Skip to main content Accessibility help

Olfactory identification dysfunction, aggression and impulsivity in war veterans with post-traumatic stress disorder

  • J. F. Dileo (a1), W. J. Brewer (a2), M. Hopwood (a3), V. Anderson (a4) and M. Creamer (a5)...



Due to neuropsychological conceptualizations of orbitoprefrontal cortex (OFC) dysfunction underpinning impulsive aggression and the incidence of such behaviour in post-traumatic stress disorder (PTSD), this study aimed to explore olfactory identification (OI) ability in war veterans with PTSD as a probe of putative OFC dysfunction; and to explore the utility of OI ability in predicting aggressive and impulsive behavior in this clinical population.


Participants comprised 31 out-patient male war veterans with PTSD (mean=58.23 years, s.d.=2.56) recruited from a Melbourne Veterans Psychiatry Unit, and 31 healthy age- and gender-matched controls (mean=56.84 years, s.d.=7.24). All participants were assessed on clinical measures of PTSD, depression, anxiety, and alcohol misuse; olfactory identification; neurocognitive measures of dorsolateral prefrontal, lateral prefrontal and mesial temporal functioning; and self-report measures of aggression and impulsivity.


War veterans with PTSD exhibited significant OI deficits (OIDs) compared to controls, despite uncompromised performance on cognitive measures. OIDs remained after covaring for IQ, anxiety, depression and alcohol misuse, and were significant predictors of aggression and impulsivity.


This research contributes to emerging evidence of orbitoprefrontal dysfunction in the pathophysiology underlying PTSD. This is the first study to report OIDs as a predictor of aggression and impulsivity in this clinical population. It prompts further exploration of the potential diagnostic utility of OIDs in the assessment of PTSD. Such measures may help delineate the clinical complexity of PTSD, and support more targeted interventions for individuals with a greater susceptibility to aggressive and impulsive behaviors.


Corresponding author

*Address for correspondence: Associate Professor W. Brewer, ORYGEN Research Centre (Locked bag 10), Parkville, Victoria, 3052, Australia. (Email:


