Frontal lobe injuries, violence, and aggression

Abstract

Knowledge stored in the human prefrontal cortex may exert control over more primitive behavioral reactions to environmental provocation. Therefore, following frontal lobe lesions, patients are more likely to use physical intimidation or verbal threats in potential or actual confrontational situations. To test this hypothesis, we examined the relationship between frontal lobe lesions and the presence of aggressive and violent behavior. Fifty-seven normal controls and 279 veterans, matched for age, education, and time in Vietnam, who had suffered penetrating head injuries during their service in Vietnam, were studied. Family observations and self-reports were collected using scales and questionnaires that assessed a range of aggressive and violent attitudes and behavior. Two Aggression/Violence Scale scores, based on observer ratings, were constructed. The results indicated that patients with frontal ventromedial lesions consistently demonstrated Aggression/Violence Scale scores significantly higher than controls and patients with lesions in other brain areas. Higher Aggression/Violence Scale scores were generally associated with verbal confrontations rather than physical assaults, which were less frequently reported. The presence of aggressive and violent behaviors was not associated with the total size of the lesion nor whether the patient had seizures, but was associated with a disruption of family activities. These findings support the hypothesis that ventromedial frontal lobe lesions increase the risk of aggressive and violent behavior.

Positron Emission Tomography of Regional Brain Metabolic Responses to a Serotonergic Challenge in Major Depressive Disorder with and without Borderline Personality Disorder

“…We did not find a difference in the orbitofrontal cortical area between depressed patients with BPD and MDD without BPD in contrast to findings from both lesion (Butter et al, 1970;Grafman et al, 1996;Heinrichs, 1989;Raleigh et al, 1979) and neuroimaging studies (De La Fuente et al, 1997;Goyer et al, 1994;New et al, 2002New et al, , 2004Siever et al, 1999) that suggest a role for the orbitofrontal cortex in impulsive aggression. Our sample of depressed women with BPD did not differ significantly in terms of clinical measures of aggression and impulsivity from the depressed women without BPD (see Table 1).…”

“…Lesion studies suggest that control of aggression may be mediated by the anterior cingulate gyrus and orbitofrontal region (Butter et al, 1970;Grafman et al, 1996;Heinrichs, 1989;Raleigh et al, 1979). Functional neuroimaging studies of brain glucose metabolism in borderline and other aggressive and impulsive patients have also implicated the anterior cingulate area.…”

Neurocognitive elements of antisocial behavior: Relevance of an orbitofrontal cortex account

“…As a general principle, it is important to distinguish antisocial behavior that emerges following some form of head trauma in individuals without prior histories of antisocial behavior, and a long history of antisocial behavior without evidence of brain trauma. In this respect it is often noted that psychopaths are more likely to show physical violence than non-psychopath criminals (Hare, 1999), whereas there is little evidence that patients with OFC lesions are physically violent (Grafman et al, 1996). As a further distinction, the aggression of OFC patients tends to be reactive/hostile in contrast to that of psychopaths which is arguably more proactive/instrumental .…”

Risky decisions and response reversal: is there evidence of orbitofrontal cortex dysfunction in psychopathic individuals?

“…However, it should be noted that the behavioural disturbance demonstrated by such patients differs from that shown by psychopathic individuals. Patients with OFC lesions frequently show reactive aggression in response to frustration or perceived threat [2,12,28]. In contrast, the behaviour of psychopathic individuals is characterised by highly instrumental aggression motivated by material gain or towards establishing respect [20,69].…”