E. S. Shneidman (1993) has proposed that psychache (i.e., unbearable psychological pain) is directly associated with suicide and mediates the effects of all other relevant psychological factors. The present research tested this proposition by examining whether psychache mediates the relationship between perfectionism and suicidality. Furthermore, the link between perfectionism and psychache was examined for mediation by unfulfilled psychological needs. Participants were 264 undergraduate students. Structural equation modeling with bootstrapped estimates determined that psychache fully mediated the relationship between socially prescribed perfectionism and suicidality. Additionally, the relationship between socially prescribed perfectionism and psychache was partially mediated by unfulfilled psychological needs.