Strangulation: “A Practice Homicide”

TFC’s Jaime Gabrielli dives into strangulation, a deadly but often misunderstood form of violence that can be interpreted, for good reason, as “a practice homicide.”

Strangulation hides in the darkest corners of domestic violence and emerges as one of the biggest warning signs that the relationship could end in murder.

Like many forms of intimate partner violence, strangulation is misunderstood, minimized, underreported, and often undetected entirely. However, it’s not merely another form of physical abuse. It is a severe crime that drastically increases the risk of serious injury and lethality. With as little as 3-10 pounds of pressure—less force than it takes to pull the trigger on a gun—an abuser can cut off blood flow to a victim's brain, causing unconsciousness within seconds, and death within minutes. It’s an action that also reveals a particularly dangerous mindset: Abusers who strangle are openly communicating their ability and willingness to kill, and belief that they are entitled to absolute control over the most basic life function—breathing.

Though it’s sometimes misidentified as “choking,” strangulation refers to pressure applied from the outside, cutting off the flow of oxygen or blood to the brain. Choking, meanwhile, refers to a blockage inside the throat that makes it hard to breathe. 

Many people do not realize how common and hazardous strangulation is in abusive relationships. An estimated 68-80% of women in violent relationships will be strangled by their partner. Fatality studies reveal that almost half of all domestic violence homicide victims experienced at least one episode of strangulation before being murdered. Female victims of strangulation face a 750% greater risk of being killed by their abuser—a factor elevated to 1,100% if their partner has access to a gun. These numbers aren't merely statistics—they represent a clear warning and call for immediate intervention.

Confusion at a Potentially Deadly Cost

Strangulation injuries often go untreated because, in almost half of all cases, it leaves no signs of external injury.  However, the invisible damage that results can be permanent. Strangulation and suffocation are leading causes of traumatic brain injury when oxygen deprivation damages the internal structures of the brain. Survivors commonly experience memory gaps and neurological problems that they often don’t connect with the assault. This unnerving and brutal form of violence leaves victims disoriented, confused, and sometimes with no memory of what happened. Because they are unable to recall and relay details of the assault, the professionals they rely on for help must be aware of the warning signs and trained to respond immediately and effectively.

Victims can experience headaches, difficulty swallowing and speaking, breathing problems, and vision changes immediately or days after an assault. Even with no visible injuries, they remain at risk for catastrophic and deadly complications days and even weeks after the incident from conditions such as carotid artery dissection, blood clots, stroke, and aspiration pneumonia. The psychological impact of being strangled is equally traumatic for survivors, and many report feeling as though they were going to die during the attack.

Adding to the confusion victims experience is widespread misinformation about strangulation during sex, especially among adolescents and young adults. The terms "sexual choking” and "erotic asphyxiation" are misleading labels that promote a common misbelief that consensual strangulation during intimacy isn’t as dangerous as strangulation that occurs during an assault. This idea clouds people’s understanding of consent and can have deadly consequences. Many victims of sexual strangulation do not consent to the act before it happens. And even participants who do agree are likely not giving truly informed consent if they don’t understand they could be seriously harmed or killed in the process. Advocates, members of law enforcement, and healthcare providers will all tell you the same thing: There is no safe way to strangle someone.

Perspective on Strangulation from Advocates and Our Community Partners

The undeniable correlation between strangulation and future homicide demands a stern and serious response from the criminal justice system. Strangulation of a partner or family member has been a felony in Montana since 2017. All 50 states and multiple US territories have felony assault strangulation laws and at least 22 federally recognized tribes consider strangulation a felony under tribal code.

Even with stricter penalties, rates of this offense continue to increase. Montana Board of Crime Control statistics show reported statewide strangulation cases have grown by about 25% since 2019. Despite the known risks and increasing prevalence, resources specifically addressing strangulation response protocols remain scarce.

A common understanding of strangulation as a deadly form of domestic violence is crucial in promoting an informed response from all systems involved. Law enforcement, medical professionals, and domestic violence advocates act as firsthand witnesses to the devastating physical and psychological aftermath of strangulation. Sharing collective wisdom gained from working on the frontlines with survivors helps improve multi-agency response and intervention strategies.

