Strangulation in the context of
domestic violence
Domestic violence (also known as domestic abuse or family violence) is violence or other abuse that occurs in a domestic setting, such as in a marriage or cohabitation. ''Domestic violence'' is often used as a synonym for ''intimate partner ...
is a potentially lethal form of
assault
An assault is the act of committing physical harm or unwanted physical contact upon a person or, in some specific legal definitions, a threat or attempt to commit such an action. It is both a crime and a tort and, therefore, may result in crim ...
.
Unconsciousness
Unconsciousness is a state in which a living individual exhibits a complete, or near-complete, inability to maintain an consciousness, awareness of self and environment or to respond to any human or environmental Stimulus (physiology), stimulus. ...
may occur within seconds of
strangulation
Strangling is compression of the neck that may lead to unconsciousness or death by causing an increasingly hypoxic state in the brain. Fatal strangling typically occurs in cases of violence, accidents, and is one of two main ways that hanging ...
and death within minutes. Strangulation can be difficult to detect and until recently was often not treated as a serious crime. However, in many jurisdictions, strangulation is now a specific criminal offense, or an aggravating factor in assault cases.
Differences from choking
Although sometimes the words are used interchangeably, "strangulation" and "choking" are not the same thing. Choking is when air flow is blocked by food or a foreign object in the trachea – something that can be addressed by the
Heimlich maneuver
Abdominal thrusts, also known as the Heimlich maneuver or Heimlich manoeuvre, is a first aid procedure used to treat upper airway obstructions (or choking) by foreign objects. American doctor Henry Heimlich is often credited for its creation. ...
. Strangulation, by contrast, is defined by reduced air flow and/or blood flow to or from the brain via the intentional external compression of blood vessels or the airway in the neck. Notably, however, many victims of strangulation refer to the assault as "choking".
Both manual strangulation (i.e., gripping the throat with one’s hands) and ligature strangulation (e.g., belts, scarves) have been reported in
intimate partner violence
Intimate partner violence (IPV) is domestic violence by a current or former spouse or partner in an intimate relationship against the other spouse or partner. IPV can take a number of forms, including physical, verbal, emotional, economic and sex ...
cases.
Epidemiology
A systematic review of 23 articles based on 11 surveys in 9 countries (N=74,785, about two-thirds of whom were women) found that 3.0% to 9.7% of women reported that they had at some time been strangled by an intimate partner.
A total of 0.4% to 2.4% – with 1.0% being typical – reported that they had experienced it in the past year, and women were between 2 times and 14 times more likely to be strangled by an intimate partner than were men.
The most recent national survey in the U.S. that asked about strangulation by an intimate partner asked 16,507 adults (55% of whom were women) if a partner had tried to hurt them by choking or suffocating them. A total of 9.7% responded that a partner had done so at some point in their lifetime; 0.9% reported that it had happened during the past year.
The prevalence of strangulation appears to be decreasing in Canada, the only country with multiple cross-sectional surveys that measure strangulation.
The first major study of surviving victims of strangulation assault found that 99% of the 300 victims in criminal cases involving "choking" were female. In 2000, a meta-analytic review of gender differences in physical aggression against a heterosexual partner concluded that ". ..'choke or strangle' is very clearly a male act, whether based on self- or partner reports." A similar conclusion was reached in a 2014 multi-nation review: "…women are more likely than men to report that they were strangled by an intimate partner."
A series of studies conducted in Canada found the same gender discrepancy and reported that strangulation by an intimate is more common among disabled persons, cohabiting (vs. married) persons,
and those in a step- (vs. biological) family. Women who had been abused by an intimate partner reported higher rates of strangulation.
Strangulation is sometimes fatal. According to a large U.S. case control study, prior strangulation is a substantial and unique predictor of attempted and completed homicide of women by a male intimate partner. The study showed that the odds of becoming an attempted homicide victim increased 7-fold and the odds of becoming a homicide victim increased 8-fold for women who had been strangled by their partner. When over three dozen other characteristics of the victim, perpetrator, and incident were taken into account, however, strangulation no longer was a unique predictor.
Strangulation is so common in battering (50% or more battered women report that they've been strangled) that it doesn't differentiate abuse in which the victim survives or dies.
Experience of strangulation
Strangulation has been likened to drowning and researchers at the University of Pennsylvania have likened non- or near-fatal strangulation to water boarding,
which is widely considered a form of torture.
A special issue of the ''Domestic Violence Report'' devoted to the crime of strangulation states: "Many domestic violence offenders and rapists do not strangle their partners to kill them; they strangle them to let them know they can kill them—any time they wish. Once victims know this truth, they live under the power and control of their abusers day in and day out."
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Outcomes
Strangulation can produce minor injuries, serious bodily injury, and death. Evidence of the assault can be difficult to detect because many victims may not have visible injuries and/or their symptoms may be nonspecific.
Victims may have internal injuries
Internal bleeding (also called internal hemorrhage) is a loss of blood from a blood vessel that collects inside the body. Internal bleeding is usually not visible from the outside. It is a serious medical emergency but the extent of severity depen ...
