“Do You Know What It Feels Like to Drown?”: Strangulation as Coercive

Control in Intimate Relationships

Supplemental to Kristie A. Thomas, Manisha Joshi, & Susan B. Sorenson

March 2014

• Address a gap in the literature:

• Extend prior work by using grounded theory in a qualitative study to explore women’s experiences of, thoughts about, and reactions to being strangled

• Offer insight into strangulation as a mechanism of coercive control in abusive relationships

Purpose & Brief Description of the Study

• Intimate partner violence (IPV)• Physical abuse• Coercion• Dominance• Strangulation• Victimization

Key Terms & Concepts

• IPV conceptualized as a typology1, initially proposed as two types:• 1) Patriarchal terrorism• 2) Common couple violence

• Key factor in distinguishing type of IPV – control, which defines:• An abuser’s motives• A victim’s experiences• The entire context of the relationship

• Coercion + control = “condition of unfreedom”2

• Experienced as entrapment by the victim

Overview of Literature: Coercive Control

1. Johnson, 1995, 2006; Johnson & Ferraro, 2000; Kelly & Johnson, 20082. Stark, 2007, p. 205 (see article at p. 2)

• Dutton & Goodman (2005) model• Nonfatal strangulation implies to the victim that

the abusive partner can and perhaps will kill; serves as a way to induce compliance in a victim

• Strangulation induces behavioral and emotional reactions, which facilitates coercive control:• Strangulation is painful1

• Strangulation evokes fear2 and panic3

Overview of Literature: Strangulation & Coercive Control

1. Turkel, 20102. Banzett, Lansing, Evans, & Shea, 19963. Junger, 1998

• Current literature, “provides important but relatively limited insight into women’s experiences of strangulation and surrounding events” (p. 3)

• Two studies including 38 women who were victims of attempted homicide by an intimate partner1:

• Victims reported extreme jealousy, threats, and stalking leading up to the attack

• Most attacks occurred while trying to end the relationship• Women were described as being in shock, incoherent,

hysterical, and very badly injured after the attack• Nearly half of women reported being “completely

surprised” by the severe assault2

Overview of Literature: Women’s Experiences of Life-Threatening Violence

1. Farr, 2002; Nicolaidis et al., 20032. See article at p. 3; Nicolaidis et al., 2003

• Focus groups and semi-structured interviews with:• Women living in a domestic violence shelter• Strangled at least once by an intimate partner

• Exploration of the following in the context of an intimate relationship:• Battered women’s experiences of, thoughts about, and

reactions to being strangled• Whether the women perceive strangulation as a

method of control• Women’s experiences of coercive control in relation to

strangulation incidents and in the relationship

Study Aims

• Practice-research engagement approach, which involves the following:1

• City officials• Advocates• Service providers

Method

1. See Brown, Bammer, Batliwala, & Kunreuther, 2003

• Participants recruited from domestic violence shelter in a large U.S. city• Confidential• Short-term refuge for female IPV victims and their children

• Author(s):• Attended shelter community meetings• Door-to-door introduction of study to residents• Posted fliers on bulletin boards in communal areas in the shelter

• Screening:• Intakes conducted in private room at shelter • Adaptations of the Revised Conflict Tactics Scale1

• Screening question for strangulation: “In the past 12 months, has an intimate partner ever tried to physically assault you by choking you, or putting his hands around your throat and squeezing it, or putting a piece of clothing/wire/cord around your throat and pulling it tightly?”

Participant Recruitment & Screening

1. Straus, Hamby, Boney-McCoy, & Sugarman, 1996

• 17 women:• Age range: 21 to 47 years• African American (n = 14)• White (n = 2)• West Indian (n = 1)

• Other demographic information:• Completed high school (n = 15)• Attended some college or vocational training or

completed college (n = 7)• Married (n = 3); Divorced (n = 4); Single (n = 10)• All participants had children

Study Participants

• Alternating multi-method approach:• Begin with individual interviews• If interview fruitful, conduct focus groups• Finish with individual interviews for in-depth

exploration and follow-up of new concepts that emerged during the process

• In summary, the following were conducted:• Eight in-depth interviews• Two focus groups (1st group: 4 participants; 2nd

group: 5 participants)

Data Collection

• Interviews and focus groups: • Semi-structured format

• Opening general prompt:• “Let’s start by talking about your relationship with your

husband/boyfriend/male friend, especially in the last 12 months”

• Subsequent questions:• Open-ended• Informed by the literature review• Focus on themes: the nature of the intimate relationship, the

experience of strangulation, events that triggered the assault, perceptions of strangulation as a form of IPV, impact of strangulation on other domains in life, and help-seeking

Interview & Focus Group Protocol

• Interviews were audio recorded and transcribed

• Grounded Theory1: used in analysis of data from interviews and focus

• Two stage analysis:• 1) Line-by-line open coding• 2) Focused axial coding approach

• Concepts grouped into two categories as a result of axial coding:• 1) Immediate power and control during the incident• 2) Maintaining power and control after the incident

Data Management & Analysis

1. Corbin & Strauss, 2008

• Organized by study aims:

• 1) Experience of strangulation (described as choking by participants)

• 2) Women’s perceptions of men’s motivations for using strangulation

• 3) Description of coercive control that accompanied strangulation in women’s relationships

Results

• Almost all participants were strangled multiple times (n = 13)

• Strangulations usually occurred in the context of other violence

• Most men used their hands, but in at least five incidents they used telephone cords, a rope, or a board to strangle the women

Women’s Experiences of Strangulation

• Men’s response to feeling they were not in control of partner

• Jealousy• Accusations of infidelity• Failure to comply with partner’s demands• Refusal to have sexual intercourse• Tried to go out with friends• Did not make dinner for partner

• Wanting to end the relationship

Perceived Strangulation Triggers

• Statements by partner during strangulation, fell into three categories:• 1) Threats

• Death threats - most common among participants• Physical harm

• 2) Accusations• Cheating

• 3) Directives• Instructions on behavior

Reports of Partners’ Statements

• Range of reactions, not mutually exclusive• Nearly all victims reported thinking they

were going to die (n = 16) • Disbelief and shock• Reaction to physical pain• Emotional pain

Victims’ Thoughts & Reactions During the Incident

• Thoughts of children• Fear of never seeing them again• Worry about impact of their death on children• Concern over protecting children (when present

during incident)• Fear for health of unborn babies (for four women

who were pregnant during strangulation)• Focus on survival• Struggling to breathe• Trying to make him stop

Thoughts, cont.

• Little to no control over when/how the strangulation incident ended

• Most instances: • Men stopped and let go – but not until the woman

lost consciousness• Intervention by third party:• Knock on the door• Intervening person present when strangulation

began• One incident: victim was able to free herself

Ending of Incident

• Major theme:• Strangulation incident elicited immediate and

lasting fear• Heightened awareness of vulnerability and

fear, which impacted victims in multiple ways:• Three women ended relationship• Four described feeling trapped

Victims’ Subsequent Reactions

• Women who stayed in relationship after first strangulation:• Altered behavior to avoid more violence

• For one participant:• Being strangled did not increase her fear, but did

increase her aggression towards her partner

Reactions, cont.

• Three general themes:

• 1) Strangulation is a way to exert power and control during an assault

• 2) Strangulation serves as a warning, to exert control beyond the assault

• 3) Abusive partners perceive their actions will escape detection and will not result in outside repercussions

Perceived Motivations for Strangulation

• Strangulation occurred in conjunction with other abusive tactics/physical abuse

• Most described their partner’s behavior as “controlling” or used a similar expression

• Coercion or forced to have sexual intercourse (n=5)

• Partners exerted control over almost every area of victim’s lives:• Relationships with loved ones• Parenting• Employment

• Variety of control tactics were used by the abusive partner:• Death treats• Stalking and monitoring (during and after relationship)• Control over how victim dressed• Enlisting others to monitor them• Manipulating the women’s emotional and social vulnerabilities

Strangulation & Coercive Control

• Recognition of nonfatal strangulation as a serious and unique form of IPV

• National Institute of Justice• 2011 – funded the Strangulation Training Institute

• Nonfatal strangulation – nearly 30 states have passed laws deeming it a felony offense

• Authors provide “unique contribution to the literature, offering insight into strangulation as a mechanism of coercive control in abusive relationships” (p. 9)

Discussion

• Strangulation is a useful illustration of the importance of behavior and context in coercive control1

• Death threats• Difficult to detect/rarely leaves physical evidence• Strangulation as a means of gaining/maintaining

control over victim

• Gender is a critical aspect of both strangulation and coercive control

• Lifetime risk of IPV strangulation in the general population is 1:100 (for men) and 1:10 (for women)2

Discussion: Strangulation & Coercive Control

1. As described in Dutton & Goodman’s (2005 model)2. Black et al., 2011

• History of nonfatal strangulation is a substantial risk factor in women’s homicides – yet the danger is largely unrecognized

• Clinicians should carefully scrutinize a client’s sense of safety

• Jealousy and controlling behaviors are risk factors of assault

• Screening specifically for strangulation can help assess mental health needs

• Training for mental health providers is needed to properly identify how strangulation manifests psychologically and physically in IPV victims

• Better understanding of IPV and strangulation as a means of coercive control can lead to better services for IPV victims

Practice Implications

• Coercive controlling relationships do not always involve strangulation

• We do not know whether or how intimate partner strangulation is used in the absence of coercive control

• Learning more about the considerations that lead women to either flee or remain in the relationship will help researchers better understand the use and effects of IPV strangulation

• Research is needed on potential ethnic differences in strangulation

• Current study = small qualitative study

• Future recommendations:• Larger/more diverse sample• Use of nonshelter population• Mixed-methods research

Limitations & Future Research

• “Strangulation is a particularly pernicious form of coercive control” (p. 11)

• Strangulation:• Often not detected• Can be used repeatedly with few visible effects• Triggers immediate and complete helplessness• Constitutes torture under the United Nation’s

Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment1

• A way to literally silence women

Conclusion

1. Copelon, 1994

Questions and/or Comments?