Strangulation Among Victims of Intimate Partner Violence: Informing the Social Work Response

Background and Purpose: Strangulation is a form of severe intimate partner violence (IPV) that affects up to 9.7% of women worldwide (Sorrenson, Joshi & Sivitz, 2014) and up to 89% of IPV victim-survivors (Messing et al., 2014). Strangulation is a risk factor for homicide, has been described as a form of torture, and is compared to drowning by women who experience it (Thomas, Joshi, Sorrenson, 2014). Despite the deadly consequences, strangulation often leaves few visible injuries and is under-identified by social workers and law enforcement (Kwako et al., 2011). This study examines the factors associated with strangulation in order to inform the social service response to this severe form of violence. 

Methods: Data from 19,959 intimate partner domestic violence incidents were gathered from a single Police Department in the Southwest U.S. (2011-2013). Logistic regression was used to examine the association between strangulation and incident specific characteristics including demographic information, co-occurring acts of violence and abuse, injury, and elements of coercive control such as intimidation, demands, and harassment.

Results: Strangulation was reported in 7.39% (n=1,474) of IPV cases; 58.62% (n=864) of women strangled said that this was the worst incident of violence that they experienced. Female (OR=3.68, p<.001), African American victim-survivors (OR=1.62, p<.001) were more likely to be strangled, as were victim-survivors who had previously made it known to their partner they wanted to end the relationship (OR=1.35, p<.01). During an incident of strangulation, the perpetrator was also likely to hold their partner down (OR=2.68, p<.001), restrict her movement (OR=1.73, p<.001), and suffocate her (OR=4.40, p<.001). Intimidation, an element of coercive control, was more likely to be present in cases of strangulation (OR=1.29, p<.001). However, other acts of severe violence, such as hitting with an object (OR=.48, p<.01), punching/slapping (OR=.63, p<.001) and kicking/stomping (OR=.54, p<.05), were less likely to occur with strangulation. Victim-survivors who were strangled were more likely to suffer from the following injuries: unconsciousness (OR=8.57, p<.001), endangering a fetus (OR=1.75, p<.01), discoloration (OR=2.15, p<.001), bruises (OR=2.05, p<.001), and scratches (OR=2.01, p<.001). Finally, those who were strangled were also more likely to be hospitalized (OR=1.65, p<.01).   

Conclusions and Implications: Although women who are strangled are not likely to present with visible injuries, in this sample, when strangulation was identified, injuries consistent with strangulation were also identified. Along with the relatively low proportion of strangulation victims in this sample when compared to previous studies of IPV victim-survivors, this suggests that police are under-identifying strangulation. Social workers should be aware of the less visible signs of strangulation – such as a hoarse voice, sore throat, and difficulty breathing. Women who are strangled are also likely to be held down, and may injure their partner (e.g., by scratching) in self-defense. Although strangulation is not likely to occur with other serious violent acts, it is likely to co-occur with at least some coercive controlling behaviors. It is important for social workers to be aware of risk for lethality and coercive control to provide better advocacy when working with victim-survivors of IPV strangulation.