Kasuistiken Rechtsmedizin 2016 · 26:53–55 DOI 10.1007/s00194-015-0072-z Published online: 13 January 2016 © Springer-Verlag Berlin Heidelberg 2015

A. Tzikas · S. Kornappel · K. Püschel Institute of Forensic Medicine Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

Autoerotic deaths and low socioeconomic status Presentation of two cases

Introduction Autoerotic death is defined as accidental death during sexual self-stimulation (masturbation), commonly by an instrument that is used to enhance the sexual pleasure. The definition excludes deaths during sexual activity that result from the coexistence of a pathological state (socalled coital coronary). The most common type of autoerotic death is that induced through asphyxiation of the victim; therefore, it is also known by the terms autoerotic asphyxiophilia, hypoxyphilia or simply sexual asphyxia. This practice represents a deviation of sexual behavior (paraphilia) and according to the literature is usually associated with individuals with a higher education and of higher social status [1, 2]. In this article two cases of asphyxiophilia are presented. The special characteristics of each case were evaluated with an emphasis on the socioeconomic status of the victims.

in the door the police officers saw a man in the toilet and decided to forcibly open it. The man was sitting on the toilet floor and was naked with his clothes lying on the floor. No vital signs were present, the body was cold and lividity was present on the dorsal side of the body. Also lying next to the body was a bag with a torn belt and the rest of the belt was coiled around the neck and around the left and right wrists (.  Figs.  2a, b, c, d). The external examination of the body revealed a key holder on a lanyard which was inserted deep into the anus of the deceased for autoerotic purposes (.  Fig. 3). No alcohol or drugs were found inside the toilet. The examination of the toilet and the external examination of the body showed no further signs of violence. An autopsy was not performed and the toxicological analyses were negative for alcohol and drugs. As there were no other signs of violence the cause of death was determined to be strangulation during sexual asphyxia.

Case reports

Case 2

Case 1

A 32-year-old laborer was found dead in the barn of an old farmhouse. The deceased was found by his employer and the body was situated inside a rain barrel (.  Fig. 4a, b). A propane gas cylinder was found a few meters away from the barrel and a hose from the gas cylinder was placed inside the half-opened barrel lid (.  Fig. 4b). The deceased was found in a sitting position inside the barrel, half-naked (the trousers and underwear were pulled down to the feet and a sweatshirt in a regular position was worn on the upper body) with a pallid face and highly devel-

A homeless 43-year-old man was found dead by the police inside a portable chemical toilet (.  Fig. 1). A women who lived nearby saw him go into the toilet in the afternoon after leaving a trolley outside. The woman noticed that the trolley was still there 4 h later and decided to check if the man was still inside. The door was locked and when she knocked she received no answer. The next day she noticed that the trolley was still there and decided to inform the police. By looking through a gap

oped lividity and rigidity. A pornographic magazine was found between the legs and a sticky substance could be identified on the glans penis (semen). The external examination of the body showed no traces of violence. According to the police the deceased was a known exhibitionist. An autopsy and toxicological analyses were not performed. The cause of death was classified as gas asphyxiation during sexual asphyxia.

Discussion The augmentation of sexual pleasure through asphyxiation is a widespread act in various cultures and was also well known in many ancient civilizations. This type of death usually involves male individuals, although female victims are also involved in a smaller number of incidents. The main reason for death during asphyxiophilia is usually a loss of control or malfunction of

Fig. 1 8 Schematic representation of the scene where the body was found in a portable chemical toilet Rechtsmedizin 1 · 2016 

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Fig. 3 8 Key holder with lanyard in the anus and after removal from the anus of the victim (insert) Fig. 2 8 Front (a) and side (b) views of the belt coiled around the victim’s neck and the parts of the belt coiled around the left (c) and right (d) wrists of the victim

Fig. 4 8 a, b The victim situated inside a half-opened rain barrel in the basement of the building with a pornographic magazine between the legs. The hose of the gas cylinder can also be seen (see insert)

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Abstract · Zusammenfassung the so-called rescue mechanisms and is also a reason why these deaths are sometimes thought to be due to suicide [3–8]. In the fourth edition of the diagnostic and statistical manual of mental disorders (DSM-IV) the American Psychiatric Association classifies autoerotic asphyxia under the general term of paraphilias. Under this term several different disorders are listed and among them sexual masochism. The term also defines sexual behavior and fantasy that usually involve unusual activities and situations with the participation of unusual objects. The 10th edition of the international classification of diseases (ICD-10) by the World Health Organization (WHO) also describes these sexual deviations under the term disorders of sexual preference including disorders, such as sexual sadism and masochism, pedophilia and autoerotic deaths. These classifications describe an act through which the individual achieves sexual pleasure by oxygen deprivation. The insufficient amount of oxygen supplied to the brain leads to a malfunction of the limbic system resulting in the rapid activation of sexual sensitivity [1, 9, 10]. According to the literature people engaging in this type of paraphilia are usually well educated, with a higher income and occupational status. Spengler reported that the participants in his study were mostly people living in good circumstances, were well educated and wealthy. He assumed that probably by having more time and money at their disposal, these persons were seeking “stronger” sexual experiences. Moser and Levitt believed that more educated people are more affluent and perhaps more willing to participate in a study in order to define their sexuality. Sandnabba et al. found that the majority of the participants in the study also referred to people with leading positions at work and some of them also played a distinguished role in their community [11– 14]. This article presents two extraordinary cases that deviate from this context given in the literature. The first case was that of a homeless 43-year-old man with no income and the second case involved an unskilled casual worker with a well-known history of exhibitionism. Both cases pertained to people with lower education levels, very low income and

