Neuropsychological and Cognitive

Psychophysiological Substrates of Impulsive

Aggression
Ernest S. Barratt, Matthew S. Stanford, Thomas A. Kent, and Alan Felthous

The purpose of this study was to test whether subjects who commit impulsive vs non-impulsive
aggression differ on measurements of personali~, neuropsychology, and cognitive psycho-
physiology, and whether these differences can yield information regarding the etiology of
impulsive aggression. Subjects were two groups of prison inmates, distinguished by their
committal of impulsive or nonimpulsive aggression, and matched noninmate controls. All
inmates met DSM III-R criteria for an antisocial personality disorder but for no other
disorder. Impulsiveness, anger, and peak P300 latencies did not differ between the inmate
groups, but verbal symbol decoding and peak P300 amplitudes did. Impulsiveness and verbal
skills were inversely correlated. Impulsiveness was inversely correlated with, and verbal skills
positively correlated with P300 amplitudes. The results indicate that aggression is not
homogenous, even among antisocial persons, and that impulsive aggression is related to
neuropsychological and cognitive psychophysiological measures of information processing
beyond those factors related to criminality alone. © 1997 Society of Biological Psychiatry

Key Words: Impulsive Aggression, P300 ERPs, verbal deficits, prisoners, antisocial person-
ality disorder

BIOL PSYCHIATRY 1997;41 : 1045-1061

Introduction being contrasted as impulsive vs non-impulsive. Although

Defining human aggression poses clinical and research
nosological problems (Lion 1991; Bech and Mak 1995).
There is no universally accepted nosology of human
aggression but there is a long history of aggressive acts
From the Department of Psychiatry and Behavioral Sciences (ESB. TAK. AFt. the
Department of Neurology (TAK). the Department of Pharmacology and
Toxicology (TAK), The University of Texas Medical Branch, Galveston.
Texas; and the Department of Psychology, University of New Orleans, New
Orleans, Louisiana (MSS).
Address reprint requests to Ernest S. Barratt, PhD. Department of Psychiatry and
Behavioral Sciences, University of Texas Medical Branch. 301 University
Boulevard. Galveston, TX 77555-0443.
Received June 29. 1994; revised March 3. 1996.
the labels for these two types of acts have varied among
authors (Berkowitz 1974; Heilbrun et al 1976; Linnoila et
al 1983; Coccaro et al 1989), construct and predictive
validity studies (Heilbrun 1972; Heilbrun et al 1978;
Shoham et al 1989; Virkkunen et al 1989; DeJong et al
1992; Atkins et al 1993) support the distinction between
these two types of aggression. The general purpose of this
study is to test hypotheses related to information process-
ing differences between persons who commit impulsive
and nonimpulsive aggressive acts.
Impulsive aggression is defined in this study within
B arratt's (1991) nosology which includes three classes of

