Ironically, erotic asphyxiation (EA) began in the 17th century as a medical treatment for erectile dysfunction when doctors observed that male hanging victims often developed erections.
Now we have Viagra, but erotic asphyxiation is more prevalent than ever. Accidental autoerotic asphyxiation-related deaths among teenage boys are critically on the rise. Many of those are mistaken for suicides because forensic experts are unfamiliar with autoerotic asphyxiation. What usually happens is the person stands on a chair placing a noose around their neck. Then they step off the chair, commencing the self-strangulation process. Optimally, they achieve orgasm before the scenario becomes lethal; sub-optimally they knock the chair over or lose consciousness before getting back on it, and they die.
There other common modes of erotic asphyxiation are suffocation, ligature strangulation, inhaling volatile solvents, drowning, chest compression by a heavy object or person, and crucifixion.
A Tale of Two Euphorias
Erotic asphyxiophilia connects two sources of euphoria: orgasm and hypoxia (lack of oxygen). Whenever you deprive the brain of sufficient oxygen, brain cells begin dying rapidly. This rapid cell death causes a series of biochemical reactions in aerobic and brain tissues, called the glutamate cascade. The brain responds to this by releasing a receptor blocker to prevent glutamate uptake in the synaptic gap, which avoids glutamate overload and further brain cell loss. This receptor blocking contributes to the lucid, semi-hallucinogenic hypoxic state.
The release of β-endorphin in the hypothalamus and pituitary also contributes to hypoxic euphoria. β-endorphin serves as the body’s natural ligand for the μ-opioid receptor. Ligands are like keys, and receptors are like door locks. When you put the right key in the right lock, you open the door. When a ligand binds to a receptor and opens a cellular door, it unlocks a chemical reaction. The chemical reaction behind the μ-opioid receptor door numbs pain. β-endorphin is about 80 times stronger than morphine. The reason pain subsides, immediately after an acute physical trauma, even though the symptoms still exist, is because β-endorphin binding activates opioid receptors. β-endorphin also promotes a sense of security, increases relaxation and stimulates adrenaline production.
Swimmers, who have nearly drowned, say they felt elation before losing consciousness; this is hypoxic euphoria. Mountain climbers also experience hypoxic euphoria at high altitudes. However, this does not happen with hypoxia caused by sudden aircraft decompression, suggesting that low oxygen levels are not the sole source of hypoxic euphoria. Several studies investigated this and found connectivity-related neurochemical abnormalities.
The Ventral Tegmental Area (VTA), which is an essential part of the reward circuitry, is the primary brain region involved in orgasm. Several brain regions transmit information to VTA neurons regarding how well basic human needs, (breeding, feeding, bonding etc.) are satisfied. The VTA is a subcortical structure in the old mammal brain. This means, among other things, evolution designed it to do, not think. Hence, when we have an orgasm the VTA presumes, based on input from other brain regions regarding bodily changes that we are breeding. Breeding is second only to feeding on the evolutionary biology list of cardinal concerns. Hence, the VTA releases dopamine, because dopamine is the brain’s happy dance drug, which nature uses to get us to participate in behaviors that promote evolutionary biology’s agenda.
Dopamine is the essential neurotransmitter in the brain’s reward system. The reward circuitry used by orgasm is the same system used by heroin. I have done heroin twice, but it was the absolute best feeling I have ever had. If you have ever done heroin, you know it is similar to sustaining the sensation of sexual climax from seconds to hours - contributing to its appeal. It not only uses the same reward circuitry as sex, but it also uses it longer. Longer is always good where sex is involved. This intensity might explain the decreased sex drive in heroin addicts—the reward circuitry, which pursuing orgasm would use, is already in use by the narcotic. When you have an orgasm (or do heroin), it deactivates your amygdala, which is where fear resides in the brain. Additionally, heroin, like erotic asphyxiation, also decreases the amount of oxygen that gets to the brain.
Connecting the dots
\When you combine the dopamine and oxytocin rewards from orgasm, with the β-endorphin analgesic bonuses from hypoxia, while deactivating the amygdala, you create a highly stimulating and hedonically rewarding neurochemical event that is a prescription for disaster. It feels exceptionally good. Even though you are hurting yourself physically to achieve this feeling, β-endorphin is 80 times stronger than morphine, so you are numb to the pain. Also, even if you were not numb, you would not care because your deactivated amygdala mutes your fear response, which is critical to safety. If not for fear, we would walk in front of speeding trucks. When the absence of fear allows asphyxophiles to push beyond the limits, it becomes lethal.
Autoerotic asphyxiation is inherently sexual heroin, which is ingenious actually. The asphyxiophile's brain has devised a way to manufacture a narcotic-like high endogenously that exceeds typical sexual gratification by employing certain behaviors. However, like heroin addicts, most asphyxophiles meet early, undignified deaths, e.g., David Carradine, although his demise was more undignified than premature. Still, it was devastating for his family and understandably so. Sadly, thousands of parents discover their teenage sons this way every year. Erotic asphyxiation often results in a death and a murder charge, even though the homicide was unintentional.
Adding guilt and blame to situations like these is not useful. However, seriously studying the people who participate in these behaviors is. Asphyxaphiles do not order their sexual proclivities from Amazon any more than you or I do. An important consideration for neuroscientists is the involvement of the hypothalamus. β-endorphin only binds in the pituitary and hypothalamus. How much does hypothalamic remodeling contribute to this scenario, and how, and why? Understanding hypothalamic remodeling is imperative in understanding compulsive overeating, drug addiction, alcoholism, serial murder, incest, child abuse, and rape.
Only thousands die from erotic asphyxiation each year, but millions die from compulsive eating, alcoholism, drug addiction, serial murder, incest, child abuse, and rape and related deaths. Human biology, like the need to feel love and express love, is generic. We are a social species; ubiquitous tolerance and empathy are not negotiable concerns. The value of fully understanding humans participating in extreme behaviors is that they magnify things that would otherwise remain hidden in normal circumstances. The only way to know what a rock looks like is to look at it from all sides and every angle. We must meticulously investigate all behaviors that utilize the brain structures involved in reward and stress regulation if we want to become thoroughly versed in the human brain. As Hippocrates said, “The ability of a disease to do damage lies in its capacity to go undetected.” Remain fabulous and phenomenal.