Scarfing Research Articles

Socially Dangerous Sexual Paraphilias: Description of the Problem

Abstract This article deals with the study of the prevalence, aetiology, pathogenesis, and treatment of paraphilias such as sexual sadism, exhibitionism, voyeurism, and autoerotic asphyxiation. The aim of this study was to summarise all available literature on socially dangerous paraphilias. Based on the PRISMA guidelines, the current review brings together all the existing literature on socially dangerous paraphilias. Socially dangerous paraphilias may be caused by biological, psychological, and social factors and are treated with antiandrogens, gonadotropin-releasing hormone analogues, and selective serotonin reuptake inhibitors as well as psychotherapy. High-quality placebo-controlled studies on the treatment of socially dangerous paraphilias are lacking. Clinicians should be aware that the prevalence of socially dangerous paraphilias is not negligible and that people with deviant sexual urges should be encouraged to seek professional help before committing a crime or a self-injurious act. More extensive epidemiological studies are required to clarify the actual prevalence of socially dangerous paraphilias in the population and methods of their treatment alongside with destigmatisation of patients with paraphilias.

Transforming traumatic intensity: Living with the uncertainty of terrifying symptoms

ABSTRACT In this case, presentation of a patient who experienced severe sexual abuse in childhood and attempted to manage his traumatic dreams and flashbacks with autoerotic asphyxiation, the author describes how she tolerated the anxiety of a life-threatening symptom while engaging in a deep and transformative treatment. She writes about her understanding of the symptoms, how she bore the accompanying anxiety, and what the mutative forces were that led to the patient relinquishing the symptom and progressing forward. Mutative factors included the creation of a relational home, ongoing awareness of forward edge meanings of the patient’s behaviors (including the potentially lethal symptom) and the establishment of deep mutual trust, both generally and specifically in the patient’s capacity to know what he needed in order to grow. These factors helped the patient integrate his sense of shame and self-loathing. The therapist’s deep trust in the patient’s sense of what he needed as she guided the treatment deepened the bond between them and created the paradoxical sense of both intensity and calm that the patient longed for. This paper details dreams that illustrate the nature of the therapeutic relationship and the patient’s internal experience. The therapist details her own experience in the co-transference in this highly charged case. Overall, this paper will help therapists to recognize, connect with, and protect traumatized patients, while not being distracted by the frightening symptoms themselves.

ASFIXIA AUTOERÓTICA – QUANDO A VERGONHA MARCA A CENA

Autoerotic death is defined as accidental death that occurs during individual and solitary sexual activity in which some type of instrument or apparatus was used to increase the victim’s sexual stimulation leading to an unintentional death. We present the autopsy report of a 50-year-old man presented for autopsy with a history of suicide by hanging. The characteristics of the victim’s clothes, the semen stains on the clothes, with the presence of toilet paper next to them, suggesting masturbation and the absence of a hanging groove due to protective foam used by the victim, allowed the reconstitution of the probable mechanism produced by the victim in his asphyxia with the help of a rope and an elastic band attached to the heel of a high shoe, which, when broken, would have produced the fatal accident. The description of this case is important to alert to the concept of autoerotic death and avoid the misinterpretation of the legal medical etiology, allowing accidental cases to be interpreted as suicides, or even natural deaths to be interpreted as autoerotic deaths without fitting into the concept of autoerotic death, which must always be an accidental death. Keywords: autoerotic death, autoerotic asphyxia, autopsy.

Choking Autoerotic Asphyxiation: For a Reconfiguration of Discourses Around Breath Play

With this commentary, I wish to address a 2-fold issue around the topic of autoerotic asphyxiation (AeA): (i) that the historical trend towards the pathologization of kink and other forms of sexuality considered ‘Other’ is particularly salient in the case of AeA and is potentially harmful for AeA practitioners; (ii) that the medicalizing terms used to describe the phenomenon (including, precisely, “autoerotic asphyxiation”, can be seen as both cause of, and caused by, a disconnect between research on the topic and the community within which the practice exists.

The Mental Capacity Act 2005 and autoerotic asphyxiation: pleasure versus the risk of harm

SUMMARYThere has been a series of judgments in recent years emanating from the Court of Protection in England and Wales involving sexual relations. One such judgment is unique in that it is the first time the court has assessed capacity in the sexual practice of autoerotic asphyxiation in a person with a diagnosis of autism spectrum disorder. This article reviews the judgment and specifically the key section of the Mental Capacity Act 2005, section 27, which applies to capacity decisions in the context of family relationships, including sexual relationships. The practice of autoerotic asphyxia can be a complex and emotive subject and dangerous to individuals undertaking it. The judgment provides guidance and a framework for applying the Act to assess the capacity of someone practising autoerotic asphyxia that can be used in clinical practice for people with any mental disorder.