, such as laryngo-tracheal injuries, digestive tract
The gastrointestinal tract (GI tract, digestive tract, alimentary canal) is the tract or passageway of the digestive system that leads from the mouth to the anus. The GI tract contains all the major organs of the digestive system, in humans a ...
injuries, vascular injuries, nervous system
In biology, the nervous system is the highly complex part of an animal that coordinates its actions and sensory information by transmitting signals to and from different parts of its body. The nervous system detects environmental changes th ...
injuries and orthopedic
Orthopedic surgery or orthopedics ( alternatively spelt orthopaedics), is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal ...
injuries. Clinical symptoms of these internal injuries may include neck and sore-throat pain, voice changes (hoarse or raspy voice or the inability to speak), coughing, swallowing abnormalities, and changes in mental status, consciousness and behavior. Neurological symptoms may include vision changes, dimming, blurring, decrease of peripheral vision and seeing "stars" or "flashing lights." Post-anoxic encephalopathy
Encephalopathy (; from grc, ἐνκέφαλος "brain" + πάθος "suffering") means any disorder or disease of the brain, especially chronic degenerative conditions. In modern usage, encephalopathy does not refer to a single disease, but r ...
, psychosis
Psychosis is a condition of the mind that results in difficulties determining what is real and what is not real. Symptoms may include delusions and hallucinations, among other features. Additional symptoms are incoherent speech and behavior ...
, seizures
An epileptic seizure, informally known as a seizure, is a period of symptoms due to abnormally excessive or neural oscillation, synchronous neuronal activity in the brain. Outward effects vary from uncontrolled shaking movements involving much o ...
, amnesia
Amnesia is a deficit in memory caused by brain damage or disease,Gazzaniga, M., Ivry, R., & Mangun, G. (2009) Cognitive Neuroscience: The biology of the mind. New York: W.W. Norton & Company. but it can also be caused temporarily by the use ...
, cerebrovascular accident and progressive dementia
Dementia is a disorder which manifests as a set of related symptoms, which usually surfaces when the brain is damaged by injury or disease. The symptoms involve progressive impairments in memory, thinking, and behavior, which negatively affe ...
may be indicative of neuropsychiatric
Neuropsychiatry or Organic Psychiatry is a branch of medicine that deals with psychiatry as it relates to neurology, in an effort to understand and attribute behavior to the interaction of neurobiology and social psychology factors. Within neurop ...
effects.
Signs of life-threatening or near fatal strangulation may include sight impairment, loss of consciousness
Loss may refer to:
Arts, entertainment, and media Music
* ''Loss'' (Bass Communion album) (2006)
* ''Loss'' (Mull Historical Society album) (2001)
*"Loss", a song by God Is an Astronaut from their self-titled album (2008)
* Losses "(Lil Tjay son ...
, urinary or fecal incontinence
Fecal incontinence (FI), or in some forms encopresis, is a lack of control over defecation, leading to involuntary loss of bowel contents, both liquid stool elements and mucus, or solid feces. When this loss includes flatus (gas), it is referred ...
and petechiae (pinpoint hemorrhages). Even victims with seemingly minimal injuries and/or symptoms may die hours, days, or weeks later because of progressive, irreversible encephalopathy.
Some visible signs of strangulation a victim may incur include injuries to the face, eyes, ears, nose, mouth, chin, neck, head, scalp, chest and shoulders: redness, scratches or abrasions, fingernail impressions in the skin, deep fingernail claw marks, ligature marks ("rope burns"), thumbprint-shaped bruises, blood-red eyes, pinpoint red spots called "petechiae" or blue fingernails
A subungual hematoma is a collection of blood ( hematoma) underneath a toenail or fingernail. It can be extremely painful for an injury of its size, although otherwise it is not a serious medical condition.
Nature
A laceration of the nail bed ...
.
Laws
Because of involvement of the medical profession, specialized training for police and prosecutors, and ongoing research, strangulation has become a focus of policymakers and professionals working to reduce intimate partner violence and sexual assault.
As of November 2014, 44 U.S. states, the District of Columbia, the federal government and two territories have some form of strangulation or impeded breathing statute. Twenty-three states and one territory have enacted legislation making strangulation a felony. One state legislature, Utah, passed a joint resolution which made legislative findings that can help prosecutors apply existing assault statutes with a special emphasis on non-fatal strangulation assaults. In 2013, Congress re-authorized the Violence Against Women Act
The Violence Against Women Act of 1994 (VAWA) is a United States federal law (Title IV of the Violent Crime Control and Law Enforcement Act, ) signed by President Bill Clinton on September 13, 1994. The Act provided $1.6 billion toward investi ...
and added, for the first time, strangulation and suffocation as a specific federal felony.
Improving detection and intervention
Starting in 1995, the work of Gael Strack and Casey Gwinn in San Diego has helped identify and address challenges in detecting, investigating, and prosecuting strangulation and suffocation offenses in intimate partner violence, sexual assault, elder abuse, and child abuse cases. In 2011, Strack and Gwinn created the Training Institute on Strangulation Prevention, the most comprehensive training program in the United States for the documentation, investigation, and prosecution of non and near-fatal strangulation assaults. They have published multiple state-specific books to guide the investigation and prosecution of non and near-fatal strangulation assaults.
See also
* Child abuse
Child abuse (also called child endangerment or child maltreatment) is physical, sexual, and/or psychological maltreatment or neglect of a child or children, especially by a parent or a caregiver. Child abuse may include any act or failure to a ...
* Violence against children
Domestic violence occurs across the world, in various cultures, and affects people across society, at all levels of economic status; however, indicators of lower socioeconomic status (such as unemployment and low income) have been shown to be ri ...
References
{{reflist
Domestic violence
Law enforcement
Criminal case law