© 1997 Society of Biological Psychiatry 0006-3223/97/$17.00

Pll S0006-3223(96)00175-8
1046 BIOLPSYCHIATRY
1997;41:1045 1061
aggressive acts: 1) premeditated; consciously executed or
planned aggressive acts; these acts are best described
within a psychosocial model (Bandura 1973; Tedeschi and
Felson 1994); 2) medically related: aggression as a symp-
tom of a medical disorder as typified by its main use in
DSM-IV (American Psychiatric Association 1994); 3)
impulsive: a hair trigger response to a stimulus that results
in an agitated state and culminates in an aggressive act
during the agitated state; interpersonal communication is
often nonadaptive during the agitated state and informa-
tion processing appears to be inefficient (Elliot 1976,
1992).
The need for a better understanding of human aggres-
sion including impulsive aggression has been noted (Eich-
elman 1992; Stein, 1994). Barratt et al (1995b) using
Robins and Guze's (1970) criteria for a psychiatric syn-
drome, argued that impulsive aggression should be in-
cluded as a disorder in future Diagnostic and Statistical
Manuals of the American Psychiatric Association along
with Intermittent Explosive Disorder (the only disorder in
DSM-IV that is exclusively an aggression disorder). Hol-
lander and Stein (1995) edited an extensive review of
impulsivity and aggression and noted that "remaining
problems in the field of impulsivity and aggression in-
clude.., the need for better definition of both dimensional
and categorical variables" (p 4).
The present study extends impulsive aggression re-
search by using: 1) a semistructured interview to classify
aggressive acts as impulsive or premeditated rather than
relying on indirect measures of potential aggressiveness;
2) personality, cognitive psychophysiological, and neuro-
psychological techniques to study information processing
differences between persons who commit impulsive ag-
gressive vs premeditated aggressive acts. We propose that
nonadaptive interpersonal communication that is charac-
teristic of the highly impulsive aggressive person when
agitated is related to a lack of impulse control as a result
in part of frontal lobe dysfunctioning, a high level of
anger/hostility which leads to agitation when disinhibited,
and verbal skill deficits which are related to both parietal
and temporal lobe dysfunctioning. Self-report personality
trait measures will be used to measure impulsiveness and
anger/hostility. Neuropsychology techniques will be used
to measure verbal skills and cognitive psychophysiologi-
cal techniques will be used to identify cortical dysfunc-
tioning. The a priori interrelationships of these constructs
as stated above provide the basic rationale for this study.
To test this general proposal, specific hypotheses related to
this rationale will be tested using each of three types of
measurements: personality, neuropsychology, and cogni-
tive psychophysiology. No studies of impulsive aggression
have been reported using these three types of assessment
on the same subjects but the need for such research has
E.S. Barratt et al
been expressed. Lewis (1992) emphasized the need to look
at multiple measurements of the concomitants of violence
noting that "...when impulsivity, hypervigilance, and
cognitive expressive deficits coexist, the psychophysiolog-
ical stage is set for violence to occur" (p 388). Volavka et
al (1992) reviewed psychobiological studies of aggression
and concluded "...that substantial progress in this field
will be impossible without integrative multidisciplinary
studies" (p 247).
Personali~ Traits and Aggression
Self-report personality inventories have been used as both
predictor (Barratt 1991; Novaco 1994) and criterion (Bech
and Mak 1995) measures of aggression. Further, a wide
range of self-report personality questionnaires have been
developed to measure aggression per se (Cloninger 1987;
Buss and Durkee 1957). Two of the more commonly
studied personality traits in aggression research are anger/
hostility (Tangney et al 1992; Novaco 1994) and impul-
siveness (Barratt 1994). Barratt (1991) suggested that
impulsiveness and anger/hostility characterize impulsive
aggression. Lish et al (1996) noted that "anger is the
emotional state that usually precedes an aggressive act" (p
24). Mood states including anger can affect cognitive
functioning and information processing in adverse ways
(Taylor et al 1991; Rolls 1995). Likewise, impulsiveness
has been related to information processing through pro-
posed differences in attention (Dickman 1993), arousal
(Eysenck and Eysenck 1985; Revelle et al 1980; Revelle et
al 1987), and/or maintaining a cognitive tempo or selected
rate of information processing (Barratt 1983, 1987; Barratt
and Patton 1983). Stanford and Barratt (in press) have
shown that measures of impulsiveness, selected verbal
skills including reading, continuous motor performance,
and judging time intervals, define a second order factor of
temporal information processing. Related to the latter,
Atkins et al (1993) demonstrated that impulsive errors of
commission using a continuous performance task were
correlated significantly with hostile aggression, which is
similar to impulsive aggression as defined in this study.
Irritability, a complex personality trait as measured by
most self-report personality questionnaires, includes both
impulsive and anger personality traits (Caprara et al 1985).
Brown and Goodwin (1984) reported that impulsiveness
and irritability were significantly related to aggression.
Coccaro et al (1989) used a combination of self-report
questionnaires including the Buss-Durkee Hostility Inven-
tory (BDHI, Buss and Durkee 1957) and the Barratt
Impulsiveness Scale (BIS, Barratt 1985; Patton et al 1995)
to distinguish between the irritable-impulsivity and ag-
gression-assault components of aggression. This distinc-
tion implies different information processing stages for
Impulsive Aggression
initiating the aggressive act; the irritable impulsivity stage
involves a "lowered threshold for a response to a noxious
stimulus" (Coccaro et al 1989) while the aggression-
assault stage comes later.
It is hypothesized in this study that impulsive aggressive
inmates (IAIs) will score higher than nonimpulsive ag-
gressive inmates (NIAIs) and noninrnate controls (NICs)
on self-report measures of impulsiveness and anger.
Neuropsychology Tests and Aggression
A wide range of neuropsychological techniques has been
used to study aggression (Stein et al 1995; Reiss et al
1994; Mirsky and Siegel 1994). The etiological implica-
tions of these findings are complexly intertwined with
developmental and environmental constructs (Reiss et al
1994; Nestor 1992). As noted, Barratt (1983, 1993) has
proposed that the rate or tempo of information processing
or (temporal information processing) is related to impul-
siveness and selected verbal information tasks including
reading (Stanford and Barratt, in press). Consistent with
Barratt's proposal, dyslexia and dysphasia have been
related to temporal information processing (Tallal 1993).
Further, one of the more consistent neuropsychological
findings found in both criminals and noncriminals is an
inverse relationship between impulsive aggression and
verbal abilities (Mungas 1988; Vitiello et al 1990; Reiss et
al 1994). Many of these studies have involved criminals or
psychopaths and as Raine and Scerbo (1991) noted, a
"...conceptual issue that has received little attention in
violence research concerns the issue of whether the cor-
relates of violence differ in any substantive way from the
correlates of crime..." (p 3). This study addresses this
issue by comparing two groups of inmates who have
exhibited different types of aggressive acts.
It is predicted in the present study that IAIs will score
lower than NIAIs and NICs on verbal skills including
reading.
Cognitive Psychophysiology and Aggression
Event-related potentials (ERPs), especially the P300 com-
ponent, have a long history as measures of brain function-
ing related to information processing (Donchin 1979;
Hillyard and Kutas 1983; Duncan et al 1994). The focus in
this study will be on the P300 as a measure of differences
in brain functioning related to information processing
among inmates and noninmate controls although other
components of the ERPs will be evaluated as possible
sources of differences in brain functioning among the
groups. The latency of the P300 is generally agreed to be
a measure of stimulus evaluation time (Hillyard and Kutas
1983; Scheffers and Johnson 1994) while the amplitude of
BIOLPSYCHIATRY 1047
1997;41:1045-1061
the P300 has been related to the neural resources available
to process a stimulus. Lower P300 amplitudes purportedly
involve fewer neural resources and usually have been
associated with less efficient cognitive functioning and/or
pathological states (Branchey et al 1988; Duncan et al
1994; Pritchard 1989). The amplitude of the P300 has been
related to a wide range of cognitive processes including,
for example, attention, stimulus probability, arousal, re-
ducing uncertainty, and memory context upgrading.
Donchin (1981) noted that "we have shown that it is the
subjective probability of the stimulus, not its prior proba-
bility that determines the amplitude of the P300" (p 497).
Johnson (1986, 1989, 1993) included subjective probabil-
ity as part of his "triarchic model of P300 amplitude" and
postulated multiple subcortical generator sources for the
P300 in different sensory modalities and at different
topographical sites. Subjective probability will be manip-
ulated in this study in a modification of the oddball
paradigm which has been used traditionally to elicit P300s.
Although a large number of studies have related ERPs
to psychopathy which is associated with a "proneness to
commit violent and aggressive crimes" (Mirsky and Siegel
1994), very few studies have related ERPs to violence and
aggression in general and none to impulsive aggression
per se. Drake et al (1988) reported longer latency P300
ERPs in patients with "impulsive, aggressive, and violent
behavior." Branchey et al (1988) reported lower amplitude
P300 peaks among aggressive alcoholics; they noted that
patients with histories of incarceration for crimes involv-
ing physical violence had the lowest P300 amplitudes. In
topographical studies, the cortical areas most often related
to aggression are the frontal lobes (Raine and Scerbo
1991) and the temporal lobes, especially left temporal
(Wong et al 1994). As noted, ERPs will be used in the
present study to measure hypothesized brain correlates of
information processing deficits. Delays in the evaluation
time of verbal symbols and a lack of mobilization of
sufficient neural resources to make correct verbal discrim-
inations could be related to nonadaptive information pro-
cessing in interpersonal relationships as observed among
IAIs when agitated. It is predicted that IAIs in contrast to
NIAIs and NICs will have lower P300 peak amplitudes
and longer latency P300 peak latencies in a visual discrim-
ination task involving different probabilities of stimuli.
Further, topographically these ERP group differences will
primarily involve the frontal lobes (based on predicted
higher levels of impulsivity among the IAIs) and the left
temporal and parietal lobe areas (based on predicted lower
verbal skill levels among the IAIs). It is not assumed that
the proposed cortical loci differences are necessarily the
primary or only loci for neural differences related to
aggression between the two inmate groups since informa-
tion processing is related to parallel processing at different
1048 BIOLPSYCHIATRY
1997;41:1045-1061
levels of circuitry in brain functioning (Weiger and Baer
1988; Marr 1982).
Criminali~ vs Aggression
It is proposed that inmates will differ from noninmates on
the personality, neuropsychology, and cognitive psycho-
physiological measures in directions consistent with the
results of past studies (Raine 1993). Inmates compared to
NICs will have higher impulsiveness and anger/hostility
scores, poorer verbal skills, and longer latency and lower
amplitude P300 peaks. The present research will extend
prior research by characterizing differences between in-
mates who display impulsive and nonimpulsive (premed-
itated) aggression. This is not a study of criminal behavior
per se, but as noted, it is predicted that inmates vs normal
controls will differ as in past studies.
Methods
Subject Selection
Subjects (all male) were 57 inmates and 44 noninmate
controls (NICs) matched with a random sample of inmates
for age, race, and education. The inmates were in the
Texas Department of Criminal Justice (TDCJ) prisons.
The control subjects were employees of the University of
Texas Medical Branch (UTMB) or TDCJ correctional
officers.
Inmates were referred by prison officials and were
identified as having problems controlling their aggressive
behaviors. All subjects had the research explained to them
both orally and in written consent forms. The research and
consent forms were approved by the UTMB Institutional
Review Board for human research.
Of 566 inmates screened for the study, 309 inmates
were eliminated by chart screening using the exclusion
criteria below. Of the remaining 257 inmates, 155 volun-
teered for the initial interview during which the study was
explained and 138 agreed to participate in the medication
phase of the study. Of the 17 who did not volunteer, 11
were not interested in the study, 3 did not want to take
medication, and 3 denied aggressive behaviors. Additional
subjects were eliminated during ERP artifact screening (6
inmates and 4 NICs). Data for left-handed subjects were
also not included in the analyses (1 NIC and 6 inmates).
Using a semi-structured interview (see below), the
remaining inmates were divided into two groups: 1)
impulsive aggressive inmates (IAIs, n = 27); 2) non-
