Introduction: DSM-5 mentions autoerotic asphyxia in the paraphilic disorders section, as a specifier for the diagnostic of sexual masochism disorder. Strangulation activities have also been observed in the “choking game”. The term “strangulation activity” is considered as more appropriate than “choking game”. While sharing a same behavior, autoerotic asphyxia and non auto-erotic strangulation activities might represent a very distinct pattern of disorders. We describe here a case report of a 25-year old male internship student who has practiced manual self-strangulation up to 40 times a day since adolescence. In the examination of this case we identify individual clinical aspects of this case in a process-based holistic case conceptualization.
Case description: The patient is a 25 years old male with a post-graduate degree who presented with a recent history of poor work performance and work-related stress during an internship. He has a concomitant history of both ketamine and cannabis use disorders, and reports urges to self-strangulate, sometimes specifically avoiding contact with friends engage in this behavior and that he has never attempted to discontinue self-strangulation. Neuropsychological assessment found a cognitive functioning below that expected given his educational level. Our intervention consists of a 3-weeks cognitive and motivational therapy program in addiction unit with associated abstinence.
Conclusion: Autoerotic asphyxia is a behavior observed not only in the context of sexual masochism disorder, but also as a specific addictive behavior, in the absence of sexual arousal, possibly as a result of emotional dysregulation.
Sexual addiction is a growing reality. The acknowledgment of this disorder requires to identify vulnerability factors. Besides, it would improve the management and treatment of these people. We used a cross-sectional study with a sample of voluntary subjects recruited online anonymously. A prepared questionnaire explored the general and clinical data of the sample. The psychometric scales used were: Carnes Sexual Addiction Screening Test, the French Big Five Inventory for personality dimensions and the Rosenberg Scale for self-esteem. Five hundred and ten individuals were included. 38 people (8%) had sexual addiction. 68 people (13%) had attenuated symptoms of sexual addiction. The average age of the group with sexual addiction was 30.8 years with a male predominance. The majority had a higher academic level, was single (39.5%) and are working (73.7%). Our study revealed that self-esteem was below average in 73.7% of people with sexual addiction. Concerning personality dimensions, individuals with sexual addiction had higher scores in Neuroticism. The analytic study showed that four variables were statistically correlated with sexual addiction: male sex; low self-esteem; a large N dimension and a low C and E dimension. The concept of sexual addiction, still poorly defined, is beginning to be recognized. The need for more research is required to identify the factors of vulnerability with the aim of developing the preventive axis and improving the quality of life.
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