The archaeological record indicates that the ancient lowland Maya sacrificed a wide variety of people in caves for various reasons. Ritual theorists have proposed that individuals chosen for sacrifice cross‐culturally are typically outsiders either geographically or socially with slaves, prisoners of war, children (typically orphaned), sorcerers and the physically handicapped. Prior to this study, all but the physically handicapped were documented as sacrificial victims at cave sites. The site of Midnight Terror Cave in the Cayo District of Belize contains at least 118 individuals and is now one of the largest sacrificial assemblages ever discovered in the Maya Lowlands. This assemblage supports previous notions of who the ancient Maya chose for human sacrifice and documents the first cases of physically handicapped sacrifices. Two individuals with probable Klippel–Feil syndrome, a physically debilitating pathological condition with many associated abnormalities that would have made certain aspects of social life difficult, were documented in the assemblage. Ultimately, these results suggest that ritual theory predicts all the types of social outcasts chosen for sacrifice Maya caves. Copyright © 2015 John Wiley & Sons, Ltd.