Strangulation (domestic violence)

Last updated on 23 June 2017

Strangulation in the context of domestic violence is a potentially lethal form of assault. Unconsciousness may occur within seconds of strangulation and death within minutes. Strangulation can be difficult to detect and until recently was often not treated as a serious crime. However, in many jurisdictions strangulation is now a specific criminal offense, or an aggravating factor in assault cases.

Differences from choking

Although sometimes the words are used interchangeably, "strangulation" and "choking" are not the same thing. Choking is when air flow is blocked by food or a foreign object in the trachea – something that can be addressed by the Heimlich maneuver. Strangulation, by contrast, is defined by reduced air flow and/or blood flow to or from the brain via the intentional external compression of blood vessels or the airway in the neck. Notably, however, many victims of strangulation refer to the assault as "choking".

Manual strangulation (i.e., gripping the throat with one’s hands) is the most common method of strangulation in intimate partner violence, although ligatures (e.g., belts, scarves) are sometimes used.

Epidemiology

A systematic review of 23 articles based on 11 surveys in 9 countries (N=74,785, about two-thirds of whom were women) found that 3.0% to 9.7% of women reported that they had at some time been strangled by an intimate partner.[1] A total of 0.4% to 2.4% – with 1.0% being typical – reported that they had experienced it in the past year, and women were between 2 times and 14 times more likely to be strangled by an intimate partner than were men.[1]

The most recent national survey in the U.S. that asked about strangulation by an intimate partner asked 16,507 adults (55% of whom were women) if a partner had tried to hurt them by choking or suffocating them. A total of 9.7% responded that a partner had done so at some point in their lifetime; 0.9% reported that it had happened during the past year.[2]

The prevalence of strangulation appears to be decreasing in Canada, the only country with multiple cross-sectional surveys that measure strangulation.[3]

The first major study of surviving victims of strangulation assault found that 99% of the 300 victims in criminal cases involving "choking" were female.[4] In 2000, a meta-analytic review of gender differences in physical aggression against a heterosexual partner concluded that ". ..'choke or strangle' is very clearly a male act, whether based on self- or partner reports."[5] A similar conclusion was reached in a 2014 multi-nation review: "…women are more likely than men to report that they were strangled by an intimate partner."[1]

A series of studies conducted in Canada found the same gender discrepancy and reported that strangulation by an intimate is more common among disabled persons,[6] cohabiting (vs. married) persons,[3][7] and those in a step- (vs. biological) family.[8] Women who had been abused by an intimate partner reported higher rates of strangulation.[9][10]

Strangulation is sometimes fatal. According to a large U.S. case control study, prior strangulation is a substantial and unique predictor of attempted and completed homicide of women by a male intimate partner. The study showed that the odds of becoming an attempted homicide victim increased 7-fold and the odds of becoming a homicide victim increased 8-fold for women who had been strangled by their partner.[11] When over three dozen other characteristics of the victim, perpetrator, and incident were taken into account, however, strangulation no longer was a unique predictor.[12] Strangulation is so common in battering (50% or more battered women report that they've been strangled) that it doesn't differentiate abuse in which the victim survives or dies.[12]

Experience of strangulation

Strangulation has been likened to drowning[13] and researchers at the University of Pennsylvania[14] have likened non- or near-fatal strangulation to water boarding,[1] which is widely considered a form of torture.

A special issue of the Domestic Violence Report devoted to the crime of strangulation states: "Many domestic violence offenders and rapists do not strangle their partners to kill them; they strangle them to let them know they can kill them—any time they wish. Once victims know this truth, they live under the power and control of their abusers day in and day out."[15]

Outcomes

Strangulation can produce minor injuries, serious bodily injury, and death. Evidence of the assault can be difficult to detect because many victims may not have visible injuries and/or their symptoms may be nonspecific.

Victims may have internal injuries, such as laryngo-tracheal injuries, digestive tract injuries, vascular injuries, neurological system injuries and orthopedic injuries. Clinical symptoms of these internal injuries may include neck and sore-throat pain, voice changes (hoarse or raspy voice or the inability to speak), coughing, swallowing abnormalities, and changes in mental status, consciousness and behavior. Neurological symptoms may include vision changes, dimming, blurring, decrease of peripheral vision and seeing "stars" or "flashing lights." Post-anoxic encephalopathy, psychosis, seizures, amnesia, cerebrovascular accident and progressive dementia may be indicative of neuropsychiatric effects.[15][16][17][18][19][20][21]