Are psychological distress, substance misuse, and sexual sensation seeking associated with autoerotic asphyxiation-related distress?

Autoerotic asphyxiation (AEA) involves enhancing sexual arousal by deliberately self-inducing a reduction of oxygen to the brain. Most studies of AEA have focused on those who have expressed distress or who have died from the practice. The present study explores correlates of AEA-related distress in a community sample, focusing on self-reported measures of psychological distress, substance misuse, and sexual sensation seeking. Individuals who expressed an interest in AEA ( n = 165) participated in an online anonymous survey. Findings revealed a significant positive association between AEA-related distress and symptoms of depression, and a significant negative association between AEA-related distress and sexual sensation seeking. Both depression and sexual sensation seeking remained associated with AEA-related distress at the multivariate level. The findings are consistent with prior literature on AEA that suggests comorbidity with depression and highlights the importance of psychological screening when people present to clinicians due to AEA, particularly for depression. Contrary to our hypothesis, those with higher sexual sensation seeking reported lower levels of AEA-related distress. Future research on AEA-related distress may benefit from using a sexual sensation seeking measure that better assesses sexual dysregulation.

An Illustrative Case of Suicidal Hanging Versus Accidental Hanging Associated With Autoerotic Activity

The majority of hanging deaths are relatively straightforward when opining the manner of death, typically determined to be suicide. However, there are rare hanging deaths that require the forensic pathologist to seek additional information. Forensic pathologists commonly consider an accidental manner of death when the hanging death scene includes evidence of solitary sexual activity consistent with autoerotic asphyxia. Here, the authors present a case of an initially apparent suicidal hanging where important death scene details photographed by the medical examiner investigator and history provided by family members during subsequent conversations ultimately helped the forensic pathologist conclude an opinion that the hanging was accidental, likely due to autoerotic activity. The decedent, who hanged himself in the closet of his bedroom, was wearing shorts that were initially believed to be inadvertently torn; however, further investigation revealed his shorts were intentionally modified to expose his genitalia. Additional evidence documented from the death scene photographs and conversations with his mother revealed items and activities consistent with autoerotic behavior. Before opining a manner of death in hanging deaths, forensic pathologists are encouraged to consider details beyond that obtained from the initial death scene investigation and postmortem examination. A thorough medicolegal death investigation should not be viewed as introducing cognitive bias, but rather as necessary information needed to determine the most accurate cause and manner of death.

Autoerotic Deaths in Hamburg, Germany: Autoerotic accident or death from internal cause in an autoerotic setting? A retrospective study from 2004-2018

IntroductionAutoerotic deaths are rare events. The death scene is often bizarre and the death unexpected, thus often requiring forensic autopsies. Our analysis will provide an overview of the expected range of causes and manners of death in cases of autoerotic deaths. MethodsA retrospective analysis was carried out on all scientific and forensic autopsies and postmortem examinations performed at the Department of Legal Medicine in Hamburg, Germany, over the period of 2004–2018. Results25 cases of autoerotic fatalities were identified over this 15-year-period or one to two cases per year, respectively. Autopsies were carried out on 23 of these cases. 16 (64%) of the cases involved autoerotic accidents and 7 (28%) from internal causes of death during an autoerotic act. Two cases had not undergone an autopsy. On average, those who were involved in autoerotic accidents had been younger in age (average age: 37 years) than the individuals who died from internal disease (average age: 61 years). Only one woman was involved. The most common cause of death in autoerotic accidents was strangulation (hanging: 8 cases, ligature strangulation: 1 case), followed by smothering of the respiratory tract (4 cases). Fatal intoxication was diagnosed in three of the cases. Fatalities with natural cause of death solely involved cardiovascular causes of death. ConclusionsAutoerotic deaths involved a wide range of natural and non-natural causes of death. The reconstruction of such unusual cases and detection of non-natural fatalities requires thorough investigation of the scene of death as well as a postmortem external and internal examination including a chemical toxicological and blood alcohol analysis.

