What do you typically think of when you hear the word “strangulation”? If you are like most people, the word probably triggers a mental image of hands around someone’s throat. Thinking forward to the aftereffects of strangulation, you might imagine bruises around a person’s neck, redness, scratches, or other visible signs of injury.
Although those are common results, it is not uncommon for a person to present with no external injuries after having been strangled. Rather, a person could potentially be suffering from serious internal injuries. If overlooked, internal injuries can result in severe or permanent conditions.
North Carolina’s strangulation law requires both that the perpetrator “strangle” the victim and inflict “physical injury.” This post explores the meaning of those elements, the potential issues that may arise in applying them, and the approach other jurisdictions take toward the crime of strangulation. The post closes with some observations about whether North Carolina’s current definition of strangulation adequately addresses the ways in which the crime may occur.
Elements of Strangulation
Under G.S. 14-32.4(b), any person who assaults another person and inflicts physical injury by strangulation is guilty of a Class H felony. Although the word “strangulation” is not statutorily defined, we can presume its definition to be what we typically think of when we hear the word. Ordinarily, strangulation involves placing hands around someone’s neck, although an object such as clothing, a cord, or something else could be used instead.
More than mere placement of hands on a person’s neck is necessary, however, to constitute strangulation. Strangulation involves some cutting off of blood flow, passage of air, or ability to swallow. North Carolina Criminal Pattern Jury Instruction (N.C.P.I.) 208.61 (Feb. 2005) provides that strangulation involves “a form of asphyxia characterized by closure of the blood vessels and/or air passages of the neck as a result of external pressure on the neck brought about by hanging, ligature, or the manual assertion of pressure.” This language aligns with the dictionary definition. Merriam-Webster defines strangulation as “excessive or pathological constriction or compression of a bodily tube that interrupts its ability to act as a passage.”
Assault by strangulation requires, in addition to “strangulation” as defined above, some “physical injury.” This element sets a lower threshold than the injury requirements in other statutes. For example, for assault on a law enforcement officer, “physical injury” is statutorily defined as “cuts, scrapes, bruises, or other physical injury which does not constitute serious injury.” G.S. 14-34.7(c). This degree of injury is far less than serious injury or serious bodily injury, an element of other assault offenses. See generally Brittany Williams, Defining “Injury” for North Carolina Assault and Other Offenses (UNC School of Government, Feb. 2022). Still, the requirement introduces an additional element for the offense beyond the act of strangulation.
Non-external Signs and Symptoms of Strangulation
The injuries caused by strangulation may be minor, or they may be severe and result in permanent conditions or death. An act of strangulation may result in common visible signs of injury, such as bruises, redness, scratches to the neck, ligature marks, abrasions under the chin, subconjunctival hemorrhages (red eyes), or petechiae (pinpoint, round spots that appear on the skin as a result of bleeding). It is also possible for there to be internal physical injuries without external signs of injury. Some examples that can occur right away include vision changes, ringing in the ears, swollen tongue, cuts and abrasions in the mouth, involuntary urination and defecation, difficulty breathing, trouble swallowing, and other voice or throat changes. Long term effects can also include miscarriages and lung injuries. More about short- and long-term injuries can be found here: Maureen Funk & Julie Schuppel, Strangulation Injuries (Wisconsin Medical Journal, 2003).
According to the Training Institute on Strangulation Prevention, even minimal force may cause bleeding or swelling inside the neck. Both bleeding and swelling can progress slowly and not cause obvious problems until the airway becomes blocked or a vascular emergency (like an aneurysm) occurs. As the body tries to heal, blood clots may form inside the artery and block blood flow or break off and travel to the brain, resulting in clinical findings similar to those of a stroke. Compression of neurologic structures located in the back of the neck can result in the slowing of the pulse and progress to cardiac arrest. Strangulation may also cause fluid overload in the lungs up to two weeks after the assault.
Appellate Interpretations of Physical Injury
Our appellate courts have recognized that physical injury may be present within the meaning of assault by strangulation where no injuries were visible. The defendant in State v. Brunson, 187 N.C. App. 472 (2007), was found guilty of assault by strangulation where the victim’s vision blurred, her head hurt, she had difficulty breathing, and she had a sore neck. The Court of Appeals found that the defendant waived the argument that the evidence was insufficient for the charges, which included strangulation, and even if the defendant had preserved the argument, the evidence was sufficient to support the various charges. In an unpublished opinion, State v. Christenson, 2022-NCCOA-545, the Court of Appeals held that testimony that the victim experienced pain when she moved her neck and had difficulty eating two days following the strangulation was sufficient evidence to withstand a motion to dismiss.
We so far do not have any North Carolina precedent on strangulation where the victim presented with more serious injuries. One reason could be that more serious charges are possible, eliminating the need to charge assault by strangulation, a Class H felony. Many internal injuries from strangulation may fall within the category of serious injury and even serious bodily injury, supporting more serious assault charges.
In cases involving child abuse, serious injury is statutorily defined as physical injury that causes great pain and suffering, including serious mental injury. Decisions interpreting the element of serious injury in assault cases use a similar definition. See generally State v. Carpenter, 155 N.C. App. 35 (2002); State v. Williams, 184 N.C. App. 351 (2007); State v. Rowe, 231 N.C. App. 462 (2013). When a person suffers serious injury by strangulation, a charge of assault with a deadly weapon inflicting serious injury, a Class E felony under G.S. 14-32(b), may be appropriate because the perpetrator’s hands may constitute a deadly weapon.
