Command Hallucinations and Criminality: A Clinical Quandary Richard Rogers, PhD; David Nussbaum PhD; and Roy Gillis, MA Clinical literature on the role of command hallucinations in producing antisocial behavior is sparse and fragmented. This article reviews exploratory models of auditory hallucinations and the prevalence of command hallucinations in clinical and forensic settings. In addition, clinical guidelines are offered for assessing the authenticity of command hallucinations and their relevance to criminal behavior within the context of forensic evaluations. Controversy on the relationship of com- mand hallucinations to criminal behav- ior was highlighted in the recent United States Supreme Court case of Colorado v. C0nne1ly.l.~ Boldly entering into this foray, the American Psychological As- sociation (APA)3 stated that it found "no studies or reports concluding that per- sons who obeyed command hallucina- tions were chronically impaired" (p. 20). The APA suggested that less than one percent of individuals receiving com- mand hallucinations obeyed them, ar- guing that this was statistical evidence that command hallucinations are not coercive. An entirely separate issue of forensic concern is establishing the veracity of reported command hallucinations. As noted by Re~nick,~ simulated auditory hallucinations are a common form of malingering used by criminal defend- ants. Indeed, command hallucinations represent an intraindividual phenome- non that may provide mitigation or ex- culpation in a criminal triaL5a6 The "compelling" nature of command hal- lucinations is one of many factors used in arguments against volitional in- capacity." * The present article will review the lit- erature on command hallucinations in relation to criminal behavior. In addi- tion, command hallucinations will be addressed as a clinical issue in examin- ing their authenticity and influence on criminal behavior. Clinical guidelines will be offered for the assessment of criminal defendants who report com- mand hallucinations. Dr. Rogers is Senior Psychologist and Coordinator of Research at METFORS, Clarke Institute of Psychiatry, and Associate Professor of Psychiatry at the University of Toronto. Dr. Nussbaum is a Staff Psychologist and Mr. Gillis is a research scientist, METFORS, Clarke Institute of Psychiatry. Address correspondence to Dr. Rogers at METFORS, 1001 Queen St. West, Toronto, Ontario. Canada M6J 1 H4. Etiology and Prevalence Explanatory models of auditory hal- lucinations abound, suggesting both the complexity of these phenomena and the weakness of our etiological explanations. Bull Am Acad Psychiatry Law, Vol. 16, No. 3, 1988 251