Autoerotic Asphyxiation: Forensic, Medical, and Social Aspects
Paperback, 6x9 in, 208 pages Bibliography
Wheatmark, August 2006
Of the various types of abnormal sexual behavior, the most dangerous and bizarre is autoerotic asphyxiation, also known as asphyxiophilia, sexual hanging, sexual asphyxia, scarfing, breath control play, and terminal sex. Though at least one autoerotic asphyxiation death occurs in the United States each day, it is almost unknown as a distinctive psychopathological entity in forensic medicine and psychology.
Dr. Sergey Sheleg and Dr. med. Edwin Ehrlich draw from their own research, as well as the work of others, to provide a comprehensive review of this problem. Bringing together information from a variety of disciplines, Autoerotic Asphyxiation: Forensic, Medical, and Social Aspects is a valuable resource for pathologists, criminal investigators, criminologists, coroners, physicians, attorneys, life insurance experts, and funeral directors, as well as parents and living AEA practitioners.
About the authors
Dr. Sergey Sheleg graduated from Minsk Medical School. He conducted the first analysis of autoerotic fatalities in the Republic of Belarus, describing specific features that would aid in the investigation of suspected autoerotic asphyxiation.
Dr. med. Edwin Ehrlich began his career as a research scientist at the Institute of Forensic Medicine in Germany. He studied the forensic aspects of brain injuries and taught a forensic pathology course for medical students.
The source of autoerotic asphyxiation practice is an enigma to researchers in spite of the long-known history of its occurrence.
The most common question asked by families and friends about the bizarre sexual behavior of a loved one who died as a result of autoerotic asphyxiation is: Why did he do it?
To answer, it must first be understood that "abnormal sexual behavior" and "sexual perversions" are relative terms used to describe socially unacceptable or unlawful sexual practices. To the asphyxiator, his ritualistic hanging is a fixated and necessary sexual practice. The asphyxiator is forced into abnormal behavior by the same forces that drive a normal man into normal sexual activity.3,14
The exact reasons that individuals engage in autoerotic asphyxiation practice are not as simple. Some are seeking sexual pleasure, while others are interested in the sensations associated with anoxia.
The association of hypoxia and sexual arousal has been noted as having transcultural and historical significance.110 Adelson (1973) considered autoerotic fatalities "a unique group of accidental hangings involving young boys between the ages nine and fourteen or fifteen."1 And there is the Eskimo connection.110 Stearns (1953) reports the following: "Anthropologists have reported that Eskimo children hang themselves in some game, probably sexual …"213 Diamond et al. (1990) agree: "Eskimo children have been reported to seek unconsciousness as a delightful game."64 Resnik (1972) states: "Children of Shoshone-Bannock Indians play games where suffocation is a part of the game."183 De Coccola and King (1986) report a Barren Land Eskimo fatal case.61
Autoerotic asphyxia is probably the least understood of the paraphilias. There are many reasons this practice is so obscure. First, it is difficult to ascertain the number of practitioners of asphyxophilia due to the social stigma, lack of professional awareness, and few practitioner-recorded experiences. Also, there have been many studies done on autoerotic death victims, studies that do not fully reveal past histories of the asphyxiators. Conversely, there are relatively few studies available on living practitioners.230
In the book Autoerotic Fatalities by Hazelwood et al. (1983), the authors suggest that the most common psychological processes underlying autoerotic asphyxia are the desire for the subjective experience of hypoxia, the acting out of a masochistic fantasy that includes being abused, tortured, or executed, and the desire to be sexually aroused through risk-taking.98 A patient interviewed in connection with the study done by Dr. Dietz illustrated these processes. The patient indicated that his autoerotic asphyxiation began at age twelve, though he could not recall how he first came to use it. He said that in the early years of his practice, he enjoyed the subjective experience of hypoxia and passing out, which was always associated with a fantasy that powerful women were doing this to him. Often he tied himself up or cross-dressed and fantasized that the women had done this to him as well. His history illustrates the elements of hypoxia-seeking and masochistic fantasies.
In 1994, Friedrich and Gerber studied five adolescent male practitioners of autoerotic asphyxia.85 This is one of the few studies done on living practitioners. Several characteristics are reported in the five boys studied. They include a history of choking, physical abuse, sexual abuse, other risk-taking behaviors, and pairing of sexual arousal with the choking experience. Their behavior was found to be ritualistic and compulsive and most likely the result of more significant etiological precursors. Physical and sexual abuse can be precursors to the abnormal sexual behavior.
