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Strangling

Strangling is the intentional compression of the neck through external pressure, typically using hands, arms, or a ligature, which obstructs blood flow to the brain and/or airflow to the lungs, resulting in cerebral hypoxia, unconsciousness, or death.^[1] This mechanism differs fundamentally from choking, an internal blockage of the airway such as by foreign material.^[2] Unconsciousness can occur within 5 to 15 seconds of sustained pressure, even with minimal force applied to key vascular structures like the carotid arteries or jugular veins.^[3]^[4] The primary types of strangling include manual strangulation, executed with the assailant's limbs, and ligature strangulation, involving a cord or similar object without body suspension; hanging, which relies on gravitational force via suspension, is typically distinguished as a separate category.^[5] Physiologically, death arises from multiple pathways: initial venous congestion leading to cerebral edema, arterial occlusion causing ischemia, direct tracheal compression inducing asphyxia, or reflexive vagal stimulation triggering cardiac arrest.^[6] In forensic contexts, strangling often leaves subtle or absent external injuries, complicating diagnosis, yet it accounts for a significant proportion of homicidal asphyxias and serves as a lethality indicator in intimate partner violence due to its efficiency and potential for delayed complications like thromboembolism or neurological damage.^[5] Observed across species in predation, such as felids compressing prey necks to expedite incapacitation, strangling exemplifies a conserved biomechanical vulnerability in mammalian anatomy.^[7]

Definition and Mechanisms

Physiological Processes

Strangulation induces hypoxia primarily through external compression of the neck's vascular and airway structures, leading to reduced cerebral oxygenation. Compression of the jugular veins occurs first due to their lower occlusion threshold—approximately 4.4 pounds (2 kg) of pressure—causing venous congestion and elevated intracranial pressure, which impairs cerebral blood outflow.^[5] Subsequent occlusion of the carotid arteries, requiring about 11 pounds (5 kg) of force bilaterally, drastically reduces arterial inflow to the brain, dropping cerebral blood flow to levels insufficient for consciousness within 7-14 seconds.^[8] Airway obstruction via tracheal compression demands higher force, around 33 pounds (15 kg), to fully collapse the trachea, though partial blockage exacerbates hypoxia when combined with vascular effects.^[5] Neurogenic mechanisms contribute via stimulation of the carotid sinus baroreceptors and vagus nerve, triggering reflex bradycardia or even cardiac arrest. Pressure on these structures activates parasympathetic responses, slowing heart rate and potentially causing hypotension, which compounds cerebral ischemia independently of direct hypoxia.^[9] Sustained compression leads to neuronal death from prolonged oxygen deprivation, with brain cells beginning irreversible damage after 4-6 minutes of anoxia, though vascular mechanisms can precipitate unconsciousness far sooner than airway closure alone.^[8] Unlike choking, which involves internal obstruction of the airway (e.g., by foreign material) without neck compression, strangulation applies external force targeting multiple pathways—vascular, respiratory, and neural—often rendering it more rapidly incapacitating due to prioritized blood flow disruption over mere ventilation impairment.^[1] Delayed fatalities may arise from secondary effects like cerebral edema or arterial dissection, but primary lethality stems from acute cerebral hypoperfusion.^[5]

Classification of Types

Strangulation is mechanically classified into manual and ligature variants, differentiated by the directness and leverage of force application to the neck's vascular and airway structures, independent of intent or context. Manual strangulation relies on bodily appendages, such as hands, forearms, or elbows, to exert compressive pressure, often yielding inconsistent and fluctuating force due to the perpetrator's physical limitations and fatigue. This method predominates in spontaneous interpersonal violence, where no implements are immediately available, as evidenced by forensic analyses of assault cases showing hand marks or bruising patterns consistent with digit compression.^[10]^[5] Ligature strangulation, by contrast, utilizes elongated, flexible materials like cords, wires, belts, or fabrics looped around the neck to achieve constriction, permitting amplified and prolonged pressure via pulling, twisting, or knotting for mechanical advantage. Such implements distribute force more evenly and sustain occlusion longer than manual efforts, frequently resulting in linear abrasions or furrow marks in autopsy findings. This classification holds irrespective of whether the ligature is handheld or fixed, emphasizing the absence of body weight as the dominant vector.^[5]^[10] A key distinction from hanging lies in the primary force mechanism: strangulation excludes gravitational suspension of the body weight via ligature as the chief compressive agent, relying instead on externally applied or self-induced tension without full suspension. Hanging typically involves partial or complete body drop, accelerating vascular compromise through momentum, whereas non-suspensory ligature use—possible in homicidal or certain suicidal acts—mirrors strangulation mechanics but avoids this dynamic loading. Overlaps occur in atypical suicides employing self-tightening ligatures without drop, yet forensic differentiation hinges on positional evidence and injury kinematics.^[5]^[11] Hybrid configurations enhance ligature efficacy through mechanical aids, such as garrotes incorporating rigid handles, torsade twists, or levers to intensify torque and precision in constriction. These devices, distinct from simple cords by their engineered leverage, amplify force application beyond manual capacity, as documented in historical forensic texts and case studies of deliberate compression.^[5]

