Sexual Masochism Disorder with Asphyxiophilia:A Deadly yet Underrecognized Disease

DSM-5 distinguishes between paraphilias and paraphilic disorders. Paraphilias are defined as atypical, yet not necessarilydisordered, sexual practices. Paraphilic disorders are instead diseases, which include distress, impairment in functioning, or entailrisk of harm one’s self or others. Hence, DSM-5 new approach to paraphilias demedicalizes and destigmatizes unusual sexualbehaviors, provided they are not distressing or detrimental to self or others. Asphyxiophilia, a dangerous and potentially deadlyform of sexual masochism involving sexual arousal by oxygen deprivation, are clearly described as disorders. Although autoeroticasphyxia 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 becauseit often can be confounded with suicide cases, particularly in the Italian context where family members of the victim often try todisguise autoerotic behaviors of the victims. The current paper provides a review on sexual masochism disorder with asphyxiophiliaand discusses one specific case as an example to examine those conditions that may or may not influence the likelihood that deathfrom autoerotic asphyxia be erroneously reported as suicide or accidental injury