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Theorien und Erklärungsmodelle


Diese Seite ist noch in Arbeit. Kursive englische Begriffe harren noch der Übersetzung; viele Zitate sind noch nicht eingebaut. Geduld bitte.
Demnächst wird die Seite wegen ihrer unverschämten Größe in die einzelnen Teile (in etwa) "Demographie", "Erklärungsversuche", "Frauen", "Zusammenhang mit anderen Paraphilien", "Eskimos" und "Therapie" unterteilt werden.

In der Forschungsliteratur finden sich nur selten Ansätze zur Erklärung des Phänomens. Dabei wird von so gut wie allen Autoren der Aspekt ignoriert, daß sich aus den vorhandenen Daten eigentlich gar keine Antworten auf die Frage "Wer praktiziert sowas eigentlich?" gewinnen lassen, sondern bestenfalls auf die Frage "Wer stirbt dabei?". Es scheint derzeit nur eine Handvoll Berichte über lebende Praktiker zu geben, die fast alle nur ins Blickfeld der Forschung geraten sind, weil sie sich freiwillig in Behandlung begeben haben: LS72 (neun Interviewte), Edm72 (ein Patient), Her74 (?), RF79 (ein Patient), WB83 (ein Patient), CC89 (ein Patient), Lun92 (fünf Patienten), FG94 (fünf Patienten), Coo96 (zwei Patienten), JH97 (ein Patient). Die vorhandenen Theorien sind also cum grano salis, besser noch mit einem ganzen Salzfaß zu genießen.

"Einsame, schizoide, introvertierte und kontaktarme Sonderlinge": Wer tut sowas eigentlich? Oder vielmehr: Was glauben Psychologen und Gerichtsmediziner, wer sowas tut?

"Wir selbst haben im Lauf der Jahre 50 Fälle sammeln können. Man findet unter ihnen alle Altersstufen. Von den Opfern war der Jüngste 14 Jahre, der Älteste 72 Jahre alt - unter ihnen Arbeiter, Bauern, aber überwiegend Intellektuelle mit differenzierten Berufen, auch Studenten, Beamte, Akademiker, darunter ein Arzt und Tierarzt, Geistliche, Verheiratete und Unverheiratete. Auffallend ist die große Zahl Jugendlicher und Pubertierender, ebenso von Männern höheren Alters. Über Persönlichkeit der Betreffenden und die Psychopathologie ihrer oft lange fortgesetzten abartigen sexuellen Betätigung ist meist wenig zu eruieren. Sie wissen sie gewöhnlich geschickt zu verheimlichen, nicht zuletzt, weil es sich in der Mehrzahl um einsame, schizoide, introvertierte und kontaktarme Sonderlinge handelt, die ihr Innenleben gegenüber ihrer Umgebung und Familie abzuschirmen pflegen." (Pro60, S. 256)

"Diese Menschen sind meist Einzelgänger und Sonderlinge, die kaum Freunde und keine Bindungen zum anderen Geschlecht haben." (Wit75, S. 5f)

"Das Defizit an Verheirateten unterstreicht u. E. eine abnorme Veranlagung der von autoerotischen Unfällen Betroffenen." (CK+78, S. 137)

"Eine deutliche Erhöhung der Zahl der Ledigen im Vergleich zur Gesamtbevölkerung ist aber vorhanden. Dies zeigt, daß ein Teil der Autoerotiker allein und ohne engen Kontakt zur Umwelt leben will [Hervorhebung K.P.] und keine Partnerschaftsbeziehung eingeht." (Sch75, S. 27)

Auf die Vermutung, daß die Einsamkeit eine unfreiwillige sein könnte und gerade Menschen ohne Bindungen häufiger autoerotische Unfälle erleiden als Menschen, die ihre sexuellen Vorlieben mit einem Partner teilen können, scheinen nicht viele Autoren zu kommen.

Zum Akademikeranteil schreibt Schwab:

"Die Gruppe der 'Geistigen Berufe, Akademiker und Studenten' mit 18 Fällen ist insofern interessant, als sie in einer normalen Gesellschaftsstruktur nur mit etwa 6% der Gesamtbevölkerung vertreten ist. Diese erhebliche Diskrepanz läßt sich dadurch erklären, daß mit höherem Bildungsniveau auch die Rolle der Phantasie im Sexualbereich größer wird. Da bei autoerotischen Handlungen die Phantasie eine wichtige Funktion einnimmt, liegt hier die Ursache für die relativ hohe Anzahl" (Sch75, S. 27)

Ebenso Du Chesne u.a.:

"Die überraschende Tatsache, daß im Gesamtmaterial nur von 12% der tödlichen autoerotischen Unfälle Arbeiter, dagegen von 50% Angestellte, Selbständige und Angehörige der Intelligenz betroffen waren, sollte von kompetenten Soziologen gedeutet werden." (CK+78, S. 137)

Dagegen heißt es bei Blanchard und Hucker:

"Der Bildungsgrad der Verstorbenen fand sich selten in den gerichtsmedizinischen Aufzeichnungen. (...) Es sieht so aus, als würde der Bildungsgrad eher in den Akten vermerkt, wenn er über dem Durchschnitt lag."  (BH91, S. 373)


Frauen:

Die Daten hierzu sind spärlich: in "Fatal and Near-Fatal Autoerotic Asphyxial Episodes in Women" wurden ganze neun Fälle untersucht. Eine gebräuchliche Definition des autoerotischen Erstickungstodes (Res72) legt von vornherein fest, dass es sich beim Opfer um einen jungen Mann handeln muß.

"Erwähnenswert ist, daß die ersten Eindrücke in vier Fällen (44%) Mord (zwei), Selbstmordversuch (einer) und Unfalltod bei sexuellen Aktivitäten mit dem Partner (einer) waren. Diese Ergebnisse unterstützen die Behauptung, daß die bisher berichteten Manifestationen weiblicher autoerotischer Asphyxie-Aktivitäten die Ermittler anfänglich in die Irre führen können. Unsere Absicht in der Darlegung dieser Ergebnisse ist es daher, die Aufmerksamkeit für die subtileren Merkmale dieses Syndroms bei Frauen zu erhöhen, damit diese Fälle in Zukunft seltener unterdiagnostiziert oder fälschlich als Unfalltod eingeordnet werden." (BHH93, S. 70)

"Die Fundsituationen der weiblichen Fälle präsentieren sich in der Regel weniger offensichtlich als die üblicheren Fälle bei Männern, in denen Fetischismus, Bondage und Geräte oder Methoden, die erniedrigen und/oder echte oder simulierte Schmerzen hervorrufen sollen, offenbar eine weit signifikantere Rolle spielen. Im Vergleich dazu sind die weiblichen Fälle weniger bizarr; in nur einem Fall tauchen pornographisches Material und Fesselungen auf und nur in einem anderen Wäscheklammern zur masochistischen Stimulation. In den restlichen Fällen gibt es keine Anzeichen für ungewöhnliche Hilfsmittel." (BHH93, S. 72)

Es bestehen die Möglichkeiten, daß Frauen

Bei der derzeitigen Datenlage ist es kaum möglich, dazu eine Aussage zu treffen.


Zusammenhang mit anderen Paraphilien:

In der Folge zitiere ich ausführlich aus der Zusammenfassung von "Age, Transvestism, Bondage and Concurrent Paraphilic Activities in 117 Fatal Cases of Autoerotic Asphyxia"  (BH91), da es sich um eine vergleichsweise fundierte Studie handelt. Die  kanadischen Provinzen Alberta und Ontario führen autoerotische Erstickungstode, anders als das in Deutschland der Fall ist, gesondert in der Todesursachenstatistik auf. Die 117 untersuchten Fälle stammen aus den Jahren 1974 bis 1984.

"Unsere Daten zeigen, daß mit dem Alter der Anhänger autoerotischer Asphyxie die Wahrscheinlichkeit (oder die Intensität) einer gleichzeitigen Beschäftigung mit Transvestitismus oder Bondage steigt. Diese Ergebnisse sind konsistent mit der Beobachtung, daß die Masturbationsrituale der Betreffenden im Laufe der Zeit allmählich elaborierter werden. Die vorliegenden Daten sind jedoch nicht longitudinal und lassen die Möglichkeit offen, daß ein ganz anderes Entwicklungsmuster das gleiche cross-sectional Ergebnis hervorgebracht haben könnte. So ist es zum Beispiel vorstellbar, daß eine cross-sectional Stichprobe der Anhänger autoerotischer Asphyxie aus zwei unterschiedlichen Populationen besteht: einer jüngeren Gruppe, deren Mitglieder (wenn sie überleben) weder Transvestitismus noch Bondage ausbilden, sondern eher von der autoerotischen Asphyxie ablassen (und aus der Stichprobe verschwinden), und einer älteren Gruppe mit erheblichen Neigungen zu Transvestitismus und Bondage, die eigentlich mit jenen Paraphilien begonnen und die autoerotische Asphyxie erst in fortgeschrittenem Alter entwickelt haben. Das zweite Szenario ist komplizierter und daher weniger attraktiv als Erklärungsmodell für die Gesamtdaten. Es hebt allerdings den Umstand hervor, daß nicht notwendigerweise alle Fälle autoerotischer Asphyxie die gleiche Entwicklungsgeschichte oder die gleiche Ätiologie haben müssen.
(...)
Verschiedene Modelle werden erörtert, um die generelle Neigung der Paraphilien zum gehäuften Auftreten zu erklären. Abel et al. (1988) stellten die Hypothese auf, daß die fehlenden negativen Folgen des ersten devianten Aktes die Hemmungen des Paraphilen verringern, auch andere paraphile Phantasien auszuleben; die Autoren unternehmen jedoch nicht den Versuch, zu erklären, warum ein Paraphiler überhaupt multiple abweichende Phantasien hat.* Bancroft (Bancroft, J. (1989) Human Sexuality and Its Problems (2nd edn). London: Churchill Livingstone) bemerkt, daß die Tendenz der Paraphilien zum Clustering die Vermutung nahelegt, daß die Bedingungen, die für die Entwicklung einer bestimmten Paraphilie nötig sind, unter Umständen die Entwicklung anderer begünstigen. Er mutmaßt, daß dieses Potential aus einer Besonderheit des individuellen für das sexuelle Lernen zuständigen Zentrums herrührt. Dies entspricht der Annahme einer paraphilen Veranlagung. Freund (Freund, K. (1976) Diagnosis and treatment of forensically significant anomalous erotic preferences. Canadian Journal of Criminology and Corrections, 18, 181-189) führte das Konzept der "courtship disorder" ein, um seine Feststellung zu erklären, daß verschiedene Kombinationen aus Voyeurismus, Exhibitionismus, Toucheurismus und Vergewaltigung häufig im selben Individuum zusammentreffen. In einer Reihe von Artikeln (z.B. Freund, K. (1990) Courtship Disorder. In Handbook of Sexual Assault: Issues, Theories, and Treatment of the Offender (eds W.L. Marshall, D.R. Laws & H.E. Barbaree). New York: Plenum) stellte er die Theorie auf, daß dieses Ergebnis aus dem Versagen eines Mechanismus resultiert, der das normale menschliche Paarungsverhalten koordiniert und dessen Dysfunktion dazu führt, daß verschiedene Komponenten der normalen Abfolge in bruchstückhafter und unmodulierter Form ausbrechen. Es gibt gegenwärtig keine greifbaren Beweise für einen der von diesen Autoren vorgeschlagenen Mechanismen zur Erklärung der Häufung von Paraphilien.
Die generelle Tendenz einzelner Paraphilien, die Wahrscheinlichkeit des Auftretens anderer zu erhöhen, kann unsere Feststellung erklären, daß das beobachtete Maß an Transvestitismus im Verlauf der Kurve ansteigt, die von keinen Anzeichen für Bondage zu mittleren Werten für Bondage führt. Erklärungsbedürftig ist das unerwartete Ergebnis, daß eine weitere Zunahme der Bondage-Werte mit einer Abnahme der Transvestitismus-Werte einhergeht. [Grafik folgt]
Der absteigende Ast der Bondage-Transvestitismus-Kurve impliziert das Wirken eines zweiten Faktors, der eine negative Korrelation zwischen den unterschiedlichen Arten paraphilen Verhaltens erzeugt, und der unter bestimmten Bedingungen den Effekt des Clustering-Faktors abschwächt oder überwiegt. Ein wahrscheinlicher Kandidat für diesen Faktor ist response competition. Es ist denkbar, daß zwei, drei oder mehr erotische Impulse, die zur gleichen Zeit erregt werden, um die Aufmerksamkeit konkurrieren - wie auch nicht-erotische Impulse oder gleichzeitige Aufgaben - und daß das völlige Aufgehen in einem oder zwei starken Impulsen zur Vernachlässigung anderer Möglichkeiten führt. So könnte die Annahme einer response competition erklären, warum in der vorliegenden Studie die sehr stark an Bondage interessierten Personen weniger zum Transvestitismus neigten als Personen, die sich nur mäßig mit Bondage beschäftigten.
(...)
Unser Schlußkommentar betrifft die grundlegende Natur der autoerotischen Asphyxie und die Implikationen für ihre Behandlung. Es mag Anhänger geben, deren einziges Ziel bei dieser Aktivität die rein körperliche Empfindung der zerebralen Anoxie ist. Es könnte sogar möglich sein, hartnäckige Fälle mit der Verschreibung von Medikamenten wie Amylnitrit zu behandeln, das ähnliche Empfindungen bei viel geringerem Risiko hervorruft. Die vorliegenden Daten geben leider keine Auskunft darüber, ob solche "reinen" Asphyxiophilen existieren oder wie sie zu identifizieren wären. Andererseits legen die Daten die Vermutung nahe, daß es sehr wahrscheinlich viele Fälle gibt, für die die rein körperlichen Empfindungen der Anoxie nicht die einzige Quelle sexueller Stimulation darstellen. Es ist schließlich nicht nötig, Lippenstift aufzutragen oder sich die Fußknöchel zu fesseln, um Anoxie auszulösen. Es mag sogar Fälle geben, in denen die zerebrale Anoxie per se lediglich eine Begleiterscheinung der Selbststrangulation, des Erhängens oder Erstickens ist. Solche Fälle würde man klinisch als Masochisten mit besonders gefährlichen Neigungen behandeln.**"  (BH91, S. 375f.)

