Physical and sexual abuse, salivary cortisol, and neurologic correlates of violent criminal behavior in female prison inmates

Background: Both physical and emotional traumas have been related to neurologic and neuroendocrine abnormalities that may be associated with violent behavior. Methods: A modified case-control design was used for blinded comparison of 113 female inmates convicted of violent and nonviolent crimes. History of having been physically or sexually abused, neurologic history and physical examination, basal salivary cortisol levels, and associated variables were investigated to identify possible risk factors for violent compared to nonviolent criminal convictions. Results: Of all inmates studied, 95% had neurologic histories predating the current crime and/or neurologic examination abnormalities. Logistic regression revealed morning cortisol levels, number of years since last abuse, number of prior suicide attempts, and traumatic brain injuries with loss of consciousness to be significantly associated with current violent convictions, with a mean of two brain injuries with loss of consciousness per subject in the violent group. Conclusions: A greater number of traumatic brain injuries with loss of consciousness and suicide attempts, more recent abuse, and low morning basal salivary cortisol levels could be associated with dangerous violent criminal behavior, including murder, in female prison inmates. Future research should investigate neuroendocrine challenges, more psychiatric and violence measures, and different populations with longitudinal designs. (C) 2004 Society of Biological Psychiatry.