Women's Experience of Strangulation in Intimate Relationships

Purpose: Strangulation is a significant risk factor for attempted or completed homicide of women by their male intimates. Strangulation can have substantial physical (e.g., throat and neck injuries, breathing problems), neurological (e.g., loss of sensation, speech problems) and psychological (e.g., post traumatic stress disorder, insomnia) health effects. Oxygen deprivation due to strangulation can induce unconsciousness within seconds, and brain injury and death within minutes. Strangulation is often incorrectly referred to as choking. Choking involves internal blocking of the trachea by a foreign object like food, whereas strangulation involves oxygen deprivation due to compression of blood vessels or air passages of the neck as a result of external pressure. The distinction is legally important and the latter should specifically be addressed as strangulation. Strangulation is particularly pernicious because, unlike other forms of physical violence, it often leaves no external evidence on the skin. The difficulty in detecting strangulation is a challenge for police and medical professionals, which helps make it a particularly useful means of intimidation and harm for an abuser. Current knowledge about strangulation in the context of intimate relationships is limited. No studies provide women's own descriptions of their experience of strangulation, its impact on different domains of their life, and the resources they chose to (or chose not to) use for help and support. To address this research gap, the current study was designed.

Methods: Eight in-depth interviews and two focus groups were conducted with 17 women survivors of strangulation by a male intimate. All participants were 18 years or older and were recruited from the only domestic violence shelter in an east coast city in the U.S. Interviews and focus groups were semi-structured, were audio-taped, and were transcribed verbatim. Ground theory method was used for data analysis.

Results: Fifteen women had experienced multiple strangulations, and 14 had lost consciousness in one or more incidents. Perpetrators typically used their hands; objects such as shoe laces and clothing also were used. Women tended to associate the term “choking” with hands and “strangulation” with objects. They experienced a range of physical problems (e.g., difficulty breathing/swallowing, neck pain, hoarse voice) that lasted from a week to months, and psychological problems such as nightmares, insomnia, anxiety and fear of a male putting his arms around them. Most often, women contacted family or friends for help. When police were called they rarely took action unless injuries were visible. Few women disclosed the assault to a medical provider and rarely did a provider ask them about strangulation. Women who shared their experience with the shelter staff were rarely told about the risks associated with strangulation or use of the correct term, that is, strangulation versus choking.

Conclusions and Implications: Strangulation is a common form of intimate partner violence against women. Training police officers to detect and investigate strangulation is crucial. Medical providers need training in the detection, assessment and evaluation of strangulation-related symptoms and injuries. Moreover, all advocates and women's shelter staff should be educated about strangulation.