impulsive (premeditated) aggressive inmates (NIAIs, n =
30). This research also includes noninmate outpatients but
the n to date is too small to report meaningful results. The
data for this study were obtained during the baseline phase
of a study that related anticonvulsants to the control of
E.S. Barratt et al
impulsive aggression (the results of the medication trials
will be published elsewhere).
The ethnic makeup of the three groups of subjects was
not significantly different from each other: 1) 1AIs: Afro-
American, 13; Hispanic, 7; white, 7; 2) NIAIs: Afro-
American, 15; Hispanic, 7; white, 8; 3) NICs: Afro-
American, 25; Hispanic, 10; white, 9 (×2 [4] = 1.19).
There were also no significant differences among the three
groups for age in years (IAIs, M = 26.6, SD = 3.9; NIAIs:
M = 26.4, SD = 4.5; NICs: M = 26.1, SD = 4.2; F2Aoo
= 1.03) and highest grade level completed in school (IAIs:
M = 9.9, SD --- 1.4; NIAIs, M = 9.9, SD = 1.4; NICs:
M = 11.0, SD = 1.6; F2Aoo = 1.42). NICs were paid for
participating in the study.
INCLUSION CRITERIA. Inmates were not selected for
the study based on the crimes they committed to get into
prison but, rather, on the aggressive acts they committed
while in prison. Formal disciplinary reports of the correc-
tional officers were used as entry measures for aggression.
Each inmate in TDCJ prisons is given a handbook of
Disciplinary. Rules and Procedures. Known violations of
these rules can result in formal disciplinary reports being
filed. An inmate may contest a formal report and a hearing
and possible dismissal of the charge if the hearing officers
agree with the inmate. No "dismissed" incidents were used
as data in this study.
There were no differences between the two inmate
groups in the types of crimes committed that resulted in
imprisonment. Although no formal measure of self-re-
ported aggression was used to measure aggressive behav-
iors in early life, the Psychiatric Diagnostic Interview-
Revised (PDI-R, Othmer et al 1989) has items related to
fighting before age 16 and fighting as adults as part of the
antisocial personality disorder interview; 98 percent of the
inmates responded "yes" to these items for both age levels.
Further, in the initial informal screening interview, in-
mates were asked how long they had problems with
aggressive behaviors and all identified the problems as
predating incarceration.
To enter the study, an inmate must have committed at
least three documented aggressive acts as outlined in the
Handbook over the three-month period prior to entry into
the study. Most inmates had more incidents, with the
average inmate having about 6.2 incidents. The aggressive
acts were evaluated for intensity and for impulsiveness/
nonimpulsiveness. The intensity of each act was weighted
according to its social significance within the prison on a
ten-point scale established with the help of prison officials.
Hitting a correctional officer or prison employee was rated
10, for example, while hitting another inmate was rated 8.
To classify the aggressive acts as impulsive or nonim-
pulsive, a brief semistructured interview was developed
Impulsive Aggression
that was used along with the correctional officers' formal
reports to make the classification. An impulsive aggressive
act was defined as a hair-trigger, non-premeditated re-
sponse to a stimulus that results in an immediate aggres-
sive act or an agitated state that culminates in an aggres-
sive act. An example of a nonimpulsive aggressive act was
intentionally hitting an inmate because he was a member
of another gang. To establish the reliability of the inter-
view, two independent raters classified 58 acts with a
kappa of 0.83 (p < 0.0001). All aggressive acts cannot
clearly be classified as impulsive or nonimpulsive. Only
subjects whose aggressive acts were clearly impulsive or
nonimpulsive were used in this study. The NICs had no
history of repeated aggressive outbursts.
EXCLUSION CRITERIA. Subjects were excluded for: 1)
having a prorated verbal and performance WAIS IQ less
than 80; 2) having a current major DSM-III-R Axis I
disorder as measured by the PDI-R (Othmer et al 1989);
(subjects were not eliminated for having an antisocial
personality disorder (ASP); 3) presently taking medica-
tion; or 4) having a neurological or other serious medical
disorder. Neurological and medical screenings were based
on life history data, the medical chart (includes a record of
medical examinations while in prison), and a five-minute
resting EEG under eyes open and closed conditions at the
beginning of the psychophysiological recording session.
The EEG recordings were visually scanned for any indi-
cations of slowing or other suggestions of a neurological
disorder. This was not intended to be a clinical EEG but a
gross screen.
All of the inmates qualified for an antisocial personality
disorder and 55 percent of the inmates had a lifetime, but
not current, substance abuse disorder that was evenly
distributed among inmate groups. None of the NICs met
criteria for a psychiatric disorder.
Measurement Techniques and Instruments
SELF-REPORT PERSONALITY MEASURES. Barratt im-
pulsiveness scale (BIS; Barratt 1985; Patton et al 1995): a
total score of general impulsiveness is obtained by sum-
ming three subtest scores: motor (act without thinking),
cognitive (making-up one's mind quickly), and nonplan-
ning (not planning ahead).
NEO-PI impulsiveness facet (Costa and McCrae 1985):
A self-report measure of behavioral self-control.
Anger expression scale (Spielberger 1988) measures
anger-in, anger-out, anger control, and total anger expres-
sion.
Since many of the inmates had poor verbal skills, the
questionnaire items were read to all subjects. Subjects
BIOLPSYCHIATRY 1049
1997;41:1045-1061
were taught to respond to cards that contained possible
item responses.
NEUROPSYCHOLOGY AND READING TESTS. Wechsler
adult intelligence scale (WAIS; Wechsler 1955). Three
verbal (comprehension, similarities, vocabulary) and three
performance (digit symbol, block design, picture arrange-
ment) subtests were administered. Prorated verbal (VIQ)
and performance (PIQ) IQs were calculated.
Wechsler Memory Scale--Revised (WMS-R; Wechsler
1987). Verbal memory, visual memory, and attention/
concentration scores were used.
Gray oral reading test (GORT; Gray 1963) provides a
grade-level score based on the "mechanics" of oral read-
ing. Word repetition, mispronunciations, and word substi-
tutions or omissions are typical errors.
E R P RECORDING CONDITIONS AND ANALYSES, S u b -
j e c t s were seated in a comfortable chair in a semi-
darkened room. They wore earphones that masked extra-
neous sounds with a continuous white noise in the 45-60
dB range (adjusted to the comfort of the subject). Nineteen
scalp electrodes (International 10-20 System) were at-
tached using an electro-cap. Fifteen electrode sites were
used in this study: F3, Fz, F4, T3, C4, Cz, C4, T4, T5, P3,
Pz, P4, T6, O1, O2. Impedance for each electrode was less
than 5 Kohms. All ERP data were acquired using SCAN
software (Neurosofl 1993) and a Nihon Kohden (Model
EEG-4221) polygraph with a bandpass of 0.05-30 Hz.
Electrodes were referenced to linked ears. Subjects were
grounded via an electrode on the forehead. Electrooculo-
grams (EOGs) were recorded from electrodes placed 2.5
cm supraorbitally and 1.5 cm laterally from the left eye.
EEGs and EOGs were digitized every 4 ms for a 1000 ms
interval beginning 100 ms prior to stimulus onset. EOG
artifact contamination was removed using the method of
Semlitsch et al (1986); a transmission coefficient was
computed based on the estimated covariance of the aver-
age potentials of the ocular channel with the EEG channels
in the frequency domain and this coefficient was sub-
tracted from each ERP sweep point by point. All trials
were averaged to identify peaks after this correction. Peak
amplitudes were measured using baseline levels of the
average amplitude of the 100 ms of recordings prior to a
stimulus presentation. Latencies were measured from
stimuli onset.
Seven subjects (3 IAIs, 3 NIAIs, 1 NICs) were elimi-
nated because of excessive artifacts under all conditions.
After ERPs for trials in which response errors were
eliminated, at least 96 percent of the sweeps for the
remaining subjects were used in computing subject aver-
ages for all conditions and tasks. No trials were lost due to
ocular artifacts using the Semlitsch et al (1986) procedure.
1050 BIOL PSYCHIATRY
1997;41:1045-1061
The actual number of trials averaged across conditions
were comparable across groups after all contaminated
trials were removed. During the 0.1R condition of the off
target task, only 17.5 trials were used to obtain the average
ERPs for each subject. This is below the suggested
minimum of 20 trials for individual ERP averages; how-
ever, the error rates were relatively low and constant
across groups and the number of trials was considered
comparable to those in other conditions.
Subjects were run at the same time each day starting
between 12:30 PM and 1:30 PM. The starting time was at
least one hour after their last meal. Subjects did not smoke
during the day prior to being run. There were no group
differences in the time of year that subjects were run since
an attempt was made to run subjects in all groups during
different seasons (Polich and Geister 1991) (X2 [6 df] =
1.39).
Although the primary focus in this study was on P300,
the amplitudes and latencies for N 100, N200, P200, P300
and slow wave peaks were determined for each task and
stimulus condition. The time windows for these peaks
were: N100, 100-200 ms; P200 and N200, 200-300 ms;
P300, 300-600 ms; slow wave, 550-750 ms. Peaks were
identified initially by visual inspection and amplitude and
latency values were then assigned using computer soft-
ware (SCAN). A random sample of peak values was
identified by a second observer to check on the reliability
of the visual inspection.
TASK DESCRIPTION AND INSTRUCTIONS. Subjects w e r e
seated in front of a 48.3 cm monochrome video screen
with their eyes 54 cm (_ 2 cm) from the center of the
screen. Stimuli were 8 mm square letters at the center of
the screen. A 1000 Hz tone one second in duration
sounded one second prior to the appearance of each letter.
Letters remained on the screen for 1 second with a
3-second interstimulus interval. Subjects were instructed
to relax, fixate on the dot in the middle of the screen, and
rest their arms on the chair. Subjects completed the
following three two-choice response tasks with two min-
utes between tasks.
Odd-left: The letter "A" appeared on 80 percent (0.8
condition) of the trials and the letter "B" appeared on 20
percent (0.2 condition) of the trials. Subjects pressed a
response key with the left forefinger when "B" appeared
and the right forefinger when "A" appeared, Their fore-
fingers rested on the response keys prior to the press. The
letters "A" and "B" were presented randomly over 100
trials.
Odd-right: The same procedure as odd-left except right
and left hands were reversed for pressing the keys in
response to the two letters.
Off-target: The general procedure is the same as the first
E.S. Barratt et al
two tasks but with the addition of 17 unexpected stimuli
(letters other than "A" or "B") being presented randomly
along with the target and nontarget stimuli. The unex-
pected stimuli were presented in 10 percent of the trials
(0.1 nonresponse condition; 0.1NR), "B" in 10 percent of
the trials (0.1 response; 0.1R), and "A" in 80 percent of the
trials (0.8 condition). Letters were presented randomly
over 175 trials. Subjects used their dominant hand to
respond to the 0.1R condition stimuli and their nondomi-
nant hand to respond to the 0.8 condition stimuli.
RATIONALE FOR SELECTION AND ORDER OF PRESENTA-
TION OF COGNITIVE PSYCHOPHYSIOLOGICAL TASKS. The
three tasks were presented as three separate experiments.
Subjects were instructed to respond to 0.2, 0.8, and 0.1R
stimuli to provide a behavioral measure of alertness. They
were not instructed to "respond quickly." Past research
(Barratt 1993) indicated that impulsiveness is usually
inversely related to reaction times when there is a warning
signal prior to the imperative stimulus and subjects are
instructed to "respond quickly." Thus, it was expected that
the IAIs would have longer reaction times than the NIAIs
although probably not statistically significant different
latencies. It was also expected that both inmate groups
would have longer reaction times than the NICs.
Data Analyses
Personality and neuropsychology data were analyzed for
group differences using Kruskal-Wallis one-way analysis
of variance (ANOVAs) and the Wilcoxon signed ranks
test (Siegel and Castellan 1988). Performance errors were
analyzed using chi square (×2) for independent samples.
Within-task-group differences for ERPs and reaction times
(RTs) were analyzed using ANOVAs and Dunn's multiple
comparisons procedure (Bonferroni "t" procedure) where
appropriate (Kirk 1982). Multiple comparisons (e.g.,
group X electrode x task) were analyzed using repeated
measure ANOVAs with Greenhouse-Geisser corrections
for violations of the sphericity assumption and Bonferroni
multiple comparison tests if appropriate (Kirk 1982; Har-
ris 1994).
Electrode groupings for within-task analyses include: 1)
midline electrodes (Fz, Cz, Pz); 2) left vs right hemi-
sphere; 3) selected groupings to test specific hypotheses
(e.g., frontal F3-F4, temporal T3-T4). An ANOVA was
also computed for group differences among all electrodes.
Before analyzing the ERP data, the raw score peak
amplitudes and latencies were converted to normalized
scores using a procedure suggested by McCarthy and
Wood (1985). This involved determining, for example, the
maximum and minimum amplitudes for all electrodes
within electrode groups for each group of subjects and
Impulsive Aggression BIOLPSYCHIATRY 1051
1997;41:1045-1061

