The Violent Reality of Strangulation

Written by Emily Arismendy

When we think about intimate partner violence (IPV) and sexual assault, strangulation is often overlooked even though it is one of the strongest predictors of homicide in abusive relationships. Victims who experience non-fatal strangulation by an intimate partner are 750% more likely to be murdered by that partner in the future. Despite its severity, strangulation is widely misunderstood. 

What Is Strangulation? 

Many people mistakenly use “choking” and “strangulation” interchangeably, but they are entirely different. 

• Choking is the blockage of respiratory passage by a foreign object. Choking is a result of a foreign body such as food or an object blocking the airway and preventing the exchange of oxygen carbon dioxide. 

• Strangulation is a form of asphyxiation involving the closure of the respiratory passage and/or blood vessels in the neck using the application of external pressure to the neck. It often involves the restriction of blood flow through the jugular veins or carotid arteries. 

Strangulation is a form of power and control, a calculated way for an abuser to assert dominance over their victim. It is often used in sexual violence, whether as part of a broader pattern of IPV or as a standalone act of assault. One study found that the prevalence of strangulation was 38% with Domestic Violence and 12% with Sexual Assault and that most intimate partner encounters with strangulation had significant risk for lethality. 

These numbers are severely underreported because many survivors do not recognize strangulation as a crime. This lack of awareness extends beyond victims, it exists among the entire population including public officials. 

Strangulation is life-threatening 

Strangulation is one of the deadliest forms of IPV, and its effects are often invisible. Someone who survives strangulation may appear physically unharmed, but that does not mean they are safe. It can cause unconsciousness within seconds and death in as little as four minutes. Even if a victim regains consciousness, the damage may already be done. 

According to the Training Institute on Strangulation Prevention, nearly four in five victims of strangulation are strangled manually (with hands). And almost all, or 97 percent of strangulation attempts, also involve blunt force trauma. 

Some of the life-threatening effects of strangulation include changes in one’s voice, neck pain, difficulty swallowing or breathing, ear pain, vomiting blood, vision change, tongue swelling, bloodshot eyes, and lightheadedness. 

One study found that out of 102 living victims of strangulation who underwent medicolegal evaluation nine (9%) women were pregnant at the time of the attack. The risks for these victims are even greater, as strangulation can lead to miscarriage and birth complications. 

Invisible symptoms 

Because strangulation does not always leave obvious marks, those who are untrained might fail to document it properly. Some victims have no visible bruising but suffer internal injuries, including: 

• Difficulty swallowing or speaking 

• Memory problems or confusion 

• Dizziness, headaches, or loss of consciousness 

• Bloodshot eyes from broken capillaries 

• Neck pain, tenderness, or swelling 

Forensic nurses play a crucial role in documenting strangulation injuries. However, many hospitals and law enforcement agencies do not routinely screen for strangulation leading to missed evidence and weaker legal cases. 

Legal and Judicial Challenges 

Even when strangulation is reported, it is rarely taken as seriously as it should be. Many victims say police officers dismissed their reports because there were “no visible injuries.” 

• Many juries do not understand the severity of strangulation. Without visible bruising, they assume the attack was not serious. 

• Attorneys and judges are often unaware of how lethal strangulation is. Cases are frequently miscategorized as “simple assault” instead of an attempted homicide. 

• Police may not ask the right questions. They may focus on whether a victim could breathe instead of asking about loss of consciousness, memory gaps, or throat pain, which are key signs of strangulation. 

Some states, including Texas, have recognized the danger and passed specific strangulation laws, making it a felony offense. However, training for law enforcement, prosecutors, and juries remains inconsistent, allowing dangerous offenders to walk free. 

Without proper education, the courts fail survivors, and the consequences can be fatal. 

The Role of Pornography 

In recent years, strangulation has become mainstream in pornography. Many young people first see strangulation in a sexual context through porn, without any understanding of its dangers. 

Research by Fight the New Drug found the following disturbing conclusions: 

• At least 1 in 3 porn videos show sexual violence or aggression.  

• Women Receive 97% of Physically Aggressive Acts in Porn. 

• 88% Of Popular Porn Videos Contain Violence 

Because of porn, strangulation is often seen as “just another kink” rather than the life-threatening act it is. Consent, communication, and boundaries are essential in intimacy, but many people, especially young viewers, do not understand the risks. It is critical to have informed discussions about boundaries, risks, and safety rather than assuming it is harmless because it is commonly depicted in porn. 

Protecting Survivors 

Strangulation is a serious and potentially fatal form of violence that must be recognized and addressed with the urgency it demands. It can cause severe internal injuries, brain damage, or even death within minutes, sometimes without leaving visible marks.  

Despite this, strangulation is often minimized or misunderstood in legal and medical settings, leaving survivors without the protection or justice they deserve. Proper education for law enforcement, medical professionals, and the legal system is essential to ensuring that strangulation is identified, documented, and prosecuted appropriately.  

It is also critical to challenge the normalization of strangulation in media and sexual content, reinforcing the importance of clear communication, consent, and boundaries in intimate relationships. Taking strangulation seriously can save lives, prevent further harm, and create a system that truly supports survivors. 

Eloise House 

At SAFE, we have a remarkable team of Forensic Nurses who are trained in intimate partner violence and are highly skilled in identifying strangulation and its serious implications. At Eloise House, survivors can receive comprehensive medical forensic exams at no cost, including documentation of strangulation injuries that might not be immediately visible. Our nurses understand the medical, legal, and emotional complexities of strangulation and work closely with advocates and law enforcement to ensure survivors have the support they need. Whether or not someone chooses to report, our forensic team provides a safe space for care, education, and healing. 

If you’ve experienced an unwanted sexual encounter, dating or domestic violence, or sex trafficking, contact SAFE for free resources and specialized care through the confidential, 24-hour SAFEline.  Call: 512–267–SAFE (7233), Text: 737–888–7233, or Chat: safeaustin.org/chat.