When one person puts hands around the neck of another and squeezes, that is strangulation.

It is a serious word that fits the potentially lethal action. Often erroneously called “choking,” it is not.

“Choking” refers to a blockage inside your throat, making it difficult to breathe. Strangulation is when pressure is applied from the outside, cutting off blood vessels and/or airflow in the neck, preventing oxygen from reaching the brain.

This pressure can cause loss of consciousness in 5 to 10 seconds, and it can cause death in a few minutes.

In the late 1990s, when I was Clinton County district attorney, a noticeable proportion of our domestic violence cases included the victim describing being “choked.”

Often, however, there were no marks, so we thought she was fine.

If the incident also involved violence that left bruises, like hitting, kicking, or pushing down the stairs, we paid attention to that. If there was only “choking,” then there might not even be a criminal charged.


Victims themselves dismissed being “choked” as serious because, once the compression of their neck stopped, it seemed they were all right.

While it was happening, they were terrified they were going to die, but when the attacker’s hands were removed and they could breathe again, they thought the danger was past.

We now know that is not necessarily so. Pressure on the structures of the neck can cause unseen and unrecognized injuries. We did not know enough at first to understand the seriousness of non-lethal strangulation.

Over the last 20 years, some prosecutors and doctors have continued to pay attention and gradually identified the kinds of harm caused by strangulation.

They have shown that the absence of external signs does not mean there was no injury. Whether death resulted or not, only half of strangulation victims had marks on their necks, and only 15 percent of those marks were clear enough to photograph.

The idea that if there are no marks you weren’t really hurt is another myth to dispel.

Not all injuries show on the outside; there can be internal physical injuries. In addition, there may be neurological damage from the loss of oxygen.


Domestic violence that includes squeezing the victim’s throat is not unique to our area; it is typical everywhere.

Recognition of its seriousness has spread across the country, resulting in criminal laws specific to strangulation in at least 45 states, including New York, since 2010.

Since these statutes focus on the cutting off another person’s blood flow or breathing, even if physical injury is not visible, there is better ability to prosecute.

The line is thin between causing loss of consciousness and causing death. Strangling another person comes right before homicide on a continuum of violence. Strangulation that stops short of killing may still cause significant health consequences, both physical and psychological.

Some examples that occur immediately include vision changes, ringing in the ears, swollen tongue, cuts and abrasions in the mouth, swelling of the neck, difficulty breathing, trouble swallowing, and other voice or throat changes.

Neurological damage such as loss of memory, dizziness, headaches, vomiting, extreme weakness, involuntary urination and behavior changes can be the result of strangulation.


When a victim says she cannot remember what happened, law enforcement or family may be frustrated, thinking she is trying to protect her attacker.

That may not be it at all. According to medical experts, our memory is in the part of the brain that dies first when there is lack of oxygen.

The effects are not always temporary.

If you were strangled, have you noticed that your voice is now hoarse or that you have speech issues that you didn’t before?

Has your behavior changed to be more combative or to have seizures? Are you experiencing anxiety, or an inability to focus? These are all symptoms to see a doctor about and explore whether there is physical damage or even a traumatic brain injury or post-traumatic stress.

Everyone should learn about the lethality of strangulation.

We all need to be aware of the serious effects experienced by survivors and help them get appropriate medical care.

Addressing strangulation is about effective criminal prosecution and more. It is also about connecting victims to health care and emotional support.

Penny Clute was Clinton County district attorney from 1989 through 2001, then Plattsburgh City Court judge until her retirement in January 2012.


Alliance for HOPE International is one of the leading domestic violence and sexual assault prevention and intervention organizations in the United States.

It serves, as its website says, as the clearinghouse, research center and national affiliation organization for Family Justice Centers and other multi-agency models that serve victims of domestic violence, sexual assault, elder abuse, child abuse, and/or human trafficking.

Much information is available on strangulation, including training for medical and law enforcement personnel to help them recognize the signs and symptoms: www.allianceforhope.com/training/online-resource-library

And Alliance for HOPE’s Family Justice Center offers, among other resources, a webinar with Dr. Bill Smock on long-term health consequences of strangulation: https://tinyurl.com/ybgzuxg6

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