Table 1. Group Comparisons of Impulsiveness and Anger

Non-impulsive Impulsive aggressive
Noninmate controls aggressive inmates inmates

Test M SD M SD M SD

Barratt impulsiveness scale 32.6 12.2 48.0 11. I 51.9 11.3

NEO impulsiveness facet score 16.3 4.1 18.7 3.9 18.6 3.8
Anger in 16.5 4.3 21.4 4.8 20.2 4.2
Anger out 16.0 4.1 20.8 4.6 21.1 4.6
Anger control 22,6 5.2 17.4 4.2 16.0 4,3
Anger expression 27.0 5.9 41.3 6.2 39.1 6.9

Scores for noninmate controls were all significantly different (p -< 0.(X)5) from both groups of inmates for all tests. The scores for the two inmate groups did not differ
significantly from each other for any test (Kruskall-Wallis one way analysis of variance by ranks and the Wileoxon signed ranks test),

then using the formula suggested by McCarthy and Wood Neuropsychology and Reading Tests
(1985) for normalizing the amplitudes for all subjects. The two groups of inmates differed significantly from
This procedure permits topographical comparisons that each other on four of the five individual verbal skills
were not affected by the absolute voltage levels of the measures. This is in contrast to scores on visual-spatial
ERPs. The vector method (McCarthy and Wood 1985) subtests where there were no significant differences be-
was also used to normalize the amplitudes for midline
tween the two inmate groups. In general, the NICs scored
electrode analyses as a check on the method used here.
significantly better than both inmate groups on all of the
The results of the ANOVAs using the vector method to
neuropsychology tests including the verbal subtests. Pic-
normalize the midline electrode amplitudes did not differ
ture arrangement scores, a WAIS performance subtest that
significantly from the results using the procedure de-
is often considered a nonverbal counterpart of verbal
scribed above.
comprehension (Lezak 1983), were not significantly dif-
Neuropsychology, cognitive psychophysiology, and
ferent among the three groups. The WAIS verbal compre-
personality measures were intercorrelated using Pearson
hension subtest scores were also not significantly different
product moment correlation coefficients (Harris 1994).
between the two inmate groups (Table 2).
Differences between correlations were tested for signifi-
cance using the Fisher r-to-z' transformation (Kirk 1990).

Behavioral and Cognitive Psvchophysiological

Data Presentation
The main hypotheses involve comparing two inmate
groups who displayed two different types of aggression. A
noninmate control group was included to compare the
inmate-noninmate results of this study with reported
relationships between criminals and noncriminals (Raine
1993). Because of the extensive data analyses, all of the
results are not presented in detail for inmate-noninmate
analyses and for all of the insignificant differences be-
tween inmate groups for the cognitive psychophysiologi-
cal analyses. Rather, summary statements are included to
cover these selected analyses.
Results
Impulsiveness and Anger Self-Report Measures
Contrary to predictions, the anger and impulsiveness
scores did not differ significantly between the NIAIs and
Behavioral Measures
REACTION TIMES. There were no significant differ-
ences in reaction times between the two inmate groups and
between the NICs and NIAIs. The NICs and IAIs differed
significantly on reaction times in three conditions: 1)
odd-left 0.8 (Fz,99 =- 3.37, p < 0.05, Dunn's test with
alpha = 0.05); 2) odd-left, 0.2 (F2,99 = 4.02, p < 0.05;
Dunn's test with alpha = 0.05; 3) odd-right, 0.8 (F2,99 =
3.28, p < 0.05, Dunn's test with alpha = 0.05.
Although the differences in reaction times were in
general not significant between groups, the inmates had
longer latencies than the NICs in all instances. This latter
result is consistent with past research which reported
inverse relationships between impulsiveness and reaction
times, even though the subjects were not instructed to
respond quickly in the present experiment (Table 3).
P E R F O R M A N C E ERRORS. Performance errors included

the IAIs. The NICs scored significantly lower than both responding before a stimulus appeared, not responding
inmate groups on both anger and impulsiveness (Table 1). within 1000 ms, or responding to a letter other than "A" or
1052 BIOL PSYCHIATRY E.S. Barratt et al
1997;41:1045-1061

Table 2. Group Comparisons of Neuropsychology Test Scores

Inmates
Non-impulsive Noninmate Impulsive
aggressives controls aggressive Probability levels of differences between
(NIAI) (NIC) (IAI) groups~
Test M SD M SD M SD NIC vs NIAI NIC vsIAI NIAI vslAI
WAIS
Comprehension 10.61 2.55 8.41 3.19 6.33 2.56 <0.01 <0.01 NS
Similarities 12.39 2.60 10.76 2.07 9.11 2.61 <0.0l <0.01 0.01
Vocabulary 9.07 2.18 9.02 3.41 6.01 2.14 <0.01 <0.01 <0.05
Digit symbol 10.95 2.72 9.22 1.92 9.21 1.67 <0.01 <0.01 NS
Block design 11.60 1.99 9.91 3.00 9.56 2.85 <0.01 <0.01 NS
Picture arrangement 9.07 2.33 9.02 2.11 9.02 1.55 NS NS NS
VIQ (Prorated) 103.19 11.12 93.99 14.1 84.86 1(/.99 <0.01 <0.01 <0.01
PIQ (Prorated) 103.47 12.98 98.2 11.19 95.22 8.32 <0.05 <0.01 NS
WMS-R
Attention/concentration 94.81 16.00 87.66 l 3.04 83.74 18.49 NS <0.01 NS
Verbal memory 93.1 13.73 85.02 11.42 78.19 9.49 <0.01 <0.01 <0.05
Visual memory 102.88 18.16 95.99 13.69 89.41 17.24 NS <0.01 NS
GORT
Grade level 10.00 3.42 8.71 3.41 5.18 2,49 NS <0.01 <0.01
"Based on Kruskall-Wallisone way analysis of variance by ranks and the Wilcoxon signed ranks test.

