Brooke Batesel, in an exam room in the emergency department at CoxHealth in Springfield, is an assistant coordinator of Forensic Nursing and an expert in strangulation (particularly regarding cases of domestic violence). She is an RN and a board-certified Sexual Assault Nurse Examiner. (Photo by Jym Wilson)


Part of a series on domestic violence in Springfield and Greene County. Need help? See related story.

Strangulation is one of the most abusive and lethal ways to demonstrate power and control in domestic violence situations. It is also among the most common.

“The abuser is basically holding their life in their hands and having control on whether or not that person takes another breath,” said Brooke Batesel, a forensic nurse at CoxHealth. “It’s a very personal assault, and you can strangle someone without leaving any marks.” 

A person strangled can become unconscious within seconds. All it can take is six to eight seconds of pressure to the neck, Batesel said.

“The person is unconscious and can die within minutes if that pressure is not released,” she said. “And I’m talking one to two minutes.”

As part of its in-depth investigation into the widespread and everyday occurrence of domestic violence in Springfield and Greene County, the Springfield Daily Citizen reviewed probable cause statements from 150 domestic assault charges filed in 2022. 

In those cases, about one-third of the defendants were accused of strangling the victim.   

  • Part I: Black eye for Greene Co.
  • Part II: Obstacles to leaving
  • Part III: Systemic issues
  • Part IV: Searching for solutions

According to national data, one in four women will experience intimate partner violence in their lifetime, and of those, up to 68 percent will suffer near-fatal strangulation at the hands of their partner. 

Someone strangled just once in an intimate partner relationship is 750 percent more likely to be killed by their abuser than those who have never been strangled, according to information from the Training Institute on Strangulation Prevention. 

Trained to spot physical signs of strangulation

WARNING: Some readers may find details to be disturbing.

Batesel is a trained expert on strangulation. She treats victims of sexual assault and domestic violence, including physical abuse and strangulation. 

Strangulation has “devastating physical and psychological effects” on the victim and is rooted in the abuser’s need for power and control, Batesel said. 

Physical signs include red marks, bruising, cord or rope burns, petechiae (red spots), subconjunctival hemorrhage (bloodshot eyes). Victims often have difficulty breathing after being strangled. They may have a raspy voice or might lose their voice. 

Victims often drool due to the swelling in their airway and often have ringing in the ears. 

“You can also see bruising or teeth marks on the sides of their tongue,” Batesel said. “That is an attempt to push their tongue out between their teeth to open their jaw to take a breath. It’s a very serious assault.”

It’s common to see scratches on a victim’s neck where they tried to pry their abuser’s hands away, Batesel said.  

“You can have a fracture to the hyoid bone, but you don’t have to have those things to have suffered a serious strangulation event.” The hyoid is the small U-shaped bone located below the mandible (lower jaw) and at the front of the neck. 

“All of these signs and symptoms are possibilities, but it’s not a checklist,” she added.

A person often can be strangled yet have no red marks or bruising. That doesn’t mean the victim didn’t suffer a serious assault that left internal injuries. 

“There can be fatal cases of strangulation and there are no marks left on the patient’s neck,” Batesel said. “It’s very challenging for law enforcement to identify that unless the victim comes forward and discloses strangulation.”

Strangulation can result in neck pain, memory loss, heart attack or brain injury. It can also lead to a stroke which can happen hours to days — or even weeks — later.

That’s why police investigators often will revisit victims. They know that evidence of assault — including bruising, swelling or stroke might appear later, said Sgt. Chris Rasmussen, with the Springfield Police Department.

While it’s more common to see female victims who have been strangled by a man, Batesel said she does treat male victims who have been strangled by a woman.

“I don’t see it often, but we have seen it,” she said. 

The Training Institute on Strangulation Prevention is a program of the Alliance for Hope International. Gael Strack, CEO and co-founder of the alliance, said in 2022 that strangulation is “now recognized as a gender crime.”

“It is a weapon of choice,” Strack said. “Men are strangling their victims to control them, to maintain control, to cause great bodily injury and or to kill you.

“Many victims who report being strangled also report they have been threatened with death,” she said. “And many of them believed that they were going to die.”

Batesel received her specialized training from the Training Institute on Strangulation Prevention and suggested anyone wanting to learn more visit the institute’s website

Death can come in a minute (click to expand)

The following information is from Domestic Violence Service Management

Strangulation has the effect of cutting off blood flow to the brain by restricting the blood vessels in the neck (blood vessels that carry oxygen-rich blood to the brain). When oxygen-rich blood is cut off from the brain the following events can happen: 

  • After 7 seconds — the person strangled can become unconscious or faints
  • After 15 seconds — the person strangled can lose control of their bladder
  • After 30 seconds — the person strangled can lose control of their bowels
  • After 1 minute — the person strangled can die. 

If a person survives a strangulation assault, the brain might not fully recover, especially if a large amount of brain cells have died. 

A person also might experience brain injury if they were unconscious for an extended period of time after being strangled, or if they have a stroke as a result of strangulation.  

Brain injury due to strangulation can lead to a number of health conditions and difficulties, including limb weakness and paralysis; balance issues; physical tremors; changes in vision; memory problems; speech and language difficulties; mood changes; difficulty with planning and problem solving; headaches; vascular Parkinson’s disease; dementia and other neurocognitive impairment. 

Immediate injuries from strangulation include: cervical spine injury, neck fractures, heart attack, voice changes, internal bleeding, lung disease, blood clot, swollen blood vessel (aneurysm.) 

