RetractedArticleLiterature Review

Review: Autoerotic Asphyxiation in the United States

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Abstract

The purpose of this article is to define autoerotic asphyxia and present the enigma as a preventable problem. Articles published between 1856 and 1994 are identified through medline, referenced citations, and expert opinion. The literature selected were those most often cited and for which the methodological assumptions could be identified. Interventional strategies determined included legislation/regulation, technology, and education. Injury and death from autoerotic asphyxia can be controlled by pre-event, event, and post-event phase control. However, there are formidable barriers in the way.

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... Since the 1950s an ever-increasing number of accidental autoerotic deaths (AADs) have been reported [1,2,8,9,10,14,15,16,19,23]. However, the vast majority of reported cases have been males. ...
... Thus, cases of autoerotic fatalities among females are not only rare but also pose a challenge to investigators. Moreover, most of the female cases reported in the literature are identical and not all cases designated as AADs fulfilled the criteria according to the definition [2,3,4,5,6,7,8,9,10,11,14,15,16,17,19,20,21,22,23], which requires an accidental, solitary death caused by a lethal paraphilia [1]. Persons who engage in paraphiliac behaviour and who accidentally "overdo" the paraphilia needed for their sexual arousal and orgasm may die of the paraphilia. ...
... In the literature, 57 female AADs have been reported but many of them are identical ( Table 2). When the remaining cases [3,6,7,10,11,13,16,17,19,20,21,22,23] are scrutinised according to the definition of AAD, according to which, a death is only an AAD if it is solitary, accidental and caused by a lethal paraphilia, only 10 cases [3,11,13,16,17,22] fulfil these criteria ( Table 2). The rest of the cases would better be described as either suicides [19], natural death during masturbation [8,9,10,20] or accidents not directly caused by lethal paraphilia [6,7,8,9]. ...
Chapter
Accidental autoerotic death (AAD) is defined as a solitary, accidental death caused by a lethal paraphilia including hanging, strangulation, invert suspension, plastic-bag asphyxiation, electrophilia, and anesthesiophilia. Young white men comprise the largest group of victims, whereas the number of female AADs reported in literature is extremely small. In both sexes, AAD is most often seen in young to middle-aged adults. Practitioners tend to utilize a great range of elaborate devices and props, often designed to cause real or simulated pain, with pornographic material and evidence of cross-dressing and fetishism like intimate feminine garments. The absence of typical props in the majority of female AADs may impede the differentiation of AADs from suicides or homicides. To exclude the possibility of sexual homicide or suicide, investigators must establish the presence of key death scene characteristics before the death can be appropriately classified as an autoerotic fatality. The location elected for the autoerotic performance is usually secluded, often with evidence of repeated autoerotic behavior. Bondage is common, and death scene investigators must ensure that any bondage could have been secured by the deceased himself. Padding of the rope, especially in neck ligatures, to prevent subsequently detectable abrasions or bruises is regularly found. Because of the accidental nature of AAD, a failed rescue mechanism is usually evident. A lack of features of suicide with no antemortem evidence of suicidal ideation or depression is diagnostic for AAD; an overt suicide note is usually not present. Thorough investigations regarding life and environment of the victim and the circumstances of death may be effective in the determination of the manner of death in equivocal cases. Twelve general behavioral characteristics that investigators can look for to help them identify autoerotic death scenes are listed.
... Since the 1950s an ever-increasing number of accidental autoerotic deaths (AADs) have been reported [1,2,8,9,10,14,15,16,19,23]. However, the vast majority of reported cases have been males. ...
... Thus, cases of autoerotic fatalities among females are not only rare but also pose a challenge to investigators. Moreover, most of the female cases reported in the literature are identical and not all cases designated as AADs fulfilled the criteria according to the definition [2,3,4,5,6,7,8,9,10,11,14,15,16,17,19,20,21,22,23], which requires an accidental, solitary death caused by a lethal paraphilia [1]. ...
... In the literature, 57 female AADs have been reported but many of them are identical ( Table 2). When the remaining cases [3,6,7,10,11,13,16,17,19,20,21,22,23] are scrutinised according to the definition of AAD, according to which, a death is only an AAD if it is solitary, accidental and caused by a lethal paraphilia, only 10 cases [3,11,13,16,17,22] fulfil these criteria ( Table 2). The rest of the cases would better be described as either suicides [19], natural death during mas-turbation [8,9,10,20] or accidents not directly caused by lethal paraphilia [6,7,8,9]. ...
Article
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Four previously unpublished cases of female asphyxiophilia are presented. All women were found immobilised by obviously self-tied ropes, string or handcuffs. The women, who were alone at the time of death, died of a lethal paraphilia. The autopsies revealed asphyxiation as the cause of death, caused in two cases by suffocation as a result of hanging and strangulation and in the other two cases by plastic bags placed over the individuals head. In one case there was additional evidence at the scene that the deceased had inhaled ether. In none of the four cases was there any indication that the asphyxiation was due to homicide or suicide. Thus they can be described as accidental autoerotic deaths (AAD). The four cases closely mirror findings from scenes of male AADs, although autoerotic practices are generally believed to be rarer among females than in males.
... Studies of AEA present a typology of features in which the performance of AEA is built around the use of props which contribute to the act's mise en scène (see Blanchard and Hucker 1991, Cooke et al. 1994, Uva 1995, Jenkins 2000. Of primary importance is the use of a ligature and restraint typically identified with acts of bondage and, crucially, some form of escape mechanism, used to release the pressure causing the asphyxia. ...
... The psychopathology of AEA has been commonly explored through masturbatory guilt, castration anxiety and sexual masochism. Crucially, however, risk and risk-taking behaviour is acknowledged as the most common motivation (see Hazelwood et al. 1983, Cooke et al. 1994, Uva 1995Jenkins 2000;Cowell 2009). The risk of harm in erotic asphyxiation as a practice shared between partners has led to its marginalisation in sadomasochistic (SM) communities as it appears to be a direct affront to those who subscribe to the 'safe, sane and consensual' maxim. ...
Article
Celebrity sexual scandal has long attracted the attention of the popular media and is a motivating force in the construction of celebrity identity. Its aftermath is often carefully stage-managed by agents, publicists and promoters, but always mediated and beyond the control of the celebrity. It is the relationship between celebrity and a particular sexual transgression – autoerotic asphyxiation (AEA) – that is our focus here in terms of how celebrity and AEA have been similarly read and discussed. This is illustrated through a consideration of the diverse case studies of the peculiarly perverse and untimely deaths of INXS front man Michael Hutchence, found naked in a hotel room in 1997, veteran B-movie actor David Carradine, discovered hanging from a wardrobe in a Thai hotel in 2010, and the bizarre reports regarding British Conservative MP Stephen Milligan's death in 1994. In considering the practices and discourses around it, we argue that AEA both reveals and makes sense of the tensions and contradictions inherent in celebrity identity. In particular, the article considers the complex negotiations between the private and public selves, contradictory discourses that seek to make sense of an AEA death and the impact it has on the celebrity persona. Ultimately we argue that the nature and content of the sex act and death reconfigures and fixes the celebrity identity that existed prior to the celebrity's association with AEA.
... Auto-erotic asphyxiation is a recognized paraphilia that involves the deliberate induction of cerebral hypoxia, up to but not including the loss of consciousness, in order to enhance or produce orgasm (Hucker & Stemac 1992;American Psychiatric Association 1994;Uva 1995). The asphyxiation in this auto-erotic behaviour is reported to be achieved by a variety of means, and frequently, results in the accidental death of the individual involved. ...
... There are only a few accounts of the treatment of auto-erotic asphyxiation in people without disabilities; these have included the use of medication (Cesnick & Coleman 1989), behaviour therapy involving covert sensitization and teaching of coping strategies (Haydn-Smith et al. 1987), and education (Uva 1995). A literature search did not identify any case of treatment of this behaviour in individuals with an intellectual disability 1 . ...
Article
Background The treatment of individuals with severe intellectual disabilities who engage in self-injurious sexual practices and are incapable of giving consent poses a significant challenge to health care services. Treatment options can be highly personal and intrusive, and potentially pose a risk of litigation. However, there is also a risk of being prosecuted for negligence if necessary treatment is not pursued. This paper discusses the treatment of an individual engaged in such a behaviour – auto-erotic asphyxiation. It describes how the legal aspects of the design and implementation of the treatment approach were handled.Methods The treatment approach involved a behavioural and psycho-educational programme. A single case study methodology was utilized in order to assess the effectiveness of the intervention.Results The intervention led to the learning of new adaptive behaviour. Auto-erotic asphyxiation ceased and the individual's masturbatory behaviour changed sufficiently to reduce the threat of mortality. Qualitatively, a significant reduction in the level of stress experienced by the individual's family was reported.Conclusions It is concluded that behavioural and educational techniques may be effective in the management of such cases. Further research replicating such techniques with similar cases is required prior to the efficacy of this treatment becoming established.