An examination of autoerotic asphyxiation in a community sample

Autoerotic asphyxiation (AEA) is a sexual interest that involves heightening sexual arousal by deliberately self-inducing a reduced supply of oxygen to the brain. Most of the literature on AEA is comprised of case studies and research based on people who have died from the practice. The present study explored information about AEA practices and the degree of overlap between AEA and other paraphilias in community participants. Participants (n = 395) were recruited through different online platforms to complete an anonymous survey and 165 were classified as having AEA by reporting mild to strong sexual arousal in AEA. These individuals reported that their interest emerged in late adolescence, and many reported that they discovered AEA via the internet. Regarding safety precautions people take during their AEA practice, 19% of participants reported that they did not use safety precautions. Most people (> 80%) were not distressed by their AEA interest. Additionally, significant relationships were found between AEA interest and many paraphilic interests with masochism being the only paraphilia associated with AEA when considering other paraphilic interests. These results suggest that most individuals engage in less risky manifestations of AEA than what is reported in the clinical literature and that AEA is appropriately conceptualized as a subtype of masochism. The results underscore the importance of gathering information about alternative sexual practices in community samples.

DSM-5 paraphilic disorders criteria in the light of autoerotic asphyxiophilia and non-sexual form of oxygen restriction.

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders published in 2013 has proved to be particularly interesting in the field of sexuality. It introduced a number of significant changes in the definition of sexual norms, among them a widely discussed distinction between paraphilias and paraphilic disorders. The key criterion separating the abnormal sexual interests from the disordered ones is clinically significant distress resulting directly from sexual behavior and/or the risk of suffering or harm to another person as a result of one's sexual behavior. In the case of masochism - which addresses the phenomenon of suffering quite particularly - this distinction is troublesome. Using the example of autoerotic asphyxia - a behavior from the masochism spectrum - the authors critically examine the proposed DSM-5 method of defining the standards of sexual behavior. Interesting in this regard has been a comparison between autoerotic asphyxia and free diving - a nonsexual activity which, although also associated with possible loss of life by reduction of oxygen, has not been pathologized.

Lethal asphyxiation due to sadomasochistic sex training — How some sex partners avoid criminal responsibility even though their actions lead to someone's death

IntroductionErotic asphyxiation is a sexual phenomenon in which one partner reduces the other person's brain oxygen level through strangulation. This study analyzes deaths caused by sexually-motivated strangulation to cases of homicidal choking — summarizing criminal penalties for defendants, depending on the presence of drugs, or alcohol intoxication. MethodsThe mode of analysis involves three sources of data. First, a retrospective chart review of our clinics' two recent cases. Second, a meta-analysis of these materials in relationship to forensic reports obtained from prosecutor's office. Third, we examine the prevalence of death due to strangulation in erotic and non-erotic cases using central court database. Lastly, we provide the summary of interviews involving the country's only forensic unit, which investigates criminal cases involving voluntary and involuntary strangulation. ResultsIn total, we analyzed 15 cases of sexual asphyxiation — 2 of our own; 5 reported in prosecutor's archives; 8 control cases ruled as a non-sexual homicide. The two of our clinical cases describe two victims of voluntary erotic asphyxiation, involving complex sexual environment in which a sexual partner accidentally strangulated the other one during sex. The first case describes a 30 years-old female, who required all of her past sexual partners to choke her with hands in order to reach orgasm. The second case is that of a 41 years-old homosexual male, who was still a novice to kinky play and succumbed to death as a result of being tied with a set of ropes around his neck and body. By combining findings from the analysis of our clinic's cases with 5 files obtained from prosecutor's office — we are able to compare results of these cases to controls (involving homicidal suffocation using the plastic bag). In our cases, the defendants who avoid serving prison time for strangulating in course of erotic play typically exhibit these characteristics — at the time of the killing, they were not under influence of drugs; the deceased had documented (based on witness interview, review of personal items, or medical documentation) long-standing paraphilic disorder. In controls, the likelihood of being convicted of voluntary manslaughter was lower for people who acted under the influence of drugs but higher for those under the influence of alcohol. ConclusionsThese findings show that documented presence of paraphilic tendencies in the deceased might serve as grounds for not sentencing their sex partners for prison time if they acted to satisfy someone else's kinky needs.

