Asphyxia appears to be almost like a centipede
, having many legs. However, all of its limbs and flesh is that of a human female's, with great focus on sexuality and suffocation: two pairs of hands cover up its breasts and genitals, while others also appear to be gripping at the throat and covering up the head's mouth. Asphyxia represents the death of Nora Holloway, Elle's little sister.
It appears from the locket Elle had been wearing since the mysterious disappearances in Alex
's family began. Its caterpillar likewise appearance is also a reference to the caterpillar in Alice in Wonderland
, Nora's favorite book, as mentioned on a sidenote on a photograph.