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This systematic review examines studies about serial killers 2010–2021. It has been proposed that genetic markers and environmental factors may contribute to the development of serial killers. Studies about genetic markers were compared to relevant studies supporting environmental factors and a subset of environmental and genetic factors to better understand the etiology of serial killing. There is evidence for a genetic predisposition for serial killer development. The significance of genetic testing has a promising future for studies about criminals, but there is compelling evidence of a combination of genetic, environmental, and behavioral factors that contribute to serial killing.