Resting-state functional connectivity in combat veterans suffering from impulsive aggression

Impulsive aggression is common among military personnel after deployment and may arise because of impaired top-down regulation of the amygdala by prefrontal regions.This study sought to further explore this hypothesis via resting-state functional connectivity analyses in impulsively aggressive combat veterans. Male combat veterans with (n¼28) and without (n¼30) impulsive aggression problems underwent resting-state functional magnetic resonance imaging. Functional connectivity analyses were conducted with the following seed-regions: basolateral amygdala (BLA), centromedial amygdala, anterior cingulate cortex (ACC), and anterior insular cortex (AIC). Regions-of-interest analyses focused on the orbitofrontal cortex and periaqueductal gray, and yielded no significant results. In exploratory cluster analyses, we observed reduced functional connectivity between the (bilateral) BLA and left dorsolateral prefrontal cortex in the impulsive aggression group, relative to combat controls. This finding indicates that combat-related impulsive aggression may be marked by weakened functional connectivity between the amygdala and prefrontal regions, already in the absence of explicit emotional stimuli. Group differences in functional connectivity were also observed between the (bilateral) ACC and left cuneus, which may be related to heightened vigilance to potentially threatening visual cues, as well as between the left AIC and right temporal pole, possibly related to negative memory association in impulsive aggression

Voxel-based morphometry and cortical thickness in combat veterans suffering from impulsive aggression

BACKGROUND: Problems with impulsive aggression occur in many forms of psychiatric dysfunction, and are a common complaint among combat veterans. The present study sought to examine the neuroanatomical correlates of combat-related impulsive aggression. METHODS: T1-weighted magnetic resonance images were acquired from 29 male veterans with impulsive aggression and 30 non-aggressive combat controls. Subcortical volumetry was conducted with the amygdala and hippocampus and their main constituent subdivisions as regions-of-interest (ROIs) (basolateral, centromedial amygdala; head, body, tail of hippocampus). Cortical thickness measurements were extracted for the dorsolateral prefrontal cortex, orbitofrontal cortex, and anterior cingulate cortex. Within-group correlations with psychometric measures were also explored. RESULTS: No significant group differences in cortical thickness or subcortical grey matter volumes were observed for any of the ROIs. Also, no significant correlations with any of the psychometric measures were recorded. Exploratory whole-brain analysis of cortical thickness revealed a significant group × anxiety interaction effect in a cluster located in the left lingual gyrus. CONCLUSIONS: The current findings indicate that problems with impulsive aggression may not be directly associated with alterations in cortical thickness or amygdalar/hippocampal (sub)volumes. The observed interplay between impulsive aggression problems and anxiety-related symptoms is consistent with prior work showing the two phenomena may share the same underlying (neural) mechanisms

Regions of white matter abnormalities in the arcuate fasciculus in veterans with anger and aggression problems

Aggression after military deployment is a common occurrence in veterans. Neurobiological research has shown that aggression is associated with a dysfunction in a network connecting brain regions implicated in threat processing and emotion regulation. However, aggression may also be related to deficits in networks underlying communication and social cognition. The uncinate and arcuate fasciculi are integral to these networks, thus studying potential abnormalities in these white matter connections can further our understanding of anger and aggression problems in military veterans. Here, we use diffusion tensor imaging tractography to investigate white matter microstructural properties of the uncinate fasciculus and the arcuate fasciculus in veterans with and without anger and aggression problems. A control tract, the parahippocampal cingulum was also included in the analyses. More specifically, fractional anisotropy (FA) estimates are derived along the trajectory from all fiber pathways and compared between both groups. No between-group FA differences are observed for the uncinate fasciculus and the cingulum, however parts of the arcuate fasciculus show a significantly lower FA in the group of veterans with aggression and anger problems. Our data suggest that abnormalities in arcuate fasciculus white matter connectivity that are related to self-regulation may play an important role in the etiology of anger and aggression in military veterans

Longitudinal measures of hostility in deployed military personnel

Increases in anger and hostility are commonly found after military deployment. However, it is unknown how anger and hostility develop over time, and which veterans are more at risk for developing these complaints. Data of 745 veterans one month before deployment to Afghanistan and one, six, twelve and 24 months after deployment were analyzed in a growth model. Growth mixture modeling revealed four classes based on their growth in hostility. Most of the participants belonged to a low-hostile group or a mild-hostile group that remained stable over time. Two smaller groups were identified that displayed increase in hostility ratings after deployment. The first showed an immediate increase after deployment. The second showed a delayed increase between twelve and 24 months after deployment. No groups were identified that displayed a decrease of hostility symptoms over time. Multinomial logistic regression was applied to predict group membership by age, education, early trauma, deployment stressors and personality factors. This study gains more insight into the course of hostility over time, and identifies risk factors for the progression of hostility

Proximity alert! Distance related cuneus activation in military veterans with anger and aggression problems

Problems involving anger and aggression are common after military deployment, and may involve abnormal responses to threat. This study therefore investigated effects on neural activation related to threat and escapability among veterans with deployment experience. Twenty-seven male veterans with anger and aggression problems (Anger group) and 30 Control veterans performed a virtual predator-task during fMRI measurement. In this task, threat and proximity were manipulated. The distance of cues determined their possibility for escape. Cues signaled impending attack by zooming in towards the participant. If Threat cues, but not Safe cues, reached the participants without being halted by a button press, an aversive noise (105 dB scream) was presented. In both the Threat and the Safe condition, closer proximity of the virtual predator resulted in stronger activation in the cuneus in the Anger versus Control group. The results suggest that anger and aggression problems are related to a generalized sensitivity to proximity rather than preparatory processes related to task-contingent aversive stimuli. Anger and aggression problems in natural, dynamically changing environments may be related to an overall heightened vigilance, which is non-adaptively driven by proximity

Anger and aggression problems in veterans are associated with an increased acoustic startle reflex

Anger and aggression are frequent problems in deployed military personnel. A lowered threshold of perceiving and responding to threat can trigger impulsive aggression. This can be indicated by an exaggerated startle response. Fifty-two veterans with anger and aggression problems (Anger group) and 50 control veterans were tested using a startle experiment with 10 startle probes and 10 prepulse trials, presented in a random order and with a random interval between the trials. Predictors (demographics, Trait Anger, State Anger, Harm Avoidance and Anxious Arousal) for the startle response within the Anger group were tested. Increased EMG responses were found to the startle probes in the Anger Group compared to the Control group, but not to the prepulse trials. Furthermore, Harm Avoidance and State Anger predicted the increased startle reflex within the Anger group, whereas Trait Anger was negatively related to the startle reflex. These findings indicate that threat reactivity is increased in anger and aggression problems. These problems are not only caused by an anxious predisposition, the degree of anger also predicts the startle reflex