The present prospective study examined the predictive validity of the Dutch version of the Psychopathy Check List: Youth Version for disruptive behavior in male adolescents during treatment. The study comprised two samples admitted to different secure treatment institutions in The Netherlands, Jongerenhuis Harreveld (n = 81) and Rentray (n = 66). Overall, the results demonstrate that psychopathy is a significant predictor of institutional disruptive behavior, and physical violence in particular. Furthermore, Hare's traditional Factor 2 was more strongly related to disruptive incidents than Factor 1. By using the recently proposed three- and four-factor models of psychopathy, insight into the pattern of associations between psychopathy dimensions and different types of disruptive behavior was obtained. The antisocial dimension of psychopathy appeared to be more strongly related to severe incidents than the lifestyle dimension. Regression analyses identified significant contributions of the antisocial and lifestyle dimensions to the prediction of incidents. The relatively small degree of variance explained underlines the importance of other risk factors to identify adolescents at risk of disruptive behavior during institutional treatment.