* Wenn nun ein größerer Teil der "normalen" Bevölkerung multiple abweichende Phantasien hat, aber aus Furcht vor den genannten Sanktionen nicht einmal die erste davon auslebt? Vielleicht ist das Vorhandensein der multiplen Phantasien nicht so erklärungsbedürftig, wie hier angenommen wird. Auch dazu gibt es eher wenig brauchbares Material.

** Mit der gleichen Berechtigung, aber das ist nur meine ganz persönliche Meinung, müßten auch Bergsteiger und Motorradfahrer behandelt werden.


Theorien zur Entstehung:

Eine Zusammenfassung aus Friedrich und Gerber (FG94) mit eingefügten Links auf die zitierte Literatur, soweit sie mir vorliegt:

"Die übliche vorgeschlagene ätiologische Perspektive ist die psychoanalytische. In einer Studie an acht Fällen autoerotischer Asphyxie in Hawaii schreiben die Autoren: "Tatsächlich ist wenig darüber bekannt, warum Menschen damit beginnen, Atemnot herbeizuführen, und wie diese Praktik erotisiert wird." (DIE90). Saunders (Sau89) schlägt mehrere Begründungen vor, unter anderem an Masturbation gekoppelte Schuldgefühle, Kastrationsangst und allgemeine Risikobereitschaft / Suche nach dem Thrill.
In zwei Fällen werden Mißhandlungen in der Kindheit als möglicher ätiologischer Faktor genannt. Cesnick und Coleman (CC89) schildern einen 26jährigen Patienten, der mißhandelt und sexuell mißbraucht worden war. Sie erörtern, daß Kindsmißhandlung zu self-defeating Aktivitäten führen könnte, die durch sexuell euphorisierendes Verhalten gemildert werden [Übersetzung zweifelhaft]. Wesselius und Bally (WB83) beschreiben einen 24jährigen Mann, der von seinem Vater mißhandelt und gezwungen wurde, Frauenkleidung zu tragen.
Ein weiterer Gedanke zur Ätiologie stammt von John Money (Money J, Lamacz M (1989), Vandalized Love Maps. Buffalo, NY: Prometheus Books). Autoerotische Asphyxie wird als sacrificial paraphilia beschrieben. Dieses Verhalten kommt bei Individuen vor, die das Gefühl haben, für ihr erotisches Verhalten Buße tun zu müssen und für die Lust daher an Bedrohung oder Strafe gekoppelt ist.
(...)
Es scheint, daß manche Teenager mit autoerotischer Asphyxie experimentieren und dann wieder davon Abstand nehmen, ohne daß sich klare ätiologische Elemente finden ließen (Sau89). Money (Money J (1993), What is autoerotic asphyxiation? Harvard Mental Health Letters September 8) nimmt an, daß autoerotische Asphyxie unter überdurchschnittlich erfolgreichen Menschen, Menschen mit strengem religiösem Hintergrund und Asthmatikern überrepräsentiert ist." (FG94, S. 970f.)

Friedrichs und Gerbers eigene Untersuchung an fünf Teenagern ergibt folgendes:

"Diese Jungen wiesen einige Charakteristika auf: Unter anderem liegen eine Vorgeschichte der Atemnot vor, Mißhandlung, sexueller Mißbrauch, andere risikofreudigen Verhaltensweisen, andere Traumata und die Frage, ob paired-associate learning, die Koppelung von Erregung mit Atemnoterfahrung (Kol88), eindeutig vorlag. Uns ist klar, daß junge Männer hin und wieder in harmlosen Situationen Atemnot gekoppelt mit sexueller Erregung erleben, und diese Jungen weisen nicht notwendig die Merkmale aus unserer Tabelle auf (Saunders 1989). Die Zwanghaftigkeit und das ritualisierte Verhalten, die hier an den Tag gelegt werden, sind jedoch ungewöhnlich, und höchstwahrscheinlich Auswirkungen von signifikanteren ätiologischen Vorläufern [Übersetzung zweifelhaft].
(...)
Vier von fünf Jungen hatten auch Erfahrung mit Atemnot. In jedem Fall war die Atemnot von Angst oder sexueller Erregung begleitet (...) Sogar der erste Junge, A.A., war Zeuge von Bondage-Aktivitäten geworden und hatte detaillierte Berichte über den Tod seines Vaters durch Asphyxiophilie gehört. E.E. beschrieb in seinem Interview wiederholte und ausgeprägte Atemnot, während er Oralverkehr an seinem älteren Cousin ausgeübt hatte.
Unsere Ergebnisse zu den Atemnoterfahrungen überschneiden sich mit dem von Money (Money J (1993), What is autoerotic asphyxiation? Harvard Mental Health Letters September 8) genannten Asthma. Ein Asthmatiker, der Schwierigkeiten beim Atmen hat, erfährt Erregung in Form von Panik und kann das Bedürfnis haben, diese Erfahrung zu rekonstruieren, um sie so zu bewältigen.
(...)
Zusammengefaßt scheint die Ätiologie schwerer und hartnäckiger Asphyxiophiliefälle die Koppelung von Atemnot und sexueller Erregung einzuschließen. Diese Koppelung wurde durch frühere traumatische und Mißhandlungserfahrungen im Leben dieser Jungen gefördert. Autoerotische Asphyxie war im allgemeinen auch nicht ihre einzige masochistische Verhaltensweise." (FG94, S. 972f.)

Man darf bei der Interpretation dieser Ergebnisse nicht aus den Augen verlieren, daß die Patienten sich wegen gravierender anderer Probleme in Behandlung begaben / eingewiesen wurden. Diese Verzerrung ist in der psychologischen Literatur zu Paraphilien allgemein verbreitet - wer keine auffälligen psychischen Probleme aufweist, wird nur selten ins Gesichtsfeld der Autoren wissenschaftlicher Artikel geraten.


Andere Länder, andere Sittenwidrigkeiten

In vielen Texten wird angegeben, Atemkontrollspiele seien in anderen Kulturen ein gebräuchlicher Teil des sexuellen Repertoires. Die Belege, die dafür angegeben werden, sind allerdings eher spärlich und ein Autor schreibt sie offenbar vom anderen ab:

"It is alleged that it is frequent practice among some Orientals for the sexual partners to mutually grasp each others throat in a strangling gesture and it is said that fatalities not infrequently result from this practice." (Hen71, Quellen werden nicht genannt)

"Anthropologists have reported that Eskimo children hang themselves in some game, probably sexual, and that the Yahgans in South America tied the neck to induce partial strangulation and exhilaration, at which time they saw beautiful colors (Stearns, A. Cases of Probable Suicide in Young Persons Without Obvious Motivation. J. Maine Med. Assoc., 44: 16, 1953). De Sade also traces erotized hanging behavior back to the Celts (De Sade, The Marquis. The Complete Justine, Philosophy in the Bedroom and Other Writings. Trans. by Seaver, R., and Wainhouse, A. Grove Press, New York, 1965). Shoshone-Bannock Indian children have among their games several involving risk-taking and suffocation experiences. These are called 'smoke-out,' 'red-out,' and 'hang-up." (Larry H. Dizmang, M.D. personal communication)" (Res72)

Diese "personal communication" stammt offenbar von jemandem, der die Geschichte in Melvilles "Billy Budd" gelesen hat.