" B " d u r i n g the o f f - t a r g e t task. T h e r e w e r e n o s i g n i f i c a n t o n d i f f e r e n c e s b e t w e e n the t w o i n m a t e g r o u p s as p r e v i -

d i f f e r e n c e s a m o n g g r o u p s in p e r f o r m a n c e errors ( T a b l e 4). o u s l y noted.

PEAK AMPLITUDES AND LATENCIES FOR N100, P200, P 3 0 0 PEAK LATENCIES. C o n t r a r y to p r e d i c t i o n s , t h e r e

N 2 0 0 , AND SLOW WAVE E R P s . There were no significant
g r o u p d i f f e r e n c e s in p e a k l a t e n c i e s or a m p l i t u d e s for
N 1 0 0 , P 2 0 0 , a n d N 2 0 0 E R P s for a n y task or p r o b a b i l i t y
c o n d i t i o n . T h e r e w e r e also n o s i g n i f i c a n t g r o u p differ-
e n c e s in o n s e t o f the s l o w w a v e c o m p o n e n t , h o w e v e r ,
t h e r e w e r e s i g n i f i c a n t d i f f e r e n c e s in a m p l i t u d e s o f the
slow w a v e c o m p o n e n t b e t w e e n the i n m a t e s a n d N I C s
d u r i n g the o d d - l e f t 0.2 a n d the o d d - r i g h t 0.2 c o n d i t i o n s at
s e l e c t e d e l e c t r o d e sites ( F i g u r e s 1, 2). T h e s e d i f f e r e n c e s
w e r e m o s t o b v i o u s in the p a r i e t a l leads (P3, P4, Pz) a n d
less so in c o n t i n g e n t a n t e r i o r areas (C3, Cz, C4). T h e
s i g n i f i c a n t d i f f e r e n c e s b e t w e e n i n m a t e s a n d N I C s a n d the
i n s i g n i f i c a n t results o n o t h e r t h a n P 3 0 0 p e a k E R P s are n o t
p r e s e n t e d in detail s i n c e the p r i m a r y f o c u s o f this s t u d y is
were no significant differences among the latencies of the
p e a k P 3 0 0 E R P s for a n y task or c o n d i t i o n ( F i g u r e s 1, 2, 3).
P 3 0 0 PEAK AMPLITUDES. There were no significant
d i f f e r e n c e s a m o n g g r o u p s in the P 3 0 0 p e a k a m p l i t u d e s for
the 0.8 c o n d i t i o n a c r o s s tasks. (F2.98 = 0.99). T h e r e w e r e
l i k e w i s e n o g r o u p d i f f e r e n c e s in p e a k P 3 0 0 a m p l i t u d e s
b e t w e e n h e m i s p h e r e s for l a t e r a l i z e d e l e c t r o d e c o n f i g u r a -
tions (F4, C4, P4, T4, T6, 0 2 v s F3, C3, P3, T3, T5, O 1 )
(F2,98 -- 0.02). T h e r e w a s a s i g n i f i c a n t p e a k P 3 0 0 a m p l i -
t u d e d i f f e r e n c e a m o n g g r o u p s for all e l e c t r o d e s (F2,88 =
3.46, p < 0.05 u s i n g D u n n ' s test w i t h p = 0.05; the t h r e e
g r o u p s w e r e s i g n i f i c a n t l y d i f f e r e n t f r o m e a c h o t h e r across
all e l e c t r o d e s ) ( F i g u r e s 1, 2, 3; T a b l e s 5, 6).

Table 3. Group Comparisons of Reaction Times (Milliseconds) by Task and Stimuli ~'t'

Odd-left Odd-right Off-target

0.8 0.2 0.8 0.2 0.8 0.1
M SD M SD M SD M SD M SD M SD
NICs 437 83 479 86 439 81 484 83 444 87 514 80
NIAIs 453 64 483 77 460 65 509 81 455 61 541 62
IAIs 480 63 505 73 469 59 512 63 470 71 549 88
~The NICs and IAls differed significantlyon the odd-left0.8 condition(F2.too = 3.37. p < 0.05). the odd-left0.2 condition(F2.11n~= 4.02, p < 0.05), and the odd-right
0.8 condition(F2.~oo = 3.28. p < 0.05). (Dunn's test with alpha = 0.05 was used for individualgroup comparisons).
Vl'here were no significantdifferences in reaction times between the NIAIs and NICs and the IAls and NIAIs.
Impulsive Aggression BIOLPSYCHIATRY 1053
1997:41:1045-1061

Table 4. Performance Errors: Group Comparisons ~'b

Odd-left Odd-right Off-target

0.8 0.2 0.8 0.2 0.8 0.1

NICs 0.3 1.0 0.1 1.0 1.0 1,0

NIAIs 0.4 2.0 0.3 2.0 0.3 2,0
IAls 1.0 2.0 3.0 3.0 1.0 2,0

~Errors are expressed as percentages based on total number of trials per group
for task and stimulus conditions•
bThere were no significant group differences (Xe [10] = 2.13).

Figure 3. Group comparisons of P300 super averages for offtar-

TASK × GROUP × E L E C T R O D E MIDLINE P 3 0 0 AMPLI-
TUDES. There was a significant task-by-group-by-elec-
trode interaction in P300 peak amplitudes for the midline
electrodes (Fz, Cz, Pz) (F8,336 = 5.21, p = 0.0001, e --
0.7437). This difference was primarily related to differ-
ences in the amplitudes of the NIAIs across tasks for the
Cz and Pz electrodes (Figs. 1, 2, 3; Table 5). For the
odd-left and off-target task, the NIAIs had significantly
higher peak P300 amplitudes than the IAIs at electrodes
Cz and Pz. During the odd-fight task, there was no
significant difference between the NIAIs and IAIs at any
.......... ~
3 . . . . I~s
Figure 1. Group comparisons of P300 super averages for oddleft
0.2 probability conditions. S = stimulus; NICs = noninmate
controls; NIAIs = nonimpulsive aggressive inmates; IAIs =
impulsive aggressive inmates.
get 0.1R probability condition. S = stimulus; NICs = noninmate
controls; NIAIs = nonimpulsive aggressive inmates; IAIs =
impulsive aggressive inmates.
electrode site and both inmate groups had significantly
lower amplitude P300 amplitudes than the NICs.
GROUP × TASK × CONDITION (0.2/0.1R) COMPARISONS
OF P300 AMPLITUDES. Peak P300 amplitudes for 0.2 and
0.1R conditions were also compared for pairs of lateral
homologous electrodes from anterior to posterior scalp
locations (Table 6). The NICs had significantly higher
peak amplitudes than both inmate groups at frontal elec-
trode sites for all three tasks. Contrary to predictions, the
two inmate groups did not differ significantly from each
other in peak frontal amplitudes. The IAIs when compared
with NIAIs and NICs had significantly lower P300 peak
amplitudes at all sites posterior to the frontal areas for the
odd-left 0.2 condition. For the odd-fight task, the NICs had
significantly higher peak P300 amplitudes than both in-
mate groups at all electrode sites except T3, T4, T5, T6,
~ I~.~ • and O 1. The IAIs and NIAIs did not differ significantly in
ll~0ms
s
peak amplitudes on the odd-fight task. The differences in
peak P300 amplitudes among groups for the 0.1R condi-
tion during the off-target task were similar to the 0.2
condition for the odd-left task except that there were no
significant differences among groups for electrodes C4
and O 1.

