Cowell Daniel D
Departments of Psychiatry and Behavioral Medicine, and Graduate Medical Education, Marshall University, Joan C Edwards School of Medicine, Huntington, West Virginia 25701, USA.
Pediatrics. 2009 Nov;124(5):1319-24. doi: 10.1542/peds.2009-0730. Epub 2009 Oct 12.
Voluntary asphyxiation among children, preteens, and adolescents by hanging or other means of inducing hypoxia/anoxia to enhance sexual excitement is not uncommon and can lead to unintended death. This study addresses autoerotic asphyxiation (AEA) with the intent of increasing pediatricians' knowledge of the syndrome and awareness of its typical onset among young patients. AEA is characteristically a clandestine and elusive practice. Provided with relevant information, pediatricians can identify the syndrome, demonstrate a willingness to discuss concerns about it, ameliorate distress, and possibly prevent a tragedy.
A retrospective study was undertaken of published cases both fatal and nonfatal and included personal communications, referenced citations, clinical experience, and theoretical formulations as to causation. Characteristic AEA manifestations, prevalence, age range, methods of inducing hypoxia/anoxia, and gender weighting are presented. All sources were used as a basis for additional considerations of etiology and possibilities for intervention.
AEA can be conceptualized as a personalized, ritualized, and symbolic biopsychosocial drama. It seems to be a reenactment of intense emotional feeling-states involving an identification and sadomasochistic relationship with a female figure. Inept AEA practitioners can miscalculate the peril of the situation that they have contrived and for numerous reasons lose their gamble with death.
Pediatricians should be alert to the earliest manifestations of AEA. Awareness of choking games among the young and, of those, a subset who eventually progress to potentially fatal AEA is strongly encouraged among all primary care professionals who may be able to interrupt the behavior.
儿童、青少年通过上吊或其他导致缺氧/无氧的方式进行自愿窒息以增强性兴奋的情况并不罕见，且可能导致意外死亡。本研究探讨性窒息（AEA），旨在增加儿科医生对该综合征的了解及其在年轻患者中的典型发病意识。AEA的特点是一种隐秘且难以捉摸的行为。若能获得相关信息，儿科医生就能识别该综合征，表现出愿意讨论相关问题的态度，缓解患者的痛苦，并有可能预防悲剧的发生。
对已发表的致命和非致命病例进行回顾性研究，包括个人交流、参考文献引用、临床经验以及关于病因的理论阐述。呈现了AEA的典型表现、患病率、年龄范围、导致缺氧/无氧的方法以及性别分布情况。所有资料都作为进一步思考病因及干预可能性的基础。
AEA可被视为一场个性化、仪式化且具有象征意义的生物心理社会闹剧。它似乎是对强烈情感状态的重演，涉及与女性形象的认同及施虐受虐关系。不熟练的AEA实施者可能会误判自己所制造情况的危险性，并且由于多种原因在与死亡的较量中失败。
儿科医生应警惕AEA的最早表现。强烈鼓励所有可能能够打断这种行为的初级保健专业人员关注年轻人中的窒息游戏，以及其中最终发展为可能致命的AEA的一部分人。
