The research took place over 10 years and focused on 16 male juveniles who completed or attempted sexual murders, as identified in a computer search through 1 State’s Department of Corrections. The attempted murders involved a clear intent to kill and the survival of the victim merely by chance. The research took place at the prison facilities housing these youths. Fourteen of the youths were in adult correctional facilities. Study data came from correctional records and from a clinical interview, a structured diagnostic interview, psychological tests, and an author-designed five-page interview. Results of the analysis revealed that the youths averaged 15.2 years at the time of the crime and 18.5 years at the time of the assessment. Their average IQ was 102. They were in the lower-middle-class socioeconomically. Fifteen youths had dysfunctional family systems in terms of parental abandonment or neglect, intrafamilial child abuse, unstable living arrangements with frequent geographical moves, parental criminality or incarceration, parental drug abuse, and parental fighting or other forms of violence. The 10 regularly occurring factors in this population included impaired capacity to feel guilt, neuropsychiatric vulnerabilities, serious school problems, child abuse, family dysfunction, history of interpersonal violence, prior arrests, sadistic fantasy, psychopathic personality traits, and diagnosis of a personality disorder. The youths were all waived to adult court for prosecution, found guilty, and sentenced to prison for periods ranging from 4 years to multiple life sentences. Findings indicated that most youth who commit sex murders will be released into the community by middle age and that treatment during incarceration and community-based services following release are potentially of great importance, even if they have only a small impact on recidivism. Tables, photographs, chapter reference lists, appended supplementary clinical interview questions, and index