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Letters to the Editor
June 2001

Frontal Lobe Pathology and Antisocial Personality Disorder—Reply

Arch Gen Psychiatry. 2001;58(6):611. doi:

In reply

Bigler's case study represents an intriguing analysis that contributes further evidence to the proposition that prefrontal structural deficits may predispose individuals to antisocial, violent behavior. Unlike the celebrated case study of Phineas Gage%1 and the informative neurological patients reported by Damasio et al,%2 Bigler's unusual case had conduct disorder prior to the acquired prefrontal damage. The imprudent act of playing Russian roulette epitomizes the poor decision making that is thought to characterize individuals with APD with prefrontal damage%2,3 and also the stimulation-seeking and fearless tendencies of physiologically underaroused aggressive children and adults.%4