Youth with psychopathic traits at increased risk of dying young, study finds

Young people who score high on psychopathic personality traits may be at a significantly elevated risk of dying prematurely, according to new research published in Research on Child and Adolescent Psychopathology. In a long-term follow-up of incarcerated adolescents, those with the highest levels of psychopathic traits were far more likely to die before age 35 than their lower-scoring peers. This heightened risk was not explained by other behavioral disorders such as attention-deficit/hyperactivity disorder, conduct disorder, or substance use problems.

Psychopathy refers to a pattern of personality traits that includes superficial charm, manipulativeness, lack of empathy, impulsivity, and chronic rule-breaking behavior. These traits are often associated with criminal behavior and difficulty forming healthy interpersonal relationships. In adolescents, psychopathic traits can be measured using the Hare Psychopathy Checklist: Youth Version (PCL:YV), which captures two main dimensions—interpersonal/affective features (such as shallow emotions and deceitfulness) and behavioral/antisocial tendencies (such as impulsivity and early criminal activity).

The researchers undertook this study because adolescent mortality rates have been climbing in recent years, particularly from violent and accidental causes. Past studies have linked certain psychiatric diagnoses in youth—such as conduct disorder and substance use disorders—to increased risk of dying young. However, little was known about whether psychopathic traits, as a distinct psychological profile, also predict early mortality. Given the severity and stability of these traits over time, the researchers aimed to understand whether they might pose an especially serious long-term health risk.

To answer this question, the study drew on data from 332 adolescents (mostly male) who had been incarcerated in a maximum-security juvenile facility in New Mexico between 2007 and 2011. Each participant underwent a detailed assessment of psychopathic traits using the PCL:YV, which involved both a structured interview and a review of institutional records. The average age at the time of assessment was just under 18 years.

The participants were tracked over a period of 10 to 14 years, during which the researchers attempted to determine who was still alive and who had died. Multiple sources were used to verify mortality status, including public records, social media, obituaries, and direct outreach to families or correctional institutions. By the end of the follow-up period, 33 individuals—nearly 10% of the sample—had died, a rate nearly ten times higher than the general population for that age group.

The study found that those who scored higher on the PCL:YV were significantly more likely to have died during the follow-up period. When using a common cutoff for high psychopathy (a total score of 30 or above), 18.3% of high scorers had died compared to just 8.1% of lower scorers. A similar pattern emerged when using a median split (scores of 24 and above), with 13.7% mortality among high scorers versus 6.1% for others. These differences were statistically significant.

Further analyses showed that specific components of psychopathy were linked to a faster time to death. In particular, higher scores on the behavioral and lifestyle dimensions—such as impulsivity and irresponsibility—were associated with a shorter time to mortality. Interestingly, higher scores on interpersonal traits, such as manipulativeness and superficial charm, also predicted faster death, though this effect was smaller.

In contrast, the study did not find strong evidence that other psychiatric conditions, such as ADHD, oppositional defiant disorder, or conduct disorder, were independently associated with mortality in this group. While youth with substance use problems or oppositional defiant disorder showed slightly higher rates of premature death, the differences were not statistically significant. This suggests that psychopathic traits may capture a particularly high-risk subset of adolescents—beyond what is measured by traditional diagnoses.

The causes of death among those who died were varied but often related to violent or high-risk situations. These included homicide (frequently during the commission of a crime), suicide, and unintentional injury. Only one individual died while still incarcerated. The researchers note that these fatal outcomes align with the kind of reckless and dangerous behavior often associated with psychopathic tendencies, especially those related to impulsivity and a disregard for consequences.

One of the key takeaways from this study is that not all antisocial behaviors are the same when it comes to predicting long-term health outcomes. While conduct disorder and substance use problems are well-known risk factors for various negative life outcomes, psychopathic traits appear to offer unique predictive power when it comes to premature death. The researchers suggest that psychopathy assessments could help identify incarcerated youth who are at especially high risk and who may benefit from targeted interventions.

However, the study does come with several limitations. First, the sample was drawn exclusively from a high-security juvenile facility, meaning the findings may not generalize to other populations, including youth in the general community or those with milder behavioral problems. Second, the number of female participants was relatively small, making it difficult to draw firm conclusions about gender differences. Third, the researchers conducted separate analyses for psychopathic traits and externalizing disorders, rather than examining their combined or interactive effects.

Another important limitation is that the data only covered a 10- to 14-year window. It remains to be seen whether psychopathic traits in adolescence continue to influence mortality risk later in adulthood, or whether other life experiences moderate this relationship over time. Future research might also investigate whether certain interventions—such as therapy focused on emotional regulation or impulse control—can mitigate the risks associated with high psychopathy scores.

The study, “Adolescents with Elevated Psychopathic Traits are Associated with an Increased Risk for Premature Mortality,” was authored by J. Michael Maurer, Aparna R. Gullapalli, Michaela M. Milillo, Corey H. Allen, Samantha N. Rodriguez, Bethany G. Edwards, Nathaniel E. Anderson, Carla L. Harenski, and Kent A. Kiehl.