Friedrich and Gerber (1994) sum up their observations on adolescent asphyxiators:
In summary, the etiology of severe and persisting asphyxia appears to be including the pairing of choking with sexual arousal. This pairing was facilitated by earlier traumatic and abusive events in the lives of these boys. Autoerotic asphyxia was usually not their only masochistic behavior as well. The learning theory of paired associate learning appears to be a useful concept for understanding this dynamic.
"Persistent dysregulation can lead to chronic overarousal and set the stage for repetitive, risk-taking behaviors driven possibly by the child's need to undo or master the trauma."
Litman and Swearingen (1972), however, reported that they were unable to discover any consistent history of specific traumata in childhood or any typical family pathology.136 They did find that "all but one (of nine cases) report a masochistic sexual orientation from early childhood with memories of bondage masturbation fantasies, or experiences of mutual seduction with other children involving ropes and passive submission. Memories of being sexually abused in childhood were not prominent among the subjects."
Rosenblum and Faber (1979) observed:185
Despite the paucity of research in this area, the existing evidence tentatively suggests the possibility of a developmental sequence in which a childhood preoccupation with ropes develops into asphyxially oriented adolescent masturbation, eventually resulting in a full-blown adult masochistic bondage syndrome, with possible "entrance" and "exit" points along the way. There is also the impression that asphyxia is the result of an exploratory and perhaps coincidental process in those "socially isolated with little or no access to interpersonal sensual and/or sexual opportunities."225
Many theories have been suggested for the autoerotic asphyxiation practice.
The usual causative factors for AeA suggested are psychoanalytic. Saunders (1989) suggests several rationales for the autoerotic asphyxiation practice, including guilt associated with masturbation, castration anxiety, and risk-taking/thrill-seeking in general.193 Many autoerotic scenes have a heavy masochistic overtone to them. The masochistic desire may be a form of self-punishment for sexual activity.73,241
One anonymous live practitioner of autoerotic hanging described to me his masochistic desire for being hanged by an imagined hangman for his cross-dressing activity (he was wearing ladies' panties all the time). (Author's comment)
Johnstone et al. (1960) pointed to the use of bags (during autoerotic bag suffocation) to symbolize a struggle to return to the womb.117
Money and Lamarcz (1989) suggested that autoerotic asphyxiation is a sacrificial paraphilia.161 This type of behavior occurs in individuals who feel they must atone for their erotic behavior, thus pairing pleasure with threat or punishment. Psychoanalytic formulations have viewed victims of autoerotic death in terms of an eroticization of helplessness, weakness, and a threat to life, which is overcome through survival, thus creating a sense of success.
Mental health professionals mostly agree that paraphilias, or deviant sexual behaviors, are generally thought to be caused by some form of disruption of the normal sexual development during adolescence. The asphyxiator may be compelled to engage in this practice as a result of arrested development during a stage of sexual development.
During early adolescence, males go through the autoerotic phase.118 During this phase, the adolescent has the tendency toward introversion and a richer life of secret fantasy, together with a preoccupation with self and the varying degrees of shyness and self-consciousness. A traumatic experience during this stage may cause dysregulation and disrupt the sexual development.
While these theories are useful in explaining some autoerotic asphyxiation behavior by paired-associate learning and psychological processes, there still remain questions of how young males begin the practice.
Why the asphyxiator develops this bizarre practice is mostly unknown.
Do these individuals find the pain and humiliation of hanging stimulating, or are they masochistic, dealing out a degrading punishment to a victim whose simulated death they witness taking place before them?203
Many asphyxiators can also learn of the practice by word of mouth, sex manuals, medical books, pornographic literature, or detective magazines, as well as through the media.64 Another possibility is that asphyxiators begin the practice by accidental discovery or by self-generated experiences.32
The "clustering" of paraphilias is thought to occur when the asphyxiator encounters no adverse effects from his first paraphilic experience, which loosens his inhibitions about acting out other erotic fantasies.29 Bancroft (1989) suggested that the tendency of paraphilias to occur together suggests that the conditions necessary for the development of one paraphilia may facilitate the development of others. He conjectured that this potential might stem from some characteristics of the individual's nervous system that underlies sexual learning.19
Freund (1976) introduced the concept of "courtship disorder" to explain his finding that various combinations of paraphilias occur together.84 He theorized that courtship disorder results from the failure of some mechanism that coordinates normal human courtship behavior, and whose dysfunction allows various components of the normal sequence to erupt in fragmentary and unmodulated forms.
Another possibility is suggested in the work of LaTorre (1980), who produced an experimental model for fetishism by showing that males who feel rejected by women show an enhanced response to women's clothing and a decreased response to women.133
Etiology of autoerotic asphyxiation behavior is unknown, and onset is typically in adolescence, and associated with culture and/or age-typical thrill-behavior.110