TY - JOUR

T1 - The neuropsychological outcomes of non-fatal strangulation in domestic and sexual violence: A systematic review

AU - Bichard, Helen

AU - Byrne, Christopher

AU - Saville, Christopher

AU - Coetzer, Rudi

PY - 2022/7/3

Y1 - 2022/7/3

N2 - This systematic review draws together evidence from the literature for the pathological, neurological, cognitive, psychological, and behavioural outcomes of non-fatal strangulation in domestic and sexual violence. A systematic search of PubMed, PsycINFO, CINHAL, Proquest, ASSIA, Web of Science, WestLaw, Open Grey, and Ethos was conducted, with no date limits set, to identify eligible studies. Thirty empirical, peer-reviewed studies were found which met the inclusion criteria. Pathological changes included arterial dissection and stroke. Neurological consequences included loss of consciousness, indicating at least mild acquired brain injury, seizures, motor and speech disorders, and paralysis. Psychological outcomes included PTSD, depression, suicidality, and dissociation. Cognitive and behavioural sequelae were described less frequently, but included memory loss, increased aggression, compliance, and lack of help-seeking. However, no studies used formal neuropsychological assessment: the majority were medical case studies, or based on self-report. Furthermore, few authors were able to control for possible confounds, including other physical violence and existing psychosocial difficulties. There is therefore a need for further neuropsychological research, focusing on cognitive and behavioural outcomes, using standardised tools, and control groups where possible. This is urgent, given societal normalisation of strangulation, and legal systems which often do not reflect the act’s severity and its consequences.

AB - This systematic review draws together evidence from the literature for the pathological, neurological, cognitive, psychological, and behavioural outcomes of non-fatal strangulation in domestic and sexual violence. A systematic search of PubMed, PsycINFO, CINHAL, Proquest, ASSIA, Web of Science, WestLaw, Open Grey, and Ethos was conducted, with no date limits set, to identify eligible studies. Thirty empirical, peer-reviewed studies were found which met the inclusion criteria. Pathological changes included arterial dissection and stroke. Neurological consequences included loss of consciousness, indicating at least mild acquired brain injury, seizures, motor and speech disorders, and paralysis. Psychological outcomes included PTSD, depression, suicidality, and dissociation. Cognitive and behavioural sequelae were described less frequently, but included memory loss, increased aggression, compliance, and lack of help-seeking. However, no studies used formal neuropsychological assessment: the majority were medical case studies, or based on self-report. Furthermore, few authors were able to control for possible confounds, including other physical violence and existing psychosocial difficulties. There is therefore a need for further neuropsychological research, focusing on cognitive and behavioural outcomes, using standardised tools, and control groups where possible. This is urgent, given societal normalisation of strangulation, and legal systems which often do not reflect the act’s severity and its consequences.

KW - Choking

KW - Hypoxic-ischaemic

KW - Intimate partner violence

KW - Sexual assault

KW - Systematic review

U2 - 10.1080/09602011.2020.1868537

DO - 10.1080/09602011.2020.1868537

M3 - Article

VL - 32

SP - 1164

EP - 1192

JO - Neuropsychological Rehabilitation

JF - Neuropsychological Rehabilitation

SN - 0960-2011

IS - 6

ER -