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Sexual asphyxia refers to situations where an individual enhances sexual responses with asphyxia. If it occurs during solitary activity it is termed autoerotic death. It is a relatively rare event that typically involves young males, who are found dead, hanging in a secluded or isolated location. There is often evidence of solitary sexual activity with exposure of the genitals and surrounding pornographic material Byard, ; Byard and Winskog, Asphyxia may have been caused by a variety of mechanisms including neck compression from rope nooses, covering of the nose and mouth with plastic tape, or compression of the body in confined spaces.
Other props may be more bizarre with evidence of cross-dressing, fetishism, and sadomasochism Byard, b. Deaths have occurred at all ages in sexually mature males and much less commonly in females Byard et al. The death asphyxiation fetish features usually enable differentiation from suicidal hanging, although suicide using this method has been documented in practitioners with depression Byard and Botterill, Autoerotic asphyxia is the deliberate induction of hypoxia with the intent of causing heightened sexual arousal.
Accidental autoerotic death scenes can be mistaken for either a homicide or a suicide. An autoerotic death occurs during autoerotic behavior in which a device, apparatus, prop, chemical, or behavior that is engaged to enhance sexual stimulation asphyxiation fetish death. Conservative estimates suggest that between and autoerotic fatalities occur each year in the United States alone.
Such deaths are generally accidental in nature. The identification of an autoerotic death scene requires careful crime scene investigation and reconstruction efforts. This will avoid misinterpreting consensual sexual activity as a criminal act, or an accident as an intentional suicide. Autoerotic fatalities are not the result of criminal behavior and should not be treated as crimes. Byard, in Encyclopedia of Forensic and Legal Medicine Autoerotic death is a term used when an individual has died during some form of solitary sexual activity from an accident caused by associated materials or equipment.
A variety of terms have been crafted to describe this type of death including sexual asphyxiasex hanging, asphyxiophilia, Kotzwarrism, autoasphyxiophilia, hypoxyphilia, and erotized repetitive hanging. Many of these terms emphasize the role that induced hypoxia from hanging often plays; however, death may also result from a variety of other traumatic events, including drowning, electrocution, crush asphyxia, and exsanguination, or more rarely from air embolism or volatile substance toxicity. Although deaths from autoerotic activity have been reported for many years from a wide variety of cultures, there remains considerable confusion in recognizing cases and also in accurately determining the manner of death.
Such deaths have also been incorrectly attributed asphyxiation fetish suicides and homicides.
Certainly there are cases in which the manner of death is unclear; however, the majority of cases have readily identifiable features that enable an accurate diagnosis to be made. One of the characteristic features, particularly in asphyxiation fetish practitioners, is evidence of concomitant paraphilias such as fetishism, bondage, or masochism. While these may provide useful clues as to the events leading up to death, they also demonstrate that the psychopathology underlying this behavior is complex, idiosyncratic, and often ill-understood.
Ferris, in Encyclopedia of Forensic Sciences Autoerotic or masochistic practices may involve compression of the neck inducing partial asphyxiation, alleged to heighten sexual pleasure and induce orgasm. Sexual asphyxias occur almost exclusively in men with only a few reports in the literature involving women. In the majority of deaths associated with sexual asphyxiation, there has been complete or partial suspension of the body with complex systems of ligature application, usually involving at least compression of the neck and obstruction of respiration.
These deaths are usually accidental because the fail-safe mechanisms built into the routine of the practitioner have failed. Characteristic findings in sexual asphyxias may include padding of the ligatures to prevent permanent injury, the presence of erotic or pornographic materials at the scene of death or evidence of prior ligature-related activities including grooves or damage to suspension points.
The victims asphyxiation fetish arrange mirrors or cameras so that they can either witness or record their activities. Many of these activities are associated with a variety of fetish activities, transvestitism, cross-dressing and other evidence of sexual activity including binding or piercing of the genitalia and breasts. Autoerotic death is a collective term for situations where an individual has died during some form of solitary sexual activity caused by an accident related to the particular materials or equipment being used Breitmeier et al.
A variety of other terms have been applied to this type of death including sexual asphyxiasex hanging, asphyxiophilia, Kotzwarrism, auto-asphyxiophilia, hypoxyphilia, and erotized repetitive hanging Burgess and Hazelwood, Many of these terms emphasize the role that induced hypoxia from hanging often plays, however, death may also result from a variety of other traumatic events including drowning, electrocution, crush asphyxia and exsanguination, or more rarely from air embolism or volatile substance toxicity Byard et al.
Certainly there are cases in which the manner of death is unclear, however, the majority of cases have readily identifiable features that enable an accurate diagnosis to be made Byard and Botterill, Certain infants may be quite vulnerable to apneic episodes following brief covering asphyxiation fetish the mouth and nose, either by holding the infant incorrectly or by occluding the airways during breast feeding Byard, e; Byard and Burnell, Accidental hanging asphyxiation fetish occur in adolescent males engaging in sexual asphyxia where hypoxia is used to augment solitary sexual activities Byard, f.
