Choking Games and Thrills That Kill: Dangerous Games

Dangerous Games Robert and Phyllis Evans considered themselves lucky. They had three wonderful children whom they adored and, after 26 years of marriage, their relationship was still solid. They owned a four-bedroom, two-story house in the woodsy, close-knit town of Mill Valley, California. In their yard, surrounded by wild blackberry bushes, they often saw fawns and bucks with giant antlers.

One evening in November 1999, the Evanses became concerned when they noticed a red, indented mark on their son Joel's neck. It looked like the 14-year-old high school student had pulled his T-shirt tight around his throat. Or maybe someone at school had been rough with him, his father thought.

"What happened to your neck?" his mother asked.

"Oh, it's nothing," Joel said, and went back to playing video games on his computer.

Joel was not a kid you had to worry about, so his parents let it go. He wasn't wild, and he didn't take drugs or drink. He was smart, responsible, even "a little nerdy," by his mother's estimation. He hadn't developed an interest in girls yet; he'd rather spend time on his computer and with his pet rabbit, Fafner. He didn't care that his jeans were too short, or that his straight bangs made him look like a little boy.

His older brother, Daniel, 16, was the risk-taker. He'd recently been sneaking out of the house late at night to meet with friends. Joel, on the other hand, was a more cautious type. Or so his parents thought until March 2000, some months after noticing the mark on his neck, when they came home one afternoon and couldn't find him. Thinking he was playing a favorite game -- hiding so he could pop out and surprise them -- they continued looking. Phyllis Evans surveyed her son's bedroom a second time and in the dark she saw a shadow by the window. "That's when I found him," she says, her voice trembling. "He had the cord from the mini-blind wrapped around his neck, and he was just hanging there. It was such a nightmare. You just can't believe something like this can happen."

Robert Evans immediately called 911. He cut down his son, laid him on the bed and administered CPR -- but it was too late. The coroner ruled the death a suicide, but in part because of Joel's young age, questioned whether it was intentional. None of it made any sense to his parents. This wasn't a troubled kid, or a kid who suffered from depression.

Recently, after seeing TV reports about a disturbing trend popular among teens that goes by various names -- pass out, space monkey and the choking game -- the Evanses believe they finally know what happened. The red mark on Joel's neck was evidence, they contend, that he had been experimenting with the risky suffocation game in which kids cut off oxygen to their brains momentarily to achieve a euphoric drug-like high. Tragically, it appears that Joel, like some 1,000 youths each year, accidentally strangled himself while playing around with the cord. As for how he learned about the bizarre practice, the Evanses are convinced it was from friends and the Internet.

A Private Pain Elsewhere in California, in the southern coastal town of Palos Verdes, 14-year-old Caitlin Scafati retreated after dinner most evenings and spent two hours glued to her computer. Nothing unusual about that, her parents thought. That's what kids do these days; they instant message their friends and "chat" for hours at a time. Only Caitlin had other reasons for going online.

A high school freshman, she had trouble adjusting to her school's social cliques and their emphasis on being thin and fashionable. Overweight much of her life and struggling with depression, she felt like an outcast when she became the target of cruel teasing by some of her classmates. "Are you really going to eat that?" a boy once asked Caitlin when he saw her nibbling on a doughnut. In swim class, a girl took a picture of Caitlin in her swimsuit and posted it in the locker room. "I ripped it up, threw it away and cried most of the night," she says.

In the privacy of her room, Caitlin would log onto the Internet and type in the search words "anorexia" and "cutting." Instantly, dozens of websites appeared that discussed and even promoted the behaviors. Caitlin had turned to both as a way of dealing with her painful emotions and feeling of worthlessness. When she cut her arms and legs, "It made me feel better," Caitlin explains. "I hurt so much inside that this was a way of shifting my pain to the outside."

What Caitlin found online was what she thought she never could in real life -- acceptance and understanding from others, many of whom were participating in the same self-destructive behaviors that she was. Instantly available to her were anonymous website contributors who posted comments like: "The thinner I got, the happier I felt," or "I cannot change certain circumstances in my life, but at least I have the power to control what I do and do not eat." On a cutting website were tips such as, "Cut on a full stomach," and, referring to the direction of the incision, "Always down the road, not across the street."

Unfortunately, experts say, the stories of Joel and Caitlin are not uncommon and represent a growing, destructive trend among kids across the United States and around the world. "These practices are spreading like wildfire because of the Internet," says Dr. Thomas Andrew, a pediatrician who, in his position as New Hampshire's chief medical examiner, has seen several accidental suffocation deaths among teens in the last few years. According to a 2005 Pew Internet research project, 21 million -- or 87 percent of American youth (ranging in age from 12 to 17) -- use the Internet as a source of information; 22 percent of them go online to learn more about hard-to-discuss topics like drug use, sexual health or depression.

Psychologists, pediatricians and youth counselors contend that under the radar, hundreds of websites and chat rooms are fueling an explosion of self-destructive practices considered in vogue by a surprising number of kids. They swap techniques about how to injure themselves -- and, like Joel and Caitlin, keep it all hidden from their parents.

