A 26-year-old female presents to the emergency department, stating that her husband assaulted her. She complains of headache and sore throat. When directly questioned, she states, “He choked me so bad, I thought I was going to die. I might have blacked out for a minute. It really hurts to swallow.”
Strangulation is a form of asphyxia, characterized by closure of the blood vessels and air passages of the neck as a result of external pressure. There is a distinction between strangulation and choking, which is an internal obstruction of the airway. There is a misperception that strangulation is always fatal, and patients will often describe a “choking” episode following nonfatal strangulation.
Strangulation and Domestic Violence
Strangulation has been identified as one of the most lethal forms of domestic violence. It is one of the best predictors for subsequent homicide. Prior strangulation increases the odds of strangulation homicide by more than seven times.1 For perpetrators, strangulation is the ultimate form of power and control. However, because there are often no visible injuries, patients, physicians, and law enforcement often minimize the possible health consequences of reported strangulation.