Maladaptive aggression, as present in conduct disorder (CD) and, to a lesser extent, oppositional defiant disorder (ODD), has been associated with structural alterations in various brain regions, such as ventromedial prefrontal cortex (vmPFC), anterior cingulate cortex (ACC), amygdala, insula and ventral striatum. Although aggression can be subdivided into reactive and proactive subtypes, no neuroimaging studies have yet investigated if any structural brain alterations are associated with either of the subtypes specifically. Here we investigated associations between aggression subtypes, CU traits and ADHD symptoms in predefined regions of interest.

T1-weighted magnetic resonance images were acquired from 158 children and adolescents with disruptive behavior (ODD/CD) and 96 controls in a multi-center study (aged 8–18). Aggression subtypes were assessed by questionnaires filled in by participants and their parents. Cortical volume and subcortical volumes and shape were determined using Freesurfer and the FMRIB integrated registration and segmentation tool. Associations between volumes and continuous measures of aggression were established using multilevel linear mixed effects models.

Proactive aggression was negatively associated with amygdala volume (b = -10.7, p = 0.02), while reactive aggression was negatively associated with insula volume (b = -21.7, p = 0.01). No associations were found with CU traits or ADHD symptomatology. Classical group comparison showed that children and adolescents with disruptive behavior had smaller volumes than controls in (bilateral) vmPFC (p = 0.003) with modest effect size and a reduced shape in the anterior part of the left ventral striatum (p = 0.005).

Our study showed negative associations between reactive aggression and volumes in a region involved in threat responsivity and between proactive aggression and a region linked to empathy. This provides evidence for aggression subtype-specific alterations in brain structure which may provide useful insights for clinical practice.

行为障碍（CD）和相对较小的对立违抗性疾病（ODD）中存在的适应性侵略与各种大脑区域的结构改变有关，例如腹侧前额叶皮层（vmPFC），前扣带回皮层（ACC） ），杏仁核，岛和腹侧纹状体。尽管攻击可以细分为反应性和积极性亚型，但尚未进行神经影像学研究，研究是否有结构性脑部改变与这两种亚型相关。在这里，我们调查了感兴趣的预定义区域中的攻击性亚型，CU性状和ADHD症状之间的关联。

在一项多中心研究（8-18岁）中，从158名具有破坏性行为（ODD / CD）的儿童和青少年和96名对照中获得了T1加权磁共振图像。攻击性亚型通过参与者及其父母填写的问卷进行评估。使用Freesurfer和FMRIB集成配准和分割工具确定皮质体积，皮质下体积和形状。使用多级线性混合效应模型建立了攻击量与持续性攻击之间的关联。

积极的攻击性与杏仁核体积呈负相关（b  = -10.7，p  = 0.02），而积极的攻击性与胰岛体积呈负相关（b =  -21.7，p  = 0.01）。没有发现与CU特征或ADHD症状相关。古典组比较显示，具有破坏性行为的儿童和青少年在（双边）vmPFC中的体积比对照组小（p  = 0.003），效果大小适中，左腹纹状体前部形状减小（p  = 0.005）。

我们的研究表明，在一个区域中，反应性攻击与卷入威胁反应的区域之间的数量呈负相关，而主动式攻击与与移情相关的区域之间则存在负相关。这提供了侵略性亚型特定的大脑结构改变的证据，这可能为临床实践提供有用的见解。