Serious bodily injury is statutorily defined for purposes of assault inflicting serious bodily injury, a Class F felony under G.S. 14-32.4(a), as bodily injury that creates a substantial risk of death or that causes serious permanent disfigurement, coma, a permanent or protracted condition that causes extreme pain, or permanent or protracted loss or impairment of the function of any bodily member or organ, or that results in prolonged hospitalization. Such a charge may be appropriate if, as a result of strangulation, the victim suffers a miscarriage, cardiac arrest, lung injuries, brain injuries, stroke, or protracted psychiatric symptoms.
Currently, forty-eight states have strangulation laws. Jurisdictions categorize the offense in different ways: for some it is a stand-alone felony, for others it is an assault, and for others it is a domestic violence offense. There are also differences in the ways that other states delineate strangulation. Some of these differences involve the presence or severity of injury, identity of the victim as a family member, presence of malicious intent, and enhancement of other crimes if strangulation is involved.
Some jurisdictions criminalize the act of strangulation without any requirement or finding of injury. Here are examples:
- Indiana: A person who, in a rude, angry, or insolent manner, knowingly or intentionally: (1) applies pressure to the throat or neck of another person; (2) obstructs the nose or mouth of another person; or (3) applies pressure to the torso of another person; in a manner that impedes the normal breathing or the blood circulation of the other person commits strangulation, a Level 6 felony. Ind. Code § 35-42-2-9.
- Nebraska: A person commits the offense of strangulation (Class IIIA felony) if the person knowingly or intentionally impedes the normal breathing or circulation of the blood of another person by applying pressure on the throat or neck of the other person. Neb. Stat. § 28-310.01.
- Washington: Strangulation is defined as compression of a person’s neck, thereby obstructing the person’s blood flow or ability to breathe, or doing so with the intent to obstruct the person’s blood flow or ability to breathe. Wash. Stat. § 9A.04.110(26). A person is guilty of assault in the second degree (class B felony) if he or she assaults another by strangulation or suffocation. Wash. Stat. § 9A.36.021(1)(g).
- Wisconsin: Whoever intentionally impedes the normal breathing or circulation of blood by applying pressure on the throat or neck or by blocking the nose or mouth of another person is guilty of a Class H felony. Wis. Stat. § 940.235.
Some jurisdictions criminalize the act of strangulation, with separate provisions that provide increased punishments for strangulation resulting in serious injury:
- New York: A person is guilty of criminal obstruction of breathing or blood circulation (class A misdemeanor) when, with intent to impede the normal breathing or circulation of the blood of another person, he or she either applies pressure on the throat or neck of such person; or blocks the nose or mouth of such person. A person is guilty of strangulation in the second degree (class D felony) when he or she commits the crime of criminal obstruction of breathing or blood circulation and thereby causes stupor, loss of consciousness for any period of time, or any other physical injury or impairment. A person is guilty of strangulation in the first degree (class C felony) when he or she commits the crime of criminal obstruction of breathing or blood circulation and thereby causes serious physical injury to such other person. N.Y. Penal Code §§ 121.11-121.13.
- Delaware: A person commits the offense of strangulation (class E felony) if the person knowingly or intentionally impedes the breathing or circulation of the blood of another person by applying pressure on the throat or neck of the other person. Strangulation is a class D felony if: … (b) The person caused serious physical injury to the other person while committing the offense. Del. Code § 11-607.
- Connecticut: A person is guilty of strangulation in the second degree (class D felony) when such person restrains another person by the neck or throat with the intent to impede the ability of such other person to breathe or restrict blood circulation of such other person and such person impedes the ability of such other person to breathe or restricts blood circulation of such other person. A person is guilty of strangulation in the first degree (class C felony) when such person commits strangulation in the second degree and (1) in the commission of such offense, such person … (B) causes serious physical injury to such other person. A person is guilty of strangulation in the third degree (class A misdemeanor) when such person recklessly restrains another person by the neck or throat and impedes the ability of such other person to breathe or restricts blood circulation of such other person. Conn. Gen. Stat. §§ 53a-64aa—53a-64cc.
Only a few states, in addition to North Carolina, require a finding of physical injury in connection with the act of strangulation. See Wyo. Stat. § 6-2-509 (Wyoming); Mo. Rev. Stat. § 565.073 (Missouri).
Potential Issues with North Carolina’s Physical Injury Requirement
It is not clear why the North Carolina General Assembly made “physical injury” an element of strangulation. As indicated above, many jurisdictions have not done so. Other jurisdictions may have concluded that the act of strangulation—the cutting off of blood, passage of air, and ability to swallow—presents a serious threat of harm by its very nature. They also may have recognized that physical injury usually occurs when passageways are cut off by strangulation, thus obviating the need to include physical injury as an element of the offense.
The physical injury requirement is potentially problematic for a couple of reasons. Although North Carolina’s courts recognize that nonvisible injuries may amount to physical injury, charging authorities may set too high of a bar for assault by strangulation by insisting on evidence of visible injuries.
Another potential issue lies in the wording of North Carolina’s statutes. G.S. 14-32.4 provides that the perpetrator must inflict “physical injury.” Another assault statute, G.S. 14-34.7(c), defines physical injury as including cuts, scrapes, bruises, or other physical injury “which does not constitute serious injury.” One could argue that when assault by strangulation results in serious injury, it does not satisfy this definition of physical injury, which excludes serious injury. I suspect that our courts would hold that physical injury is the minimum required for strangulation and more serious injuries are not excluded, but there is the potential for confusion.
Since physical injury is a required element of the offense of strangulation in North Carolina, my best advice is that charging authorities should be sure to inquire about both nonvisible and visible injuries. North Carolina case law affirms that both are sufficient to satisfy the requirement of physical injury. If the victim has suffered more serious injuries, charging authorities should continue to charge assault by strangulation (absent a contrary ruling by the appellate courts) as well as any other assault charges that may apply.
I welcome your thoughts and invite your comments. If you have questions about this offense, please feel free to send me an email at email@example.com.