Research Article

Addiction to self-strangulation: a case-report

Aurely Ameller*, Yann Le Strat, Marion Cadranel, Celine Portalier and Caroline Dubertret

Published: 12/05/2017 | Volume 1 - Issue 1 | Pages: 016-021


Introduction: DSM-5 mentions autoerotic asphyxia in the paraphilic disorders section, as a specifier for the diagnostic of sexual masochism disorder. Strangulation activities have also been observed in the “choking game”. The term “strangulation activity” is considered as more appropriate than “choking game”. While sharing a same behavior, autoerotic asphyxia and non auto-erotic strangulation activities might represent a very distinct pattern of disorders. We describe here a case report of a 25-year old male internship student who has practiced manual self-strangulation up to 40 times a day since adolescence. In the examination of this case we identify individual clinical aspects of this case in a process-based holistic case conceptualization.

Case description: The patient is a 25 years old male with a post-graduate degree who presented with a recent history of poor work performance and work-related stress during an internship. He has a concomitant history of both ketamine and cannabis use disorders, and reports urges to self-strangulate, sometimes specifically avoiding contact with friends engage in this behavior and that he has never attempted to discontinue self-strangulation. Neuropsychological assessment found a cognitive functioning below that expected given his educational level. Our intervention consists of a 3-weeks cognitive and motivational therapy program in addiction unit with associated abstinence.

Conclusion: Autoerotic asphyxia is a behavior observed not only in the context of sexual masochism disorder, but also as a specific addictive behavior, in the absence of sexual arousal, possibly as a result of emotional dysregulation.

Read Full Article HTML DOI: 10.29328/journal.jatr.1001003 Cite this Article


  1. Hucker SJ. Hypoxyphilia. Arch Sex Behav. 2011; 40: 1323-1326. Ref.:
  2. Krueger RB, Kaplan MS. Paraphilic Diagnoses in DSM-5. Isr J Psychiatry Relat Sci. 2012; 49: 248-254. Ref.:
  3. Hitchcock A, Start RD. Fatal traumatic asphyxia in a middle-aged man in association with entrapment associated hypoxyphilia. J Clin Forensic Med. 2005; 12: 320-325. Ref.:
  4. Quinn J, Twomey P. A case of auto-erotic asphyxia in a long-term psychiatric setting. Psychopathology. 1998; 31: 169-173. Ref.:
  5. Shields LBE, Hunsaker DM, Hunsaker JCI. Autoerotic Asphyxia: Part I. J Forensic Med. 2005; 26: 45-52. Ref.:
  6. Behrendt N, Buhl N, Seidl S. The lethal paraphiliac syndrome: accidental autoerotic deaths in four women and a review of the literature. Int J Legal Med. 2002; 116: 148-152. Ref.:
  7. Noirhomme-Renard F, Gosset C. The “choking game” and asphyxial games: epidemiological and clinical data. Rev Médicale Liège. 2011; 66: 485-490. Ref.:
  8. 8 Mechling B, Ahern NR, McGuinness TM. The choking game: a risky behavior for youth. J Psychosoc Nurs Ment Health Serv. 2013; 51: 15-20. Ref.:
  9. Katz KA, Toblin RL. Language matters: unintentional strangulation, strangulation activity, and the “choking game”. Arch Pediatr AdolescMed. 2009; 163: 93-94. Ref.:
  10. Macnab AJ, Deevska M, Gagnon F, Cannon WG, Andrew T. Asphyxial games or “the choking game”: a potentially fatal risk behavior. Inj Prev. 2009; 15: 45-49. Ref.:
  11. Ramowski SK, Nystrom RJ, Rosenberg KD, Gilchrist J, Chaumeton NR. Health risks of Oregon eighth-grade participants in the “choking game”: results from a population-based survey. Pediatrics. 2012; 129: 846-851. Ref.:
  12. Bernacki JM, Davies WH. Prevention of the Choking Game: parent perspectives. J Inj Violence Res. 2012; 4: 73-78. Ref.:
  13. “Choking game” awareness and participation among 8th graders--Oregon, 2008. Centers for Disease Control and Prevention. 2010; 59: 1-5. Ref.:
  14. Andrew TA, Fallon KK. Asphyxial games in children and adolescents. Am J Forensic Med Pathol. 2007; 28: 303-307. Ref.:
  15. Michel G, Bernadet S, Aubron V. Cazenave N. Des conduites à risques aux assuétudes comportementales: le trouble addictif au danger. Psychol Fr. 2010; 55: 341-353. Ref.:
  16. Bernheim A, Halfon O, Boutrel B. Controversies about the enhanced vulnerability of the adolescent brain to develop addiction. Front Pharmacol. 2013; 4: 118. Ref.:
  17. Billieux J, Schimmenti A, Khazaal Y, Maurage P, Heeren A. Are we overpathologizing everyday life? A tenable blueprint for behavioral addiction research. J Behav Addict. 2015; 4: 119-123. Ref.:
  18. Dudley R, Kuyken W, Padesky CA. Disorder specific and trans-diagnostic case conceptualization. Clin Psychol Rev. 2011; 31: 213-224. Ref.:
  19. Kardefelt-Winther D. Conceptualizing Internet use disorders: Addiction or coping process?. Psychiatry Clin Neurosci. 2016; 71: 459-466. Ref.:
  20. Modelli MES, Rodrigues MS, Castro BZM, Corrêa RS. Self-induced fatal air embolism: accidental autoerotic death or suicide?. J Forensic Sci. 2013; 58: 261-263. Ref.:
  21. Solarino B, Leonardi S, Grattagliano I, Tattoli L, Di Vella G. An unusual death of a masochist: Accident or suicide?. Forensic Sci Int. 2011; 204: 16-19. Ref.:
  22. Hazelwood RR, Burgess AW, Groth AN. Death during dangerous autoerotic practice. Soc Sci Med. 1981; 15: 129-133. Ref.:
  23. Sauvageau A. Current reports on autoerotic deaths--five persistent myths. Curr Psychiatry Rep. 2014; 16: 430. Ref.:
  24. Andrew T. Les jeux d’asphyxie chez les enfants et les jeunes. in Jeu du foulard et autres jeux d’évanouissement : pratiques, conséquences et prévention. Paris: L’Harmattan. 2010; 41-43.
  25. Zhu TH, Mio Nakamura, Benjamin F, Michael A, Jason R, et al. Obsessive-compulsive skin disorders: a novel classification based on degree of insight. J Dermatol Treat. 2017. Ref.:
  26. Billieux J, Philippot P, Schmid C, Maurage P, De Mol J, et al. Is Dysfunctional Use of the Mobile Phone a Behavioural Addiction? Confronting Symptom-Based Versus Process-Based Approaches. Clin Psychol Psychother. 2015; 22: 460-468. Ref.: