Archives of Sexual Behavior

, Volume 42, Issue 5, pp 895–900 | Cite as

Shibari: Double Hanging During Consensual Sexual Asphyxia

  • Paolo Roma
  • Floriana Pazzelli
  • Maurizio Pompili
  • Paolo Girardi
  • Stefano Ferracuti
Clinical Case Report Series


We describe a case of shibari, a double hanging sexual asphyxia practice, which ended fatally for one of the two women involved. We present the autopsy findings and a psychiatric and psychometric evaluation of the surviving participant. The survivor had a borderline personality disorder, had suffered sexual abuse as a child, and had a history of illicit substance consumption, self-harm behavior, and sexual dysregulation. This case study raises doubts regarding the safety measures adopted by participants in masochistic practices and the engagement of people with psychiatric disorders in these extremely dangerous games. Further case studies of living participants in such games are likely to shed light on this practice and facilitate treatment.


Sadomasochism Autoerotic asphyxia Forensic psychology Paraphilias Shibari 


  1. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.Google Scholar
  2. Behrendt, N., Buhl, N., & Seidl, S. (2002). The lethal paraphiliac syndrome: Accidental autoerotic deaths in four women and a review of the literature. International Journal of Legal Medicine, 116, 148–152.PubMedCrossRefGoogle Scholar
  3. Beitchman, J. H., Zucker, K. J., Hood, J. E., daCosta, G. A., & Akman, D. (1991). A review of the short-term effects of child sexual abuse. Child Abuse and Neglect, 15, 537–556.PubMedCrossRefGoogle Scholar
  4. Butcher, J. N., Dahlstrom, W. G., Graham, J. R., Tellegen, A., & Kaemmer, B. (1989). The Minnesota Multiphasic Personality Inventory-2 (MMPI-2): Manual for administration and scoring. Minneapolis: University of Minnesota Press.Google Scholar
  5. Byard, R. W., Hucker, S. J., & Hazelwood, R. R. (1993). Fatal and near-fatal autoerotic asphyxial episodes in women: Characteristic features based on a review of nine cases. American Journal of Forensic Medicine and Pathology, 14, 70–73.PubMedCrossRefGoogle Scholar
  6. Cloninger, C. R., & Svrakic, D. R. (2000). Personality disorders. In B. J. Sadock & V. A. Sadock (Eds.), Kaplan and Sadock’s comprehensive textbook of psychiatry (Vol. 2, 8th ed., pp. 2063–2104). Philadelphia: Lippincott Williams and Wilkins.Google Scholar
  7. First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (1997a). Structured clinical interview for DSM-IV Axis I disorders-clinical version (SCID-CV). Washington, DC: American Psychiatric Press.Google Scholar
  8. First, M. B., Spitzer, R. L., Gibbon, M., Williams, J. B. W., & Benjamin, L. S. (1997b). Structured clinical interview for DSM-IV Axis II personality disorders (SCID II). Washington, DC: American Psychiatric Press.Google Scholar
  9. Gosink, P. D., & Jumbelic, M. I. (2000). Autoerotic asphyxiation in a female. American Journal of Forensic Medical Pathology, 21, 114–118Google Scholar
  10. Katerndahl, D., Burge, S., & Kellogg, N. (2005). Predictors of development of adult psychopathology in female victims of childhood sexual abuse. Journal of Nervous and Mental Disease, 193, 258–264.PubMedCrossRefGoogle Scholar
  11. Levy, K. N., Meehan, K. B., Weber, M., Reynoso, J., & Clarkin, J. F. (2005). Attachment and borderline personality disorder: Implications for psychotherapy. Psychopathology, 38, 64–74.PubMedCrossRefGoogle Scholar
  12. McLean, L. M., & Gallop, R. (2003). Implications of childhood sexual abuse for adult borderline personality disorder and complex posttraumatic stress disorder. American Journal of Psychiatry, 160, 369–371.PubMedCrossRefGoogle Scholar
  13. Millon, T. (1994). The Millon Clinical Multiaxial Inventory-III Manual. Minneapolis, MN: National Computer Systems.Google Scholar
  14. Neeleman, A. J. (2007). Seksualiteit als thema in de behandeling van mensen met een borderlinepersoonlijkheidsstoornis [The relevance of sexuality in the treatment of borderline personality disorder]. Tijdschrift Voor Psychiatrie, 49, 233–240.PubMedGoogle Scholar
