Displaced aggression predicts switching deficits in people with temporal lobe epilepsy Amara Gul ⁎, Hira Ahmad Department of Applied Psychology, The Islamia University of Bahawalpur, Pakistan abstract article info Article history: Received 25 June 2014 Revised 14 September 2014 Accepted 15 September 2014 Available online xxxx Keywords: Cognition Executive function Temporal lobe Aggression Mood Anger Epilepsy This study examined the relationship between task-switching abilities and displaced aggression in people with temporal lobe epilepsy (PWE). Participants (35 PWE and 35 healthy controls) performed emotion and gender classification switching tasks. People with temporal lobe epilepsy showed larger switch costs than controls. This result reflected task-switching deficits in PWE. People with temporal lobe epilepsy reported higher anger ru- mination, revenge planning, and behavioral displaced aggression compared with controls. Displaced aggression was a significant predictor of the task switch costs. It is suggested that displaced aggression is a significant marker of task-switching deficits. © 2014 Elsevier Inc. All rights reserved. 1. Introduction 1.1. Temporal lobe epilepsy and aggression Temporal lobe epilepsy (TLE) is one of the most common types of ep- ilepsy in which seizures occur in temporal lobes and are often character- ized by memory impairments and sensory changes. Seizures can be either complex or partial depending upon the symptoms. Complex partial sei- zures spread through a large area of the temporal lobe, which results in loss of consciousness. Simple partial seizures are confined to small areas in the temporal lobe such as the amygdala and hippocampus and do not disturb consciousness. Etiological factors range from traumatic injury, brain infections, mesial temporal sclerosis, to genetic syndromes [1]. Mood fluctuations and associated behavioral changes appear frequently in epilepsy, which have adverse effects on quality of life and functional capacities [2–5]. Changes in mood are a stronger predic- tor of quality of life than seizures [6,7]. Seizures are also associated with violent acts and aggressive behavior [8–10]. People with temporal lobe epilepsy (PWE) often report anger, low mood, irritability, and aggres- sion towards others [11–15]; however, better coping mechanisms and social support can improve health-related quality of life [7]. Aggression in PWE can be categorized on the basis of its relationship with seizures: ictal, interictal, and postictal aggression. The ictal and postictal forms of aggression often complicate epilepsy where psychotic symptoms such as delusions, hallucinations, mood changes, and aggression may arise [16,17]. Interictal aggression is independent of ictal activity and may be related to antisocial personality disorder [16]. These symptoms may lead to self-destructive acts; episodic dyscontrol; and antisocial, catastrophic, and serious assaultive acts [17,18]. Significant associations have been found among several neuroana- tomical regions/structures and aggressive behaviors, such as reduction in prefrontal gray matter which contributes to aggressive impulses [19]. Regions of the prefrontal cortex (PFC) are involved in aggression as well as in other cognitive functions such as inhibition of emotions and reduced activations of PFC, particularly the medial and orbitofrontal regions which are associated with violent, aggressive, and antisocial acts [20]. Brain areas such as the hypothalamus and the periaqueductal gray matter of the midbrain are also critical for aggressive expression. Areas of the midbrain have a connection with the amygdala and prefrontal cortex. Electrical stimulation of the hypothalamus generates aggressive acts, and receptors in the hypothalamus determine aggression in coor- dination with neurotransmitters, such as low levels of serotonin, which explain vulnerability to impulsiveness and potential aggression [21,22]. Aggression is linked with social learning [23]. Angry feelings and re- current thoughts about anger predict aggressive behavior [24]. Anger regulation is related to well-being and health [25]. Aggression is displaced towards innocent individuals when a person is unable to strike back to the original provocateur [26]. Individuals may ruminate about the original provocateur and maintain an aggressive mood. As a Epilepsy & Behavior 41 (2014) 109–113 ⁎ Corresponding author. Tel.: +92 307 504 7077. E-mail addresses: amara_psychology@hotmail.com (A. Gul), hiraahmad1987@gmail.com (H. Ahmad). http://dx.doi.org/10.1016/j.yebeh.2014.09.044 1525-5050/© 2014 Elsevier Inc. All rights reserved. Contents lists available at ScienceDirect Epilepsy & Behavior journal homepage: www.elsevier.com/locate/yebeh