Unintentional asphyxiation deaths in adolescents: autoerotic asphyxia and asphyxial games as part of the same syndrome = Muertes por asfixia no intencional en adolescentes: asfixia autoerótica y juegos de asfixia como parte del mismo síndrome
OBJECTIVES: Unintentional asphyxia among preadolescents and adolescents by compression of the neck and other means of inducing hypoxia / anoxia in order to get exhilarating effects are not new or uncommon behaviors and can lead to death by accident. Medical science has described autoerotic asphyxiation and more recently asphyxial games “choking games” as different entities. This study addresses both behaviors to understand the characteristics of how these practices are presented as well as the risks factors to them in order to determine if there are substantial differences between the two practices, or if instead they are related behaviors. Accurate knowledge of these behaviors based on scientific evidence will facilitate the understanding of the etiology and manifested features and facilitate the implementation of preventive measures to avoid such deaths. METHODS: A retrospective study of fatal cases published in recognized scientific journal articles of both autoerotic asphyxiation and choking game behaviors in the adolescent population was made. Articles on sociology, psychoanalysis and psychiatry as well as studies previously published case series and epidemiological studies to assess student population etiological factors and risk factors associated with behaviors were included in this review. Features of both behaviors, such as prevalence, age distribution, gender, type of asphyxia and place of occurrence are presented. RESULTS: The results are consistent in all variables analyzed for both behaviors. Most practitioners are men. Cases of both behaviors in preadolescence show a tendency to increase with age. The most frequent type of asphyxia identified was hanging conducted in private quarters. Psychiatric and psychoanalytic literature identifies common elements between male castration complex, failed oral psychosexual development and the practice of asphyxia in its integration with sociological theories of risk and confrontation ordeal in adolescence. The review of epidemiological studies reveals common elements in the development of both practices in terms of risk factors. CONCLUSIONS: The evidence suggests a link between both practices and allows to theorize that they are part of the same syndrome. Integrating psychoanalytic and sociological concepts as well as the risk factors suggests a linear sequential model of development in four stages: childhood syndrome rope, asphyxial games associated to masturbation, Adolescent autoerotic asphyxia and Adult Autoerotic Asphyxia fetishist / bondage Syndrome. Death is explained in each of the stages as failed physiological and emotional adaptation mechanisms. It is important to disseminate knowledge of these practices among health professionals and further studies should be carried out in regarding deaths by hanging in children and adolescents.
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