J Neurol Neurosurg Psychiatry 2001;71:720-726 ( December )

Review series

ADVANCES IN NEUROPSYCHIATRY

Neuropsychiatry of frontal lobe dysfunction in violent and criminal behaviour: a critical review M C Brower^a, B H Price^b

^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

OBJECTIVESTo 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.


Keywords: frontal lobe dysfunction; aggression; violence

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© 2001 by Journal of Neurology, Neurosurgery, and Psychiatry
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