Rachel, who asked that her real name not be used, lived in Camden County during much of her relationship with her abuser and now resides in Riverside. She is one of a growing number of women who are reporting being strangled during domestic violence incidents nationwide, authorities say.
And while in Burlington County, law enforcement officials and others maintain that the number of these nonlethal strangulation cases have not spiked locally, but they say that awareness of the seriousness of nonlethal strangulation is on the rise and that the response to this type of attack is being handled much differently than in years past.
Domestic violence advocates say the changes are the result of their work, which started slowly about a decade ago when domestic violence began to be viewed more and more seriously and as something that should no longer be considered a private affair that the assailant and victim could eventually work out. They say it is all too common for nonlethal strangulation to be part of these attacks.
A 2008 Journal of Emergency Medicine study found that a woman who experiences nonlethal strangulation — whether by someone’s hands or by ligature or other means — is seven times more likely to be the object of a murder attempt by her assailant. It also found that 43 percent of women killed in domestic violence attacks, and 45 percent of attempted-murder victims, had been strangled by a partner in the previous year.
In 2011, the most recent figures available, there were 380 murders in New Jersey, according to the Uniform Crime Report, compiled by the New Jersey State Police. Strangulation is included in the same category as hanging, drowning and asphyxiation.
But advocates have spread the message to victims as well as police, courts and others involved in these cases — even the attackers — that someone does not have to be killed to be strangled. They start by stressing that “strangling” is not synonymous with “choking,” as traditionally thought, and that strangling can have serious consequences other than death.
From there, they have been pushing for more and more police departments to get special training in how to handle and recognize strangling in domestic violence situations when it might not be apparent that the act has happened, and to charge assailants appropriately.
Burlington County has been making many of these changes.
A form of control and assault
“It’s (nonlethal strangulation) traditionally been a common form of control and assault in domestic violence cases,” said Sandy Clark, executive director of the New Jersey Coalition for Battered Women.
Clark also is on the New Jersey Domestic Violence Fatality and Near Fatality Review Board, which studies domestic violence homicide cases provided by police and prosecutors to see how these deaths could have been prevented.
“We’ve been trying to impress upon law enforcement that this is strangulation and not choking,” Clark said.
“Choking is literally choking on a piece of food, or allergies,” said Karen Hoisington, program director of Providence House Domestic Violence Services of Burlington County, which has a counseling center in Delran and a safe house for victims at an undisclosed location.
Providence House also trains community volunteers to become members of a domestic violence response team that assists victims immediately after an incident at the local police station or hospital.
“Strangulation is an aggressive act that abusers know often when to stop,” Hoisington said.
She said that choking is internal and strangulation is external, and that strangulation is involved in eight out of 10 domestic violence cases.
Clark said of new training and other efforts among those involved in this problem, “What we’re seeing today is the result of advocates working for the past 10 years (to raise this awareness). I don’t think the incidents (of strangulation) are going up (in New Jersey), but the recognition is that it’s not choking.”
“Clients are surprised” when they learn they have actually been strangled and not choked, Hoisington said. “They don’t realize how serious this is and that it can have residual health consequences. It can lead to brain damage because of a lack of oxygen to the brain.”
Voice changes (hoarseness, raspiness or loss of voice); breathing changes (difficulty or inability to breathe); involuntary incontinence and nausea; dizziness; miscarriage; mental status changes (sleep disturbance, amnesia, stress, restlessness or combativeness); fractured bones or injured cartilage in the neck; lung damage; fluid in the lungs; pneumonia; vision or hearing changes, and memory loss are among other results of strangulation.
“In general, you see more education coming out as far as strangulation cases they used to call choking,” Riverton police Chief John Shaw said. “Providence House and the state are pushing training and things to look for.”
Shaw said officers in his department stay up to speed on anything new regarding domestic violence, including attending regular meetings with authorities from the Burlington County Prosecutor’s Office.
“They listen to what prosecutors are encountering in the courtroom,” Shaw said.
Officer training has increased
He said that officers have had basic training in how to handle strangulation cases in the past, but that in the past couple of years the training has increased.
“A lot of times, people think people have to die for it to be strangulation,” Shaw said. “They downplay and think it’s choking if people don’t die. … They see people choke and not die.”
“One of the reasons strangulation has been underreported and underappreciated is there are often no visible injuries,” Clark added. “A black eye might look more serious, although a woman might have lost consciousness (from strangulation).”
“It’s a very high-risk factor for homicide,” she said. “A victim can be killed in five minutes, so in my mind, it’s attempted murder. If you’re strangled for two minutes, you’re half-dead.”
“There should be a red flag that goes up that this person could kill someone. It’s (strangulation) a relatively easy way to kill someone or to send a message that ‘I can very easily kill you if you don’t do what I say.’ ”
Dr. William L. Manion, who is the assistant medical examiner for Burlington County and a part-time assistant medical examiner for Ocean and Atlantic counties, said strangling someone is not only relatively easy but also convenient, because a gun or another weapon isn’t needed to accomplish it. He said it is also an assault that is “up close and personal.”
“When an offender puts their hands around a victim’s throat and squeezes, their intent is to seriously harm the victim,” added Florence police Capt. Brian Boldizar.
Manion explained that in strangulation the assailant usually goes for the jugular (large veins of the neck that drain blood from the head), causing petechial hemorrhaging in the eyes.
“It is easy to press the jugular vein and prevent blood in the head from going back to the heart. When the blood can’t go through the jugular, it builds up and causes small blood vessels to hemorrhage,” he said.
The bleeding is shown as tiny red dots or pinpoints and can appear as small hemorrhages in the whites of the eyes and inside the eyelids. If there is a really intense assault, they can be seen on the bridge of the nose, Manion said.
In addition to bruises on the neck, police will now look for petechial hemorrhaging as well other evidence of strangling that can occur during an attack or afterward.
“Things are more advanced now,” said Pemberton Township police Detective Danielle Hann of the handling of cases involving nonlethal strangulation.
Hann is the department’s domestic violence liaison and the coordinator for the officers’ training through Providence House and coordinator of the domestic violence response teams.
Hann said judges and the Burlington County Prosecutor’s Office are part of the new efforts in addition to police departments.
“There’s a great flow among all the agencies (involved in domestic violence) in Burlington County,” she said.