Historical Applications

In Executions and Punishments

In ancient Rome, manual strangulation served as an execution method for slaves, non-citizens, and certain criminals, valued for its simplicity and minimal equipment requirements compared to crucifixion or decapitation reserved for citizens.^[12] This approach involved direct compression of the neck by hands or basic ligatures, often performed summarily to enforce discipline among lower classes without public spectacle.^[13] During the Spanish Inquisition (1478–1834), the garrote—a mechanical device featuring an iron collar fixed to a post and tightened via a screw or lever—was applied to strangle heretics who recanted and converted, sparing them live burning at the stake while still allowing posthumous incineration of the body as a symbolic punishment.^[14] This method emerged as a "merciful" alternative within inquisitorial proceedings, where secular authorities carried out sentences after ecclesiastical trials, with the device's design enabling controlled asphyxiation to minimize overt resistance.^[15] The garrote evolved into Spain's primary state execution tool by the early 19th century, formalized around 1812–1813 under Ferdinand VII as a civilian standard, replacing less reliable manual techniques with a post-mounted collar that applied steady pressure to the neck's blood vessels and airway.^[16] It remained in use for ordinary crimes until September 27, 1974, when the last execution occurred—Salvador Puig Antich in Barcelona—totaling over 200 documented applications in the modern era, often criticized for causing variable durations of unconsciousness from seconds to minutes depending on the executioner's precision.^[17] Strangulation's decline as a preferred punitive method stemmed from its inherent inconsistencies: manual or early ligature forms relied on the executioner's sustained force, frequently resulting in incomplete occlusion, prolonged hypoxia, and visible convulsions lasting up to 10–15 minutes, as opposed to rapid cervical fracture in long-drop hanging.^[18] By the 19th century, European states shifted to drop-enhanced suspension or firearms for greater reliability and reduced public distress, reflecting empirical observations of garrote failures where victims survived initial compression only to suffer extended agony.^[19] In Spain, despite mechanical refinements, the method's persistence until abolition highlighted regional adherence to tradition over broader humanitarian reforms.^[16]

In Warfare and Covert Operations

In close-quarters combat and espionage, strangling techniques have been employed for their potential to achieve silent lethality, minimizing the risk of alerting nearby enemies compared to firearms or edged weapons. During World War II, British and Allied special forces, including commandos and the Office of Strategic Services (OSS), received training in manual strangle holds as part of hand-to-hand combat doctrines emphasizing rapid incapacitation from behind or in surprise engagements. Major W.E. Fairbairn, a pioneer in these methods, detailed strangle holds in manuals like Get Tough! (1942), instructing operators to apply pressure to the neck's vulnerable structures for quick neutralization without noise, as gunshot reports could compromise missions in occupied territories.^[20] These techniques often targeted the carotid arteries via vascular neck restraints, compressing blood flow to induce unconsciousness in seconds or death if sustained, allowing operatives to eliminate sentries or isolated targets undetected.^[21] In training scenarios, such holds were practiced for their empirical effectiveness in low-light or confined spaces, where Fairbairn's system prioritized "one-second" kills to prevent victim screams or struggles from drawing attention. Garrote wires, portable ligatures of piano wire or cord, supplemented manual methods in OSS and Special Operations Executive (SOE) kits for similar silent assassinations, though their use required victim immobility to avoid prolonged resistance.^[22] The tactical advantages include stealth—lacking the auditory or visual signatures of blades or bullets—and the physiological reality that carotid occlusion can cause cerebral hypoxia faster than airway compression alone, often within 10-14 seconds under ideal conditions.^[23] However, limitations persist: untrained or resistant victims can counter with elbow strikes or thrashing, extending the engagement and risking exposure, as empirical combat accounts note that neck holds demand superior positioning and strength, failing against armored or alert foes. Post-World War II, military doctrines shifted emphasis from routine lethal hand-to-hand training to integrated firearms proficiency, with broader forces deprioritizing strangulation amid rising mechanized warfare, though special operations retained variants for targeted kills; concurrent developments in non-lethal restraints for policing influenced some adaptations, prioritizing temporary incapacitation over fatality to align with rules of engagement.^[24]^[25]

