OPDV Bulletin:
Strangulation in Domestic Violence and Sexual Assault

"He choked me~ but there are no marks."

In 1999, the Clinton County District Attorney's Office and the New York Prosecutors Training Institute (NYPTI) hosted the nation's leading experts in the prosecution and investigation of strangulation cases. Assistant District Attorney Gael Strack and George McClane, MD, both from San Diego, California, presented their findings at the three-day conference, "Detection and Prosecution of Strangulation in Domestic Violence and Sexual Assault Cases," funded by the US Department of Justice Violence Against Women Grants Office and the New York State Division of Criminal Justice Services. The following is adapted from a condensed portion of their presentation.

"He choked me - but there are no marks." Strangulation has only recently been identified as one of the most lethal forms of domestic violence. When perpetrators use strangulation to silence their victims, this is a form of power and control that has a devastating psychological effect on victims and a potentially fatal outcome. Historically, "choking" was rarely prosecuted as a serious offense because victims minimize the level of violence and police and medical personnel fail to recognize it.

Strangulation is defined as a form of asphyxia and is characterized by closure of the blood vessels and/or air passages of the neck as a result of external pressure on the neck. It is often incorrectly referred to as choking which involves blocking, or obstructing the windpipe. Ten percent of violent deaths in the US each year are due to strangulation, with six female victims to every male.

Strangulation by ligature is done with a cord like object that could include anything from a telephone cord to articles of clothing. Manual strangulation is done with the hands, forearms (as in the classic chokehold), or standing or kneeling on the victim's throat.

Clinically, a victim who is being strangled first experiences severe pain, followed by unconsciousness, and then brain death. The victim will lose consciousness by any one or more of the following: blocking of the carotid arteries (depriving the brain of oxygen), blocking of the jugular veins (preventing deoxygenated blood from exiting the brain), and/or closing off the airway, causing the victim to be unable to breathe. Only eleven pounds of pressure placed upon both carotid arteries for ten seconds is necessary to cause unconsciousness. If pressure is released immediately, consciousness will be regained within ten seconds. After 50 seconds of continuous oxygen deprivation the victim rarely recovers. To completely close off the trachea, three times as much pressure (33 lbs.) is required. For comparison purposes, it only takes 8 lbs. of pressure to pull a trigger on a gun.

Fifty percent of victims report symptomatic voice changes which may be as mild as simple hoarseness or a complete loss of voice. Many victims also report that it is difficult or painful to swallow. This is due to injury of the larynx cartilage and/or hyoid bone, a small horseshoe shaped bone in the neck. Difficulty getting a breath may be due to the hyperventilation that normally accompanies a terrifying event, but more importantly may be secondary to underlying neck injury. It is critical to know that breathing changes may initially appear to be mild, yet underlying injuries may kill the victim hours or days later due to decompensation of the injured structures. Involuntary urination and defecation often occurs. Officers should inquire about such because victims may be embarrassed and reluctant to disclose these facts unless asked.

Visible injuries to the neck may include scratches, abrasions, and scrapes. Redness on the neck may be fleeting, but may demonstrate a detectable pattern. These marks may or may not darken to become a bruise. Bruises may not appear for hours or even days. Chin abrasions are also common, as are tiny red spots called petechiae. These are caused by ruptured capillaries and may be found around the eyes, under the eyelids, anywhere on the face, and on the neck above the area of constriction. Blood red eyes are due to capillary rupture in the white portion of the eyes. This phenomenon suggests a particularly vigorous struggle between the victim and assailant.

In 70 to 80 percent of all domestic violence cases, the victim will recant. Therefore law enforcement should anticipate this and plan on prosecution based on the evidence, just like in a murder case. Efforts should be made to investigate the cases like an attempted homicide case. It is important to ask as many questions as possible at the earliest time possible. For specific questions and checklists to assist in detecting and investigating strangulation cases, go to http://www.correctionhistory.org/northcountry/html/knowlaw/strangulationinvestigation3.htm.

Condensed by NYPTI, (518) 432-1100, the Continuing Legal Education and Mutual Assistance Division of the New York State District Attorneys Association. The points of view or opinions stated in this article are those of the particular author and do not represent the official position of the NYS Division of Criminal Justice Services. Information dealing with a specific legal matter should be researched in original and current sources of authority.

Note to Officers and Prosecutors: Treat Your Strangulation Cases Seriously

Start by using the word "strangle" as opposed to the word "choke." Strangle means to obstruct seriously or fatally the normal breathing of a person. Choke means having the windpipe blocked entirely or partly by some foreign object like food.

"How to Improve Your Investigation and Prosecution of Strangulation Cases" by Gael B. Strack, San Diego Assistant City Attorney and Dr. George McClane, Emergency Physician, October 1998, updated May 1999 is an excellent article. It can be obtained by request from Gael B. Strack at: Gael B. Strack at gstrack@SanDiego.gov