... 'Typical' autoerotic death refers to ligature asphyxiation which comprises the majority of these cases [54,66,68]. Table 28.1 characterizes the 'typical' autoerotic asphyxia participant [31,67,75]. 'Atypical' autoerotic death encompasses the remainder of the asphyxiation mechanisms such as plastic bag asphyxia [39,40,51,63,68], inhalation of noxious chemicals such as propane, butane and nitrous oxide [27,35,36,44,46,47,68,69], aqua-eroticum [32,60,71] and includes other acts designed to attain sexual fulfilment, such as electricity [2,19,42,65,68,70], injection of air into the penis leading to generalized subcutaneous emphysema [74], insertion of a crochet needle into the urethra in a woman [22] and metal devices or a plastic bottle constricting and/ or inserted into the penis [1,5,23]. ...
... As autoerotic deaths are innately enigmatic, awareness that this practice may lead to a fatality is critical. Emergency medicine physicians who may encounter participants of autoerotic asphyxia should be educated about the risk factors associated with this behaviour and should be encouraged to identify, report and counsel families and friends coping with autoerotic asphyxia [75]. Several myths pertaining to autoerotic asphyxia persist, and this chapter has strived to dispel these myths (Table 28.5) [55]. ...
... From the epidemiological point of view most cases have been described by American authors [16,17], with an incidence in the USA of 1 to 2 deaths in every one million habitants; in Canada the incidence seems to be decreasing [18], but a higher prevalence in women has been noticed. A recent study in Australia showed a rate of 0.3 cases per million inhabitants per year [19]; the same study showed a rate of 0.1 cases in Sweden; in Germany the estimated incidence is equal to 0.49 cases, while in Scandinavia it is about 1 to 2 per million inhabitants [20]. ...
... According to the literature the age range involved in such practices is between 16 and 74 years (mean 33 ± 12) [18]. In a Uva's review [17], 71% of the victims were under the age of 30 years old. In adolescents this practice seems relatively common, although the differential diagnosis with another typical practice of the adolescent world that has nothing to do with sexual pleasure must always be taken into consideration, and that is the 'choking game' [27,28]. ...
Article
Literature describe relatively few studies about accidental death in autoerotic maneuvers. Authors report three new cases on this topic that involved adult male individuals. The purpose of the paper is to increase the knowledge and the classification of the phenomenon and give a contribution for the forensic medicine and psychiatric implications. The dynamics of the investigation of the scene, the autopsy finding and the examination of the medical history are particularly important for forensic professionals that must classify the event as a suicide, homicide or as an accidental event. The Authors describe the phenomenon also from the epidemiological point of view that shows a high prevalence of men, even if in Italy there are not official estimates. Last but not least the Authors and take in consideration and discussed about the existence in the subject of a para-physiological habitude or a real type of pathology as paraphiliac disorders (masochism, fetishism, travestic fetishism).
... The condition of such corpses also suggests that asphyxiophilia is frequently comorbid with other paraphilias: The corpse is sometimes cross-dressed or wearing makeup, the content of pornographic material is of a sadomasochistic nature, or the corpse is found with self-applied gags or bindings on his hands, feet, or genitals (Blanchard & Hucker, 1991). In Diagnostic and Statistical Manual of Mental Disorders (4th ed., Text rev.) (DSM-IV-TR; American Psychiatric Association [APA], 2000), asphyxiophilia is called "hypoxyphilia," under the presumption that hypoxia enhances sexual sensations (e.g., Uva, 1995). Such an association has not been established, however; the sexual interest might instead be focused on psychological associations with the actual behaviors, rather than with any physiological effects of hypoxia (Blanchard & Hucker, 1991). ...
... I am not confident that the resistance would be so robust or unequivocal in the current climate. 12 The mortality rate range of autoerotic asphyxia has been estimated at between 250 to 1000 deaths per year in the United States (Uva, 1995) ...
Article
Full-text available
The case for using academic journals lists is critically scrutinised. An effect of their use, it argued, is to stifle diversity and constrict scholarly innovation. A monoculture is fostered in which a preoccupation with shoehorning research into a form prized by elite, US-oriented journals overrides a concern to maintain and enrich the diversity of topics, the range of methods and the plurality of perspectives engaged in business and management research. Use of a particular journal list, such as the one prepared by the Association of Business Schools (ABS), can come to dominate the scholarly terrain of a particular discipline with consequences that can be damaging to funding as well as to research culture.
... The maximum number of retracted articles were from the USA (313; 39.37%), followed by Germany (151; 18.99%). The maximum number of retracted articles on mental disorders (21; 37.50%) was also from the USA (14)(15)(16)(17)(18)(19)(21)(22)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36). The USA was followed by the UK, which was the origin of 17.85% (10 in number) of the retracted articles. ...
Article
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This study was aimed at assessing the retracted medical literature on mental disorders. Another aim was to test the hypothesis that the weak research infrastructure in certain countries and the rising pressure to publish in Asia due to the progress of science in that continent may have contributed to the increase in the number of retractions. A bibliometric search was carried out using the PubMed database. The data were analysed using SPSS version 21. The retraction rate for articles on mental disorders (number of retracted articles per 100,000 published articles on mental disorders) varied from a low of 3.56 (for 2005) to a high of 49.25 (for 2012). Of the 38 articles for which the reasons for retraction could be accessed, 10 (26.31%) were retracted for fraud. Overall, 0.0138% of all articles on the biomedical sciences were retracted. Of the articles on mental disorders, 0.0095% were retracted. There was a disproportionately greater number of retractions in the case of articles originating from low- and middle-income countries than high-income countries. Similarly, there was a disproportionately greater number of retractions in the case of articles originating in Asian countries than non-Asian countries.
... xii The mortality rate range of autoerotic asphyxia has been estimated at between 250 to 1000 deaths per year in the United States (Uva, 1995) ...
Article
Full-text available
The case for using academic journals lists is critically scrutinised. An effect of their use, it argued, is to stifle diversity and constrict scholarly innovation. A monoculture is fostered in which a preoccupation with shoehorning research into a form prized by elite, US-oriented journals overrides a concern to maintain and enrich the diversity of topics, the range of methods and the plurality of perspectives engaged in business and management research. Use of a particular journal list, such as the one prepared by the Association of Business Schools (ABS), can come to dominate the scholarly terrain of a particular discipline with consequences that can be damaging to funding as well as to research culture.
... 8 It has been increasingly identified over the past few decades as a cause of accidental death. 9 The most common scenario in adolescents is thrill-seeking behavior and/or sexual experimentation merged with a pseudomasochistic fantasy of bondage and pain. 1 The risk of sudden accidental death due to loss of consciousness and loss of control of the strangulation device differentiates this behavior from attempted suicide, so it should be treated, and future care planned, accordingly. 9 ...
... General agreement exists regarding the potential for serious injury or death among certain sexual practices associated with S&M, particularly related to sexual asphyxiation. Uva (1995) estimated between 250 and 1000 deaths occur due to autoerotic asphyxiation in the United States each year. Similarly, Litman and Swearingen (1972) estimated 50 deaths per year in the United States due to asphyxiation associated with bondage. ...
Article
The current exploratory study investigated associations between personality and psychopathology, as measured by the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), and engagement in sadomasochistic (S&M) behaviors in a sample of individuals presenting for treatment of problematic sexual behavior and/or sexual addiction. Profiles were established by sex for both low-risk (e.g., seeking out humiliation and loss of power during sexual experiences) and high-risk (e.g., engagement in sexual asphyxiation) presentations. A series of correlation and multiple regression analyses were conducted to establish associations. Results indicated that a scale measuring trauma-related symptoms (PK) predicted both high-risk and low-risk S&M behaviors, across sexes. Among men, schizoptypal characteristics, hypomanic activation, disconstraint, and negative emotionality predicted both risk levels. Low-risk behaviors in men were also predicted by self-deprecation, familial alienation, low positive emotions, and anxiety. Conversely, high-risk S&M behaviors in men were predicted by antisocial behavior, trait psychoticism, and generalized fearfulness. High-risk S&M behaviors in women were predicted by self-deprecation, disconstraint, competitiveness, anger, antisocial behaviors, and aberrant experiences, among others. History of sexual abuse was a predictor of low-risk and high-risk S&M behavior in women only. Findings are discussed in terms of implications for treatment and further research.
... alcohol, drugs, various gaseous substances, etc.) [7]. Statistics regarding this phenomenon are not clearly known, however, autoerotic asphyxia most often involves white males between 9 and 80 years of age [4][5][6][7][8]. ...
Article
"Autoerotic asphyxia" typically involves an individual hanging or ligature, resulting in self-induced oxygen deprivation brought about by neck compression during sexual activity. Little about the so-called "atypical forms" of autoerotic asphyxia, which also involve compression of the chest or abdomen, has been published in forensic literature. When death results from such practices, they are usually deemed accidental, however, suicide or homicide must also be considered. The authors present a single case of accidental fatal asphyxia by the simultaneous compression of the neck, chest, and abdomen using a chair-bed. The victim was known to have had masochistic tendencies. In order to confirm the hypothesis of accidental death, the results of crime scene investigations, and autopsy findings, including histological and toxicological analysis, are summarized here.
... Asphyxiophilia is one of the most dangerous conditions associated to SMD and is characterized by the use of various strategies to achieve the level of oxygen depletion needed to enhance sexual arousal, such as self-strangulation, hanging, suffocation with an object like a plastic bag over the head, chest compression, use of gas or volatile solvents, or a combination of these, up to the point of loss of consciousness [5]. Participants often establish some sort of "rescue mechanism" as a safety release in case they lose consciousness. ...