Accidental Death Due to Autoerotic Asphyxia Coupled With Fetishistic Transvestism

Fetishistic transvestism is a disorder of sexual perversion associated with fantasies and sexual urges to dress in opposite gender clothing as a means of arousal and adjunct to masturbation and coitus. However, transvestism has been described in schizophrenia and psychosis and fetishism in the course of simple schizophrenia. Our reported case is a 26 year-old male found hanging in transvestite attire wearing blouse and petticoat. There was no psychiatric background and no known previous suicidal behavior of the deceased. The manner of death was finally considered to be an accident. The cause of the death was accidental hanging provoked by fatal autoerotic asphyxia.

Accidental Death Due to Autoerotic Asphyxia Coupled With Fetishistic Transvestism

Fetishistic transvestism is a disorder of sexual perversion associated with fantasies and sexual urges to dress in opposite gender clothing as a means of arousal and adjunct to masturbation and coitus. However, transvestism has been described in schizophrenia and psychosis and fetishism in the course of simple schizophrenia. Our reported case is a 26 year-old male found hanging in transvestite attire wearing blouse and petticoat. There was no psychiatric background and no known previous suicidal behavior of the deceased. The manner of death was finally considered to be an accident. The cause of the death was accidental hanging provoked by fatal autoerotic asphyxia.

Masturbation in the light of Islam and Christianity - allowed or not?

<p class="abstract">One of the interesting and intention seeking topic most commonly discussed all over the world regarding its allowance in Islam and Christianity. Masturbation has been thought as one of the means for releasing stress. However, wanking frequently because of lust obviously has some side an effect medically about which a lot of research works still needs to be done. Some medical experts believe that it may lead to infertility if performed frequently; with decreased sperm count, volume and density. Islam has forbidden the act of masturbating and considered it an act of sin. The reason it is called a sin is due to the overwhelming probability that the individual could get involved in adultery. Both religions endorse the fact that marriage helps to avoid adultery. However, masturbating temporarily decreases sperm count, that is why, if you visit fertility clinics for sperm analysis, they ask you not to masturbate or have sexual intercourse for more accurate assessment. The only time where reduction in sperm per ejaculate becomes an issue clinically is if a couple is having difficulty to conceive, in which case the first suggestion a physician would make is for the man to abstain from masturbation between sessions of sexual intercourse (if there is any concern that this is contributing to fertility issues). Frequent masturbation may also lead to auto-erotic asphyxia. Autoerotic or sexual asphyxia, a potentially lethal sexual practice, refers to sexual arousal that is produced while reducing the oxygen supply to the brain.</p>

Stadistic Study of Accidents and Non-Intentioned Injuries Associated with Kinky-BDSM Practices in The Spanish Comunnity

Objective: To collect quantitative data about the non-intentioned injuries and accidents associated with kinky-BDSM sexual practices, to provide an objective knowledge in this area. Design and Method: It was performed a questionnaire that included three parts (personal data, sexual behaviour data, and injuries data), and was distributed to kinky-BDSM practitioners, 18 or older, who were living in Spain during the study. The distribution was done in three ways: in person; through Internet social network; and with an Adobe forms questionnaire in the project’ website. All the answers were printed, encoded and filed. The data was processed by statistic functions of Microsoft Excel. Results: We obtained a sample with 119 valid answers (77 men, 40 women, 1 transsexual and 1 with non-specified sex). 71.43% of the sample recognized that had suffered at least one accident performing his/hers practices. The % of persons who admit to have suffered an accident was bigger in the group who use drugs when having BDSM-sex, in comparison to who don’t (83.63% against 65.08%). The most common non-intentioned injuries were hematomas (21.51% of the common injuries); most common cause, a spanking not well performed (21.90% of the common accidents). Most common circumstances where the accidents take place were being accompanied (82.89%) and without drug consumption (81.58%). Only in the 40% of the cases, an external aid was searched. Conclusions: The kinky-BDSM practitioners evidence a risk perception bias, because the practice conceived as most dangerous (autoerotic asphyxia) only causes a few accidents/injuries (1.45%) and doesn’t match with the real most dangerous practice (due to the importance of the injuries), the bondage or the most common (spanking). It has been observed a paradoxical relationship about drug consumption and probabilities of accident. It has been done a feedback of the information obtained to the kinky-BDSM community in Spain so they can start to organize activities to make more secure their activities.

