Choking game
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The choking game, or fainting game[1][2] is the act of intentionally cutting off oxygen to the brain with the goal of inducing temporary loss of consciousness and euphoria. A related internet challenge, the blackout challenge, encourages the use of the choking game online.
Reasons for practice
Limited research has been conducted regarding motivations for practicing the fainting game, although
- Peer pressure, a challenge or dare, a rite of passage into a social group or amusement over erratic behavior.[5]
- Curiosity in experiencing an altered state of consciousness, the experience of a greyout, or an imagined approximation to a near-death experience.[5]
- A belief that it can induce a brief sense of euphoria (a rushing sensation or high).[3][5]
- The prospect of intoxication, albeit brief, at no financial cost.
Reasons for practice are distinct from erotic asphyxiation. Steve Field, chairman of the Royal College of General Practitioners in London,[6] claims that the fainting game is pursued primarily by children and teens "to get a high without taking drugs." Children "aren't playing this game for sexual gratification." It is frequently confused with erotic asphyxiation, which is oxygen deprivation for sexual arousal. Unlike erotic asphyxiation, practice of the fainting game appears to be uncommon in adulthood.[7]
Mechanisms of effect
There are two main mechanisms behind many variations of this practice, both resulting in
Strangulation
A ligature such as a belt or rope around the neck, or hands or arm pressure on the neck compresses the internal carotid artery. Apart from the direct restriction of blood to the brain there are two other significant responses produced by pressing on the neck:
- Pressing on the carotid arteries also presses on vasodilatationin the brain leading to insufficient blood to perfuse the brain with oxygen and maintain consciousness.
- A message is also sent via the carotid sinus hypersensitivity.
Increased breathing
The second mechanism requires hyperventilation (forced overbreathing) until symptoms of hypocapnia such as tingling, light-headedness or dizziness are felt, followed by a breath-hold. This alone is enough to cause a blackout, but it is widely believed that the effect is enhanced if lung air pressure is increased by holding the breath "hard" or "bearing down" (tightening the diaphragm as in a forced exhalation while allowing no air to escape or having an assistant apply a bear-hug).[11] These latter actions may augment the effects of hypoxia by approximating the Valsalva maneuver, causing vagal stimulation.
The hyperventilation leads to an excessive elimination of
In the body alkalosis generally induces vasodilation (widening of the blood vessels) but in the brain alone it causes vasoconstriction (narrowing of the blood vessels)[citation needed]. This vasoconstriction appears to be made even worse by a sudden increase in blood pressure caused by squeezing or holding the breath "hard". The alkalosis-induced euphoria can be followed rapidly by hypoxia-induced unconsciousness. The sequence of events leading to unconsciousness from hyperventilation is as follows[citation needed]:
- Decrease in partial pressure of alveolar CO2.
- Decrease in partial pressure of arterialCO2.
- Increase in blood pH, (respiratory alkalosis).
- Vasoconstriction of blood vessels supplying brain.
- Pooling of the blood present in the brain at the time.
- Brain rapidly uses up oxygen (O2) available in the pooled blood.
- O2 concentration in the brain drops.
- Unconsciousness from hypoxia of cerebral tissue.
Because the brain cannot store reserves of oxygen and, unlike other organs, has an exceedingly low tolerance of oxygen deprivation, it is highly vulnerable if vasoconstriction is not reversed. Normally, if the brain is hypoxic, autonomous systems in the body divert blood to the brain at the expense of other organs; because the brain is vasoconstricted this mechanism is not available. Vasoconstriction is only reversed by the build-up of carbon dioxide in the blood through suspension of breathing.
In some versions the bear-hug is replaced by pressure on the neck in which case blackout is a hybrid of strangulation and self-induced hypocapnia.
Other mechanisms
Unconsciousness may be induced by other methods although these are controversial: pressure over the
In both strangulation and self-induced hypocapnia blackouts the victim may experience dreaming or hallucinations, though fleetingly, and regains consciousness with short-term memory loss and involuntary movement of their hands or feet. Full recovery is usually made within seconds if the strangulation stops.
Prevalence
A 2008
A challenge, named the "Blackout challenge", became widespread on TikTok in 2021, resulting in multiple fatalities of children.[14]
Injuries and fatalities
Any activity that deprives the brain of oxygen has the potential to cause moderate to severe brain cell death leading to permanent loss of neurological function ranging from difficulty in concentration or loss of short-term memory capacity through severe, lifelong mental disability to death.[15] Statistics on fatalities and neurological damage are controversial; no definitive, empirical study exists although the indications are that the practice is a significant contributor to death and disability, particularly among male juveniles in most developed countries. Many believe that deaths are significantly underreported because of false attributions to suicide.[16]
One study by the U.S. Centers for Disease Control and Prevention (CDC) found sufficient evidence to indicate that since 1995 at least 82 youths between the age of 6 and 19 have died in the United States as a result of the game (roughly 1% of the deaths attributed to suicide by suffocation in the same age group), see chart. Of these 86.6% were male, and the mean age was 13.3. 95.7% of these deaths occurred while the youth was alone; parents of the decedents were unaware of the game in 92.9% of cases. Deaths were recorded in 31 states and were not clustered by location, season or day of week.[17] Neurological damage is harder to attribute accurately because of the difficulty of linking generalised, acquired neurological disability to a specific past event.