INTERRELATIONSHIPS OF SELECTED PERSONALITY,

NEUROPSYCHOLOGICAL, AND COGNITIVE PSYCHOPHYSIO-
LOGICAL MEASURES ACROSS TASKS FOR COMBINED
GROUPS. The main purpose of these analyses was to get
a global overview of the interrelationships among selected
neuropsychology-personality measures and midline P300
amplitudes. Measures were selected that were relevant to
the main hypotheses.
3 . . . . l~s
Impulsiveness and anger were significantly intercorre-
lated (Table 7) consistent with past research (Barratt et al
Figure 2. Group comparisons of P300 super averages for odd-
right 0.2 probability condition. S = stimulus; NICs = noninmate 1995a). Items on self-report anger scales often include
controls; NIAIs = nonimpulsive aggressive inmates; IAIs = "control" implications and therefore correlate significantly
impulsive aggressive inmates. with impulsiveness measures.
1054 BIOLPSYCHIATRY E.S. Barratt et al
1997;41:1045-1061

Table 5. Peak P300 Amplitudes across Groups, Conditions, and Tasks

Odd-left Odd-right Off-target

N1Cs NIAIs 1Als NICs NIAIs IAls NICs NIAIs IAls

0.8 0.2 0.8 0.2 0.8 0.2 0.8 0.2 0.8 0.2 0.8 0.2 0.8 0.1 0.8 0.1 0.8 0.1

F3 5.9 10.7 3.3 8.9 4.9 6.4 5.1 8.9 4.6 4.9 5,0 5.4 5.1 8.3 3.1 6.0 4.0 5.0
Fz 6.7 10,5 3.4 7.2 5.3 6.1 5.3 9.9 5.3 6.7 5.1 6.6 5.3 9. l 3.1 5.4 4.4 4.8
F4 8.0 13,4 4.7 6.3 5.3 5.2 6.0 10.2 4.7 6.7 5,2 6.9 6.3 7.5 4.5 5.3 5.6 5.3
T3 4.9 6.9 3.5 6.5 3.1 4.1 4.7 6.0 3.0 4.5 3.6 4.8 4.7 5.4 2.9 4.5 3.6 3.0
C3 7.5 11,9 4.4 9.9 5.1 6.5 7.8 10.9 5.6 8.5 5.7 6.3 6.8 9.9 4.7 8.9 5.3 5.7
Cz 8.(1 11.1 5.0 9.6 5.3 6.2 8.5 13,4 4.4 7.7 4.9 7.4 5.7 9.1 4.0 8.9 5.0 5.6
C4 7,6 9.9 6.1 8.6 5.6 6.7 7.2 13.7 5.0 8.0 4.8 7.5 8.2 8.6 5.2 7.8 6.0 5.4
T4 4.4 6,3 3.4 4.0 3.4 4.0 1.8 4.9 3.2 3.4 4.0 4.8 5.4 5.6 4.4 5.4 4.3 5.4
T5 5.4 7.8 4.5 7.7 3.4 3.6 5.2 8.4 4.1 6.9 3.3 5.0 5.5 5.9 4.1 5.8 3.2 3.1
P3 8.1 13.6 6.3 12.3 5.3 7.3 8.6 13,4 6.7 9.8 5.7 8.2 8.4 10.5 6.0 9.3 5.8 6.0
Pz 9.8 14.1 6.5 10.8 5.7 7.2 11.1 14.7 7.2 9.5 6.3 8.5 9.5 11.0 5.9 9.8 6.0 6.5
P4 8.1 11.4 6.1 10.2 5.8 7.2 10.3 13.4 6.4 9.9 5.6 7.9 8.7 10.4 5.6 9.6 5.l 6.1
T6 4.1 7.1 3.6 6.6 2.9 4.1 5.2 7.2 3.3 5.0 4.1 4.6 4.9 6.1 3.4 5,9 2.5 3.7
O1 4.4 7.4 3.8 7.0 3.1 3.7 3.6 7.3 4.3 6.1 3.4 4.7 5.1 5.4 3. t 5,2 2.4 2.7
02 7.8 12.1 6.9 10.1 4.5 5.9 6.7 11.6 5.4 9.6 4.5 6.6 8.3 9.5 7.1 7,1 3.1 3.4

Both impulsiveness and anger were inversely related to
the neuropsychology measures with impulsiveness (and
not anger) correlations being significant (Table 7). Impul-
siveness was correlated significantly higher with VIQ than
with the other neuropsychology tests. The V1Q had the
highest average correlation among the intercorrelations of
the neuropsychology tests with an especially high corre-
lation with the GORT.
Consistent with the relationship of the personality mea-
sures with the neuropsychology measures, impulsiveness
and anger were negatively related to P300 amplitudes
while the neuropsychology measures were positively re-
lated (Table 8). The correlations of the personality-
neuropsychology measures with the P300 amplitudes var-
ied across tasks. During the odd-left task, the BIS had a
significantly higher negative correlation with the P300
amplitude at Fz than at Pz. The reverse was true for the
VIQ and GORT measures with the Pz P300 amplitude
correlation being significantly higher at Pz than at Fz.
During the odd-fight task, the correlations of BIS, VIQ,
and GORT with P300 amplitudes at each of the midline
electrodes were not significantly different, although they

Table 6. P300 Peak Amplitude Differences across Groups and Tasks for the 0.2 and 0.1R Probability Conditions for Selected
Electrode Configurations
Odd-left Odd-right Off-target
(0.2 Condition) (0.2 Condition) (0.1R Condition)

Electrode ANOVAs F2.9~ Individual electrodes ANOVAs F2.9,~ Individual electrodes ANOVAs F2,99 Individual electrodes
configuration Ip) (Group differences) "'h IT) /Group differences)"J' (p) (Group differences) ~'t'
Fz, Cz, Pz 4.61 Fz 1>2,3 7.90 Fz 1>2,3 4.01 Fz 1>2,3
(<0.05) Cz 3 < 1,2 (dO.() 11 Cz 1> 2,3 ( <(I.05 ) Cz 3<1,2
Pz 3< 12 Pz 1>2,3 Pz 3<1,2

F3, F4 6.21 F3 I >2,3 5.65 F3 1>2,3 5.60 F3 1>2,3

(<0.01) F4 1>2,3 ( <0.01 ) F4 1>2,3 (<0,01) F4 1>2,3
C4, C3 6.94 C4 3< 1,2 7.92 C4 I >2,3 8,25 C3 3<1,2
1<0.01 ) C3 3< 1,2 (<0.(11) C3 I >2,3 (<0,01)
P4, P3 5.00 P4 3< 1,2 5.01 P4 l >2,3 6,30 P4 3<1,2
(<0.01) P3 3< 1,2 /<0.01 ) P3 1>2,3 (<0.01) P3 3<1,2
T3, T4 1.09 1.06 1.02
(NS/ (NSi (NS)

T5, T6 3.27 T5 3< 1,2 2.82 2.83

(<0.05) T6 3< 1,2 iNS) (NS)
O1, 02 7.19 Ol 3< 1,2 3.91 02 3< 1,2 3.49 02 3<1,2
(<0.01 ) 02 3< 1,2 (<0.05) (<0.05)

"Group I = noninmate controls (NICs); Group 2 = nonimpulsive aggressive inmates IN1Als): Group 3 = impulsive aggressive inmates (lAls).
~'Dunn's test with alpha = 0.05 was used for individual group comparisons.
Impulsive Aggression BIOLPSYCHIATRY 1055
1997-41:1045-1061

Table 7. Intercorrelations of Personality, Neuropsychology and Reading Tests for Combined Groups"
BIS ANG VIQ PIQ Verbal mem Visual mem GORT

Barratt impulsiveness scale (BIS)

Anger out (ANG) 0.51 --
V1Q (prorated) -0.52 -0.19 I

PIQ (prorated) -0.33 - 0.10 0.54

WMS-R verbal memory (Verb Mere) -0.29 -0.14 0.43 0.24 --
WMS-R visual memory (Vis Mem) -0.33 ,0.13 0.50 0.56 0.35 --
Gray oral reading test (GORT) -0.35 -0.19 0.67 0.40 0.42 0.47

~n = 100; r.o~ = 0.25.

were significantly different from zero (Table 8). Also, the
positive-negative pattern of the correlations was the same
as during the odd-left task.
During the off-target task, the anterior-posterior gradi-
ent of the BIS correlations with the midline electrodes was
the same as during the odd-left task (Table 8), however,
the VIQ and GORT correlations did not differ signifi-
cantly across electrodes as they had during the odd-left
task, although these correlations were also significantly
different from zero.
Discussion
Impulsiveness and Anger
The IAIs did not score significantly higher than the NIAIs
on self-report measures of impulsiveness and anger as had
been predicted. There are several possible explanations for
this. First, the self-report measures of anger and impul-
siveness may not discriminate among subjects who have
very high levels of both traits (Barratt et al 1995a). These
measures do discriminate between persons with high and
low trait scores as evidenced by the NICs scoring signif-
icantly lower than both inmate groups as was expected.
A second and probably more plausible explanation
relates to both inmate groups meeting the criteria for an
antisocial personality disorder. Impulsiveness and irrita-
bility (anger) are both potential criteria for an antisocial
personality disorder (American Psychiatric Association
1994). It would be expected that two groups with this
disorder would not differ significantly on impulsiveness
and anger, especially impulsiveness.
Neuropsychology/Reading
In general, the IAIs scored significantly lower than the
NIAIs on verbal skill tests as predicted. The one exception
was the WAIS comprehension subtest score that was not
significantly different between the two inmate groups.
Related to this finding, there were no significant differ-
ences among the three groups on the WAIS picture
arrangement subtest, a test that is considered to be a
nonverbal counterpart of the comprehension subtest. Thus,
all three groups are not different in the ability to compre-
hend using nonverbal symbols, the NICs comprehend
significantly better than both inmate groups using verbal
symbols, and the two inmate groups do not differ on verbal
comprehension. The items on the WAIS comprehension
subtest provide a context, often social, for the responses.
Words per se may not be understood but often can be
interpreted within the context of the overall text for the
item. This is in contrast to the verbal tests that were
significantly different between the inmate groups that
either did not provide a context for interpreting words per
se (WAIS similarities and vocabulary subtests; WMS-R
verbal memory subtest) or were scored for errors in the