"The activity of producing a temporary state of asphyxia by constriction of the carotid vessels in the neck for sexual gratification has been defined by anthropologists for centuries. The Eskimos, for example, are known to choke each other as part of their sexual activity and it is common for their children to suspend themselves by the neck in playing. (Freuchen, Book of the Eskimos, Cleveland 1961, S. 212)" (WS+77)

"Anthropologists have observed similar asphyxial practices among Eskimo children (Res72), the Yaghans of South America (Stearns, A.W.(1953), Cases of probable suicide in young persons withouth obvious motivation. Maine Med. Assn. J., 44: 16-23), the Celts (Sade, Marquis de (1791), The Complete Justine, Philosophy in the Bedroom and Other Writings, tr R. Seaver & A. Wainhouse. New York: Grove Press, 1965), and the Shoshone-Bannock Indians (Melville, H. (1928), Billy Budd, Foretopman. In: The Shorter Novels of Herman Melville, ed. B. Evans. Greenwich, Conn.: Fawcett Publications). It is said (Hen71) to be a frequent practice among some Orientals for the sexual partners to grasp each other's throat in a strangling gesture, which sometimes results in fatalities. Resnik (Res72) personally noted several games in which excited children choke each other by compressing the neck or chest." (RF79)

"In addition, anthropologists have pointed out that certain ethnic and cultural groups (e.g., Eskimos) are known to choke each other as part of their sexual activity. In such cultures it is common for the children to suspend themselves by the neck during play." (LW82 zitiert WS+77)

"The late professor Leopold Breitenecker, former Professor and Director of the Institute of Forensic Medicine of the University of Vienna, Austria, described pressure on the neck during sexual activity as an activity common in Eskimo and Southeast Asian people. This practice was brought to Europe and Africa by French Foreign Legionnaires and presented occasional problems in forensic pathology for Professor Breitenecker and his colleagues. He maintained an acute interest in geographic forensic pathology ..." (Editor's note in Ems83)

"A stone sculpture in the Museo de Antropológia in Mexico City depicts a naked man with a rope looped around his neck. Scars are visible on his cheeks and forehead, and his penis, once erect, has been fractured from the sculpture. The museum sign beneath the statue states that it is a Mayan relic from the late classic or early postclassic period depicting an adolescent from a phallic cult. The scars on his face are said to be facial decorations. The sculpture was apparently done c. 1000 A.D., the approximate date of the transition between the late classic and early postclassic periods. (...)
Whether the ancient Maya had discovered autoerotic asphyxia, as the sculpture so strongly suggests, will perhaps never be known with certainty. It is known, however, that the Maya believed that the souls of individuals who hang themselves go directly to paradise, where they are received by Ixtab, goddess of the hanged (Alexander 1964). The representation of Ixtab in a Mayan manuscript drawing shows her in a kneeling posture, her one visible nipple erect, suspended by a noose around her neck; her ankles appear to be bound together (see the Dresden Codex on p. 316 of Anders 1963).
Frazer (1959) described ritual and religious hangings among the Greeks and other ancient cultures." (HDB83)

"This was attributed to the experiences of French Foreign Legionnaires who had been stationed in French Indochina (Vietnam) before its independence from France. This was also a topic discussed by Prof. Leopold Breitenecker, late professor of legal medicine of the University of Vienna, Austria, in his lectures. Pressure on the neck during intercourse was practiced and occasionally resulted in deaths of one of the partners due to the effect on the carotid sinus." (Min85)

"The practice of sexual asphyxia has been described in anthropological studies of various populations in Europe and the Orient and also among peoples such as the Inuit and Yaghan Indians (RF79)." (BB88)

"Anthropological data show that asphyxiation in order to enhance sexual stimulation occurs in several cultures. Among the Eskimos, asphyxiation is often part of adult sexuality and asphyxiation is also common in children's games (Freuchen D (Ed.): Peter Freuchen's book of the Eskimos. Cleveland, OH: The World Publishing Company, 1961). Children of Shoshone-Bannock Indians play games where suffocation is a part of the game (Res72). Further, the old Celts were known to asphyxiate themselves."
(IE89)

"Walsh, Stahl, Unger, Lilienstern, and Stephens (WS+77) report that producing a temporary state of asphyxia by constriction of the carotid vessels in the neck for sexual gratification has been known to anthropologists 'for centuries'. 'The Eskimos,' they write, 'are known to choke each other as part of their sexual activity and it is common for their children to suspend themselves by the neck in [sex] play' (p. 158)." (Sau89)

"Eskimo children have been reported to seek unconsciousness as a delightful game. (Freuchen D (Ed.): Peter Freuchen's book of the Eskimos. Cleveland, OH: The World Publishing Company, 1961)" (DIE90)

"De Sade described the practice in his erotic novel Justine (1791) (see Seaves & Wainhouse 1965) and in a footnote the editors attribute it to pre-Christian Celts in Britain. Hazelwood et al. (HDB83, p. 14) suggest that it was known to the Mayas of ancient Mexico who recognised a goddess, Ixtab, of the hanged." (Huc90)

"Manual or ligature compression of the carotid arteries in the neck, which causes hypoxia that is intended to prolong orgasm during anterior or posterior intercourse, was originally reported by Prof. Leopold Breitenecker (personal communication), Director of the Institute of Forensic Medicine at the University of Vienna, who claimed that the technique had been practiced by Eskimos and by Asians before it was introduced to Europe by French Foreign Legionnaires returning from war in Indo-China, where the technique was performed by prostitutes to increase the client's sensation of ejaculation." (EKD91)

"Statuary from Mexico from the end of the first millennium suggests that the Mayans were cognizant of the association between asphyxia and erotica: one of a man with an erection and a noose around his neck still survives. And we do know that they believed the souls of those who hanged themselves went directly to paradise, where they were received by Ixtab, the Goodess of the Hanged. Statues of her depict a young woman on her knees with a rope around her neck, with pronouncedly erect nipples." (BP93)

"Inuit Indians, which is to say, Eskimos, are also known to have practised this, and numerous European historians have chronicled its use in what was then called Cochin China, and later, French Indo-China. French Legionnaires are said to have brought it from there to France." (BP93; als Quelle ist EKD91 angegeben)

"Although the first description of autoerotic asphyxial deaths appeared in the American literature in the 1950s, the use of asphyxia as a means of enhancing sexual gratification was apparently previously well-known. As examples, neck compression with heterosexual activity was known to generations of Eskimos, and the Marquis de Sade described the induction of erotic sensations by self-suspension in his book 'Justine', published in 1791." (CCM94, Quelle vermutlich Res72)

"Anthropologists have long been aware of asphyxial practices among various cultures, including the Inuit of the Arctic and the Yaghans of South America (Hirschfield, N. (sic): Sexual anomalies: the origins, nature and treatment of sexual disorders. New York 1948: 374-377)." (TBS94)

Magnus Hirschfeld, der wohl gemeint ist, schreibt zwar einiges über die Strangulation; die hier zitierten Fakten tauchen bei ihm aber nicht auf.

"Anthropologists have described asphyxial practices in both adults and children. A frequent practice among Orientals is to strangle the throat to heighten sexual pleasure (Hen71). Likewise, the Yahgans in South America tied the neck to induce partial strangulation which produced exhilaration and at which time, they saw beautiful colors (Stearns, A. Cases of Probable suicide in young persons without obvious motivation. J Maine Med Assoc 1953; 44:16). The Celts also utilized erotic hanging for pleasure (DeSade, the Marquis. The Complete Justine, Philosophy in the Bedroom and other Writings. New York 1965). Children, similarly partake in this practice. For example, the Eskimo children hang themselves in a sexual game (Res72). Moreover, the Shoshone-Bannock Indian children play 'smoke-out,' 'red-out,' and 'hang-up,', which are suffocating games (Melville, H. Billy Budd, Foretopman in the Shorter Novels of Herman Melville. Greenwich 1928).

"The Marquis de Sade traced the origin of the practice to the Celts (als Quelle ist BP93 angegeben, wo davon allerdings nichts steht), but early accounts have also been found in the Eskimo and American Indian cultures, the Mayan Indians having a goddess of the hanged, Ixtab, usually depicted on her knees with a rope around her neck and with erect nipples." (JH97)


Noch nicht untergebrachte Zitate:

"Das Alter der Opfer lag zwischen 10 und 56 (mean 26.0, median 24.0) Jahren. Die Altersverteilung war deutlich verschoben; ein Drittel der Opfer war jünger als 19 Jahre."  (BH91, S. 373)

"Wie aus der Altersverteilung der Stichprobe zu erwarten war, war die überwiegende Mehrheit, 85 Fälle, zum Zeitpunkt der tödlichen Asphyxie noch ledig. 27 waren verheiratet oder lebten in festen Partnerschaften, fünf waren geschieden oder getrennt.
Es gab keine Anzeichen dafür, daß der Homosexuellenanteil signifikant von der Gesamtbevölkerung abwich. Drei Opfer waren ihren Familien oder Bekannten als homosexuell bekannt; in einem vierten Fall wurde homosexuelles pornographisches Material am Unfallort und unter den Hinterlassenschaften des Verstorbenen gefunden."  (BH91, S. 373)

"Zusammenfassend kann man sagen, daß das Familien- und Berufsleben des Autoerotikers in keiner Weise auffällig ist und auch keinerlei direkte Rückschlüsse auf ein autoerotisches Verhalten zuläßt." (Sch75, S. 29)

"50 Autoerotiker [von 85, K.P.] zeigten keine Auffälligkeiten oder unnormale Verhaltensweisen. Ihr psychisches Verhalten lieferte nicht den geringsten Hinweis auf autoerotische Handlungen. Allgemein kontaktarm waren 10 Personen, 15 Männer hatten keine Beziehungen zum weiblichen Geschlecht. 12 Autoerotiker waren charakterlich abnorm, das entspricht etwa der doppelten Anzahl verglichen mit einem normalen Bevölkerungsdurchschnitt. Daraus kann man schließen, daß eine abnorme Persönlichkeit viel eher zu autoerotischen Handlungen neigt.
In einigen Fällen ergaben sich wichtige Anhaltspunkte für Motive und Hintergründe der Handlung. 6 Verunglückte beschäftigten sich mit weiblicher Kleidung oder zeigten Freude am Verkleiden, benahmen sich aber in sexueller Hinsicht normal, sodaß kein Verdacht einer abartigen Betätigung aufkommen konnte. In allen 6 Fällen war auch bei dem tödlichen Unfall eine transvestitische oder fetischistische Komponente vorhanden. Das Gleiche gilt auch für die Vorliebe für Fesselungen (3 Fälle) oder die intensive Beschäftigung mit Plastikmaterial, Gummi und ähnlichen Stoffen (5 Fälle).
Die Beschäftigung mit Sexualliteratur oder Pornographie wird nur in 2 Fällen ausdrücklich erwähnt. Allerdings ist es fraglich, ob genügend Aussagen dazu gemacht wurden. Es fällt weiterhin auf, daß in 5 Fällen die Opfer eine sehr starke religiöse Bindung hatten. Eine mögliche Erklärung ist vielleicht darin zu sehen, daß gerade bei starker Religiosität Konflikte zwischen Religion und Sexualität entstehen, die dann in autoerotischen Handlungen abreagiert werden. In 6 Fällen waren die Opfer nicht in ihren eigenen Wohnungen oder getrennt von ihren Ehefrauen. Hier muß man annehmen, daß durch die Trennung der fehlende familiäre und sexuelle Kontakt durch autoerotische Handlungen ersetzt wurde.
3 Fälle wiesen eine Selbstmordneigung bzw. einen Selbstmordversuch in der Vorgeschichte auf. In 16 Fällen werden dagegen Selbstmordabsichten oder Anhaltspunkte für ein solches Handeln ausdrücklich verneint. Eine erhöhte Neigung und Häufigkeit zum Selbstmord liegt nicht vor." (Sch75, S. 31f.)

"In 35,9% der Fälle ließ sich keine Erwähnung irgendwelcher paraphiler Objekte oder Aktivitäten neben der autoerotischen Asphyxie finden.
(...)
Die Untersuchung der Daten ergab, daß mit steigendem Alter der Personen der Anteil, bei dem Anzeichen für Bondage, Transvestitismus oder beides gefunden worden waren, stetig ansteigt. Der Zusammenhang zwischen Alter, Bondage und Transvestitismus wurde mittels einfacher Korrelationskoeffizienten ermittelt. Die Ergebnisse bestätigten, daß die älteren Personen beim tödlichen Unfall intensiver mit Bondage beschäftigt gewesen waren (r=0.27, P=0.004, two-tailed). Die älteren Personen beschäftigsten sich auch intensiver mit Transvestitismus (r=0.40, P<0.001, two-tailed). Die multiple correlation von Alter und Transvesititismus plus Bondage ergab r=0.45. " (BH91, S. 373f.)

