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The Choking Game

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Some medical examiners and doctors are looking at the increase in teenage suicide rates from suffocation over the last decade and questioning whether some might in fact have been accidental, the result of a choking game experience gone wrong. In the game, teens (and sometimes children) use a strap of some kind wrapped around their necks to temporarily cut blood flow to the head. One variation of the game involves holding your breath and getting punched in the chest until you black out. Yet another version involves bending over and trying to induce hyperventilation by taking deep breaths followed by someone giving them a “bear hug”. Regardless of the method, the goal is always the same – cut off your oxygen until you pass out.

It is estimated that as many as 20% of teens and preteens play the game. Sometimes it is played in groups. It is believed that nearly all of the deaths were youths who played the game alone. Males were much more likely to die from the choking game than females.

Asphyxiation produces an adrenaline rush and sensation of being high. It is often described as a “tingly” or “floating” feeling. A second high is produced when the pressure is released and oxygen rushes back to the brain.

There are two mechanisms behind this practice. Both result in cerebral oxygen deprivation to the brain. The two mechanisms are strangulation and self-induced hypocapnia.

Strangulation occurs when pressure on or around the neck compresses the internal carotid artery. This method is responsible for most of the reported fatalities. The method is especially dangerous when practiced alone and is often mistaken for suicide.

Self-induced hypocapnia requires hyperventilation until symptoms like tingling, light-headedness, or dizziness are felt. This is followed by a breath hold. This alone is enough for the desired effect, but the effect is often enhanced if a bear-hug is given. Sometimes the bear-hug is replaced by pressure on the neck. This causes a sort of hybrid of strangulation and self-induced hypocapnia.

Injuries may result from the game include brain damage and heart attacks. Three minutes without oxygen is all takes to do irreversible damage. Problems can be minor, like a flushed face, headaches, bloodshot eyes, loss of concentration, slurred speech, agitation, and aggression. They can also be major health problems – neuron-muscular problems, memory problems, coma, concussion, fractures, as well as permanent neurological disabilities such as seizures. Any activity that deprives the brain of oxygen has the potential to cause moderate to serious brain cell death leading to permanent loss of neurological function.

Many of the teens who have died from the choking game were described as bright, students who apparently were intrigued by a method of getting high that doesn’t involve drugs or alcohol.

The game has actually been around for years in one form or another, but it appears to be spreading. One theory is that the internet has made it easier to learn about the game. A search of YouTube turned up several videos of people playing the game and demonstrations on how to play.

The choking game should not be confused with autoerotic asphyxiation. This is self-strangulation during masturbation and is mainly done by teenage boys and men.

The choking game is known by numerous other names:

  • Pass-out game
  • Space monkey
  • Suffocation roulette
  • Fainting game
  • Purple hazing
  • Blacking out/blackout
  • Dream game
  • Flat liner
  • Space cowboy
  • Cloud nine

Whatever you call it, there are a few warning signs that someone you know may be playing the choking game:

  • Discussion of the game or its aliases
  • Bloodshot eyes
  • Marks on the neck
  • Wearing high-necked shirts, even in warm weather
  • Frequent, severe headaches
  • Disorientation after spending time alone
  • Increased and uncharacteristic irritability or hostility
  • Ropes, scarves, and belts tied to bedroom furniture or doorknobs or found knotted on the floor
  • The unexplained presence of dog leashes, choke collars, bungee cords, etc.
  • Petechiae (pinpoint bleeding spots) under the skin of the face, eyelids, or the conjunctiva (the lining of the eyelids and eyes)

Many coroners and medical examiners label choking game deaths as suicides because they don’t have the time or resources to look for alternate explanations. Choking game fatalities are not nearly as common as suicide deaths. About 5,000 suicide deaths were reported from 1995 through 2007. It is possible that some of them were unrecognized choking game deaths, most were believed to be actual suicides.


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