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Bully on the Brain

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Feb. 14, 2000 (Boston) -- For the first time, a brain defect that could be at least partly responsible for extremely violent criminal actions and antisocial behaviors of some men has been identified, report researchers from the University of Southern California (USC).

Men with antisocial personality disorder (APD) -- a form of mental illness often seen in serial killers and other violent, aggressive, wildly impulsive, or dangerous people -- had an 11% reduction in a certain type of tissue (gray matter) in the part of the brain known as the prefrontal cortex when compared with either normal men or men with a history of drug or alcohol abuse but no APD.

Researchers have pinpointed the prefrontal cortex as the part of the brain where emotion, arousal, attention, moral conscience, and self-control primarily reside.

The link between extremely violent and antisocial behavior and damage to prefrontal cortex from disease or trauma has been long established. One of the most famous cases was that of a Vermont railroad worker named Phineas Gage, who in 1848 survived and, remarkably, recovered rapidly from a horrific accident in which a heavy iron tamping rod more than three feet in length was driven by an explosion completely through his skull. Following the accident, however, he underwent a dramatic personality change, and began to display many of the traits of APD, including antisocial behavior, use of sexually explicit language, apparent lack of moral conscience, impulsiveness, irritability, aggressiveness, and an inability to focus on work or plan for the future.

Although children are not typically diagnosed with personality disorders until they reach adulthood, according to the American Psychiatric Association, children that exhibit signs similar to APD typically violate rules and show signs of extreme aggression, such as the torture of animals or other people, frequent bullying or threatening, use of weapons that could cause serious injury, lying, sexual aggression, vandalism, and theft. Adults with APD frequently commit criminal acts, get into fights, cheat, show a general disregard for the safety of themselves or others, and show a lack of remorse for their own behavior.

But the findings from the USC study raise legal and ethical questions about whether some violent offenders are completely responsible for their actions, and whether they can or should be treated with specific interventions that could curb impulsive behaviors and dampen their aggressive tendencies so that they no longer present a threat to society at large.

"I don't think anyone would argue that you can treat extreme antisocial behavior by locking people away, but then how would we treat them, and is it possible to prevent such behaviors from occurring in the first place?" asks M. Marsel Mesulam, MD, in an interview with WebMD seeking objective analysis. Mesulam is professor of psychiatry and behavioral sciences at Northwestern University Medical School in Chicago.

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