MMPI-2 Correlates of Sadomasochism in a Sexual Addiction Sample: Contrasting and Men and Women

The current exploratory study investigated associations between personality and psychopathology, as measured by the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), and engagement in sadomasochistic (S&M) behaviors in a sample of individuals presenting for treatment of problematic sexual behavior and/or sexual addiction. Profiles were established by sex for both low-risk (e.g., seeking out humiliation and loss of power during sexual experiences) and high-risk (e.g., engagement in sexual asphyxiation) presentations. A series of correlation and multiple regression analyses were conducted to establish associations. Results indicated that a scale measuring trauma-related symptoms (PK) predicted both high-risk and low-risk S&M behaviors, across sexes. Among men, schizoptypal characteristics, hypomanic activation, disconstraint, and negative emotionality predicted both risk levels. Low-risk behaviors in men were also predicted by self-deprecation, familial alienation, low positive emotions, and anxiety. Conversely, high-risk S&M behaviors in men were predicted by antisocial behavior, trait psychoticism, and generalized fearfulness. High-risk S&M behaviors in women were predicted by self-deprecation, disconstraint, competitiveness, anger, antisocial behaviors, and aberrant experiences, among others. History of sexual abuse was a predictor of low-risk and high-risk S&M behavior in women only. Findings are discussed in terms of implications for treatment and further research.

Sexual Masochism Disorder with Asphyxiophilia: A Deadly yet Underrecognized Disease.

DSM-5 distinguishes between paraphilias and paraphilic disorders. Paraphilias are defined as atypical, yet not necessarily disordered, sexual practices. Paraphilic disorders are instead diseases, which include distress, impairment in functioning, or entail risk of harm one's self or others. Hence, DSM-5 new approach to paraphilias demedicalizes and destigmatizes unusual sexual behaviors, provided they are not distressing or detrimental to self or others. Asphyxiophilia, a dangerous and potentially deadly form of sexual masochism involving sexual arousal by oxygen deprivation, are clearly described as disorders. Although autoerotic asphyxia has been associated with estimated mortality rates ranging from 250 to 1000 deaths per year in the United States, in Italy, knowledge on this condition is very poor. Episodes of death caused by autoerotic asphyxia seem to be underestimated because it often can be confounded with suicide cases, particularly in the Italian context where family members of the victim often try to disguise autoerotic behaviors of the victims. The current paper provides a review on sexual masochism disorder with asphyxiophilia and discusses one specific case as an example to examine those conditions that may or may not influence the likelihood that death from autoerotic asphyxia be erroneously reported as suicide or accidental injury.

Whose Consent Matters? Sado-Masochism and Governmentality in Canadian Consent Law

The 2011 Supreme Court of Canada decision on R. v. J.A. changed existing sexual consent law in Canada, effectively determining that consent given prior to sexual acts is vitiated if all parties are unable to maintain a state in which they can continuously express consent. J.A. involved consensual erotic asphyxiation resulting in unconsciousness. The stigma surrounding this sado-masochistic sexual act did effect the verdict, but prejudice against marginalized sexual practices only begins to explain the ruling. The vitiation of prior consent to sex is a regulatory decision that prescribes behaviour in an attempt to create a certain type of subject: specifically, one who meets both the physical and ideological needs of the state. In order to thrive the state requires workers that are physically healthy and able to productively labour. In order to ensure that workers act as appropriately productive citizens the state needs to ensure that the ideological and political orientation of workers results in complicity with the normative expectations of the state. The ultimate factor determining what kind of consent is effective and who is able to give it is based on social, capitalist utility. SM sexual practices can lead to physical harm and therefore a decrease in productivity, and can involve a critical interrogation of (un)freedom, (de)subjectivity, and power. Both factors present a threat to the needs of the state, and as a result sadomasochism is criminalized. While utilizing Foucauldian theory, and considering J.A. through the lens of capitalist utility, it becomes apparent that the question of consent and prior consent is answered in deference to creating productive and docile citizens.Keywords: R. v. J.A., sado-masochism, sexual consent law, governmentality, social utility-----Bibliography: Desjardins, Bridgette: Whose Consent Matters? Sado-Masochism and Governmentality in Canadian Consent Law, INSEP, Vol. 2, Issue 1-2014, pp. 18-30. https://doi.org/10.3224/insep.v2i2.19843

Invisible suffering: breathlessness in and beyond the clinic

Invisible suffering: breathlessness in and beyond the clinic

P3.150 Alternative Sexual Practises and Prevalent STI/HIV Among STD Care-Seeking Men Who Have Sex with Men

BackgroundSTI/HIV prevention messages targeting men who have sex with men (MSM) include recommendations to avoid unprotected anal intercourse. Beyond anal intercourse, MSM may engage in a range of alternative sexual...