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Frontolimbic Morphometric Abnormalities in Intermittent Explosive Disorder and Aggression

  • Emil F. Coccaro
    Correspondence
    Address correspondence to: Emil F. Coccaro, M.D., Clinical Neuroscience Research Unit, Department of Psychiatry and Behavioral Neuroscience, University of Chicago, 5841 South Maryland Avenue, Chicago, IL 60637.
    Affiliations
    Clinical Neuroscience Research Unit, Department of Psychiatry and Behavioral Neuroscience, Pritzker School of Medicine, The University of Chicago
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  • Daniel A. Fitzgerald
    Affiliations
    Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL

    Mental Health Service Line, Jesse Brown Veterans Administration Medical Center, Chicago, Illinois
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  • Royce Lee
    Affiliations
    Clinical Neuroscience Research Unit, Department of Psychiatry and Behavioral Neuroscience, Pritzker School of Medicine, The University of Chicago
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  • Michael McCloskey
    Affiliations
    Department of Psychology, Temple University, Philadelphia, Pennsylvania
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  • K. Luan Phan
    Affiliations
    Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL

    Mental Health Service Line, Jesse Brown Veterans Administration Medical Center, Chicago, Illinois

    Department of Psychology, University of Illinois at Chicago, Chicago, Illinois

    Department of Anatomy and Cell Biology, University of Illinois at Chicago, Chicago, Illinois
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Published:October 05, 2015DOI:https://doi.org/10.1016/j.bpsc.2015.09.006

      Abstract

      Background

      Converging evidence from neuroimaging studies suggests that impulsive aggression, the core behavior in the DSM-5 diagnosis intermittent explosive disorder (IED), is regulated by frontolimbic brain structures, particularly orbitofrontal cortex, ventral medial prefrontal cortex, anterior cingulate cortex, amygdala, insula, and uncus. Despite this evidence, no brain volumetric studies of IED have been reported as yet. This study was conducted to test the hypothesis that gray matter volume in frontolimbic brain structures of subjects with IED is lower than in healthy subjects and subjects with other psychiatric conditions.

      Methods

      High-resolution magnetic resonance imaging scans using a three-dimensional magnetization-prepared rapid acquisition gradient-echo sequence were performed in 168 subjects (n = 53 healthy control subjects, n = 58 psychiatric controls, n = 57 subjects with IED). Imaging data were analyzed by voxel-based morphometry methods employing Statistical Parametric Mapping (SPM8) software.

      Results

      Gray matter volume was found to be significantly lower in subjects with IED compared with healthy control subjects and psychiatric controls in orbitofrontal cortex, ventral medial prefrontal cortex, anterior cingulate cortex, amygdala, insula, and uncus. These differences were not due to various confounding factors or to comorbidity with other disorders previously reported to have reduced gray matter volume. Gray matter volume in these areas was significantly and inversely correlated with measures of aggression.

      Conclusions

      Reductions in the gray matter volume of frontolimbic structures may be a neuronal characteristic of impulsively aggressive individuals with DSM-5 IED. These data suggest an anatomic correlate accounting for functional deficits in social-emotional information processing in these individuals.

      Keywords

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