Accidental strangulation resulted from hypoxyphilia associated with multiple paraphilias and substance abuse: a psychological autopsy case report

We report a case of a 34-year-old male who was found hanged by his neck in his own apartment. The deceased was dressed in women’s nylon panties, bra, nylon pantyhose, and a wig. The immediate cause of his death was found to be asphyxia due to hanging but the manner of his death was initially considered to be equivocal. The psychological autopsy based on the structured interview with the deceased’s parents, sexual partner, and closed friends using Beck’s Suicide Intent Scale (SIS), Paykel’s Interview for Recent Life Events (IRLE), Duke Social Support Index (DSSI), the Structured Clinical Interview for DSM-IV-TR (SCID-I), Hamilton Depression Rating Scale (HAM-D), and our structured suicide information questionnaire based on the pamphlet “Suicide Prevention and Psychological Autopsy” (Department of U.S. Army) and some published articles was performed and the data were analyzed. The interviews with the informants showed that the deceased was single; was engaged in homosexual behavior; was well educated with a university degree; was employed; has not been diagnosed with any chronic illnesses; never had suicidal attempts in the past; didn’t have any history of alcohol and drug abuse; wasn’t recently emotionally upset; didn’t have any chronic and recent interpersonal problems with his family, sexual partner, and friends; had plans for the future. The deceased has not being diagnosed with any psychiatric illnesses during his life. But the scrupulous crime scene investigation was indicative that diseased was meeting the DSM-IV-TR diagnostic criteria for substance abuse, multiple paraphilias involving sexual masochism (hypoxyphilia), transvestic fetishism, and agalmatophilia (a paraphilia that involves being sexually attracted to a doll, statue or mannequin). Integration of the psychological autopsy data with the crime scene findings allowed identification of this event as an accidental death (autoerotic asphyxia).