The ventral medial prefrontal is located in the frontal lobe at the bottom of the cerebral hemispheres and is implicated in the processing of risk and fear, as it is critical in the regulation of amygdala activity in humans.

The ventromedial prefrontal cortex is connected to and receives input from the ventral tegmental area, amygdala, the temporal lobe, the olfactory system, and the dorsomedial thalamus.

[5] This huge network of connections affords the vmPFC the ability to receive and monitor large amounts of sensory data and to affect and influence a plethora of other brain regions, particularly the amygdala.

Research in developmental neuroscience also suggested that neural networks in the ventromedial prefrontal cortex are rapidly developing during adolescence and young adulthood supporting emotion regulation through the amygdala,[6] being associated with a decrease in cortisol levels.

There are only a few reports of people with early-onset vmPFC damage during childhood, but these individuals tend to have severe antisocial behavior and impaired moral judgment.

[2] Patients with bilateral lesions of the vmPFC develop severe impairments in personal and social decision-making[5][8] even though most of their intellectual ability is preserved.

People with damage to the ventromedial prefrontal cortex still retain the ability to consciously make moral judgments without error, but only in hypothetical situations presented to them.

[5] People with early damage to the ventromedial prefrontal cortex are more likely to endorse self-serving actions that break moral rules or cause harm to others.

In functional imaging studies, increased activity in the vmPFC is associated with thinking of these personal moral situations, while making harmless decisions does not.

A damaged vmPFC causes impairments of behavioral control and decision making, consequences which are rooted in emotional dysregulation.

The first and most famous case of someone with defects to this region was Phineas Gage, a railroad construction foreman who had his vmPFC bilaterally destroyed in an accident in 1848.

In patients with vmPFC damage, evidence shows that there is a correlation between emotional disregulation and dysfunction in real world competencies.

In experiments with participants allowing snakes to come near or away from them, acts of courage correlated with activation in the vmPFC, specifically the subgenual anterior cingulate cortex.

[9] Patients with focal lesions in the vmPFC show personality changes such as lack of empathy, irresponsibility, and poor decision making.

[20] In addition, a correlation between individuals with a history of physical violence and decreased grey matter density in the vmPFC has been evidenced.

[22] The right half of the ventromedial prefrontal cortex was associated with regulating the interaction of cognition and affect in the production of empathic responses.

[26] Treatments geared to the activation of the ventromedial prefrontal cortex were therefore suggested for individuals and parent-child relationships affected by PTSD.

Specific deficits in reversal learning and decision-making have led to the hypothesis that the ventromedial prefrontal cortex is a major locus of dysfunction in the mild stages of the behavioral variant of frontotemporal dementia.

[28] The capacity for mature defense mechanisms such as intellectualization, compensation, reaction formation, and isolation has been tied to proper functioning of the right ventromedial prefrontal cortex, while more primitive defense mechanisms such as projection, splitting, verbal denial, and fantasy have been found to rely on other regions, primarily in the left hemisphere.

[32] In general, the ventromedial prefrontal cortex plays a major role in the later stages of memory consolidation.