Increasing Awareness and Understanding: Strangulation
Strangulation is one of the most dangerous forms of violence that occurs in intimate partner violence. In recent years there has been an increase in training and understanding of how strangulation increases lethality in intimate relationships as well as the use of assessment tools when working with those who have experienced domestic or intimate partner violence. But there is still a lot of misinformation about strangulation. Even more startling, in recent years strangulation has been normalized by both television and film and social media, even though it is one of the strongest predictors of future homicide and long-term injury. It is critical to have a clear definition of what strangulation is, the risks associated with strangulation, especially in the context of intimate partner violence, and what steps to take if it occurs to you or someone you know.
What Is Strangulation?
Strangulation is the obstruction or compression of blood vessels and/or airways by external pressure to the neck, which interferes with normal breathing or blood circulation.
It is different from suffocation, which involves depriving a person of air—sometimes referred to as asphyxiation or smothering. While both are dangerous, strangulation is especially lethal because it targets essential blood flow and oxygen supply to the brain.
Why Strangulation Is So Dangerous
Despite its severity, approximately 50% of strangulation incidents leave no visible injury, and only around 15% result in marks that can be photographed. The absence of marks does not mean the person was not in danger.
Here’s what makes strangulation particularly deadly:
- Millions of brain cells die every second the brain is without oxygen
- Survivors have a high risk of traumatic brain injury
- Intimate partner violence that includes strangulation increases a victim’s risk of being murdered by 750%, and if a firearm is involved the risk increases by 1,100%
- When an abuser uses an object to choke or strangle (e.g., rope, clothing), there is a higher level of risk due to premeditation, lethality, and emotional detachment
In law enforcement contexts, 50–80% of peace officers killed on duty are by a person who had a history of domestic violence and strangulation.
What Happens During Strangulation?
When strangulation occurs, a person may experience alterations in consciousness. During these moments the brain “stops recording” and a person may come in and out of awareness. What makes this challenging is that these incidents may only last 1-2 seconds and the person may not even be aware that they lose consciousness. This has a direct impact on recognizing the severity of the incident and why documentation and medical care is so vital.
Aftermath of Strangulation: What Strangulation Does to the Body
While someone may initially report feeling fine or have expected soreness and tenderness around the throat or chest, strangulation can cause long term health consequences. Going to the ER after strangulation, even if feeling “fine” can be lifesaving. Some of the long-term impacts include:
- Carotid artery damage, which can cause delayed death
- Pulmonary edema (fluid in the lungs), can occur with carotid artery damage
- Carotid body compression, affecting heart rate
- Laryngeal damage
Who Are the Victims?
While anyone can be a victim, women are disproportionately impacted:
- 1 in 10 women have been strangled.
- Among women experiencing intimate partner violence:
- 50–80% have been strangled
- 80% have been strangled more than once
- It is the second leading cause of death in intimate partner violence
- These survivors score highest in suicidality and lowest in hope
Who Are the Perpetrators?
There is no justification for someone who strangles another person. Yet, it is important to understand what factors may contribute to an increased risk of such dangerous behaviors. To make impactful changes we must address both sides of the issue. And research paints a concerning and consistent picture:
- Many have an ACE (Adverse Childhood Experiences) score of 5+.
- 90% were sexually assaulted as children.
- 80% say their mothers did not believe them when they reported abuse.
- Strangulation is a gendered crime:
- 90% of perpetrators are men
- 93% involve intimate partners
- Among those who kill their partners, 37% use strangulation—often referred to as the “last warning shot” due to strangulation being a critical predictor of future homicide.
A Growing Problem: Normalization of Strangulation in Culture
Over the past several years, strangulation has become normalized in media and social spaces:
- Movies and TV often portray it unrealistically, without showing consequences.
- MMA and combat sports use of choking as technique.
- Pornography increasingly depicts aggressive choking.
- In sex culture, what used to be labeled “violent” is now often called “rough,” with many not fully understanding the risks.
- Social media trends like the “Choking Game/Blackout Challenge” encourage dangerous behaviors among adolescents.
The Question of Consent
One might ask, what if two consenting adults who are not in an abusive relationship engage in choking or strangulation as something they enjoy? The key part to this is our definition and understanding of consent.
Consent must be:
- Fully informed — meaning the individual understands the medical risks.
- Withdrawable at any time — but strangulation dims the brain, making it impossible to withdraw consent when consciousness is impaired.
In reality:
- 76–90% of participants did not consent to strangulation during sex.
- 85% wanted it to stop but 67% were unable to stop it.
Final Thoughts
When strangulation occurs in intimate partner violence, it is not a minor act. It is attempted homicide, a medical emergency, and a major red flag for future lethal violence. Yet because it often leaves no visible injuries, its severity is too often underestimated.
If you or someone you know has experienced strangulation, seek medical care immediately, even if no marks are visible. And reach out to local domestic violence services, such as Faces of Hope, for support.
References:
St. Luke’s CARES
Alliance for Hope International
Institute for Addressing Strangulation
Training Institute on Strangulation Prevention
