Recognizing & Responding to Asphyxiation within Abusive Relationships

Asphyxiation – being deprived of oxygen by impeding blood or air flow – is one of the most highly lethal forms of abuse commonly used within intimate relationships. Asphyxiation includes strangulation (external pressure on the neck/throat), choking (internal blocking of the airway), drowning, hanging, and suffocation. And, even though strangulation is a felony in Texas, it is still very likely to be missed or misunderstood by victims and first responders alike due to “invisible” evidence and the already complicated dynamics of domestic violence crimes.

“He pushed me against the wall by my throat.”

“He put me in a chokehold.”

“He held a pillow over my face.”

All of these common statements made by victims describe asphyxiation. However, even when a victim is able to voice what happened to them, they typically don’t know that what they’re describing is asphyxiation, and first responders often haven’t been trained to recognize the signs and dig deeper to uncover evidence of this highly dangerous and life-threatening abuse.

Asphyxiation is hard to identify because it very rarely leaves external marks. Popular media would have us believe that if someone is strangled, they will immediately develop red marks and fingertip bruises on their neck. However, we know that most strangulation victims have no visible injuries. And, the darker a victim’s skin tone, the less likely external injuries will be visible to the naked eye, meaning communities of color are disproportionately impacted when we miss this glaring red flag for future homicide.

More and more research with victims of gender-based violence is finding that all forms of asphyxiation are more commonly used in abusive relationships than previously thought, and that abusers who asphyxiate pose the most dangerous threat to their victim and society as a whole. Being strangled one time makes a victim at least seven times more likely to be murdered. We also know that abusers who strangle pose the highest threat to the lives of law enforcement officers, and the correlation between mass shooters and a history of strangulation has been well documented.

When we rely on external signs of asphyxiation, we miss an opportunity to intervene and prevent future homicide, not only for the victim, but our entire communities. We must ensure that community-based advocates and first responders within the criminal legal system have the training and tools to ask the right questions, conduct thorough investigations, and hold society’s most dangerous offenders accountable.

To learn more about how to identify and investigate strangulation and other forms of asphyxiation without relying on visible injury, visit to access to Strangulation Investigations, presented in collaboration with RESPOND Against Violence. This free, six-part, on-demand video series is geared towards Texas law enforcement but useful for anyone committed to eradicating domestic violence in their communities. Watch the trailer here.

Written by Brooke Meyer, director of the Institute for Coordinated Community Response.