"Die 'autoerotischen Unfälle mit Todesfolge' aus den Lehrbüchern der Gerichtsmedizin, meist durch Selbstfesselungen und Strangulationen umgekommene Masochisten, sind in gewisser Hinsicht direkte Opfer dieses Abstoßungs- und Isolierungsprozesses. Sie waren genötigt, ihre sexuellen Spiele allein zu spielen, waren einer eigenen masochistischen 'Szene' beraubt und blieben so auf dem frühen, realitätsfernen und infantilen Phantasieniveau, auf dem die sexuellen Ideale noch aus dem Themengebiet realer Folter und Tötung entliehen werden müssen. Die Befriedigung muß sich dann auf die Phantasie beschränken oder unter Gefahr für das eigene Leben in Szene gesetzt werden." (Bah92)

"It is, perhaps, ironic that the few survivors of such potentially lethal practices, who present themselves for treatment for other reasons (such as burgeoning depression, guilt, etc.), often manifest pervasive psychopathology. In a conventional psychiatric sense, they would qualify as 'infinitely sicker' than those who perish at their own hands." (Coo96)

Blinder ist wohl noch selten ein Autor in die Falle der "klinischen Stichprobenverzerrung" getappt. Während man davon ausgehen darf, dass tot ein halbwegs repräsentativer Querschnitt der - psychisch, soweit sich das im Nachhinein feststellen lässt, wohl relativ unauffälligen - gesamten Atemkontrollspieler-Population aufgefunden wird, erscheinen in der Praxis des Psychiaters natürlich nur diejenigen, die gute Gründe dafür haben. Wer nicht unter Depressionen und Schuldgefühlen wegen seiner sexuellen Praktiken leidet, den bekommt kein Psychiater jemals zu sehen ...

"Finally, the three cases described herin, as is consistent with findings from other studies, illustrate the extreme diversity of the condition. Thus, it may be conjectured that some practitioners of auto-erotic asphyxial behaviors may be in 'good' mental health, high functioning, and to all outward appearances, 'perfectly normal'. Yet others may present with multiple paraphilias and pervasive psychopathologies. Therefore, survivors need holistic assessment and the tailoring of treatment, which may consist of several ingredients, including pharmacotherapy in some cases, to their specific needs." (Coo96)

"Singles predominated at 43%, 30% were married, 10% were either divorced or widowed, while the remaining 17% were undocumented. In just about half of the cases where the victim was married, the wife was aware of the behavior, and in one case the victim dressed up as a transvestite before intercourse. The victims were evenly distributed among students and skilled and unskilled workers at 14, 16 and 18%, respectively, while 8% were academics, 10% officials, 2% retired, and 32% undocumented. (...) The age range was wide (10-71 years), and the majority of victims (64%) were <29 years old, which agrees with the findings of others. (...) Most of the victims were described as well-adjusted men, but the information on premorbid psyche and habitus has been limited to mental disorder, depression, and confinement in a psychiatric ward, making it difficult to characterize the personality of the deceased. (...) In the whole case material there was no evidence of psychotic disorder. Two victims were homosexuals, which is not higher a frequency of homosexuality compared with that of the population in general." (BM95)

Book und Perumal interviewten 1993 anlässlich eines einschlägigen Todesfalls einige Prostituierte in Durban zum Thema Atemkontrollspiele:

"Regarding prevalence, one of the women stated that she services an average of two different men a week in this fashion. Admittedly, she is her brothel's in-house expert on bondage and discipline; but still, this extrapolates to numbers an order of magnitude more than was expected!
Concerning gender, none of them has ever heard of females requesting this service. Although the women said that Indian men frequently requested bondage and discipline with their sex, no non-whites have ever requested this specific type of service. None of the nine female prostitutes interviewed ever services blacks.
Regarding the mechanisms employed, we invite you to accept the maxim that man's inventiveness truly is without limit. All ages were represented, with a preponderance of middle-aged men. Concerning drugs, none of the interviewed women recall ever having a client of this nature use anything other than alcohol or tobacco.
Concerning just how far to go with the asphyxia, the clients indicate this to the women. Several need to be smothered or choked until quite blue in the face and nearly completely unconscious. One woman discontinued 'seeing' a regular client of hers - one whom she had regularly serviced over several years - because he pressured her to strangle him more and more - and especially because he was in his late sixties - she was afraid she would accidentally kill him.
Concerning how these men come to know about asphyxial erotica, most of the prostitutes opinioned that it probably occurred during their youth, and that it became addictive. One of the women gave two examples in support of this theory: One of her clients confided that his female babysitter regularly used to sit naked on his face, forcing him to perform cunnilingus on her and causing him near suffocation. Now an adult, he can only achieve sexual gratification when nearly smothered. Her other example does not deal with asphyxia (...)
Another of the women regularly services a 'little British clarinet player'. He has told her that when he was a boy, his mother would punish him by partially smothering him with her hand over his mouth and nose. He has mentioned nothing else about his early years, but if anything else sexually untoward transpired - or if even one half of what Freud said about Oedipal complexes is true - it becomes easy to see the connection between his boyhood and the present: She has to insert two of her toes into his nostrils and cover his mouth with the instep of his other foot while she masturbates him, with his orgasm occurring only when he's gagging and 'dark blue in the face'.
Regardless of any deeper cause for certain men doing this, the girls are unanimous in saying that they do it because they like it, because it either allows them to climax, or it intensifies their climax. They like it because the adrenaline it releases is productive of excitement and pleasure." (BP93)

"It is difficult wholeheartedly to embrace any of these convoluted explanations. What is obvious is that certain people require a degree of asphyxia in order to achieve their preferred degree and type of sexual gratification - it makes them feel good. Beyond this, we limit our comments to acknowledging the existence of 'unconscious psychodynamics', even if we do not understand them." (BP93)

"There is considerably less masochism among the women practitioners than among the men." (BP93, zitieren allerdings vermutlich irgendjemand anders. Original finden, Zitat rauswerfen.)

"He reported that on day 10 of lithium therapy he tried unsuccessfully to repeat his ritual. He related that his behavior was motivated more out of curiosity as to 'lost virility,' than seeking sexual pleasure or relief from his psychic distress. He wept in frustration that he could no longer achieve euphoria or orgasmic release, continued an inordinate amount of physical stimulation, and finally achieved ejaculation. What had been an easily achieved nightly ritual of escape had become unsatisfying. It had become quite difficult for him to even sustain an erection and achieve orgasm." (CC89)

"Childhood abuse or some other factor could conceivably result in a learned helplessness and self-defeating activity which could be relieved by engaging in sexually euphoric behavior - establishing a learned association and thus becoming a self-perpetuating feedback loop. Whether or not such feedback becomes lodged in the thinking or erotosexual pathways in the brain can only be further speculated upon at this point." (CC89)

"In such literature, a young male is ridden by a large-breasted Amazon type of woman wearing leather boots, thin panties, and a skimpy brassiere. Her eyes flash with anger; in one hand she holds a whip and in the other, the reins of her horse - in this case, the young man whose reins are in the form of a ligature around his neck. His face is swollen and edematous and he appears to be sweating profusely.
It is my speculation that this perversion reenacts the victim's feelings of emasculation by his mother. She is seen as a powerful woman who controls her son's masculinity. If when he dies he is wearing panty hose or other female attire, symbolically and on a fantasy level, it is his mother who dies." (Dan80)

"It is not possible to see any particular psychodynamics in her lethal sexual behavior. There was no pornographic material in the bathroom. The basic idea of her using a phallus for sexual gratification makes one wonder why this was necessary when she had her married boyfriend (who acknowledged having intercourse with her)." (Dan80)

"What is clear here also applies to males who engage in lethal autoerotic behavior. Each seeks being totally in power to reach a fantasied wish to control life and death. They engaged in such a struggle while alone, narcisstically carrying out the battle for mastery of their inner conflict by eroticizing their helplessness, weakness, and threat to life. Both the males and this female appear to have either lost the battle to have life win out over death, or they unconsciously moved closer to death as the chosen solution, one which ends their fears that mastery is not possible and that a more fulfilling sexual image cannot be attained. Perhaps their death also means that they feel that a meaningful object relationship with a lover and intimate friend will never be possible and autoerotic pleasures are not that fulfilling." (Dan80)

"It is also typical that the decedent was described as happy and successful, without signs of alcohol or drug abuse ..." (DIE90)

"The danger itself might be a source of sexual excitement in some practitioners of asphyxiophilia. One frequently reported feature of those involved with asphyxiophilia seems to be an orientation toward masochism or violence and death associated with eroticism (LS72, Mon88). However, as accounts of eroticized danger in asphyxiophilia are lacking, it is unknown whether this is a common source of sexual excitement. We ourselves doubt this is so, since few data support this contention. Those involved in asphyxiophilia appear to be generally young, well adjusted and without apparent signs of psychopathology. It is probable that this is solitary play-acting, where, as Resnik (Res72) succinctly puts it: 'dying, rather than death, appears to be the end-game; this would seem to mitigate against the self-destructive and suicidal nature of the behavior.'" (DIE90)

"Characteristics such as the binding of body parts other than the neck, and use of or presence of sadomasochistic erotica, seem in keeping with the practice but are also difficult to interpret since most such individuals are not known to indulge in asphyxiophilia. At present, there are few reports by practitioners of asphyxiophilia about their own inner experiences or motives (WB83, CK86, LS72, Mon88). More first-person reports would assist in understanding the aberration. It is possible in at least some individuals, as in the case of our model that eroticism has a wide polymorphous base. He and others might have had a strong desire for novel and unique sexual stimulation." (DIE90)

"The patient himself was on the borderline of educational subnormality; he required special help with reading and other subjects, and verbalized poorly. (I.Q. Stanford Binet (Form L) Scale, 75-85). During childhood he behaved reasonably well and at school 'showed responsibility, initiative, reliability and honesty' and sought to manage his relationships with others positively. He tended to keep his thoughts and feelings to himself and revealed little outward anxiety. His self-identity was poor and his reality testing ability weak. He was unaggressive in his approach to others and was easily influenced by those immediately in contact with him.
About three years before his referral he had had a girl friend. On one occasion she had surprised him in his bedroom whilst he was changing and had thrown her arms round him. He was distressed by this but also sexually excited, and from this time onwards dated his own tendency to masturbate. This made him feel guilty, and this feeling was intensified by an adverse comment made by his mother when she noted some 'girlie' pictures in his room. As a result of these increasing feelings of guilt the patient began to indulge in different forms of abnormal practice. He found that forcing something in his rectum tended to increase his sexual excitement although it was quite painful. Later he began to threaten himself with knives while masturbating, and then again in a state of intense guilt would bury his head in his pillow at the moment of emission. Finally he began fixing a rope around his neck; his objective apparently was to hamper his state of consciousness to prevent full awareness of what he was doing. It would seem that his feelings of guilt had led to a need to punish himself.
(...)
Unfortunately it proved impossible to integrate his sexual life into a total personal relationship. After leaving the structured environment of school he failed to settle down to a stable job pattern or any stable relationship. He always had good intentions, but gave up easily and gradually drifted into promiscuity.
(...)
It was noted that the patient's feelings of intense guilt were markedly absent after initial therapy, and occurred in the absence of any formal symptoms of depression.
Finally, this case does tend to support the suggestion that these abnormal and dangerous sexual practices may result more from the pervert's desire to punish himself for his sexual behaviour than from any questionable heightening of sexual pleasure resulting from the self-induced asphyxia."
(Edm72)

