Choking Hazard
Every new parent is haunted by the thought. We research every gadget, examine every toy. We are inundated with foreboding exclamation marks, boldfaced warning statements, product recall alerts, and the voice of Nancy Grace – all culminating in a message so pervasive that it would be downright shocking to encounter a parent, pediatrician, caregiver, or retail employee who could not immediately rattle off the risks, signs, and response protocol. If such a person entered our child’s orbit, we would require that they immediately educate themselves about the very real danger of choking, and anxiously listen for the sound of their voice joining the refrain of the informed majority:
“As new parents, keeping your baby safe from choking hazards is a top priority. By being aware of potential choking risks, baby-proofing your home, and staying vigilant during playtime and feeding, you can create a safer environment for your little one. Familiarizing yourself with the signs of choking and knowing how to respond promptly can make all the difference in critical situations.”
Opting out of this life-saving chorus would paint one with the black mark of negligence, and for good reason. Continued ignorance is chosen, shameful, and cruel. How could anyone fail to do their part in protecting a child from a well-known, detectible, and preventable danger? How could anyone wish such devastating grief on a parent?
I mean, the sheer terror evoked by the mere threat of it; the excruciating possibility of a spare part reaching up and gripping an infant by the throat, applying pressure to the delicate structures of the neck, interrupting the supply of oxygen to their brain, and blocking the flow of blood for even a moment is horrifying.
Oh, you noticed?
Correct. That’s not choking.
That’s STRANGULATION.
We are crystal clear on the definition of choking in the context of a child: “When a person can't speak, cough, or breathe because something is blocking (obstructing) the airway.” Choking is not a violent criminal act. There is no perpetrator. It's an accident. A tragic, preventable accident.
When a person intentionally, knowingly, or recklessly impedes the breathing or circulation of the blood of another person by applying pressure to the throat or neck, by way of suspension (hanging), a garrote (ligature), or their bare hands (manual) - that is strangulation.
An extremely gendered crime, strangulation is known as the last warning shot because it is a powerful predictor of future homicide. Any pressure applied to the neck is dangerous, and there is no safe iteration of this act – not even when it occurs during “consensual” sex. There is no chunk of banana, no stray Lego, no oversized pastel button lodged in an airway. It is a criminal act, with a perpetrator, and it is never an accident. Strangulation is used by the most dangerous criminals, the most violent rapists, and lurks in the criminal history of most cop killers. It is the end of the line. Coercive control in its most extreme form. Next stop, murder.
And yet, we – survivors, law enforcement officers, medical professionals, and advocates – frequently use the wrong term when describing one of the most lethal acts of violence women suffer at the hands of an intimate partner. Substituting “choking” for “strangulation” has chilling repercussions that mirror another persistent phenomenon. When a stranger breaks into a home and assaults, rapes, or murders the inhabitant(s), we are horrified. We expect law enforcement to work tirelessly to solve the case. We demand that justice be served. We condemn this violence. However, when “boyfriend” or “husband” replaces stranger; when “domestic” precedes violence, we allow our perception of these barbaric crimes to be softened. We stop short of expecting much of anything. We make no demands. We turn away from savagery if we detect even a hint of familiarity between victim and criminal, but it is that familiarity, that betrayal of trust and safety, that makes these crimes far MORE barbaric. This phenomenon persists because we allow it.
If we truly want to live in a commonwealth with zero violence; if our mission truly is to end intimate partner abuse in families and the community, we must commit to holding ourselves and others accountable.
We MUST use proper terminology to describe every criminal act of strangulation.
We MUST demand justice for every crime in which the victim and perpetrator know one another.
Our failure to mount a public outcry isn’t a numbers game:
An average of 140 children choke to death every year.
An average of 76 women are shot and killed by an intimate partner...every month.
How many women will die before it’s socially expected for all voices to join this life-saving chorus? Where is the paintbrush for this black mark? Why aren’t ALL first responders making an effort to get this right? Expected to get this right? Why aren’t we demanding it?
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The following account was written by our founder in November 2024 during Strangulation Awareness Month, two months prior to the release of our Bible, and three months prior to the Netflix release of American Murder: Gabby Petito.
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The day my abuser strangled and suffocated me for the first time (outside of the bedroom – please visit our new “Death Play” page to learn more), at least twice and so violently that I lost bowel control, I had no idea how close I had come to death. That I had reached one of the last known indicators that my brain was rapidly expiring. That I may face the risk of subsequent death for months to come, even if the attack left no visible signs. Embarrassed and confused, I threw my underwear away and took my abuser out to dinner for his birthday. I was desperate for peace and had no idea that all I would receive from this man was escalating lethality.
The next day, he strangled and suffocated me five more times. Outweighed by more than 70 pounds, and far outmatched by his rage, premeditation, and malevolence, I still don’t know how I survived. He hit me hard enough to call for help, and help came bearing handcuffs.
