The
fainting game (also known as the
choking game and a wide variety of local slang names), is a loose term that covers activities designed to induce a partial or complete loss of consciousness brought about by the intentional deprivation of oxygen to the brain for a period of time. There are two distinct methods used to achieve oxygen deprivation:
strangulationStrangling is compression of the neck that may lead to unconsciousness or death by causing an increasingly hypoxic state in the brain. Fatal strangling typically occurs in cases of violence, accidents, and as the mechanism of suicide in hangings...
and self-induced
hypocapniaHypocapnia or hypocapnea also known as hypocarbia, sometimes incorrectly called acapnia, is a state of reduced carbon dioxide in the blood. Hypocapnia usually results from deep or rapid breathing, known as hyperventilation....
.
The term 'game' is used because these activities have typically been pursued by children as recreation; the practice among adults appears to be uncommon and generally in the different context of the pursuit of
erotic asphyxiationErotic asphyxiation refers to intentionally cutting off oxygen to the brain for sexual arousal. It is also called asphyxiophilia, autoerotic asphyxia, or breath control play. Colloquially, a person engaging in the activity is sometimes called a gasper...
. However, experts state that for some teens, the choking game can take on elements of erotic asphyxiation.
Extent of and reasons for its practice
Although the fainting game is believed to be practiced widely, few empirical studies have been done.
No empirical study is known to have been done on the reasons for its attraction but anecdotally stated reasons include:
- During school, to get out of class.
- Peer pressure, a challenge or dare
A dare is a risky challenge one person suggests to another, to try to get the person to prove their courage. It can also mean to confront bravely.Dare may also refer to:Arts & Entertainment* Dare , an album by The Human League...
, a rite of passageA rite of passage is a ritual that marks a change in a person's social status. It is a universal phenomenon which can show anthropologists what social hierarchies, values and beliefs are important in specific cultures. Rites of passage are often ceremonies surrounding events such as childbirth,...
into a social group or amusement over erratic behavior.
- Curiosity in an altered state of consciousness
An altered state of consciousness, , also named altered state of mind is any condition which is significantly different from a normal waking beta wave state. The expression was used as early as 1969 by Charles Tart and describes induced changes in one's mental state, almost always temporary...
, the experience of a brownoutA brownout, or grey-out, is a transient loss of vision characterised by a perceived dimming of light accompanied by a brown hue and a loss of peripheral vision. It is a precursor to fainting or a blackout and is caused by hypoxia, a loss of blood pressure or restriction of blood flow to the brain...
, an imagined approximation to a near death experience.
- A belief that it can induce a brief sense of euphoria
Euphoria is medically recognized as a mental/emotional state defined as a sense of great elation and wellbeing. Technically, euphoria is an affect, but the term is often colloquially used to define emotion as an intense state of transcendent happiness combined with an overwhelming sense of wellbeing...
(a rushing sensation or highAn altered state of consciousness, , also named altered state of mind is any condition which is significantly different from a normal waking beta wave state. The expression was used as early as 1969 by Charles Tart and describes induced changes in one's mental state, almost always temporary...
).
- A belief that it may enhance erotic feelings.
- The prospect of intoxication
Intoxication is the state of being affected by one or more psychoactive drugs. It can also refer to the effects caused by the ingestion of poison or by the overconsumption of normally harmless substances.Some types of intoxication:*A mechanism of disease....
, albeit brief, at no financial cost.
A 2008
Centre for Addiction and Mental HealthThe Centre for Addiction and Mental Health is a consortium of mental health clinics at several sites in Toronto, Ontario, Canada. Its name in French is Centre de Toxicomanie et de Santé Mentale...
study found that at least 79,000 students in the Canadian province of
OntarioOntario is a province located in east-central Canada, the largest by population and second largest, after Quebec, in total area. Ontario is bordered by the Canadian provinces of Manitoba to the west and Quebec to the east, and 5 U.S...
participated in this act. The 2006 Youth Health Risk Behavioral Survey in
Williams CountyWilliams County is a county located in the state of Ohio, United States. As of 2000, the population was 39,188. Its county seat is Bryan and is named for David Williams, one of the captors of John André in the American Revolutionary War.-Geography:...