Medical and Forensic Analysis

Acute Indicators and Diagnosis

Acute indicators of strangulation include petechiae, which manifest as pinpoint hemorrhages on the eyelids, conjunctivae, and facial skin due to elevated venous pressure impeding blood drainage from the head.^[9] ^[26] These petechiae result from capillary rupture during neck compression and are more prominent in cases involving prolonged venous obstruction rather than complete arterial blockage.^[5] External neck injuries, such as linear abrasions or contusions from ligatures or fingertip impressions in manual strangulation, often appear as horizontal or diagonal marks, though their visibility depends on the force applied and skin resilience.^[27] ^[28] Internal acute findings encompass fractures of the hyoid bone or thyroid cartilage, with hyoid fractures occurring in approximately 25-30% of manual strangulation cases but less frequently in ligature types due to differing pressure distributions.^[29] ^[30] Soft tissue hemorrhages in the neck muscles and strap muscles, along with laryngeal edema, contribute to airway compromise and are detectable via dissection in postmortem examinations.^[5] Diagnostic evaluation in acute settings employs computed tomography (CT) scans to identify soft tissue swelling, vascular injuries, and subtle fractures not apparent externally, with non-contrast CT preferred initially for alert patients.^[31] ^[11] Laryngoscopy or fiberoptic endoscopy assesses mucosal damage and edema in the upper airway, guiding interventions like intubation if stridor or hoarseness indicates obstruction.^[32] However, external signs are absent in up to 50% of non-fatal strangulation incidents, complicating initial assessment and necessitating comprehensive history-taking alongside imaging.^[28] ^[33] Forensic diagnosis faces challenges in distinguishing strangulation from natural causes, as subtle internal hemorrhages can mimic postmortem lividity or age-related fragility, requiring correlation of autopsy findings with scene evidence like witness statements or ligature recovery.^[34] ^[5] Petechiae and neck marks must be differentiated from artifacts or unrelated trauma through histological analysis confirming vital reaction timing.^[27] In ambiguous cases, multidisciplinary review integrates radiological and pathological data to establish causality.^[35]

Delayed and Long-Term Consequences

Vascular complications, particularly carotid artery dissection, represent a critical delayed risk in non-fatal strangulation survivors, potentially leading to ischemic stroke hours to weeks post-incident due to intimal tears and thromboembolism from mechanical neck compression.^[5]^[36] Forensic case reports document bilateral dissections with symptoms emerging days after manual strangulation, underscoring the need for neuroimaging in asymptomatic patients to detect subclinical vessel injury.^[36] Such dissections elevate stroke risk through embolization or vessel occlusion, with mechanical trauma to the carotid sheath identified as the primary causal mechanism in peer-reviewed analyses.^[37] Hypoxic-ischemic brain injury from strangulation-induced cerebral hypoperfusion can yield long-term neurological deficits, including memory impairment, executive dysfunction, seizures, and PTSD-like symptoms persisting months to years.^[38] Neuropsychological evaluations of domestic violence survivors reveal pathological changes such as anoxic damage correlating with loss of consciousness during the event and subsequent cognitive sequelae, including deficits in attention and processing speed.^[38] These outcomes stem from prolonged cerebral hypoxia rather than direct trauma, with empirical data indicating incomplete recovery in many cases despite initial stabilization.^[39] Additional delayed effects encompass recurrent laryngeal nerve neuropraxia or injury, manifesting as persistent hoarseness, vocal cord paresis, or stridor from compression or stretch during neck pressure.^[40]^[41] Thyroid cartilage fractures or soft tissue trauma may contribute to chronic dysphonia or airway compromise over time, though these are less frequently documented in long-term follow-up.^[33] Underdiagnosis prevails due to the insidious onset of these complications, often mistaken for unrelated conditions, as symptoms like subtle cognitive decline or delayed vascular events evade routine acute assessment protocols.^[33]^[37]

Epidemiological Data

Prevalence in Homicides and Suicides

Strangulation constitutes a significant method in homicides, particularly those involving female victims and intimate partners. Globally, the United Nations Office on Drugs and Crime (UNODC) reports that asphyxiation and strangulation are among the most common methods employed in gender-related killings of women and girls, often perpetrated by intimate partners or family members using physical force rather than firearms or sharp weapons.^[42] In intimate partner homicides, prior non-fatal strangulation incidents precede approximately 43% of cases, indicating a pattern of escalating violence culminating in fatal compression of the neck.^[43] Demographically, female victims comprise about 68% of strangulation homicides, with rates elevated among those under 45 years old, while male-on-male strangulation remains rarer outside institutional settings like prisons, where interpersonal violence in confined environments contributes to higher incidences.^[44] In suicides, ligature strangulation—distinct from full suspension hanging—involves self-application of pressure to the neck without body weight drop, and represents a minority of asphyxial deaths. In the United States, asphyxia suicides (encompassing hanging, strangulation, and suffocation) accounted for 26.7% of all 42,773 suicides in 2014, though pure ligature strangulation cases are rare, with most asphyxial events classified as hangings.^[45] Males predominate in these deaths, reflecting broader gender disparities in suicide methods favoring mechanical compression over other means. Additionally, accidental autoerotic asphyxiation fatalities, involving intentional hypoxia for sexual gratification, are estimated at 500 to 1,000 annually across the United States and Canada, frequently misclassified as suicides due to scene similarities and lack of explicit evidence of erotic intent.^[46] Such misclassifications contribute to underreporting of non-suicidal ligature-related deaths. Historical trends in strangulation fatalities show relative stability, but advancements in forensic pathology, including detailed autopsy protocols for hyoid and cartilage fractures, have uncovered prior undercounting in ambiguous cases initially ruled as natural or accidental.^[47] Global homicide data from UNODC indicate consistent patterns in female victimology, with no marked decline despite awareness campaigns, underscoring persistent challenges in prevention.^[48]

