Strangulation: The Most Lethal Form of Domestic Violence


Strangulation is a highly dangerous form of domestic violence that is a predictor of lethality.

In May 2018, The Center for Family Safety and Healing collaborated with The Ohio State University Wexner Medical Center Project S.A.F.E. (Safe Assessment For Everyone) program to host “Safer Today: Understanding Lethality and Domestic Violence.” Local law enforcement, prosecution and forensic nurses shared valuable knowledge on strangulation and its lasting physical and psychological effects on victims.

First, let’s de-bunk a common myth. In a recent survey of battered women, 68 percent experienced strangulation as a method of violence. However, most strangulation incidents leave no marks or bruising on the victim. (Wilbur et al,. 2001)

After a violent incident, domestic violence victims sometimes disclose that they were “choked”, opposed to strangled. To clarify, choking is defined as the obstruction of the air passages due to a foreign body, such as a piece of food. Strangulation is a form of asphyxia in which blood vessels or air passages are closed due to external pressure on the neck. Abusers may strangle their victim(s) with their hands and forearms, or with a nearby object such as a scarf, belt, seat belt, shoestring, necklace or rope.

So what can we draw from this? Victims often have poor recall of events due to loss of consciousness from the strangulation. Because most strangulation incidents leave no external marks on the victim, it is possible that symptoms can be overlooked or downplayed, even if a police report is made the same day and the victim is seen in an emergency department. Physical and psychological symptoms may appear days or weeks afterward. Common visible injuries that can develop on a victim are petechiae, small broken blood vessels, which can develop near the mouth, face, earlobes, eyelids and eyeballs.

Police and first responders should look for signs other than immediate bruising, such as slurred speech, redness around the eyes or scalp, difficulty swallowing or a hoarse voice. In addition, if a victim is seen by a health care provider, the provider should consider requesting an MRI, CT scan or ultrasound to reveal internal injuries. Victims can die up to 36 hours after strangulation with no visible external injuries.

We know that a victim with a history of non-fatal strangulation is seven times more likely to become a victim of homicide.* The aftermath can leave her feeling helpless and vulnerable, especially knowing that someone who claims to love her is willing and able to kill her. Lasting effects include dizziness, combativeness, suicidal ideations, panic attacks, eyelid droop, weakness, paralysis, sensory defects, seizures, loss of consciousness and incontinence. In addition, victims may experience permanent voice changes (often referred to as hoarseness), breathing changes, difficulty swallowing, neck swelling, decreased heart rate and long-term amnesia.

The Training Institute on Strangulation Prevention is an excellent resource for providers and organizations that provides in-depth descriptions of strangulation symptoms and statistics. Below are three helpful fact sheets:

Law enforcement uses a screening tool called the Lethality Assessment Program – Maryland Model, often referred to as MLAP, to determine if a victim is at high risk for lethality by a current or former intimate partner. This tool was created by the Maryland Network Against Domestic Violence in 2005. It was originally designed for law enforcement, but is now used by allied professionals such as nurses, social workers, hospital personnel, case workers and court personnel.

If a victim screens in as high risk, law enforcement informs the victim and asks if they want to speak with a domestic violence advocate. Officers make the call to community-based domestic violence service program (DVSP) and proceed with one of two responses.

Response #1: The victim chooses to speak with an advocate
The advocate leads a brief conversation with the victim discussing safety planning for the next 24 hours. The officer may then assist in transporting the victim to shelter or beginning the process of obtaining a protection order.

Response #2: The victims chooses not to speak with an advocate
In this case, the officer still calls the DVSP and offers again (no more than twice) if the victim would like to speak with the advocate. If the victim declines, the officer will discuss safety planning over the phone with that advocate and relay the information to the victim. The officer may review factors that are predictors of homicide and other measures concerning the victim’s safety and well-being.

In Franklin County, MLAP Team Members include the following police departments: Columbus Division of Police, Franklin County Sheriff’s Office, Bexley, Grandview Heights, Grove City, Groveport, Hilliard, Minerva Park, Reynoldsburg, Upper Arlington, Valleyview, Westerville and Whitehall.

In addition to police departments, the following Franklin County law enforcement townships are MLAP Team Members: Blendon Twp, Clinton Twp, Franklin Twp, Mifflin Twp, Perry Twp and Sharon Twp.

Local MLAP Team Members also include the following domestic violence service providers (DVSP) and partners: The Center for Family Safety and Healing, Franklin County Office of Homeland Security and Justice Programs and the Columbus City Attorney’s Office.

National Resources

  • The Training Institute on Strangulation Prevention
    StrangulationTrainingInstitute.com
  • Crisis Text Line
    Text “HOME” to 741-741
    CrisisTextLine.org
    Crisis Text Line is a free, 24/7 support for those in crisis. Live, trained Crisis Counselors receive the incoming texts and respond via a secure online platform.

Local Resources

  • CHOICES
    614-224-HOME (4663)
    LSSNetworkOfHope.org
    CHOICES provides a 24-hour domestic violence crisis line, in addition to temporary emergency shelter, advocacy and counseling.
  • The Center for Family Safety and Healing (TCFSH) Adult Services Program
    614-722-8293
    familysafetyandhealing.org 
    TCFSH provides evidence-based domestic violence advocacy and counseling, safety planning and legal assistance.

*Glass, N., Laughon, K., Campbell, JC., Hanson, G., Sharps, P.W., Taliaferro, E. (2008). Non-fatal strangulation is an important risk factor for homicide of women. J of Emer Med 35, 329-335.

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