DON'T LET YOUR KIDS TRY THIS!

The fainting game (also known as the choking game and a wide variety of local slang names), refers to intentionally cutting off oxygen to the brain with the goal of inducing temporary syncope and euphoria. There are two distinct methods used to achieve oxygen deprivation: strangulation and self-induced hypocapnia.

According to Dr. Steve Field, chairman of the Royal College of General Practitioners in London, the fainting game is pursued primarily by children and teens "to get a high without taking drugs." Children "aren't playing this game for sexual gratification." It is frequently confused with erotic asphyxiation, which is oxygen deprivation for sexual arousal. Unlike erotic asphyxiation, practice of the fainting game appears to be uncommon in adulthood.


Limited research has been conducted regarding motivations for practicing the fainting game, although thrill-seeking has been identified as a risk factor, as has the perception that it is a low-risk activity. Anecdotal reasons stated include:

Being released from class during the school day.

Peer pressure, a challenge or dare, a rite of passage into a social group or amusement over erratic behavior.

Curiosity in experiencing an altered state of consciousness, the experience of a brownout, or an imagined approximation to a near death experience.

A belief that it can induce a brief sense of euphoria (a rushing sensation or high).

The prospect of intoxication, albeit brief, at no financial cost.

There are two main mechanisms behind many variations of this practice, both resulting in cerebral hypoxia (oxygen deprivation to the brain). The two mechanisms tend to be confused with each other or treated as one but are quite dissimilar although both have the potential to cause permanent brain damage or death. The two mechanisms are strangulation and self-induced hypocapnia and work as follows:

A ligature such as a belt or rope around the neck, or hands or arm pressure on the neck compresses the internal carotid artery. Apart from the direct restriction of blood to the brain there are two other significant responses produced by pressing on the neck:

Pressing on the carotid arteries also presses on baroreceptors. These bodies then cause vasodilatation (dilation (widening) of the blood vessels) in the brain leading to insufficient blood to perfuse the brain with oxygen and maintain consciousness.
A message is also sent via the vagus nerve to the main pacemaker of the heart to decrease the rate and volume of the heartbeat, typically by a third. In some cases there is evidence that this may escalate into asystole, a form of cardiac arrest that is difficult to treat. There is a dissenting view on the full extent how and when a person reaches a stage of permanent injury, but it is agreed[by whom?] that pressure on the vagus nerve causes changes to pulse rate and blood pressure and is dangerous in cases of carotid sinus hypersensitivity.
This method is responsible for most, but not all, of the reported fatalities.
The method is especially dangerous when practiced alone. Involuntary movements can lead to head trauma and other injuries. If standing, loss of consciousness can result in substantial head trauma through falling. In the event that consciousness is not immediately regained, medical help cannot be sought by a third party, observer, or friends. If the administration of CPR or basic life support is needed due to respiratory or cardiac arrest, help would not be available or quickly summonable when unconscious or not breathing. Also this act could be mistaken for suicide when practiced alone, but accidentally observed by a stranger, to whom the motivation behind the apparent 'strangulation' is not known.

The second mechanism requires hyperventilation (forced overbreathing) until symptoms of hypocapnia such as tingling, light-headedness or dizziness are felt, followed by a breath-hold. This alone is enough to cause a blackout, but it is widely believed that the effect is enhanced if lung air pressure is increased by holding the breath "hard" or "bearing down" (tightening the diaphragm as in a forced exhalation while allowing no air to escape or having an assistant apply a bear-hug). These latter actions may augment the effects of hypoxia by approximating the Valsalva maneuver, causing vagal stimulation.
The hyperventilation leads to an excessive elimination of carbon dioxide (CO2) whereas no significant additional amounts of oxygen can be stocked in the body. As only carbon dioxide is responsible for the breathing stimulus, after hyperventilation, breath can be held longer until cerebral hypoxia occurs. The blood also becomes abnormally alkaline as a result of the excessive elimination of carbon dioxide; this subsequent rise in blood pH is termed alkalosis. Alkalosis interferes with normal oxygen utilization by the brain. The symptoms of alkalosis are: neuromuscular irritability, muscular spasms, tingling and numbness of the extremities and around the mouth, and a dizziness, or giddiness, often interpreted as a sense of euphoria. This brief euphoria is what practitioners of the fainting game seek.
In the body alkalosis generally induces vasodilatation (widening of the blood vessels) but in the brain alone it causes vasoconstriction (narrowing of the blood vessels). This vasoconstriction appears to be made even worse by a sudden increase in blood pressure caused by squeezing or holding the breath ‘hard’. The alkalosis induced euphoria can be followed rapidly by hypoxia-induced unconsciousness. The sequence of events leading to unconsciousness from hyperventilation is as follows:

Decrease in partial pressure of alveolar CO2.

Decrease in partial pressure of arterial CO2.

Increase in blood pH, (respiratory alkalosis).

Vasoconstriction of blood vessels supplying brain.

Pooling of the blood present in the brain at the time.

Brain rapidly uses up oxygen (O2) available in the pooled blood.

O2 concentration in the brain drops.

Unconsciousness from hypoxia of cerebral tissue.

Because the brain cannot store reserves of oxygen and, unlike other organs, has an exceedingly low tolerance of oxygen deprivation, it is highly vulnerable if vasoconstriction is not reversed. Normally, if the brain is hypoxic, autonomous systems in the body divert blood to the brain at the expense of other organs; because the brain is vasoconstricted this mechanism is not available. Vasoconstriction is only reversed by the build-up of carbon dioxide in the blood through suspension of breathing.
In some versions the bear-hug is replaced by pressure on the neck in which case blackout is a hybrid of strangulation and self-induced hypocapnia.