Non-Fatal Incidents in Assaults

Non-fatal strangulation occurs in approximately 3% to 10% of lifetime intimate partner violence (IPV) cases among U.S. women, with past-year prevalence ranging from 0.4% to 2.4%.^[49] In emergency department assessments of abused women, about 10% report prior non-fatal strangulation by their partner.^[50] Such incidents serve as a key predictor of escalated violence, with victims experiencing non-fatal strangulation facing a 7- to 8-fold increased risk of subsequent homicide by the same perpetrator compared to those without.^[51] This elevated risk stems from the act's demonstration of intent to control vital functions, often preceding lethal attempts.^[50] Empirical data indicate that male partners perpetrate 80% to 90% of reported non-fatal strangulations in IPV contexts, reflecting physical strength disparities that enable sustained pressure on the neck despite resistance.^[52] Female victims predominate in documented cases, comprising the majority of emergency visits and advocacy program reports, though bidirectional violence exists.^[53] Male victims represent 10% to 20% of IPV strangulation reports in some community surveys, but underreporting is prevalent due to stigma, fear of disbelief, and lower service utilization rates among men.^[54] This underreporting does not equate incidence levels with female victimization, as severe assaults like strangulation show gendered asymmetries driven by average physiological differences in upper-body strength.^[55] Beyond IPV, non-fatal strangulation appears in 5% to 12% of sexual assaults, often as a coercive tactic during non-consensual encounters, with victims frequently showing minimal external injuries that delay recognition.^[56] In street-level assaults, such as robberies or fights, strangulation is less systematically tracked but contributes to a small fraction of emergency department admissions for assault-related trauma, estimated at under 0.002% of total U.S. visits from 2016 to 2020.^[53] Legislative changes have enhanced detection; the UK's Domestic Abuse Act 2021, effective June 2022, criminalized non-fatal strangulation as a standalone offense, resulting in thousands of charges and improved victim identification through specialized training.^[57] Similar U.S. state laws, such as those mandating strangulation protocols in protocols like Utah's, have increased reporting by over 200% in implementing jurisdictions by facilitating forensic exams and legal referrals.^[58]

Non-Criminal Contexts

Autoerotic and Consensual Practices

Autoerotic asphyxiation involves the self-application of mechanical or chemical means to induce cerebral hypoxia during solitary sexual activity, typically for the purpose of enhancing arousal through the euphoric effects of oxygen deprivation. Common methods include hanging with adjustable ligatures, plastic bags over the head, or chemical inhalants that restrict oxygen intake, often combined with genital stimulation.^[59]^[60] The practice seeks to exploit the physiological response where hypoxia triggers a surge in endorphins and other neurotransmitters, producing sensations akin to intensified orgasm by linking oxygen starvation to sexual pleasure.^[61]^[62] This form of self-induced asphyxia aligns with paraphilic interests classified under asphyxiophilia in diagnostic frameworks, where the restriction of airflow heightens sensory experiences through dominance over one's own autonomic responses or simulated submission to peril. Anecdotal and forensic case reviews indicate its occurrence across demographics, predominantly among males, driven by the causal mechanism of hypoxia amplifying neural reward pathways during masturbation.^[60] Historical documentation traces similar self-asphyxial practices to literary and medical accounts from the 19th century onward, though earlier isolated references exist in erotic literature exploring boundary-pushing sensations.^[63] Consensual practices, often termed breath play within BDSM contexts, extend these dynamics to partnered sexual encounters, involving manual compression of the neck or other restrictions to modulate oxygen flow during intercourse. Such acts emphasize negotiated power exchanges, where one participant applies pressure to evoke submission or control, mirroring autoerotic thrills but incorporating interpersonal trust and verbal cues. Surveys from the early 2020s report rising experimentation among young adults, with approximately 25% of men and 45% of women, and up to 61% of gender-diverse individuals, having experienced choking in consensual settings.^[64] A 2021 study of nearly 5,000 U.S. undergraduates highlighted its normalization, with 20-50% prevalence rates in recent cohorts attributing popularity to cultural depictions and the pursuit of intensified physiological highs from transient hypoxia.^[65] These practices draw on innate drives for sensory extremity, where oxygen modulation causally intensifies endorphin release and perceived erotic dominance-submission interplay, distinct from non-consensual applications.^[66]

