Cerebrospinal fluid 5-hydroxyindolacetic acid and aggression: a critical reappraisal of the clinical data

Over the past 15 years several clinical studies have been published dealing with the hypothesis that disturbances in central serotonergic functioning could be related to outward directed aggression and impulsivity. Close reading of the 22 relevant reports, however, raises doubt about the unequivocality of the results across diagnostic boundaries and in comparison with normal controls. Only eight of the studies are methodologically acceptable and seem to support the hypothesis. Taking all data together, it is concluded that some relationship exists between decreased serotonin metabolism, as reflected by lowered cerebrospinal fluid 5-hydroxyindolacetic acid, and certain aspects of aggressive behavior in a subgroup of young, male, personality-disordered subjects with seriously deviant behavior.