Strangulation: Raising awareness
by: Jessica Burks, VPC Program advocate
November is Strangulation Awareness Month. At the Violence Prevention Center, through our work with survivors of domestic violence and sexual assault in Cook County, we see strangulation far too often. Strangulation is an extreme form of violence used by perpetrators of domestic abuse and sexual assault. Despite its prevalence and severity, we’ve found that community members, system professionals, and even survivors themselves often lack vital knowledge about strangulation.
Understanding strangulation
Strangulation refers to external pressure on the neck that obstructs blood flow to and from the brain, and sometimes obstructs the ability to breathe. This could be someone putting one or both hands on a victim’s neck, using an arm or other body part or object to apply pressure to the neck, or putting the victim in a “chokehold.”
Domestic violence and sexual assault are rooted in perpetrators’ desire to exert power and control over their victims. Strangulation is the ultimate physical expression of power & control: the perpetrator exercises power over the victim by literally controlling the victim’s ability to get oxygen to their brain, controlling whether the victim lives or dies.
To understand strangulation, we need to understand how oxygen gets to the brain. Two systems provide oxygen to the brain: the respiratory system (breathing) and the cardiovascular system (heart and blood flow.) When we breathe, we breathe in oxygen. That oxygen goes into our blood, and our blood then carries and delivers that oxygen to our organs. Arteries carry oxygenated blood to the brain while veins carry deoxygenated blood away from the brain. This cycle of respiration and blood flow is what gives your brain a constant supply of oxygen.
Even when you hold your breath, your body still has oxygenated blood in it for some time, and as long as blood flow continues, your brain can continue to receive oxygen for a while. Because blood flow to and from the brain is not restricted when you hold your breath, most people can hold their breath for 30 - 90 seconds with relative ease, and some people like elite free divers can hold their breath for even longer, in the 10-20 minute range. What sets strangulation apart from simply holding your breath is that blood flow to and from the brain is obstructed. During strangulation, oxygenated blood cannot get to the brain and deoxygenated blood is trapped in the brain, which causes catastrophic damage in an exceptionally short amount of time.
Why is strangulation so serious?
The brain needs oxygen. The brain is the most sensitive organ to oxygen deprivation. Without oxygen, brain cells malfunction and die very quickly. Loss of consciousness, brain damage, and death occur in a matter of seconds with strangulation. The longer a strangulation lasts, and the more times that someone has been subjected to nonfatal strangulation, the more severe the damage to the brain and to the delicate internal structures of the neck.
This timeline shows just how quickly damage occurs during strangulation:
Loss of consciousness at 5-10 seconds
Anoxic seizure at 14 seconds
Loss of bladder control at 15 seconds
Petechiae (burst blood vessels) at 10-30 seconds
Loss of bowel control at 30 seconds
Death occurs at 62 seconds to 157 seconds
Strangulation survivors who lost consciousness (which occurs at only 5-10 seconds) will not remember passing out because the brain stops recording memories. Asking a strangulation survivor if they passed out is often not a reliable way of determining if they lost consciousness. Most survivors determine that they lost consciousness because they “lost time,” or can’t account for how they got from one place to waking up in another.
Strangulation often leaves no externally visible injuries. Over 50% of all strangulations (both fatal and nonfatal) leave no externally visible injuries. Of the 50% of strangulations that do leave externally visible injuries, only 15% of those leave injuries that are visible enough to be captured by camera. The lack of externally visible injuries (and the misconception that strangulation usually leaves marks) can lead to minimization of the seriousness of strangulation by law enforcement, the courts, medical professionals, and sometimes survivors themselves.
Strangulation can cause serious internal injuries. Even when there are no externally visible injuries after a strangulation, there may be internal injuries. Brain cell death, burst blood vessels in the brain, internal bleeding, damage to the carotid artery and jugular vein (dissection), and damage to the thyroid are just a few examples of some of the internal injuries that can occur without any externally visible signs. These injuries are a ticking time bomb, resulting in delayed stroke or death days, weeks, months, or even years after a strangulation. Additionally, women who are strangulation survivors report higher rates of thyroid cancer and thyroid related problems later in life.
Strangulation is a medical emergency. Survivors should seek treatment in the ER as soon as possible, even if you look and feel fine. A VPC advocate can accompany you or someone you know who has experienced strangulation to the ER for support.
Fatality risk: Strangulation is known as the “last warning shot” before intimate partner homicide. Domestic violence victims who are strangled by their abusers are 750% more likely to be killed by their abuser in a future assault. Among domestic abuse victims who are strangled by their abuser, 70% report that they believed they were going to die when their abuser was strangling them.
It doesn’t take much pressure to strangle. The jugular vein (which carries deoxygenated blood away from the brain) is closest to the surface of the neck, while the carotid artery (which carries oxygenated blood to the brain) is slightly deeper, and the trachea (airway) is deepest. Depending on the amount of force used during strangulation, one, two, or all three of these structures can be obstructed. The neck is an incredibly vulnerable part of the body, and it doesn’t take much force to obstruct the neck’s arteries, veins, or the trachea. Just 4.4 psi of pressure obstructs the jugular vein, 11psi obstructs the carotid artery, and 33psi obstructs the airway. To put this into perspective, the average adult male handshake is anywhere from 80-160psi, and it takes around 20 psi to open a pop can.
Help is available
The Violence Prevention Center is here for you. If you or someone you know has been affected by domestic violence or sexual assault, call 218-387-1262 24 hours a day to speak with an advocate. A VPC advocate can accompany you to the ER for emergency medical treatment in the aftermath of abuse or assault. Our services are free and confidential. We’re here to listen and help you figure out what comes next.
To learn more about strangulation:
The Training Institute on Strangulation Prevention is a great resource for learning more about strangulation. They are an internationally recognized organization with free webinars and a wealth of information on their website, allianceforhope.org/training-institute-on-strangulation-prevention.