Table 8. Personality, Neuropsychology and Reading Related to Midline P300 Amplitudes (0.2 and 0.1R Conditions) across Tasks
for Combined Groups
Odd-left~ Odd-fight" Off-target"

Fz Cz Pz Fz Cz Pz Fz Cz Pz

Barratt impulsiveness scale (BIS) -0.44 -0.34 -0.27 -0.31 -0.41 -0.41 -0.37 -0.30 -0.21
Anger out (ANG) -0.31 -0.22 -0.17 -0.21 -0.20 -0.24 -0.22 -0.16 --0.07
WAIS VIQ (prorated) 0.28 0.35 0.46 0.28 0.40 0.42 0.36 0.40 0.34
WAIS PIQ (prorated) 0.24 0.23 0.29 0.17 0.18 0.22 0.30 0.28 0.30
WMS-R verbal memory (Verb Mem) 0.24 0.35 0.36 0.36 0.37 0.30 0.27 0.30 0.18
WMS-R visual memory (Vis Mem) 0.15 0.22 0.25 0.16 0.26 0.19 0.33 0.35 0.26
Gray oral reading test (GORT) 0.20 0.26 0.37 (/.23 0.37 0.34 0.40 0.42 0.35

aStimulus probability - 0.2. hStimulus probability = 0.1.