The ability to recognize and communicate the implications of strangulation can be the difference between life and death for victims. With that in mind, I recently asked my fellow advocates and our partners in law enforcement and emergency medicine to share insights they have gained about this uniquely dangerous crime, and how they are supporting strangulation survivors in our community. Here’s what they had to say:

I define strangulation as a practice homicide. When taken to completion, death is the result. Strangulation puts the victim's life in the offender's hands, and the only thing stopping them is their own decision to let go. When committed, it is a threat of death. "I'm going to kill you" is the statement being made. Starting to kill, then stopping, is the action being taken. It is law enforcement policy that a strangulation or neck hold is only to be done in a life and death situation, as it is considered a form of lethal force. Law enforcement's consideration of it being lethal force should give pause to any downplaying of its seriousness. —Steven Cornish, Internet Crimes Against Children Detective (former Violence Against Women Detective), Helena Police Department

As someone who witnesses the impact of forensic nursing every day, I understand how essential a detailed forensic medical exam can be—particularly for patients reporting strangulation. These exams not only improve the quality of medical care but also provide critical documentation that can support any future law enforcement or legal proceedings. Expanding our program to include these patients was a natural and necessary next step. Since we began responding to strangulation cases in March 2025, we have already provided six patients with forensic medical exams—a reflection of both the need and the value of this service in our community. —Whitney Brothers, Forensic Nurse Coordinator, St. Peter’s Health

When diving into conversations [about strangulation], I let clients know that it takes the same amount of pressure to open a pop can as it does to lethally strangle someone. Most strangulation victims do not have physical marks left on their bodies, and they don’t understand the physiological consequences. While it is never my intention to scare clients, I know educating them about the danger of strangulation is critical to their well-being. —Maggie Hanzel, Direct Services Advocate, The Friendship Center

We frequently educate our clients about myths surrounding strangulation and sex. We need people to understand that giving consent to have sex is not the same as giving consent to be strangled. —Terri Stotts, Residential Advocate, The Friendship Center

Halting the Progression Toward Homicide

While we may be experts in our respective fields, survivors are the experts in their own lives. Intimate partner strangulation is a strong indicator of escalating violence in the relationship. Victims who disclose strangulation require immediate safety planning, medical attention, and strong legal protection. Most importantly, these resources must be accessible without requiring immediate separation from the abuser, acknowledging that the most dangerous period for a survivor is often during attempts to leave.

Supporting survivors in safely exiting abusive relationships requires planning that addresses many complex reasons they remain with their partners: financial entrapment, housing insecurity, concern for children and pets, and fear of escalated violence. Safety planning must be an individualized and survivor-led process.

Flexible funding programs that provide unrestricted emergency financial assistance to victims often make the difference between staying and leaving for good. Housing partnerships with local landlords, extended hotel voucher programs, and rapid rehousing funding are essential components of realistic exit strategies. Those with children need free legal representation and advocacy as they navigate complex parenting issues and ongoing safety concerns. Pet fostering programs address another major barrier to leaving, as many survivors stay out of concern for beloved animals. Community mobilization efforts must involve faith communities, employers, public officials, and healthcare systems to create multiple pathways of support beyond existing domestic violence services.

At The Friendship Center, we hope that increasing knowledge about intimate partner strangulation and its risks will result in this crime being taken more seriously the first time it happens. By improving our collective responses to strangulation and providing collaborative support to victims, we can halt the progression toward homicide and save lives in our community.

---

If you or someone you know has experienced strangulation, The Friendship Center can help. Check out our services page to learn about our free, confidential, 24/7 services and visit our strangulation resource page to learn more about what strangulation can look like, symptoms to monitor, and when it's important to seek medical attention following a head injury.

Info on Strangulation

For more information and resources about strangulation, visit Alliance for HOPE International's Training Institute on Strangulation Prevention. In addition to offering training and technical assistance to family violence professionals worldwide on strangulation and suffocation crimes, they have a number of free prevention resources and information about violence-related legislation across the country.