Asphyxiation bdsm

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Use the link below to share a full-text version of this article with your friends and colleagues. Learn more. Intentional asphyxiation le to cerebral hypoxia, starving the brain of oxygen and inducing hypoxic euphoria, but carries a serious risk of accidental death, especially if practised alone.

This article raises the question as to whether it could usefully be regarded as having addictive properties. A review of the literature, together with eight case study vignettes, are presented. Intentional asphyxiation can occur with or without sexual activity. Initiation often occurs in adolescence, with development in some cases of an entrenched behaviour pattern, driven by a strong euphoriant effect, without adequate safeguarding from serious harm, and being undertaken by people with comorbidities. There does not appear to be strong evidence of seeking support for cessation of the practice.

Intentional asphyxiation behaviours may have addictive properties, and understanding this aspect of the problem may be fruitful in guiding research and interventions aimed at addressing it. Asphyxia occurs when the exchange of oxygen and carbon dioxide in the body is impaired [ 1 ].

This article focuses on intentional asphyxia by strangulation, highlighting both the pleasure and risk associated with the behaviour, and questions whether it could usefully be regarded as possessing addictive properties. Asphyxia by strangulation has historically been associated with a sexually aroused state, shown physically in those executed by hanging in the 17th century [ 4 ]. Intentional asphyxiation is a common practice in those engaging in consensual BDSM bondage and discipline; dominance and submission; sadism and masochism , an abbreviation used to cover a wide range of sexual activities that are often concealed from the mainstream public [ 5 ].

Changes to the most recent Diagnostic and Statistical Manual of Mental Disorders DSM-5 [ 8 ] introduce a distinction between paraphilia atypical sexual interests, but not necessarily disordered and paraphilic disorders sexual interests that cause distress or dysfunction [ 9 ].

This change to editions is deed to de-medicalize and de-stigmatize paraphilias, providing they are not distressing or detrimental to self or others. However, intentional asphyxiation also occurs without connection to sexual activities [ 14 ], and thus would not be considered under the umbrella of paraphilias [ 4 , 15 , 16 ]. It could be argued that a drive for hedonism the seeking of pleasure is a better explanation of the route to intentional asphyxia, rather than a paraphilic drive.

Intentional asphyxia, particularly performed alone, can be fatal [ 20 ]. The starvation of oxygen through hypoxia can lead to reduced blood flow to the arms, legs and hands, making it difficult to undo a restraint or stand [ 3 ]. This, alongside losing consciousness, are possible reasons for death occurring, even when those performing the behaviour are standing, kneeling or sitting. While consensual social-asphyxiation is performed with others, solo-asphyxiation is often concealed and only uncovered after a fatality; therefore, there are no routine public health statistics on its epidemiology [ 21 ].

A review of recorded deaths and news reports in the United States concluded that of 70 deaths of young people aged 6—19 years that were likely to be attributed to the choking game, Confirming the secretive nature of the behaviour, It is unclear whether these cases were fatal at the first practice of solo-asphyxiation or whether there had been a history of repeated behaviour prior to death.

Death may occur due to the individual believing that they can control the act of asphyxia and stop before losing consciousness. This, however, often happens quicker than expected and the risk is underestimated [ 23 ]. When deaths occur, if solo-sexual activity is present at the time of fatality, the coroner is more likely to determine accidental death rather than suicide [ 12 , 22 ].

However, without prior knowledge of solo-asphyxiation, coroners may be led to reach an open verdict or that of suicide. This view appears to be supported in a recent report [ 24 ], which shows that deaths by hanging in England were most likely However, the majority of deaths deemed accidental via solo-asphyxiation [ 23 ] showed no evidence of solo-sexual activity or an escape mechanism e. Hanging was reported as the most common suicide method in the United Kingdom in , with a higher prevalence among men Deaths by hanging and accidental hanging have also been found to be ificantly higher in males than females during adolescence aged 10—19 years [ 27 ].

This may be a of unknown or misunderstood solo-asphyxia accidental deaths, otherwise attributed to suicide. There is evidence that the practice of intentional asphyxia is initiated from an early age, and that a large proportion of young people are aware of asphyxia-related techniques e. Of those who had participated, Furthermore, there was a ificant relationship with other risk , including poor mental health, substance use, poor nutrition, exposure to violence, sexual activity and gambling [ 29 ].

