The authors studied five adolescent male practitioners of autoerotic asphyxia to determine contributors to its etiology. Extensive histories including detailed sexual histories were obtained from each boy. Their life histories suggested an early history of choking, in combination with physical or sexual abuse, was related to the development of autoerotic asphyxia. Each boy appeared to have paired choking with sexual arousal, and autoerotic asphyxia was a persisting behavior pattern for four of five boys. This sample is the largest study of living practitioners of this behavior and suggests the heretofore unmentioned history of either choking or abuse.