Signs of life-threatening or near fatal strangulation may include sight impairment, loss of consciousness, urinary or fecal incontinence and petechiae (pinpoint hemorrhages).[22] Even victims with seemingly minimal injuries and/or symptoms may die hours, days, or weeks later because of progressive, irreversible encephalopathy.[23]

Some visible signs of strangulation a victim should look for are injuries to their face, eyes, ears, nose, mouth, chin, neck, head, scalp, chest and shoulders, including: redness, scratches or abrasions, fingernail impressions in the skin, deep fingernail claw marks, ligature marks ("rope burns"), thumbprint-shaped bruises, blood-red eyes, pinpoint red spots called "petechiae" or blue fingernails.[24]

Laws

For many years across the country, prosecutors have failed to treat non- and near-fatal strangulation assaults as serious crimes, largely due to the lack of physical evidence. Because of involvement of the medical profession, specialized training for police and prosecutors, and ongoing research, strangulation has become a focus of policymakers and professionals working to reduce intimate partner violence and sexual assault.

As of November 2014, 44 U.S. states, the District of Columbia, the federal government and two territories have some form of strangulation or impeding breathing statute.[25] Twenty-three states and one territory have enacted legislation making strangulation a felony.[25] One state legislature, Utah, passed a joint resolution which made legislative findings that can help prosecutors apply existing assault statutes with a special emphasis on non-fatal strangulation assaults.[26] In 2013, Congress re-authorized the Violence Against Women Act and added, for the first time, strangulation and suffocation as a specific federal felony.[27]

Improving detection and intervention

Starting in 1995, the work of Gael Strack and Casey Gwinn in San Diego has helped identify and address challenges in detecting, investigating, and prosecuting strangulation and suffocation offenses in intimate partner violence, sexual assault, elder abuse, and child abuse cases. In 2011, Strack and Gwinn created the Training Institute on Strangulation Prevention, the most comprehensive training program in the United States for the documentation, investigation, and prosecution of non and near-fatal strangulation assaults.[28] They have published multiple state-specific books to guide the investigation and prosecution of non and near-fatal strangulation assaults.[29] Published appellate opinions have begun to proliferate across the United States as courts are upholding felony strangulation convictions even with minimal external visible injury to the victims. The importance of multi-disciplinary responses by doctors, nurses, advocates, police officers, and prosecutors has become clear in properly identifying, treating, investigating, and prosecuting strangulation assaults.