Furthermore, they had a ificantly higher rate of suicide contemplation and poor mental health compared with those who played in groups [ 31 ]. Supporting a comorbidity link with the choking game, a survey of 9—year-olds from France revealed that 9. This research concluded that those engaging in the practice may be doing so to regulate negative mood stemming from depression [ 32 ]. This research is, however, limited, as it does not specify frequency of participation or distinguish social- and solo-asphyxiation behaviour.

The use of ligatures rather than hands in manual asphyxia and solo-play increases the risk to life and, sadly, awareness of this behaviour is most often uncovered after death. The floor is littered with pornographic magazines, a bottle of hand lotion, and several articles of women's underclothing. Though he hangs from a bar that would only meet him at eye level, his knees are bent and his full weight hangs from the Disney necktie he wore to his eighth-grade graduation.

The knot cinched up to his larynx resembles the bow that one typically uses to tie one's shoes. He then went to his bedroom to do his homework. Approximately 1 hour later, his mother went to check on him and discovered him slumped in a corner with a belt around his neck… No suicide note was found. The county medical examiner ruled that the death resulted from accidental asphyxiation by hanging.

No suicide note was found. The medical examiner determined that the teen had died at 9. They had played the game before, wrapping the towel around the neck and hanging from the dispenser. Estimated time of hanging was five minutes. Initial Glasgow coma score was 6 and pH was 7. He had a petechial rash on his face and a linear abrasion around the neck.

Fifteen to 20 minutes after asking to be excused from class, he was found in the wash-room with a towel from a towel dispenser wrapped around his neck. Initial Glasgow coma score was 3 with pH 6. He was supported in the intensive care unit but there was no neurologic improvement over 48 hours. After discussion with the parents, the decision was made to withdraw life support. The patient was resuscitated initially but died 5 days later after support was withdrawn. A sexual assault examination was performed, and the finding was negative.

The case was investigated as a possible homicide or suicide. Upon questioning relatives, it was disclosed that the deceased had played the choking game. No one knew she had been playing the game alone… Her mother found her in a partial suspension, hanging from the top bunk bed with 2 shoelaces tied end-to-end and around her neck. At the age of 14 years, he experienced first strangulation activity with friends at school using a scarf to induce the hypoxia.

After a short period of time experimenting with friends, he started strangulating himself, by using both fists to apply pressure to his carotid arteries. He described pleasant feeling of narcosis and transient amnesia at the beginning of this behavior, as well as transient hypoacousia and distortion of vision. These phenomena tended to decrease with time, with only the relaxing effect of self-strangulation remaining. Mr B started smoking marijuana occasionally at the age of 14 y.

He also fulfilled criteria for ketamine use disorder, with a debut at 17 y. At the time of clinical evaluation, Mr B was self-strangulating up to 40 times a day, only when alone, and describes no sexual arousal. He described frequent urges to self-strangulate, sometimes specifically avoiding contact with friends in order to engage in this behavior. He reported that he never made a ificant attempt stop this behavior before his hospital admission.

A clinical examination did not find any paraphilic disorder associated with this behavior, or any Axis I disorder. Mr B has no sexual impairment and was involved in a heterosexual relationship of 3 years duration. He was fully clothed and appeared to have no obvious injuries. There was no evidence of sexual activity and weather conditions were described as inclement. A mobile fingerprint machine was brought to the scene to assist in identification.

His fingers showed evidence of cyanosis and he was believed to have been dead for approximately fifteen hours before discovery. The police visited the deceased's family at their home and initially informed them of death by suicide hanging. He had planned a trip to the cinema with them that day and the family were in disbelief that the death was intentional.

At this visit, explicit details of the scene were not given to the family and a coroner's inquest was opened, to be held three months later. Presented at the inquest, a witness statement from the ambulance service described difficulty in the GPS tracking of the location of the deceased. A post mortem revealed he had consumed alcohol, but blood levels were below that of the UK drink drive limit. Medical reports and family statements revealed his struggles and desire to reduce a long-term battle with cocaine addiction. The family also revealed a preference for asphyxiation and hypoxic euphoria in a consensual relationship from an early age and experimentation of solo-asphyxiation as .

Mental health services and the family were unaware he was asphyxiating alone. It's clear that [the deceased] tied the ligature himself and attached it to a tree and intended to, I would say, lose consciousness—but lose partial consciousness. That's the act of euphoria. For a verdict of suicide I have to accept beyond all reasonable doubt.

If there's any element of doubt, it can't be suicide. I note there's no suicide note, there's no text or electronic communication, which we normally experience in this court. I understand the ligature was at a height he could stand up if he wanted to and I have heard this is something he practised. As a result I feel that the only legal conclusion I can come to is it was an accidental death. Better awareness of intentional asphyxiation is needed in both clinical and emergency settings.

A survey of physicians showed that more than a third were unaware of the choking game and therefore may miss presenting symptoms [ 39 ]. In , a health professional posted in a nursing forum for advice after a visit from a mother and adolescent son with ligature marks on his neck [ 40 ]. The mother had concerns of a suicide attempt, yet the male confided to the nurse that the marks were a result of solo-asphyxiation [ 40 ]. Better awareness of warning s such as bloodshot eyes, headaches, marks on neck, petechiae on face, ligatures tied to bedroom furniture, disorientation and mood swings is needed [ 40 ].

While there is research that suggests that mental health support services may be aware of some individuals who practise solo-asphyxiation, many are unknown until after a fatality [ 4 ]. As the practice of asphyxiation is rarely spoken of to family members of the deceased [ 4 ], there may be many accidental deaths mistaken for suicide in this way. Furthermore, family members may clean away paraphernalia from the scene of death to avoid perceived embarrassment [ 36 ], or emergency services may reach an incorrect conclusion at the scene of death, rendering a verdict of accidental death less probable.

While there is a dearth of research in this area, researchers presenting Case G concluded that solo-asphyxiation had the appearance of being highly addictive, with the individual performing solo-asphyxiation up to 40 times a day since adolescence [ 14 ].

Cognitive therapy treatment was delivered through an addiction ward, focusing on identification, exposure and ability to control high-risk situations, cognitive restructuring and restoring depleted self-esteem that led to cessation of the behaviour [ 14 ]. It could be argued that intentional asphyxiation has properties seen in addictive behaviours. Initiation often occurs with others, and the behaviour can provide an intense euphoriant effect.

Indeed, in some cases it may be the earliest stimulating behaviour encountered before alcohol, drugs and sexual pleasure , with multiple reports of its initiation in childhood and adolescence [ 14 , 15 , 17 , 28 , 33 ]. This euphoriant effect may lead to establishment of an entrenched pattern of behaviour despite the risk of death.

There are also reports that tolerance to the psychological effects of asphyxia can develop [ 14 , 34 ]. The insula, a region in the brain that has been linked to decision-making in relation to risk and reward, is thought to have an important role in addiction [ 41 , 42 ]. This part of the brain is also involved in processes that control breathing, and could provide some explanation to the potential addictive qualities of asphyxia.

Research is needed with living performers of intentional asphyxiation. The dearth of research to date may be due to its secretive nature and associated stigma. It would be worth examining how far those who practice the behaviour experience a sense of loss of control over the behaviour, and their interest in receiving treatment to address this.

Research is also needed into public health advice and support for those practising this behaviour and their families. As with recognized addictive disorders, a harm reduction approach may be worth investigating, including guidance for the safer practice of intentional asphyxiation, such as use of fail-safe mechanisms.

Intentional self-asphyxiation may have addictive properties. There is evidence of early initiation, the development of an entrenched behaviour pattern driven by strong euphoriant effects, often linked to mental health problems without adequate regard for risk of death. With this in mind, it would be worth examining how far prevention, treatment approaches and harm reduction used for addictive disorders could be used to address this problem.

Volume , Issue 4. The full text of this article hosted at iucr. Please check your for instructions on resetting your password. If the address matches an existing you will receive an with instructions to retrieve your username. Addiction Opinion and Debate Open Access. Angel Marie Chater , Corresponding Author angel. E-mail: angel. First published: 04 September Tools Request permission Export citation Add to favorites Track citation. Share Share Give access Share full text access.

Asphyxiation bdsm

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