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To identify the extent (size), range, (variety), and nature (characteristics) of evidence on the use of physiological biomarkers in forensic psychiatry, a systematic scoping review was conducted following JBI methodology and PRISMA-ScR guidance. Data on study characteristics and results were extracted by two independent reviewers from 431 primary research studies published in scientific journals and dissertations. Most studies were conducted in North America (53.4%) and Europe (41.3%). The majority employed an observational design (95.6%) and were cross-sectional (87.7%). Studies predominantly focused on males (84.9%) and adults (85.9%). The most common diagnoses were psychopathy\/antisocial personality disorder (51.7%) and sexual disorders (21.8%). Brain activity served as a biomarker outcome in 51.3% of studies, followed by peripheral sympathetic arousal (29.2%) and peripheral sexual arousal (13.8%). Biomarker assessment methods reflected these findings. Etiologic biomarker functions were most common (77.2%), followed by diagnostic functions (12.7%). Findings reveal several gaps in the existing scientific literature. Specifically, more experimental and longitudinal research is needed to integrate physiological biomarkers into e.g., interventions, effect monitoring, and (risk) assessment. Also, a greater focus on juveniles, patients with psychotic and substance use disorders, and the use of newer biomarker assessment methods measuring peripheral arousal is essential to advance the field.<\/jats:p><jats:sec><jats:title>Systematic review registration<\/jats:title><jats:p><jats:uri>https:\/\/osf.io\/<\/jats:uri>, 10.17605\/OSF.IO\/46QBU.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpsyt.2025.1580615","type":"journal-article","created":{"date-parts":[[2025,4,29]],"date-time":"2025-04-29T05:24:35Z","timestamp":1745904275000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Using physiological biomarkers in forensic psychiatry: a scoping review"],"prefix":"10.3389","volume":"16","author":[{"given":"Jenthe","family":"Mens","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erik","family":"Masthoff","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Bogaerts","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pauline","family":"Heus","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,4,29]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"342","DOI":"10.1186\/s12889-017-4257-0","article-title":"Inside the nation\u2019s largest mental health institution: a prevalence study in a state prison system","volume":"17","author":"Al-Rousan","year":"2017","journal-title":"BMC Public Health"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(16)30142-0","article-title":"Mental health of prisoners: prevalence, adverse outcomes, and interventions","volume":"3","author":"Fazel","year":"2016","journal-title":"Lancet Psychiatry"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291712002887","article-title":"A whole-of-population study of the prevalence and patterns of criminal offending in people with schizophrenia and other mental illness","volume":"43","author":"Morgan","year":"2013","journal-title":"Psychol Med"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2019.00715","article-title":"Long-term violent reoffending following forensic psychiatric treatment: comparing forensic psychiatric examinees and general offender controls","volume":"10","author":"Bengtson","year":"2019","journal-title":"Front Psychiatry"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(21)00170-X","article-title":"Effectiveness of psychological interventions in prison to reduce recidivism: a systematic review and meta-analysis of randomised controlled trials","volume":"8","author":"Beaudry","year":"2021","journal-title":"Lancet Psychiatry"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1016\/j.bionps.2020.100029","article-title":"Biomarkers and neurobehavioral diagnosis","volume":"4","author":"Ewen","year":"2021","journal-title":"biomark Neuropsychiatry"},{"key":"B7","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1177\/1079063208314820","article-title":"Social desirability and sexual offenders: a review","volume":"20","author":"Tan","year":"2008","journal-title":"Sex Abuse"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2019.00940","article-title":"Are there any biomarkers for pedophilia and sexual child abuse? 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