International Journal of Law and Psychiatry 32 (2009) 266–271

Contents lists available at ScienceDirect

International Journal of Law and Psychiatry

Aggression, psychopathy and brain imaging — Review and future recommendations

Katarina Wahlund ⁎, Marianne Kristiansson
Karolinska Institutet, Stockholm, Sweden

a r t i c l e i n f o a b s t r a c t

Keywords: Violent behavior appears to result from a complex web of interacting genetic as well as environmental
Aggression factors. Psychopathy is a strong predictor for relapse in violent acts. The current review shed light on rapidly
Psychopathy expanding knowledge in brain imaging related to violent behavior and psychopathy. A literature search was
Brain Imaging performed in PubMed, Cochrane and PsycInfo combining the key words: mentally disordered offender/
fMRI aggression/violence/ crime/forensic psychiatry/brain imaging neuroimaging/fMRI/MRI/PET/SPECT/lack of
empathy/psychopathy and antisocial personality disorder. The reviewed material, which consisted of 48
articles, indicates a rather strong consensus on the connection between dysfunctional parts of the frontal and
temporal lobes and violent antisocial behavior and psychopathy. In future studies, it would be useful to focus
on the limbic system and to investigate which parts of the frontal lobes and cerebral networks that are of
interest in the psychopathic personality. Moreover, the reviewed material highlights some of the
methodological difficulties in this area of research such as selection bias in the recruitment of patients,
inadequate matching of control subjects, and sometimes incongruous results. In the future we hope that
brain imaging can be used to map biological deviations in different offenders in order to try to learn more
about the different mechanisms behind violent behaviors.
© 2009 Elsevier Ltd. All rights reserved.

1. Introduction probably be more interesting to consider functional differences, such

Earlier studies have pointed to a complex web of biological and
social risk factors underlying antisocial and violent behavior (Raine,
2002). Whether these risk factors eventually lead to antisocial and
violent behavior in any single individual depends on a large set of
possible interactions, which are still largely in need of further research
(Raine, 2002). Specific traits in the personality may, regardless of
diagnosis, be related to violent behavior. Accordingly, there are dif-
ferent motives and different triggers for violent behavior such as
hatred, jealousy, perceived insult, fantasy, distortions of reality or
the urge to gain money or dominance. Despite a strong consensus on
the complex causes of violent behavior, general psychiatry and for-
ensic psychiatry are often limited to referring violent behavior to
specific psychiatric diagnoses defined in the diagnostic manual DSM-
IV (American Psychiatric Association, 1994, 2000). According to DSM-
IV, subjects have to fulfill a number of criteria in order to receive a
certain diagnosis, and even then, two subjects assigned the same
diagnosis could present very differently, since they may not share the
same criteria. To illustrate this; in order to be assigned the diagnosis
Borderline Personality Disorder (BPD), a subject has to fulfill five out
of nine different criteria. In practice therefore, two BPD patients may
only really share one of the specified criteria. Therefore, it would
⁎ Corresponding author. Department of Clinical Neuroscience, Division of Forensic
Psychiatry, Karolinska Institutet, Box 4044, S-141 04 Huddinge, Sweden. Tel.: +46 607
15 39; fax: +46 8 711 71 41.
E-mail address: katarina.wahlund@ki.se (K. Wahlund).
as intentions and motives that control and trigger different types of
offenders. Such differences could be explored with regards to factors
such as impulse control and lack of empathy. Criminal investigative
analyses (Hazelwood & Warren, 2000; Meloy, 2000) and case studies
(Kristiansson, 1995), have already suggested differences in motives
and triggers underlying violent behavior.
2. Aggression
Quite commonly throughout the literature, aggression is subdivided
into affective (also called reactive) or predatory (also called proactive)
aggression (McEllistrem, 2004; Meloy, 1988, 2006). Affective aggression
is the mammalian response to a threatening situation and is therefore
not inappropriate per se. It is enacted instantly as a direct response to
provocation, such as during a verbal argument that turns into a physical
fight. Physiologically, affective aggression is preceded by intense auto-
nomic arousal manifested by pounding heart, racing pulse, shallow
breathing, elevated blood pressure, and muscle tension, preparing the
body for fight or flight.
