Experiencing Command Hallucinations

Voices Inside Your Head

Imagine not only hearing voices inside your head, but scary ones that degrade you and your family and instruct you to harm others. Command hallucinations are the most dangerous types of auditory hallucinations experienced by people with psychotic episodes. They are not easy to control because they may be so demeaning, that patients eventually succumb to their instructions.

Command hallucinations may be experienced in schizophrenia, schizoaffective disorder, bipolar I disorder with psychotic features, major depressive disorder with psychotic features, substance-induced psychotic disorder and more. Patients usually complain of the voices being unpleasant and disturbing.

It’s important to keep in mind the differences between men and women with schizophrenia:

  • Men tend to develop it at an earlier age (early to middle 20s)
  • Men tend to have more negative symptoms (apathy, social withdrawal, blunting of affect, poverty of speech and thought, loss of motivation and anhedonia)
  • Men tend to have a poorer course
  • Women tend to develop it at a later age (late 20s and on)
  • Women tend to have more affective symptoms (depression, mood instability) and auditory hallucinations
  • Women tend to have a better course

Because women tend to have more auditory hallucinations, they should logically also experience more command hallucinations; however, it’s not clear if this is true. But what is true is the distressing nature of command hallucinations. For instance, when a patient hits a staff member, it’s not always due to the patient disliking the staff or being angry with them.

Sometimes patients hit staff or others in their surroundings because “the voices told me to do it.” A patient may complain that they were hearing voices inside their head degrading their family members and making them very upset. When this occurs, a patient may become very restless, attempting to neutralize the voices with violence.

During a psychotic episode, the voices tend to get worse. This may then be followed by the voices confusing the patient, by telling them that a certain person is out to get them. The patient refuses to believe but at the same time, can no longer take these menacing messages within their mind.

The voices then command the patient, “Hit him now! Kill him already! What the hell are you waiting for?” And that’s when the patient unfortunately reacts. Whenever a loved one or a friend tells you that they’ve been feeling different lately, take a compassionate stance and actively listen to what they are trying to tell you.

Can you imagine how hard it is to come out to your friends and family and tell them that you are hearing voices within your head? It’s almost as if you don’t want anyone to know. But if you are experiencing voices within your head, you have to let someone who you trust know about them.

Never keep these experiences to yourself, because you never know when they might become too overwhelming, causing you to commit a tragedy. Coming out and sharing your experiences is always the best step that you can take. Forget the existing stigma; allow the The DSM Ready Movement to take care of it by working hard every day to extinguish it.

You just do your part and share your experiences with the world. In return, we’ll give you the help, comfort and support that you deserve!

Are you Ready? (This is Defeating Stigma Mindfully)


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