"Clearly, the Internet is a major tool for good," says Ken Mueller, co-director of , an informational website about youth culture. "But as we're seeing now, it can also lead to great harm. Kids become addicted to these sites, and suddenly behaviors that used to be considered taboo are no longer hidden, which makes them seem more acceptable -- even cool."

On the Internet, Caitlin found "pro-ana" (short for pro-anorexia) websites that view anorexia nervosa in a positive light -- a lifestyle choice rather than a psychological disorder. Suffering from the illness, and losing so much weight that she fainted, the last thing Caitlin needed were tips on how to avoid consuming food -- "drink lots and lots of water" or "adopt a dog and feed him your food." Some pro-ana sites provided motivational messages: "Say it now and say it loud: I'm anorexic and I'm proud." Still others bombarded her with color photos of Kate Moss, Calista Flockhart and other thin, beautiful actresses and models to "inspire" her to avoid food.

In May, the first study that examined the impact of eating-disorder websites confirmed their destructive influence. Researchers at Lucile Packard Children's Hospital at Stanford University in Palo Alto, California, found that 40 percent of adolescents who had been hospitalized for eating disorders had spent time on pro-ana websites.

When Caitlin clicked on cutting websites, she found short bios of famous self-injurers, including Princess Diana and singer Fiona Apple, which, she says, "made it seem cool and okay." She even discovered sites that gave her tips on how to hide her wounds. On one discussion board, a cutter suggested, "Depending on wear [sic] the cuts are ... sweatbands will work very well."

"I was amazed to find so many other people with my same problems," Caitlin says. "I felt so isolated, but online I found solidarity from strangers who I felt some connection to."

Though not as common as anorexia -- approximately 7 million females and 1 million males suffer from eating disorders -- cutting is a growing epidemic among teenage girls. Experts who study self-injury estimate that as many as one out of every 200 teen girls hurt themselves, resulting in 2 million reported cases per year. "Because of the awareness created by these websites," says CPYU.org's Mueller, "cutting has gone from being a way to cope to the hip thing to do."

In fact, studies suggest that there are 3 million self-injurers in the United States. Two million of them cut or burn themselves, while the other million hit, brand, scar, or excessively pierce themselves. "People who cut themselves believe they are horribly flawed in some way," says Wendy Lader, PhD, clinical director of S.A.F.E. Alternatives, a referral and treatment program for self-injurers. "It makes them feel strong. They think, I'm not like the rest of you. I'm tough. I can tolerate pain or starvation better than you. But no matter how much they cut or starve themselves, they're not dealing with the real issue -- their out-of-control emotions."

Loss and Learning Robert Evans now believes that for his son Joel, the pass-out game "was something that he thought he could control -- something that was secret from us. He didn't have the intent to hurt himself." Asphyxia games -- hyperventilating and holding your breath -- have been around for decades. One version, autoerotic asphyxia, is used by some older boys and men as a way of intensifying sexual climax. The choking game, done mostly for thrills and often in groups, does not derive from the darker psychological motives behind anorexia and self-injury, but the Internet is fueling more extreme methods.

Google certain keywords and with a few clicks on the right links you'll be connected to a spirited discussion about the choking game. One teen calls it "overrated," while another provides directions about how to play it, including the recommendation: "Have your friend or 'spotter' use his inner wrist to apply pressure to the jugular vein NOT THE WINDPIPE!!!"

"It's about pushing the envelope farther to have an extreme experience," says pediatrician Thomas Andrew, who points to popular television programs like Fear Factor to further explain the growing popularity of the choking trend. "We're living in an 'I dare you' culture." Andrew says that kids are adding ropes, belts and plastic bags to the game. "And many are playing alone, which is so dangerous. They don't think of where it can lead. Death is not on their radar screen."

For several years, Yahoo and AOL have been shutting down self-injury sites on their servers. But this kind of information is still available in online chat rooms, which are much harder to police. And short of violating the First Amendment's guaranteed right to free speech, there is frankly no way to eliminate these sites altogether.

What parents need to do, say child-care professionals, is to pay more attention. "There are usually signs, some very obvious, to watch out for," says Lynn Grefe, CEO of the National Eating Disorders Association. Excessive exercise regimens and developing rituals around eating are anorexia tip-offs. A rash of cuts on the body are signs of self-injury. Bloodshot eyes, dizziness and red marks on a child's neck are indications of the choking game.

In 1998, when Caitlin Scafati was 15, she finally decided to talk to her parents about her cutting habits. They helped her to begin getting the counseling she needed. Now 23, recovered from her disorders and hoping to become a social worker, Caitlin says she had to scar her body and lose an unhealthy amount of weight before she recognized the danger of the sites she was visiting. She has never accessed them again.

Last April, Joel Evans would have turned 20. It was around that time that his father, Robert, having learned more about the choking game, felt a sense of relief. He could in some way finally understand how his son's death came about.

"We initially had so many questions," says Phyllis Evans, "and doubts." The memory of finding her son that March night will never leave her. But, she says, "five years later, your heart heals a little. The pain is a little less intense."