Cerebellar roots of aggression in violent psychopathic offenders: evidence from structural neuroimaging studies

Investigations of structural brain abnormalities in antisocial personality disorder and psychopathy associated with aggression have focused on prefrontal, limbic, and paralimbic regions. In this narrative review, a series of structural neuroanatomical studies are discussed, which points toward an important role of the cerebellum in antisocial and aggressive behavior. Across the reviewed studies, volumetric reduction of the vermis and right posterior cerebellum was a consistent finding in violent psychopathic offenders. The observations agree with results in healthy volunteers, which show that volumes of the vermis and right cerebellar hemisphere are correlated with impulsivity and aggressive behavior. Deviations in cerebellar volumes in violent psychopathic offenders are proposed to be part of a deficient neural circuit implicated in emotion regulation and executive functions.