Adolescent Mental Health and the Choking Game

Abstract

OBJECTIVES: To examine the demographic and health risk factors associated with participation in the choking game (CG), a dangerous and potentially fatal strangulation activity in which pressure is applied to the carotid artery to temporarily limit blood flow and oxygen. METHODS: We obtained data from 2 cross-sectional studies realized respectively in 2009 and 2013 among French middle school students. The 2009 (n = 746) and 2013 (n = 1025) data sets were merged (N = 1771), and multivariate modeling was conducted to examine demographic and clinical characteristics of youth reporting a lifetime participation in the CG. The 2 studies included questions about risk-taking behaviors and substance use, and standardized assessments were used to collect conduct disorder symptoms and depressive symptoms. RESULTS: In the merged 2009 and 2013 data set, the lifetime prevalence of CG participation was 9.7%, with no statistically significant differences between boys and girls. A multivariate logistic regression revealed that higher levels of conduct disorder symptoms (odds ratio: 2.33; P , .001) and greater rates of depressive symptoms (odds ratio: 2.18; P , .001) were both significantly associated with an increased likelihood of reporting CG participation. CONCLUSIONS: The significant relationship between elevated levels of depressive symptoms and participation in the CG sheds new light on the function of self-asphyxial activities. However, with the finding that higher rates of conduct disorder symptoms were the most important predictor of CG participation, it is suggested that the profile and the underlying motivations of youth who engage in this activity should be reexamined.

Does intentional asphyxiation by strangulation have addictive properties?

“…Peer pressure has also been suggested as a route to initiation [33], and there is a wide range of such 'thrillseeking games'; namely, 'suffocation roulette', 'space monkey', 'gasp', 'knock out', 'blackout', 'minutes in heaven' and 'flat-lining' [32,34]. Of additional concern is the use of YouTube to broadcast these asphyxiation games, with evidence of access to 65 videos (90% male performers); 55% showed hypoxic seizures and were collectively viewed 173550 times [35].…”

“…Supporting a comorbidity link with the choking game, a survey of 1771 9–16‐year‐olds from France revealed that 9.7% had participated, and had higher rates of substance use and depressive symptoms than those who did not [32]. This research concluded that those engaging in the practice may be doing so to regulate negative mood stemming from depression [32]. This research is, however, limited, as it does not specify frequency of participation or distinguish social‐ and solo‐asphyxiation behaviour.…”

“…While there seems to be a link with other problems such as substance use [17] and mental health [32], a study in Saudi Arabia [33] suggests that young people are engaging in the behaviour to achieve the same sort of ‘high’ (from cerebral hypoxia) without substances, instead using ligatures such as scarfs, curtain ropes and garden hoses, with siblings and alone. In contrast to earlier reports, asphyxia performance has been described as more common in ‘athletic, average to above‐average students, who would ordinarily shun alcohol and drugs’, providing a possible false sense of security as a substance‐free ‘high’ [34].…”

Multimodal imaging of sclerochoroidal calcification associated with choroidal neovascular membrane

“…6,7 Moreover, this high-risk recreational activity may be a marker for coexisting substance use or psychiatric illness. 11 If the strangulation is found to be a suicide attempt or concerning features such as suicidal ideation and intent are identified, emergent psychiatric evaluation is necessary. If strangulation is found to have occurred from child abuse, legal involvement including child protective services is necessary as dictated by local and federal protocols of the region.…”

Conjunctival and periorbital petechiae presumed secondary to self-inflicted asphyxiation in a pediatric patient

“…6,7 Moreover, this high-risk recreational activity may be a marker for coexisting substance use or psychiatric illness. 11 If the strangulation is found to be a suicide attempt or concerning features such as suicidal ideation and intent are identified, emergent psychiatric evaluation is necessary. If strangulation is found to have occurred from child abuse, legal involvement including child protective services is necessary as dictated by local and federal protocols of the region.…”