,
OhioOhio is a Midwestern state of the United States. The thirty-fourth largest state by area in the U.S., it is the seventh-most populous with nearly 11.5 million residents...
found that 11% of youths aged 12–18 years and 19% of youths aged 17–18 reported ever having practiced it.
Mechanisms behind the activity
There are only two mechanisms behind all of the many variations of this practice, both resulting in
Cerebral hypoxiaCerebral hypoxia refers to deprivation of oxygen supply to brain tissue. Mild or moderate cerebral hypoxia is sometimes known as diffuse cerebral hypoxia. It can cause confusion and fainting, but its effects are reversible. Total deprivation of oxygen to the brain is called cerebral anoxia...
(oxygen deprivation to the brain). The two mechanisms tend to be confused with each other or treated as one but are quite dissimilar although both have the potential to cause permanent brain damage or death. The two mechanisms are
strangulation and
self-induced hypocapniaHypocapnia or hypocapnea also known as hypocarbia, sometimes incorrectly called acapnia, is a state of reduced carbon dioxide in the blood. Hypocapnia usually results from deep or rapid breathing, known as hyperventilation....
and work as follows:
Strangulation
A ligature such as a belt or rope around the neck, or hands or arm pressure on the neck compresses the
internal carotid arteryIn human anatomy, the internal carotid artery is a major artery of the head and neck that helps supply blood to the brain.-Classification:Terminologia Anatomica currently breaks the artery into four parts: "cervical", "petrous", "cavernous", and "cerebral"...
. Apart from the direct restriction of blood to the brain there are two other significant responses produced by pressing on the neck:
- Pressing on the carotid arteries also presses on baroreceptors. These bodies then cause vasodilation
Vasodilation refers to the widening of blood vessels resulting from relaxation of smooth muscle cells within the vessel walls, particularly in the large arteries, smaller arterioles and large veins. The process is essentially the opposite of vasoconstriction, or the narrowing of blood vessels. When...
(dilation (widening) of the blood vessels) in the brain leading to insufficient blood to perfuse the brain with oxygen and maintain consciousness.
- A message is also sent via the vagus nerve
The vagus nerve , also called pneumogastric nerve or cranial nerve X, is the tenth of twelve paired cranial nerves, and is the only nerve that starts in the brainstem...
to the main pacemakerThe contractions of the heart are controlled by chemical impulses. The rate these impulses fire controls the heart rate.The cells that create these rhythmical impulses are called pacemaker cells, and they directly control the heart rate...
of the heartThe heart is a muscular organ found in all vertebrates that is responsible for pumping blood throughout the blood vessels by repeated, rhythmic contractions...
to decrease the rate and volume of the heartbeat, typically by up to a third. In some cases there is evidence that this may escalate into asystoleIn medicine, asystole is a state of no cardiac electrical activity, hence no contractions of the myocardium and no cardiac output or blood flow...
, a form of cardiac arrestA cardiac arrest, also known as cardiopulmonary arrest or circulatory arrest, is the abrupt cessation of normal circulation of the blood due to failure of the heart to contract effectively during systole....
that is difficult to treat. There is a dissenting view on the full extent how and when a person reaches a stage of permanent injury, but it is agreed that pressure on the vagus nerve causes changes to pulse rate and blood pressure and is dangerous in cases of carotid sinus hypersensitivity.
This method is responsible for most, but not all, of the reported fatalities. The method is especially dangerous when practiced alone and can be mistaken for suicide where the motivation is not known.
Self-induced hypocapnia
The second mechanism requires
hyperventilationIn medicine, hyperventilation is the state of breathing faster and/or deeper than necessary, bringing about lightheadedness and other undesirable symptoms often associated with panic attacks...