Article
Full-text available
DSM-5 distinguishes between paraphilias and paraphilic disorders. Paraphilias are defined as atypical, yet not necessarily disordered, sexual practices. Paraphilic disorders are instead diseases, which include distress, impairment in functioning, or entail risk of harm one?s self or others. Hence, DSM-5 new approach to paraphilias demedicalizes and destigmatizes unusual sexual behaviors, provided they are not distressing or detrimental to self or others. Asphyxiophilia, a dangerous and potentially deadly form of sexual masochism involving sexual arousal by oxygen deprivation, are clearly described as disorders. Although autoerotic asphyxia has been associated with estimated mortality rates ranging from 250 to 1000 deaths per year in the United States, in Italy, knowledge on this condition is very poor. Episodes of death caused by autoerotic asphyxia seem to be underestimated because it often can be confounded with suicide cases, particularly in the Italian context where family members of the victim often try to disguise autoerotic behaviors of the victims. The current paper provides a review on sexual masochism disorder with asphyxiophilia and discusses one specific case as an example to examine those conditions that may or may not influence the likelihood that death from autoerotic asphyxia be erroneously reported as suicide or accidental injury.
... Although it is unrealistic to expect general pediatricians to become experts in the management of complex biopsychosocial disorders such as AEA, familiarity with this paraphilia will be helpful in identifying and discouraging child/adolescent choking games that can progress to fully developed AEA. Uva, 28 for example, recommended preventive strategies such as including AEA in national or state electronic injury data systems, including such practices in school sex education programs for students and parents, and discouraging television producers from sensationalizing AEA. She would also teach mothers of newborns how to breastfeed infants properly to avoid partial asphyxiation and the hypothesized suffocation cycle (a technique generally taught to mothers who are breastfeeding). ...
Article
Voluntary asphyxiation among children, preteens, and adolescents by hanging or other means of inducing hypoxia/anoxia to enhance sexual excitement is not uncommon and can lead to unintended death. This study addresses autoerotic asphyxiation (AEA) with the intent of increasing pediatricians' knowledge of the syndrome and awareness of its typical onset among young patients. AEA is characteristically a clandestine and elusive practice. Provided with relevant information, pediatricians can identify the syndrome, demonstrate a willingness to discuss concerns about it, ameliorate distress, and possibly prevent a tragedy. A retrospective study was undertaken of published cases both fatal and nonfatal and included personal communications, referenced citations, clinical experience, and theoretical formulations as to causation. Characteristic AEA manifestations, prevalence, age range, methods of inducing hypoxia/anoxia, and gender weighting are presented. All sources were used as a basis for additional considerations of etiology and possibilities for intervention. AEA can be conceptualized as a personalized, ritualized, and symbolic biopsychosocial drama. It seems to be a reenactment of intense emotional feeling-states involving an identification and sadomasochistic relationship with a female figure. Inept AEA practitioners can miscalculate the peril of the situation that they have contrived and for numerous reasons lose their gamble with death. Pediatricians should be alert to the earliest manifestations of AEA. Awareness of choking games among the young and, of those, a subset who eventually progress to potentially fatal AEA is strongly encouraged among all primary care professionals who may be able to interrupt the behavior.
... They are almost always homicidal except in the extremes of age or in otherwise healthy adults who are under the influence of drugs or alcohol or are epileptics or imbeciles [9,10]. In some cases they have been observed in those individuals who are engaged in paraphilia or asphyxiophilia [11,12]. ...
Article
Full-text available
Case Report Way back in 1929, the accidental death of famous dancer Isadora Duncan gained a high profile. Even to this day, there are reports of accidental strangulation, though rarely. And we refer these to as Isadora Duncan syndrome. We report such a case of accidental strangulation in which the orna (dupatta) of the pillion rider got entangled into the rear wheel of a motorcycle and constricted her neck. We also intend to increase the awareness among the Indian population about the caution and care while wearing traditional clothes and drapes and the safety measures required in motorcycles/rickshaws to prevent such incidents.
... 1 Hanging is a common form of autoerotic asphyxiation, though may be overrepresented in the literature due to unintentional deaths resulting from such practices. [2][3][4][5] Annually, between 200 and 1000 people in the United States (U.S.) -mostly men -are estimated to die from autoerotic asphyxiation 5,6 due to oxygen deprivation, neck compression, airway obstruction, and other causes. [7][8][9][10] ...
Article
Objective: In a random sample of undergraduate students, we aimed to: (1) establish the prevalence of choking and being choked; (2) examine demographic and situational predictors of being choked, and (3) examine demographic and situational predictors of choking someone. Participants: 4168 randomly sampled undergraduates at a large public U.S. university. Methods: A cross-sectional, confidential online survey. Results: We found that 26.5% of women, 6.6% of men, and 22.3% of transgender and gender non-binary participants reported having been choked during their most recent sexual event. Additionally, 5.7% of women, 24.8% of men, and 25.9% of transgender and non-binary participants reported that they choked their partner at their most recent event. Choking was more prevalent among sexual minority students. Conclusions: Choking is prevalent among undergraduate students; implications for college sexual health education are discussed.
... La littérature entre 1954 et 2004 rapporte 408 cas dans 57 articles (19) les âges allant de 9 à 77 ans. Ainsi aux Etats-Unis elle est estimée à 250 à 1000 morts par an (20), en Scandinavie elle est estimée à 0.5 à 1 par million d'habitats (21). ...
Thesis
La pendaison manquée reste une pathologie relativement fréquente d?admission en réanimation médicale soit 84 cas entre 1998 et 2010 à l'Hôpital Central du CHU de Nancy. Cette population importante vis-à-vis de la littérature internationale permet de faire une étude sur la prise en charge, les facteurs pronostiques etle devenir de ces patients. Après un bref rappel historique et social de la pendaison, le problème est abordé dans le cadre actuel du suicide. Le mécanisme de la pendaison est abordé d?un point de vue anatomique et physiopathologique, en fonction des différentes définitions utilisées en médecine. Une présentation de la prise en charge médicale de la pendaison est abordée ainsi qu'une revue de la littérature internationale sur ce sujet ainsi que les données antérieures nancéennes.L'étude porte sur 79 cas. Elle suivra l'ordre chronologique de la prise en charge depuis la découverte du pendu jusqu'à sa sortie de réanimation. L'étude présente les différents paramètres cliniques, paracliniques ou biologiques de chacune de ses étapes en recherchant les critères significatifs de bons ou de mauvais pronostiques. Cette thèse confirme les données de la littérature antérieure concernant le score de Glasgow, l'arrêt cardio-respiratoire et met en évidence de nouveaux facteurs pronostiques cliniques et biologiques. Une deuxième partie de l'étude porte sur le devenir du groupe des patients vivants à la sortie de laréanimation (58%). 33 personnes ont pu être contacté, mettant en évidence la bonne évolution souvent sans séquelles de cette population avec très peu de récidive
... [24][25][26][27][28] Further, strangulation as part of solo masturbation has also been noted due to the occasional unintentional deaths, mostly of young men. [29][30][31][32][33] Given the potential health risks, including death, associated with choking/strangulation whether as part of sex, non-sexual adolescent "choking games," or intimate partner violence (IPV), [34][35][36][37][38] we need to better understand these sexual behaviors and how they fit into college students' broader sexual exploration. ...
Article
Background Probability-based surveys of college students typically assess sexual behaviors such as oral, vaginal, and anal sex. Little is known about the broader range of sexual behaviors in which students engage. Aims In a random sample survey of undergraduate students, we aimed to: (1) describe how recently participants had engaged in solo and partnered sexual behaviors, (2) examine how frequently participants enacted certain rough sex sexual behaviors (e.g., light spanking, hard spanking, choking, slapping, and others), (3) assess participants’ frequency of experiencing certain rough sex behaviors, (4) describe participants’ frequency of threesome/group sex, (5) assess the characteristics of participants’ experiences with choking during sex; and (6) examine choking and face slapping in regard to consent. Methods A confidential, online cross-sectional survey of 4,989 randomly sampled undergraduate students at a large U.S. university. Outcomes Participants reported having engaged in a broad range of solo and partnered sexual activities, including rough sex behaviors. Results The most prevalent general sexual behaviors were solo masturbation (88.6%), oral sex (79.4% received, 78.4% performed), penile-vaginal intercourse (73.5%), and partnered masturbation (71.1%). Anal intercourse was the least prevalent of these behaviors (16.8% received, 25.3% performed). Among those with any partnered sexual experience, 43.0% had choked a partner, 47.3% had been choked, 59.1% had been lightly spanked and 12.1% had been slapped on the face during sex. Clinical translation College health clinicians and educators need to be aware of the diverse and evolving range of solo and partnered sexual behaviors reported by students. In addition to counseling students about pregnancy and sexually transmitted infection risk, clinicians might assess patients’ engagement in diverse sexual behaviors, such as choking/strangulation during sex, given the risk for serious outcomes including death. Strengths and limitations Strengths of our research include the large sample size, use of random sampling, high response rate for college populations, broad range of behaviors assessed, and novel data on choking during sex. Among our limitations, we did not assess to what extent the experiences were wanted, pleasurable, or appealing to participants. Except for in relation to choking and slapping, we also did not assess issues of consent. Conclusion Participants reported engaging in diverse sexual behaviors, some of which have important clinical implications, are understudied, and warrant further research. Herbenick D, Patterson C, Beckmeyer J, et al. Diverse Sexual Behaviors in Undergraduate Students: Findings From a Campus Probability Survey. J Sex Med 2021;XXX:XXX–XXX.
