Cold-Blooded and on Purpose: A Review of the Biology of Proactive Aggression

Abstract

Proactive aggression (PA) is a planned and unprovoked form of aggression that is most often enacted for personal gain or in anticipation of a reward. Frequently described as "cold-blooded" or goal oriented, PA is thought to be associated with low autonomic arousal. With this view in mind, we performed a scoping review of the biological correlates of PA and identified 74 relevant articles. Physiological findings indicated a robust association between PA and reduced resting heart rate, and to a lesser extent a relationship between PA and decreased heart rate and skin conductance reactivity, perhaps indicating dampened sympathetic function. The twin literature identified PA as a heritable trait, but little evidence implicates specific genes in the pathogenesis of PA. Neuroimaging studies of PA pinpoint impaired amygdala function in the assessment and conditioning of aversive stimuli, which may influence the establishment of behavioral patterns. Nodes of the default mode network were identified as possible neural correlates of PA, suggesting that altered function of this network may be involved in the genesis of PA. Given the overlap of PA with reactive aggression and the overall behavioral complexity of PA, it is clear that multiple endophenotypes of PA exist. This comprehensive review surveys the most salient neurobiologically informed research on PA.

Keywords: HPA axis; autonomic function; event-related potentials; molecular genetics; neuroimaging; proactive aggression; twin studies.

Figure 1

Article screening flow diagram.

Figure 2

Neuroimaging findings of proactive aggression (PA), as quantified by the Reactive–Proactive Questionnaire [11], grouped by brain region. ACC, anterior cingulate cortex; Assoc., associated; PCC, posterior cingulate cortex; MPFC, medial prefrontal cortex; CU, callous–unemotional; MAOA-L, monoamine oxidase A low-activity genotype; GMD, grey matter density; IPL, inferior parietal lobe; DLPFC, dorsolateral prefrontal cortex; STS, superior temporal sulcus; BOLD, blood oxygenation level-dependent.