Erotic asphyxiation

Erotic asphyxiation refers to intentionally cutting off oxygen to the brain for sexual arousal. It is also called asphyxiophilia, autoerotic asphyxia, kotzwarraism, or breath control play. A person engaging in the activity is sometimes called a gasper. The erotic interest in asphyxiation is classified as a paraphilia in the Diagnostic and Statistical Manual of the American Psychiatric Association.

Practice
Various methods are used to achieve the level of oxygen depletion needed such as a hanging, suffocation with a plastic bag over the head, self-strangulation such as with a ligature, gas or volatile solvents, chest compression, or some combination of these. Sometimes, complicated devices are used to produce the desired effects. The practice can be dangerous even if practiced with care and has resulted in a significant number of accidental deaths. Uva (1995) writes “Estimates of the mortality rate range of autoerotic asphyxia between 250 to 1000 deaths per year in the United States.” Cases have also been reported in Scandinavia and in Germany.

Deaths often occur when the loss of consciousness caused by partial asphyxia leads to loss of control over the means of strangulation, resulting in continued asphyxia and death. While many do enjoy incorporating asphyxiophilia into sex with a partner, others enjoy this behavior by themselves, making it potentially more difficult to get out of dangerous situations. Victims are often found to have rigged some sort of "rescue mechanism" that has not worked in the way they anticipated as they lost consciousness. In some cases autoerotic asphyxiation may have triggered carotid sinus reflex death, but this claim is controversial.

In some fatality cases, the body of the asphyxiophilic individual is discovered naked or with his penis exposed, with pornographic magazines nearby, with dildos or other sex toys nearby, or with evidence of his having ejaculated. Bodies found at the scene of an accidental death often show evidence of other paraphilic activities, such as fetishistic cross-dressing and masochism.

In the BDSM community, interactions of this nature may be referred to as breathplay or sometimes edgeplay, and generally include a partner. Because like other forms of edgeplay breathplay pushes the limits of "safe, sane and consensual", situations involving breath control can be assessed using the acronym RACK or Risk Aware Consensual Kink. Partners are generally expected within this community to be cognizant of and responsible for the dangers that they may take part in.

The great majority of known erotic asphyxial deaths are male; among all known cases in Ontario and Alberta from 1974 to 1987, only one out of 117 cases was female. Some individual cases of women with erotic asphyxia have been reported. The mean age of accidental death is mid-20s, but deaths have been reported in adolescents  and in men in their 70s.

Lawyers and insurance companies have brought cases to the attention of clinicians because life insurance claims are payable in the event of an accidental death, but not of suicide.

History
Historically, the practice of autoerotic asphyxiation has been documented since the early 1600s. It was first used as a treatment for erectile dysfunction and impotence. The idea for this most likely came from subjects who were executed by hanging. Observers at public hangings noted male victims developed an erection, sometimes remaining after death (death erection), and occasionally ejaculated when being hanged. Note that, however, ejaculation occurs in hanging victims after death because of disseminated muscle relaxation; this is a different mechanism from that sought by AEA practitioners.

Famous cases
The composer Frantisek Kotzwara died from erotic asphyxiation in 1791, probably the first recorded case.

Sada Abe killed her lover, Kichizo Ishida, through erotic asphyxiation in 1936, proceeding to cut off his testicles and carry them in her handbag for a number of days. The case caused a sensation in 1930s Japan and has remained one of the most famous Japanese murder cases of all time.

Stage and screen actor Albert Dekker was found in 1968 with his body graffitized and a noose around his neck in his bathroom.

The artist Vaughn Bodé died from this cause in 1975.

Progressive rock musician Kevin Gilbert died from this in 1996, as did drummer Robin Hanssen.

The death in 1994 of Stephen Milligan, the British Conservative MP for Eastleigh, was a case of autoerotic asphyxiation combined with self-bondage.

Hideto Matsumoto, guitarist of X Japan, died mysteriously by self-strangulation with a towel. Autoerotic asphyxiation is one of several proposed scenarios.

Michael Hutchence, lead singer of INXS is rumored to have died from auto-erotic asphyxiation in 1997, although suicide was the official cause of death.

A more recent case is the death in 2004 of the extreme right-wing National Front party member Kristian Etchells.

On March 28, 2007, the New York Times had a front-page story on a teenager who had suffered a heart attack and spent three days in a coma after hanging himself for a "rush". This was apparently an instance of the choking game, which had become a major health hazard to adolescent youth in the United States in the 21st century.

Cultural references
Autoerotic asphyxiation is key to the plots of many books, movies, and TV shows.

