Why Psychopathy Still Matters in Violence Prevention — 10 Years Later

Dr. Sarah DeGue
Oct 14
4 min read

Neuroscience is helping us pinpoint who’s most at risk—and how to intervene earlier to prevent violence. But we still haven't done it.

“Psychopathy is an early-appearing risk factor for severe and chronic violence. … Yet, despite a vast base of research, the public health approach to violence has generally neglected this key variable.” — Reidy, Kearns, DeGue, Lilienfeld, Massetti & Kiehl (2015)

Ten years ago, in a paper titled "Why Psychopathy Matters", colleagues and I made a bold call: psychopathy and its childhood precursors—particularly callous-unemotional (CU) traits—should be central to violence prevention frameworks. We argued that a small subgroup of individuals with psychopathic traits disproportionately drives serious violence, yet our public health models have largely overlooked them.

10 Years Later: Has Anything Changed?

Still a Blind Spot in Public Health

Despite being widely cited, the Reidy framework hasn't catalyzed the population-level shift it called for. Psychopathy metrics remain rare in surveillance systems, prevention planning, or large-scale evaluations. A 2022 follow-up paper confirmed what many practitioners suspected: most systems remain reactive rather than proactive when it comes to CU traits.

The gap Reidy and colleagues identified? It's still very much with us.

What's New: Promising Developments

The past decade has produced some encouraging signs—though most remain in treatment rather than primary prevention:

New intervention approaches show change is possible. A new virtual reality trial targeting emotion recognition in youth with CU traits showed reductions in callous-unemotional traits and conduct problems at follow-up. Portugal's PSYCHOPATHY.COMP program—a compassion-focused therapy for detained youth—earned a "Promising" rating from CrimeSolutions based on medium-to-large effect sizes in reducing psychopathic traits.

The treatability question matters for prevention. Reviews of treatment studies show that about half successfully reduce CU traits, challenging the old "psychopaths are untreatable" narrative that Reidy et al.'s (2013) review showed was never well-supported. If these traits can shift in detained adolescents, early intervention before problem behaviors emerge becomes even more promising. Common elements across successful interventions—goal-setting, interpersonal skills training, parent coaching, and reward-based (not punishment-based) approaches—could be adapted for primary prevention in schools and community settings.

Neuroscience is providing prevention targets. Ongoing research on emotion processing, reward learning, and attention modulation is giving us clearer targets for early intervention. Studies link CU traits to deficits in emotion recognition and altered reward-system activation, offering new clues for prevention. The field also increasingly recognizes that individuals with CU traits aren’t all the same—recent meta-analyses highlight neural and behavioral differences—pointing toward screening tools that could identify youth who’d benefit most from targeted primary prevention.

What Hasn't Changed

Let's be honest about the gaps:

No widespread surveillance: National systems still don't routinely track psychopathy/CU metrics
Small-scale studies: Most research remains limited in size and duration
Unknown durability: We lack long-term follow-up data on whether early gains persist
Implementation science lag: We know too little about delivering interventions with fidelity in real-world settings

What This Means for Primary Prevention

The Window Is Wide Open—If We Act

The original Reidy paper emphasized that psychopathy has an early genesis, making primary prevention essential. Traits like empathy and emotion recognition are most plastic in middle childhood—exactly when primary prevention should happen. Yet we're still waiting for evidence-based primary prevention programs specifically designed for youth showing early CU traits.

Treatment Success Points to Prevention Potential

If interventions can reduce CU traits in detained adolescents, imagine what's possible before antisocial behavior becomes entrenched. The key elements—emotion recognition training, reward-based skill building, parent coaching—are exactly the kinds of approaches that work in primary prevention settings.

We Need Universal Screening with Targeted Support

To implement effective primary prevention, we need CU trait screening integrated into schools and pediatric care—with clear pathways to evidence-based support. This means selected and indicated prevention programs that don't stigmatize but do provide intensive, mechanism-focused intervention for high-risk youth.

Fill the Gap Between Research and Practice

Most promising interventions exist in research or clinical settings. Primary prevention practitioners need:

Adaptations of evidence-based approaches for school and community settings
Training on working with youth showing early CU traits
Implementation guidance on fidelity, engagement, and family involvement
Better measurement tools that work in prevention (not just clinical) contexts

Demand the Evidence We Need

We urgently need:

RCTs of primary prevention programs specifically targeting early CU traits
Long-term follow-up (5+ years) showing prevention of violence, not just symptom reduction
Cost-effectiveness data comparing primary prevention to later intervention
Implementation science on delivering these programs at scale

Yet this week's additional RIFs at CDC—including more cuts to the Division of Violence Prevention—along with broader reductions in federal research funding, are moving us in exactly the wrong direction. At the moment we need more investment in prevention science, we're getting less.

The Bottom Line

Ten years after Reidy and colleagues made the case for integrating psychopathy into violence prevention, we're still working almost entirely on the tertiary end. The treatment evidence shows these traits can change—but we're intervening far too late.

A small percentage of youth with significant CU traits drive a disproportionate amount of serious violence. Reaching them before they hurt someone—through effective primary prevention—could transform outcomes for entire communities. That's not just a public health opportunity; it's an ethical imperative.

The science points clearly to early intervention. It's time for primary prevention practice to catch up.

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