Adolescents and young adults commonly engage in choking/strangulation during sex. Because it is so prevalent, psychologists will likely provide psychotherapy to many patients who are engaging in sexual choking/strangulation. However, they may have little to no training on this emergent topic. Despite its dangers, including death, sexual choking/strangulation is increasingly viewed as normal among young people in consensual, ongoing relationships. This article proposes a classification of different types of sexual choking/strangulation, summarizes the literature on sexual choking/strangulation, and provides an example of a fictitious psychotherapy patient who discusses being frequently choked/strangled in her established romantic relationship. The case is analyzed using principle-based ethics. Psychologists who treat patients engaging in consensual choking/strangulation face various ethical challenges, including respecting their patients’ autonomy versus protecting patients from harm. To aid psychologists in their ethical decision making, the authors offer culturally relevant recommendations informed by a gender-sensitive framework; these include alliance-strengthening suggestions, psychoeducation, awareness of the potential overlap with domestic/intimate partner violence, and a multidisciplinary approach. (PsycInfo Database Record (c) 2026 APA, all rights reserved)
Turkson et al. (Mon,) studied this question.