Film

 * In the beginning of the film Life as a House, actor Hayden Christensen, playing the troubled teen character Sam Monroe, performs erotic asphyxiation hanging in his closet while huffing chemicals out of a plastic bag. The result, though, borders the comical, as the closet doesn't support him and he falls among a heap of clothes.
 * An accidental death in the film The Ruling Class (1972), starring Peter O'Toole
 * "Scarfing" is practiced by the character Tate (while listening to women's tennis) in the controversial 2002 Larry Clark film Ken Park (with a non-simulated masturbation scene).
 * Full Frontal - The character played by David Duchovny dies of what is portrayed to be autoerotic asphyxiation. This may have been a reference to the fact that the character Fox Mulder, played by Duchovny in "The X-Files," was told by Clyde Bruckman, played by Peter Boyle, that he might die that way.
 * Killing Me Softly in which Alice, the protagonist, experiments with autoerotic asphyxiation.
 * This practice was also depicted as leading to the death of a character in Rising Sun, a movie based on the novel of the same name by Michael Crichton.
 * It appears in the less publicized 2003 movie Young and Seductive, starring Julian Wells, Alana Evans, and Robert Donovan.
 * The practice was central to Nagisa Oshima's highly controversial 1976 movie In the Realm of the Senses.
 * The main hero of Kirill Serebrennikov's 2006 movie Playing the Victim Valya did some scarfing with his girlfriend.
 * Paul Prior, a war photographer in the New Zealand film In My Fathers Den meets a girl in a pub and proceeds to take off his belt and practice erotic asphyxiation which makes the girl pick up her things and leave.
 * Mason Verger makes reference to it when speaking about his crimes in Hannibal
 * MacIntyre "Mac" Womack, portrayed by Steve Lemme, practiced autoerotic asphyxiation while masturbating in a police cruiser in the film Super Troopers.
 * In the opening sequence of the movie Dangerous Desires, the main character played by Richard Grieco, accidentally kills a woman he is having sex with via putting a scarf around her neck during climax. In a later scene,the same character simulates the act upon Angie Everhart's character, although Everhart's character fakes her death.
 * In Knocked Up - Jonah (Jonah Hill) & Jason (Jason Segel) ask Ben (Seth Rogan) not to masturbate while choking himself. Jonah adds that if he has to do so, play with a friend for safety.
 * In the stoner comedy Puff Puff Pass, the character of Otis (LaVan Davis) is seen performing autoerotic asphyxiation on himself in a closet while looking through a peephole.

Literature

 * Marquis de Sade's novella Justine.
 * William S. Burroughs' novel Naked Lunch has a number of scenes in which a man is hanged, gets an erection, and ejaculates. This qualifies as a minor theme of the book and is revisited in much of Burroughs's subsequent work.
 * Thomas Harris' novel Hannibal features a character named Mason Verger, who performs it in front of Hannibal Lecter. Hannibal gives him drugs, and convinces him to slice off his face. (Although Verger recalls Lecter as having fed his face to his dogs, he is later told that he ate it himself.) At this point Lecter breaks Mason's neck, leaving him severely deformed, and permanently confined to a specialized sickbed or wheelchair.
 * In chapter 29 of Kurt Vonnegut's novel "Galápagos", there is a flashback scene to the youth of one of the main characters, the con-artist James Wait, to when he was working as a homosexual prostitute in New York city. In the recounted episode, Wait accidentally kills a European prince who has paid for Wait to strangle him with a silk sash so that he may experience erotic asphyxiation. Wait strangles the prince for longer than instructed so that while the prince does have an orgasm, he dies moments later.
 * P. D. James, An Unsuitable Job for a Woman
 * Erika Barr, Acquisiti (ISBN)
 * Irvine Welsh's book Filth feature a scene where the main character starts choking a girl he is having sex with; when the girl complains "You're choking me,” he responds with “Well, choke me back” and “cut off the gas”. Later on, this behaviour becomes usual in their relationship.
 * Chuck Palahniuk's book Haunted features a story called "Guts," which tells several stories of accidents while masturbating. Palahniuk discusses that one of the reasons for an increase in teen suicides is actually disguised AEA, because many parents try to reclothe the asphyxiated teen and make it look like a less humiliating death.
 * It has been suggested that Robert Browning's dramatic monologue Porphyria's Lover is about erotic asphyxiation rather than murder.
 * Michael Connelly refers to autoerotic asphyxia due to self-strangulation in his novel A Darkness More Than Night.
 * Henrik H. Langeland's novel Wonderboy (2003).
 * Robert Rankin referenced autoerotic asphyxia in his novel Snuff Fiction.
 * Stephen King's 1408 mentions Henry Storkin who killed himself practicing this act.
 * Sidney Sheldon's Bloodline has a part in the book wherein Sir Alec Nichols hires a filmmaker to record this act being done by a hired prostitute and another man.

