Accidental Hanging: A Case Of Autoerotic Asphyxiation Determined After Additional Information From Family
INTRODUCTION: The rate of suicide in the United States has increased over the last ten years, much of which is attributed to asphyxia by hanging. The majority of hanging deaths are relatively straightforward when opining manner of death, most commonly suicide. However, when details from the scene investigation contradict findings consistent with a suicide, obtaining additional information before concluding a manner of death is essential.
CASE HISTORY: A 29-year-old man was found dead from a reported suicidal hanging. No suicide note or signs of struggle were observed at the scene. Important death scene details were critical to understand the circumstances of the decedent's death. These include the ligature, decedent's attire, specific items in the room photographed by the medical examiner investigator and additional history provided by family members during subsequent conversations with the medical examiner's office. Ultimately, the medical examiner concluded the hanging was accidental, likely due to autoerotic activity.
DISCUSSION: Factors that may trigger the need for additional information in a hanging death include the lack of a history of depression, suicidal trigger, or departure note at the death scene; evidence of solitary sexual activity; or a young impressionable decedent. Before opining manner of death in hanging deaths, medical examiners should consider investigative details and information provided by family members beyond that obtained from the initial death scene investigation and findings at the postmortem examination. Accuracy in manner of death determinations can have a lasting impact on family members as well as public health policies and initiatives.