Strangulation, also known as throttling or chokeholding, involves compressing the neck to obstruct blood vessels and/or airflow. It can be done manually, with a ligature like a rope or belt, or by applying pressure against a wall or floor. Strangulation is extremely dangerous and can lead to serious injury or death in just minutes. While it may seem possible to strangle someone without leaving external marks, there are often internal injuries that can be detected through medical examination. Strangulation should never be taken lightly or attempted, even if the intent is not to kill.
Mechanism of Strangulation Injury
Strangulation can cause a variety of damaging effects through both suffocation and vascular obstruction. Pressure on the airway and veins/arteries of the neck can include:
- Blocking airflow and preventing oxygen from reaching the lungs and brain
- Occlusion of the jugular veins, preventing deoxygenated blood from exiting the brain
- Occlusion of the carotid arteries, cutting off oxygenated blood supply to the brain
- Vagal response – pressure triggers the vagus nerves to slow the heart rate
This leads to cerebral hypoxia – a lack of oxygen to the brain. Unconsciousness can occur within 5-10 seconds if blood flow is fully occluded. Permanent brain damage and death will follow rapidly if strangulation persists. Even if the victim survives, they may suffer serious consequences like stroke, neurological deficits, and pneumonia from aspiration during the attack.
Detecting Strangulation Injuries
Strangulation may leave no visible external injuries, especially in lighter-skinned individuals. However, it frequently causes internal damage that can be identified on medical evaluation. Tell-tale signs include:
Neck Trauma
- Petechiae – small red spots caused by broken blood vessels
- Scratches or abrasions from fingernails
- Bruising may develop hours after the attack
- Swelling around the neck
Neurological Changes
- Altered mental status – confusion, memory loss, unconsciousness
- Dizziness, vertigo, loss of balance
- Difficulty speaking, voice changes, coughing or drooling
- Facial tremors or seizures from lack of oxygen to the brain
Ocular Signs
- Petechiae in the eyes and eyelids
- Retinal hemorrhaging
- Vision changes or loss
The severity of markers depends on factors like duration and amount of pressure applied during the attack. But absence of external injuries does not preclude internal damage. Strangulation victims should always undergo comprehensive medical screening.
Detecting Recent Strangulation
In suspected strangulation cases, victims should be evaluated as soon as possible, even if they initially refuse medical care. Signs most evident in the first 48 hours include:
Voice and Throat Changes
- Raspy, hoarse voice
- Coughing or throat clearing
- Pain or difficulty speaking and swallowing
- Breathing changes from airway swelling
Neurological Symptoms
- Lightheadedness, headache, numbness
- Loss of memory, confusion, decreased coordination
- Lethargy, drowsiness from brain hypoxia
Psychological Trauma
- Fear, anxiety, restlessness
- Personality changes
- PTSD symptoms like flashbacks and nightmares
Many of these effects are transient but still indicate life-threatening injury occurred. Strangulation victims should be monitored for delayed complications like stroke, blood clots, and pulmonary issues.
Long Term Effects of Strangulation
Surviving strangulation can lead to chronic physical and emotional issues stemming from both hypoxia and direct trauma. Long term consequences may include:
Brain Damage
- Memory and cognition impairment
- Speech, language, and swallowing difficulties
- Headaches, vertigo, tremors
- Stroke from vascular injury
- Movement disorders like seizures
Psychological Trauma
- PTSD – flashbacks, insomnia, hypervigilance
- Depression and anxiety disorders
- Personality changes – irritability, mood swings
Other Effects
- Chronic neck and throat pain
- Voice and breathing changes
- Sleep apnea
- Vertigo and balance problems
- Vision changes from retinal damage
The high morbidity of strangulation means most survivors suffer permanent disability to some degree. Extensive rehabilitative therapy is often needed to restore speech, cognition, and emotional health.
Fatal Strangulation
Any strangulation incident can easily become lethal. Death can occur immediately or be delayed for hours or days. Mechanisms of fatal strangulation include:
- Asphyxiation from airway compression or respiratory obstruction
- Cerebral anoxia from lack of blood flow to the brain
- Cardiac arrhythmias from vagal stimulation
- Carotid or vertebral artery dissection leading to stroke
- Hyoid bone fracture with internal bleeding
- Cervical spine fractures and spinal cord trauma if the head is forced into extreme flexion or extension
Even if the victim appears fine initially, complications like stroke, seizures, and cerebral edema can result in delayed death. Any loss of consciousness during an attack is highly ominous. Prompt emergency medical care is vital.
Statistics on Strangulation Injuries and Fatalities
Some key statistics on the prevalence and dangers of strangulation include:
| 10 seconds | Time until loss of consciousness in severe strangulation cases |
| 4 minutes | Duration of cerebral anoxia before risk of permanent brain damage or death |
| 20% | Portion of female domestic violence victims reporting at least one strangulation incident |
| 70% | % of strangulation victims with NO visible injuries per research studies |
| 300% | Increased risk of later homicide in domestic abuse cases if strangulation occurred |
| 50% | % of female strangulation victims who believe they will be killed by their abuser |
These sobering statistics illustrate why strangulation is one of the most lethal forms of violence. The lack of external injury should never give a false sense of security. All strangulation incidents need immediate medical assessment given the risk of delayed complications and death.
Legal Consequences of Strangulation
Most jurisdictions have enacted laws specifically criminalizing strangulation as a felony. Even if no bruising or marks are visible, medical documentation of internal injuries can provide evidence to prosecute. Potential legal consequences include:
- Felony assault or domestic violence charges
- Up to 10 years in prison in some states
- Enhanced penalties if done against pregnant women, children, or elderly
- Restraining orders prohibiting contact with the victim
- Anger management and batterer intervention programs
- Homicide charges if the victim dies
Strangulation is considered a major risk factor for eventual intimate partner femicide. Courts may prosecute aggressively to prevent escalating violence. There is no “safe” way to strangle someone – all cases warrant criminal charges.
Prevention of Strangulation
The only effective way to prevent strangulation injury and death is by completely avoiding this act under any circumstances, no matter how angry or threatened a person feels. Some tips include:
- Seek help from domestic violence resources if in an abusive relationship
- Avoid physical confrontations and walk away if needed
- Use calming techniques to manage anger and aggression
- Communicate with the other person if conflict arises
- Contact emergency services if a situation seems dangerous
- Speak up if witnessing violent or aggressive behavior in others
Public awareness and education is also key to curb strangulation assault and domestic violence. With support and early intervention, perpetrators can learn nonviolent ways to settle disputes. But the most important step begins with each person’s commitment to express emotions constructively, not physically.
Conclusion
Strangulation involves blocking the airway and blood vessels of the neck, which can lead to catastrophic injury and death within minutes. While it may seem possible to do without leaving external marks, medical evaluation nearly always detects internal trauma. Strangulation should never be attempted – it frequently causes severe long term impairment or fatality. Strong legal deterrents like felony charges help provide accountability and prevent recurrences. Ultimately, stopping strangulation requires education, resources, and each individual’s responsibility to resolve conflicts peacefully. With support and alternative coping methods, we can foster safer relationships and communities free of such intimate partner violence.