Autoerotic asphyxia is the induction of a state of oxygen deficiency t
o enhance sexual excitement and orgasm. It has been practiced for cent
uries, and there are many reports of fatalities. The authors report a
case of a hiving participant that shows a number of characteristics di
fferent from those of fatalities. The case study also raises doubt abo
ut the conventional view that participants have no wish to die. We fee
l that further case studies of living participants will lead to a grea
ter understanding of the practice and will facilitate treatment.