Command hallucinations have been implicated in some cases of physical assault by patients with schizophrenia. This paper is, to our knowledge, the first in the literature to describe sexual assault and this form of psychopathology.
A brief series of four young male patients with schizophrenia who attempted and, in one case, succeeded in sexually assaulting young women as a direct response to command type or imperative auditory hallucinations is described.
All four patients had limited or no sexual experience prior to the incidents described and their illness has attacked them at their “psychological Achilles heel”.
All four had lengthy in-patient admissions and proved quite resistant to conventional treatments.
We would suggest that command hallucinations need to be taken very seriously: some patients do as their voices command.