Suicide is heartbreaking. And suicide is especially crushing when a teenager has made the lethal choice to end their life. What happened? As the adults in their lives we cannot fathom how things went so bad, so fast. We feel so certain there could have been another way, a different choice. Yes, we might have been mad, but love comes first, above all, and we would have helped you.

And so begins the hell for parents and loved ones of a teen suicide. You are full of questions and “what ifs,” reeling in shock and disbelief. You rethink everything. What did you miss? Were there signs? You thought it was normal teenage angst and withdrawal. You had no idea it was this bad.

Or, maybe, you did. Maybe your teen’s life was a maelstrom of chaos and upheaval. He or she kept unraveling, becoming riskier, angrier, withdrawn or hell-bent on self-destruction. You were considered the enemy. Communication had shut down. You felt powerless. It was hard to recognize this snarky stranger, who avoided eye contact with you at all possible costs, as your child.

Teenage years, by definition, are tumultuous. The brain is not fully developed. Hormones reconfigure bodies and play havoc with emotions. Psychologically, teens need to individuate – pull away from their parents to become their own person. These years are physically, emotionally, mentally and socially difficult. They can be hard to negotiate. Teens can be extreme and dramatic — and their parents, too, who wonder who they have become in trying to manage and protect their teenager. It’s a highly sensitive and volatile stage of life.

Teen years birth an enormous primal need for social acceptance and a desire for more and more personal freedom. There is experimentation with substances and sex. Boundaries are taunted and tested. There are secrets. There can be confusion, doubt, worry and impulsivity. Heightened feelings and significant relationships can lead to intense urgency; everything feels immediate and important. The needs of the social group become primary.

But what happened, what led your teen to choose suicide? Why? Why? Why? That is the question keeping you awake at night. Most likely, you didn’t see this coming. You are stupefied, doubled over with your heart exploded.

The familiar expression, “Suicide is a permanent solution to a short-term problem” seems most apt when describing teen suicide. Young people tend to see the world in black-and-white constructs. They have no idea that life is made up of a 3rd, 12th and 27th acts. In their suicidal state, they feel without options. They are up against a hard wall. They are in extreme mental and emotional distress and see no way out. Or, at that moment in time, fired up by alcohol and/or drugs, they have the “F-its” and make an impulsive – and deadly – choice.

Suicide never happens for just one reason. There is a confluence of factors that lead to a tipping point.

The risk factors for suicide include a family history of suicide, mental illness, substance abuse and/or violence which increase genetic vulnerabilities; a prior suicide attempt; a history of self-harm; exposure to suicide; incarceration as well as a firearm within the home.

Suicide can be the result of biological factors, such as bipolar disorder, schizophrenia, major depression, unrelenting physical pain and the like.

There are soul-killing, traumatic experiences such as bullying, childhood sexual abuse, family violence, ostracism, etc., that lead to suicidal thoughts and actions.

There are feelings of failure, worthlessness, shame, self-loathing, abandonment and unabated rage that fuel suicidality.

Individual and idiosyncratic elements become enormous stressors. Think eating disorders, perfectionism, risky behavior, poor academic performance, family problems, sexual identity issues, chronic lying, gambling, legal problems, substance abuse and the like.

The Journal of Addiction Disorders reported, “Over 70% of adolescent suicides may be complicated by drug and alcohol use and dependence.” For teens, drug and alcohol can create bonding experiences with their peers, alleviate social anxiety, loosen inhibitions and self-medicate anxiety and depression. Substance abuse becomes a self-harming coping response that distorts thinking, increases impulsivity and amplifies emotions. In other words, a distraught, depressed or angry person becomes more so under the influence of substances and can make a lethal choice.

In addition to the possible neurochemical imbalances, genetic predispositions, serious mental health issues, unrelenting social pressures and/or substance abuse, emotions plus distorted and constricted thinking are what drive a suicide. Here are 13 possible reasons why a teenager chooses suicide:

1. The pain of their daily life is too much to bear.
2. They feel alone, misunderstood and/or hated.
3. They have experienced a cluster of losses, failures or problems and cannot envision any way to recover and get back on their feet.
4. Everything feels hopeless, stuck and unfixable.
5. They are in big, big trouble and see no way out.
6. They feel their parents don’t care or are too angry to help anymore.
7. They are filled with shame and regret.
8. They are seething with rage.
9. They are filled with self-hate.
10. Their heart has been broken and they feel completely unlovable.
11. The idea of suicide has become seductive.
12. They want to follow in the footsteps of their classmate.
13. They felt like they are going crazy.

Understanding suicide helps. It does not take away the horrific pain, but it can help make sense of the unimaginable. When we learn more, we have a basis for comparison. We learn, perhaps, that our situation, alas, is not so unusual. We comprehend more fully the biochemical or psychosocial elements that led to our teen’s suicide.

When we understand more, we are no longer so confused and haunted by the “whys.” We find ourselves on steadier footing, more emotionally and mentally grounded. We can take a deeper breath and begin to accept the unacceptable.

Understanding serves as a powerful healing ally on this journey of deep grief and recovery where you piece together– over much time and with great patience — the pieces of your exploded heart.