in one case homelessness. The experience of this unusual phenomenology led to the conclusion that autoerotic asphyxiation could also be practiced by individuals of the lower socioeconomic class of society. It is suggested that this type of paraphilia is not only a privilege of wealthy, educated and distinguished people and by assuming this fact we believe that the presented cases reflect the true socioeconomic identity of at least some of the victims.

Corresponding address Prof. Dr. K. Püschel Institute of Forensic Medicine Hamburg, University Medical Center Hamburg-Eppendorf Butenfeld 34, Haus Nord 81 (N81) 22529 Hamburg [email protected]

Compliance with ethical guidelines Conflict of interest.  A. Tzikas, S. Kornappel, K. Püschel declare that there are no conflicts of interest. The accompanying manuscript does not include studies on humans or animals.

References   1. Byard RW (1994) Autoerotic death- characteristic features and diagnostic difficulties. J Clin Forensic Med 1:71–75   2. Janssen W, Koops E, Anders S, Kuhn S, Püschel K (2005) Forensic aspects of 40 accidental autoerotic deaths in Northern Germany. Forensic Sci Int 147:61–64   3. Solarinoa B, Leonardi S, Grattagliano I, Tattoli L, Di Vellaa G (2011) An unusual death of a masochist: accident or suicide? Forensic Sci Int 204:e16–e19   4. Innala SM, Ernulf KE (1989) Asphyxiophilia in Scandinavia. Arch Sex Behav 18:181–189   5. Rosenblum S, Faber MM (1979) The adolescent sexual asphyxia syndrome. J Am Acad Child Psychiatry 8:546–558   6. Rupp JC (1980) Sex-related deaths. In: Curran WJ, McGarry AL, Petty CS (eds) Modern legal medicine, psychiatry and forensic science. Davis F.A., Philadelphia, pp. 575–587   7. Campbell M (1989) More on autoerotic death (letter). J Am Acad Child Adolesc Psychiatry 28:137   8. Dietz PE (1983) Recurrent discovery of autoerotic asphyxia. In: Hazelwood RR, Dietz PE, Burgess AW (eds) Autoerotic fatalities. DC Heath, Lexington, pp. 13–44   9. American Psychiatric Association (ed) (2000) Diagnostic and statistical manual of mental disorders, 4th edn. American Psychiatric Association, Washington D.C. 10. Disorders of sexual preference (1993) In: The ICD10 Classification of Mental and Behavioral Disorders. Diagnostic criteria for research. http://www. who.int/classifications/icd/en/GRNBOOK.pdf

Rechtsmedizin 2016 · 26:53–55 DOI 10.1007/s00194-015-0072-z © Springer-Verlag Berlin Heidelberg 2015 A. Tzikas · S. Kornappel · K. Püschel

Autoerotic deaths and low socioeconomic status. Presentation of two cases Abstract This article presents two cases of autoerotic death involving asphyxiophilia in which the victims were from the lower levels of society. This is in apparent contradiction to the previously assumed theory that such sexual deviations were mostly practiced by people from the more affluent classes of society. An analysis of these two cases demonstrates that such practices are not only the domain of privileged members of society and that the previous assumption is probably now outdated. Keywords Masturbation · Asphyxia · Paraphilias · Deviation, sex · Masochism

Autoerotische Todesfälle und niedriger sozioökonomischer Status. Zwei Kasuistiken Zusammenfassung Im vorliegenden Beitrag werden zwei autoerotische Todesfälle im Zusammenhang mit Asphyxiophilie vorgestellt, deren Opfer aus einer niederen sozialen Schicht stammten. Dies steht im klaren Widerspruch zur bisherigen Theorie, dass sich sexuelle Verhaltensabweichungen dieser Art meist bei Personen finden, die einer wohlhabenderen Schicht angehören. Eine Analyse der beiden Fälle zeigt, dass solche Praktiken nicht allein das Betätigungsfeld privilegierter Mitglieder der Gesellschaft sind. Die bisherige Annahme muss wahrscheinlich verworfen werden. Schlüsselwörter Masturbation · Asphyxie · Paraphilie · Abweichendes Sexualverhalten · Masochismus

11. Beech AR, Harkins L (2012) DSM-IV paraphilia: descriptions, demographics and treatment interventions. Aggress Violent Behav 17:527–539 12. Spengler A (1977) Manifest sadomasochism of males: results of an empirical study. Arch Sex Behav 6(6):441–56 13. Moser C, Levitt EE (1987) An exploratory-descriptive study of a sadomasochistically oriented sample. J Sex Res 23(3):322–337 14. Sandnabba NK, Santtila P, Nordling N (1999) Sexual behavior and social adaptation among sadomasochistically-oriented males. J Sex Res 36(3):273–282

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