This mixed-methods study is an exploration of the perceived distresses critical to the development of suicidal ideation and suicide attempts among lesbian, gay, bisexual, transgender, and questioning adults (18 and older) from their own perspectives and not compared to the heterosexual perspective. A triangulated mixed-methods design was used. In the study the Psychache Scale (Holden & Mehta, 1998), the Gay Identity Questionnaire (Brady & Busse, 1994), and the Suicide Ideation Scale (Rudd, 1989) were used to test the theory that psychache (unbearable psychological pain) is positively correlated with homosexual identity formation, suicidal ideation, and suicide attempts for participants responding to a Web-based survey. Thirty participants responded to the Web-based survey, 3 of whom granted in-depth interviews. This study found a positive correlation between psychache and suicidal ideation. In addition, it found, through in-depth semi-structured interviews, that sexual orientation is an identity; it influences how one might view himself and herself, and that the other-effect, or how others might view a person based on his or her sexual orientation can influence the development of suicidal ideation and suicide attempts.