  15. Oddone Paolucci, E., Genuis, M. L., & Violato, C. (2001). A meta-analysis of the published research on the effects of child sexual abuse. Journal of Psychology, 135, 17–36.CrossRefGoogle Scholar
  16. Ogata, S., Silk, K., Goodrich, S., Lohr, N., Westen, D., & Hill, E. (1990). Childhood sexual and physical abuse in adult patients with borderline personality disorder. American Journal of Psychiatry, 147, 1008–1013.PubMedGoogle Scholar
  17. Oklota, M., Niemcunowicz-Janica, A., Sackiewicz, A., Ptaszynska-Sarosiek, I., & Szeremeta, M. (2010). Deaths during asphyxia induced to escalate sexual experience. Case reports. Archiwum Medycyny Sądowej i Kryminologii, 60, 275–280.Google Scholar
  18. Quinn, J., & Twomey, P. (1998). A case of auto-erotic asphyxia in a long-term psychiatric setting. Psychopathology, 31, 169–173.PubMedCrossRefGoogle Scholar
  19. Raven, J. C. (1938). Standard progressive matrices: Sets A, B, C, D and E. London: H.K. Lewis.Google Scholar
  20. Richters, J., De Visser, R., Rissel, C. E., Grulich, A. E., & Smith, A. M. A. (2008). Demographic and psychosocial features of participants in bondage and discipline, “sadomasochism” or dominance and submission (BDSM): Data from a national survey. Journal of Sexual Medicine, 5, 1660–1668.PubMedCrossRefGoogle Scholar
  21. Sansone, R. A., Gaither, G. A., & Songer, D. A. (2002). The relationships among childhood abuse, borderline personality, and self-harm behavior in psychiatric inpatients. Violence and Victims, 17, 49–55.PubMedCrossRefGoogle Scholar
  22. Sauvageau, A., & Racette, S. (2006). Autoerotic deaths in the literature from 1954 to 2004: A review. Journal of Forensic Sciences, 51, 140–146.PubMedCrossRefGoogle Scholar
  23. Soloff, P., Lynch, K., & Kelly, T. (2002). Childhood abuse as a risk factor for suicidal behavior in borderline personality disorder. Journal of Personality Disorders, 16, 201–214.PubMedCrossRefGoogle Scholar
  24. Trull, T. (2001). Structural relations between borderline personality disorder features and putative etiological correlates. Journal of Abnormal Psychology, 110, 471–481.PubMedCrossRefGoogle Scholar
  25. Weaver, T., & Clum, G. (1993). Early family environments and traumatic experiences associated with borderline personality disorder. Journal of Consulting and Clinical Psychology, 61, 1068–1075.PubMedCrossRefGoogle Scholar
  26. Wechsler, D. (1981). Manual for the Wechsler Adult Intelligence Scale—Revised. New York: The Psychological Corporation.Google Scholar
  27. World Health Organization. (1992). International classification of diseases and health related problems (10th rev.). Geneva: Author.Google Scholar
  28. Yen, S., Shea, M. T., Battle, C. L., Johnson, D. M., Zlotnick, C., Dolan-Sewell, R., et al. (2002). Traumatic exposure and posttraumatic stress disorder in borderline, schizotypal, avoidant, and obsessive-compulsive personality disorders: Findings from the Collaborative Longitudinal Personality Disorders Study. Journal of Nervous and Mental Disease, 190, 510–518.PubMedCrossRefGoogle Scholar
  29. Zanarini, M. C., Frankenburg, F. R., Reich, D. B., Hennen, J., & Silk, K. R. (2005). Adult experiences of abuse reported by borderline patients and Axis II comparison subjects over six years of prospective follow-up. Journal of Nervous and Mental Disease, 193, 412–416.PubMedCrossRefGoogle Scholar
  30. Zanarini, M. C., Yong, L., Frankenburg, F. R., Hennen, J., Reich, D. B., Marino, M. F., et al. (2002). Severity of reported childhood sexual abuse and its relationship to severity of borderline psychopathology and psychosocial impairment among borderline inpatients. Journal of Nervous and Mental Disease, 190, 381–387.PubMedCrossRefGoogle Scholar
  31. Zubenko, G. S., George, A. W., Soloff, P. H., & Schulz, P. (1987). Sexual practices among patients with borderline personality disorder. American Journal of Psychiatry, 144, 748–752.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Paolo Roma
    • 1
  • Floriana Pazzelli
    • 2
  • Maurizio Pompili
    • 1
  • Paolo Girardi
    • 1
  • Stefano Ferracuti
    • 1
  1. 1.NESMOS Department (Neurosciences Mental Health and Sensory Organs) “Sapienza”, Faculty of Medicine and PsychologyUniversity of RomeRomeItaly
  2. 2.RomeItaly

Personalised recommendations