Aggression Addiction and Relapse: A New Frontier in Psychiatry

There is an increased risk for abnormal or pathological aggression in individuals suffering from psychiatric disorders. Aggression is commonly ethologically demarcated as either appetitive or reactive, each with its own behavioral characteristics, functionality, and neural basis that may transition from adaptive to maladaptive depending on genetic and environmental factors. One type, pathological appetitive aggression, is hypothesized to result from excessive activation of evolutionary conserved reward circuits, which also mediate the rewarding effects of addictive drugs. Indeed, inappropriate appetitive aggression shows core features of addiction: aggression is often sought despite immediate or long-term adverse consequences, and relapse (recidivism) rates among violent offenders are as high as relapse rates in drug addiction. Despite these similarities, pathological aggression seeking has not been commonly incorporated into the conceptual framework of addiction and psychiatric disorders. Such a reconceptualization may positively impact therapeutic strategies to prevent pathological aggression and decrease recidivism (relapse) rates after incarceration or inpatient treatment