We know that abusers strangle their victims as a way to exert power and control over them—they want their victims to know they can kill them at any time. But let’s not also forget strangulation has a just-as-sinister cousin: suffocation. It could be done with a hand, a pillow or another object, or by applying pressure to a victim's chest, but the purpose of suffocation is to restrict oxygen to a sometimes-deadly level. Both suffocation and strangulation show an escalation in violence, say experts, and if it’s not the cause of a domestic violence homicide, it’s certainly a sign things are headed in a deadly direction.
The Last Warning Shot
Suffocation might be considered even more sinister than strangulation because there are no bruises left on the neck showing an abuser’s hands pressed into the victim’s skin, making suffocation nearly impossible to prove. And abusers know this.
“Strangulation and/or suffocation is definitely a method of choice by abusers—it’s a very effective way to exert power and control over a victim,” says Gael Strack, CEO and co-founder of the Alliance for HOPE International and the Training Institute on Strangulation Prevention.
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“It sends a very strong and clear message to the victim that I control your last breath and I can get away with it. The inability to breathe is one of the most frightening and terrorizing experiences any person can go through.”
Strack says that abusers who strangle or suffocate their victims know it often leaves little to no visible evidence of the internal injury or trauma it causes, making it easy for the abusers to avoid accountability.
“Experienced batterers know police officers generally look for visible evidence of injury in order to make an arrest,” says Strack.
Suffocation, like strangulation, is on the end of the continuum of violence, just before death, says Strack, which is why she calls these methods “the last warning shot.”
“Studies show most victims in the United States are killed by the use of a firearm, but before they are shot, at least 50 percent are strangled,” she says.
Suffocation Often Goes Along with Strangulation
Based on focus groups with survivors, we know batterers suffocate their victims in order to silence them, says Strack. They may cover the victim’s mouth or nose with their hands, a pillow or a plastic bag, or sit on the victim’s chest. If they restrict air flow long enough, the victim will lose consciousness and death can occur in under 5 minutes.
Suffocation is also thought to occur in conjunction with strangulation most of the time, according to a report by forensic pathologist Dean Hawley for the National Strangulation Training Institute.
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Hawley writes that the most typical scenario is for the victim to be on their back on the bed or floor with the abuser sitting on him or her, strangling them. The pressure of the abuser sitting on the victim’s chest reduces his or her ability to expand their chest wall during breathing, suffocating them.
Suffocation is often suspected in homicide cases where the victim is especially vulnerable, such as with children, the elderly or adults impaired by alcohol or drugs.
Survivors Might Not Recognize Suffocation as Abuse
Despite its obvious deadly nature, survivors who have been suffocated may not bring this up with an advocate or support person. The reasons can range from trauma, which can impede a survivor’s ability to remember information, as well as a lack of blood to the brain, which has the same effects.
“They also minimize strangulation or suffocation for many reasons—it could be happening so often, they don’t see any injuries so they think it’s not serious or no one will believe them,” Strack says.
Survivors may also be asked—by an advocate, physician or someone in law enforcement—if they’ve ever been “choked.” Strack says some survivors don’t identify with that word, considering what happened to them to be minor and not as serious as being choked, strangled or suffocated. Some may have been convinced by an abuser that strangulation is part of “normal” sexual behavior. Victims may also minimize the abuse in order to protect her abuser from being arrested.
“We are finding the better question is, ‘Has anyone applied pressure to your neck by any means? Did your breathing change in any way?’”
This is why it’s important to consider documenting abuse as a survivor. If you find yourself waking up with fuzzy memories of a violent incident, with soreness around your neck or chest area, or find it difficult to take a full breath, record these symptoms in a place where your abuser can’t find them, such as a notebook you keep at your office, a friend’s house or in a safe deposit box.
If You’ve Been Suffocated, Seek Medical Attention
Many victims of suffocation may not think it’s necessary to talk to a doctor if there are no signs of the assault. However, the after-effects of suffocation can be identical to strangulation (see “Strangulation Can Leave Long-Lasting Injuries” for more information). Even a temporary lack of oxygen can cause brain damage.
Survivors may also experience vision changes, tongue swelling, difficulty swallowing or breathing, left- or right-side weakness in the body, memory loss, paralysis or psychological injuries such as anxiety, nightmares, depression or suicidal ideations. In the case of pregnant survivors, suffocation can cause miscarriage.
Strack also encourages advocates to read “Why Didn’t Someone Tell Me? Health Consequences of Strangulation (Suffocation) Assault for Survivors” published in the Domestic Violence Report.
California Passes “Duty to Warn” Law
In January, a law went into effect in California requiring law enforcement officers to ask domestic violence survivors if they were strangled, record this information—helping to track those individuals who strangle—and inform survivors of the dangers of internal injuries, urging them to seek medical attention.
Strack says she hopes this results in a decline from suffocation and strangulation deaths, which can sometimes occur a day or more after an assault, even when a survivor feels like he or she is OK.
“Because internal injuries may develop or worsen within 24 to 72 hours, you have to pay attention and, if things change, go to the ER. We don’t want victims to suffer a stroke. Every second counts to the brain,” says Strack.
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