What is autoerotic asphyxiation?

Quick Answer
Autoerotic asphyxiation, also known as hypoxphilia, is an act of reducing the flow of oxygen to the brain to heighten sexual arousal and orgasm. The blood flow to the brain is reduced by self-hanging, intentional strangling, or suffocation. Autoerotic asphyxiation is most commonly practiced by males and is usually a solitary act. Autoerotic asphyxiators use cords, belts, ropes, neckties, scarves, or plastic bags to strangle or suffocate themselves while masturbating. Autoerotic asphyxiation is also practiced with a partner as a form of sexual masochism.
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Causes

There is no known cause for autoerotic asphyxiation. Some experts believe the practice may be related to childhood trauma, such as sexual abuse. Others believe it may stem from an anxiety about death. The anxiety is relieved, and sexual gratification is obtained, by repeatedly “cheating death.”

Risk Factors

There are no known factors that predispose a person to engage in autoerotic asphyxiation. People who practice autoerotic asphyxiation are often involved in otherwise healthy relationships. However, there are some comorbidities that can be associated with the practice of autoerotic asphyxiation, including mood disorders, anxiety disorders, and other forms of masochism, sadism, and fetishism.

People who play the choking game as adolescents or teenagers also may be predisposed to practicing autoerotic asphyxiation. The choking game is “played” by depriving the brain of oxygen through strangulation or by hugging a person from behind until he or she passes out. The choking game produces a feeling of euphoria and, therefore, is used as a means of getting high.

Symptoms

Autoerotic asphyxiation is a dangerous practice that can end in death. Because it is normally a solitary act that is practiced behind locked doors, it may be difficult to determine if a person is at risk. However, there are some signs and symptoms, including the following: unexplained bruises on the neck; bloodshot eyes; bed sheets, belts, ties, or ropes tied in strange knots and found in unusual places; frequent, severe headaches; disorientation after being alone; wearing high-neck shirts or scarves in warm weather; locked bedroom or bathroom doors; and wear marks on bed posts or closet rods. Aside from death, there are some potential complications that are associated with autoerotic asphyxiation, including heart attack and permanent brain damage.

Screening and Diagnosis

Each year, as many as one thousand people in the United States are found dead—naked or partially naked—hanging by their necks in their bedroom closets (or in similar positions). Sexual paraphernalia is often found nearby.

People who practice autoerotic asphyxiation do not intend to kill themselves. They often devise some sort of safety mechanism that is intended to prevent accidental death in case they lose consciousness. Safety mechanisms may include slip knots or hanging from something that is shorter than they are. These safety mechanisms often fail because the person becomes disoriented and is unable to take the necessary steps to restore the flow of oxygen. Many people also mistakenly believe that autoerotic asphyxiation with a partner is safe because they assume that the partner can remove the object that is cutting off the flow of oxygen after the person who is being asphyxiated loses consciousness.

It is difficult to diagnose autoerotic asphyxiation because it often goes undetected until it results in death. People who practice autoerotic asphyxiation tend to go to great lengths to keep it a secret; most do not discuss it with peers, parents, or clinicians.

Screening for autoerotic asphyxiation requires that clinicians be knowledgeable about autoerotic asphyxiation, its signs and symptoms, and other related risky behaviors, such as the choking game. It may be helpful for clinicians to begin a discussion about autoerotic asphyxiation with people who are assumed to be engaging in the practice by approaching the subject in a nonsexual way. Instead of focusing on the sexual aspects or autoerotic asphyxiation, the clinician could focus on the dangers of getting high by self-hanging, strangulation, or suffocation.

Treatment and Therapy

Treatment for autoerotic asphyxiation may include a combination of cognitive behavior therapy and medication. Common medications for the treatment of autoerotic asphyxiation include selective serotonin reuptake inhibitors and antiandrogens.

Prevention

Education is key to the prevention of autoerotic asphyxiation. Education about the dangers of the choking game and about autoerotic asphyxiation may take place both at home and as part of sex education classes at school.

Once the behavior has started, many children begin looking for a way to perform autoerotic asphyxiation safely, so they need to be told that there is no safe way to do it. Clinicians should also be educated about autoerotic asphyxiation. Education could be incorporated into medical, nursing, and psychology curricula, and into primary care, psychiatry, and emergency medicine residency programs.

Bibliography

Cowell, Daniel. “Autoerotic Asphyxiation: Secret Pleasure, Lethal Outcome.” Pediatrics 124.5 (2009): 1319–24. Print.

Hucker, Stephen. “Hypoxphylia/Auto-Erotic Asphyxia.” Web. 13 Feb. 2012. http://www.forensicpsychiatry.ca/paraphilia/aea.htm.

MedicineNet.com. “Paraphilias.” Web. 13 Feb. 2012. http://www.medicinenet.com/paraphilia/article.htm#.

Sheleg, Sergey, and Edwin Ehrlich. Autoerotic Asphyxiation: Forensic, Medical, and Social Aspects. Tucson, AZ: Wheatmark, 2006. Print.

Warner, Jennifer. “Some Docs in the Dark about Choking Game.” Web. 13 Feb. 2012. http://www.webmd.com/parenting/news/20091214/some-docs-in-the-dark-about-choking-game.

Website of Interest

American Academy of Pediatrics

http://www.aap.org

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