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This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract DSM-5 distinguishes between paraphilias and paraphilic disorders. Paraphilias are defined as atypical, yet not necessarily disordered, sexual practices. Paraphilic disorders are instead diseases, which include distress, impairment in functioning, or entail risk of harm one's self or others. Hence, DSM-5 new approach to paraphilias demedicalizes and destigmatizes unusual sexual behaviors, provided they are not distressing or detrimental to self or others. Asphyxiophilia, a dangerous and potentially deadly form of sexual masochism involving sexual arousal by oxygen deprivation, are clearly described as disorders.
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Pacific Center for Sex and Society - Asphyxiophilia and autoerotic death

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The mean age at death was 37 years, the oldest individual being Only 1 teenager, age 15, was reported. Safety devices, both simple and elaborate, were often present to prevent death. In 2 of our cases, there was a device that could be used to loosen the ligature, and in 3 cases, simply standing or adjusting the body position would loosen the ligature.
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