... AA and other accidental deaths in some way related to solitary sexual activity were described by Hazelwood, Dietz and Burgess [25] and their Autoerotic fatalities from 1983 is one of the first studies on this subject [see [26][27][28][29][30][31]. The vast majority of the findings on the characteristics of AA come from post-mortem forensic and medical examinations [31,32] and living breath-practitioners seldom present themselves to psychiatrists or reveal their preferences. Individuals can be accessed via Internet communities of people with atypical sexual preferences (e.g., fetlife.com), ...
Article
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The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders published in 2013 has proved to be particularly interesting in the field of sexuality. It introduced a number of significant changes in the definition of sexual norms, among them a widely discussed distinction between paraphilias and paraphilic disorders. The key criterion separating the abnormal sexual interests from the disordered ones is clinically significant distress resulting directly from sexual behavior and/or the risk of suffering or harm to another person as a result of one's sexual behavior. In the case of masochism - which addresses the phenomenon of suffering quite particularly - this distinction is troublesome. Using the example of autoerotic asphyxia - a behavior from the masochism spectrum - the authors critically examine the proposed DSM-5 method of defining the standards of sexual behavior. Interesting in this regard has been a comparison between autoerotic asphyxia and free diving - a nonsexual activity which, although also associated with possible loss of life by reduction of oxygen, has not been pathologized.
Article
Asphyxia may be broadly defined as any condition that leads to tissue oxygen deprivation. This article reviews traumatic causes of asphyxia, including the syn drome known as traumatic asphyxia, where a crush injury to the thoracoabdominal area gives the striking clinical triad of cervicofacial cyanosis and oedema, subcon junctival haemorrhage and cutaneous petechial haemorrhages of the face, neck and upper chest. Other traumatic causes of asphyxia reviewed are strangulation due to hanging and autoerotic asphyxiation. However bleak the initial prognosis may appear, any patient who presents with a history of asphyxiation should initially be resuscitated according to the prioritized approach: airway with cervical spine control, oxygenation and ventilation, and circulation. The clinical appearance of the patient is not an indicator of outcome. The identification and treatment of associated compli cations and injuries is vital, since these are a major cause of morbidity and mortality if the patient survives the initial asphyxiation insult.
Article
A case of sexual asphyxial death by hanging is presented. A 35-year-old male, found dead lying on his face in a bed of a truck cab, had hanged himself from a window frame using a leather belt. He was completely naked. There were pornographic and sadomasochistic magazines beneath his face, opened to pages depicted nude photographs of a woman. Autopsy findings revealed a ligature mark on the neck and petechial hemorrhages in the conjunctivae, but there were no hemorrhages in the neck muscles or fractures of the hyoid bone or the thyroid cartilage. The alcohol levels in the blood and urine were 0.78 and 0.45 mg/ml, respectively. The circumstances suggested that his death was accidental, and due to asphyxia by hanging performed to enhance sexual gratification during masturbation. Sexual asphyxia is reviewed and discussed.
Article
Relatively little is known about death in children following hanging. This 12-year retrospective study in southeast Scotland revealed 12 such deaths among children <15 years of age, involving 10 boys and 2 girls. The rate of hanging deaths was 0.7 deaths/100,000 children/year and was equal to that from falls in children during this time period. The children who died following hanging were aged between 4 and 14 years. All 12 children were in cardiac arrest when found, and 11 were declared dead at the scene, demonstrating the limited potential to reduce the death rate through improved treatment. Scrutiny of the circumstances surrounding each death suggested that 6 of the deaths were accidents and 6 were suicides. There appears to be some, albeit limited, potential to prevent some hanging deaths in children through increased parental supervision, education, and restriction of access to ligatures.
Article
Death resulting from plastic bag asphyxia has been recognized for >40 years, but relatively little is known about either its epidemiology or its pathophysiology. Over 15 years (1984-1998), 30 deaths were attributed to plastic bag asphyxia among the 14,560 autopsies performed in the Forensic Medicine Unit in Edinburgh. These 30 deaths involved 20 male and 10 female subjects, with an age range of 13 to 81 years. Eleven had some alcohol measurable in the blood, with four having levels >80 mg/dl. Only one individual appeared to have ingested a drug overdose, but inhaled substances within the plastic bag may have contributed to death in five cases. The absence of childhood accidental deaths may reflect successful preventive measures. The 3 accidental deaths involved adults (including 2 who died of autoerotic asphyxia), and the remaining deaths were 27 suicides. Of those who committed suicide, most (59%) had chronic psychiatric illness rather than chronic debilitating or terminal physical illness. In contrast with reports from the United States, publicity associated with "self-deliverance" did not result in an increased number of deaths from plastic bag asphyxia (4 deaths in this series). Analysis of the circumstances of all the deaths revealed them to be difficult to predict and hence prevent.
Article
The authors from the Florence Forensic Department present a case that demonstrates the paradigms attached to accidental deaths while performing autoerotic maneuvers. The incidents of such practices are underestimated and are only the tip of the iceberg since they do not represent the cases that are never reported due to successful practice. After analyzing the statistic data, the authors describe the case and discuss about the element that prove the accidental nature of the death and the importance of the correct application of forensic methodology at the scene and in the mortuary.
Article
The syndrome of auto-erotic asphyxia (AEA) involves the deliberate induction of cerebral hypoxia to produce or enhance sexual excitement. This sexual practice is normally only discovered when death results from the act because these individuals rarely seek professional advice. The practice of AEA in the living case presented here was initially misinterpreted as parasuicidal behaviour. This type of sexual behaviour should always be considered a differential for parasuicidal activity involving asphyxia. Aetiology, treatment and the need for health professionals to be aware of this syndrome are discussed.
Article
This case concerns an unusual suicidal plastic bag suffocation. An elderly white man was found dead and partially disrobed in his apartment lying supine on a sofa with a plastic bag closed by a rope over the head and the upper and lower extremities tightly tied with two other ropes, the end of both arranged into slipknots (self-rescue mechanism). Police investigations found no pornography in the apartment, and circumstantial data alleged no psychiatric disorders or suicidal intentions. The autopsy excluded signs of struggle and sexual intercourse as well as any type of injury or physical illness. Chemical analyses on the peripheral blood excluded acute drugs and/or alcohol intoxication. A differential diagnosis of the manner of death was performed, including scenarios of accidental autoerotic asphyxiation, homicide during either sexual activity or ritualistic, elderly suicide. The collected data most strongly supported the hypothesis of a suicidal asphyxiation simulating homicide to devolve a life insurance to the victim’s sons because of economic difficulties.
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Autoerotic death is an uncommon cause of death with higher prevalence in middle aged Caucasian people, usually but not always caused by accidental self-hanging. The main cause for it is a sexual compulsion of the practitioners, who seek controlled hypoxia as a mean to improve their sexual experience. In order to achieve this goal they try different methods to decrease their brain oxygenation: mechanical asphyxia, electrocution, chemical abuse, etc. Even though they usually take preventive measures sometimes these are not functioning properly making them loose their consciousness and finally die. This article presents a typical case of self-hanging associated with masochistic behavior.
Article
Autoerotic asphyxia is the induction of a state of oxygen deficiency to enhance sexual excitement and orgasm. It has been practiced for centuries, and there are many reports of fatalities. The authors report a case of a living participant that shows a number of characteristics different from those of fatalities. The case study also raises doubt about the conventional view that participants have no wish to die. We feel that further case studies of living participants will lead to a greater understanding of the practice and will facilitate treatment.
Article
Fractures of the human hyoid bone encountered in forensic anthropology cases involving apparent homicide victims have been interpreted as markers of strangulation. Caution is required in this assessment since modifications of the hyoid bone, cervical vertebrae, and cartilage of the trachea, thyroid and larynx may be the results of arrested ontogenetic development, hard-force trauma, autopsy mishandling and pathology. Some ten agents involving compression of circulatory vessels conducting blood to and from the brain are reviewed in this study which concludes with an account of a case investigated by the author where a homicide victim, a young Afro-American female living in Syracuse, New York, had a damaged hyoid bone. However, she had not been strangled by her aggressor; he killed her by pushing her living body against a wall. Only by examining all of the preserved osseous and cartilaginous structures of the neck may the forensic anthropologist achieve an accurate reconstruction of the manner of death associated with hyoid bone fractures.