Television

 * In the Six Feet Under season 2 episode "Back to the Garden," the opening death scene is of a man who is masturbating and slips and hangs by accident whilst experimenting with asphyxiation.
 * The Family Guy episode "The Perfect Castaway", features a game of "I Never" where Glenn Quagmire drinks to performing erotic asphyxiation with an illegal alien from Home Depot, then doing the same thing with someone from Jo-Ann Fabrics. In the episode "Breaking Out Is Hard to Do", Stewie tries to pull a plastic bag over his head "just like that boy from INXS", a reference to the band member's death by autoerotic asphyxiation. Also, there is a reference in the episode "Lois Kills Stewie", where Peter starts a rumor about Rob Schneider paying migrant workers from Home Depot to choke him in the shower. When Stewie takes over the world and becomes president, it cuts to a scene where several migrant workers are sitting on Rob Schneider's couch. When asked to watch the news, Rob Schneider says "I'm not paying you guys to watch TV, now get in the damn shower!"
 * The American version of Queer as Folk, the Showtime television series: In the first-season finale, Brian Kinney (Gale Harold) turns 30, an event looked upon by some in the gay community (jokingly and otherwise) as the year one "dies". Kinney decides to experience scarfing, but his best friend Michael (Hal Sparks) discovers and stops him. Kinney claims he wanted to experience "the best fucking orgasm of my life", but Novotny counters that it would have been "the last fucking orgasm of your life". When it aired, the episode featured a disclaimer about the dangers of the practice and discouraged viewers from attempting it.
 * CSI: Crime Scene Investigation, (2005, Season 6, episode 2, "Room Service") of the CBS television series involves death by autoerotic asphyxiation.
 * In the HBO series Entourage, Johnny Drama asks Turtle if he ever "Jerks off with a belt around his neck".
 * The League of Gentlemen
 * The 2006 George Carlin HBO Special Life is Worth Losing.
 * X-Files, episode "Clyde Bruckman's Final Repose" (first aired Friday, October 13, 1995), the psychic Bruckman (played by Peter Boyle, who won an Outstanding Guest Actor Emmy for the part) implies that Special Agent Fox Mulder will die of AEA.
 * "Peep Show", a UK Channel 4 TV show, when Jez says "I'm so bored, dangerously bored, I even considered doing that thing that Michael Hutchence and that MP did".
 * The Law & Order: Special Victims Unit episode Ridicule involves a woman who the investigators thought had died as a result of erotic asphyxiation
 * Upright Citizens Brigade TV show.
 * In the FX series Dirt, the character Lucy Spiller achieves sexual pleasure by being choked during intercourse.
 * On the HBO Show OZ, the character Robson manipulates Wolfgang Cutler to try AEA, but murders him instead.
 * In the IFC show Whitest Kids U' Know, a character played by Trevor Moore accidentally kills himself while performing AEA, and then becomes a ghost who is highly embarrassed by the development.

Other

 * The song "Self Suicide" by Welsh rap group Goldie Lookin' Chain includes two references to the death of Michael Hutchence, including the line "Wanking with a bag on your head tied to a door/That bloke from INXS he knew the score"
 * The 1960s-1970's underground cartoonist Vaughn Bode died from AEA.
 * In December 2005, Dane Cook, who hosted Saturday Night Live, played a character whose wife told his loved ones that he had died of AEA instead of being in a coma.
 * Brutal death metal band Devourment has a song called "Autoerotic Ashpyxiation"
 * In the novel Pig by Irvine Welsh, the main character indulges in both AEA and "scarfing".
 * The death of British MP Stephen Milligan by autoerotic asphyxiation is briefly mentioned in the song Mr. Robinson's Quango on the album The Great Escape by British rock band Blur.
 * The electro group SITD has a song called "Asphyxiation".
 * "Asphyxiophilia" is a song by the industrial rock group fetish 69
 * The Genitorturers song "Asphyxiate" describes someone engaging in a sexual act involving a cord that is presumably erotic asphyxiation.
 * The song "Dead Goon" on Mr. Bungle's self-titled album is about an antisocial youth who dies from autoerotic asphyxiation.
 * In the song "No Apologies", Eminem raps, "I choke mic's like asphyxiation / When I'm stranglin' my own throat masturbatin'"
 * The electronica group Blaqk Audio features a song titled "Between Breaths" including the lyrics "Please, please, please don't take it, take it, take it, take it easy on me. Just make it, make it, make it, make it harder to breathe."
 * The game Grand Theft Auto IV, has an in game store called Autoeroticar.