Hypoxyphilia

Arch Sex Behav (2011) 40:13231326 DOI 10.1007/s10508-011-9824-3

ORIGINAL PAPER

Hypoxyphilia

Stephen J. Hucker

Published online: 30 July 2011 American Psychiatric Association 2011

Abstract ThisistheAdvisorsreportonHypoxyphilia,asitis currently called in DSM-IV, submitted at the request of the DSM-5 Paraphilias Subworkgroup of the Sexual and Gender Identity Disorders Workgroup. The background literature is reviewedtogether with informationfrom the authorsrecent and as yet unpublished research derived from an internet survey of more than 100 living practitioners of this paraphilic activity. It is recommended that the termasphyiophilia,already used in the literature, is preferable as there is little to indicate that the effects of oxygen deprivation per se are the primary motive for the behavior; rather, it is sexual arousal to restriction of breathing. It is properly regarded as a severe and potentially dangerous manifestation of Sexual Masochism which can result in physical harmordeathandthereforeshouldbeidentiedassuch,perhaps as a specier. However, there is no good reason to identify it as a separate paraphilia though it should be named in the DSM-5 text asitisawell-recognizedandunusualmodeofdeath.Lesssevere forms of Sexual Masochism which do not threaten life or otherwise cause serious physical harm should not be regarded as mental disorders.

Keywords Hypoxyphilia Asphyxiophilia

Sexual masochism Paraphilia

Hypoxyphilia was rst introduced into the Diagnostic and Statistical Manual in the revision of its third edition and has been included in subsequent editions, always as a subtype of Sexual Masochism. In DSM-IV-TR (American Psychiatric Association, 2000), it is characterized as a particularly dangerous form of

Sexual Masochism [that] involves sexual arousal by oxygen deprivation obtained by means of chest compression, noose, ligature, plastic bag, mask, or chemical.The behavior is also described in the ICD-10 Classication of Mental and Behavioural Disorders (World Health Organization, 1992), separately from Sadomasochism, under Other Disorders of Sexual Preference, simplyastheuseofstrangulationoranoxiaforintensifyingsexual excitement.

Whether hypoxyphilia should remain a subcategory of SexualMasochisminDSM-5orgivenaplaceamongthespecically named paraphilias is one of the central concerns to be addressed in this report. If it is given a separate identity, a further issue would be the criteria that should be required for the diagnosis.

Background Literature on Hypoxyphilia

Examples of an association between asphyxia and sexual arousal have been described in other cultures and historical periods. The earliest medical reference in English (Ryan, 1836) mentioned examples of asphyxiationto excite the venereal appetite and, for a century thereafter, reports in the...