"Several features characterize these boys. They include a history of choking, physical abuse, sexual abuse, other risk-taking behaviors, other trauma, and whether or not paired-associate learning, in which pairing of arousal with the choking experience (Kol88) was clearly evident. We realize that there are benign instances of teenage boys engaging in occasional pairings of choking with sexual arousal, and these boys do not necessarily have the features in this table (Sau89). However, the compulsivity and ritualistic behavior exhibited here is unusual, and most likely it is a function of more significant etiological precursors.
The majority of the features in the summary table are related to extreme arousal and feeling out of control. Physical and/or sexual abuse characterized each boy. For each boy except C.C., the sexual abuse involved direct contact including penetration. An important consequence of severe abuse is dysregulation, including altered psychophysiology (Kol88) as well as an impaired capacity for self-soothing (Braun BG (1988), The BASK model of dissociation. Dissociation 1:4-23). 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 (Braun BG (1988), The BASK model of dissociation. Dissociation 1:4-23).
The other traumatic events in the lives of these boys are also consistent with dysregulation. The events include parental chemical dependency or mental illness, emotional abuse and neglect, violence between parents, or the early loss of a parent. It is possible that the earlier traumatic experiences predisposed these boys toward a greater likelihood of deviant sexual arousal after sexual abuse. Early trauma predisposing to impaired arousal patterns has been suggested (Kol88).
Other risk-taking behavior was also evident. It is unlikely that sexual risk-taking would emerge unless other behavioral pathways regarding risk-taking had already been established. Four of five boys also had a direct experience of being choked. In each case, the choking was accompanied by either fear or sexual arousal, again adding to dysregulation and feeling out of control. Even the first boy, A.A., witnessed bondage activities and was told in some detail about his father's death due to hypoxyphilia. E.E. described in his interview repeated and pronounced sensations of choking while performing oral sex on his older cousin.
Our finding of choking overlaps with the asthma suggested by Money (Money J (1993) What is autoerotic asphyxiation? Harvard Mental Health Letters September 8). An asthmatic who is having trouble breathing experiences arousal, i.e., panic, and may seek to recreate the experience as a way to master it.
Not surprisingly, paired-associate learning, or the pairing of arousal and masochism (Kol88), appeared to be evident in each case. The boys' early traumas predisposed them to even greater arousal. In all cases, choking and sexual arousal were part of each boy's emotional substrate. Because of the out-of-control nature of this arousal, some effort at mastery or undoing is to be expected. The unique pairing of dysregulation that included both choking and sexual arousal contributed to the emergence of hypoxyphilia, a persisting pattern of behavior in at least four of the five boys discussed.
In summary, the etiology of severe and persisting autoerotic asphyxia appears to include 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."
(FG94)

"One of the problems in attempting to classify human behavior is that it represents an overlapping continuum rather than a series of discrete diagnostic entities. For example, although the motivations of practitioners of autoerotic asphyxia are poorly understood, it is recognized that there is an overlap with certain of the other paraphilias, including fetishism, transvestism, masochism, sadism, and bondage (Hazelwood RR, Dietz PE, Burgess AW. Sexual fatalities: behavioural reconstruction in equivocal cases. J Forensic Sci 1982; 27:763-73. / Litman RE, Curphey T, Shneidman ES, Faberow NL, Tabachnick N. Investigation of equivocal suicides. JAMA 1963; 184:924-9 / CK86 / Brown JRWC. Paraphilias: sadomasochism, fetishism, transvestism and transsexuality. Br J Psychiatry 1983; 143: 227-31 / HDB83, 77-100 / Res72 / BH91). Although a study of the psychological profiles of a quite select and small group of surviving practitioners has demonstrated significant depression with suicidal ideation (LS72), generally, there is no indication that practitioners wanted to die or were suffering from any significant psychiatric disturbance (BHH90, DIE90)."
(BB98)

"In North America, the typical victim is a white male between the ages of 15 to 25 years, who is engaged in solitary masturbation augmented by self-induced hypoxia (BB88). The participants can be from any socioeconomic group, single, married, or divorced/widowed at the usual rate adjusted for age. The behavior is repetitive, and frequently the paraphernalia associated with the practice becomes more elaborate as the participant ages and becomes more experienced. Preadolescent boys are often found fully clothed, with a simple ligature or noose; in teenagers the genitals are frequently bared, with pornographic materials on hand at the scene, and evidence of masturbation. Adult victims, particularly men, often exhibit transvestitism and/or masochism, and the ligatures take on a more complex quality."
(GJ00)

"There are prominent differences between most cases of male and female sexual autoasphyxiation. The men tend to have a much more elaborate ritual than the females do, exhibiting fetishisms and/or using bizarre props. Rectal foreign bodies such as vegetables, vibrators, pieces of wood, or traffic cones have been reported, along with many forms of masochistic injuries to the genitalia (BH91, LS72, BHH90). Mirrors (or video cameras) are often placed so that the victim can observe his own activities."
(GJ00)

"The incidence of cases appears to be increasing. Litman and Swearingen estimated ~50 deaths per year in the United States in 1972 (although admittedly using very little data to extrapolate from), (LS72), whereas Byard et al. have calculated >1000 deaths in males, and <20 females in 1996 (BHH90). The cause for the increase is not clear, because the reason for an individual to practice sexual autoasphyxiation is unknown. It would seem inevitable that the number of indivicuals who carry out this experience will increase, because now the media and the Worldwide Web give information on the practice. Some persons may thus try out sexual autoasphyxia simply from curiosity; however, there are several pieces of evidence that indicate that the practice of sexual autoasphyxiation is not necessarily a learned behavior. Foremost is the tendency for practitioners to be very secretive about their actions, hiding it away from even lovers and spouses, and there has been little to no press coverage until very recently, yet the numbers of victims has been growing during the last 25 years. Although pornographic magazines are common at the scene, and some of them depict bondage, this is invariably sadomasochistic material on bondage and torture, not strangulation or autoasphyxia. Curran et al. even note one instance of a young man who committed suicide via a gunshot to the head. His possessions and suicide note indicated that he practiced sexual autoasphyxia, and his note further indicated that he thought he was going insane, because he had never heard of anyone else with this behavior, and that his condition was unique (Curran WJ, McGarry AL, Petty CS. Modern legal medicine, psychiatry and forensic science. Philadelphia: F.A. Davis Co., 1980)."
(GJ00)

"Personen mit der Neigung zu Fesselungs- und Knebelungspraktiken gelten - was auch auf unseren Fall zutrifft - als Einzelgänger und Sonderlinge, die kaum (sexuellen) Kontakt zum anderen Geschlecht hatten (Dürwald, W.: Zur Beurteilung autoerotischer Unfälle. Beitr. gerichtl. Med. 22, 91-101 (1962) / Schwarz, F.: Unfallmäßige Todesfälle bei autoerotischer Betätigung. Beitr. gerichtl. Med. 19, 142-154 (1952))."
(GM93)

"The man described in this paper was wearing 'intimate' garments of both sexes during the performance of his autoerotic activities. Such a bisexual 'splitting' of the body image has obvious symbolic significance, inasmuch as the clothing stimulates the practitioner's erotic fantasy. Female clothes (panty hose, brassiere, girdle, and shoes in the present case) worn by a male transvestite represent attempts of identification with a woman - the woman has a penis - and their main function is to deny the anatomical difference of the sexes and thus refute the idea that there is a fear of castration. (Zavitzianos, G.: The object in fetishism, homeovestism and transvestism. Int J Psychoanal 58: 87-495, 1977)
Male homeovestism (i.e. athletic supporter) is conceived not only as a tendency of fighting or denying figurative castration, but also to preclude homosexuality by attempting to reinforce identification with the father. (Zavitzianos, G.: Homeovestism: Perverse form of behaviour involving wearing clothes of the same sex. Int J Psychoanal 53: 471-477, 1972) Freud's example of an athletic support belt entirely covering the male genitalia, thus concealing the distinction between sexes, allegedly saves the fetishist from becoming homosexual by allowing women to serve as sexual objects. (Freud, S.: Fetishism. In The Complete Psychological Works of Sigmund Freud. Hogarth Press, London, 1961, pp. 152-157)"
(HRA85)

"In Case 5 the patient was treated initially with medroxyprogesterone acetate with good effect, although the patient's fantasies and dangerous activities returned subsequently. After much discussion, he underwent bilateral orchidectomy. Although he still requires a small dose of Depo-Provera, he has not engaged in such behavior for 3 years."
(Huc85)

Aus der Schilderung des Falles selbst ist allerdings kein ungewöhnlicher Leidensdruck abzulesen. Die Behandlung geschah offenbar eher in der Absicht, das durch die Atemkontrollspiele gefährdete Leben des Patienten zu retten.

"Asphyxiophilic behavior often leads to death ..."
(IE89)

Eine solche Formulierung ist nur dann sinnvoll, wenn man den Zusammenhang von Gesamtmenge der Praktizierenden und Anzahl der Todesfälle betrachtet. Zahlreiche Menschen ertrinken jedes Jahr, aber die Formulierung "Schwimmen führt häufig zum Tode" käme trotzdem niemandem in den Sinn.

"Investigations of asphyxiophilia deaths indicate that most practitioners are happy, successful, and lacking signs of depression or death wish."
(IE89)

"Asphyxiophilia seems to be predominantly a phenomenon of the young. Experimentation, the need for sexual stimulation, and lust for new experiences is often great. Young people are often single and might have few opportunities for sexual contacts with others. Older people practice asphyxiophilia as well, but observed deaths indicate that it is much more common among the young. It can well be that most practitioners stop practicing asphyxiophilia after their early years. In that case it would be interesting to know why some practitioners stop while others continue. It is possible that the habit is so dangerous that most practitioners of asphyxiophilia die in their early years. It is also possible that many people obtain enough sexual satisfaction when they get a sexual partner. A partner may also assure that the practitioner of asphyxiophilia survives. Another possibility is that older people practice asphyxiophilia with more precautions. Further, the fear of negative reactions can make people stop or result in solitary practice in hidden places, which in itself might increase the sexual excitement and stimulation.
It is difficult to know why other sexual variations coexist with asphyxiophilia. The discovery of one variant sexual behavior may increase the chance of discovering a potential for sexual excitement from other variant sexual behaviors. Sensations experienced by asphyxiation might also increase the general ability to maximize sexual pleasure with the help of other variant sexual behaviors. Asphyxiophilia cases with coexisting variant sexual behaviors are more obviously autoerotic and might therefore be relatively overreported."
(IE89)

"A number of psychodynamic explanations have been proposed, for instance, that the use of plastic bags is motivated by an unconscious desire to return to the womb. (Johnstone JM, Hunt AC, Milford-Ward E: Plastic bag asphyxia in adults. Br Med J ii: 1714-1715, 1960)" (JH97)

"He finds this added risk a further stimulation for his excitement. He stated that his motivation for wanting to be so close to death is for the act to serve as a reminder of the gift of life, and in spite of the danger involved he believes he is in full control and that he will not die. The interviewer, however, felt that he had ambivalent feelings about death." (JH97)

