A 22-year-old man is found dead in his bedroom, suspended by a soft ligature from a doorknob in a semi-standing position. The scene shows pornographic magazines, a mirror positioned to view himself, and padding placed under the ligature on the neck. There are no signs of struggle, no suicide note, and no history of depression. What is the MOST likely manner of death?

• A Suicidal hanging
• B Accidental death during autoerotic asphyxia ✓
• C Homicidal strangulation staged as hanging
• D Death from positional asphyxia during intoxication

Explanation

The combination of nudity, pornographic material, a mirror for self-viewing, padding under the ligature to prevent marks, and a semi-standing position with a soft ligature are classic features of autoerotic asphyxia. This is an accidental death during solitary sexual activity involving intentional oxygen deprivation for arousal. The scene is characteristically organized and lacks evidence of struggle or suicidal intent. Padding under the ligature is a key differentiator from suicidal hanging.

Reference: Reddy's The Essentials of Forensic Medicine and Toxicology, 34th ed.

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Written and medically reviewed by the StethoPrep medical team.