The presence of fetish items and pornography, and the secluded nature of the scene, usually mean that the diagnosis presents no difficulties, although death scenes in females tend to be more subtle Byard et al. At least 82 deaths have occurred in the United States from this type of activity in recent years Toblin et al. Individuals were aged from 6 to 19 years average It is possible that the increase in mortality has resulted from the use of ligatures and solitary activity Andrew and Fallon, Environmental causes of suffocation include exposure to gases such as methane while playing in sewers and wheat silos Byard and Wilson, Eriksson, in Forensic Epidemiology The suicide method used reflects above all the availability of the means by which the suicide is committed.
This asphyxiation fetish sometimes related to the profession of the suicidee, but also the popularity in media, especially from information accessible on the Internet, through which suicide methods can spread widely and rapidly. Males are known to use more violent methods such as shooting, hanging, and intentional traffic crashes, whereas women more often use intoxication and drowning.
Hanging is a very common suicide method, especially among men. Contrary to some popular belief the mechanism is, in most cases, not a fracture of the cervical spine, but external pressure upon the carotid arteries, hence blocking the blood supply to the brain.
The former mechanism is associated with judicial hangings, in which the body is dropped from a higher level. The differential diagnosis to consider in some cases is accidental hanging, as in autoerotic asphyxia. Homicidal hanging is very rare, but can be suspected if the body shows s of other trauma or if a very high concentration of a drug is detected in the toxicological analysis.
A suicidal shot is most often located to the head, more seldom to the chest, and the cause of death is brain laceration and exsanguination, respectively. A homicidal shooting can in some cases be difficult to differentiate from a suicide, but depression, a suicide note, and suicide attempts are factors which may favor suicide in combination with a meticulous scene and autopsy investigation. An accidental shooting injury may be located to any body region and a reconstruction can be an important tool to conclude the manner of death.
In some cases the manner suicide vs homicide may not be clear from the physical evidence. Intoxication is in many countries the most commonly used method among women. Prescribed psychopharmaceuticals such as neuroleptics and antidepressive agents are commonly used, and may indicate that the suicidee asphyxiation fetish a history of psychiatric disease, often depression, or bipolar disorder.
The differential diagnosis to consider in these cases is accidental intoxication, particularly if the decedent is a drug addict. Drowning is also a suicide method used by women most commonly; more often so when open water is available. The obvious differential diagnosis to consider in these cases is accidental drowning. Suicide through sharp force trauma is uncommon, although many persons attempt suicide by cutting themself over the radial artery in the nondominant wrist.
The method is, however, doomed to fail in most cases since the artery is small and only exceptionally can lead to a fatal exsanguination. To succeed with this method, a larger artery such as the brachial, the femoral or the carotid, must be opened. A stab wound into the heart also has a high risk of lethality, and is sometimes used.
A suicide by stabbing or cutting can often be distinguished from a homicide through the presence in the former of so-called hesitation injuries, ie, multiple superficial, parallel cuts close to the deeper and fatal injury. The differentiation between suicidal and homicidal cut and stab wounds is not always straightforward, however. Suicidal blunt force trauma is uncommon, and almost always requires a high degree of potential energy. Examples are intentionally crashing the car into a heavy or immobile object, jumping or lying before a moving object such as a train or another motor vehicle, or jumping from a high place.
Jumping is not uncommon and to some extent reflects that the suicidee lacks other means of readily committing suicide. The popularity of a locale is also a factor to consider; some locations have afforded many the opportunity to commit suicide through the years, such as the Golden Gate Bridge and the Asphyxiation fetish State Building, leading to preventive measures such as high barriers that are difficult to scale.
A homicidal fall from, eg, a balcony, may represent an honor killing, and this fact emphasizes the importance of investigating the decedent's background. A high blood alcohol concentration may indicate an accidental fall. Self-inflicted injury through fire, burns, and scalds is uncommon, but is seen more commonly during periods of political protest against an ongoing war or enemy occupation. James L. Knoll, Robert R. Hazelwood, in Aggression and Violent Behavior It has been noted that a subset of SSSMs engaged in autoerotic asphyxiation and other sadomasochistic practices, allowing them to assume the role of the victim, or at least one of a sexual masochist.
This hypothesis would seem to hold only for those circumstances in which the offender plays the role of a victim during autoerotic practices. It would not seem to apply to those who, during or following the offense, assume the very identity of the victim they have tortured. Sexual Asphyxia Sexual asphyxia refers to asphyxiation fetish where an individual enhances sexual responses with asphyxia.
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Sexual Masochism Disorder with Asphyxiophilia: A Deadly yet Underrecognized Disease