These effects can happen moments after the assault — or months to years after the assault.

Janice Thompson, a survivor of domestic abuse and violence, recounts her experiences to reporters from the Springfield Daily Citizen. (Photo by Jym Wilson)

Survivor recalls being strangled

It’s been 20 years since Janice Thompson was brutally assaulted by her then-husband Greg Marvin. 

According to court documents, Marvin beat her, threw her into a wall and down a set of stairs. He put her in a bathtub and held her face under running water so she couldn’t breathe, and poured cleaning fluids into her face and eyes.

And he strangled her. 

“He took me by the throat,” Thompson recalled, closing her eyes and putting her right hand to her throat, “and pushing me up. He had me up on the wall like this and my feet were dangling. And he was yelling.

“I remember my lips feeling big, full, and a lot of pressure behind my nose,” she continued. “It felt like all the blood in my body was coming into my head.”

Her vision darkened, becoming fuzzy and narrow. She described a “prickly” sensation and her ears were ringing.  

If this doesn’t stop, I’m going to die.

Janice thompson

“It felt like forever but maybe (it was) just seconds,” Thompson said. “It wasn’t long enough for me to pass out, but long enough for me to have a clear thought of: If this doesn’t stop, I’m going to die.” 

Thompson said she reached out and scratched Marvin’s face with all the strength she could muster. He let go of her neck, and she fell to the ground. 

The assault continued for several hours. At some point, Marvin stripped Thompson of her clothes to prevent her from running away. She eventually did escape and a friend convinced her to seek medical treatment the following day. Thompson filed for a restraining order against Marvin. 

Thompson and Marvin had been married seven years and had three children — who were staying at their grandparents’ home when the assault occurred. 

Prior to that night, Marvin had not been physically abusive, but he had been emotionally abusive, controlling and often irrationally jealous. 

On the night of the assault, the couple had been to a rock concert. Marvin became angry because he convinced himself that Thompson somehow had slipped away during the show and had sex with one of the musicians. 

Unlike most victims, Thompson doesn’t have to worry about her abuser hurting her again. In 2018, Marvin was convicted of assaulting another woman and the man that woman was with in the Bass Pro Shops parking lot in Springfield. He was sentenced to serve 45 years in prison.

Sgt. Chris Rasmussen leads the Springfield Police Department’s domestic violence unit. (Photo by Jym Wilson)

Strangulation and the law

Strangulation is such an integral part of domestic violence that police officers are trained to ask victims specifically if they were strangled. Officers often note if the victim lost consciousness or “blacked out” as a result. Some note in their reports if the victim speaks in a hoarse voice.

Sgt. Rasmussen, head of the Springfield Police Department’s Domestic Violence Unit, said officers know to dig for details when a victim reports being strangled or has apparent signs of being strangled like red marks on the neck, scratches or bruising. 

“(Officers) try to have them explain the experience,” Rasmussen said, “because the more detailed you can get about what they were feeling, like all the way up to, ‘I soiled myself when they did that’ or ‘I started seeing spots,’ which (are) indications that they’re cutting off blood flow.”

According to Rasmussen, sometimes victims pass out and do not realize they were unable to breathe.

“It can happen that quick,” he said. “A lot of times what will happen is they’ll go unconscious and they will soil themselves.”

Police need to note details such as whether the victim could breathe — which happens in about half the cases Rasmussen sees — because it’s important when it comes to criminal prosecutions. 

Charging options

Missouri law has four different criminal charges for domestic assault. “Strangulation” is mentioned in one of the four charges.

The least severe is domestic assault in 4th degree, a misdemeanor.

Criminal assault in the third degree, a Class E felony, is defined as an attempt “to cause physical injury or to knowingly cause physical pain or illness.”

Criminal assault in the third degree, a Class D felony, includes the language “causes physical injury to such domestic victim by any means, including but not limited to, use of a deadly weapon or dangerous instrument, or by choking or strangulation.”

Domestic assault charge in the first degree is a Class B felony.  It describes the crime as an “attempt to kill or knowingly cause or attempt to cause serious physical injury to a domestic victim.”

The crime can be upgraded to a Class A felony, the most serious level of criminal charge, if the defendant “inflicts serious physical injury on the victim.”

“(Strangulation) is associated with greater risk of lethality,” said Emily Shook, first assistant prosecuting attorney with the Greene County Prosecuting Attorney’s Domestic Violence Unit. 

“Also, a strangulation incident with difficulty breathing raises it to a higher level of offense versus a grab to the neck that’s distinct from strangulation,” she said.

About Living in Fear

This special investigative report explores the far-reaching and insidious nature of domestic abuse in our community. Living in Fear will be presented in four parts over the next two months:

  • Part I: Black eye for Greene County, published May 8-11, looks at the depth and breadth of the problem here.
  • Part II: Obstacles to leaving, to be published in late May, will examine the dynamics and complications facing victims looking to leave abusive relationships.
  • Part III: Systemic issues, to be published in early June, puts a focus on the criminal justice system and potential shortcomings.
  • Part IV: Searching for solutions, to be published in late June, taps local, regional and national experts in search of ways to improve the system and reduce domestic violence.

Jackie Rehwald

Jackie Rehwald is a reporter at the Springfield Daily Citizen. She covers housing, homelessness, domestic violence and early childhood, among other public affairs issues. Her office line is 417-837-3659. More by Jackie Rehwald