Choking Game
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The choking game, also known by a large number of other names (see the end of article), is not technically a game but a schoolyard activity involving the production of unconsciousness or near unconsciousness by restriction of the supply of oxygen to the brain. According to demographics, the practice of this highly dangerous activity is strongly weighted towards juvenile males but includes females and adults of both genders. The activity has been responsible for a large number of juvenile deaths and permanent neurological disabilities almost entirely among the juvenile male cohort. There are estimates that as many as 250 to 1,000 young people die in the United States each year playing some variant of the choking game. Tracking the exact number is difficult because many of the cases are reported as suicides. [1]
The attractions are manifold: it is done as a dare, it can induce a brief sense of euphoria, it is reported to enhance erotic feelings, it may be amusing to some to watch others losing consciousness or behaving erratically, the prospect of an altered state of consciousness, the experience of a brownout or, more recently, copycatting elements of the film Flatliners. It is also free, legal and appears innocuous to those without a proper understanding of the mechanism involved in cerebral hypoxia and cerebral anoxia.
How the choking game works
There are actually two distinct methods involved. Both result in unconsciousness by depriving the brain of oxygen but the mechanisms are very different. The two tend to get confused or treated as one. The two mechanisms are strangulation and self-induced hypocapnia and work as follows:
Strangulation
Blood flow to the brain is restricted by compressing the carotid artery in the neck. This is achieved either by pressing the thumbs against the arteries on both sides of the neck simultaneously or the use of a ligature. Apart from the direct restriction of blood to the brain there are two other significant physiological responses to pressing on the neck:
- Pressing on the carotid arteries also presses on baroreceptors known as the carotid sinus bodies. These bodies then cause vasodilation (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 to the main pacemaker of the heart to decrease the rate and volume of the heartbeat, typically by up to a third. [2] In some cases there is evidence that this may escalate into asystole, a form of cardiac arrest that is difficult to treat. The vulnerability of the victim and speed of onset is unpredictable and not properly understood. There is a dissenting view on the full extent of this 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.
The use of thumbs on the neck can be self-induced and usually stops automatically on blackout. Where an assistant applies hand pressure, and in all cases where a ligature is used, stopping at the right moment before permanent damage occurs becomes a judgment on the part of the operator or just good luck. Self-strangulation through the use of a ligature is the most common cause of death or brain damage although many schoolchildren have accidentally killed or caused permanent brain damage to their friends by all methods. It is believed that many deaths attributed to suicide by adolescents are actually solo self-asphyxiations and death was an unintended outcome. [3]
Self-induced hypocapnia
This involves no compression of the neck but requires hyperventilation for a minute, or until symptoms of hypocapnia such as tingling, light-headedness or dizziness are felt, followed by a breath-hold. The effect is greatly enhanced if lung air pressure is increased by holding the breath "hard", that is forcing exhalation while allowing no air to escape. This alone is enough to cause a blackout but usually tradition requires one of a number of other actions such as a bear hug given from behind or pressure applied by another person under or over the heart, usually with the head of another participant. The fact that hyperventilation causes rapid cerebral hypoxia is paradoxical because the body should be well stocked with oxygen after overbreathing. The mechanism here is that the blood is made abnormally alkaline as a result of the excessive elimination of the carbon dioxide (CO2) that keeps it acidic; this rise in blood pH is termed alkalosis. 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 euphoria. This brief euphoria is what practitioners of the fainting game seek. Unfortunately alkalosis has other far reaching and very complex effects on the neuromuscular system and among other things it interferes with normal oxygen utilization by the brain. In the body alkalosis generally induces vasodilatation but in the brain alone it causes vasoconstriction. This vasoconstriction appears to be exacerbated 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 of Pulmonary alveolus 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 maintains no reserves of O2 and, unlike other organs, has an exceedingly low tolerance of O2 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 CO2 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.
This mechanism is too complex to be dealt with adequately within this article; for a good treatment of the paradoxical relationship between hyperventilation and hypoxia see USAF Respiratory Physiology.
In some traditional 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: Pressure over the carotid sinus 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 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 invalidities every year, particularly when played alone or with a ligature. Permanent brain damage may not be immediately apparent.
Other names
The practice goes by many other names in different parts of the world or simultaneously in a single location. The names are usually one of several types: ones that assign drug-like qualities to the game, ones that describe the effects, ones that emphasize the risks involved, and others that come from pop-culture references. Common names in the United Kingdom, Australia and North America include:
Airplaning, America Dream Game, Black Out Game, Breath Play, Breathing the Zoo, Bum Rushing, California Blackout, California Choke, California Dreaming, California Headrush, California High, California Knockout, Choking Out, Cloud Nine, Crank, Dream Game, Dreaming Game, Dying game, The Fainting Game, Fall Out Game, Flat Liner, Flatline Game, Flatliner Game, Funky Chicken, Getting Passed Out, Grandma's Boy, Halloween, High Riser, Hoola Hooping, Hyperventilation Game, Indian Headrush, Knockout Game, Passing Out Game, Pass-out Game, Purple Dragon, Natural High, Redline, Rising Sun, Rocket Ride, Sandboxing, Sleeper Hold, Space Monkey, Speed Dreaming, Suffocation Game, Suffocation Roulette, Teen Choking Game, Tingling Game, Trip to Heaven, Wall-Hit
See also
External links
- www.ChokingGame.net Accurate, reliable Choking Game information and statistics
- Choking Game Education
- DB Foundation - Education of Dangerous Adolescent Behaviors
- Deadly Games Children Play
- Open forum for Q&A about the Choking Game
- KidsBeSafeOnline
- USAF Respiratory Physiology an excellent treatment of hypoxia and triggers to respiration
- Breath Control Play
- carotid sinus hypersensitivity
- Association de Parents d'Enfants Accidenté s par Strangulation (in English)
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