Invisible scars of domestic violence


One in three women will be affected by domestic violence in their lifetime. Often, the bruises and broken bones they endure are visible, but there's another form of violence that doesn't always leave any marks.

These are the victims of a crime that often leaves no visible scars.

"Being strangled, I thought I was going to lose my life," said 'Jennifer,' a domestic violence victim.

Jennifer -- who asked to conceal her identity -- was beaten and strangled by her ex-boyfriend.

"He picked me up, my entire body, and slammed me down with my head hitting first. He used my purse strap, and he used that to strangle me," she said.

The assault lasted for hours. Jennifer was left unconscious but alive. She checked herself into the hospital that night.

Audrey Bergin, a domestic violence expert, says about 23 percent of victims that come to the ER after an assault have been strangled.

"It really is one of the leading risk factors or predictors for a relationship that may become lethal," said Bergin, Program Manager of the Domestic Violence Program at Northwest Hospital.

A domestic violence victim who has been strangled is over nine-times more likely to be killed. It can lead to stroke, miscarriage and pneumonia. Problems -- even death -- can occur hours or days later. However, detecting the injury in the ER is a challenge.

"The big issue with strangulation is even on pale skin, it doesn't leave any external marks," Bergin said.

Bergin teamed with Nurse Rosalyn Berkowitz to develop a protocol for strangulation victims at their hospital.

"So strangulation, what is the big deal about it? You can die from it," said Berkowitz, R.N.,
Clinical Leader, Emergency Department at Northwest Hospital.

They devised a standard exam and a list of questions to ask victims. They also use a device to help document injuries. By filtering out wave lengths of light, it lets you see bruising, handprints and red marks that aren't visible to the naked eye. The goal: to give victims more evidence for police reports and ultimately help them come up with a plan for leaving.

After a year of abuse, Jennifer finally had enough. Her boyfriend is behind bars.

"I just hope other women don't wait that long. I'm lucky to be here," Jennifer said.

They say it takes an average of seven to nine times for a victim to finally leave an abusive situation. To date, only about 30 states, including Florida and Georgia, consider strangulation a felony. It is a misdemeanor in the other states.

Additional Information On Strangulation:

What is it? Strangulation is one of the most lethal forms of violence. It is a form of asphyxia (lack of oxygen) in which blood vessels and air passages are closed as a result of external pressure on the neck. Strangulation is not the same as choking. Choking refers to an internal injury, whereas strangulation refers to an external injury. Strangulation can induce the loss of consciousness within about 10 seconds and death within 4-5 minutes. There are three forms of strangulation: hanging, manual and ligature. Manual strangulation is the most common form of strangulation used in domestic violence cases.

Some Facts about Strangulation: 

  • Studies show that 23% to 68% of female victims of domestic violence have experienced at least one strangulation assault by a male partner during their lifetime.
  • Strangulation can be a recurring form of violence. In a study of 62 abused women who came to a shelter, 68% had a history of strangulation, and on average, each woman had been strangled 5.3 times in their relationships.
  • Strangulation can pose physical health effects such as dizziness, nausea, sore throat, voice changes, throat and neck injuries, breathing problems, swallowing problems, ringing in the ears, and vision changes. It can also cause neurological effects like facial drooping, eyelid drooping, loss of sensation, loss of memory and paralysis. Psychological effects such as depression and PTSD are also common.
  • Strangulation often leaves no marks or external evidence on the skin. In a study of police records of 300 strangulation cases, victims did not have any visible injury in 50% of the cases, and in 35% of the cases, the injuries were too minor for the police to photograph.

(Source: http://www.sp2.upenn.edu/ortner/docs/factsheet_strangulation.pdf)