References

  1. ^ a b c d Sorenson SB, Joshi M, Sivitz E (2014). "A systematic review of the epidemiology of nonfatal strangulation, a human rights and health concern". American Journal of Public Health. 104 (11): e54-e61. PMID 25211747. doi:10.2105/AJPH.2014.302191.
  2. ^ Black MC, Basile KC, Breiding MJ., et al. The National Intimate Partner and Sexual Violence Survey (NISVS): 2010 summary report. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 2011. http://www.cdc.gov/violenceprevention/pdf/nisvs_report2010-a.pdf
  3. ^ a b Brownridge DA (2008). "The elevated risk for violence against cohabiting women: A comparison of three nationally representative surveys of Canada". Violence Against Women. 14 (7): 809–832. doi:10.1177/1077801208320368.
  4. ^ Strack G, McClane G, Hawley D (2001). "A review of 300 attempted strangulation cases – Part I: Criminal legal issues". Journal of Emergency Medicine. 21: 303–309. doi:10.1016/S0736-4679(01)00399-7.
  5. ^ Archer J (2000). "Sex differences in physically aggressive acts between heterosexual partners: a meta-analytic review". Psychological Bulletin. 126 (5): 651–680. PMID 10989615. doi:10.1037/0033-2909.126.5.651.
  6. ^ Brownridge DA (2006). "Partner violence against women with disabilities: prevalence, risk, and explanations". Violence Against Women. 12 (9): 805–822. doi:10.1177/1077801206292681.
  7. ^ Brownridge DA (2004). "Understanding women's heightened risk of violence in common-law unions: Revisiting the selection and relationship hypotheses". Violence Against Women. 10 (6): 626–651. doi:10.1177/1077801204265017.
  8. ^ Brownridge DA (2004). "Male partner violence against women in stepfamilies: an analysis of risk and explanations in the Canadian milieu". Violence Vict. 19 (1): 17–36. doi:10.1891/vivi.19.1.17.33239.
  9. ^ Barrett BJ, St. Pierre M (2011). "Variations in women’s help seeking in response to intimate partner violence: findings from a Canadian population-based study". Violence Against Women. 17 (1): 47–70. PMID 21199809. doi:10.1177/1077801210394273.
  10. ^ Macmillan R, Gartner R (1999). "When she brings home the bacon: Labor-force participation and the risk of spousal violence against women". J Marriage Fam. 61 (4): 947–958. doi:10.2307/354015.
  11. ^ Glass N, Laughon K, Campbell JC et al. (2008). "Non-fatal strangulation is an important risk factor for homicide of women". J Emerg Med. 35 (3): 329–335. doi:10.1016/j.jemermed.2007.02.065.
  12. ^ a b Campbell JC, Webster D, Koziol-McLain J et al. (2003). "Risk factors for femicide in abusive relationships: results from a multisite case control study". Am J Public Health. 93 (7): 1089–1097. doi:10.2105/AJPH.93.7.1089.
  13. ^ Thomas, Kristie A.; Joshi, Manisha; Sorenson, Susan B. (March 2014). ""Do you know what it feels like to drown?": strangulation as coercive control in intimate relationships". Psychology of Women Quarterly. Sage. 38 (1): 124–137. doi:10.1177/0361684313488354. Pdf.
  14. ^ "Home page". ortnercenter.org. Evelyn Jacobs Ortner Center on Family Violence, University of Pennsylvania.
  15. ^ a b "Law reform targets the crime of strangulation". Domestic Violence Report. 19 (6): 81–100. August–September 2014. Pdf.
  16. ^ Joshi, Manisha; Thomas, Kristie A.; Sorenson, Susan B. (October 2012). ""I didn't know I could turn colors": health problems and health care experiences of women strangled by an intimate partner". Social Work in Health Care. Taylor and Francis. 51 (9): 798–814. PMID 23078012. doi:10.1080/00981389.2012.692352. Pdf.
  17. ^ Malek AM, Higashida RT et al. (2000). "Patient presentation, radiographic features, and treatment of strangulation-induced bilateral dissection of the cervical internal carotid artery". Journal of Neurosurgery. 92: 481–487. PMID 10701540. doi:10.3171/jns.2000.92.3.0481.
  18. ^ Malek AM, Higashida RT, Phatouros CC, Halbach VV (1999). "A strangled wife". Lancet. 353 (9161): 1324. PMID 10218532. doi:10.1016/S0140-6736(98)12179-7.
  19. ^ Milligan N, Anderson M (1980). "Conjugal disharmony: a hitherto unrecognised cause of strokes". Br Med J. 281 (6237): 421–2. PMC 1713281 Freely accessible. PMID 7427300. doi:10.1136/bmj.281.6237.421.
  20. ^ Smith DJ, Mills T, Taliaferro EH (2001). "Frequency and relationship of reported symptomology in victims of intimate partner violence: the effect of multiple strangulation attacks". J Emerg Med. 21 (3): 323–9. PMID 11604297. doi:10.1016/s0736-4679(01)00402-4.
  21. ^ Valera EM, Berenbaum H (2003). "Brain injury in battered women". J Consult Clin Psychol. 71 (4): 797–804. PMID 12924684.
  22. ^ Christe A, Thoeny H, Ross S, Spendlove D, Tshering D, Bolliger S, Grabherr S, Thali MJ, Vock P, Oesterhelweg L (2009). "Life-threatening versus non-life-threatening manual strangulation: are there appropriate criteria for MR imaging of the neck?". Eur Radiol. 19 (8): 1882–9. PMID 19283386. doi:10.1007/s00330-009-1353-2.
  23. ^ McClane GE, Strack GB, Hawley D (2001). "A review of 300 attempted strangulation cases Part II: clinical evaluation of the surviving victim". J Emerg Med. 21 (3): 311–5. PMID 11604295. doi:10.1016/s0736-4679(01)00400-0.
  24. ^ publication by Training Institute on Strangulation Prevention and the California District Attorneys Association|appendix 25| title= Facts That Victims of Choking (Strangulation )Need to Know!|year= 2013
  25. ^ a b "Strangulation / Impeded Breathing" (PDF). National District Attorneys Association.
  26. ^ "Strangulation and Domestic Violence. Joint Resolution, 2010 General Session". State of Utah.
  27. ^ "Memorandum concerning the Violence Against Women Reauthorization Act of 2013" (PDF). U. S. Department of Justice.
  28. ^ "Training Institute on Strangulation Prevention.".
  29. ^ Strack G, Gwinn C. (2011). "On the edge of a homicide: Strangulation as a prelude". Criminal Justice. 26 (3): 32–36.

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