Approximately 250 deaths per year in the United States are attributed to the dangerous sexual paraphilia of autoerotic asphyxia. There are few studies of live practitioners of this practice which includes the act of self-asphyxiation, usually by hanging, while masturbating. Common features of the syndrome is the adoption of the role of a female transvestite, the use of pornographic material, the special kind of location for the hanging ritual, and the dynamics arising out of having a dominant mother and physically ill father. With adolescent males the ritual tends to be solitary, while in adults the tendency is to move into a homosexual couple practice that has sadomasochistic features. The source of such a practice is an enigma to researchers in spite of the long-known history of its occurrence. Few practioners have been studied while alive, and most practitioners have been studied by psychological autopsy. The authors report the history of a 24-year-old male, with a 10-year practice of autoerotic asphyxia who was first seen for a conversion reaction which affected his ability to walk. His symptoms began soon after a vigorous and repetitive engagement in his hanging ritual which left him very light-headed and weak-kneed. He believed he had caused himself permanent physical damage and he sought professional assistance at that time.