(forced overbreathing) until symptoms of
hypocapniaHypocapnia or hypocapnea also known as hypocarbia, sometimes incorrectly called acapnia, is a state of reduced carbon dioxide in the blood. Hypocapnia usually results from deep or rapid breathing, known as hyperventilation....
such as tingling, light-headedness or dizziness are felt, followed by a breath-hold. This alone is enough to cause a blackout but it is widely believed that the effect is enhanced if lung air pressure is increased by holding the breath "hard", that is forcing exhalation while allowing no air to escape or by a bear-hug by an assistant. These later actions may augment the effects of hypoxia by approximating the
Valsalva maneuverThe Valsalva maneuver or Valsalva manoeuvre is performed by forcible exhalation against a closed airway, usually done by closing one's mouth and pinching one's nose shut...
, causing vagal stimulation.
The fact that hyperventilation causes rapid
cerebral hypoxiaCerebral hypoxia refers to deprivation of oxygen supply to brain tissue. Mild or moderate cerebral hypoxia is sometimes known as diffuse cerebral hypoxia. It can cause confusion and fainting, but its effects are reversible. Total deprivation of oxygen to the brain is called cerebral anoxia...
is paradoxical because the body should be well stocked with oxygen after over-breathing. The mechanism here is that the blood is made abnormally alkaline as a result of the excessive elimination of
CO2Carbon dioxide is a chemical compound composed of two oxygen atoms covalently bonded to a single carbon atom. It is a gas at standard temperature and pressure and exists in Earth's atmosphere in this state...
; this subsequent rise in blood
pHpH is a measure of the acidity or basicity of a solution. It is defined as the cologarithm of the activity of dissolved hydrogen ions . Hydrogen ion activity coefficients cannot be measured experimentally, so they are based on theoretical calculations...
is termed
alkalosisAlkalosis refers to a condition reducing hydrogen ion concentration of arterial blood plasma . Generally alkalosis is said to occur when pH of the blood exceeds 7.45...
.
The symptoms of alkalosis are: neuromuscular irritability, muscular spasms, tingling and numbness of the extremities and around the mouth, and a dizziness, or giddiness, often interpreted as a sense of
euphoriaEuphoria is medically recognized as a mental/emotional state defined as a sense of great elation and wellbeing. Technically, euphoria is an affect, but the term is often colloquially used to define emotion as an intense state of transcendent happiness combined with an overwhelming sense of wellbeing...
. This brief euphoria is what practitioners of the fainting game seek.
Unfortunately alkalosis has other far-reaching and dangerous effects on the neuromuscular system and, among other things, interferes with normal oxygen utilization by the brain. In the body alkalosis generally induces vasodilatation (widening of the blood vessels) but in the brain alone it causes
vasoconstrictionVasoconstriction is the narrowing of the blood vessels resulting from contraction of the muscular wall of the vessels, particularly the large arteries, small arterioles and veins. The process is the opposite of vasodilation, the widening of blood vessels. The process is particularly important in...
(narrowing of the blood vessels). This vasoconstriction appears to be made even worse by a sudden increase in blood pressure caused by squeezing or holding the breath ‘hard’. The alkalosis induced euphoria can be followed rapidly by hypoxia-induced unconsciousness.
The sequence of events leading to unconsciousness from hyperventilation is as follows:
- Decrease in partial pressure
In a mixture of ideal gases, each gas has a partial pressure which is the pressure which the gas would have if it alone occupied the volume. The total pressure of a gas mixture is the sum of the partial pressures of each individual gas in the mixture....
of alveolarAn alveolus is an anatomical structure that has the form of a hollow cavity. Found in the lung, the pulmonary alveoli are spherical outcroppings of the respiratory bronchioles and are the primary sites of gas exchange with the blood. Alveoli are particular to mammalian lungs...
CO2.
- Decrease in partial pressure of arterial CO2.
- Increase in blood pH, (respiratory alkalosis).
- Vasoconstriction of blood vessels supplying brain.
- Pooling of the blood present in the brain at the time.
- Brain rapidly uses up O2 available in the pooled blood.
- O2 concentration in the brain drops.
- Unconsciousness from hypoxia of cerebral tissue.