Associated Risks and Empirical Outcomes

Estimates indicate that autoerotic asphyxiation results in 250 to 1,000 fatalities annually in the United States, primarily among males aged 15 to 35, due to unintended interruptions in oxygen supply during solitary practices involving neck compression.^[67] ^[60] Case reports document similar deaths in partnered consensual scenarios, such as BDSM activities, where manual strangulation or ligatures lead to rapid cerebral hypoxia and cardiac arrest despite mutual agreement.^[68] Forensic analyses reveal no verifiable safe pressure or duration thresholds, as vascular occlusion can occur within seconds, rendering even monitored attempts probabilistically lethal due to variables like positioning errors or delayed intervention.^[69] Survivors of non-fatal consensual strangulation exhibit neuropsychological impairments comparable to mild traumatic brain injury, including deficits in working memory, executive function, and balance, as evidenced by fMRI studies showing altered prefrontal cortex activation during cognitive tasks.^[70] ^[39] These outcomes stem from carotid artery compression inducing cerebral ischemia, with risks persisting even in brief episodes; one review of intimate partner violence survivors found strangulation independently associated with acquired brain injury after controlling for other trauma.^[38] Repeated exposure may foster addiction-like escalation via intermittent hypoxia's dopamine release, heightening tolerance and future incident probability without corresponding safety gains.^[71] Medical consensus underscores irreversible vascular and neurological damage from such practices, contradicting portrayals in pornography and media that downplay perils by implying controllability.^[72] Surveys reveal widespread misconception among young adults that consensual choking is low-risk, yet empirical data affirm cumulative harm potential, including chronic neck pathology and heightened stroke susceptibility.^[73] Legally, courts have invalidated consent in autoerotic asphyxiation cases involving capacity assessments, deeming participants unable to weigh existential risks against gratification, as seen in UK Court of Protection rulings prioritizing preservation of life over experiential autonomy.^[74] ^[75] Insurance disputes further classify these deaths as non-accidental, reflecting judicial recognition of inherent foreseeability.^[76]

