Frontal lobe injuries, violence, and aggression: A report of the Vietnam Head Injury Study
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 l…
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Inability to properly integrate exteroceptive and interoceptive information results in behavior inappropriate to context, explaining altered non-aggressive social behavior and aggression observed in individuals with orbitofrontal cortex damage.
“The inability to properly integrate exteroceptive and interoceptive information will result in behavior that is inappropriate to that context, explaining the altered non-aggressive social behavior (e.g., Beer et al. 2003; Eslinger & Damasio 1985; Saver & Damasio 1991; see Damasio et al. 1990) and aggression (Grafman et al. 1996) observed in individuals with OFC damage.”
From The brain basis of emotion: a meta-analytic review (2012) · cites this paper as Grafman et al. 1996
The VMPFC is particularly vulnerable to damage in all severities of TBI because it abuts the cranial floor and frontal cranial bone, making it susceptible to coup and contrecoup forces from nearly all directions.
“The VMPFC, which serves as an inhibitory control center for the limbic system, is particularly vulnerable to damage in all severities of TBI as this region abuts the cranial floor and frontal cranial bone, making it susceptible to coup and contrecoup forces from nearly all directions [31,44,45].”
The VMPFC serves as an inhibitory control center for the limbic system.
“The VMPFC, which serves as an inhibitory control center for the limbic system, is particularly vulnerable to damage in all severities of TBI as this region abuts the cranial floor and frontal cranial bone, making it susceptible to coup and contrecoup forces from nearly all directions [31,44,45].”
The role of the VMPFC in negative urgency impulsivity is supported by evidence that individuals with penetrating TBI to the VMPFC are significantly more likely to become aggressive than those with penetrating TBI elsewhere.
“The role of the VMPFC in negative urgency impulsivity is also supported by evidence that individuals with penetrating TBI to the VMPFC are significantly more likely to become aggressive than those with penetrating TBI elsewhere [44].”
Cites
A continuous performance test of brain damage
Rosvold, H. E., Mirsky, A. F., Sarason, I., Bransome, E. D., & Beck, L. H. (1956) · Journal of Consulting Psychology · doi:10.1037/h0043220 · Cited by 2,261 · see citing works
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The brain basis of emotion: a meta-analytic review
Lindquist, K. A., Wager, T. D., Kober, H., Bliss-Moreau, E., & Barrett, L. F. (2012) · Behavioral and Brain Sciences · doi:10.1017/s0140525x11000446 · Cited by 2,320 · see citing works
“…will result in behavior that is inappropriate to that context, explaining the altered non-aggressive social behavior (e.g., Beer et al. 2003; Eslinger & Damasio 1985; Saver & Damasio 1991; see Damasio et al. 1990) and aggression (Grafman et al. 1996) observed in individuals with OFC damage.”
BackgroundHow (and where) does moral judgment work?
Greene, J., & Haidt, J. (2002) · Trends in Cognitive Sciences · doi:10.1016/s1364-6613(02)02011-9 · Cited by 1,945 · see citing works
Behavioral Ethics in Organizations: A Review
Treviño, L. K., Weaver, G. R., & Reynolds, S. J. (2006) · Journal of Management · doi:10.1177/0149206306294258 · Cited by 1,837 · see citing works
A neural basis for social cooperation
Rilling, J. K., Gutman, D. A., Zeh, T. R., Pagnoni, G., Berns, G. S., & Kilts, C. D. (2002) · Neuron · doi:10.1016/s0896-6273(02)00755-9 · Cited by 1,451 · see citing works
Assessment of executive functions: Review of instruments and identification of critical issues.