"This report differs from the numerous reports of autoerotic asphyxial fatalities, which are mainly of solitary heterosexual men. Death is unlikely to occur if there is another participant, and in this case the client practiced with his partner. His fantasies were predominantly heterosexual, but he had recently developed an interest in homosexuality. This may reflect his current partner's unwillingness to participate because of the risks involved. He has periods of depression, and the interviewer felt that his presentation contradicted the conventional view that victims have no wish to die. The current case does show some of the previously noted characteristics, for example, the increasing elaboration of the ritual with time, the greater involvement of cross dressing and bondage, and the increased risk. One study of living participants reported a history of early choking in combination with sexual or physical abuse. The client stated that he discovered the practice by accident at the age of 12 during an episode of choking, but he did not describe any early abusive experiences. He stated that one function of the asphyxial behavior was to remind him of the value of life, with being rescued from death creating a feeling of relief and of being pleased to be alive. The interviewer, however, felt that the client showed signs of depression and had an ambivalent view regarding death. His case appears to contradict the conventional wisdom that participants have no wish to die.
Many explanations for the practice have been postulated. It is tempting to look for psychodynamic explanations, such as a wish to return to the womb; however, the client's own view is that he discovered the practice of autoerotic asphyxia by accident and that he uses plastic bags because they are cheap and accessible. In his case, the practice is probably maintained because it provides a relief from his feelings of depression and futility." (JH97)

"These nine men were, for the most part, intelligent, verbal, and cooperative. We feel that these volunteer subjects were motivated by loneliness, a wish to share their interests with others, and a need to legitimatize their underground practices. For several there was an element of a cry for help. (...) The subjects are all middle class, white men. Most of them have been depressed and suicidal at some time, although not at the present time. All but one of them 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. This research revealed no consistent patterns of family interaction or of early traumatic experiences.
The general sexual orientation is toward homosexuality, although many of these men have had heterosexual experiences, and several prefer women. There is a trend toward increasing homosexuality with age, probably because bondage gratifications are more easily obtained in the homosexual world than through contacts with women. There also seems to be a trend with increasing age away from self-immobilization and auto-erotic masturbation toward participation with real partners. Partnerships are facilitated by the underground press. Indeed, many of our callers responded to the ad in a poignant search for other people who might share their deviation. (...) In every man there was an interaction between fantasy and sensation. For none of them was fantasy alone sufficient to produce orgasm. They needed, in addition, fetish objects and a scenario. Most of them were impotent without these props.
(...)
The outstanding impression created by this group of subjects was that of pervasive loneliness and isolation. We felt that these men were all deeply depressed and death oriented. They fought off the death trend and defended themselves against suicide by their perversions. (...) A constant death orientation was obvious in all our subjects. Six of the nine gave histories of episodes of serious depression often accompanied by suicide attempts. Of the remaining three who denied depression and suicide, one had a guiding sexual fantasy of being attacked and tenderly murdered; a second had almost killed himself while engaged in solitary hanging masturbation; and a third always needed danger and the closeness of death in order to have orgasm. Eight of the nine have experimented in the past with nooses and strangulation, mostly self-hanging. Apparently self-asphyxiation is a common component added early in the development of the bondage syndrome. Most bondage practitioners know about hanging thrills but are frightened and shy away from the obvious danger to life. Several said they are saving hanging for the ultimate scene or eventual suicide.
The essential element that these men had in common was the erotization of a situation of helplessness, weakness, and threat to life which was then overcome in survival, and there was eventual triumph. Some of the subjects consciously and overtly emphasized the theme of strength and endurance. (...) Often in these men an increase in boredom or depression was signaled by impotence which responded only to increases in the masochistic death-oriented fantasy life and scenes. We felt that these men were reaching out through self-destructive activities for some type of relationship and some type of transcendence beyond their restricted and depressed life styles and personality traits.
Taken as a whole, the perversion was in a sense a creative and artistic effort to overcome loneliness, boredom, depression, and isolation. The protagonist here became the producer, director, author, and chief actor in his own dramatic construction. The actual dramatization aspect of this was at a minimum in solitary masturbation and at a maximum when one of these men became the object of attention of a number of sadistic partners. Narcissism was always a prominent feature. Even when there were other people present and participating, the subjects were preoccupied with their own fantasies and their own version of what was going on. Various fetishes were prominent in the form of costumes, ropes, boots, initiation rituals, etc. In addition, partners when they were included participated as part objects or as actors in assigned roles, rather than as recognized people. The subjects really preferred it that way, usually finding new partners and only occasionally maintaining long relationships over time. When married, they had difficulty with their wives, more because of basic personality traits of self-preoccupation than for their peculiar sexual behaviors. Of course solitude held special dangers for these men. While masturbating with bondage apparatus, several had had close brushes with death. When partners were present, the partner would be protective. So there was a premium on being able to secure partners. This played a part in the tendency toward homosexuality since it is easier to find homosexual partners than heterosexual partners in the bondage scene.
We were impressed by the diversity of characters among the subjects, the variety of fetish components, and the intermixture of apparatus, of ropes, of bondage, of various psychological components, moral discipline, humiliation, pain, and punishment, and of the combinations of homosexuality and heterosexuality. In this group transvestite elements were surprisingly infrequent. Each man had his own special most desired combination of components and could adjust to less optimal circumstances to different degrees. Nearly always the fantasy is more important than the actions, as if the sexual experiences and sexual partners are felt as fragments of experiences and fragments of people held together by imagination like tiles in a mosaic.
(...) All our subjects were aware of the pornographic, bondage literature. About one third of them had been strongly influenced by it, they said, and several of them had elaborate, expensive collections. An interesting side-light on this is that from time to time these men would become bored or guilty with their collections and disposed of them only at a subsequent time to renew them. The bondage practitioners confirmed Stoller's concept that there is a congruent pornography for every man's perversion. In addition, about a third of the subjects said they had first discovered important components of their perversion through pornography.
We were unable to discover any consistent history of specific traumata in childhood or any typical family pathology. Apparently the choice of deviant pattern is unique for each subject and is dependent on complex determinants which might only be reconstructed by an intensive series of depth interviews. Disturbances in core family relationships, impairment in gender identity development, poor ego development and specific conditioning experiences are all involved. (Marmor J: 'Normal' and 'deviant' sexual behavior. JAMA 217: 165-170, 1971) Typically the subjects had few memories of childhood relationships. The details were meager and stereotyped. All of them saw themselves clearly as male in gender, but there was a strong feminine identification as well. Intertwined with masochistic attitudes was a stubborn streak of indomitable endurance, a challenge to death, and finally an invitation and welcome to death.
(...)
At the time they talked with us, two of the nine subjects strongly denied any psychiatric disorder, any history of depression, or any need for treatment. The others, however, acknowledged that they had had periods of depression and three had made suicide attempts. (...) The majority have had some psychiatric treatment, and while only one of them asked for or was interested in more treatment at the present time, it is probable that several will seek psychotherapy in the future.
We felt that each of these men would benefit from treatment emphasizing real personal relationships to offset the overwhelming loneliness, inadequacy, and fragmentation which they have in common. In our past experience, a combination of individual and group therapy extending in time over several years has been most helpful for patients who were sexually deviant, isolated, depressed, and self-destructive (Litman RE: Interpersonal reactions involving one homosexual male in a heterosexual group. J Group Psychother 4: 440-449, 1961)." (LS72)

"It is believed that most practitioners of this compulsive love-map distortion die one day or another ..." (Lun92)

"In four out of five cases the practitioners were intelligent and socially well-adjusted men. Four of them were younger than 25 years. It is doubtful whether this is a representative group, because it is not unlikely that survivors differ from victims. Nevertheless interviews with these five revealed aspects already known from the literature.
All five felt the AEA as an addiction and wanted to be helped. The history of 4 of them revealed no major psycho-pathology and none had had psychiatric treatment in the past. Their auto-erotic behaviour had been a complete secret up until now. One of them had been married, three others had hetero-erotic experiences and only the mentally handicapped young man, who was in a pre-puberal state, had no sexual experience. To our surprise the medical history of 3 of the practitioners revealed episodes of hypoxia due to a medical condition. One was born with a congenital heart failure, two others had a history of chronic respiratory problems. In 3 out of 5 cases there also was a history of obstetrical hypoxia. Whether this is a coincidence or not must be subject of future research. Nevertheless the hypothesis that experiences with accidental hypoxia may have an influence on the development of asphyxiophilia, is intriguing.
(...)
As in all paraphilia where the practitioner wants to get rid of his addiction, a functional analysis of the sexual development and of actual behavioral aspects, is the founding of all treatment. When possible no drugs like MPA are used. In a behavior oriented psycho-therapy other auto-erotic activities and other sexo-erotic fantasies are reinforced to diminish the compulsory aspects of AEA. In fact, in these five cases we treated, the first step was the most important. To be able to speak about the strange habit for the first time in their life, worked for all of them like a catharsis. In all cases there was no cure in the sense of total eradication of the desire to conduct AEA. One man stopped immediately practising AEA because he had become very scared after having read about auto-erotic deaths in the media. In 3 of 5 cases AEA no longer was practised but only used as a fantasy in a 'normal' masturbatory act. In one case the practitioner, more aware of the risks and relieved by legitimation of his habit, changed his behavior to a less risky form of inducing hypoxia." (Lun92)

Zur Therapie: HM+87

"In contrast to most other forms of sexual deviance, sexual asphyxia appears to be an activity confined to middle- and upper-class white males. These males tend to be young; most of the recorded fatalities have occurred among teenage or young adult males who were unmarried at the time of their death." (LW82)

"Such behavior usually begins in adolescence, when it is a solitary act. However, as the practitioner matures into adulthood the syndrome may become less lethal. This is because he may be able to involve partners in the process to protect him. Such partners are, however, used solely for the purpose of protection of the practitioner and take no part in the act itself. In all other aspects sexual asphyxia remains a solitary act." (LW82)

"One additional important point should be stressed here: no deviant subculture has grown up around the practice of sexual asphyxia. There is no underlying thread that connects one practitioner with another, and participants do not, however subtly, advertise what they do. The solitary nature of the act means that locating one practitioner, even a deceased one, is not likely to lead us to others among his friends and associates. This is unlike other forms of sexual deviance, such as prostitution and homosexuality, where subcultures are well defined and have been extensively examined in the literature. It is even true of other sexually deviant behaviors such as bondage and sadomasochism that have not been extensively studied by sociologists." (LW82)

"Perhaps the young are victims of the practice so frequently because they are, like youth everywhere, often oblivious of the dangers involved in what they do. They are straightforward about it - they simply hang themselves. Moreover, because the act is solitary, when something goes wrong and they lose control, they lose their lives as well.
As practitioners become older, they probably become more cautious; they use more elaborate devices and many search for partners. Perhaps then it is merely adaptive behavior that leads to homosexual liaisons. Such unusual practices are indeed more likely to be accepted or at least tolerated by homosexual partners than by heterosexual ones." (LW82)

"When we examine the social origin of the act and the actor, it is clear that many of the victims have severe difficulties obtaining sufficient sexual gratifications by other means. They lacked sufficient sexual outlets and generally had difficulty interacting with females. Although some researchers (Res72, RF79) believe that the act generally becomes more elaborate as the practitioner ages, our data indicate that the introduction of fetishes and transvestism may occur early or late. One plausible explanation for the elements of bondage and sadism that may enter into the practice is that the only source of willing partners the practitioner can find is among members of the bondage community - whether they are heterosexual or homosexual. In order to receive the gratifications of sexual asphyxia with safety, they submit to other forms of sexual deviance, bondage, and so forth. They do not seek the painful pleasures of sadomasochism but rather endure them for the sexual pleasures of sexual asphyxia that they seek. There is a great difference, thus, between the practitioner of sadomasochism and the sexual asphyxiate.
In the end, however, many of these men return to solitary practice or never find willing partners; and when an accident occurs, their search for a satisfactory sexual outlet for their sexual needs becomes terminal." (LW82)

"That hanging is the common denominator and some degree of bondage is extremely frequent suggests that expiation of feelings of guilt for sexual activity must play an important role in initiating the pattern of behavior. The individual may be acting out on himself what he fantasizes doing to others. There is even a suggestion that by assuming the posture of a hanged man, the actor is paying in advance for his pleasure, and the added elements of masochism, bondage, and even self-mutilation form a constellation of reactions to a guilt-stricken attitude about sexuality. While we remain ignorant of the psychodynamics that can produce such a disturbed state of mind, we can only recall the couplet from Hugh Kingsmill's parody of A.E. Housman's pessimistic style:

But bacon's not the only thing
That's cured by hanging from a string."