Between attack and education, I would interact with nearly a dozen law enforcement officers, several detention center employees, a victim’s advocate, two paramedics, five medical professionals, and multiple triage and clerical employees. I would call an ambulance, sobbing because I was so dizzy I couldn’t walk or drive my kids to school. An emergency room visit, an EPO, and a hospital follow-up with my primary care provider, who sent me directly to a second emergency room visit.
I sang, but I used the wrong lyrics. “Choked”, “Grabbed my neck”, “Held me down”, “I’m sorry, I can’t breathe very well”, and “He mostly had his hands around my neck and his knee in my chest”. None of them corrected me; none of them uttered a word.
After a week my head was still bobbing and my speech was still halting, but I was becoming less of a “desperate, stunted zombie” – my description of the mental and physical side effects I was suffering. The only diagnosis yet offered was concussion, but my head didn’t hurt at all. I knew something wasn't right, and it left me wondering if I would ever be the same.
In the wee hours of the morning one week after my attack, I logged into LinkedIn to search for advocacy pages. As a CPA exclusively serving nonprofits, including two dedicated DV organizations, I felt compelled to connect with a wider network of resources and find ways to use my experience for good. I followed the National Domestic Violence Hotline page, and they had recently shared an infographic that would change my life forever.
The Dangers of Strangulation
Strangulation can cause traumatic brain injuries, which can affect long-term memory
Strangulation is a significant predictor for future lethal violence
If your partner has strangled you in the past, the likelihood of them killing you is 10 times higher
Strangulation is one of the most lethal forms of domestic violence; unconsciousness occurs within seconds, and death within minutes
It’s possible to show no outward symptoms of strangulation
The comment thread underneath shook me to my core. I learned that my risk of being murdered by my abuser had just skyrocketed. That strangulation often leaves no visible injury even when it is fatal.
I learned that a brain deprived of oxygen is harmed much more quickly than any other organ, with millions of brain cells dying every single second. That blocking blood supply not only means no fresh blood flowing into the brain, but also that blood cannot exit, immediately building lethal pressure.
I learned that a firm handshake may exert more force than is needed to end a life.
I learned that strangulation victims may initially present as confused, upset, or uncooperative, but thanks to a host of tools that are readily available and free, first responders can gauge the presence and degree of danger, detect risk factors of future lethality, and determine if any pressure was applied to the neck in any way.
I learned that law enforcement should interview victims over a span of several days, documenting new details as they emerge, due to the known prevalence of memory loss. Strangulation is a medical emergency and warrants immediate medical attention in every case, and first responders should be trained to recognize strangulation victims and ensure they receive a comprehensive exam.
When I called 911, I had no idea what to expect. I just knew that I needed help. I wish I had been able to convey why I needed help, but I was struggling to think, breathe, and speak, and I did a poor job advocating for myself. I hadn’t yet fully arrived at the reality that my “marriage” had just ended and my murder was underway.
I placed the call because I knew that head injuries are serious, and he hit me so hard that it knocked me down and left me feeling dazed. I used my Apple watch, because he had taken my phone. I said I didn’t need an ambulance because I wasn’t bleeding, and bleeding felt like the only justification for an additional resource. Like many survivors before me, I was already minimizing the harm, second-guessing my decision, and feeling increasingly unworthy of help.
There was something else, something that I had noticed but could not put into words until a few days later…
When he landed that final blow, it wasn’t in the midst of a struggle. We were in separate rooms, and I was getting ready to leave. I was changing my shirt, and suddenly he lunged at me. It was meant to be stealthy, and it was meant to harm. He had dropped the mask completely. There would be no more conversation. No more blame, shame, or half-hearted apologies for his violence. He would continue to wear the mask for others, but he was no longer performing for me. He had realized that his act could not silence me, control me, or crush my spirit.
From that moment forward, I knew that he had intended to kill me.
The officers arrived. There was no danger checklist, no lethality assessment, and not a word uttered about strangulation.
“He mostly had hands around my neck and his knee in my chest”, I told them.
Nothing.
There was a bruise on my abuser’s inner bicep from the day before, an ugly bruise he kept mentioning during his birthday dinner, between examining my mottled hands and wrists, sighing at the damage he had done while forcibly restraining me a few hours earlier.
The man who had bellowed “I will put you in the ground!” pointed out this bruise to the officers. He said I was very dysregulated; easily triggered. Out of control. A tale as old as time. While generations before me were locked in towers, beheaded, lobotomized, or drugged into a docile stupor, I was arrested. Charged with the crime of surviving. Documented as “mentally unstable” without so much as a phone call to my medical providers, my family, my employers past or present, or my landlord to authenticate the claims.
My struggle to breathe? They told my abuser I was faking a panic attack.