References

[1]
About strangulation and hanging: Language matters - PMC - NIH
Strangulation is defined as asphyxia by closure of the blood vessels and/ or air passages of the neck as a result of external pressure on the neck.Missing: pathology | Show results with:pathology
[2]
[PDF] Non Fatal Strangulation/Suffocation: Four Common Myths
Myth: Strangulation and choking are the same thing.*. Fact: Strangulation is the external application of physical force that impedes either.Missing: definition | Show results with:definition
[3]
[PDF] Non Fatal Strangulation/Suffocation: What Every Judge Should Know
Strangulation Can Happen Fast. A strangulation victim can become unconscious in. 5-10 seconds and die within minutes.9. Strangulation Does Not Require Much ...
[4]
[PDF] 53 Chapter 5 Medical Evidence in Non-Fatal Strangulation Cases
Strangulation is one of the most lethal forms of domestic violence. Minimal pressure on the neck can cause serious injury, and even in fatal cases of ...
[5]
Strangulation Injuries - StatPearls - NCBI Bookshelf
Mar 3, 2025 · Strangulation injuries result from external forces applied to the neck, causing a range of traumatic pathology.
[6]
Section I - Non-Fatal Strangulation
Injury and death from strangulation occur from one or more mechanisms. The first mechanism is venous obstruction, whereby occlusion of the jugular veins ...
[7]
[PDF] Non-Fatal Strangulation Documentation Toolkit
A case of suicidal ligature strangulation by using a tourniquet method. The American. Journal of Forensic Medicine and Pathology, 31(1), 85–86. Atkins, B. Z., ...
[8]
Mechanism of loss of consciousness during vascular neck restraint
We conclude that the most important mechanism in loss of consciousness was decreased cerebral blood flow caused by carotid artery compression.
[9]
Hanging Injuries and Strangulation - Medscape Reference
Mar 31, 2025 · When a person is strangled (either intentionally or accidentally) or hanged, the pathophysiology starts with decreasing blood flow and air flow, ...
[10]
Fatal and non-fatal strangulation in Sweden - ScienceDirect.com
Manual strangulation involves the use of hands or arms, while ligature strangulation refers to the use of a cord, rope, chain, or similar object.
[11]
[PDF] Guidelines for clinical management of non-fatal strangulation
There are three main categories: hanging, ligature strangulation and manual strangulation1. Non-fatal strangulation (NFS) is where the patient has not died.
[12]
What is the reason that capital punishment in the Roman Republic ...
Aug 15, 2020 · Strangling is mentioned in Scripture, so it dates back to Hebraic times. And the Persians introduced hanging by the neck, originally a more ...
[13]
Why was strangulation such a common Roman method of execution ...
May 8, 2016 · 316 votes, 24 comments. Certainly not, most Roman punishments were meant to fit the crime... you had "the sack" culleus - for patricide (a ...
[14]
Merciful (but messy) alternatives to lethal injection.
May 5, 2006 · As the debate over the constitutionality of death by lethal injection made its way to the Supreme Court in last month's case of Hill v.
[15]
The Project Gutenberg eBook of The Inquisition of Spain
BOOK VI—PRACTICE (Continued). Chapter VII—Torture. PAGE. General Use of Torture in Secular Courts, 1. The Inquisition not exceptionally cruel ...
[16]
The Garrote - Capital Punishment UK
The garrotte (or garrote) was the standard civilian method of execution in Spain. It was introduced in 1812/13, at the beginning of the reign of Ferdinand VII.
[17]
Garrote vil. The macabre instrument for executing the death ... - Gale
Jun 26, 2024 · The tool used for centuries by the Spanish State to carry out capital punishment executed the last two convicts in 1974 and was deleted from the country's ...
[18]
The Spanish Garotte - Hansard - UK Parliament
The present system of executing criminals is attended with unequal and needless torture and often leads to revolting and discreditable scenes.
[19]
The History of Hanging - Historic UK
As a form of capital punishment, hanging was introduced to Britain by ... method of simple strangulation hitherto used. How Hanging Kills. The position ...Missing: decline | Show results with:decline
[20]
GET TOUGH! How To Win In Hand To Hand Fighting
£7.99 to £13.99 In stock £10 deliveryGet Tough is filled with clear, graphic line drawings which, with the easy-to-follow directions, demonstrate the Fairbairn System.Missing: strangling techniques
[21]
Co. C recruits learn responsible use of force
Jan 31, 2013 · By applying pressure to the carotid artery, the major artery of the head and neck, blood flow is restricted to the brain causing the enemy to ...Missing: WWII | Show results with:WWII
[22]
Garrotes: From Spy Lore To Practical Use For The Everyday Man
Garrotes inhabit the realm of spy novels and World War II special-ops lore, but people really did use these things to kill each other.Missing: oss | Show results with:oss
[23]
Essential Unarmed Combat: The Anatomy of a Chokehold | SOFREP
May 29, 2023 · The compression aims to impede the blood flow to the brain via the carotid arteries, the blood vessels found on both sides of the neck. That ...
[24]
How hand-to-hand combat training in the US military has evolved
Oct 3, 2025 · After World War II, there was no further emphasis on hand-to-hand fighting. Drill sergeants and instructors taught it, but it wasn't a priority.Missing: shifts non-
[25]
[PDF] 01 - 2007 National Study On Neck Restraint In Policing
A vascular neck restraint is an empty hand control technique which does not rely upon the subjects' ability to feel and respond to pain stimulus to be effective ...
[26]
Indicators of strangulation in medico-legal assessments: A scoping ...
Sep 29, 2025 · The fact that petechial haemorrhages after strangulation are considered to be a sign of severe neck compression [40] in combination with the ...
[27]
Asphyxia - Pathology Outlines
Jul 18, 2022 · Asphyxia: generic term that indicates a condition resulting from an interference with respiration due to the lack of oxygen in the air or in the blood.<|separator|>
