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Rampage school shootings, such as in Stoneman Douglas High School in Florida in February 2018, not only occupy the public discourse, they also relate to questions on violence and crime, mental health, education and marginalization in the United States, as well as race and gender - with all shooters being male, almost all being white. These instances represent a still unsolved puzzle to research with prevention measures sill at large. In my project, I analyze a full sample of rampage school shootings from 1969-2019 (62 shootings). This paper discusses findings from a preliminary analysis of 40 cases. My analysis includes both long-term social and mental health factors in the years prior to the shooting, as well as triggers in the month prior to the shooting, and behavior on the day of the shooting. Findings highlight that the often-described psychopathic, publicity-seeking shooter exists, but comprises a minority in the sample. A much larger group of shooters perceive a rampage school shooting as a “way out”. These shooters show paths that include different combinations of factors: mental health struggles such as psychopathy, or autism, coupled with troubled family histories of physical or sexual abuse, as well as marginalization and bullying at school. They often show limited access to mental health care in times of need, and supervision by educational personnel who are overworked and overwhelmed. For many eventual shooters, the only way out of what they perceive to be a “no exit” scenario seems to be a shooting that annihilates all existing societal pressures. Gender stereotypes seem to put additional strains on shooters, as they perceive these expectations as unachievable burdens – especially while struggling with mental disorders, family abuse, and bullying. Different types of shooters also show different patterns in preparation for and behavior during the shooting. Implications for prevention are discussed.