TASK 2: ACQUIRED BRAIN INJURY &
CRIMINALITY
THE EFFECTS OF ACQUIRED BRAIN INJURY ON CRIMINAL BEHAVIOUR
PATIENT PROFILES OF CRIMINAL BEHAVIOUR IN THE CONTEXT OF TBI (LANE ET AL.)
TBI = an alternation in brain physiology / anatomy caused by an external force
Glasgow Coma Scale (GCS) – determines severity of TBI
15-point scale measuring best motor, verbal, eye-opening responses immediately
after TBI
13-15: mild, 9-12: moderate, 8 or below: severe
Aggression is a major complication of TBI BUT no concrete definition of aggression in
TBI research
Aggressive behaviours post-TBI reported in 11-96% of the cases
Aggression = verbal outbursts & physical violence toward objects & others
Various studies reported wide range (25-87%) of inmates having history of TBI – 8.5%
in general population
Possible association between TBI & criminal behaviour
Methods Retrospective chart review of patients currently / previously enrolled in
Neuropsychological program
Case selection: age ≥ 18, history of severe TBI, frontal lobe injury, post-TBI
criminal / aggressive behaviour resulting in police intervention /
incarceration
CASE SERIES
Case 1 Case 2
37 year old male 37 year old male
History of nonpenetrating TBI at age History of nonpenetrating TBI at age
22 20
Initial GCS = 5, coma > 2 weeks Initial GCS = 4, coma > 3 weeks
Polysubstance abuse prior to TBI ADHD prior to TBI
1 arrest on drug-related charges Complex & strained upbringing
After TBI: After TBI:
Damage to left frontal lobes, left Bilateral dorsomedial frontal & PF
temporo-parietal lobes contusion
Personality change with chronic Diffuse atrophy of corpus callosum
aggression Personality change with rigidity &
Cognitive disorder not otherwise oppositionalism, chronic aggression,
, specified (NOS) with nonfluent impulsivity, dementia
expressive aphasia Multiple police interventions following
Adjustment disorder with depressed verbal & physical aggression directed
mood toward staff & peers
3 arrests due to assault + parole
violation
DISCUSSION
Pre-TBI factors influenced post-TBI behaviour every patient experienced worsening
aggression after TBI
Risk factors Specific TBI-related & unrelated risk factors for aggression post TBI: (1)
for injury severity, (2) history of multiple TBIs with loss of consciousness,
aggression (3) aggressive traits pre-TBI, (4) history of substance abuse, (5) history
of comorbid depressive & anxiety disorders
TBI as risk Clear association between TBI involving frontal lobe & aggressive
factor for behaviour
incarceration Recent meta-analysis: 51% of incarcerated subjects had history of TBI
Risk factors for incarceration (similar to those for TBI): (1) low
socioeconomic status, (2) low education, (3) male gender, (4) history of
substance abuse, (5) psychiatric disorders, (6) general propensity to
engage in risky behaviour
Risk factors may lead to TBI, which may then lead to aggression
Aggressive behaviour can predate, be caused by, or exacerbated by
TBI
Legal Effects of TBI on behaviour may go unnoticed – people may attribute
implications blame onto individual rather than injury
Essential to have experts who are well versed in TBI
Experts need to relay knowledge to jury members, so they can
make educated decision about defendants behaviour
Clinical When individual has TBI + trouble with the law possible reason for
implications behaviour must be determined in an individualised manner
Precise & practical definition of aggression necessary to establish
guidelines to documenting aggressive behaviour
A FORENSIC NEUROPSYCHIATRIC APPROACH TO TBI, AGGRESSION AND SUICIDE (WORTZEL)
Types & severities of symptoms that follow TBI vary widely between & within individuals
as they recover
CRIMINALITY
THE EFFECTS OF ACQUIRED BRAIN INJURY ON CRIMINAL BEHAVIOUR
PATIENT PROFILES OF CRIMINAL BEHAVIOUR IN THE CONTEXT OF TBI (LANE ET AL.)
TBI = an alternation in brain physiology / anatomy caused by an external force
Glasgow Coma Scale (GCS) – determines severity of TBI
15-point scale measuring best motor, verbal, eye-opening responses immediately
after TBI
13-15: mild, 9-12: moderate, 8 or below: severe
Aggression is a major complication of TBI BUT no concrete definition of aggression in
TBI research
Aggressive behaviours post-TBI reported in 11-96% of the cases
Aggression = verbal outbursts & physical violence toward objects & others
Various studies reported wide range (25-87%) of inmates having history of TBI – 8.5%
in general population
Possible association between TBI & criminal behaviour
Methods Retrospective chart review of patients currently / previously enrolled in
Neuropsychological program
Case selection: age ≥ 18, history of severe TBI, frontal lobe injury, post-TBI
criminal / aggressive behaviour resulting in police intervention /
incarceration
CASE SERIES
Case 1 Case 2
37 year old male 37 year old male
History of nonpenetrating TBI at age History of nonpenetrating TBI at age
22 20
Initial GCS = 5, coma > 2 weeks Initial GCS = 4, coma > 3 weeks
Polysubstance abuse prior to TBI ADHD prior to TBI
1 arrest on drug-related charges Complex & strained upbringing
After TBI: After TBI:
Damage to left frontal lobes, left Bilateral dorsomedial frontal & PF
temporo-parietal lobes contusion
Personality change with chronic Diffuse atrophy of corpus callosum
aggression Personality change with rigidity &
Cognitive disorder not otherwise oppositionalism, chronic aggression,
, specified (NOS) with nonfluent impulsivity, dementia
expressive aphasia Multiple police interventions following
Adjustment disorder with depressed verbal & physical aggression directed
mood toward staff & peers
3 arrests due to assault + parole
violation
DISCUSSION
Pre-TBI factors influenced post-TBI behaviour every patient experienced worsening
aggression after TBI
Risk factors Specific TBI-related & unrelated risk factors for aggression post TBI: (1)
for injury severity, (2) history of multiple TBIs with loss of consciousness,
aggression (3) aggressive traits pre-TBI, (4) history of substance abuse, (5) history
of comorbid depressive & anxiety disorders
TBI as risk Clear association between TBI involving frontal lobe & aggressive
factor for behaviour
incarceration Recent meta-analysis: 51% of incarcerated subjects had history of TBI
Risk factors for incarceration (similar to those for TBI): (1) low
socioeconomic status, (2) low education, (3) male gender, (4) history of
substance abuse, (5) psychiatric disorders, (6) general propensity to
engage in risky behaviour
Risk factors may lead to TBI, which may then lead to aggression
Aggressive behaviour can predate, be caused by, or exacerbated by
TBI
Legal Effects of TBI on behaviour may go unnoticed – people may attribute
implications blame onto individual rather than injury
Essential to have experts who are well versed in TBI
Experts need to relay knowledge to jury members, so they can
make educated decision about defendants behaviour
Clinical When individual has TBI + trouble with the law possible reason for
implications behaviour must be determined in an individualised manner
Precise & practical definition of aggression necessary to establish
guidelines to documenting aggressive behaviour
A FORENSIC NEUROPSYCHIATRIC APPROACH TO TBI, AGGRESSION AND SUICIDE (WORTZEL)
Types & severities of symptoms that follow TBI vary widely between & within individuals
as they recover
