OBJECTIVE To determine reasons for suicide attempts in adolescents and to examine the relationship between these reasons and psychological functioning. METHODS Self-reported reasons for suicide attempts and psychological functioning were examined in 120 adolescent suicide attempters who presented to a pediatric general hospital. RESULTS Consistent with prior research, the most frequently endorsed motives for self-harm were to die, to escape, and to obtain relief. More manipulative reasons for overdose (such as making people sorry) were endorsed less frequently. Adolescents who cited death as a reason for their suicide attempt reported more hopelessness, socially prescribed perfectionism, depression, and anger expression. Discriminant function analyses indicated that high levels of depression and anger expression predicted a self-reported wish to die, and high levels of depression and socially prescribed perfectionism predicted death as the primary reason reported for the suicide attempt. CONCLUSIONS Systematic assessment of the reasons for a suicide attempt is a useful tool for clinicians in determining recommendations for follow-up treatment.