Accidental Autoerotic Deaths and Mental Disorder: A Scoping Review

Area of Science:

• Forensic Psychology
• Psychiatry
• Sexual Health

Background:

• Accidental autoerotic death, or autoerotic asphyxia, involves inducing hypoxia during sexual activity, with data often obscured by non-disclosure or differing forensic systems.
• A significant association exists between autoerotic behaviors and comorbid mental disorders, necessitating further investigation.

Purpose of the Study:

• To identify and review the association of comorbid mental disorders with accidental autoerotic deaths.
• To understand the psychological landscape surrounding potentially fatal paraphilic behaviors.

Main Methods:

• A systematic literature search was conducted on August 23, 2023, across Cochrane, PubMed, ScienceDirect, and SCOPUS.
• English-language studies were screened using the PRISMA-ScR guideline for scoping reviews.
• Eighteen studies were identified that linked specific mental disorders to autoerotic deaths.

Main Results:

• Identified mental disorders associated with autoerotic deaths include paraphilia, vaginismus, gender dysphoria, multiplex paraphilia, alcohol dependence, bipolar disorder, borderline personality disorder, and substance use disorder.
• Inhalant use (e.g., chloroform, toluene, xylene) was implicated in autoerotic fantasies leading to death.
• The review identified 18 specific mental disorders linked to autoerotic fatalities.

Conclusions:

• Prospective clinical screening and comprehensive psychological autopsies are crucial for determining the prevalence of accidental autoerotic death and associated mental health conditions.
• The classification of paraphilias involving harmful acts within diagnostic systems, such as the impulsive-compulsive-reward spectrum, warrants further consideration.