Non-fatal Strangulation - An Overview

Non-fatal strangulation on the edge of a homicide

Gwinn, Strack, & Mack, 2014

Strangulation is pressure put on the neck, such that there is reduction of blood flow through the brain or constriction of breathing through the airway in the throat resulting in disruption of brain function by asphyxiation. Pressure is sustained, not instant so time/force/contact area combines to sustain oxygen obstruction to the brain (Strack, et al, 2014).

Strangulation is a gendered crime with perpetrators of strangulation almost always a man (Strack, et al, 2014). Many offenders strangle their victims to let them know “they can kill them at any time” (Gwinn, Strack, & Mack, 2014). Strangulation features as a high indicator of lethality with victims who are strangled once up to 800% more likely to be killed by the same perpetrator (Strack, et al, 2014). Police and others working in the domestic and family violence field use risk assessment tools to identify strangulation as a key indicator of increased risk of harm due to domestic and family (Douglas & Fitzgerald, 2014).

Signs and symptoms of strangulation

A wide range of signs and symptoms of strangulation have been identified (see table on next page), but at the same time these may not be easily detected (Douglas, 2018; Douglas & Fitzgerald, 2014; Pritchard, Reckdenwald, & Nordham, 2017) with no external signs of immediate injury in up to 40% of NFS cases. Victims may also be physically unresponsive and experiencing PTSD symptoms following non-fatal strangulation (Pritchard, Reckdenwald, & Nordham, 2017). The lack of apparent injuries means that non-fatal strangulation is often missed, misidentified or minimised by victims, police and medical staff (Douglas, 2018).

FACE

• Petechiae (tiny red spots- slightly red or florid) • Scratch marks • Facial drooping • Swelling

NEUROLOGICAL

• Loss of memory • Loss of consciousness • Behavioural changes • Loss of sensation • Extremity weakness • Difficulty speaking • Fainting • Urination • Defecation • Vomiting • Dizziness • Headaches

EYES AND EYELIDS

• Petechiae to eyeball • Petechiae to eyelid • Bloody red eyeball(s) • Vision changes • Droopy eyelids EARS • Ringing in ears • Petechiae on earlobe(s) • Bruising behind the ear • Bleeding in the ear

MOUTH

• Bruising • Swollen tongue • Swollen lips • Cuts/ abrasions • Internal petechiae

CHEST

• Chest pain • Redness • Scratch marks • Bruising • Abrasions

VOICE AND THROAT CHANGES

• Raspy or hoarse voice • Unable to speak • Trouble swallowing • Painful to swallow • Clearing the throat • Coughing • Nausea • Drooling • Sore throat

SCALP

• Petechiae • Bald spots (from hair being pulled) • Bump to the head (from blunt force trauma or falling to the ground)

BREATHING CHANGES

• Difficulty breathing • Respiratory distress • Unable to breathe

Source: Adapted from Signs and Symptoms of Strangulation Factsheet available on the QCDFVR online resources page.

Health Impacts

Strangulation is responsible for a range of health impacts that can appear within days or take years to emerge (De Boos, 2019; Douglas, 2018; Strack, et al, 2014; Taliaferro, Hawley, McClane, & Stack, 2009).

Health impacts include:

Internal injuries Haematomas

Fractured hyoid bone

Vocal cord immobility

Stroke Airway obstruction

Respiratory complications

Anoxic (traumatic) brain damage

Delayed swelling

Displaced laryngeal fractures

Carotid dissection

Delayed death from blood clots, stroke and brain damage caused by lack of oxygen

Strangulation is also commonly associated with sexual assault. For example, non-fatal strangulation was reported by 7.4% of victims attending a sexual assault centre in Western Australia (Zilkens, et al, 2016). Douglas and Fitzgerald (2013) noted that a Queensland study of domestic violence orders (DVO) where women who alleged strangulation also made allegations of other offences, most of which (87 %) were violent offences, including other forms of assault, sexual assault and threats of violence or murder.

Queensland

In Queensland choking, suffocation or strangulation in a domestic setting is a stand-alone offence under the Criminal Code 1899, with a maximum penalty of seven years imprisonment (Queensland Courts, 2019). The Queensland Sentencing Advisory Council (QSAC) notes that the offence must be committed without the victim’s consent; and the victim and perpetrator must be in a domestic relationship, or the offence must be associated with domestic violence (QSAC, 2019).

Information on non-fatal strangulation is scarce (QSAC, 2019), but we do know, that in Queensland:

• 12% of women (from 328 couples) applying for a DVO reported being strangled by their partner at least once (Douglas & Fitzgerald, 2013); and

• 1687 offenders faced court on the charge of strangulation from July 2019-Sep2019; with 793 of these imprisoned (Queensland Courts, 2019)

Research and training

It is clear that there is still much to learn: there is still a dearth of research in this field and adequate specialised training and integrated responses, so victims can be more effectively screened for strangulation injuries that may otherwise be overlooked (Douglas & Fitzgerald, 2014; Pritchard, Reckdenwald, & Nordham, 2017).

QCDFVR has a particular interest in furthering research about non-fatal strangulation. To this end, QCDFVR is negotiating a Memorandum of Understanding with the Red Rose Foundation. A project that has been commenced is evaluating the training that has been delivered by the Red Rose Foundation, in conjunction with the San Diego Training Institute on Strangulation Prevention.

References

De Boos, J. (2019). Review article: Non-fatal strangulation: Hidden injuries, hidden risks. Emergency Medicine Australia, 31, 302-308.

Douglas, H. (2018). A red flag for homicide. Should non-fatal strangulation be made a stand alone criminal offence? APPS Policy Forum. . Canberra: Asia & the Pacific Policy Society.

Douglas, H., & Fitzgerald, R. (2013). Legal processes and gendered violence: Cross application for Domestic Violence Protection Orders. University of New South Wales Law Journal, 36(1), 56.

Douglas, H., & Fitzgerald, R. (2014). Strangulation, domestic violence and the legal response. Sydney Law Review, 231, 231-254.

Gwinn, C., Strack, G., & Mack, M. (2014). Law reform targets the crime of strangulation. Domestic Violence Report, 19(6), 81-82.

Pritchard, A., Reckdenwald, A., & Nordham, C. (2017). Nonfatal strangulation as part of domestic violence: A review of research. Trauma, Violence and Abuse, 18(4), 407-424. QSAC. (2019). Sentencing spotlight on choking, suffocation or strangulation in a domestic setting. Brisbane: Queensland Sentencing Advisory Council.

Queensland Courts. (2019). Queensland Courts’ domestic and family violence (DFV) statistics. Brisbane: The State of Queensland, Queensland Courts. Retrieved from https://www.courts.qld.gov.au/court-users/ researchers-and-public/stats

Sorenson, S., Joshi, M., & Sivitz, E. (2014). A systematic review of the epidemiology of nonfatal strangulation. A human rights and health concern. American Journal of Public Health, 104(11), e54-e61. S

track, G., Gwinn, C., Hawley, D., Green, W., Smock, B., & Riviello, R. (2014). Why didn’t someone tell me? Health consequences of strangulation assaults for survivors. Domestic Violence Report, 19(6), 87- 89.

Taliaferro, E., Hawley, D., McClane, G., & Stack, G. (2009). Strangulation in intimate partner violence. Intimate partner violence: A health based perspective. Oxford University Press. Inc.

Zilkens, R., Phillips, M., Kelly, M., Mukhtar, S., Semmens, J., & Smith, D. (2016). Non-fatal strangulation in sexual assault: A study of clinical and assault characteristics highlighting the role of intimate partner violence. Journal of Forensic and Legal Medicine, 43, 1-7.