Youth Engaging in the 'Choking Game' -- Be on Alert

Robert Glatter, MD


December 12, 2016

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Hi. I am Dr Robert Glatter, an emergency medicine physician with Northwell Health and Lenox Hill Hospital in New York City. I want to talk today about a very dangerous game known as the "choking game."

Youth who engage in the choking game—which is intentionally blocking blood to the brain in search of a rush when the strangulation stops—put themselves at risk for serious injury or death. According to a new research study in the December 2016 issue of Pediatrics,[1] those who participate in the game alone also face significantly high rates of suicidal thoughts. Researchers looked at data from the 2011 and 2013 Oregon Healthy Teens Survey. This survey is conducted every other year in Oregon, which is the only US state that conducts statewide formal surveillance on this topic. Responses from teens who reported engaging in the choking game in group settings were compared with responses from those who participated alone. This game involved pressing on the carotid artery by hand, or with objects such as belts, in order to achieve a euphoric state when the pressure is released and blood flow returns.

Among the nearly 21,000 eighth-grade students in this study, 3.7% participated in the choking game and 18% of them had done so alone. Adjusting for gender and geography, respondents who participated in the choking game alone had nearly five times the odds of having contemplated suicide compared with those who reported participating in a group setting. They were also more likely to report poor mental health.

Authors of this study say that solitary participation may signal underlying distress and be similar to nonsuicidal self-injury, which, in a sense, is a gateway behavior for suicide. They cite previous research showing that nearly a third of pediatricians and family doctors are unaware of the choking game and say this study clearly underscores a need for increased provider awareness and education, prevention messaging, as well as patient referrals for mental health services when warranted. It appears that those who participate in the choking game alone are at higher risk of considering suicide. The authors view it less as a stunt or game and more as an expression of underlying distress and a marker for nonsuicidal injury, which is a gateway behavior for suicide.

It is vital that we educate pediatricians, family doctors, and emergency physicians about the choking game so that they can have a frank discussion with patients and parents about this dangerous act. Targeted messaging of healthcare providers may then lead to prompt referrals to mental health professionals. Parents and teachers need to establish an open line of communication to help prevent children, as well as teens, from attempting this addictive and potentially deadly behavior. As parents and teachers, we owe it to our children to help protect them from this dangerous "game."

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