title: Sexual Masochism Disorder with Asphyxiophilia: A Deadly yet Underrecognized Disease.
abstract: DSM-5 distinguishes between paraphilias and paraphilic disorders. Paraphilias are defined as atypical, yet not necessarily disordered, sexual practices. Paraphilic disorders are instead diseases, which include distress, impairment in functioning, or entail risk of harm one's self or others. Hence, DSM-5 new approach to paraphilias demedicalizes and destigmatizes unusual sexual behaviors, provided they are not distressing or detrimental to self or others. Asphyxiophilia, a dangerous and potentially deadly form of sexual masochism involving sexual arousal by oxygen deprivation, are clearly described as disorders. Although autoerotic asphyxia has been associated with estimated mortality rates ranging from 250 to 1000 deaths per year in the United States, in Italy, knowledge on this condition is very poor. Episodes of death caused by autoerotic asphyxia seem to be underestimated because it often can be confounded with suicide cases, particularly in the Italian context where family members of the victim often try to disguise autoerotic behaviors of the victims. The current paper provides a review on sexual masochism disorder with asphyxiophilia and discusses one specific case as an example to examine those conditions that may or may not influence the likelihood that death from autoerotic asphyxia be erroneously reported as suicide or accidental injury.
authors.affiliation: Department of Medical Sciences, Surgery and Neurosciences, Santa Maria alle Scotte University Hospital of Siena, Siena, Italy.
authors.forename: Anna
authors.identifier: 0000-0002-4451-4682
authors.initials: A
authors.lastname: Coluccia
authors.affiliation: Department of Medical Sciences, Surgery and Neurosciences, Santa Maria alle Scotte University Hospital of Siena, Siena, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Gabbrielli
authors.affiliation: Department of Medical Sciences, Surgery and Neurosciences, Santa Maria alle Scotte University Hospital of Siena, Siena, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Gualtieri
authors.affiliation: Department of Medical Sciences, Surgery and Neurosciences, Santa Maria alle Scotte University Hospital of Siena, Siena, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Ferretti
authors.affiliation: Department of Medical Sciences, Surgery and Neurosciences, Santa Maria alle Scotte University Hospital of Siena, Siena, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Pozza
authors.affiliation: Department of Molecular Medicine, University of Siena School of Medicine, and Department of Mental Health, University of Siena Medical Center (AOUS), Siena, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Fagiolini