Choking game
The choking game, also known by various names such as the "pass-out challenge" or "blackout game," is a dangerous activity primarily engaged in by children, teenagers, and young adults. Participants intentionally restrict oxygen flow to the brain, seeking a brief euphoric state or "high" that occurs when they faint or nearly lose consciousness. This activity can be played alone or with others, often using items like belts or scarves to apply pressure to the neck.
Despite the perceived excitement, the choking game carries severe risks, including seizures, brain damage, and even death. Many participants mistakenly believe it is a safe alternative to drug use, partly due to misleading instructional content available online. Symptoms of participation can include unexplained bruises, bloodshot eyes, and frequent headaches, making it crucial for parents and caregivers to be informed about the signs and dangers.
Education and open discussions about the choking game are vital for prevention, as many young people may not realize the life-threatening nature of this activity. Awareness among healthcare professionals is also critical to ensure early detection and intervention. Despite ongoing efforts, the choking game and its variants continue to threaten youth safety, particularly on social media platforms.
Choking game
ALSO KNOWN AS: Airplaning; American dream; black out game; breath play; California high; choke out; cloud nine; fainting; fainting game; flatline; flatliner; gasp; ghost; hanging; Hawaiian high; knock out; natural high; pass out game; purple dragon; rising sun; space cowboy; space monkey; suffocation roulette; pass-out challenge; blackout challenge
DEFINITION: The choking game is an activity in which, most frequently, children, teenagers, and young adults use strangulation to reduce the flow of oxygen to the brain. This reduction in oxygen flow leads to a temporary state of euphoria, or a “high.” There are two ways to play the choking game. The first is to apply pressure to the neck using the hands or a ligature, such as a belt, necktie, scarf, or other device, until the person faints or nearly passes out. The second is for one person to take a deep breath and hold it while another grips them in a “bear hug” from behind until the first person passes out. The choking game is most commonly “played” by two people, but it can also be played alone.
Causes
There is no known reason why some people participate in the choking game while others do not. Many adolescents mistakenly believe that the game is a safe way to get high because it does not involve drugs or alcohol.
The Internet may also give children a false sense of security about the game. One can find numerous instructional videos online that teach how to participate in the choking game, but these videos most often do not include information about the activity’s dangers.
In March 2018, Melissa Chan, writing for Time.com, reported finding more than 36 million YouTube videos related to the pass-out game and about 500,000 videos associated with playing the choking game. The videos included media reports as well as instructions on how to play such games. In December 2017, YouTube stated that it would hire more staff to review videos for content that violates its guidelines regarding content that endangers children. Such content includes videos of “content that's intended to encourage dangerous activities that have an inherent risk of physical harm,” such as the choking game. That month, the company reviewed 2 million videos and took down 150,000, including footage related to the choking game, which could endanger child safety.
Many people also mistakenly believe that if they play the choking game with another person, doing so will be safe. The other player is trusted to remove the object cutting off the oxygen after the person being asphyxiated loses consciousness.
Risk Factors
No known factors predispose a person to begin playing the choking game. Many children who play the game do not otherwise engage in risky activities, such as drug and alcohol use. However, some factors are common to those who play the game, including age and peer pressure. The choking game is often played by children and young adults aged nine to twenty years, and most children learn about the game from other children.
Symptoms
Because many parents have never heard of the choking game, they are not likely to know the signs that their child may be participating. Symptoms that one is playing the game include the following: having unexplained bruises on the neck; having bloodshot eyes; leaving bedsheets, belts, ties, or ropes tied in strange knots and in unusual places; having frequent, severe headaches; being disoriented after being alone; wearing high-neck shirts or scarves, even in warm weather; locking one’s bedroom or bathroom doors; leaving marks of wear on bed posts or closet rods; and showing curiosity about the choking game or asphyxiation in general. The choking game is a dangerous practice that can lead to seizures, fractures, retinal hemorrhages, brain damage, stroke, and death.
Screening and Diagnosis
The choking game often goes undetected until the person who has been playing the game dies. It is unknown how many people die each year from playing the game because many cases are likely classified as suicides. However, most people who play the game do not intend to kill themselves. Those persons who play it alone often devise some sort of safety mechanism that is intended to prevent accidental death if they lose consciousness. Safety mechanisms may include using slip knots or arranging to hang from something shorter than themselves. These safety mechanisms often fail because the person becomes disoriented and is unable to take the necessary steps to restore the flow of oxygen.
Physicians and other clinicians trying to determine whether their patients have been playing the choking game need to be knowledgeable about the game and its warning signs. Screening for evidence of the choking game can take place during routine physical examinations or when a patient presents with symptoms. Diagnosis is based on the patient’s symptoms and medical history.
Treatment and Therapy
Treatment for choking game participants may include a combination of cognitive-behavioral therapy and education about the dangers of asphyxiation.
Prevention
Education is critical to preventing children from playing the choking game. Once the behavior has started, many children begin looking for a way to play the game safely, so they must be told there is no safe way to do it.
Parents should also be educated about the choking game, including the warning signs. Parents who believe their child may be participating in the game should discuss the dangers with their child and then seek treatment for the child. The child’s physician may be able to provide a referral. Even if parents do not believe their child is playing the game, they should still discuss the game's dangers with their children.
Many clinicians remain unaware of the choking game. Education about the game could be included in continuing education programs. It could also be incorporated into medical, nursing, and psychology curricula and primary care, psychiatry, and emergency medicine residency programs.
In the mid-2020s, despite awareness and education, the choking game remained popular with adolescents and young adults. On the social media site TikTok, the choking game was renamed "the blackout challenge" or "the pass-out challenge." These challenges gained popularity in 2021 as users posted videos of themselves and friends cutting off their oxygen supply to obtain levels of euphoria. The prevalence of these videos is especially concerning, as many serve as visual step-by-step directions for how to participate in a life-threatening activity. Some statistics indicate that many middle and high school students have participated in these challenges. Despite efforts to remove these videos from social media, they remain highly available.
Bibliography
Chan, Melissa. "Kids Are Playing the 'Choking Game' to Get High. Instead, They're Dying." Time.com, 12 Mar. 2018. Canadian Reference Centre, search.ebscohost.com/login.aspx?direct=true&db=rch&AN=128544983&site=eds-live. Accessed 11 Feb. 2019.
McClave, Julie L., et al. "The Choking Game: Physician Perspectives." Pediatrics, vol. 125, no. 1, 2010, pp. 82–87.
"Once Popular 'Choking Game' Is Making A Comeback Thanks To Social Media." CBS News, 6 Sept. 2016, www.cbsnews.com/newyork/news/choking-game. Accessed 23 Aug. 2024.
Parker-Pope, Tara. "'Choking' Game Deaths on the Rise." The New York Times, 14 Feb. 2008, archive.nytimes.com/well.blogs.nytimes.com/2008/02/14/choking-game-deaths-on-the-rise. Accessed 23 Aug. 2024.
Re, Laura, et al. "The Choking Game: A Deadly Game. Analysis of Two Cases of 'Self-Strangulation' in Young Boys and Review of the Literature." Jour. of Clinical Forensic and Legal Medicine, vol. 30, 2015, p. 29+.