Article
Between 1978 and 1997 the Institute of Legal Medicine of the Hannover Medical School examined 17 fatal autoerotic deaths. The incidence for the Hannover region was 0.49 cases per million inhabitants per year. The victims included 17 men with an average age of 36.8 years; a peak in the age distribution was seen between 20 and 29 years. Twelve of the men were found by friends or family in a domestic environment, while other situations in which the victims were found included the victim’s own car, a hotel room, a canal embankment, a public parking lot as well as the holding cell of the youth detention center. The men were of varying socioeconomic status and held a number of different types of jobs or still attended school. Five of the men were found completely nude, while five were only undressed below the waist. Four men wore women’s clothes and two were fully clothed with exposed genitals. Besides women’s clothes, other objects found at the scene included various types of sexual aids, including ropes, chains, metal bars, locks, sex magazines, condoms, plastic bags, rubber items, etc. In four cases blood alcohol levels between 0.1 and 2.5‰ (urine alcohol levels between 0.2 and 2.5‰) were found. Toxicologic examination revealed chloroform, ketamin, a propane–butane gas mixture in one case each, and in two cases cocaine and morphine. Causes of death included central paralysis after strangulation (seven cases), asphyxiation (4), subarachnoid hemorrhage (2), intoxication (1), hypothermia (1), left heart failure (1), and drowning (1). The history, findings at scene, and autopsy findings and, in individual cases, other investigations are of utmost importance to accurately reconstruct a fatal autoerotic accident.
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Choking/strangulation during sex is prevalent among young adults, with one study finding that 58% of women college students had ever been choked during sex. However, no qualitative study has examined women’s experiences with choking/strangulation during sex outside of intimate partner violence. The purpose of our qualitative interview study was to investigate women’s experiences with choking and/or being choked during partnered sex. Through in-depth interviews with 24 undergraduate and graduate women students ages 18 to 33, we sought to understand how women communicate about choking, their learning about and initiation into choking, their feelings about being choked and choking others, as well as consent and safety practices used in relation to choking. We found that women had first learned about choking through diverse sources including pornography, erotic stories, magazines, social media, friends, and partners. While all 24 women had been choked during sex, only 13 of 24 had ever choked a partner. They described having engaged in choking with men as well as women and with committed as well as more casual partner types. Participants described consensual and non-consensual choking experiences. While many women enjoyed choking, others did it largely to please their sexual partner. Women described different methods and intensities of having been choked. Although very few had ever sought out information on safety practices or risk reduction, and only some had established safe words or safe gestures with partners, participants consistently expressed a belief that the ways in which they and their partner(s) engaged in choking were safe.
Article
IntroductionThere are two forms of voluntary and temporary asphyxiation: the “fainting game” better known as “the choking game”, “blackout”, “space monkey” and the erotic asphyxiation. These conducts involve inducing cerebral hypoxia with the aim of developing an altered, euphoric-like state. Unlike the choking game, erotic asphyxiation implies a sexual activity. The objective of our work is to describe these two types of asphyxiation, which are little known by the medical world and nevertheless responsible of numerous complications, including death.Method We performed a systematic review (Medline, Science Direct) between January 1988 and August 2011 to identify the frequency, as well as the clinical and psychopathological data, and to present available ways of screening and management.ResultsThese practices correspond to two different categories. The fating game of concerns teenager risk behaviors. Erotic asphyxiation is a characteristic of young adult masochistic activity. Both of these practices pose the risk of evolving towards a behavioral addiction. According to the model of the affective-behavioral addiction, the fainting game has an addictive potential mainly for teenagers displaying mental and other addictive disorders. The erotic asphyxiation dependence is considered to be a paraphiliac addiction, which also features the tolerance mechanism. Consequently, dependent subjects experience the need to escalate exposure in order to reach the same level of pleasure. They increase the number, the time and the intensity of hypoxia, thus heightening the risk of death and complications. A behavioral addiction is therefore regarded as a risk factor.Conclusion We encourage clinicians to acquaint themselves with the main alert signs (preexisting risk factors, behavior modifications, neck erythema, unexplained somatic disorders) to screen patients for this type of conduct and to take into account such an addictive component in clinical settings.
Chapter
Eine 39 Jahre alt gewordene alkoholabhängige Frau habe von ihrem Hausarzt eine Packung Distraneurinkapseln (25 Stück) verschrieben bekommen, sie solle morgens und mittags je 1, abends 2 Kapseln einnehmen. Aus der Apotheke zurückgekehrt, begann sie zu Hause mit ihrem Ehemann Alkohol zu trinken, es sei zu einem Streit gekommen, in dessen Verlauf die Frau die Polizei angerufen habe. Der Ehemann sei daraufhin gegen 17.00 Uhr in Gewahrsam genommen und zur Wache verbracht worden. Ein Atemalkoholtest habe einen Atemalkoholwert von 1,29 mg/l ergeben. Gegen 04.00 Uhr morgens sei der Ehemann wieder entlassen worden (!). Er selbst habe angegeben, seine Ehefrau schlafend auf dem Sofa angetroffen zu haben, er habe sie geweckt, sie habe u.a. zu ihm gesagt, dass sie die Distraneurintabletten eingenommen habe. Ihr Zustand habe sich deutlich von dem bei sonstiger Alkoholisierung unterschieden. Gegen 05.30 Uhr habe er den Notarzt verständigt, der nur noch den Tod feststellen konnte.
Article
The Choking Game (TCG), practiced by adolescents, involves forced asphyxiation to obtain a ‘high’, occasionally causing seizures or death. Few parents report discussing TCG with their child despite their critical role in injury‐prevention. This paper examined parental knowledge of TCG and perceptions of TCG‐related discussions with their child. From parent responses, eight thematic elements were identified: Risks; Awareness; Peer Context; External Resources; Basic Information; Prevention Strategy; Participation; and Told Not To. We propose a guide for parents planning a TCG prevention discussion is offered based on naturally occurring parental conversations.
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Türkiye’de tıp eğitimi gerçek anlamda ilk kez 14 Mart 1827 tarihinde Vezneciler’de Tulumbacıbaşı Konağında Tıphane” adıyla kurulan okulda başlar. 1839’da “Mekteb-i Tıbbiye-i Adliye-i Şâhâne” adını alan okulda; Avusturya’dan gelen Dr. Charles Ambroise Bernard ilk kez adli tıp derslerini 1841’de “ Tıbb-i Kanuni” adı ile vermeye başlar ve ilk otopsi de başına sırık düşerek ölen bir işçinin cesedine uygulanır. Aradan bunca yıl geçmiş olmasına rağmen, bugün ülkemizde “adli tıp” olması gereken yerde midir? Bu soruya, “evet” yanıtı vermemiz ne yazık ki olanaksızdır. Tüm dünyada “adli tıp” ve daha genel bir ifade ile “adli bilimler” günümüzde bilim ve teknolojideki ilerlemelerle birlikte, birçok adli, tıbbi ve sosyal olayın aydınlatılmasında önemli bir konum kazanmıştır. İletişim ve teknoloji çağına dönüşen 21.yüzyıl adli tıbbı, sosyal, popüler ve bir o kadar da medyatik hale getirmiştir. Türkiye’de evrensel örneklerin dışında, adli tıbbın uygulamaları tek bir merkezi yapı olan Adli Tıp Kurumu bünyesinde yürütülmekte; üniversiteler büyük ölçüde bu uygulamaların dışında kalmaktadır. Adli tıbbın ülkemizdeki mevcut bu sistemi başlı başına devasa bir sorundur. Adli tıp ve adli bilimler alanında; öğrenci, asistan ve uzmanların eğitimi, bilginin elde edilmesi ve paylaşımı, materyalden yararlanma ve rutin uygulamalara katılımda ciddi problemler bulunmaktadır. Bu durum, doğallıkla bilimsel araştırmaların yapılması; bilginin toplumda üretilmesi, yayılması ve kullanımı açısından da önemli bir engel oluşturmaktadır. Öte yandan, görevi ve uzmanlığı ne olursa olsun, tüm hekimler meslek yaşamında adli tıp konularıyla hemen her gün karşılaşmaktadırlar. Mesleki olarak adli tıp konularında kendilerini geliştirmek, güncel bilgi ve uygulamalara ayak uydurmak durumundadırlar. İşte bu ortak çalışma, yalnızca adli tıp asistan ve uzmanlarına değil; adli tıp konuları ile karşılaşan tüm hekimlere ve hatta tıp öğrencilerine yardımcı olmak üzere hazırlandı. Toplumda her gün adli tıp ile ilgili sorunların artması ve adli tıbbın kimi zaman olumsuz da olsa hep gündemde kalması nedeni ile, bu tür bilimsel kaynaklara neden gereksinim duyulduğu aşikârdır. İstanbul Tabip Odası Yönetim Kurulu ve Klinik Gelişim Dergisi Yayın Kurulu’na; Adli Tıp özel sayısı çıkarılmasına destekleri için teşekkür ederiz. Klinik Gelişim Dergisi’nin bu özel sayısının hazırlanma sürecinde; adli tıp açısından “kitap formatı” niteliğinde, kapsamlı bir başvuru kaynağına dönüştüğünü gördük. Bu çalışma aynı zamanda, bizde adli tıbbın temel konularını içeren kitap ve benzeri çalışmalar arasında, “yerinde kaynak gösterme” yöntemi ile hazırlanmış, “derleme” türü, ilk kapsamlı çalışma özelliği de taşımaktadır. Bununla birlikte, konu başlığı seçimi ve içeriklerinde, derginin amacı ve hacmi dışına taşan bilimsel ayrıntılardan bilinçli olarak kaçınmaya çalıştık. Öte yandan bu ortak çalışmada, birçok meslektaşımızın, özellikle süre kısıtlılığı nedeni ile “yazar” olarak yer alamadığını üzülerek belirtmek zorundayız; anlayışla karşılanacağını umuyoruz. Tüm hekimlerin adli tıp konuları ile “hiç karşılaşmamasını” dileyemesek; “nadiren karşılaşmasını” dilesek de, bu çalışma şayet, hekimlerin gerek duyduklarında yararlanabilecekleri bir kaynak olabilecek ise, mutluluk duyarız. Saygı ve dostlukla… Mart 2009 Dr. Sermet KOÇ Dr. Muhammet CAN
Chapter
The mechanism of death in asphyxia is impairment of oxygen and carbon dioxide exchange. Mechanical asphyxia (i.e., physical interference with breathing and/or circulation) is frequently encountered in medicolegal death investigations. Although the presence of external and internal petechiae is considered a hallmark of an asphyxial death, this finding is not invariable in different types of mechanical asphyxia. Consequently, debate continues about the relative roles of impaired breathing and circulation in the formation of petechiae. Hanging is a common type of mechanical asphyxia, occurring under various circumstances, some unusual. A range of external and internal postmortem findings is observed. Other types of mechanical asphyxia can have more subtle physical signs stressing the importance of the systematic approach of the “complete autopsy” in these cases. In deaths caused by inhalation of toxic gas (e.g., carbon monoxide), confirmation of the cause of death is only by toxicological testing.