[28]
[PDF] Death By Strangulation – Dr. Dean Hawley - Mark Wynn Consulting
The injuries that may occur include patterned contusions and abrasions caused by fingernails, finger touch pads, ligatures, or clothing. These injuries are then.
[29]
Hyoid Bone Fracture Pattern Assessment in the Forensic Field - NIH
Mar 22, 2024 · In hanging and ligature and manual strangulation, asphyxia occurs due to the neck region's compression, leading to air passage impairment [3].
[30]
Hyoid Fracture and Strangulation - Office of Justice Programs
Hyoid fracture frequently indicates manual strangulation, although ligature strangulation, hanging, and other forms of trauma to the neck cannot be ruled out ...<|separator|>
[31]
Imaging of alert patients after non-self-inflicted strangulation - NIH
Nov 13, 2023 · The results indicate that MRI is more appropriate than CT for alert patients presenting after non-self-inflicted strangulation.
[32]
(PDF) Strangulation Forensic Examination: Best Practice for Health ...
Aug 6, 2025 · A summary of how to perform a forensic examination of the strangled patient is provided along with important documentation takeaways and useful forms.
[33]
Management of non-fatal strangulation in general practice - RACGP
Strangulation refers to external pressure applied to the neck, causing compression of and potentially injury to vital structures, and obstruction of blood and/ ...
[34]
Pitfalls and Artifacts in the Neck at Autopsy - PMC - PubMed Central
It can be difficult to differentiate the hemorrhages associated with postmortem hypostasis from true bruising caused by strangulation.
[35]
Death by hanging: examination of autopsy findings and best ...
Hanging is a form of death caused by constriction of the neck by a ligature, where the constricting force is derived from the gravitational drag of the ...<|separator|>
[36]
Fatal and non-fatal bilateral delayed carotid artery dissection after ...
We describe two cases of carotid artery dissection following strangulation with delayed symptoms as well as discuss medical diagnostic problems and their ...Missing: long- effects
[37]
Neurological Implications of Nonfatal Strangulation and Intimate ...
In addition to direct hypoxic–ischemic damage from NFS, mechanical trauma to the cervical blood vessels and the airway can cause delayed neurological sequelae.
[38]
[PDF] neuropsychological outcomes of non-fatal strangulation in domestic ...
Jul 3, 2022 · Fatal and non-fatal bilateral delayed carotid artery dissection after manual strangulation. Forensic Science International, 149(2-3), 143 ...<|separator|>
[39]
Strangulation as an acquired brain injury in intimate-partner ... - NIH
The aim of this work was to examine the relationship between strangulation related alterations in consciousness (AIC) and cognitive and psychological outcomes
[40]
Transient vocal paralysis following strangulation injury - PubMed
Three of these had unilateral paralysis; the fourth had bilateral paralysis on two separate occasions of strangulation. All patients recovered in 4 to 20 days.Missing: hoarseness | Show results with:hoarseness
[41]
Bilateral Recurrent Laryngeal Nerve Neuropraxia after an attempted ...
Aug 7, 2025 · Recurrent laryngeal nerve neuropraxic injury is a possible consequence of strangulation. This can give rise to hoarseness and stridor with a ...
[42]
[PDF] Global Study on Homicide - Gender related killing of women and girls
Source: UNODC homicide statistics. Male and female rates of intimate partner homicide ... for committing femicide is often asphyxiation or strangulation ...
[43]
Non-fatal Strangulation is an Important Risk Factor for Homicide of ...
Data were derived using the Danger Assessment. Non-fatal strangulation was reported in 10% of abused controls, 45% of attempted homicides, and 43% of homicides.Missing: global | Show results with:global
[44]
The Characteristics and Circumstances of Fatal Interpersonal ...
Feb 23, 2025 · Most victims of strangulation are women (68.2%), under the age of 45 (52.3%), and Anglo-European (73.3%). Most individuals are killed by someone ...
[45]
Epidemiology of asphyxiation suicides in the United States, 2005 ...
Jan 8, 2018 · Among the 42,773 suicides in 2014, 11,407 (26.7%) were due to hanging, strangulation, or suffocation (collectively referred to as asphyxia for ...
[46]
Autoerotic deaths: a 25-year retrospective epidemiological study
It is written in almost all articles on autoerotic deaths that these fatalities account for about 500 to 1000 deaths per year in the United States and Canada.Missing: misclassified suicide
[47]
Homicidal and suicidal ligature strangulation--a comparison of the ...
Suicides by ligature strangulation are rare events. In Berlin (3.5 million inhabitants; ca. 500 suicides per year) approximately one case per year occurs.Missing: statistics | Show results with:statistics
[48]
[PDF] Global Study on Homicide – Gender-related killing of women and girls
Source: UNODC homicide statistics. Rates of female total homicide and intimate partner/family-related homicide, selected countries in the. Americas, 2016.
[49]
A Systematic Review of the Epidemiology of Nonfatal Strangulation ...
We reviewed the literature on the epidemiology of nonfatal strangulation (also, albeit incorrectly, called choking) by an intimate partner.Missing: decline execution
[50]
Non-fatal strangulation is an important risk factor for homicide ... - NIH
attempted homicide/completed homicide) and strangulation was observed, thus indicating that women strangled in both abuse groups have higher DA scores. Table 2.
[51]
Non-fatal strangulation is an important risk factor for homicide of ...
The purpose of this study was to examine non-fatal strangulation by an intimate partner as a risk factor for major assault, or attempted or completed homicide ...
[52]
Assault by strangulation: sex differences in patient profile and ... - NIH
