Teen Psychopathy and Premature Death: A Discussion of Screening, Risk, and Treatment

Wednesday, June 25, 2025. Although he’s survived his teens, this post is for Cole and his parents.

Teens with high psychopathic traits are dying young at alarming rates. Here’s what every therapist, school, and policymaker needs to know about screening and saving lives.

A groundbreaking study published in Research on Child and Adolescent Psychopathology followed 332 incarcerated youth over a 10- to 14-year period.

What researchers found was grim: teens with high psychopathic traits (scoring 30+ on the PCL:YV) had an 18.3% mortality rate before age 35, more than double the rate of lower-scoring peers (Maurer et al., 2025).

“Eleven of the sixty participants who scored 30 or above died during the follow-up period... a mortality rate nearly ten times the expected base rate” (Maurer et al., 2025, p. 21).

These weren’t overdoses from untreated depression alone, or violence explained by poverty.

The predictive factor wasn’t trauma, conduct disorder, or ADHD. It was psychopathic traits.

What Counts as Psychopathic in Adolescents?

Let’s define our terms. In teens, “psychopathy” isn’t a diagnosis—it’s a risk constellation.

The Psychopathy Checklist: Youth Version (PCL:YV), developed by Robert Hare and colleagues, evaluates 20 criteria split across two key dimensions:

• Interpersonal-Affective traits: superficial charm, manipulativeness, lack of remorse, shallow affect.

• Lifestyle-Antisocial traits: impulsivity, irresponsibility, early rule-breaking, thrill-seeking.

Scores range from 0 to 40. A score of 30+ is considered clinically high.

What makes these teens different from others with behavioral problems is the combination of calculated interpersonal coldness and chronic impulsive risk-taking.

Mortality Math: How Bad Are the Numbers?

The findings are decidedly unambiguous:

• Among teens who scored 30+, 18.3% died before age 35.

• Among teens with lower PCL:YV scores, 8.1% died in the same window.

• The average death rate in the general population for this age group? Less than 2%.

This is not about theoretical risk. It’s about funerals happening during what should be the most resilient years of life.

Inside the Brain: The Paralimbic Dimmer Switch

Why do psychopathic traits lead to early death? Part of the answer lies in neurobiology.

Kent Kiehl’s neuroimaging work shows that teens with high psychopathic traits exhibit hypoactivity in the paralimbic system—a brain circuit responsible for empathy, fear, and consequence evaluation (Kiehl, 2006).

“The relevant functional neuroanatomy of psychopathy thus includes limbic and paralimbic structures that may be collectively termed the ‘paralimbic system’” (Kiehl, 2006, p. 110).

This underfunctioning creates a twofold risk: danger doesn’t feel real, and reward feels irresistible (Crone et al., 2016). In high-stakes situations—reckless driving, gunplay, crime escalation—this circuitry failure can be fatal.

Three Pathways to an Early Grave

High-trait teens tend to die in one of three ways:

• Instrumental Violence: calculated crime that escalates to homicide.

• Impulsive Suicide: quick, lethal acts with little forethought.

• Risk-Fueled Accidents: overdoses, crashes, fatal stunts.

All are linked to the lifestyle/antisocial side of psychopathy. The issue isn’t just poor judgment—it’s a profound neurological mismatch between stimulus and consequence.

Screening Tools at a Glance

Effective early screening is the difference between prevention and prediction. The best tools are:

• PCL:YV – Gold standard for forensic and high-risk settings. Requires structured interview and collateral file review.

• Inventory of Callous-Unemotional Traits (ICU) – 24-item parent/youth self-report tool useful in schools and clinics.

• Child Problematic Traits Inventory (CPTI) – Designed for ages 3–12, this identifies CU traits long before adolescence.

Each tool focuses on early indicators: lack of guilt, low emotional responsiveness, manipulation, and thrill-seeking.

Building a Tiered Screening Protocol

To implement this responsibly, organizations need a tiered, multi-informant approach:

Universal observation and behavioral markers: teachers, coaches, or probation officers flag risk patterns—particularly low empathy + high impulsivity.

Self-report or caregiver-rated instruments: (e.g., ICU) for initial screening.

Full evaluation with the PCL:YV for high scorers or youth already in contact with the justice or psychiatric system.

A screening protocol must include clear referral pathways, trained clinicians, and follow-up. Screening without services is unethical and increases stigma.

From Score to Service: Implementation Roadmap

Let’s say you identify a teen with a high PCL:YV score. What next?

• Assign a clinical case manager who understands both trauma and antisocial dynamics.

• Implement evidence-based therapy with fidelity—this is not a time for generic CBT.

• Engage the family system, including parenting support and secure external structure.

• Monitor weekly, with built-in rewards for prosocial behavior (a method shown to work, particularly in decompression models).

One example of this is the Mendota Juvenile Treatment Center, which cut violent recidivism rates in high-trait teens from 70% to just 10% (Caldwell & Van Rybroek, 2001).

Evidence-Based Interventions That Still Move the Needle

Decompression Therapy (MJTC Model)

Reward-based reinforcement of even small prosocial behavior. This model has the best success with high-trait incarcerated youth (Caldwell & Van Rybroek, 2001).

Multisystemic Therapy (MST)

A family- and community-based approach that can be adapted for CU traits with the right training. Not as effective as MJTC for severe cases, but a strong secondary line.

Early Childhood Attachment and Emotion Coaching

Research by Frick et al. (2014) shows that callous-unemotional traits can be softened when positive parenting strategies are implemented early—even as young as age 3 or 4.

Ethical Tripwires: Screen, Don’t Stigmatize

Screening for psychopathy in youth is ethically fraught. Here’s how to do it responsibly:

• Use the word “risk,” not “psychopath.” Language matters, especially for families.

• Tie screening to services. If no intervention is available, don’t screen.

• Audit for bias. Black and brown youth are disproportionately labeled as “dangerous.” Scoring systems must be culturally attuned.

Final Takeaway: This Is a Preventable Mortality Crisis

When a teen’s psychology doubles or triples their risk of dying young, that’s not just a behavior problem—it’s a public health emergency.

And it’s one we can act on.

Screen early. Intervene intensively. Train your staff. Build the safety net.

Because many of these teens aren’t monsters—they’re wired for risk, raised in chaos, and walking around with neurons tuned to short-term survival.

With the right care, they might actually get a chance to live long enough to change. Let’s try to give them that chance.

Be Well, Stay Kind, and Godspeed.

REFERENCES:

Caldwell, M. F., & Van Rybroek, G. J. (2001). Efficacy of a decompression treatment model in the clinical management of violent juvenile offenders. International Journal of Offender Therapy and Comparative Criminology, 45(4), 469–477. https://doi.org/10.1177/0306624X01454005

Crone, E. A., van Duijvenvoorde, A. C. K., & Peper, J. S. (2016). Annual research review: Neural contributions to risk-taking in adolescence—developmental changes and individual differences. Journal of Child Psychology and Psychiatry, 57(3), 353–368. https://doi.org/10.1111/jcpp.12502

Frick, P. J., Ray, J. V., Thornton, L. C., & Kahn, R. E. (2014). Can callous-unemotional traits enhance the understanding, diagnosis, and treatment of serious conduct problems in children and adolescents? Psychological Bulletin, 140(1), 1–57. https://doi.org/10.1037/a0033076

Kiehl, K. A. (2006). A cognitive neuroscience perspective on psychopathy: Evidence for paralimbic system dysfunction. Psychiatry Research, 142(2–3), 107–128. https://doi.org/10.1016/j.psychres.2005.09.013

Lynam, D. R., Caspi, A., Moffitt, T. E., Loeber, R., & Stouthamer-Loeber, M. (2007). Longitudinal evidence that psychopathy scores in early adolescence predict adult psychopathy. Journal of Abnormal Psychology, 116(1), 155–165. https://doi.org/10.1037/0021-843X.116.1.155

Maurer, J. M., Gullapalli, A. R., Milillo, M. M., Allen, C. H., Rodriguez, S. N., Edwards, B. G., Anderson, N. E., Harenski, C. L., & Kiehl, K. A. (2025). Adolescents with elevated psychopathic traits are associated with an increased risk for premature mortality. Research on Child and Adolescent Psychopathology, 53(1), 17–28. https://doi.org/10.1007/s10802-024-01233-6

Salekin, R. T., & Lochman, J. E. (2008). Child and adolescent psychopathy: The search for protective factors. Criminal Justice and Behavior, 35(2), 159–172. https://doi.org/10.1177/0093854807312796