (from-to)303-309
Number of pages7
JournalBritish Journal of Clinical Psychology
Early online date11 May 2017
Publication statusPublished - Sept 2017

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