(Obe84)

"The individual who survives repeated brushes with death probably believes that he has ultimate control over the outcome of his dangerous autoerotic sessions, and it is unusual for those who do this to seek treatment or to reveal these habits to therapists they may be seeing for other problems. Where the behavior is identified to a knowledgeable therapist, however, it may be possible to save or prolong the patient's life with antiandrogenic medication, which reduces the intensity of his sexual drive. Thus, it is important for physicians to be aware that treatment is available for persons known to cross-dress, bind themselves, or asphyxiate themselves. Counterbalancing the possibility of bringing the occasional patient to effective treatment is the risk that dissemination of information on autoerotic asphyxiation will provoke the sexually immature, confirmed sexual masochists, or even suicidal persons to experiment with asphyxiation (Dietz, P.E., 'Television-Inspired Autoerotic Asphyxiation,', Journal of Forensic Sciences, Vol. 34, 1989, pp. 528-529)." (OHD93)

"We formerly thought that the range for auto-erotic accidents was between the ages of about 17-25 and 55-65 but it is now clear that the range is much wider, i.e. 11 to 80, and it may prove to be even wider still." (PGK85)

"It is still true that all of the victims are male. No example or report of an example of a female dead in these circumstances is yet known to us." (PGK85)

"Der 21jährige war offenbar Psychopath*. Er hatte große Pläne, wollte etwas Großes werden, hauptsächlich bei der Presse. Sein tägliches Leben war nur mit Arbeit ausgefüllt, in die er sich geradezu 'hineinstürzte'. Geselligkeit spielte für ihn keine Rolle. In seiner Ausbildung (Student der TU) war er fünf Jahre zurück** und wollte das mit aller Gewalt nachholen. Über Frauenbekanntschaften wenig bekannt. Er soll einmal flüchtige Beziehungen auch intimer Art zu einer 37jährigen Frau gehabt haben, die er in ihrer Wohnung besuchte und die etwa ein halbes Jahr andauerten. Mutter hysterisch, dabei aber sehr praktisch, ebenso wie auch er mehr praktisch eingestellt war. Nur greifbare Dinge konnten ihm imponieren. Er neigte dazu, seine eigenen Fähigkeiten und Kräfte zu überschätzen. Frauen gegenüber war er im allgemeinen sehr zurückhaltend, geradezu ablehnend, äußerte häufig, daß ihm Frauen nachstellen ('die will etwas von mir'). Offenbar hatte er eine gewisse Furcht, mit Frauen in sexuelle Fühlung zu kommen. Ihnen gegenüber war er mehr passiv, äußerte, 'in einer Ehe müßte die Frau ihn nehmen, nicht er sie', war aber sonst offenbar leidenschaftlich und hatte großes Interesse an obszönen Unterhaltungen. Bei ihm wurden Bücher über Mann und Frau sowie über Unfruchtbarkeit in der Ehe gesehen. Er war im allgemeinen ein Sonderling, aber aufgeweckt. Das Wort 'Selbstbefriedigung' war für ihn ein rotes Tuch. Er war Sportler, boxte, trainierte jeden Morgen mit einem Lauf und trank vorher 1 l Wasser. Er rauchte nicht, trank auch keinen Alkohol." (PRW92)

* Die folgende Schilderung bietet dafür nicht gerade zahlreiche Anhaltspunkte.
** Wie kann ein 21jähriger fünf Jahre in seiner Ausbildung zurück sein?

"Since living persons with this syndrome are so rare (Fußnote: William H. Masters, M.D., has informed me that such sexual behavior has never been reported by patients he has studied.) (...) I would have much preferred one living patient but have been unable to locate one in the ten years of my interest." (Res72)

Warum ist er nicht hingegangen und hat eine Domina interviewt?

"In erotized hangings, I believe that constriction of the neck (secondary to suspension) results in (1) a disruption of the arterial blood supply resulting in a diminished oxygenation of the brain (a condition of anoxic anoxia) and (2) an increased carbon dioxide retention (a condition of relative hypercapnia). Either will heighten sensations through diminished ego controls that will be subjectively perceived as giddiness, light-headedness, and exhilaration. This reinforces masturbatory sensations. In fact, ejaculatory pleasure is often accompanied by holding the breath or contracting the neck strap muscles." (Res72)

Because of castration anxiety, libidinal and aggressive impulses directed at forbidden (incestuous) objects may be turned against the self as punishment. The feminine posture of passivity and helplessness places the subject completely in another's power, removing responsibility for any sexual gratification. The anxiety can be understood by viewing the gamble with death as an index of the forbidden wish itself. At times, then, a suicide may be the ultimate payment for the guilt of separation or the fear of punishment for an incestuous wish. To anticipate actively (hanging behavior) what one passively fears or wishes is understandable.
(...)
That castration anxiety is present in this syndrome seems clear; whether the anxiety is generated from a fear of mother or father (or both) is less important.
The dominant aim of the hanging behavior - to be suspended by the neck - (or cut off) allays the castration anxiety. The hanging may also be a punishment for masturbation (...)
I feel that emphasis in the erotized hanging syndrome should be placed upon the oral incorporative-oral aggressive conflict, as well as the adolescent's anxiety at separation.
(...)
Thus the theme of incorporation and separation-individuation is a very important one. Clinical material from Little (28) illustrates the utilization of the erect penis alone and the erect penis plus the extended body, as with Mr. K. (I would add the suspended erect body) as unconscious representations of the umbilical connection to mother.
(...)
It may well be that the total defensive identification with the mother from whom he separates is to be female. This is acted out by wearing women's clothing, while at the same time the femininity and castration are denied by manipulating the penis.
(...)
In the only clinical report of the circumstances surrounding a first hanging episode, Shankel and Carr describe a patient who, at the age of ten or eleven, became depressed ('I wasn't really trying to kill myself') and wondered what hanging would be like; he then experimented with it. In this intial hanging, he developed an erection and found the experience exhilarating (31). Why did he select hanging to wonder about? My explanation for this selection is the overdetermination of the neck as the focus for castration anxiety and being suspended as the focus for separation anxiety. The erection and the exhilarating experience associated with the hanging were probably influenced by the physiologic mechanisms I have described. This boy began his hanging behavior two years prior to his ability to ejaculate, which again confirms that the cerebral sensations per se while hanging are important, and that the ejaculation is of secondary reinforcement. The boy's fantasies would help us immeasurably, but they are not reported. I would speculate that they involve a separation theme. Furthermore, I think that smothering (while feeding), or breath-holding experiences while crying, may be early determinants of the search for exalted sensations resulting in neck compression behavior.
(...)
Why is this syndrome reported to occur only with boys? I believe boys experiment with neck binding play as an upward displacement of castration concerns. The exciting feelings will lead to erection and this may or may not be associated with masturbation. As the behavior becomes more elaborate, bondage and/or fetishism may be added. The absolute absence of females reinforces the theoretical position that this syndrome is related to phallic anxiety concerns. Females do engage in other behaviors that enhance sexual sensations but without neck specificity. One example of highly sublimated male neck cathexis may be the social institution of the necktie, until recently solely a male fashion hallmark. There is an associated behavioral component - knotting and tightening the tie (noose) about the neck, and later releasing it!
Two levels of psychosexual conflict are formulated (Fig. 2). At the genital level, castration is feared. The subject feels inhibited with girls and in his fantasy imagines himself as feminine. By repeatedly constricting the neck, symbolic amputation of the neck and head of the penis occurs; castration is meted out and survived again and again. The simultaneous masturbation reifies the presence of the penis, thus denying castration, the equivalent of which is actually occurring. With the untying of the rope, the castration is undone, and the oedipal guilt assuaged through the masochistic brush with death. During the course of the fantasy, compression of the neck produces a relative hypoxia which heightens subjective sexual sensations. The hanging behavior may be necessary for ejaculation. (For instance, I do not know whether these boys can have erections without hanging.) (...) Thus, the fantasy which serves to defend against separation and/or castration becomes pleasurably associated with hanging behavior. (...)
At the oral level, the conflict is over separation from the mother. Immobilization and asphyxia contribute to the fantasies of feeding, reunion, and rebirth. The male infant, while feeding (whether at the breast or the bottle), has been observed to develop erections. The neonate may experience a relative asphyxia in association with the sense of well-being derived from feeding; these sensations may then be accompanied by a gastrourethral reflex resulting in erection. The continued choice to be learned while feeding may be: feed and remain somewhat short of breath at the risk of letting go of the nipple, or breathe completely and lose the good visceral feelings, and the associated erection. Mothers may often interpret the child's relinquishing of the nipple as a personal rejection rather than as a very real choice against asphyxiation. The child's conflict may very well be that an erection feels good just as feeding does. The conflict, then, is one between separating (to breathe) and strangling (while feeding). A permissive mother will allow the infant to separate from the source of food (and her) as he needs; an intrusive mother can control by forcing the breast (and herself) - she becomes the "smother mother."
(...)
When the gamble with death is erotized, the probability of death is greatly enhanced. The symbolic realization of approaching death closely and then escaping it, exemplified by the repetitive hanging behavior, has its deepest roots in fantasies of uniting with mother. By escaping from the rope, whether by the knife as Roland did, or through the untying of knots, unity with and separation from mother are acted out as rebirth fantasies. Such fantasies are not at all uncommon in suicidal patients. I believe that the process of separating per se has been erotized, and it is therefore this behavior which is repetitively reenacted. These people are not suicidal in the sense that they seek death as much as they seek the dying experience to deny their fear of separation. It is the erotization of leaving and returning, appearing and disappearing, dying and being reanimated.
(...)
Although dying, rather than death, appears to be the end-game, this would not seem to mitigate the self-destructive and suicidal nature of the behavior. The repeated episodes of high death-risk sexual activity attempt to bind or avert anxiety. They are maneuvers to ward off overwhelming feelings of depression.
Ejaculation has also been equated with symbolic death. That is, in each orgasmic experience one loses a part of the self. This loss has been associated with expiring; one feels spent, empty, and frequently lapses into a deep sleep from which one awakens alive and rejuvenated.
(...)
The significant variables of intent, timing, opportunity for detection, choice of method, and the recognized risk of death as manifested by precautions against it, all must be evaluated in reaching a judgment of the lethality of the self-destructive behavior. These all appear to be significantly high in this syndrome. In addition, the nature of any self-destructive act must take into consideration unconscious dynamic factors, as I have outlined. When this is done, it would seem appropriate to consider this a suicidal syndrome of life threatening behavior, involving erotization of dying brought about in order to escape overwhelming anxiety, rather than 'accidental death'. The latter term appears to be a sterile solution which disregards complex psychologic influences and multiple determinants. The 'erotized repetitive hanger' commits suicide for the same reason the alcoholic or the repetitive overdose-taker, or the psychotic does - because he is compelled by unconscious forces to take risks that endanger his life." (Res72)

