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Abstract
Violence is a multifaceted and heterogeneous phenomenon, closely linked to severe mental disorders. Far from being an isolated event, recent evidence suggests that pathological aggression emerges from dysfunctions in specific brain circuits, which are critical for emotional regulation and inhibitory control. To consolidate and critically analyze the scientific evidence published between 2021 and 2025 on the neuroanatomical, functional, and brain connectivity correlates associated with violent behavior in diverse psychiatric populations. A systematic review was conducted following the PRISMA 2020 statement guidelines. The literature search included the PubMed, Scopus, and Web of Science databases (January 2021 - 2025), prioritizing empirical studies and meta-analyses that employed neuroimaging techniques such as Structural Magnetic Resonance Imaging (MRI), Functional MRI (fMRI), and Diffusion Tensor Imaging (DTI) to compare violent versus non-violent subjects in clinical conditions including schizophrenia, psychopathy, Borderline Personality Disorder (BPD), and Post-Traumatic Stress Disorder (PTSD). Methodological quality and risk of bias were assessed using the Newcastle-Ottawa Scale and AMSTAR-2. Due to the methodological heterogeneity of the studies, a narrative synthesis was chosen. Fifteen studies were analyzed, with methodological quality ranging from moderate to high. At the structural level, data show a consistent volumetric reduction in amygdala nuclei (central and basal), the hippocampus, and hypothalamic subunits, along with cortical thinning in prefrontal areas and the superior temporal gyrus. Functionally, an "aggression network" involving the insula and cingulate cortex was delineated, highlighting a hyperactivation of the ventral striatum in response to rewarding stimuli. Connectivity analysis revealed dysregulations in the "Triple Network" (default mode, salience, and central executive networks) and negative functional connectivity between the dorsolateral prefrontal cortex and limbic structures. Furthermore, normative modeling confirmed extreme deviations in cortical thickness in patients with violent psychosis. Violent behavior appears to be underpinned by a transdiagnostic neurobiological basis. This is characterized by an imbalance between hyperactive limbic systems (impulse generators) and hypofunctional frontotemporal cortical systems (responsible for inhibitory control). These connectivity and morphometric patterns are emerging as promising biomarkers for precision psychiatry and for the design of personalized neuromodulation strategies.
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