Frontal lobe injuries, violence, and aggression : A report of the Vietnam head injury study

• Published in: Neurology Vol. 46; no. 5; pp. 1231 - 1238
• Main Authors: GRAFMAN, J, SCHWAB, K, WARDEN, D, PRIDGEN, A, BROWN, H. R, SALAZAR, A. M
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01-05-1996
• Subjects: Adult; Aggression; Analysis of Variance; Anger; Biological and medical sciences; Brain - pathology; Brain Injuries - classification; Brain Injuries - physiopathology; Brain Injuries - psychology; Chi-Square Distribution; Child; Craniocerebral Trauma - classification; Craniocerebral Trauma - physiopathology; Craniocerebral Trauma - psychology; Depression; Family; Female; Frontal Lobe - injuries; Humans; Injuries of the nervous system and the skull. Diseases due to physical agents; Interpersonal Relations; Male; Medical sciences; Military Personnel; Parent-Child Relations; Personality Inventory; Reference Values; Registries; Retrospective Studies; Traumas. Diseases due to physical agents; United States; Vietnam; Violence; United States; Vietnam; Human; Nervous system diseases; Correlation; Frontal lobe; Violence; Craniocerebral; Diseases of the osteoarticular system; Trauma; Cerebral disorder; Central nervous system disease; Skull disease; Behavior; Aggressiveness
• ISSN: 0028-3878; 1526-632X
• DOI: 10.1212/WNL.46.5.1231

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.