Associations of multiple trauma types and MAOA with severe aggressive behavior and MAOA effects on training outcome

Eur Neuropsychopharmacol. 2020 Jan;30:66-74. doi: 10.1016/j.euroneuro.2017.06.016. Epub 2017 Jul 1.


Previous research showed that the disposition to react with disproportionate aggression in adults is influenced by an interaction between a variant in the X-chromosomal monoamine oxidase A gene (MAOA) and early traumatic events. Such studies have often focused on a single type of trauma, whereas we know that experiencing multiple trauma types is associated with more detrimental consequences. The differential susceptibility hypothesis suggests that individuals who are most susceptible to adversity, are also most likely to benefit from supportive experiences in childhood. Differences in susceptibility are thought to be partly genetically driven. In the present study we explored whether a genotype of MAOA linked to lower expression of the gene (MAOA-L) modified the effect of multiple types of trauma on aggression and/or altered responsiveness to treatment among adults with severe aggression. Forensic psychiatric outpatients (FPOs) (N=150) receiving treatment for aggression regulation problems were recruited. Traumatic events and aggression were measured using self-report. FPOs with multiple trauma types and those with the MAOA-L allele reported more severe levels of aggression. No interaction effects between MAOA genotype and trauma emerged. There were no differences in response to the intervention between FPOs with and without the MAOA-L variant, whereas FPOs with a single type of trauma showed the slowest reduction of aggression. FPOs with multiple types of trauma reported the highest levels of aggression over the course of treatment. Future research is needed to elucidate this association in further detail. The current study emphasized the importance of early recognition of early traumatic events.

Keywords: Aggression; MAOA; Trauma.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Adverse Childhood Experiences / psychology*
  • Adverse Childhood Experiences / trends
  • Aggression / physiology
  • Aggression / psychology*
  • Behavior Therapy / methods
  • Behavior Therapy / trends
  • Female
  • Forensic Psychiatry / methods*
  • Forensic Psychiatry / trends
  • Gene-Environment Interaction
  • Humans
  • Male
  • Mental Disorders / genetics*
  • Mental Disorders / psychology*
  • Mental Disorders / therapy
  • Middle Aged
  • Monoamine Oxidase / genetics*
  • Treatment Outcome


  • Monoamine Oxidase
  • monoamine oxidase A, human