In recognition of Domestic Violence Awareness Month, Sarah Shaffer, MBA, BSN, RN, HACP, SANE-A of the Aultman Serenity Program, takes a look at one of the most dangerous markers of intimate partner violence: strangulation.

Domestic violence remains a serious and often life-threatening public health issue in Ohio. Its effects extend far beyond physical injuries and can have lasting consequences for survivors, families and communities. Survivors of intimate partner violence may experience physical injuries, chronic health conditions, depression, anxiety, post-traumatic stress and other mental health concerns.

According to data from the Ohio Domestic Violence Network (ODVN), Ohio recorded 157 domestic violence-related fatalities between July 1, 2024, and June 30, 2025, which is the highest number since ODVN began its annual tracking in 2015 and a 37% increase from the previous year. This milestone underscores why domestic violence and its most lethal warning signs demand our attention.

Strangulation: A Serious Warning Sign

Strangulation, sometimes referred to as “choking,” is one of the most dangerous forms of intimate partner violence. It can cause serious injury or death, even when there are few or no visible injuries.

Research has identified nonfatal strangulation as a significant risk factor for intimate partner homicide. One study found that women who had experienced nonfatal strangulation by an intimate partner had more than a 750% increased risk of experiencing a completed homicide compared with abused women who had not experienced strangulation.

Strangulation should never be minimized or dismissed simply because a survivor does not have visible bruising or other obvious injuries. In fact, visible injuries are only seen around 50% of the time.

What Does Strangulation Look Like?

Strangulation involves external pressure applied to the neck that interferes with oxygen or blood flow to the brain. To help recognize the signs, symptoms can be categorized into distinct physical indicators:

• Respiratory and voice symptoms: Difficulty breathing or swallowing, coughing, shortness of breath, voice changes, hoarseness or difficulty speaking.
• Neurological and systemic symptoms: Headache, dizziness, confusion, vision changes, loss of consciousness or memory, a feeling of impending death or urinary/bowel incontinence.
• Physical and visible signs: Neck pain or tenderness, facial or neck swelling, small red spots called petechiae around the eyes, face or neck, along with bruising or scratches to the neck.

Importantly, serious internal injuries can occur even when there are no visible external injuries.

Why Is Strangulation So Dangerous?

Strangulation can interfere with oxygen reaching the brain and can damage structures of the neck, airway, blood vessels and other tissues. Some complications may not be immediately apparent.

A history of strangulation should be taken seriously during a medical evaluation, particularly when the survivor reports loss of consciousness, difficulty breathing or swallowing, voice changes, neurological symptoms or significant neck pain.

Medical complications from strangulation are often delayed. A survivor may appear completely fine immediately following an assault, only to experience life-threatening delayed effects hours or even days later – such as delayed stroke, carotid artery dissection, progressive brain swelling or respiratory failure.

If you or someone you know has experienced strangulation, seeking medical evaluation and support from a trained professional can be an important part of safety planning.

If You Need Help

Programs like Aultman Serenity provide round-the-clock specialized care to patients experiencing violence. This includes domestic violence, sexual assault, strangulation, human trafficking and other forms of interpersonal violence.

Specialized forensic nurses provide care and work collaboratively with healthcare providers, law enforcement, EMS, advocates and community partners. Aultman’s Serenity team also participates in continuing education and community outreach to increase awareness and improve the response to violence.

Resources

For immediate danger, call 911.

Ohio Domestic Violence Network (ODVN)
1-800-934-9840
ODVN can connect survivors with local domestic violence programs, including advocacy, shelter, counseling, legal assistance and other resources.

National Domestic Violence Hotline
1-800-799-SAFE (7233)

Domestic Violence Project, Inc.
330-453-7233

Sources:
Alliance for Hope International
Ohio Domestic Violence Network (ODVN)
Glass N, Laughon K, Campbell J, Block CR, Hanson G, Sharps PW, Taliaferro E. Nonfatal strangulation is an important risk factor for homicide of women. J Emerg Med. 2008 Oct;35(3):329-35. doi: 10.1016/j.jemermed.2007.02.065. Epub 2007 Oct 25. PMID: 17961956; PMCID: PMC2573025.