Harvard Mental Health Letter

Ask the doctor: What is the choking game?

Q. I was half listening to the television the other night and heard something about kids dying from the choking game. What is that? How can I tell if my child might be playing this game?

A. As you've surmised, the choking game is a misnomer for an activity that can be deadly. The phrase refers to the practice of self-strangulation or strangulation of one person by another in order to produce a feeling of euphoria. Although "choking game" is probably the most common nickname for this practice, it goes by many others — the blackout game, scarf game, pass-out game, tap out, elevator, flatliner, and space monkey, to name a few. The choking game differs from autoerotic asphyxiation (choking oneself during sexual stimulation).

During the choking game, youths typically tie a belt, scarf, or rope around their necks until they feel light-headed. In other cases, one youth will choke another to the point of fainting. By placing pressure on the neck and airway, the youths are reducing oxygen to the brain (resulting in a state called cerebral hypoxia), which causes light-headedness. Youths learn the techniques by watching peers do it, often at parties, but sometimes also by watching videos posted online.

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