Strangulation an overlooked red flag in domestic violence - Albuquerque Journal

Strangulation an overlooked red flag in domestic violence

What must it be like when anger turns to rage, then to violence.

But not with a slap, a punch, a push, a kick. Not with fists or knives or a gun, but with hands firmly around the neck, squeezing tighter and tighter.

You struggle to breathe, to stay alert, to stay alive.

Panic shoots through you, paralyzes you. You cannot scream. Blood flow through your carotid arteries slows, ceases. With no oxygen reaching your brain, you black out quickly – in about 6.8 seconds.

Death can occur within 62 to 152 seconds.

There may be no outward signs of the damage he has done. If you don’t die then, you worry no one will believe it was as bad as it was. You may not believe it yourself.

But it is that bad.

If you don’t die then, you are 750% more likely to be killed later by your abuser. If he has access to firearms, then 1,100% more likely.

Gail Starr ticks off the shocking statistics as she sounds the alarm about strangulation and its implications. All domestic violence is bad, and as a nurse with Albuquerque Sexual Assault Nurse Examiners, or SANE, Starr has seen plenty of that.

Gail Starr, nurse and clinical coordinator at Albuquerque SANE, sounds the alarm about strangulation as one of the most lethal forms of domestic violence. ROBERTO E. ROSALES/JOURNAL

Strangulation ratchets up the risk level significantly. Yet it doesn’t receive the public attention it should.

“It needs to be known by everyone that strangulation is a serious thing that should not be blown off,” said Starr, who is also clinical coordinator at SANE in Downtown Albuquerque. “It’s a huge red flag. It’s a strangler telling you, ‘I can kill you and I will kill you.'”

Stalking is also a red flag, she added.

I met Starr recently on my tour of the Family Advocacy Center, a one-stop location for agencies, including SANE, dedicated to aiding victims of domestic violence and sexual assault.

Two days before my visit, news had broken that the death of Gabby Petito, a young Florida woman whose fatal cross-country trip with her fiancé became a national obsession, was ruled a homicide by strangulation.

The high-profile tragedy generated public discourse on domestic violence, and Starr said she hopes it can now be a catalyst for talking about strangulation and its deadly implications.

She is convinced that if law enforcement, the courts, advocates, medical personnel and survivors see strangulation as a key risk factor for homicide – including mass shootings, child abuse resulting in death and police killings – lives might be saved.

“It could help how we identify cases with the potential to become lethal and how we handle them,” she said.

More than one in four women who identified themselves as being in abusive relationships said they had experienced non-fatal strangulation, according to a study published in the National Center for Biotechnology Information.

Starr’s own statistical analysis of the domestic violence patients she sees puts that number locally much higher at 44%.

Yet it wasn’t until 2018 that New Mexico classified strangulation as a serious violent crime. Before then, a defendant who strangled another could be charged with a felony if charged at all, but that charge could and often was reduced to a misdemeanor if a jury was not convinced that the person’s hands can be deadly weapons or that strangling causes real harm.

New Mexico was the 46th state to make strangulation a felony offense. Ohio remains the only state where strangulation is a misdemeanor. In South Carolina, strangulation is part of other felony offenses but is not a stand-alone felony.

Strangulation gets short shrift in part because it does not always produce visible signs of assault and can be hard to prove, Starr said.

“When I do trainings, I talk about how the stereotypes of scratches and bruises aren’t always the case and that only about a third of the cases show any external injury at all,” she said.

With no obvious signs of trauma, police, jurors and the victims themselves can miss the significance of strangulation. That, she said, can lead to deadly consequences.

Compression of the carotid arteries, the major vessels that supply blood and oxygen to the brain, can create potentially lethal blood clots. The trachea can be torn. Both can kill hours or even days after the strangulation.

Even more deadly is strangulation as a significant predictor of future lethal violence.

“The most dangerous domestic violence offenders strangle their victims. The most violent rapists strangle their victims. We used to think all abusers were equal. They are not,” said Casey Gwinn, president of Alliance for HOPE International and co-founder of Training Institute on Strangulation Prevention, from which many of the statistics Starr refers to derive. “So when you hear ‘He choked me,’ now we know you are on the edge of a homicide.”

Perhaps the most crucial people to educate about strangulation are the victims themselves.

“I had a patient who told me she couldn’t tell police about her abuser because he would kill her,” Starr said. “And I told her, ‘Honey, you’re going to be killed even if you don’t report him.'”

What must it be like when anger turns to rage, then to violence, his hands firmly around the neck. You look into his eyes, the person you used to love, maybe still love, and what you see scares you. Your eyes show your fear, your terror, and you know he sees that, wants that.

And you know, you have to know now, that the next thing you need to look at is your way out.

UpFront is a front-page news and opinion column. Reach Joline at 730-2793,, Facebook or @jolinegkg on Twitter.


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