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BDSM involves a diverse range of practices usually involving role-playing games in which one person assumes a dominant role and another person assumes a submissive role. Unintentional Strangulation Deaths from the Choking Game Among Youths Aged 6--19 Years --- United States, 1995--2007 The choking game is defined as self-strangulation or strangulation by another person with the hands or a noose to achieve a brief euphoric state caused by cerebral hypoxia.