Accidental Autoerotic Deaths and Mental Disorder: A Scoping Review

Accidental autoerotic death, more commonly known as "autoerotic asphyxia," is an extreme paraphilic behavior wherein individuals induce cerebral hypoxia during self-stimulated sexual activities, often by constricting the neck or obstructing respiratory passages. Data on accidental deaths caused by autoerotic play is very low because of the non-disclosure of the mode/circumstances of death or non-paralleled forensic systems in many countries. There is a high likelihood of coexisting mental disorders with such behavior. This review identifies the association of any comorbid mental disorder with accidental autoerotic deaths.

On August 23, 2023, a systematic literature search was carried out through Cochrane, PubMed, ScienceDirect, and SCOPUS, and studies identified in the English language were screened using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review (PRISMA-ScR) guideline. Eighteen studies identified specific mental disorders with autoerotic deaths, including paraphilia, vaginismus, gender dysphoria, multiplex paraphilia, alcohol dependence, bipolar disorder, borderline personality disorder, and substance use disorder. Inhalant use like chloroform, toluene, and xylene was implicated during autoerotic fantasies.

Prospective clinical screening and comprehensive multicentric psychological autopsy studies are needed to clarify the prevalence of accidental autoerotic death and related mental health conditions in the future. Given the possibility of accidental death, it remains to be seen whether paraphilia involving a single harmful event could be classified as a specifier within the impulsive-compulsive-reward spectrum, similar to how newer diagnostic systems address substance use disorders.