Because the brain cannot store reserves of O
2 and, unlike other organs, has an exceedingly low tolerance of O
2 deprivation, it is highly vulnerable if vasoconstriction is not reversed. Normally, if the brain is hypoxic, autonomous systems in the body divert blood to the brain at the expense of other organs; because the brain is vasoconstricted this mechanism is not available. Vasoconstriction is only reversed by the build-up of CO
2 in the blood through suspension of breathing. If this build-up does not happen quickly enough, or if the vasodilation mechanism itself is slow to respond, irreversible brain damage or death becomes a possibility.
In some versions the bear-hug is replaced by pressure on the neck in which case blackout is a hybrid of strangulation and self-induced hypocapnia.
Other mechanisms
Unconsciousness may be induced by other methods although these are controversial: Pressure over the
carotid sinusIn human anatomy, the carotid sinus is a localized dilation of the internal carotid artery at its origin, the common carotid artery bifurcation. A synonym for the carotid sinus is the carotid bulb.-Functions:...
may induce a syncope (fainting) without any other action at all but this is difficult to reproduce and is not the basis of the game. For those susceptible to carotid sinus syncope, of which most people would be unaware until it occurred, this can be an exceedingly dangerous game.
In both
strangulation and
self-induced hypocapnia blackouts the victim may experience dreaming or hallucinations, though fleetingly, and regains consciousness with short-term memory loss and involuntary movement of their hands or feet much to the amusement of the onlookers. Full recovery is usually made within seconds but these activities cause many deaths and permanent brain injuries every year, particularly when played alone or with a ligature. Permanent brain damage may be subtle and not immediately or eventually obvious to either the participants or its observers. Often, it is impossible to be sure if someone has sustained brain damage or not.
Injuries arising from the practice
Any activity that deprives the brain of oxygen has the potential to cause moderate to severe brain cell death leading to permanent loss of neurological function ranging from difficulty in concentration or loss of short term memory capacity through severe, lifelong mental disability to death.
Statistics on fatalities and neurological damage are controversial, no definitive, empirical study exists although the indications are that the practice is a significant contributor to death and disability, particularly among male
juvenilesIn law, the term minor is used to refer to a person who is under the age in which one legally assumes adulthood and is legally granted rights afforded to adults in society. Depending on the jurisdiction and application, this age may vary, but is usually marked at either 18, 20, or 21...
in most developed countries. Many believe that deaths are significantly undereported because of false attributions to suicide.
One study by the U.S.
Centers for Disease Control and PreventionThe Centers for Disease Control and Prevention is a United States federal agency under the Department of Health and Human Services based in Atlanta, Georgia. It works to protect public health and safety by providing information to enhance health decisions, and it promotes health through...
(CDC) found sufficient evidence to indicate that since 1995 at least 82 youths between the age of 6 and 19 have died in the United States as a result of the game, see chart on the right. Of these 86.6% were male, the mean age being 13.3. 95.7% of these deaths occurred while the youth was alone; parents of the decedents were unaware of the game in 92.9% of cases. Deaths were recorded in 31 states and were not clustered by location, season or day of week. Neurological damage is harder to attribute accurately because of the difficulty of linking generalised, acquired neurological disability to a specific past event.
Incidental, or indirect, injuries may arise from falling or uncontrolled movements and crushing by a ligature or an assistant. Such injuries may include concussion, bone
fractureA fracture is the separation of an object or material into two, or more, pieces under the action of stress.The word fracture is often applied to bones of living creatures, or to crystals or crystalline materials, such as gemstones or metal. Sometimes, in crystalline materials, individual crystals...
s, tongue biting and hemorrhaging of the eye.
The CDC encourages parents, educators and health-care providers to familiarize themselves with the signs of the game. These include: discussion of the game; bloodshot eyes; marks on the neck; severe headaches; disorientation after spending time alone; ropes, scarves, and belts tied to bedroom furniture or doorknobs or found knotted on the floor; and unexplained presence of things like dog leashes, choke collars and bungee cords.
See also
- Erotic asphyxiation
Erotic asphyxiation refers to intentionally cutting off oxygen to the brain for sexual arousal. It is also called asphyxiophilia, autoerotic asphyxia, or breath control play. Colloquially, a person engaging in the activity is sometimes called a gasper...
- Shallow water blackout - for further discussion on the hyperventilation mechanism
External links