Chapter
Vorgeschichte: Eine 39 Jahre alt gewordene, alkoholabhängige Frau habe von ihrem Hausarzt eine Packung Distraneurinkapseln (25 Stück) verschrieben bekommen; sie solle morgens und mittags je 1, abends 2 Kapseln einnehmen. Aus der Apotheke zurück gekehrt, begann sie zu Hause, mit ihrem Ehemann Alkohol zu trinken. Es sei zu einem Streit gekommen, in dessen Verlauf die Frau die Polizei angerufen habe. Der Ehemann sei daraufhin gegen 17.00 Uhr in Gewahrsam genommen und zur Wache verbracht worden. Ein Atemalkoholtest habe einen Atemalkoholwert von 1,29 mg/l ergeben. Gegen 04.00 Uhr morgens sei der Ehemann wieder entlassen worden (!). Er selbst habe angegeben, seine Ehefrau schlafend auf dem Sofa angetroffen zu haben; er habe sie geweckt, sie habe u.a. zu ihm gesagt, dass sie die Distraneurintabletten eingenommen habe. Ihr Zustand habe sich deutlich von dem bei sonstiger Alkoholisierung unterschieden. Gegen 05.30 Uhr habe er den Notarzt verständigt, der nur noch den Tod feststellen konnte.
Deaths in an autoerotic setting are usually due to accidental asphyxia, in which the individual accidently hangs or strangles themselves while inducing hypoxia for the purpose of heightened arousal. Death occurs when the level of hypoxia causes the individual to lose consciousness and is thus unable to prevent the neck compression from becoming lethal. In some cases there is an "escape" mechanism incorporated into the set-up which may fail. In rare cases, death is not as an immediate result of the autoerotic activity and is as a result of natural causes, which may or may not be related to the process. This case demonstrates the death of a 69 year old male which has occurred in the setting of a complex autoerotic environment, not as a result of asphyxiation, but rather as a result of natural causes which is likely to have been brought about by repeated similar activity. The autopsy revealed pulmonary emboli and lower limb deep vein thrombosis. There was no other natural disease of note and no features considered typical of asphyxiation.
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Volatile substance abuse and autoerotic behaviour are distinct phenomenon. Still considerable overlap is observed in some cases. Autoerotic deaths in transvestite are reported in young males, who tend to experiment alone and are heterosexual. We present a rare case of an autoerotic death involving a fatal combination of plastic bag asphyxia, and, intoxication with inhaled toluene whitener and alcohol. Of note in this case is the fact that the victim was a male with transvestite attire. Toluene and alcohol are known to have additive effects. Furthermore, toluene inhalation may induce cardiac arrhythmias, particularly aggravated by high sympathetic activity during autoerotic ritual. We discuss the death scene investigation, past use of lethal and nonlethal paraphilia, and, findings at autopsy in arriving at conclusion of accidental mode of death.
Article
The first reports about death in connection with auto-erotic activities date back to around 1900 in the German literature. The individuals concerned are mostly discovered in locked-up rooms. It is also the experience from death investigations that there is usually no knowledge among the next of kin about such sexual preferences. Mostly, the individuals involved are men originating from all age groups and professional backgrounds, but usually beyond adolescence and middle age. The phenomenon is almost unknown in women. Death by strangulation represents the most frequent type, and this occurs partly with self-restraints. The body itself may exhibit signs of sexual stimulation and usually also represent the mechanism or the trauma leading to death. Injuries to the male genitalia can also result from a special variant of auto-sexual activity, namely from so-called 'kobold injuries'.
Chapter
The current Transplantation Act was passed by the German Parliament in 1997. Its primary intention was to create the prerequisites to encourage people to act as organ donors. Any organ donations from dead individuals are only permitted if brain death has been diagnosed beyond any doubt according to the regulations of the Transplantation Act. The organ donor has to be examined medically and there are special regulations regarding the conservation, preparation, storage and transport of human organs. Prior to any medical procedures aiming to obtain organs or tissues from a dead individual, it has to be absolutely ascertained that no person will ever be prematurely or incorrectly diagnosed as being brain dead. The typical perimortem involvement of the forensic medical expert comprises his or her presence in the operation theatre during organ retrieval.
Article
A records survey at the Office of the Chief Medical Examiner in Edmonton, Alberta from 1990 to 1997 reveals outdoor suicidal hangings to be a common occurrence, particularly in rural areas. These isolated settings may result in delayed discovery and decomposed remains. Three case studies are presented involving outdoor hangings with extended postmortem intervals - 5 weeks, 16 months and 10 years, respectively. The last case presented many of the diagnostic elements associated with autoerotic asphyxia and the difficulties of differentiating this accidental manner of death from suicide after 10 years of decay and scene deterioration are discussed.
Article
Suicides due to plastic bag asphyxia have been reported in the literature but remain unusual. The circumstances of such deaths are reviewed and illustrated by the case of a 32-year-old male who was found dead in a lorry cab. The remarkable point is that the victim followed instructions from an American movie he had watched. This case emphasizes the importance of the investigation to determine the manner of death.
Chapter
Forensisch-traumatologische Untersuchungen sind in vielfältigen rechtlichen Zusammenhängen von Bedeutung; sie dienen der Befunderhebung, Dokumentation und Asservierung. Bei der Beurteilung von Verletzungen sind Suizide, Suizidversuche, Selbstbeschädigungen einerseits, Unfälle und Unglücksfälle sowie Körperverletzungs- und Tötungsdelikte andererseits zu differenzieren. Unter Traumatomechanik versteht man eine schädigende Krafteinwirkung, die über eine Deformation eine Kontinuitätsunterbrechung, also eine Gefügetrennung des Gewebes nach sich zieht. Gewalteinwirkungen werden hinsichtlich ihrer Verursachung eingeteilt in mechanische Insulte (stumpfe und scharfe Gewalt), Schussverletzungen, Erstickungen, Tod im Wasser, thermische Energie (Hitze, Kälte), Elektrizität, Blitzschlag, Strahlen, Verhungern, Vernachlässigung, Kindstötung, Abtreibung, Tod in abnormer Körperposition etc.
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A substantial proportion of vaccine-preventable diseases occur among adults. Each year, there are more than 20,000 influenza-associated deaths during epidemics, approximately 40,000 deaths related to pneumococcal disease, and one to five cases of diphtheria. More than 300,000 hepatitis B infections occur annually, mostly in patients 15 to 29 years old. From 1982 to 1986, 96% of patients with tetanus were age 20 and older. Among young adults, 5% to 20% are susceptible to rubella and measles, and outbreaks occur where these persons congregate. Most adults are not immunized, despite recommendations for vaccines against these diseases. Vigorous efforts are needed to implement strategies to reduce disease incidence, morbidity, and death among adults.
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To identify and quantify the major external (nongenetic) factors that contribute to death in the United States. Articles published between 1977 and 1993 were identified through MEDLINE searches, reference citations, and expert consultation. Government reports and complications of vital statistics and surveillance data were also obtained. Sources selected were those that were often cited and those that indicated a quantitative assessment of the relative contributions of various factors to mortality and morbidity. Data used were those for which specific methodological assumptions were stated. A table quantifying the contributions of leading factors was constructed using actual counts, generally accepted estimates, and calculated estimates that were developed by summing various individual estimates and correcting to avoid double counting. For the factors of greatest complexity and uncertainty (diet and activity patterns and toxic agents), a conservative approach was taken by choosing the lower boundaries of the various estimates. The most prominent contributors to mortality in the United States in 1990 were tobacco (an estimated 400,000 deaths), diet and activity patterns (300,000), alcohol (100,000), microbial agents (90,000), toxic agents (60,000), firearms (35,000), sexual behavior (30,000), motor vehicles (25,000), and illicit use of drugs (20,000). Socioeconomic status and access to medical care are also important contributors, but difficult to quantify independent of the other factors cited. Because the studies reviewed used different approaches to derive estimates, the stated numbers should be viewed as first approximations. Approximately half of all deaths that occurred in 1990 could be attributed to the factors identified. Although no attempt was made to further quantify the impact of these factors on morbidity and quality of life, the public health burden they impose is considerable and offers guidance for shaping health policy priorities.
