Strangulation is one of the most dangerous and terrifying forms of abuse, yet it often leaves behind no visible scars. It’s a method of control that is far more common than many realize – and far more deadly. Survivors of domestic and sexual violence may experience strangulation at the hands of an abuser not just once, but repeatedly, often without ever receiving medical attention or realizing the severity of the harm inflicted on their bodies.
This blog post will explore how abusers use strangulation as a tool of power and control, the medical dangers of being strangled (even “just once”) and why it’s critical to take every incident of strangulation seriously.
What Is Strangulation?
Strangulation occurs when pressure is applied to the neck, restricting blood flow and/or airflow. There are two main types: manual strangulation, which involves the use of hands, and ligature strangulation, which involves an object such as a rope, belt, scarf, or even a piece of clothing. In both cases, the goal is to exert control, instill fear, or render the victim unconscious.
Sometimes when a victim is reporting being strangled, they’ll say something like, “They were choking me!”
Unlike choking, which involves blockage of the airway from inside the throat (like when food gets stuck), strangulation is external – It involves force from the outside that compresses the neck. This distinction is critical because strangulation is a deliberate, violent act, often used in abusive relationships to establish dominance and instill terror.
Strangulation as a Tool of Power and Control
In abusive relationships, strangulation is rarely random. It is highly intentional and often escalates over time. An abuser may use strangulation as a way to “punish” a survivor for speaking out, trying to leave, or asserting autonomy. Survivors frequently report that it is one of the most frightening forms of abuse they’ve experienced.
Strangulation sends a clear message: I can kill you – and I can do it with my bare hands. Many survivors recall abusers saying things like “I could kill you right now and no one would know,” or “This won’t even leave a mark.” Unfortunately, that’s often true.
No Marks Doesn’t Mean No Harm
One of the most dangerous misconceptions about strangulation is that if there are no bruises or red marks, there’s no real harm done. But the truth is that only about 15% of strangulation victims have significant visible injuries on the outside of their neck. (By
“significant” we mean able to be photographed as evidence). This is because the pressure applied during strangulation often compresses blood vessels, airways, and soft tissue beneath the skin, leaving minimal external signs.
Even when marks are present, they may fade within hours or days. Internal injuries, on the other hand, can cause lasting damage or even death days or weeks after the assault. Some methods of strangulation intentionally do not leave marks on their victims as well – something an experienced abuser may be aware of.
Some of the internal injuries that can occur from strangulation include:
- Carotid artery dissection (a tear in the artery wall that can lead to stroke)
- Tracheal (windpipe) damage
- Swelling of the throat, leading to delayed airway obstruction
- Brain damage from lack of oxygen (even if unconsciousness doesn’t occur)
- Vocal cord injuries
- Blood clots
The “Momentary” Myth
Many survivors (and sometimes even professionals) minimize strangulation by calling it a “brief” or “momentary” act. But the human brain starts to suffer damage after just 10 seconds without oxygen. Unconsciousness can occur within 6 to 10 seconds of full compression, and death can follow within minutes. It takes 4.4 pounds of pressure placed on the jugular to render someone unconscious (for reference, that’s less pressure than it takes to fire a handgun).
Even if someone remains conscious, the effects of a single strangulation incident can be severe. Survivors might experience:
- Headaches
- Difficulty concentrating
- Memory loss
- Changes in voice
- Vision problems
- PTSD or panic attacks triggered by sensations around the neck
- Difficulty swallowing or breathing
Moreover, being strangled once increases the risk of future lethal violence by 750%. In cases of domestic homicide, many victims had previously been strangled by their partner, often without seeking medical attention. Strangulation is the highest predictor of murder in domestic/sexual violence cases.
Why Survivors Often Don’t Report It
Strangulation is deeply traumatic, and survivors may be confused, disoriented, or afraid to talk about it. The lack of visible injuries can make them feel like they won’t be believed. Some may not even realize what happened to them qualifies as strangulation, especially if they remained conscious or were gasping rather than completely unable to breathe.
Additionally, many survivors fear retaliation if they report the abuse. An abuser who is willing to strangle someone is signaling their capacity for extreme violence. Survivors are often navigating complex emotional and safety dynamics and may feel trapped, isolated, or silenced.
Misunderstanding of “Rough Sex”
Another layer of complexity is the increasing normalization of strangulation in the context of “rough sex.” Strangulation has become a frequent theme in pornography and pop culture, where it’s often depicted as edgy or exciting. As a result, some people, particularly younger individuals, are growing up believing that choking is just a regular part of sexual activity.
This belief system is dangerous and rooted in a misunderstanding of consent. Consent must be enthusiastic, informed, specific, and freely given at all times. When strangulation is introduced without clear communication, or when someone feels pressured into accepting it to please a partner, it ceases to be consensual and becomes violent.
Many survivors report being choked during sex without warning, discussion, or agreement. In some cases, an abuser will later claim it was “just sex” to downplay the severity of the act or deflect accountability. But whether strangulation happens during a fight or during sex, the medical risks are exactly the same – and they are serious.
The human body doesn’t differentiate between a hand around the throat during a physical assault and one during an intimate act. Reduced oxygen to the brain is life-threatening, no matter the context. It’s critical to challenge the idea that because something happens behind closed doors or within a relationship, it’s automatically consensual or safe.
Medical Attention Is Crucial
If you or someone you know has been strangled, even if you feel “fine” afterward, it is critical to seek medical care immediately. A trained provider can perform the necessary imaging (like CT scans or MRIs) to detect internal injuries. Delayed swelling, blood clots, or strokes can occur days or even weeks later.
Some communities have strangulation response protocols, where trained advocates and forensic nurses work together to document injuries and support survivors. If your community does not have this in place, reach out to a domestic or sexual violence agency for help navigating medical and legal systems.
What You Can Do
- Believe survivors. If someone discloses that they were strangled, take it seriously—regardless of whether you see physical injuries.
- Educate yourself and others. Talk about strangulation and its risks. Help dispel the myth that it’s “not a big deal” if no marks are left behind.
- Support legislation. In many states, strangulation is now a felony offense even without visible injuries, due to the recognized danger. Advocate for similar policies in your area.
- Reach out for help. If you’ve been strangled or fear for your safety, call the National Domestic Violence Hotline (800-799-7233), or seek immediate medical care. You can also reach out directly to Options Domestic and Sexual Violence Services and an advocate can assist you in getting the help you need.
Strangulation is not just “rough” behavior or an act of anger—it is a deadly warning sign. Survivors of this form of abuse deserve to be heard, believed, and protected. By educating ourselves and others, we can break the silence around strangulation and create a safer, more informed community.
If you need any additional information, have a question, or a concern, feel free to reach out to Options at our 24-hour toll-free helpline 800-794-4624. You can also reach an advocate via text by texting HOPE to 847411 or click 24-Hour Chat with Options.
Written by Anniston Weber
This project was supported by subgrant number 25-VAWA-07 awarded by the Kansas Governor’s Grants Program for the Office on Violence Against Women, U.S. Department of Justice’s STOP Formula Grant Program. The opinions, findings, conclusions, and recommendations expressed in this publication/program/exhibition are those of the author(s) and do not necessarily reflect the views of the Office of the Kansas Governor or the U.S. Department of Justice.