Incidental, or indirect, injuries may arise from falling or uncontrolled movements and crushing by a ligature or an assistant. Such injuries may include concussion, bone fractures, tongue biting and hemorrhaging of the eyes.[18]
The CDC encourages parents, educators and health-care providers to familiarize themselves with the signs of the game.[13] These include discussion of the game, bloodshot eyes, marks on the neck, severe headaches, disorientation after spending time alone, ropes, scarves, and belts tied to bedroom furniture or doorknobs or found knotted on the floor, and unexplained presence of things like dog leashes, choke collars and bungee cords.[19]
In popular culture
The choking game phenomenon was the subject of the 2014 television film
In the season 5 episode of Criminal Minds called "Risky Business," a serial killer uses an online version of the choking game to get teenagers to accidentally commit suicide.[20]
See also
- Archie Battersbee case
- Asphyxia
- Blue Whale Challenge
- Death
- Momo Challenge hoax
- Blackout challenge
- Benadryl challenge
- Shallow water blackout – for further discussion on the hyperventilation mechanism
References
- ^ "What Parents Need to Know About the Choking Game". www.allianceforhope.com. Retrieved 2024-01-28.
- ^ "Another schoolboy has died playing the 'choking game'". The Independent. 2015-12-21. Retrieved 2024-01-28.
- ^ PMID 21075323
- S2CID 206981471, retrieved 26 October 2011
- ^ a b c Neal (2008), p.311
- ^ Adams, William Lee (2010-01-18). "A Dangerous Pastime for Teens: The Choking Game". Time. Archived from the original on January 21, 2010. Retrieved 2010-01-21.
- ISBN 978-1-4389-1675-0
- ^ Neal (2008), pp.312-313
- ^ "Breath Play". Epedominion.com. Archived from the original on 2012-08-07. Retrieved 2012-08-19.
- ^ Asystole~treatment at eMedicine
- ^ Neal (2008), p.313 (hyperventilation)
- ^ "Some 79,000 Ont. students play choking game: survey". CTV News. Archived from the original on 7 May 2008. Retrieved 12 May 2011.
- ^ a b "Unintentional Strangulation Deaths from the 'Choking Game' Among Youths Aged 6--19 Years --- United States, 1995--2007", Morbidity and Mortality Weekly Report of the Centers for Disease Control and Prevention, 57(06); 141-144, February 15, 2008 ("PDF version" (PDF).)
- ^ "TikTok's 'blackout' challenge linked to deaths of 20 children in 18 months – report". The Independent. 2022-12-01. Retrieved 2023-02-23.
- ^ "Headway UK Brain Injury Charity"
- ^ Kids are passing out for a deadly high by Michael Okwu, Today, MSNBC.COM, February 26, 2008
- PMID 18272955.
- ^ "'Choking Game' Turned Deadly for 82 Youths" by Amanda Gardner, The Washington Post, February 14, 2008
- ^ "CDC Study Warns of Deaths Due to the 'Choking Game'" Archived 2010-03-28 at the Wayback Machine, Centers for Disease Control and Prevention press release, 14 February 2008
- ^ https://www.imdb.com/title/tt1560564/
Further reading
- Andrew, Thomas A., & Fallon, Kim K.; Fallon (2007), "Asphyxial Games in Children and Adolescents" (PDF), The American Journal of Forensic Medicine and Pathology, 28 (4): 303–307, )
- Bernacki, Jessica M; Davies, W. Hobart (2011), "Prevention of the Choking Game: Parent Perspectives", PMID 21502782, retrieved 27 October 2011
- Cash, Ralph E (November 2007), A Dangerous High (PDF), National Association of School Psychologists, retrieved 27 October 2011
- Lieberman, Richard (2009), "Choking Game" (PDF), Youth Suicide Prevention Program Training for Crisis Teams and School Staff, Los Angeles Unified School District, pp. 3–4See
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: CS1 maint: postscript (link) - Martha Linkletter; Kevin Gordon; Joe Dooley (March 2010), "The Choking Game and YouTube: A Dangerous Combination" (PDF), S2CID 33724693, archived from the original(PDF) on 2010-09-19, retrieved 26 October 2011
- McClave, Julie L.; Russell, Patricia J.; Lyren, Anne; O'Riordan, Mary Ann; Bass, Nancy E. (2010), "The Choking Game: Physician Perspectives", )
- Ramowski, S.K.; Nystrom, R.J.; Chaumeton, N.R.; Rosenberg, K.D. & Gilchrist, J. (2010), "'Choking Game' Awareness and Participation among 8th Graders - Oregon, 2008", Morbidity and Mortality Weekly Report, 59 (1): 1–5, retrieved 27 October 2011Medscape News report
{{citation}}
: CS1 maint: postscript (link) - Toblin, Robin L.; Paulozzi, Leonard J.; Gilchrist, Julie; Russell, Patricia J. (2008). "Unintentional strangulation deaths from the 'Choking Game' among youths aged 6-19 years – United States, 1995—2007". Journal of Safety Research. 39 (4): 445–8. PMID 18786433.
- Urkin, Jacob; Merrick, Joav (2006), "The choking game or suffocation roulette in adolescence (editorial)", International Journal of Adolescent Medicine and Health, 18 (2): 207–208, ]