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Neuroimaging research has shown brain morphological abnormalities associated with violence and psychosis, but individual differences are substantial and results not consistent across studies. Recently developed normative modeling of brain MRI-features provides a possibility to parse this heterogeneity by mapping inter-individual brain characteristics, which has not yet been explored in forensic psychiatry.

We explored brain heterogeneity in persons with a history of severe violence with or without a schizophrenia spectrum disorder (HoV, n=58), non-violent patients with schizophrenia spectrum disorders (SSD-NV, n=138), and healthy non-violent controls (HC) from lifetime normative trajectories of cortical thickness, surface area, and subcortical volumes. Normative models were based on Freesurfer derived regions of interest from 58,836 individuals (ages 2-100) from 82 sites. Group differences and associations between brain deviations and psychopathy traits (PCL-R scores) were investigated.

Across groups, we found an overall heterogeneous pattern of individual-level deviations, with a significantly higher frequency of extreme negative deviations in HoV (p=.020, d=.31) and SSD-NV (p=.019, d=.48), than HC. Group differences were mostly present in subcortical volumes and cortical area, but not thickness, with significant regional group-level differences within the subcallosal and insular cortices, and the cerebellum, and no significant associations to psychopathy traits.

By applying normative modeling, this proof-of-concept study demonstrates the heterogeneous pattern of brain morphometry deviations …