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a Secure Care Program,
Department of Psychiatry, Taunton State Hospital, Taunton, MA, USA, and
Harvard Medical School, Boston, MA, USA, b Departments of Neurology, McLean Hospital,
Belmont, MA, Massachusetts General Hospital, Boston, MA, and Harvard
Medical School, Boston, MA, USA
Correspondence to: Dr B H Price, Department of Neurology, Mclean Hospital, 115 Mill Street, Belmont, MA 02478, USA priceb{at}mclean.havard.edu
Received 18 July 2000 and in revised form 7 June 2001;
Accepted 2
July 2001
OBJECTIVES
To
establish the link between frontal lobe dysfunction and violent and
criminal behaviour, based on a review of relevant literature.
METHODSArticles
relating evidence of frontal lobe dysfunction with violence or crime
were collected through a MEDLINE search using the keyword "frontal
lobe" combined with the terms "aggression," "violence,"
"crime," "antisocial personality disorder," "psychopathy," "impulse control disorders", and "episodic dyscontrol."
Reference lists were then searched for additional articles.
RESULTSHigh rates of
neuropsychiatric abnormalities reported in persons with violent and
criminal behaviour suggest an association between aggressive dyscontrol
and brain injury, especially involving the frontal lobes. The studies
reviewed support an association between frontal lobe dysfunction and
increased aggressive and antisocial behaviour. Focal orbitofrontal
injury is specifically associated with increased aggression. Deficits
in frontal executive function may increase the likelihood of future
aggression, but no study has reliably demonstrated a characteristic
pattern of frontal network dysfunction predictive of violent crime.
CONCLUSIONSClinically
significant focal frontal lobe dysfunction is associated with
aggressive dyscontrol, but the increased risk of violence seems less
than is widely presumed. Evidence is strongest for an association
between focal prefrontal damage and an impulsive subtype of aggressive behaviour.
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