Predatory aggression, on the other hand, is usually more planned
and goal directed and is not preceded by heightened autonomic
arousal. It can be a response to provocation, but it is not acted out
directly, rather as revenge after a clear cool off period. In animals,
predatory aggression and violence is used to hunt prey for food and
survival. Humans can show lack of empathy and compassion and hunt
one another in order to obtain rewards such as money, sex, or power.
Predatory aggression is often associated with crimes such as serial

0160-2527/$ – see front matter © 2009 Elsevier Ltd. All rights reserved.
doi:10.1016/j.ijlp.2009.04.007
 K. Wahlund, M. Kristiansson / International Journal of Law and Psychiatry 32 (2009) 266–271
murders or rape (Silva, Leong, & Ferrari, 2004). It has been suggested
that predatory aggression is strongly connected specifically to psy-
chopathy (Barratt & Felthous, 2003; Barratt, Stanford, Dowdy, Lieb-
man, & Kent, 1999; Blair, Mitchell, Blair, 2005; Cornell et al., 1996;
Williamson, Hare, & Wong, 1987). Importantly however, psychopaths
are thought to act on impulse as well, which is reflected by the
impulsivity item and the poor behavior control item in the Psycho-
pathy Checklist Revised (PCL-R) (Hare, 2003, 1991). Subjects with
Aspergers syndrome sometimes also act in a predatory way, for in-
stance by stalking other people, maybe as a means of “communica-
tion” (Stokes, Newton, & Kaur, 2007).
3. Psychopathy
The present review will discuss contemporary research in brain
imaging on offenders, with a specific focus on psychopathy. Psycho-
pathy is a strong predictor of relapse in violent offences (Dolan &
Doyle, 2000) In 1809, psychopathy was first introduced as a concept
by Phillippe Pinel who introduced the term: ”Mania sans délir”;
“Insane without delirium”. The concept was further developed by
Cleckley in 1976 in the book “the Mask of Sanity”, (Cleckley, 1976).
Currently, psychopathy does not exist as a DSM-IV diagnosis
(American Psychiatric Association, 1994, 2000). Quite often however,
it is confused with antisocial personality disorder (APD), which is a
defined diagnosis in DSM-IV (American Psychiatric Association, 1994,
2000). Although there are some overlapping items between the two
diagnoses, they are not interchangeable i.e. not all individuals with
antisocial personality disorder are considered psychopaths. Psycho-
pathy is commonly assessed by use of the Psychopathy Checklist
Revised, (PCL-R), developed by Robert Hare (Hare, 2003, 1991). PCL-R
consists of two major parts; factor one and factor two. In factor one,
personality traits such as superficial charm, grandiose sense of self-
worth, shallow affect, lack of remorse, and lack of empathy are scored.
In factor two, behavior and life style such as impulsivity, poor be-
havioral control, parasitic lifestyle, juvenile delinquency, and criminal
versatility is scored. PCL-R has been criticized for mixing personality
traits with lifestyle and behavior. In reference to the PCL-R, some
authors subdivide psychopaths into primary and secondary psycho-
paths. The primary psychopaths have more pronounced psychopathic
personality traits scoring high on factor one, and the secondary
psychopaths are displaying antisocial behavior and lifestyle, scoring
higher on factor two (Lykken, 1995; Skeem, Johansson, Andershed,
Kerr, & Louden, 2007).
Lack of empathy is one of the characteristics of psychopathy. There
are many different aspects of empathy but it has been suggested
that psychopaths specifically lack affective empathy specifically (Blair
et al., 2005; Blair, 2006). Affective empathy constitutes non-conscious
physiological reactions such as the fight or flight reaction, character-
ized by autonomic arousal, which is controlled by the amygdala. The
amygdala is situated in the medial temporal lobe just in front of the
hippocampus, and it is involved in emotional regulation, particularly
of unpleasant emotions (Gross, 2007). A dysfunctional amygdala has
been suggested as one of the core neural correlates of psychopathy
(Blair et al., 2005; Blair, 2003, 2006). Impairments in the amygdala
could lead to deficient emotional learning, which in turn could be one
of the reasons behind the development of psychopathy (Blair, 2003,
2006; Blair, Peschardt, Budhani, Mitchell, & Pine, 2006). In addition, a
rather large set of studies have shown that individuals with psy-
chopathy fail to react to threatening stimuli (Birbaumer et al., 2005;
Patrick, Bradley, & Lang, 1993; Patrick, Cuthbert, & Lang, 1994; Raine,
1996; Raine, Lencz, Bihrle, LaCasse, & Colletti, 2000). It has been
suggested that this could be due to a dysfunctional or slow auto-
nomic nervous system or an inhibitory mechanism stemming from
other parts of the brain. Aside from the amygdala, frontal lobe dys-
function has been suggested in psychopaths (Gorenstein, 1982; Raine,
2002).
