Autoerotic Asphyxiation May Threaten More Kids Than Previously Thought

PHOTO More children and teens than pediatricians realize could be participating in a dangerous, potentially fatal sex act known as autoerotic asphyxiation.ABC News Photo Illustration
More children and teens than pediatricians realize could be participating in a dangerous, potentially fatal sex act known as autoerotic asphyxiation.

More children and teens than pediatricians realize could be participating in a dangerous, potentially fatal sex act known as autoerotic asphyxiation. So says Dr. Daniel Cowell, professor of psychiatry and senior associate dean for graduate medical education at the Marshall University Joan C. Edwards School of Medicine in Huntington, W. Va.

Autoerotic asphyxiation -- or AEA -- has been documented in the medical literature as far back as 1856. It is overwhelmingly more common in males, though female cases are not unheard of. It is an act that is usually performed when alone and involves reducing oxygen supply to the brain, usually by strangulation. The lack of oxygen leads to a sensation of giddiness or euphoria for some.

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"In the medical community, I think it tends to be regarded, if it is regarded at all, as a medical curiosity, a freak behavior," said Cowell, who wrote a review article on AEA published Monday in the journal Pediatrics.

In his article, Cowell contends that the practice could be much more common in children and teens than even those in the medical community realize. The problem, he said, is twofold: The first issue is that most of what is known about the practice is gleaned from the cases in which it leads to death. And the second is that those who practice it, particularly kids and teens, are seldom willing to talk about it.

"While it is estimated that there are 250 to 1,200 deaths per year in the U.S. from AEA, there is absolutely no way of learning how many practitioners there are with this potentially fatal behavior," he said, adding that some of these participants may be surprisingly young. "I know of cases as early as 9."

Other doctors agreed that the practice is a threat in younger age groups. "Adolescence is a time of exploration and experimentation as teens begin to develop their own sense of self," said Dr. Alanna Levine, a Tappan, N.Y.-based pediatrician.

"It is well known that teens experiment with alcohol, drugs and sex; however, it is difficult to make clear estimates about the number of adolescents engaging in AEA, as it typically occurs secretly, and it is also easy to mistake a death from AEA behavior for a suicide," she said.

Is Autoerotic Asphyxiation Truly Common in Kids?

The assertion that AEA is a common activity among children and teens may prove to be a controversial one. Robert Dunlap, a Los Angeles-based clinical sexologist and filmmaker, has studied unconventional sexual practices. Along with his film writer Claes Lilja, Dunlap helped produce the 2001 film "Beyond Vanilla," which features a number of unconventional sexual practices -- among them, AEA.

Dunlap agreed with Cowell that the true number of people who participate in AEA is nearly impossible to nail down.

"We assume that people participate in that, but it is a tricky thing to guesstimate how many people are participants," he said.

But Dunlap said that he believes that this type of behavior is not as common as some might fear.

"From what I've learned at the different conferences I've attended ... it seems to me that these cases aren't as prevalent," he said, adding that the highly publicized death of actor David Carradine in June -- a death that media reports have suggested was related to AEA -- may have underscored the dangers of this practice.

"I think that the practice may have dropped off ... in light of this," he said. "I don't think people would be as inclined to be a participant when they are thinking, 'Wow, I could probably kill myself here.'"

Warning Signs of AEA and the 'Choking Game'

Even though the exact numbers of children and teens who participate in AEA is unknown, Cowell and Levine agreed that parents would be wise to be on the lookout for evidence of the potentially deadly practice in their own children.

"Clues that a child might be engaging in autoerotic behavior include bruises or marks in the neck region, attempts to cover up the neck in a secretive manner, [and] marks on the wrists or ankles suggestive of bondage," Levine said.

Another clue for parents may be the mention of a closely related practice known by some children and teens as the "choking game," an activity usually performed with a friend that also involves cutting off oxygen to the brain in order to induce euphoria.

"Choking behaviors can lead on to more well-developed forms of AEA," Cowell said.

According to statistics from the U.S. Centers for Disease Control and Prevention, at least 82 children and adolescents died from the choking game between 1995 and 2007. Most of these children who died were 11 to 16.

However, Cowell said that many parents may not report their children's behaviors to pediatricians "because of denial and disbelief."

"Who would suspect that a 14- or 15-year-old, or even a 10-year-old, would be engaging in behavior such as this?" he said.

For parents who suspect that their child may be engaged in such risky behaviors, Cowell noted that the best course of action is to seek professional help.

"If there is any indication whatsoever that your son or daughter is involved in this behavior, what is not useful is berating, condemning or confronting that child," he said. "I would prefer to see them talk privately with the child's pediatrician or physician. If the physician says, 'What are you talking about?' they need to find someone in psychiatry or pediatrics ... someone certified in adolescent medicine, because they should know about this."

Levine agreed that parents would be wise to seek professional help, but only after attempting to delictely address the issue with their child.

"If you are a parent who is concerned their child may be engaging in AEA, talk to your child," she said. "If your child is uncomfortable talking to you about it, find an adult the child relates to who can explain the dangers of the behavior. Seek advice from professionals. It is important to intervene before it is too late."