Erotic asphyxia

Erotic asphyxiation refers to intentionally cutting off oxygen to the brain for sexual arousal. It is also called asphyxiophilia, autoerotic asphyxia, scarfing, kotzwarraism, or breath control play. Colloquially, a person engaging in the activity is sometimes called a gasper. The erotic interest in asphyxiation is classified as a paraphilia in the Diagnostic and Statistical Manual of the American Psychiatric Association.

Practice
Various methods are used to achieve the level of oxygen depletion needed such as a hanging, suffocation with a plastic bag over the head, self-strangulation such as with a ligature, gas or volatile solvents, chest compression, or some combination of these. Sometimes, complicated devices are used to produce the desired effects. The practice can be dangerous even if practiced with care and has resulted in a significant number of accidental deaths. Uva (1995) writes “Estimates of the mortality rate range of autoerotic asphyxia between 250 to 1000 deaths per year in the United States.” Cases have also been reported in Scandinavia and in Germany.

Deaths often occur when the loss of consciousness caused by partial asphyxia leads to loss of control over the means of strangulation, resulting in continued asphyxia and death. While often asphyxiophilia is incorporated into sex with a partner, others enjoy this behavior by themselves, making it potentially more difficult to get out of dangerous situations. Victims are often found to have rigged some sort of "rescue mechanism" that has not worked in the way they anticipated as they lost consciousness. In some cases autoerotic asphyxiation may have triggered carotid sinus reflex death, but this claim is controversial.

In some fatality cases, the body of the asphyxiophilic individual is discovered naked or with his penis exposed, with pornographic magazines nearby, with dildos or other sex toys nearby, or with evidence of his having ejaculated. Bodies found at the scene of an accidental death often show evidence of other paraphilic activities, such as fetishistic cross-dressing and masochism.

In the BDSM community, interactions of this nature may be referred to as breathplay or sometimes edgeplay, and generally include a partner. Because like other forms of edgeplay breathplay pushes the limits of "safe, sane and consensual", situations involving breath control can be assessed using the acronym RACK or Risk Aware Consensual Kink. Partners are generally expected within this community to be cognizant of and responsible for the dangers that they may take part in.

The great majority of known erotic asphyxial deaths are male; among all known cases in Ontario and Alberta from 1974 to 1987, only one out of 117 cases was female. Some individual cases of women with erotic asphyxia have been reported. The mean age of accidental death is mid-20s,, but deaths have been reported in adolescents  and in men in their 70s.

Lawyers and insurance companies have brought cases to the attention of clinicians because life insurance claims are payable in the event of an accidental death, but not of suicide.