Feb 11, 2020 · Assault by strangulation has the potential for severe brain injury or death. The objectives of this study were to describe the profile of ...
[53]
Strangulation victimization in the United States: Findings from a ...
May 30, 2025 · Even if victims initially survive a strangulation incident, they may endure delayed complications that could lead to death in the days or weeks ...
[54]
Barriers to Men's Help Seeking for Intimate Partner Violence - PMC
Evidence suggests that male victims of intimate partner violence (IPV) are less likely to seek help for their victimization than female victims.Missing: strangulation | Show results with:strangulation
[55]
Gender symmetry and mutuality in perpetration of clinical-level ...
A review of 91 empirical comparisons found that symmetry and mutual violence perpetration is typical of relationships involving severe and injurious assaults ...
[56]
New perspectives on risk factors for non-fatal strangulation and post ...
Non-fatal strangulation (NFS), which is strangulation that does not immediately result in death, occurs in approximately 5.1% to 12% of sexual assaults (Cannon ...Missing: street | Show results with:street
[57]
Strangulation and suffocation | The Crown Prosecution Service
Aug 25, 2022 · Section 70 Domestic Abuse Act 2021 (DA Act 2021) introduced the offence of strangulation or suffocation. Schedule 2, paragraph 4 DA Act 2021 ...
[58]
[PDF] Nonfatal Strangulation And Intimate Partner Violence Decision Tree ...
May 19, 2024 · An evaluation of an existing Utah nonfatal strangulation protocol found a 224% increase since implementation in patients seeking legal or ...
[59]
Accidental Autoerotic Deaths and Mental Disorder: A Scoping Review
Jan 23, 2025 · Accidental autoerotic death, more commonly known as “autoerotic asphyxia,” is an extreme paraphilic behavior wherein individuals induce ...Missing: misclassified | Show results with:misclassified
[60]
Sexual Masochism Disorder with Asphyxiophilia: A Deadly yet ... - NIH
Asphyxiation due to neck compression subsequent to hanging has been reported as the most common form of autoerotic death [15]. However, differentiation between ...
[61]
Well Hung | Psychology Today
Feb 27, 2014 · Erotic asphyxiophilia connects two sources of euphoria: orgasm and hypoxia (lack of oxygen). Whenever you deprive the brain of sufficient oxygen ...
[62]
Autoerotic Asphyxiation: Secret Pleasure—Lethal Outcome?
Nov 1, 2009 · Autoerotic asphyxiation (AEA) is a clinical syndrome that is classified in the Diagnostic and Statistical Manual of Mental Disorders, Fourth ...<|separator|>
[63]
Erotic Asphyxiation in the Nineteenth Century - ResearchGate
Aug 5, 2025 · Request PDF | On Jan 1, 2016, Clayton Carlyle Tarr published Pleasurable Suspension: Erotic Asphyxiation in the Nineteenth Century | Find, ...
[64]
Prevalence and Correlates of Sexual Choking and Consensual Non ...
Jan 31, 2025 · We assessed the prevalence and correlates of choking and CNC. More women (45%) and gender diverse participants (61%) had ever been choked than men (25%).Missing: breath 2020s
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Let's Chat About Sexual Choking and Breath Play | Allure
Sep 12, 2025 · Choking is increasingly common amongst undergraduate students: A 2021 survey of nearly 5,000 students at “a large U.S. university” revealed that ...Missing: 2020s | Show results with:2020s
[66]
Choking/Strangulation During Sex: Understanding and Negotiating ...
Feb 5, 2025 · This paper examined whether and how Australian adults aged between 18–35 perceived choking/strangulation in terms of “safety.”Missing: 2020s | Show results with:2020s
[67]
Autoerotic Asphyxiation: A Case Report - Psychiatrist.com
May 25, 2017 · Annually, about 250 to 1000 deaths in the US result from autoerotic asphyxiation. This case report describes an older man with ...
[68]
Fatal strangulation during consensual BDSM activity: three case ...
Request PDF | Fatal strangulation during consensual BDSM activity: three case reports | Autoerotic accidents are well-known occurrences in forensic casework ...
[69]
Strangulation: IFAS Position Statement
Strangulation risks brain injury and death as well as other adverse outcomes [1]. The neck contains vital structures including the airway and blood vessels ...Missing: studies | Show results with:studies
[70]
Frequent and Recent Non-fatal Strangulation/Choking During Sex ...
Jun 1, 2022 · Being strangled, or “choked,” by a sexual partner has emerged as a prevalent, and often wanted and consensual, sexual behavior among ...
[71]
Neuropsychological and Balance Symptoms of Abused Women ...
... women, including potential acquired brain injury from non-fatal strangulation. Despite existing evidence on the neuropsychological ...
[72]
'There is no safe way to do it': the rapid rise and horrifying risks of ...
Jul 7, 2025 · She describes being at a sexual health conference last year where data was presented on sexual strangulation – the prevalence and harms.Musician found guilty of... · The secret lives of porn addicts<|separator|>
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Choking during sex: many young people mistakenly believe it can ...
Feb 6, 2025 · This practice involves one person putting pressure on the neck of another, restricting breathing or blood flow (or both). Strangulation during ...
[74]
Autoerotic asphyxiation: capacity and best interests
Dec 18, 2020 · This case centred around whether an individual, let's call him 'James', had capacity to decide whether or not to engage in a sexual activity ...
[75]
The Mental Capacity Act 2005 and autoerotic asphyxiation
Jan 28, 2022 · He was assessed as having the capacity to consent to sex but did not have the capacity to determine contact with others, including sex workers.
[76]
Autoerotic Asphyxiation and Accidental Death Insurance: Odd Facts ...
May 11, 2021 · The federal circuit courts have recently split on the question of whether these deaths are accidents for purposes of accidental death insurance.Missing: misclassified | Show results with:misclassified<|separator|>