267
4. Brain imaging
Currently, brain imaging techniques offer the possibility not only to
measure brain volumes, but also to study neuronal processing behind
specific actions through observation and measurement of brain activity
during emotional and cognitive processing. Computer tomography (CT)
and magnetic resonance imaging (MRI) are the most common ways
of imaging the brain. In structural studies, various techniques such as
segmentation, manual outline, semi-automatic combination of manual
and automatic segmentation, and stereotachtichal cavalieri principal
(Barta, Dhingra, Royall, & Schwartz, 1997), can be used, in order to study
volumes in different areas of the brain. Brain functioning can be studied
using different techniques such as positron emission tomography (PET),
single photon emission computed tomography (SPECT) or functional
magnetic resonance imaging (fMRI). PET is a nuclear medical imaging
technique which produces a three-dimensional image or map of
functional processes in the body. The system detects pairs of gamma
rays emitted indirectly by a positron-emitting radioisotope, which is
introduced into the body on a metabolically active molecule. SPECT is a
nuclear, tomographic imaging technique that enables the study of
perfusion in the brain, either in resting state or during an active task. An
indirect measurement of brain activity is obtained by fMRI, utilizing the
hemodynamic response, related to neural activity in the brain, the so
called Blood Oxygen Level Dependency, BOLD-technique (Ogawa et al.,
1993).
5. Aim of the study
The aim of the present review is not to be a meta-analysis, but to
provide a glimpse of the research field on psychopathy and brain
imaging to date, this serving as a basis for discussion of the difficulties
that face researchers in this field. Furthermore, the review aims to
provide suggestions for future areas of research.
6. Methods
A literature search was performed in PubMed, Cochrane and PsycInfo
by combining the following key words: mentally disordered offender/
aggression/violence/crime/forensic psychiatry/brain imaging/neuroi-
maging/ fMRI/MRI/PET/SPECT/lack of empathy/psychopathy and
antisocial personality disorder. The search yielded 58 articles, eight
books, and two dissertations. From that material, only articles written in
English were reviewed. Any studies focusing on topics outside our area
of interest (studies of children or studies using methods other than brain
imaging) were excluded. In all the articles included, the reference lists
were searched and some additional references were added. The final
material consisted of 48 articles divided into three categories; review
articles, structural studies and functional studies.
7. Results
7.1. Previous review articles
In the 12 review articles included, results suggested smaller brain
tissue and decreased activity in the frontal lobes in individuals with
antisocial and violent behavior (Anckarsater, 2006; Bassarath, 2001;
Brower & Price, 2001; Hoptman, 2003; Pridmore, Chambers, &
McArthur, 2005). There were also findings indicating that deviations
in the temporal lobes and in the limbic system are more closely con-
nected to psychopathic traits (Anckarsater, 2006; Blair, 2003; Dolan,
2002; Kiehl, 2006). Blair suggested, in his review article from 2006, that
the reason why psychopathic individuals fail to avoid actions that harm
others is a disrupted ability to form the stimulus-punishment associa-
tions, necessary for successful socialization (Blair, 2006). The distur-
bance in the limbic system, the insensitivity to punishment, and the
extreme sensitivity to reward were further discussed in the latest review
268 K. Wahlund, M. Kristiansson / International Journal of Law and Psychiatry 32 (2009) 266–271
by van Honk and Schutter (2006). In this review, the authors proposed a
neurobiological construct of emotional processing in primary psycho-
pathy. They concluded that different models such as the low fear mo-
del, the somatomarker hypothesis and the violence inhibition model
probably coexist and influence each other (van Honk & Schutter, 2006).
