Strangulation Awareness Month

Following directly on the heels of October’s domestic violence awareness month, November’s designation as strangulation awareness month feels scarily apt. Because strangulation is the strongest indicator of a potential homicide in a violent relationship. A single incident of non-fatal strangulation increases the likelihood of an attempted or completed homicide by 750%. Strangulation in the context of intimate partner violence is deadly, period. And, unfortunately, everyone from survivors to advocates to law enforcement too often fail to recognize the danger of strangulation.

To clarify, most people will use the term ‘choking’. But the intentional act of in any way cutting off another person’s access to oxygen is strangulation. And it is an extremely dangerous crime. Indiana’s strangulation statute has been on the books in its current form since 2017. However, since so many people do not understand the realities and risks of strangulation, there are still far too many cases that go unreported. The most common myth about strangulation is that a person is only strangled if they die. Strangulation occurs as soon as any pressure to the face, neck, throat or torso that impedes the flow of oxygen is applied. Death is a possible outcome. But serious injury from strangulation starts within seconds. And if the victim of that strangulation attack survives, they need to be assessed by a health care provider with specific attention to the common potential injuries that come from being strangled.

Another very common myth regarding strangulation is that survivors will have visible injury like red marks or bruises around their throat. This is actually a very dangerous myth. Because the opposite is actually true. Even in fatal strangulation cases, victims only had visible bruising approximately 50% of the time. And in only about 15% of those cases were the marks and bruises severe enough to be photographed. The truth is that the majority of injuries or signs of strangulation are not visible, and they are more likely to be hidden or to be observable as behaviors rather than physical marks. For example, a hoarse voice, continual swallowing or clearing the throat are strong indicators of a strangulation assault. And, because strangulation often results in injury to the brain due to oxygen deprivation, many of the symptoms are similar to a concussion; headache, dizziness, memory issues, and other neurological symptoms.

ICADV and the Indiana Domestic Violence Fatality Review Team were extremely proud to issue and publish the Model Collaborative Strangulation Response Protocol for Indiana Jurisdictions in late 2023. Homicide Reduction Strategies Coordinator Caryn Burton has spent the last 12 months working with counties and jurisdictions across the state to design and implement their own protocols using the model protocol as a foundation. She has worked with the Indiana Emergency Nurses Association to co-facilitate at least half a dozen full-day trainings on the issue of strangulation and implementing a strangulation response protocol as a way to reduce ipv-related homicide across the state. If you, your organization or your stakeholders are interested in learning more about response to non-fatal strangulation, please feel free to read through the protocol, available on ICADV’s website, or reach out to Caryn directly to discuss the possibility of a training in your area.