CHAN, R., SHUM, D., TOULOPOULOU, T., & CHEN, E. (2008) · Archives of Clinical Neuropsychology · doi:10.1016/j.acn.2007.08.010 · Cited by 1,401 · see citing works
Blair, R. J. R. (2005) · Consciousness and Cognition · doi:10.1016/j.concog.2005.06.004 · Cited by 1,365 · see citing works
Neurobiology of Aggression and Violence
Siever, L. J. (2008) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2008.07111774 · Cited by 984 · see citing works
The neural basis of human moral cognition
Moll, J., Zahn, R., de Oliveira-Souza, R., Krueger, F., & Grafman, J. (2005) · Nature Reviews Neuroscience · doi:10.1038/nrn1768 · Cited by 930 · see citing works
Self-citationNeuroimaging Support for Discrete Neural Correlates of Basic Emotions: A Voxel-based Meta-analysis
Vytal, K., & Hamann, S. (2010) · Journal of Cognitive Neuroscience · doi:10.1162/jocn.2009.21366 · Cited by 680 · see citing works
Response inhibition and impulsivity: An fMRI study
Horn, N. R., Dolan, M., Elliott, R., Deakin, J. F. W., & Woodruff, P. W. R. (2003) · Neuropsychologia · doi:10.1016/s0028-3932(03)00077-0 · Cited by 604 · see citing works
The default-mode, ego-functions and free-energy: a neurobiological account of Freudian ideas
Carhart-Harris, R. L., & Friston, K. J. (2010) · Brain · doi:10.1093/brain/awq010 · Cited by 574 · see citing works
Brower, M. C. (2001) · Journal of Neurology, Neurosurgery & Psychiatry · doi:10.1136/jnnp.71.6.720 · Cited by 567 · see citing works
Functional Networks in Emotional Moral and Nonmoral Social Judgments
Moll, J., de Oliveira-Souza, R., Bramati, I. E., & Grafman, J. (2002) · NeuroImage · doi:10.1006/nimg.2002.1118 · Cited by 497 · see citing works
Self-citationBipolar and major depressive disorder: Neuroimaging the developmental-degenerative divide
Savitz, J., & Drevets, W. C. (2009) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2009.01.004 · Cited by 494 · see citing works
Barrett, L. F. (2012) · Emotion · doi:10.1037/a0027555 · Cited by 503 · see citing works
Précis of <i>The brain and emotion</i>
Rolls, E. T. (2000) · Behavioral and Brain Sciences · doi:10.1017/s0140525x00002429 · Cited by 397 · see citing works
Reduced sensitivity to others' fearful expressions in psychopathic individuals
Blair, R. J. R., Mitchell, D. G. V., Peschardt, K. S., Colledge, E., Leonard, R. A., Shine, J. H., Murray, L. K., & Perrett, D. I. (2004) · Personality and Individual Differences · doi:10.1016/j.paid.2003.10.008 · Cited by 344 · see citing works
The Neurobiology of Impulsive Aggression
Blair, R. J. R. (2016) · Journal of Child and Adolescent Psychopharmacology · doi:10.1089/cap.2015.0088 · Cited by 235 · see citing works
Understanding Genetic Risk for Aggression: Clues From the Brain’s Response to Social Exclusion
Eisenberger, N. I., Way, B. M., Taylor, S. E., Welch, W. T., & Lieberman, M. D. (2007) · Biological Psychiatry · doi:10.1016/j.biopsych.2006.08.007 · Cited by 229 · see citing works
Modulators in concert for cognition: Modulator interactions in the prefrontal cortex
Briand, L. A., Gritton, H., Howe, W. M., Young, D. A., & Sarter, M. (2007) · Progress in Neurobiology · doi:10.1016/j.pneurobio.2007.06.007 · Cited by 216 · see citing works
The neural basis of implicit moral attitude—An IAT study using event-related fMRI
Luo, Q., Nakic, M., Wheatley, T., Richell, R., Martin, A., & Blair, R. J. R. (2006) · NeuroImage · doi:10.1016/j.neuroimage.2005.11.005 · Cited by 191 · see citing works
Neural basis of emotional self-regulation in childhood
Lévesque, J., Joanette, Y., Mensour, B., Beaudoin, G., Leroux, J.-M., Bourgouin, P., & Beauregard, M. (2004) · Neuroscience · doi:10.1016/j.neuroscience.2004.07.032 · Cited by 184 · see citing works
Izquierdo, A., Suda, R. K., & Murray, E. A. (2005) · The Journal of Neuroscience · doi:10.1523/jneurosci.1232-05.2005 · Cited by 186 · see citing works
Fazel, S., Lichtenstein, P., Grann, M., & Långström, N. (2011) · PLoS Medicine · doi:10.1371/journal.pmed.1001150 · Cited by 181 · see citing works
A Psychophysiological Investigation of Moral Judgment after Ventromedial Prefrontal Damage
Moretto, G., Làdavas, E., Mattioli, F., & di Pellegrino, G. (2010) · Journal of Cognitive Neuroscience · doi:10.1162/jocn.2009.21367 · Cited by 182 · see citing works
Impairment of Social Perception Associated With Lesions of the Prefrontal Cortex
Mah, L., Arnold, M. C., & Grafman, J. (2004) · American Journal of Psychiatry · doi:10.1176/appi.ajp.161.7.1247 · Cited by 172 · see citing works
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Suri, D., Teixeira, C. M., Cagliostro, M. K. C., Mahadevia, D., & Ansorge, M. S. (2015) · Neuropsychopharmacology · doi:10.1038/npp.2014.231 · Cited by 167 · see citing works
Appetitive motivation predicts the neural response to facial signals of aggression.
