Helen Bichard, Christopher Byrne, Christopher W. N. Saville, and Rudi Coetzer
Neuropsychological Rehabilitation (in review)
Abstract
This paper reviews the neurological, cognitive, psychological, and behavioural outcomes of non-fatal strangulation and, given shared physiological mechanisms, asks whether the hypoxic-ischaemic literature can serve as a proxy. 27 empirical, peer-reviewed studies were found which met the inclusion criteria. Neurological consequences included loss of consciousness, indicating at least mild acquired brain injury, stroke, 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 amnesia and compliance. Overall, the evidence suggested strangulation in domestic violence and sexual assault can share all the serious consequences of hypoxic-ischaemic injury, but carries additional neuropsychological burden. However, no papers used formal neuropsychological assessment: the majority were medical case studies, or based on self-report. There is therefore a need for further neuropsychological research, focusing on cognitive and behavioural outcomes, using standardised tools, and control groups where possible. This is urgent, given societal normalisation of strangulation, and consent to ‘rough sex’ being used as a legal defence. We also discuss broader implications: the popularity of the ‘choking game’ with teenagers, and carotid injuries within mixed martial arts.
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