The objective of this cross-sectional study was to investigate if Traumatic Brain Injury (TBI) is related to decision-making deficits as well as to heightened levels of (reactive) aggression and criminal behavior in a group of Dutch male prisoners. Characteristics of aggression were assessed using three self-report questionnaires as well as systematic staff observations, complemented with data from criminal records. A semi-structured interview was conducted to rate lifetime prevalence of TBI and the Iowa Gambling Task (IGT) was completed to assess risky decision-making. Out of the total of 133 participants, 74 (55.6%) reported having sustained one or more incidents with potential TBI. Statistical comparisons between offenders with and without TBI indicated that the offenders with TBI reported significantly higher levels of (reactive) aggression on two out of three questionnaires than offenders without TBI ( p -values ranging from 0.003 to 0.008), but no significant differences were found on staff observations of aggression and on the IGT. The higher conviction rates in offenders with TBI compared to the non-TBI group showed a trend. The confirmed relationship between TBI and higher aggressive tendencies is especially relevant for forensic populations due to the high prevalence rates of TBI in offenders. How this relates to specific cognitive processes remains unclear. The lack of a statistical difference between offenders with and without TBI on the IGT is in contrast with literature in non-offender samples, but seems to be in line with other studies in forensic populations.
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