"Victims are typically described in the literature as otherwise well adjusted, high achievers who were not perceived as depressed or suicidal by family or friends. The discrepancy between this description and the data presented in table 2 could mean that the few survivors who have been interviewed are not representative of the entire group, but are a more pathological subset. During adolescence, risky, "thrill-seeking" behavior is probably the norm. The risks of sexual asphyxia are not well known, and it could therefore be viewed as no more pathological than driving a car or motorcycle at high speeds." (RF79)

"Thus, adult practitioners, in contrast to adolescents, have a clear death orientation and are certainly depressed, if not suicidal. The death orientation of these people is implicit in the name the bondage community has given to sexual asphyxia: 'terminal sex.'" (RF79)

"A second incongruency between adolescent and adult practitioners of sexual asphyxia is that the adolescents perform the act alone and are apparently heterosexual in orientation, while adults often practice it in pairs and are primarily homosexual in orientation. (...) The rationale behind the apparent shift from a heterosexual to a homosexual orientation in adulthood may lie in the instinct for survival. Self-immobilization, self-hanging, and autoerotic masturbation are clearly a greater danger to life than bondage with others participating. Partnerships can therefore spell the difference between life and death. Finding a partner willing to participate in bondage is apparently easier within the homosexual community than through relationships with women (LS72). Thus, the age-dependent shift away from solo autoerotic activity and heterosexual orientation toward homosexual activity with partners may well be adaptive in terms of survival." (RF79)

"Unaccounted for by the literature on both adolescent and adult forms of sexual asphyxia is the sizable group of hanging deaths that occur in children. (...) Whether or not these deaths among children are purely accidental or are sexual in nature is open to conjecture. The notion that such "accidents" represent pregenital acting out of sexual conflicts is supported by several of the adults interviewed by Litman and Swearingen (LS72) who claimed that, as children, they had vivid fantasies of being tied up by a woman." (RF79)

"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 sadomasochistic bondage syndrome (see figure 1). It is not presumed that any one individual must follow this entire sequence; rather, there are many possible entrance and exit points along the way. An entrance point may be defined as any point in the sequence when the behavior is adopted, which may occur during childhood as rope play, in adolescence as solo sexual asphyxial masturbation, or during adulthood as part of a larger bondage syndrome. An exit point may be defined as the time the behavior stops, either through accidental death in the case of children or adolescents, resolution (spontaneous or through intervention), or through suicide.

(Figure 1 einfügen)

The theme of the proposed model is that of a behavioral evolution based upon adaptation to psychosexual need and physical and social realities. Basically, the person develops deviant sexual needs as a response to intrapsychic conflict and then must either adapt to the physiological reality imposed by his behavior (asphyxiation) or die in the process. The form of adaptation available is in turn limited by social realities (e.g., it is easier to find a homosexual partner). The degree to which this adaptation succeeds or fails, both physiologically and emotionally, determines whether the person lives or dies. If he miscalculates his physical tolerance, does not find a partner to protect him, or gets too depressed, he will die. Failure to provide for physiological needs leads to an accidental death, whereas failure to provide for emotional needs may lead to suicide. Since the data available suggest that adolescent practitioners are usually not depressed or suicidal, whereas their adult counterparts are quite depressed and suicidal, it would seem that the risk of a sexual asphyxial death being suicidal rather than accidental increases with age. This is supported by the evidence that most adults perform this with partners for protection and are less likely to die unintentionally.
Conversely, since the adolescent is most likely to perform the act alone, he is at greatest risk of unintentional death. This notion is supported by the case reports in the literature being comprised primarily of adolescent victims. The greatest effort at intervention should be aimed at the adolescent group." (RF79)

"The description of this fascination with masochism parallels the fascination that adolescents have with risk-taking and thrill-seeking in general. Sexual risk-taking is a challenge that takes adolescents to greater danger and to the thrill that such a risk involves. Thrill-seeking is very much associated with an 'exhilarating sensation' that some individuals describe as orgasmic." (Sau89)

"Meist handelt es sich um Sonderlinge und Einzelgänger, die wahrscheinlich nicht beim ersten Versuch in dieser Richtung unfreiwillig versterben. Bisher wurden derartige Fälle fast ausschließlich bei Männern beobachtet. Aus Lebensalter, sozialer Stellung und Beruf lassen sich keine bindenden Schlüsse ziehen." (Sch66)

"Girls do not indulge in this dangerous perversion."
(Sim79)

"The sexual response cycle (SRC) in human beings is a physiologic reflex that is predominantly spinally mediated and tonically cortically inhibited (7). In order to access the physiologic sexual response cycle, humans must employ active neurologic disinhibition. Disinhibition involves the use of fantasy and/or sensual arousal, both of which work as a positive feedback process by decreasing cortical inhibition and increasing arousal. This further decreases cortical inhibition and so on. The process continues until arousal is resolved through orgasm or curtailment of sexual disinhibition.
Any event that decreases cognitive inhibition but does not simultaneously impede relevant physiologic capabilities can potentially disinhibit the sexual response cycle. Physiologic events such as mild hypoxic hypoxia and hypercapnia are cortically disinhibiting. Enhanced personal experience of sexual arousal may occur by combining sexual arousal (for example, fantasy) and physical stimulation (masturbation) with the cortically disinhibiting effects of hypoxia (as compared to occasions when no hypoxia is present)." (TBS94)

"This activity rarely involves women or homosexuals." (TBS94)

"Current literature suggests that survivors who continue to practice sexual asphyxia develop practices that include progressively sadistic and/or masochistic bondage behaviour (Res72, RF79). It is the opinion of one of us (GLS) that such observations describe cases that were studied rather than necessarily describing all survivors. As satisfying interpersonal sexual activity and intimacy become established, this form of autoeroticism may become less frequent or cease.
Those practitioners of sexual asphyxia who consult a professional typically present for other reasons, for example, family discord, developmental delay, affective disorders, other sexual concerns or achievement difficulties (RF79).
The few individuals seeking counselling for sexual asphyxia describe histories of unhappy marriages, caricature parents such as a dominant and rejecting father, depression or academic problems (RF79, Huc85).
Traditional psychoanalytic and psychodynamic postulates have been of limited value in explaining the behaviour (Res72, Masters WH, Johnson VE. Human sexual response. Boston 1966, Huc85) (...)
In Western culture, sexual information is not generally available until people become aware of their sexual response cycles. Awareness usually occurs through physical sexual stimulation (i.e., masturbation) under an umbrella of personal discovery and secrecy. Simple sensual acitivites and erotic thought are often sufficient to initiate sexual reflex disinhibition. Exploratory processes may reveal more unusual and potentially dangerous events such as hypoxia (Dan80). Particularly vulnerable are those who are socially isolated with little or no access to interpersonal sensual and/or sexual opportunities. Sexual asphyxia was shown or taught to a small number of adolescent cases (RF79) although it is the belief and experience of one of the authors (GLS) that most adolescents coincidentally discover the practice." (TBS94)

"The pleasure can be generally understood as arriving from two distinct sources (distinct but not exclusive). The first source of pleasure is physical, and the second is psychological. Both are equally potent pleasure sources of their own. Put them together and the combination can easily provide the foundation for a dangerous habit.
The physical pleasure from autoerotic asphyxia comes with the reduction of oxygen to the brain, or Hypoxia, which just means partial oxygen deprivation (DiM93, entspricht DM89). This is simple euphoric asphyxia. Less oxygen to the brain equals a semi-hallucinogenic, lucid state. It is pleasurable enough on its own to be engaged in without bondage or genital manipulation. It can be performed while entirely clothed.
(...)
The psychological source of pleasure from autoerotic asphyxia is personal, and therefore difficult to generalize. The pleasure is best understood as residing in the fantasy. It is widely accepted that the fantasy is fueled by the masochistic/cordophilic aspect of the behavior. The sexual pleasure associated with binding oneself up in a restrictive and/or complex fashion can have a twofold effect; 1) Self-restriction and 2) Pain/pleasure. The psychological pleasure derived from either of those fantasy behaviors is sufficient reason for many individuals to engage in that form of sexual activity. Bondage and masochism are widely practiced without the element of Hypoxia.
An individual involved in dangerous autoerotic behavior of any kind generally has a rich and intense fantasy life. The most accurate way to understand that form of fantasy and pleasure, on an individual basis, is to have the individual explain it to you themselves, in their own words, or to read about it in a journal of love poetry they wrote in honor of their backhoe tractor.
(...)
Additional explanations include masochistic sensations when approaching death and backing off at the last possible second. Prevailing over that brush with mortality is often perceived as empowering.(...)" (Tur)

"Adolescence is a time of risk taking and experiencing the unfamiliar. For example, often male adolescents experiment with homosexual behavior and this does not mean that these teens are gay, rather they are 'thrill-seeking'. In the same manner, the majority of adolescents who try sexual asphyxia do so just for the experience." (Uva95)

"Technology: To treat asphyxiophilia with lithium carbonate (CC89) or Depo-Provera (Mon86, OHD93) in combination with psychotherapy; to treat recalcitrant cases with amyl nitrite which produces similar sensations with much less risk (BH91)." (Uva95)

"Two major groups of people, both almost exclusively male, have engaged in this activity. Only one female death has been reported (a 35-year-old woman). One group, for the most part comprised of adolescent males, carried out the act alone. These adolescents were perceived by others as being generally happy and well-adjusted with no indications of depression or suicidal inclinations. The other category consisted of adult males usually with homosexual preferences. They engaged in autoerotic asphyxia in pairs as a means of protection from accidental death. Deaths in these cases were considere to be suicidal or homicidal rather than accidental. These homosexual adult males tended to be heavily involved in sadomasochistic rituals. If there was anger over a triangulated relationship between the homosexual pair, murder could be easily achieved by releasing the rope around the bondaged partner's neck just a bit too late. (Douglas, J.: FBI Academy. Unpublished communication, 1982)" (WB83)

"It would be logical to formulate dynamics for his behavior on the basis of hate/rage for both parents. The behavior combined the male-female, dominant-submissive, and sadistic-masochistic roles into one role. It appeared that he incorporated the roles and feelings for both parents into this one act. Indeed, it was his 'mother' in his mother's soiled clothing that he would 'hang' while reading his mother's magazine. There was likely an element of killing the child (himself) in girl's clothing in order to scorn the father. Theoretically, it was father's feet that kicked just prior to the final loss of consciousness. In one single act, the patient incorporated all of his family members with the use of his sister's clothing, as well, and the spastic kicking of the legs similar to his half-sibling. His choice of the solitary family bathroom is significant of his rage towards other family members. He would occupy the bathroom for long periods of time rather than choose a more appropriate and secluded location. One could hypothesize that at some level, the patient wished for family members to perceive his rage." (WB83)

"The frequency with which the hangings are associated with transvestitism can be traced again to castration anxiety. The transvestite retains an unconscious belief that females possess a penis. He develops this belief in childhood in reaction to his observation that his mother is without a penis. Fearing that he could be 'castrated like her,' he holds to the fantasy that she is a 'phallic mother' and therefore not a castrate. In assuming female dress he identifies with his phallic mother. This identification enables him to get close to his mother while repressing his incestuous desire for her, and his masturbation while in female garb reconfirms that he is not castrated." (WS+77)

"In up to 44% of cases of female asphyxiophilia with fatal outcome the cause of death was incorrectly diagnosed as hanging or other mode of suicide." (Zav94)

"No social class is exempt but the professional, white-collar and artistic classes are more commonly involved; and the incidence appears to be higher in the Anglo-Saxon/Germanic populations and less in Latins and Coloured." (Cam76)

 

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