Beaver, J. D., Lawrence, A. D., Passamonti, L., & Calder, A. J. (2008) · The Journal of Neuroscience · doi:10.1523/jneurosci.0033-08.2008 · Cited by 152 · see citing works
Irritability in pediatric mania and other childhood psychopathology
LEIBENLUFT, E., BLAIR, R. J. R., CHARNEY, D. S., & PINE, D. S. (2003) · Annals of the New York Academy of Sciences · doi:10.1196/annals.1301.022 · Cited by 145 · see citing works
Siclari, F., Khatami, R., Urbaniok, F., Nobili, L., Mahowald, M. W., Schenck, C. H., Cramer Bornemann, M. A., & Bassetti, C. L. (2010) · Brain · doi:10.1093/brain/awq296 · Cited by 131 · see citing works
Posttraumatic stress disorder: a theoretical model of the hyperarousal subtype
Weston, C. S. E. (2014) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2014.00037 · Cited by 114 · see citing works
Neuropsychological performance and regional cerebral blood flow in obsessive–compulsive disorder
Lacerda, A. L. T., Dalgalarrondo, P., Caetano, D., Haas, G. L., Camargo, E. E., & Keshavan, M. S. (2003) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/s0278-5846(03)00076-9 · Cited by 98 · see citing works
Rüsch, N., Weber, M., Il’yasov, K. A., Lieb, K., Ebert, D., Hennig, J., & van Elst, L. T. (2007) · NeuroImage · doi:10.1016/j.neuroimage.2006.12.007 · Cited by 93 · see citing works
Sex differences in orbitofrontal connectivity in male and female veterans with TBI
McGlade, E., Rogowska, J., & Yurgelun-Todd, D. (2015) · Brain Imaging and Behavior · doi:10.1007/s11682-015-9379-3 · Cited by 63 · see citing works
Strenziok, M., Krueger, F., Heinecke, A., Lenroot, R. K., Knutson, K. M., van der Meer, E., & Grafman, J. (2011) · Social Cognitive and Affective Neuroscience · doi:10.1093/scan/nsp036 · Cited by 38 · see citing works
Self-citationPsychological Structure and Neural Correlates of Event Knowledge
Wood, J. N., Knutson, K. M., & Grafman, J. (2005) · Cerebral Cortex · doi:10.1093/cercor/bhh215 · Cited by 38 · see citing works
Self-citationKuniishi, H., Ichisaka, S., Matsuda, S., Futora, E., Harada, R., & Hata, Y. (2017) · Frontiers in Behavioral Neuroscience · doi:10.3389/fnbeh.2016.00250 · Cited by 34 · see citing works
Bernanke, A., Hasley, R., Sabetfakhri, N., de Wit, H., Smith, B. M., Wang, L., Brenner, L. A., Hanlon, C., Philip, N. S., Ajilore, O., et al. (2024) · JMIR Research Protocols · doi:10.2196/58206 · Cited by 2 · see citing works
- Authors
- Grafman, J., Schwab, K., Warden, D., Pridgen, A., Brown, H. R., & Salazar, A. M.
- Affiliations
- National Institutes of Health (US)
- Uniformed Services University of the Health Sciences (US)
- Venue
- Neurology
- Published
- 1996-05
- Volume
- 46
- Issue
- 5
- Pages
- 1231-1231
- ISSN
- 0028-3878 (ISSN-L)
- 1526-632X
- OpenAlex
- W2029600757
- Cited by
- 696
- References
- 1
- Citations by year
- 2026: 7 · 2025: 8 · 2024: 12 · 2023: 13 · 2022: 12 · 2021: 14 · 2020: 26 · 2019: 23 · 2018: 29 · 2017: 32 · 2016: 30 · 2015: 33 · 2014: 29 · 2013: 41 · 2012: 38
- FWCI
- 2.99
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Neurology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
- Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
- Social Sciences › Psychology › Clinical Psychology › Psychopathy, Forensic Psychiatry, Sexual Offending
- Keywords
- frontal lobe lesions, ventromedial prefrontal cortex, aggression, violence, Vietnam War veterans, penetrating head injury, family breakdown
- MeSH terms
- Adult, Aggression, Analysis of Variance, Anger, Brain, Brain Injuries, Child, Depression, Family, Female, Frontal Lobe, Craniocerebral Trauma, Humans, Interpersonal Relations, Male, Military Personnel, Parent-Child Relations, Personality Inventory, Reference Values, Registries, Retrospective Studies, United States, Vietnam, Violence, Chi-Square Distribution
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