Physical Health

Open Access: No.

Abstract

This systematic review draws together evidence from the literature for the pathological, neurological, cognitive, psychological, and behavioural outcomes of non-fatal strangulation in domestic and sexual violence. A systematic search of PubMed, PsycINFO, CINHAL, Proquest, ASSIA, Web of Science, WestLaw, Open Grey, and Ethos was conducted, with no date limits set, to identify eligible studies. Thirty empirical, peer-reviewed studies were found which met the inclusion criteria. Pathological changes included arterial dissection and stroke. Neurological consequences included loss of consciousness, indicating at least mild acquired brain injury, seizures, motor and speech disorders, and paralysis. Psychological outcomes included PTSD, depression, suicidality, and dissociation. Cognitive and behavioural sequelae were described less frequently, but included memory loss, increased aggression, compliance, and lack of help-seeking. However, no studies used formal neuropsychological assessment: the majority were medical case studies or based on self-report. Furthermore, few authors were able to control for possible confounds, including other physical violence and existing psychosocial difficulties. There is therefore a need for further neuropsychological research, focusing on cognitive and behavioural outcomes, using standardized tools, and control groups where possible. This is urgent, given societal normalization of strangulation, and legal systems which often do not reflect the act’s severity and its consequences..

Relevance

Strangulation “may be the second most common cause of stroke in women under 42.”

“Our systematic literature search identified 30 empirical, peer-reviewed studies which documented the outcomes of non-fatal strangulation in IPV and sexual assault. Almost all victims were female. Severe, life-threatening injuries were reported, including stroke, arterial dissection, and symptoms of hypoxia and venous congestion. Clinical outcomes included loss of consciousness, changes to vision and voice, motor difficulties, and sensory loss. Psychological outcomes indicated profound trauma reactions, including acute and chronic fear, PTSD, dissociation, depression, anxiety and suicidality. Fewer studies reported on cognitive and behavioural changes. Those that did highlighted memory loss, executive difficulties, aggression towards the attacker, and lack of help-seeking.”

The public health group We Can’t Consent To This has collated hundreds “of cases of  women fatally strangled by men during sexual intercourse, in which the legal defence team argued that the victim consented, that therefore the death was accidental, and consequently the assailant not guilty of murder. But from a neuropsychological perspective, cognitively consent hinges on two factors: it must be informed, and there needs to be capacity to withdraw it at any point. If strangulation – its mechanics, its severity – is not understood, then the victim is not informed.”

Citation

Bichard, H., Byrne, C., Saville, C. W. N., & Coetzer, R. (2021). The neuropsychological outcomes of non-fatal strangulation in domestic and sexual violence: A systematic review. Neuropsychological Rehabilitation, 32(6), 1164–1192. https://doi.org/10.1080/09602011.2020.1868537