Asphyxia is the third boss monster encountered in Silent Hill: Homecoming. She is the manifestation of Margaret Holloway's memories of her daughter Nora, whom she suffocated as a sacrifice to maintain the pact with the Order and their god.
Asphyxia appears when Alex Shepherd finds Margaret strapped to a chair in the Otherworld Overlook Penitentiary. Alex quickly frees her and shows her Nora's locket; the memories of Nora manifest and summon Asphyxia. Judge Holloway is able to escape; she seals the door behind her with a sinister smirk, trapping Alex and Deputy Wheeler in the chamber. Asphyxia emerges from a fleshy hole in the wall and grabs Wheeler, disappearing with him before emerging again to attack Alex. Afterwards, she is promptly defeated by Alex.
Asphyxia appears to resemble a mass of female bodies gruesomely fused together in a chain. She has a single pair of legs, no feet but only hands, and uses the dozens of arms and hands to walk with, which resemble a centipede that snakes across the ground, which she uses to attack. She lacks eyes, and her mouth is covered by her upper hands growing out of her shoulders.
Asphyxia attacks with her numerous limbs, but she primarily strikes with her four main arms, often in a series of three swings. She can also spin around and knock Alex down with her long tail section, or simply charge him head on, as well as open her mouth and let out a ghastly shriek that can send Alex tumbling backwards.
Her weakness is that she is somewhat easy to dodge (though quite damaging), and her tail section is a weak vital point on her body; striking it hard enough stuns Asphyxia long enough to get a hit on her head. Successfully dodging Asphyxia's grapple attempt will leave her tail exposed and vulnerable. Striking it will bring her to her knees, leaving her head open to melee attack.
After taking enough damage, Alex forcibly parts the hands covering her mouth, forcing her to breathe, which kills her. Unlike the other bosses of the game, Asphyxia only has one combat form.
Asphyxia's name and appearance are symbolic of how Nora Holloway died: suffocation. Her mother, Judge Holloway, strangled her in order to sacrifice her, to appease the Order's god, and in doing so, protect Shepherd's Glen from Her wrath. The numerous hands choking and groping Asphyxia's body symbolize how she was murdered. True to her symbolism, it is apparent that breathing is deadly to Asphyxia, as Alex finishes her off by parting her covering hands from her mouth, forcing her to breathe, and thus, finishing her off.
Nora loved to read, particularly Alice's Adventures in Wonderland, her favorite book. Having multiple arms, Asphyxia's form appears similar to that of the Caterpillar in the book, and her "scream" is similar to how the Caterpillar blows smoke from his hookah at Alice. Joshua notes that Nora likes the Caterpillar on his photograph of her.
Asphyxia's appearance is heavily sexualized, evidenced in both her physical appearance and her sway-like, seductive movement, yet she is still unrevealing (the vaginal area and breasts are covered in the same manner as a girl would try to conceal herself), perhaps symbolizing how she was nearly a mature woman, but was denied the puberty experience. Adding further to the sexual appearance, Asphyxia comes out of very vagina-esque portals in the walls, a nod to the theme of labor and birth in the game.
As depicted in the installment, Asphyxia exhibits a tormented existence. It is noted that there is a green substance emitted from her tail when she performs a swiping attack; usually anything green emitted from the body is a sign of serious infection or is a toxin. The green substance can be attributed to poison; poison can be linked to the wellness, or lack thereof, concerning the soul and/or the mind.
Asphyxia's lack of eyes may also symbolize how Nora Holloway died. Normally, if a person loses consciousness, the lungs automatically seek air and the breathing functions continue, which makes it nearly impossible for someone to suffocate themselves. This could mean that Nora was strangled while half-conscious (perhaps while she was sleeping), which would give the hands around Asphyxia's mouth a dual meaning - not only was she unable to breathe, but she was given no reprieve, even once she blacked out.
- Asphyxia is one of only two bosses of Silent Hill: Homecoming (the other being Amnion) that was not responsible for the death of a parent, being an incarnation of the parent's memories of their murdered child. However, only Alex's intervention saved Margaret Holloway from a gruesome death at the hands of Asphyxia, meanwhile the Bogeyman was responsible for the death of Adam Shepherd.
- Like many of the creatures and characters in Homecoming, Asphyxia was designed by artist Kenzie LaMar. Some of the original design sketches reveal she had tentacle-like feelers coming out of her breasts.
- Defeating Asphyxia in the Xbox 360 version unlocks the achievement "Catch Your Breath".
- The name "Asphyxia" is Greek for "without heartbeat", typically linked with deprived oxygen levels in the body.
- Asphyxia's corpse is absent after she is killed, unlike the two prior bosses. This was likely an oversight by developers.