n - 98; rm = 0.25.
A difference of 0.16 between correlations is significant using the Fisher r-to-z transformation.
1056 BIOLPSYCHIATRY
1997;41 : 1045-1061
"mechanics" of reading (GORT; scored for word omis-
sions, mispronunciations, obvious letter reversals, etc.).
Errors on these latter subtests are more likely to be related
to decoding problems in reading than to the ability to
comprehend or understand. Although the two inmate
groups differed significantly on WMS-R verbal memory,
there was no significant difference between them on the
WMS-R visual memory. Thus, the differences between
NIAIs and IAIs are not attributable to memory differences
per se.
A distinction is often made between reading compre-
hension and reading problems related to the grapheme-
phoneme linkage (decoding) in reading (Gaddes 1980;
Njiokiktjien 1993). Many persons who do not read well
because of decoding problems can comprehend well.
These decoding problems in reading are usually labeled
developmental dyslexia. The GORT is a reading test that
is scored primarily for decoding errors. The NICs and
NIAIs did not differ significantly on the GORT but the
IAIs scored significantly lower than both NICs and NIAIs
on this test.
In summary, the neuropsychology/reading data suggest
that the two inmate groups differ significantly on deficits
involving a particular type of verbal information process-
ing, namely, developmental dyslexia (Duncan et al 1994).
They do not differ in the ability to comprehend except as
decoding of the reading symbols enters directly into verbal
information processing related to comprehension and/or
no context is present for interpreting single words. Mem-
ory per se and attention-concentration do not appear to be
related significantly to the verbal skill differences between
the two groups.
Cognitive Psychophysiology
Significant group differences in ERPs were present only
for the peak P300 amplitudes for the 0.2/0.1R stimulus
conditions. The relationships between the P300 amplitudes
for the NICs and IAIs were relatively constant across tasks
with higher amplitudes for the NICs suggesting a greater
neural involvement in the processing of the 0.2/0.1R
stimuli. The peak P300 amplitudes for the 0.2/0.1R con-
ditions for the NIAIs varied across tasks with their ERPs
showing higher amplitudes during the odd-left and off-
target task and lower amplitudes during the odd-right task.
Contrary to predictions, there were no significant P300
peak amplitude differences between IAIs and NIAIs in
frontal electrodes. This result is consistent with a lack of a
significant difference in impulsiveness between the two
inmate groups since frontal lobe dysfunctioning has been
implicated in impulsiveness (Barratt 1987, 1993; Stein et
al 1995).
There were group differences between the NIAIs and
E.S. Barratt et al
IAIs in the topography of the peak P300 amplitudes in
electrodes posterior to the frontal areas. These differences
varied with tasks and involved the aforementioned differ-
ences in the P300 peak amplitudes for the NIAIs across
electrodes and tasks. During the odd-left task, the IAIs
compared to NIAIs had significantly lower P300 peak
amplitudes posterior to frontal leads in the midline, bilat-
eral sensory-motor strip (C3, C4), bilateral posterior tem-
poral leads (T5, T6), and the striate cortex (O1, 02).
Except for the difference at electrode 02, the differences
between NIAIs and IAIs were not present during the
odd-right task. During the off-target task, the differences
in P300 peak amplitudes between IAIs and NIAIs were
similar to the differences recorded during the odd-left task
except for electrodes T5, T6, and O1. The pattern of
differences in P300 peak amplitudes between the NIAIs
and IAIs during the odd-left and off-target task were more
in line with predicted differences than those recorded
during the odd-right task. It is not clear why the P300 peak
amplitudes for the NIAIs would vary across tasks while
the amplitudes for the other two groups remained rela-
tively stable. The off-target task differs in stimuli pre-
sented and total number of trials from the odd-right and
odd-left tasks. The odd-right and odd-left tasks are similar
in stimuli presented. It may be that NIAls and NICs were
more aroused to relatively new task demands than were
the IAIs but the NIAIs did not maintain arousal as high as
the NICs when tasks become redundant. Thus, the odd-left
task was presented first and was "something different," the
odd-right task redundant, and the off-target task was again
"different." From the viewpoint of arousal, the NIAIs were
less aroused for the odd-right than odd-left task while they
were rearoused for the off-target task. In contrast, the level
of arousal for the IAIs remained relatively low across tasks
and remained relatively high for the NICs for all three
tasks. These results suggest that arousability (Zuckerman
1983, 1991) varies among the three groups which could
lead to selective attention differences among the groups
although the WMS-R attention/concentration scores were
not significantly different between IAIs and NIAIs. Barratt
(1987) and Barratt and Patton (1983) reported that persons
with high levels of impulsiveness have different threshold
levels for arousability. Persons with high levels of trait
impulsiveness in comparison to persons with average or
low levels often do not respond to less intense levels of
stimulation or to changes in stimuli. This finding can be
misinterpreted as persons with high impulsivity not being
able to respond to changes in stimuli. As Barratt and
Patton (1983) report, persons with high impulsivity can
respond to stimuli which are of interest to them. For
example, male subjects with high levels of impulsiveness
responded physiologically to sexually provocative pictures
although they did not respond to tones or randomly
Impulsive Aggression
designed visual shapes in a laboratory setting. Thus,
although the NIAIs and IAIs did not score significantly
different on self-report impulsiveness measures and on the
WMS-R attention/concentration subtest in this study, the
NIAIs in comparison to IAIs may have a lower arousabil-
ity threshold for responding to new or different stimuli in
terms of the global stimulus probability context described
by Johnson (1993). As noted, the IAIs can probably be
aroused to positively or negatively cathected stimuli which
would explain their getting agitated and becoming aggres-
sive in selected situations. Polich and Kok (1995) re-
viewed the potential role of arousal as a "unifying theo-
retical mechanism" in interpreting the bases of P300
amplitude and latency differences. They noted that "it is
not unreasonable to conclude that arousal level does affect
the P300 component in various task situations" (p 136).
The topographical differences in P300 amplitudes be-
tween IAIs and NIAIs involved primarily the posterior
temporal lobe, the parietal lobes, the sensori-motor strip,
and the striate cortex. These areas have all been implicated
in verbal information processing, especially in reading
(Rosen et al 1993; Njiokiktjien 1993; Caplan 1993). The
differences in P300 amplitudes in the parietal-occipital
areas would be especially important in decoding of verbal
symbols (LaBerge 1995) and dysfunctioning in these areas
would be consistent with the suggestion of dyslexia in
IAIs. These cortical areas have a rich multisensory input
from the pulvinar (LaBerge 1995) and could be related to
the grapheme-phoneme linkage problems often seen in
dyslexia (Njiokiktjien 1993).
Temporal information processing involved in timing
and rhythm behaviors are also related to sensory-motor
and parietal-occipital cortical areas (Merzenich et al
1993; Brooks 1986). Reading has been related to temporal
information processing (Tallal et al 1993) and Stanford
and Barratt (in press) have shown that impulsiveness,
verbal skills, and continuous performance task measures
define a second-order temporal information processing
task. It is possible that a cluster of symptoms which
include antisocial behaviors, impulsiveness, poor reading
skills, and aggressive behaviors may be related in part to
brain dysfunctioning related to temporal information pro-
cessing.
Personality, Neuropsychology, and Cognitive
Psychophysiological Measures Interrelated
Impulsiveness and neuropsychology tests were inversely
correlated (Table 7). Further, impulsiveness was inversely
related to midline P300 amplitudes while the neuropsy-
chology tests were positively related (Table 8). Both
impulsiveness and verbal tasks (e.g., VIQ and GORT)
BIOLPSYCHIATRY 1057
1997;41:1045-1061
were significantly related in general to the P300 ampli-
tudes across all tasks, however, the degree of relationship
between impulsiveness/verbal tests and midline P300
amplitudes varied across tasks. During the odd-left and
off-target tasks, impulsiveness was more significantly
related to frontal than parietal P300 amplitudes with no
differences during the odd-right task. VIQ and GORT
were more highly related to parietal lobe than frontal
activity during the odd-left task but not during the other
two tasks. To the extent that arousal is related to P300
amplitudes as discussed earlier, these different patterns of
relationships of impulsiveness and verbal skills to P300
amplitudes would suggest that at least two arousal (or
arousability) systems are involved in determining these
relationships.
A number of authors have suggested that there are two
or more arousal systems that influence cortical activity
(Broadbent 1971; Eysenck 1982; Routtenberg 1968;
Polich and Kok 1995; Zuckerman 1991), although the
exact descriptions of the systems vary. Barratt (1985) and
(Barratt and Patton (1983) have implicated the reticular
activating system as the basis for arousal related to
impulsiveness. This would be a general nonspecific type
of arousal and that which Eysenck (1982) refers to as
passive arousal or natural arousal in Polich and Kok's
(1995) classification. Verbal discrimination tasks are more
related to specific arousal systems (Eysenck 1982) or
environmental arousal (Polich and Kok 1995). Polich and
Kok (1995) note that " . . . the connection between the
P300 component and its underlying neurophysiological
mechanism(s) is not yet clear, so that a direct association
between arousal and ERPs may be difficult to demonstrate
because the former typically reflects tonic changes while
the latter are phasic in origin" (p 133). In the present study,
it appears that different arousal systems are involved with
impulsiveness and verbal skills but the exact brain loci or
processes for the two systems are not obvious from these
data.
One theoretical interpretation of P300 amplitude is that
it relates to working or immediate memory in updating the
mental model of the stimulus environment (Polich and
Kok 1995; Donchin 1981). In the present study, verbal and
visual immediate memory performance were not compa-
rably related to midline P300 amplitudes. Verbal memory
had a higher average relationship with the P300 ampli-
tudes, especially during the odd-left and odd-right tasks. In
contrast, visual memory had a higher relationship with
P300 amplitudes during the off-target task. These results
would indicate that immediate or working memory tasks
are not related to P300 amplitudes in the same way and
would suggest a modification of the memory/context
updating theory.
1058 BIOLPSYCHIATRY
1997:41:1045-1061
Impulsive vs Non-impulsive Aggression
Both the IAIs and NIAIs had higher levels of anger and
impulsiveness than NICs and satisfied the criteria for an
antisocial personality disorder. There were significant
differences between the IAIs and NIAIs in verbal skills
consistent with developmental dyslexia (Duncan et al
1994; Siegel 1994). The NIAIs and IAIs also differed in
the functioning of selected central and posterior cortical
areas with the IAIs having fewer neural resources involved
in processing the visual stimuli which were presented at
different probability levels. The differences between the
NIAIs and IAIs in brain activity suggested that the NIAIs
responded to new or novel situations with arousal levels
that were different than the IAIs. The NIAIs' ERPs
suggested arousability (or arousal) levels more sensitive to
new or different stimuli in comparison to IAIs but the
ERPs for the NIAIs also varied across tasks with lower
amplitudes during a redundant task (odd-right). To the
extent that arousal is a valid explanation for changes in the
P300 amplitudes, it appears, as noted above, that different
cortical areas have different levels of arousability or there
are different arousal systems involved in the functioning
of frontal and parietal lobes related to impulsiveness and
verbal skills. Impulsiveness and verbal skills are inversely
related as reported by Stanford and Barratt (in press) and,
further, both of these measures are significantly related to
P300 amplitudes, although in opposite directions and with
different topographical patterns in the relationships. The
data suggest that "arousability" related to performance on
sequential tasks may vary in cortical areas as a function of
task demands. Further research is needed to clarify the
effects of arousal or arousability on cortical functioning
related to the role of impulsiveness/verbal skills in impul-
sive aggression.
Both inmate groups in comparison to NICs had higher
levels of anger and impulsiveness, poorer performance on
most neuropsychology tests including the verbal tests, and
less neural involvement in frontal cortical areas as well as
selected other areas. These results are typical of past
research on the etiology of becoming a criminal (Raine
1993). Impulsive aggression is related to neuropsycholog-
ical and cognitive psychophysiological measures of infor-
mation processing beyond those which are related to
becoming a criminal. The inability to decode verbal
symbols well in reading (dyslexia) may be related to
differences in the functioning of selected cortical areas
that in combination with frontal lobe differences are
related to being impulsively aggressive. Frontal lobe
dysfunctioning and high levels of anger and impulsiveness
may be necessary for impulsive aggression but are not
sufficient.
The differences between NIAIs and IAIs can be ex-
E.S. Barratt et al
plained by two alternative explanations based on brain
circuitry: 1) brain circuitry related to arousability to new
situations is at a higher threshold for the IAIs than NIAIs
and arousal may affect cortical areas differently; 2) brain
circuitry involved with decoding verbal symbols (graph-
eme/phoneme linkage) does not function as efficiently
among IAIs as NIAIs beyond arousal influences. Both
inmate groups had poorer verbal skills and suggested
lower levels of arousability in frontal lobe functioning
than the NICs that could have led to their becoming
criminals. The consistently lower threshold of arousability
along with developmental deficits in brain maturation in
more posterior cortical areas among the IAIs in compari-
son to NIAIs could have led to stressful life experiences
that fostered the development of impulsive aggression.
From a developmental viewpoint, it is highly probable
that the reading deficits present in the impulsive aggres-
sive inmates were there from the beginning of their school
experiences. The inability to easily discriminate visual
information in social situations could have led to their
being frustrated and to impulsive aggressive acts. This
conclusion would be consistent with the studies of Dodge
and colleagues who showed that aggressive children when
compared to nonaggressive children used fewer environ-
mental cues to mediate behavior (Dodge and Newman
1981), interpreted the behavior of peers as more hostile
(Dodge 1980), and were less capable at generating poten-
tial responses to conflict situations (Richard and Dodge
1982).
Verbal skill deficits could influence impulsive aggres-
sive behavior psychosocially in other ways. For example,
the incorporation of mores and laws into memory to guide
social behavior could be impaired (Chandler and Moran
1990). Further, covert "stop-orders" for overt behavior are
often verbal and a deficit in verbal skills could limit this
inhibitory process (Camp 1977; Camp et al 1977; Berk
and Potts 1991). The two inmate groups did not differ in
general in their ability to reason but the IAIs showed a
decreased ability in information processing related to
decoding words. Learned aggressive behaviors could re-
sult from the frustrations related to these verbal skill
deficits in everyday situations, especially in early school
experiences (Hirschi 1969; Berkowitz 1974).
In summary, this study has shown that aggression is not
a homogeneous construct, even among antisocial persons.
Impulsiveness and verbal skills were inversely correlated.
Both inmate groups scored significantly higher than the
noninmate controls on impulsiveness. Verbal skills but not
impulsiveness were significantly different between the
aggressive and nonimpulsive aggressive inmates. Differ-
ent arousal systems appear to be related to impulsiveness
and verbal skill measures. Developmental deficits in
cortical areas involved with the mechanics of reading (e.g.,
Impulsive Aggression
grapheme/phoneme linkage) could result in stressors (e.g.,
poor academic performance) that influence everyday life
adjustments. Thus, it is concluded that the developmental
deficits in selected verbal skills interacting with differ-
ences in arousability thresholds result in a tendency to be
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