Article
As asphyxial episodes during autoerotic activity are rarely reported in women, a review of eight fatal cases and one near-fatal case was conducted to delineate more clearly the characteristics of this syndrome in women. Six cases involved characteristic fatal autoerotic asphyxial activity. The remaining two fatal cases were atypical in that the apparatus that was used for sexual purposes was not intended to cause asphyxia in one case and did not directly cause asphyxial death in the second case. The final case was not fatal. Significantly, the majority of women did not use unusual clothing, props, or devices to augment their activity, for example, five were completely naked and only one was found with elaborate clothing and extra ligatures. Six of the fatal cases had objective evidence of sexual activity, three had used neck padding to prevent chafing, and eight had failed self-rescue mechanisms. Of note, the initial impression in four cases (44%) was homicide (two), attempted suicide (one), and accidental death during sexual activity with a partner (one). These results support the assertion that the manifestations of female autoerotic asphyxial activity reported to date may be initially misleading to investigators. Our purpose in presenting these findings, therefore, is to increase awareness of the more subtle features of this syndrome in women in an attempt to reduce the potential for underdiagnosis or confusion with nonaccidental death in future cases.
Article
The goal of childhood injury control is to reduce disability and death from injury. The thesis of the structural approach is that losses due to injury can often be reduced most effectively by structural modification. Since injury results when agent and host interact in a permissive environment, preventive strategies can be aimed toward any of the factors that contribute to causation. Many injury control strategies are therefore available. To prevent or reduce injury, a strategy must work when used, and it must be used. Strategies that require frequent individual action may fail to be used when protection is needed. The structural approach, when available, embodies strategies that do not depend on the behavior of the individuals who need protection.
The syndrome of self-hanging while masturbating to achieve sexual gratification is known as “sexual asphyxia.” Its origins are obscure, but probably date back to the 1600s. The syndrome accounts for at least 250 deaths per year in the United States alone. Reported victims range in age from 11 to well over 60 years, but most are adolescents. Though typically perceived as happy, well-adjusted people, they are found hanging by the neck, often wearing women's clothing, apparently having died while masturbating. Few living practitioners have been interviewed. The case report of one is presented here. A developmental model is proposed to explicate the differences and similarities between adolescent and adult practitioners.
Article
A series of 43 deaths of white men during autoerotic sexual activity have been reviewed and the results of this study have been related to prior reports of autoerotic deaths in the literature. The majority of the deaths occurred in young men, less than 25 years of age. Although the investigative and pathologic findings were consistent with accidental deaths in 36 cases, there was evidence suggestive of suicide in 3 cases, and in 4 cases the manner of death was undetermined. Transvestism was associated with this activity in one-third of the cases. The psychodynamics of autoerotic sexual activity, as well as the relationship to transvestism, have been discussed. Although this entity is well known among forensic pathologists who consider it an accidental manner of death, insurers are less inclined to provide accidental death benefits in these cases. There is a need for greater public awareness of this entity for it is believed that some of these deaths among young men may be prevented with appropriate psychiatric intervention. The recent widespread dissemination of pornographic literature and films depicting explicit, deviant sexual activity may contribute to knowledge of autoerotic practices among persons with underlying psychiatric illness. Because of an increase in sexual experimentation among young persons and because of an increased awareness among investigators of the entity of autoerotic asphyxial deaths, one may expect the number of reported cases to increase in the future.
Article
The author has reported what appears to be a clearly defined masochistic hanging in the female. This is supported by many of the usual characteristics inherent in most male hangings. Although it was not the function of the police, a background study of the victim by a medical authority unfortunately was not made, which is so often the case in deaths due to sexual asphyxia.
Article
Autoerotic asphyxia is the practice of self-inducing cerebral anoxia, usually by hanging, strangulation, or suffocation, during masturbation. This study investigated the relationships between: asphyxiators' ages; two paraphilias commonly accompanying autoerotic asphyxia, bondage and transvestism; and various other types of simultaneous sexual behaviour. Subjects were two concurrent series totalling 117 males aged 10-56 who died accidentally during autoerotic asphyxial activities. Data concerning sexual paraphernalia at the scene of death or among the deceased's effects were extracted from coronors' files using standardised protocols. Anal self-stimulation with dildos, etc., and self-observation with mirrors or cameras were correlated with transvestism. Older asphyxiators were more likely to have been simultaneously engaged in bondage or transvestism, suggesting elaboration of the masturbatory ritual over time. The greatest degree of transvestism was associated with intermediate rather than high levels of bondage, suggesting that response competition from bondage may limit asphyxiators' involvement in a third paraphilia like transvestism.
Article
During the past 20 years, the sensational aspects of autoerotic fatalities have captured the attention of medical examiners, psychiatrists, law enforcement agents, and the public, as well as the individuals themselves who engage in these dangerous practices. Reports of deaths related to sexual asphyxia have been presented numerous times at national and international meetings and have been the topic of discussion on television talk shows and in the press. Autoerotic fatalities and all the sexual curiosities related to these activities have prompted death scene investigators to publish case reports, and even textbooks, on the subject. The case presented herein is one of a multicomponent paraphilia in which self-asphyxiation (autoasphyxiophilia) led to a fatal autoerotic event.
Article
The pathology of injury and its complications related to sexual activities has changed remarkably when compared with that of the past, which usually involved assaults or murders of female victims of varying ages, with moderate to serve beatings that may have accidentally resulted in the victim's death. Serial murderers, serial rapists, and molesters of both boys and girls have become much more prevalent in the last two decades in the United States. Unorthodox sexual behavior, such as "fisting," has increased in frequency, as has sexual violence related to cults, such as satanism. All of these present many challenges to medicolegal investigators. This report describes general and specific pathological sexual activities and injuries, some characteristics and methods of the perpetrators, and some specific cases as examples.
Article
Autoerotic asphyxia is an increasingly recognised syndrome in which accidental death occurs during solitary sexual activity due to failure of an apparatus that was designed to produce hypoxic augmentation of the victim's sexual response. Evidence of repetitive, secretive behaviour utilizing ropes and ligatures characterizes cases involving either males or females. Here the similarity in reported cases ends with males tending to utilize a far greater range of elaborate devices and props, often designed to cause real or simulated pain with pornographic material and evidence of cross-dressing and fetishism. Females, on the other hand, have usually been found naked with only a single ligature and no unusual or bizarre equipment. To further clarify the similarities and differences between typical cases involving males and females and to assist in the diagnosis of less obvious cases, the literature is reviewed and characteristic findings in both sexes compared and contrasted.
Article
Eight cases of autoerotic asphyxia deaths on Oahu are reviewed. Distinguishing features typically separate these deaths from intentional suicides or homicides. The sexual nature of these incidents is a salient feature of the death. The etiology of the practice is unknown but worth investigation.
Article
To determine trends in the incidence and epidemiology of acute hepatitis B in the United States we conducted intensive surveillance for viral hepatitis in four sentinel counties from October 1, 1981, to September 30, 1988. The overall incidence of hepatitis B remained relatively constant throughout the study period (average, 13.2 cases per 100 000 population), but disease transmission patterns changed significantly. The proportions of hepatitis B cases accounted for by homosexual activity and health care employment decreased 62% and 75%, respectively; the proportions of cases accounted for by parenteral drug use and heterosexual exposure increased 80% and 38%, respectively. The percentage of patients for whom no risk factor was identified (30% to 40%) did not change over time. These patients tended to belong to minority populations, and their socioeconomic level was low. The decline in the number of hepatitis B cases among homosexual men probably results from the modification of high-risk sexual behavior; the decline among health care workers is due mostly to hepatitis B immunization. The current strategy for prevention of hepatitis B, which targets high-risk groups for immunization, has failed to have a significant impact on the incidence of disease. (JAMA. 1990;263:1218-1222)
Article
Deaths of young women due to autoerotic asphyxia have been rarely reported. The case of a 19-year-old woman is described in which several of the characteristic death-scene features found in cases of male autoerotic asphyxial deaths were absent. An awareness that this syndrome may occur among women with a less obvious presentation than in men is essential so that death will not be incorrectly attributed to nonaccidental causes. This syndrome may be more common than the number of reported cases would suggest.
Article
A case of a fatal cardiac episode resulting from an unusual autoerotic practice involving the use of a vacuum cleaner, is presented. Scene investigation and autopsy findings are discussed.
Article
The details of an unusual autoerotic death are presented; the postulated method of induction of cerebral hypoxia was inhalation of nitrous oxide from a dental anesthetic machine; the theme of dental anesthesia, presumably an elaborate bondage fetish, recurred in documentary material found at the scene.
Article
An unusual case of accidental death during auto-erotic practice, where three skirts, a pinafore dress, a pair of panty hose and a plastic bag were used to wrap the head and produce partial asphyxia, is described.
Article
Death during autoerotic episodes is of special concern to law enforcement officials, the coroner or medical examiner, the family of the decedent, and to society as a whole. As in the probing of any violent demise, accurate preservation of all evidentiary material, complete photographic documentation, reconstruction of the scene, and interviews with family and acquaintances ("psychological autopsy") are mandatory for proper completion of the case. A recent, atypical instance of sexual asphyxia arising from a bizarre incident exemplifies the foregoing dicta and provides a vivid example of "psychopathia sexualis."