Hide All
Anderson, AK, Christoff, K, Stappen, I, Panitz, D, Ghahremani, DG, Glover, G, Gabrieli, JD, Sobel, N (2003). Dissociated neural representations of intensity and valence in human olfaction. Nature and Neuroscience 6, 196202.
Babor, T, Fuente, J, Saunders, J, Grant, M (1989). The Alcohol Use Disorder Identification Test: Guidelines for Use in Primary Health Care. World Health Organisation, Division of Mental Health: Geneva.
Begic, D, Jokic-Begic, N (2001). Aggressive behavior in combat veterans with post-traumatic stress disorder. Military Medicine 166, 671676.
Bennett-Levy, J (1984). Determinants of performance on the Rey-Osterrieth Complex Figure Test: an analysis, and a new technique for single-case assessment. British Journal of Clinical Psychology 23, 109119.
Best, M, Williams, JM, Coccaro, EF (2002). Evidence for a dysfunctional prefrontal circuit in patients with an impulsive aggressive disorder. Proceedings of the National Academy of Sciences USA 99, 84488453.
Blair, RJ (2004). The roles of orbital frontal cortex in the modulation of antisocial behavior. Brain & Cognition 55, 198208.
Borkowoski, JG, Benton, AL, Spreen, O (1967). Verbal fluency and brain damage. Neuropsychologia 5, 135140.
Brewer, WJ, Wood, SJ, DeLuca, C, Pantelis, C (2006). Models of olfaction for exploring neurodevelopment. In Olfaction and the Brain (ed. Brewer, W. J., Castle, D. and Pantelis, C.). Cambridge University Press: New York.
Buss, AH, Perry, M (1992). The Aggression Questionnaire. Journal of Personality & Social Psychology 63, 452459.
Chemtob, CM, Hamada, RS, Roitblat, HL, Muraoka, MY (1994). Anger, impulsivity, and anger control in combat-related posttraumatic stress disorder. Journal of Consulting & Clinical Psychology 62, 827832.
Cohen, J (1988). Statistical Power Analysis for the Behavioral Sciences, 2nd edn. Lawrence Earlbaum Associates: Hillsdale, NJ.
Critchley, HD, Rolls, ET (1996). Olfactory neuronal responses in the primate orbitofrontal cortex: Analysis in an olfactory discrimination task. Journal of Neurophysiology 75, 16591672.
Davidson, RJ, Putnam, KM, Larson, CL (2000). Dysfunction in the neural circuitry of emotion regulation – a possible prelude to violence. Science 289, 591594.
de Araujo, IET, Rolls, ET, Kringelbach, ML, McGlone, F, Phillips, N (2003). Taste-olfactory convergence, and the representation of the pleasantness of flavour, in the human brain. European Journal of Neuroscience 18, 20592068.
Doty, RL, Shaman, P, Dann, M (1984). Development of the University of Pennsylvania Smell Identification Test: a standardized microencapsulated test of olfactory function. Physiology & Behavior 32, 489502.
Eysenck, SB, Pearson, PR, Easting, G, Allsopp, J (1985). Age norms for impulsiveness, venturesomeness and empathy in adults. Personality and Individual Differences 6, 613–610.
Hamann, S (2003). Nosing in on the emotional brain. Nature Neuroscience 6, 106108.
Joseph, S, Dalgleish, T, Thrasher, S, Yule, W (1997). Impulsivity and post-traumatic stress. Personality & Individual Differences 22, 279281.
Kessler, RC, Sonnega, A, Bromet, E, Hughes, M, Nelson, CB (1995). Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry 52, 10481060.
Kline, NA, Rausch, JL (1985). Olfactory precipitants of flashbacks in posttraumatic stress disorder. Journal of Clinical Psychiatry 46, 383384.
Kotler, M, Iancu, I, Efroni, R, Amir, M (2001). Anger, impulsivity, social support, and suicide risk in patients with posttraumatic stress disorder. Journal of Nervous & Mental Disease 189, 162167.
Luria, AR (ed.) (1969). Frontal Lobe Syndromes. Elsevier: New York.
Mackay-Sim, A, Doty, RL (2001). The University of Pennsylvania smell identification test: Normative adjustment for Australian subjects. Australian Journal of Oto-Laryngology 4, 174.
Martzke, JS, Kopala, LC, Good, KP (1997). Olfactory dysfunction in neuropsychological disorders: review and methodological considerations. Biolological Psychiatry 42, 721732.
Nelson, HE, O'Donnell, A (1978). Dementia: the estimation of premorbid intelligence levels using the National Adult Reading Test. Cortex 14, 234244.
O'Donnell, ML, Creamer, M, Pattison, P (2004). Posttraumatic stress disorder and depression following trauma: Understanding comorbidity. American Journal of Psychiatry 161, 13901396.
Oozthuizen, F, Wegener, G, Harvey, BH (2005). Nitric oxide as inflammatory mediator in posttraumatic stress disorder (PTSD): evidence from an animal model. Neuropsychiatric Disease and Treatment 1, 109123.
Page, MC, Braver, SL, MacKinnon, DP (2003). Levine's Guide to SPSS for analysis of variance, 2nd edn. Erlbaum: Mahwah, NJ.
Pietrini, P, Guazzelli, M, Basso, G, Jaffe, K, Grafman, J (2000). Neural correlates of imaginal aggressive behavior assessed by positron emission tomography in healthy subjects. American Journal of Psychiatry 157, 17721781.
Rey, A (1941). L'examen psychologique dans les cas d'encephalopathie traumatique. Archives de Psychologie 28.
Rolls, ET (1998). The Orbitofrontal Cortex. Oxford University Press: London.
Rolls, ET (2000). The orbitofrontal cortex and reward. Cerebral Cortex (Special: The Mysterious Orbitofrontal Cortex) 10, 284294.
Rolls, ET, Kringelbach, ML, de Araujo, IET (2003). Different representations of pleasant and unpleasant odours in the human brain. European Journal of Neuroscience 18, 695703.
Seguin, JR (2004). Neurocognitive elements of antisocial behavior: relevance of an orbitofrontal cortex account. Brain & Cognition 55, 185197.
Stanley, B, Molcho, A, Stanley, M, Winchel, R, Gameroff, MJ, Parsons, B, Mann, JJ (2000). Association of aggressive behavior with altered serotonergic function in patients who are not suicidal [see comment]. American Journal of Psychiatry 157, 609614.
Taylor, EM (1959). Psychological Appraisal of Children with Cerebral Deficits. Harvard University Press: Cambridge, MA.
Turner, SM, Beidel, DC, Frueh, BC (2005). Multicomponent behavioral treatment for chronic combat-related posttraumatic stress disorder: trauma management therapy. Behavior Modification. Special: Beyond Exposure for Posttraumatic Stress Disorder Symptoms: Broad-Spectrum PTSD Treatment Strategies 29, 3969.
Vasterling, JJ, Brailey, K, Sutker, PB (2000). Olfactory identification in combat-related posttraumatic stress disorder. Journal of Traumatic Stress 13, 241253.
Vasterling, JJ, Brailey, K, Tomlin, H, Rice, J, Sutker, PB (2003). Olfactory functioning in Gulf War-era veterans: relationships to war-zone duty, self-reported hazards exposures, and psychological distress. Journal of the International Neuropsychological Society 9, 407418.
Vermetten, E, Bremner, JD (2002). Circuits and systems in stress. I. Preclinical studies. Depression & Anxiety 15, 126147.
Vermetten, E, Bremner, JD (2003). Olfaction as a traumatic reminder in posttraumatic stress disorder: Case reports and review. Journal of Clinical Psychiatry 64, 202207.
Weathers, FW, Litz, B, Herman, D, Huska, J, Keane, T (1993). >The PTSD Checklist (PCL): Reliability, Validity, and Diagnostic Utility. Paper presented at the Annual Convention of the International Society for Traumatic Stress Studies, San Antonio, TX, USA.
Wechsler, D (1987). Wechsler Memory Scale – Revised Manuel. The Psychological Corporation: San Antonio.
Zatorre, RJ, Jones-Gotman, M, Evans, AC, Meyer, E (1992). Functional localization and lateralization of human olfactory cortex. Nature 360, 339340.
Zatorre, RJ, Jones-Gotman, M, Rouby, C (2000). Neural mechanisms involved in odor pleasantness and intensity judgments. Neuroreport 11, 27112716.
Zigmond, AS, Snaith, RP (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica 67, 361370.



Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed