Salience Network Alterations in Reactive Aggression Across Neuropsychiatric Disorders: A Narrative Review

Reactive aggression occurs across a broad range of neuropsychiatric disorders. However, neurobiological research has typically examined this behavior within diagnosis-specific frameworks. Converging neuroimaging evidence increasingly implicates the salience network—particularly the anterior insula and dorsal anterior cingulate cortex—in threat detection, emotional reactivity, and action readiness. These processes play a fundamental role in reactive aggression. Yet, the extent to which alterations in this network represent a shared neural mechanism across diagnostic categories has not been fully integrated. The present narrative review synthesizes neuroimaging findings on salience network activity and connectivity in relation to reactive aggression across neuropsychiatric populations. Across studies, reactive aggression has frequently been associated with increased salience network engagement. Also, it has been associated with reduced functional integration with prefrontal cortex, and altered interactions with limbic areas. Emerging evidence further suggests that stress exposure, inflammatory processes, and monoaminergic modulation may further influence these network-level alterations. Collectively, these findings support a transdiagnostic, network-based model of reactive aggression and highlight directions for future research and intervention.