7.2. Structural studies
The eleven structural studies that were included pointed to dif-
ferences in brain tissue in the frontal lobes, the temporal lobes, corpus
callosum and amygdala in antisocial and psychopathic individuals
compared to controls. However, the results from these studies have
come to different conclusions. Some studies showed brain tissue loss in
the temporal lobes in violent patients (Laakso et al., 2001; Tonkonogy,
1991) and in antisocial patients (Barkataki, Kumari, Das, Taylor, &
Sharma, 2006; Laakso et al., 2001; Tonkonogy, 1991). Results from
some studies presented brain tissue loss in the frontal areas (Raine
et al., 2000), while yet other studies failed to show any differences at all
between psychopaths or subjects with antisocial personality disorder
compared to healthy controls (Dolan, 2002; Dolan, M., Deakin, W.J.,
Roberts, N., & Anderson, I., 2002; Dolan, M.C., Deakin, J.F., Roberts, N., &
Anderson, I.M., 2002; Laakso et al., 2002). In a recent study from 2007,
Narayan studied cortical thickness in violent patients with schizo-
phrenia and/or antisocial personality disorder in comparison to healthy
control subjects. Violence was associated with cortical thinning in the
medial inferior frontal and lateral sensory motor cortex, particularly in
the right hemisphere, but only subjects with a coexisting antisocial
personality disorder exhibited cortical thinning in inferior mesial frontal
cortices (Narayan et al., 2007). In another study by Raine et al. (2003),
the authors compared the corpus callosum in subjects with antisocial
personality disorder and high degree of psychopathy, recruited from
society, with healthy controls. They found an increased estimated cal-
losal white matter volume, increase in length, and reduction in callosal
thickness in the psychopathic individuals compared to the controls
(Raine et al., 2003). In another study “successful psychopaths”, who had
not been convicted were compared to “unsuccessful psychopaths” who
had been convicted. The authors found that the “unsuccessful psy-
chopaths” had reduced prefrontal grey substance (22%) but also a higher
asymmetry in anterior part of the hippocampus in comparison to the
“successful psychopaths” and healthy controls (Raine et al., 2004; Yang,
Raine, Lencz, Bihrle, LaCasse et al., 2005). In another study, pathological
liars were compared to antisocial individuals and healthy controls. The
results suggested that the pathological liars had 22–26% increased white
substance in the frontal lobes although the prefrontal grey matter/white
substance was reduced with 36–42% in comparison to both controls
groups (Yang, Raine, Lencz, Bihrle, Lacasse et al., 2005).
7.3. Functional studies
Twenty one functional studies, using the different techniques briefly
introduced in previous section (PET (7), SPECT (3) and fMRI (11)) were
included.
Various PET-studies have shown lower glucose metabolism in the
temporal lobes and frontal lobes of violent patients, both in the
prefrontal and orbitofrontal cortex (Goyer et al., 1994; Seidenwurm,
Pounds, Globus, & Valk, 1997; Volkow et al., 1995). Using PET during a
continuous performance task, Raine at al. tested the hypothesis that a
group of violent offenders, charged of murder but pleading not guilty
by reason of insanity or incompetent to stand trial, would show pre-
frontal dysfunction. In comparison to a control group, the murderers
showed significantly reduced glucose metabolism in the medial and
lateral prefrontal cortex (Raine, Buchsbaum, & LaCasse, 1997; Raine
et al., 1994). Based on these results, the murderers were further divided
into two groups on basis of early psychosocial deprivation. Murderers
without any clear psychosocial deficits had significantly lower glucose
metabolism, indicating, according to the authors, that brain abnorm-
alities constitute a greater predisposition to violence in this group
(Raine, Phil, Stoddard, Bihrle, & Buchsbaum, 1998). Furthermore, the
murderers were subdivided according to what type of violence they
had used; affective or predatory violence. The latter group showed a
pattern in glucose metabolism more similar to the healthy controls
while the impulsive group showed less metabolism in the prefrontal
regions but an increased metabolism in sub cortical regions (Raine,
Meloy et al., 1998).
Two of the SPECT-studies were performed in the resting state and
they showed that there might be a hypo perfusion in the frontal lobes of
alcoholics with antisocial personality disorder (Kuruoglu et al., 1996)
but also in subjects that had committed violent offences (Kuruoglu et al.,
1996; Soderstrom et al., 2002). In the third SPECT-study, a group of
psychopathic patients and a group of non-psychopathic patients from an
inpatient substance abuse program were scanned while performing a
semantic task. The groups were compared to one another and to a
healthy control group. The results showed an increased blood flow in the
psychopaths in relation to the non-psychopathic patients and control
subjects. This was interpreted as a greater demand on the psychopath's
brains when processing emotional words (Intrator et al., 1997).
Studies using fMRI have also revealed impairments in performing
semantic tasks in criminal psychopaths. Individuals with a high degree
of psychopathy have been shown to need more time to solve semantic
tasks with abstract and concrete words compared to control subjects
(Kiehl et al., 2004). Some studies have investigated healthy individuals
who rated high on Psychopathy Personality Inventory (PPI), a checklist
developed for psychopathic traits in the normal population (Lilienfeld
& Andrews, 1996). Results from these studies have shown that subjects
with a high degree of psychopathic traits had a significantly different
pattern of neural activity when processing a recognition task
demanding affective processing (Gordon, Baird, & End, 2004). In a
study by Kiehl et al. (2001), it was suggested that the deficient affective
processing in psychopaths might result from deficient or weakened
input from the limbic structures in psychopathic subjects. (Kiehl et al.,
2001). In contrast to that suggestion, other studies have shown in-
creased activity in limbic structures, such as the amygdala, when
psychopaths viewed emotional pictures (Muller et al., 2003). A recent
study showed differences between psychopathic subjects and control
subjects when processing facial emotions; the psychopaths showed
significantly lower activation in fusiform and extrastriate cortices
when processing happy as well as neutral and fearful faces. The
response pattern was affected by the emotion type, however; when
processing fearful faces, the healthy controls showed increased activ-
ation, while the psychopaths showed decreased activation in the
fusiform gyrus (Deeley et al., 2006). In a study on subjects with
antisocial personality disorder and healthy control subjects using a
differential aversive classical conditioning paradigm applied with
odors as unconditioned stimuli and faces as conditioned stimuli,
differential effects during acquisition were found in the amygdala and
dorsolateral prefrontal cortex. The controls showed signal decrease
while the patients' signals increased. This might seem to be an un-
expected result, but the authors hypothesized that the increase in
signal in the antisocial subjects might be due to an additional effort
put in by these individuals to form negative emotional associations
(Schneider et al., 2000). In two other studies, also using aversive dif-
ferential conditioning, psychopathic subjects did not show the same
activation in the limbic-prefrontal circuit as control subjects (Birbaumer
et al., 2005; Veit et al., 2002).
Kumari et al. investigated working memory in schizophrenic sub-
jects, subjects with antisocial personality disorder and healthy con-
trols. The antisocial subjects showed activation deficit in the left frontal
gyrus, anterior cingulated, and precuneus compared to the healthy
controls (Kumari et al., 2006). A go/no-go task was performed by
violent schizophrenic patients with a co-morbidity of APD and sub-
stance abuse disorder compared to a group of violent schizophrenic
patients with no co-morbidity. The aim of the study was to verify the
 K. Wahlund, M. Kristiansson / International Journal of Law and Psychiatry 32 (2009) 266–271
hypothesis that the group with co-morbidity would present a different
pattern of prefrontal functioning to that of the group with only
schizophrenia The results did support the main hypothesis; the group
of schizophrenic patients with APD and substance abuse had signifi-
cantly less activation in the frontal basal cortices during the go/no-go
task compared to the patients solely presenting with schizophrenia. The
same group also showed significantly higher activation in frontal motor,
premotor and anterior cingulated regions compared to the group of
patients solely presenting with schizophrenia (Joyal et al., 2007). In
another study, healthy controls, which had performed self assessment
PPI (Lilienfeld & Andrews, 1996), were tested with a game, Prisoner's
Dilemma. This is a decision-making task in which one decides whether
or not to cooperate, and in which optimal decisions can be made on
either emotional or cognitive grounds. The findings in the study sug-
gested that, while subjects scoring low on PPI had emotional biases
toward cooperation that could only overcome by cognitive effort,
subjects scoring high on PPI had an opposite bias toward defection that
likewise could only be overcome by cognitive effort (Rilling et al., 2007).
8. Conclusion
In conclusion, results from the present review suggest some,
possibly modest, relationship between deviant brain structure and
function of the frontal and temporal lobes and violent, antisocial
behavior, and psychopathy. In the future, it would be useful to focus on
the role of the limbic system and to investigate which parts of the
frontal lobes and cerebral networks (e.g. fronto-limbic ones) that are
of interest in the psychopathic personality.
9. Discussion
Brain imaging research on psychopaths struggles with some major
limitations such as difficulty with selection of patients (Abbott, 2001),
small study groups (Brower & Price, 2001; Pridmore et al., 2005) and
difficulties in finding adequately matching control subjects (Pridmore
et al., 2005). One crucial difference between studies is that some
investigate psychopaths and others investigate violent subjects in gen-
eral. Likewise, in some studies, convicted offenders are being studied,
and in others, non-convicted subjects with psychopathic traits are being
studied. Another marked difficulty relates to the diagnostic definition
of included subjects; not all studies are fully clear on how their in-
cluded subjects have been diagnosed. Diagnoses are often mixed and
few studies are able to correct for any co-morbidity. Schizophrenic
patients for instance, tend to present with high degrees of psychopathic
traits such as shallow affect and lack of empathy, which makes it difficult
to determine if these traits are expressions of the schizophrenic disease
or rather reflect psychopathic co-morbidity. The selection of control
subjects is also critical. Commonly, the control group consists of non
criminal healthy individuals recruited from the society, while the patient
group may consist of offenders sentenced to life in prison.
In research, as well as in clinical practice, it may be important to not
consider psychopaths as a homogenous group. In the future, it is likely
that researchers more commonly will make a distinction between cer-
tain subtypes of psychopaths; primary, more calculated and controlled
psychopaths who often use predatory violence, and secondary, more
impulsive psychopaths who often commit affective violence (Skeem
et al., 2007). When conducting research, it is important to be precise and
to specify what symptoms and which functions to focus on. Is empathic
ability the crucial trait that separates the psychopathic subtypes? Can we
measure empathy? Is it possible to localize empathic ability to a specific
centre in the brain or is empathy dependent on complex cerebral
networks? Most likely, there are overlapping circuits in the brain that are
of importance for social interaction, and theory of mind, functions that
are of great importance for empathic ability (King, Blair, Mitchell, Dolan,
& Burgess, 2006). However, current studies on neural localization of
empathy have pinpointed some specific areas, such as amygdala and
269
cingulate gyrus (Vollm et al., 2006). Future fMRI studies applying
connectivity analysis may increase our knowledge of the cerebral
networks that are important for empathic ability.
Is empathic ability innate, and is it possible to train empathic
capacity? With so called real time fMRI, the BOLD-response can be
followed, and it is possible to give the subject direct feedback. Using
these kinds of techniques, some researchers have investigated healthy
subjects as they provoke their own feelings. In one study, subjects
were able to activate their amygdala by deliberately thinking of
something sad (Eippert et al., 2007; Posse et al., 2003; Weiskopf et al.,
2004). In Germany this technique has also been used on psychopaths
(Eippert et al., 2007). Could this be a useful future tool to train off-
enders in empathic processing?
10. Ethical considerations
What impact could brain imaging techniques have and what
applications could a better understanding of brain functioning lead
to? Could brain images be used as evidence in court sessions, and
could diminished responsibility be argued for on the basis of deviant
emotional processing? This is a delicate matter. It is important to keep
in mind that although we have sophisticated brain imaging techni-
ques, this field is quite new and the methods have many limitations.
We still don't know exactly what activation in fMRI means. Sometimes
activation can be increased activation of inhibitory systems. It is also
important to remember that e.g. fMRI is an indirect measure of
neuronal activity. In the future more direct methods can hopefully be
used, such as magnetoencephalography (MEG).
The results from the literature strongly suggest that current
knowledge of mechanisms resulting in antisocial behavior and
psychopathy is scarce, but hopefully, in the future, we will be able to
learn more with the help of brain imaging techniques. In summary, we
need to know much more before we can draw firm conclusions on
antisocial and psychopathic traits from brain imaging data.
11. Future directions
It might be time to look beyond the DSM-IV and focus more on the
complex correlates of specific functional divergences such as lack of
empathy and lack of impulse control. In risk assessment and in
rehabilitation maybe it would be better to describe degree of im-
pulsivity and deficiency of empathy in psychopathic offenders rather
than simply categorizing subjects as having a personality disorder.
Today, fMRI is used in research to expand the knowledge on deviant
neuronal activity and reactivity in violent offenders assigned various
diagnoses compared to controls. In the future maybe imaging tech-
nique could be a complementary tool to routine clinical practice and
risk assessments and to evaluate rehabilitation. It is important to keep
in mind however that brain imaging only is an assisting tool, also
limited by generalization.
Acknowledgements
We are grateful to Karolina Sörman and Kristina Sygel for excellent
help with language revision.
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