Strangulation has only recently been identified as one of the most lethal forms of domestic violence: unconsciousness may occur within seconds and death within minutes. When domestic violence perpetrators choke (strangle) their victims, not only is this a felonious assault, but it may be an attempted homicide. Strangulation is an ultimate form of power and control, where the batterer can demonstrate control over the victim’s next breath; having devastating psychological effects or a potentially fatal outcome.

Sober and conscious victims of strangulation will first feel terror and severe pain. If strangulation persists, unconsciousness will follow.  Before lapsing into unconsciousness, a strangulation victim will usually resist violently, often producing injuries of their own neck in an effort to claw off the assailant, and frequently also producing injury on the face or hands to their assailant. These defensive injuries may not be present if the victim is physically or chemically restrained before the assault.

Losing Consciousness

Victims may lose consciousness by any one or all of the following methods: blocking of the carotid arteries in the neck (depriving the brain of oxygen), blocking of the jugular veins (preventing deoxygenated blood from exiting the brain), and closing off the airway, making breathing Impossible.

Very little pressure on both the carotid arteries and/or veins for ten seconds is necessary to cause unconsciousness. However, if the pressure is immediately released, consciousness will be regained within ten seconds. To completely close off the trachea (windpipe), three times as much pressure (33 lbs.) is required. Brain death will occur in 4 to 5 minutes, if strangulation persists.


Observing Changes

Observation of the changes in these signs over time can greatly facilitate determination of the nature and scope of internal damage produced during the assault, and lend credibility to witness accounts of the force and duration of the assault.

Documentation by photographs sequentially for a period of days after the assault is very helpful in a journal of physical evidence.

Victims should also seek medical attention if they experience difficulty breathing, speaking, swallowing or experience nausea, vomiting, light headedness, headache, involuntary urination and/or defecation.

Although most victims may suffer no visible injuries whatsoever and many fully recover from being strangled, all victims, especially pregnant victims, should be encouraged to seek immediate medical attention. A medical evaluation may be crucial in detecting internal injuries and saving a life.


Signs of Strangulation

Face- red or flushed, pinpoint red spots (petichiae), scratch marks

Eyes and eyelids petichiae to the left or right eyeball, blood shot eyes

Nose - bloody nose, broken nose, petichiae

Finger tips- bruises are circular and oval and often faint

Ear-petichiae (external and/or ear canal), bleeding from ear canal

Mouth-bruising, swollen tongue, swollen lips, cuts/abrasions

Under the chin- redness, scratch marks, bruise(s), abrasions

Chest- redness, scratch marks, bruise(s), abrasions

Shoulders- redness, scratch marks, bruise(s), abrasions

Neck- redness, scratch marks, finger nail impressions, bruise(s), swelling, ligature mark

Head- petichiae (on the scalp)

Other- hair pulled, bump(s), skull fracture, concussion


Symptoms of Strangulation

Voice changes

·         Raspy voice

·         Hoarse voice

·         Coughing

·         Unable to speak

·         Complete loss of voice 

Swallowing changes

·         Trouble swallowing

·         Painful to swallow

·         Neck pain

·         Nausea/Vomiting

·         Drooling 

Breathing Changes

·         Difficulty breathing

·         Hyperventilation

·         Unable to breath 

Behavioral changes

·         Restlessness or combativeness

·         Problems concentrating, amnesia

·         Agitation

·         Post-traumatic Stress Syndrome

·         Hallucinations


Memory Loss



Involuntary urination or defecation