Strangulation as an Acquired Brain Injury in Intimate–Partner Violence and Its Relationship to Cognitive and Psychological Functioning: A Preliminary Study

Abstract

Objective: The aim of this work was to examine the relationship between strangulation-related alterations in consciousness (AIC) and cognitive and psychological outcomes in women who have experienced intimate partner violence (IPV). Setting: Participants were recruited from a variety of settings, including women's shelters and support programs. Participants: A total of 99 women were enrolled in the study. After applying exclusion criteria for factors that could mask or confound the effects of strangulation, 52 women remained for analyses. Design: Cross-sectional, retrospective. Main Measures: We used several cognitive measures to assess learning, long-term and working memory, visuomotor speed, cognitive flexibility, and nonverbal cognitive fluency as well as several psychological measures to assess posttraumatic stress symptomatology, general distress, worry, anhedonic depression, and anxious arousal. We also used the Brain Injury Severity Assessment interview to examine the association between strangulation-related AICs and these measures of cognitive and psychological functioning. Results: Women who had experienced strangulation-related AICs performed more poorly on a test of long-term memory (P < .03) and had higher levels of depression (P < .03) and posttraumatic stress symptomatology (P < .02) than women who had not experienced strangulation-related AIC. When controlling for potential confounding variables, including number of IPV-related traumatic brain injuries, women who had experienced strangulation also performed more poorly on a measure of working memory. Conclusion: This is the first report to assess strangulation in this manner and demonstrate links to cognitive and psychological functioning. These preliminary data contribute to our knowledge of strangulation and its effects on women who have experienced IPV.

Frequent and Recent Non-fatal Strangulation/Choking During Sex and Its Association With fMRI Activation During Working Memory Tasks

“…There are three important distinctions to be made between the study reported by Valera et al ( 2022 ) and the present work. First, Valera et al ( 2022 ) utilized validated and sensitive neuropsychological tests, including the California Verbal Learning Test (Delis et al, 1987 ) and the Digit Span of the Wechsler Adult Intelligence Scale-Revised (Wechsler, 1981 ) to examine memory function, while the present study used reaction time and response accuracy during the fMRI tasks to compare behavioral performance between the choking and the choking-naïve groups. As mentioned above, fMRI task performance, in terms of accuracy and reaction time, is often not impaired in patients with acute mTBI (McAllister et al, 1999 ; Shah-Basak et al, 2018 ) and therefore may not be as sensitive as validated neuropsychological tests.…”

“…However, it should be noted that IPV, IPV-related strangulation, sexual assault, and adverse childhood experiences were not examined or controlled for by Herbenick et al ( 2021a ), and the authors acknowledged that the examination of these variables would enrich future investigations of choking as a sexual behavior. Within the context of IPV, a history of being non-fatally strangled has been associated with worse cognitive functioning (Valera et al, 2022 ). Women with histories of strangulation-related alterations in consciousness (AIC) performed significantly worse on measures of both long-term and working memory compared to women who had experienced IPV but had never experienced strangulation-related AIC (Valera et al, 2022 ).…”

“…Within the context of IPV, a history of being non-fatally strangled has been associated with worse cognitive functioning (Valera et al, 2022 ). Women with histories of strangulation-related alterations in consciousness (AIC) performed significantly worse on measures of both long-term and working memory compared to women who had experienced IPV but had never experienced strangulation-related AIC (Valera et al, 2022 ). There are three important distinctions to be made between the study reported by Valera et al ( 2022 ) and the present work.…”

“…Women with histories of strangulation-related alterations in consciousness (AIC) performed significantly worse on measures of both long-term and working memory compared to women who had experienced IPV but had never experienced strangulation-related AIC (Valera et al, 2022 ). There are three important distinctions to be made between the study reported by Valera et al ( 2022 ) and the present work. First, Valera et al ( 2022 ) utilized validated and sensitive neuropsychological tests, including the California Verbal Learning Test (Delis et al, 1987 ) and the Digit Span of the Wechsler Adult Intelligence Scale-Revised (Wechsler, 1981 ) to examine memory function, while the present study used reaction time and response accuracy during the fMRI tasks to compare behavioral performance between the choking and the choking-naïve groups.…”

“…Strangulation-related alterations in consciousness were defined by Valera et al ( 2022 ) as events that resulted in the individual experiencing symptoms of hypoxic or ischemic brain injury (e.g., dizziness, feeling stunned or disoriented, seeing stars or spots, losing consciousness, or blacking out, or posttraumatic amnesia) while or after being choked by an intimate partner in the absence of blunt force trauma to the head. While these incidents of psychological and physical trauma in the form of IPV may have resulted in chronic alterations in functional and structural neural integrity, the comparison to an IPV-exposed group without a history of strangulation-related AIC supports the conclusion that it is perhaps the history of strangulation-related AIC that is associated with worse cognitive functioning in this group (Valera et al, 2022 ). For the present study, we were interested in the frequency of incidents during which a sexual partner had choked them during sex, which we described as “pressed or squeezed your neck with their hands, arm, or an object”—without any kind of provision about physical sensations or choking intensity.…”