Addiction to self-strangulation: a case-report

Abstract

Introduction: DSM-5 mentions autoerotic asphyxia in the paraphilic disorders section, as a specifi er 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 postgraduate 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 specifi cally 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 specifi c addictive behavior, in the absence of sexual arousal, possibly as a result of emotional dysregulation.

Does intentional asphyxiation by strangulation have addictive properties?

“…Initiation often occurs with others, and the behaviour can provide an intense euphoriant effect. Indeed, in some cases it may be the earliest stimulating behaviour encountered (before alcohol, drugs and sexual pleasure), with multiple reports of its initiation in childhood and adolescence [14,15,17,28,33]. This euphoriant effect may lead to establishment of an entrenched pattern of behaviour despite the risk of death.…”

“…Arguably, it could be that the level of risk associated with the behaviour may play a role in the experience, manifesting as 'thrill seeking' [17,37]. There are also reports that tolerance to the psychological effects of asphyxia can develop [14,34].…”

“…Mr B has no sexual impairment and was involved in a heterosexual relationship of 3 years duration. MRI scanner and usual blood tests were normal’ ([14], p. 017).…”

“…While there is a dearth of research in this area, researchers presenting Case G concluded that solo‐asphyxiation had the appearance of being highly addictive, with the individual performing solo‐asphyxiation up to 40 times a day since adolescence [14]. Reasons were described as an ‘escape from reality’.…”

“…Reasons were described as an ‘escape from reality’. Cognitive therapy treatment was delivered through an addiction ward, focusing on identification, exposure and ability to control high‐risk situations, cognitive restructuring and restoring depleted self‐esteem that led to cessation of the behaviour [14].…”