Article
Despite the large population of New Orleans, including many homosexual and transsexuals, there have been relatively few cases of autoerotic deaths. The case reported here is an interesting one as it includes a bizarre form of autoerotic behavior from the standpoint of the method used. There have been no deaths reported in the literature in which the victim died as a result of jeopardizing himself by enclosing his body into plastic with an airway out of his "cocoon" in the form of a snorkel tube. He was engaged in masturbation when he apparently lost his mouth piece or airway. He attempted to use a knife to cut himself out.
Article
The sexual asphyxias have, in the past, often been described by forensic pathologists after an apparently accidental death has brought the condition to light. The following case is exceptional in that it came to light before a fatality occurred and suggests that intense self-punitive tendencies may play a part in some cases.
Article
An epidemic of 110 sudden sniffing deaths without plastic bag suffocation which occurred in American youths during the 1960's, appears to have originated on the West Coast. The incidence rate showed a sharp rise during the late 1960's. Volatile hydrocarbons most frequently involved were trichloroethane and fluorinated refrigerants. Sudden sniffing death occurred in all socioeconomic groups, with a preponderance in the suburban middle-income white family. Severe cardiac arrhythmia, resulting from light plane anesthesia, and intensified by hypercapnia or stress or activity or a combination of these, is the most likely explanation for sniffing death.
Article
(1) A case of Korsakoff's syndrome following attempted hanging is described. (2) The mechanism of brain damage by attempted hanging appears to be arterial occlusion producing stagnant anoxia. Bilateral damage to the hippocampus—one of the areas of the brain particularly susceptible to anoxia—may produce an amnestic disorder. This fact possibly accounts for case reports of the Korsakoff syndrome following attempted hanging. (3) A review of the neuropsychiatric features found in hanging survivors underlines the diagnostic difficulty which may lead to hypoxic symptoms being mistaken for hysterical disturbance. A wide variety of motor disturbances may be found. Whilst the commonest memory disturbance is a short circumscribed retrograde amnesia, severe Korsakoff states may also be found. (4) The more prolonged the period of unconsciousness the more likely is the development of irreversible damage. Coma of over 24 hours duration carries a risk of severe neuropsychiatric defect on recovery of consciousness. The period of unconsciousness may be difficult to gauge, particularly in view of "open-eye coma". (5) Schizophrenia is remarkably resistant to anoxic brain damage whereas the response of depressive illness is variable. (6) The EEG is of limited prognostic value as a normal record does not correlate with complete recovery and an abnormal record does not imply irreversible damage. (7) It may be worth while trying diuretics and hypothermia in the treatment of anoxic brain damage following hanging.
Article
An unusual case of accidental death during auto-erotic practice, where partial drowning was used to produce partial asphyxia, is reported.
Article
Approximately 250 deaths per year in the United States are attributed to the dangerous sexual paraphilia of autoerotic asphyxia. There are few studies of live practitioners of this practice which includes the act of self-asphyxiation, usually by hanging, while masturbating. Common features of the syndrome is the adoption of the role of a female transvestite, the use of pornographic material, the special kind of location for the hanging ritual, and the dynamics arising out of having a dominant mother and physically ill father. With adolescent males the ritual tends to be solitary, while in adults the tendency is to move into a homosexual couple practice that has sadomasochistic features. The source of such a practice is an enigma to researchers in spite of the long-known history of its occurrence. Few practioners have been studied while alive, and most practitioners have been studied by psychological autopsy. The authors report the history of a 24-year-old male, with a 10-year practice of autoerotic asphyxia who was first seen for a conversion reaction which affected his ability to walk. His symptoms began soon after a vigorous and repetitive engagement in his hanging ritual which left him very light-headed and weak-kneed. He believed he had caused himself permanent physical damage and he sought professional assistance at that time.
Article
An unusual case of asphyxial death during autoeroticism is described and the syndrome briefly discussed.
Article
A case of accidental death resulting from an autoerotic episode involving a high abdominal ligature is reported. Pathologic findings, physical evidence, and the psychological investigation are discussed.
Article
A death during, or soon after, masturbation associated with the presence of unusual sexual aids and probable inhalation of aerosol propellant is presented. It represents a type of sudden death associated with masturbation of which the sexual asphyxias form the greatest number.
Article
A study of 132 autoerotic asphyxial deaths revealed that family members and friends, in addition to experiencing shock over the sudden aspect of the death, frequently were the ones to discover the decedent's body and were confused by the sexual nature of the death. Clinicians are urged to be alert for signs of such potentially lethal sexual activity among the young people they see, and to be prepared to assist bereaved family members.
Article
A fatal case of accidental electrocution occurring during auto-erotic experimentation with electricity is described and the dermal histological features of electrical injury emphasized.
Article
This paper reviews some of the types of autoerotic death which have been reported and some of the psychodynamic principles which are associated with them. As cases involving females have never been reported, this presentation offers some opportunity to see how psychiatric insight assisted police investigation of an autoerotic death. Crime scene sketching and photographic evidence complement the case material so that the reader can feel he is at the crime scene. A comparison between male and female autoerotic deaths is made.
Article
In late summer several years ago, the county medical examiner was called by the police to view two bodies found in bed in a private home. The home belonged to a 39-year-old caucasian male whose body was one of those found in the bed. The other body was that of a 31-year-old caucasian female. The female body overlaid that of the male. It was obvious that the couple was engaged in sexual relations when they died. The deaths apparently were related to the use of an elaborate apparatus utilizing electrical current for stimulation. A heavy metal rod measuring 22 cm in length and 2.5 cm in diameter was inserted 18 cm into the male's rectum. A small wire was attached by a rubber band leading to a Variac voltage regulator. There was a metal rod 20 cm long with a rounded tip 1 cm wide tapering to 0.75 cm in the shaft. A metal ring was attached to the exposed end and the male partner's index finger was touching it. The rod was inserted 18 cm into the female's rectum with a similar wire attached and leading to the voltage regulator. The regulator was set at 90 volts, but the dial could be turned up to 130 volts. In the room nearby were other stimulation devices, including a La Vida vibrator on a bed table and a Niagara type vibrator found under the bed. On the bed table was also noted a 1-lb. jar of lubricating cream. The couple was last seen alive more than 24 hours before. Third-degree burns were found in the rectum and vagina with perforation of the posterior vagina and anterior rectum in the female victim. In the male victim, third-degree burns were noted on the tip of the left index finger, the rectum, and the penis. The voltage regulator was plugged into a wall socket when the police arrived.
Article
Successful injury control measures (stoplights, sprinkler systems, electrical insulation, evacuation) have long been commonplace. However, progress in injury control has been hampered by the failure to recognize that injuries cannot occur without the action of specific agents analogous to those of the infectious diseases and likewise transmitted by vehicles and vectors. These agents are the several forms of injury. Varying and interacting with the characteristics of the host and the environment, they constitute the classic epidemiologic triads that determine injury distributions, none of which are random. The injury-disease dichotomy, a universal in most of the world's major languages, may have resulted from the fact that at least some of the causes of injuries (for example, wild animals or falling trees) are more identifiable and proximate than the causes of diseases. The etiology of injuries suggests that for epidemiologic and public health purposes, the term injury should probably be defined so as to encompass those kinds of damage to the body that are produced by energy exchanges and that are manifested within 48 hours, or usually within considerably shorter periods. Strategies for injury control can be extended to the control of other pathological conditions. The active-passive distinction (the dimension expressing the extent to which control measures require people to do something) has a direct bearing on the success of public health programs, because passive approaches have historically had a far better record of success than active ones. Ten basic strategies have been identified that provide options for reducing the damage to people (and property) caused by all kinds of environmental hazards.
Article
We report two cases in which men used the hydraulic shovels on tractors to suspend themselves for masochistic sexual stimulation. One man developed a romantic attachment to a tractor, even giving it a name and writing poetry in its honor. He died accidentally while intentionally asphyxiating himself through suspension by the neck, leaving clues that he enjoyed perceptual distortions during asphyxiation. The other man engaged in sexual bondage and transvestic fetishism, but did not purposely asphyxiate himself. He died when accidentally pinned to the ground under a shovel after intentionally suspending himself by the ankles. We compare these cases with other autoerotic fatalities involving perceptual distortion, cross-dressing, machinery, and postural asphyxiation by chest compression.
Article
A case of transvestism in a male of 17 is presented to illustrate some of the psychodynamics of the illness. Since early adolescence, the patient has frequently dressed in stolen female clothing to add to the gratification of masturbation. On several occasions, he has hanged himself while in the transvestite act. Although many aspects of his behavior appeared psychopathic, they seemed, on closer examination, to have specific origins and mechanisms. Relevant to the case is the phenomenon which is pointed out, in which the body is equated with the penis. In view of Gutheil's recognition of the frequency with which male transvestites use hanging and strangulation as part of the eonistic ritual, it is suggested that the body-phallus equation may frequently play a role both in the psychodynamics of transvestism and in the utilization of constriction of the neck as a sexual stimulant.
Article
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Autoerotic death of youths causing widening concern
  • J E Brody
Brody, J. E. Autoerotic death of youths causing widening concern. New York Times 1984;17-20.
The sexual asphyxias
  • F Gwozdz
Gwozdz, F. The sexual asphyxias. Foren Sci Gazette 1970;1:2-3.