Well-trained experts and amateur survivors alike would have immediately recognized multiple warning signs present in this interaction. I’ll limit this list to five:
A distressed woman who is not articulating well or making a case for herself, and a calm man who knows exactly what to say and has no problem providing details. This screams danger - the woman may have just been strangled, suffocated, or suffered some form of traumatic brain injury. Strangulation is under communicated to law enforcement, but the experience is terrifying. You instinctively know that the stakes are now higher and that your abuser is more dangerous. Unfortunately, this can result in being more subdued or submissive. There is a marked loss of hope when man crosses into that lethal territory, even if you don’t have a name for what he just did to you. Visible injuries on a man paired with no visible injuries on a woman should alert responders that strangulation may have occurred, and they may be assessing a highly dangerous situation. Men who strangle are much more likely to be cop killers, and a woman who has been strangled by an intimate partner is 750% more likely to be murdered by that partner within a year.
My abuser mentioned that I “lived there” but “had a townhouse”. The truth was, I had moved out four months prior due to the escalating abuse, and he had just lured me back by admitting in writing that he had abused me from day one, that none of it was my fault, promised he would change, and vowed to keep me safe. He made it sound like I had my own place and had dropped by to be a nuisance. Women who move out/leave an abuser face a risk of escalating violence and lethality – 75% of domestic violence homicides take place immediately after the victim attempts to leave. This risk factor is listed on every version of a danger assessment I have found.
I told the officers that I needed to get “my” kids. I was a mess that day – I had been tricked into moving back in and I was exhausted. When I began to see that calling 911 was not providing any obvious solutions, I just wanted away. I wanted to go get my kids. I wanted to figure it out later. The presence of stepchildren in the home is a risk factor listed on every version of a danger assessment that I have found.
I said, “I don’t want to press charges.” I had never called 911 before and had no idea Kentucky was a state where one or both parties are arrested during the response to a DV call. Victims often retract statements, drop EPOs, or decline to press charges because they instinctively know that it might mean the difference between living and dying. We can be very poor witnesses, because our goal isn’t to win – it is to survive. My statement indicated that I knew I was in danger, even if I couldn’t articulate how or why. When law enforcement hears such statements, they should proceed with their investigation accordingly: “Treat every scene as a homicide and you will likely prevent one.” – Joe Berner, supervisor, crime scene specialist, San Diego PD
I have never owned a gun, but my abuser owned two assault-style weapons that had been gifted to him, and I don't think he would have denied that they belonged to him. To my knowledge he had every right to own them and had not broken any law. A woman is five times more likely to be murdered when her abuser has access to a gun. The presence of a firearm is a risk factor listed on every version of a danger assessment that I have found, including the abbreviated assessments.
I had visible injuries. My body was riddled with bruises, and after being strangled, suffocated, hit, shoved, thrown, and dragged by my hair, my head and neck were so swollen and tender that I spent the 24 hours post-attack huddled on the floor of my jail cell, quietly crying. I was in so much pain and so dizzy that I was unable to eat, drink, or sit up. After I was released, I was able to take a few pictures, and that’s when I saw it. As plain as day, among the many subtle and not-so-subtle signs of my attempted murder – the petechiae and drooping face and gravelly voice - my abuser had left his thumbprint on my throat.
My ticket punch. Coercive control at the end of the line. Next stop, murder.
When it comes to strangulation, we know better, and we’ve known for quite some time. The Strack study was published in 2001. The Glass study was published in 2008. The Domestic Violence Sourcebook, which I purchased along with Rachel Louise Snyder’s 2019 masterpiece “No Visible Bruises”, was originally published in 1995. I own the third edition, updated as of 2000. On page 80, it specifically addresses strangulation:
“[Strangulation] is peculiarly common in domestic violence cases, far more so than in stranger assaults. What form of control could be more intimate than controlling a person’s ability to breathe? Strangulation is both a serious warning sign that this is an extremely vicious abuser and a potential medical crisis that must be monitored closely. A victim who has been strangled may exhibit only mild injuries at first, then die within thirty-six hours as internal swelling increases.”
This statement has been in print since I was thirteen years old. There are copies of both of these books at my public library.
I should not know more, or care more, or speak more about strangulation than the first responders assigned to my call, but I will be grateful until my dying day that they arrested me. They protected me from a man who spent his next 24 hours lying to my family, attempting to bail me out of jail and into his custody, and bargaining for another opportunity to take my life. The man who had raised his hand and introduced himself as my future killer.
Their handcuffs are the reason my mom knows the truth.
She won’t be one of countless grieving mothers who have unwittingly hugged the chunk of banana, the stray Lego, the oversized pastel button at the funeral.
Because her daughter wasn’t choked. She was strangled.
And my mom will raise her hand, point to the criminal who murdered me, and sing.
We must ALL sing until we label dangerous men with the same fervor that we label teething rings.
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