Strangulation: the underestimated assault in domestic violence

30 to 70 per cent of women who are victims of domestic violence have been strangled

Original Article: Glenn Payette  |  CBC News  |  June 20, 2018  |

"I could feel my life slipping from myself."

Georgina McGrath was the victim of strangulation at the hands of two different male partners in Labrador, and she remembers the feeling well.

"I could feel my body going limp, and you just beg them to stop," said McGrath, fighting back tears.

It is a frightening and potentially deadly scenario that many abused women face — the hands of a loved one wrapped around their necks, squeezing.

And statistically, the more often a woman is strangled, the more likely she is to be killed.

"If the victim survives a particular assault, they are at risk of a future assault where they will be murdered," said registered nurse Morag McLean.

Damage done not always clear

According to the Training Institute for Strangulation Prevention in San Diego, California, 30 per cent to almost 70 per cent of women who experience domestic violence have been strangled. 

Sofyan Boalag raped three women in 2012 and was declared a dangerous offender in St. John's last November, with Judge Pamela Goulding noting that in one of the the assaults, "[Boalag] put his hands around her neck and squeezed until she lost consciousness."

Boalag didn't assault domestic partners, but what he did highlights the danger of strangulation. 

These dangers aren't always obvious after the fact.

"I had a client once who was strangled 200 times," said McLean, who works with victims of domestic violence in Edmonton and counsels them about the risks of strangulation.

"Often victims will experience a strangulation assault, and they will appear fine; they will appear normal at the scene."

Damage can show up even weeks later

On its website, the Training Institute on Strangulation Prevention says, "Victims may have no visible injuries whatsoever, yet because of underlying brain damage due to the lack of oxygen during the strangulation assault, they may have serious internal injuries, or die days, even weeks later."

The institute said it works to "enhance the knowledge and understanding of professionals working with victims of domestic violence and sexual assault who are strangled."

McLean said a normal man's handshake creates about 80 pounds of pressure per square inch, and that it takes far less pressure to stop the flow of blood to and from the brain.

"Eleven pounds of pressure per square inch will completely block the carotid artery, which is the main artery taking blood and oxygen to the brain," she said.

"And 4.4 pounds of pressure will occlude or block the jugular vein, and that's the vessel that takes the blood from the brain back down to the lungs to be oxygenated.

"Thirty-three pounds of pressure will occlude the trachea; so with very little effort you can occlude the major vessels and the airway and block air going to the brain."

Going to die

The psychological impacts of being strangled include depression, suicidal thoughts, nightmares, post-traumatic stress disorder and more. According to the training prevention institute, 70 per cent of women who have been strangled believed they were going to die.

That echoes her experience with strangulation, McGrath said.

"The psychological effect that it has is tremendous. Even after eight months of counselling, the nightmares are horrible," she said.

"You know that your life is in the hands of the abuser, and it is so easy for them to give that little bit more pressure."

McLean says many women who are strangled underestimate its impact.

"They don't see it as a very serious form of physical assault," she said.

"So, when we start to talk to them about strangulation, they tend to be quite horrified, and it's a very frightening thing for them to learn what the implications are."

Talking to first responders

The prevention institute says only 50 per cent of strangulation victims have visible injuries on their necks, and of those, only 15 per cent show up in photographs.

McLean says that's why it's important for doctors, nurses, the police and first responders to ask abuse victims if they have been strangled. 

"'Has anyone put anything around your throat? Has anyone applied pressure to your throat?' And explore it from there," said McLean. "Because victims don't always understand that they've been strangled."

McGrath agrees. "They should be asking that question, because two hands are just as bad as a knife or a gun."

McLean says victims sometimes say they've been choked, when they really mean they've been strangled. Choking is when a person has something caught in the throat. 

While there may not be marks on the neck, there are other indications to look for. The training institute says police and others need to check victims for signs like chest pain, difficulty breathing, trouble swallowing, sudden urination, headaches and petechiae {little red spots in and around the eye}.

At the moment, neither the RNC nor the RCMP gives specific training to members to ask domestic violence victims if they have been strangled.

McGrath and Newfoundland and Labrador Senator Fabian Manning are working on comprehensive bill on domestic violence that calls for health-care providers to report incidents, including strangulation, to the police.

Currently, only incidents involving knives and guns have to be reported.