Quick answer: Non-fatal strangulation (NFS) is one of the most serious and dangerous forms of domestic abuse. It often leaves no visible injuries (although sometimes bruising can be seen), yet carries significant risks of internal harm, brain injury and stroke. Workplaces play a vital role in recognising warning signs and responding safely, even when nothing obvious is visible.
Domestic abuse does not stop at the front door. It follows survivors into their daily lives, including into the workplace. As an employer, HR professional, line manager or wellbeing lead, you may already understand the importance of domestic abuse awareness. But one specific form of abuse remains widely misunderstood, even among professionals who work closely with those affected.
Non-fatal strangulation is that form of abuse. It is one of the strongest indicators that domestic abuse may escalate to homicide. Yet it is frequently missed, minimised or dismissed, often because there are no visible marks on the survivor’s body.
This blog aims to change that. Domestic Abuse Education has written this guide to help employers, managers and safeguarding leads understand what non-fatal strangulation is, why it is so serious, and what workplaces can do to respond more safely and confidently.
You do not need to become an expert overnight. You need to know enough to notice, respond and refer.
What Is Non-Fatal Strangulation and How Does It Differ from Choking?
Non-fatal strangulation is the application of external pressure to the neck or throat, restricting blood flow or airflow to the brain. Another person deliberately carries it out. This is a critical distinction.
The term “choking” is often used interchangeably with strangulation, but the two are medically different. Choking refers to an obstruction of the airway, such as food becoming lodged in the throat. Strangulation is an external act of force. The Institute for Addressing Strangulation (IFAS) actively encourages professionals to use the correct terminology, because precision matters when identifying, recording and responding to this form of abuse.
Using the right language helps survivors feel believed. It also helps professionals understand the true nature of what has occurred.
Why Is Non-Fatal Strangulation One of the Most Dangerous Forms of Domestic Abuse?
The danger of non-fatal strangulation lies in the gap between what is visible and what is actually happening inside the body.
Many people assume that if there are no visible injuries, the incident was not that serious. This assumption is incorrect and potentially life-threatening. Non-fatal strangulation can cause serious internal harm even when there are no marks on the skin. These include:
- Brain injury resulting from oxygen deprivation
- Increased risk of stroke, which can occur hours or even days after the incident
- Internal damage to blood vessels in the neck
- Delayed onset of symptoms, meaning a survivor may feel physically fine immediately afterwards
Symptoms that appear later can include severe headaches, dizziness, memory difficulties, changes in mood or behaviour, and difficulty swallowing. These may not be recognised as being connected to the strangulation incident by the person experiencing them, or by those around them.
Non-fatal strangulation is also recognised as a significant risk factor in domestic homicide. According to the Femicide Census Report “2000 Women”, of the 2,000 women aged 14 and above who were killed in the UK since 2014, strangulation was used in 550 (27%) of those killings, with 372 strangled by an intimate partner. This context makes clear why NFS demands serious attention.
What Has Changed in Law and Why Are Recorded Offences Rising?
A standalone offence of strangulation and suffocation was introduced in England and Wales through Section 70 of the Domestic Abuse Act 2021, coming into force on 7 June 2022. Before this, strangulation was often recorded under broader categories of assault, which meant the full scale of the problem was not captured.
The introduction of this specific offence has made a measurable difference. According to IFAS analysis, 44,426 cases of strangulation and suffocation were recorded by police in England and Wales from June 2024 to June 2025, representing a 13% increase on the previous year. Since the legislation was introduced, recorded offences have risen by 87%.
It is important to understand what this rise does and does not mean. This increase does not necessarily reflect an increase in the number of incidents. Rather, it reflects:
- Greater awareness among professionals and the public
- Improved recording and categorisation by police forces
- Increased confidence among survivors to report
- Better professional understanding of what constitutes a strangulation offence
Put simply, the data is getting more accurate. That is progress, even though the numbers themselves are sobering.
Why Is Non-Fatal Strangulation So Often Missed or Misunderstood?
There are several reasons why non-fatal strangulation is frequently overlooked, both by professionals and by survivors themselves.
The most common misconception is that strangulation must leave visible marks. It does not. Research consistently shows that many survivors of strangulation have no visible external injuries at all. This can lead professionals, friends and even survivors to minimise the severity of what has happened.
Survivors may also minimise the incident themselves. They may describe it as being “grabbed” or say that the perpetrator “just put their hands on my throat.” The language used to describe the incident can obscure its true seriousness. Combined with the absence of visible marks, this creates conditions in which strangulation is easily underestimated.
There is also a time dimension. Because symptoms can appear hours or days after an incident, the connection between a person feeling unwell and a strangulation event may not be made at all.
What Might an Employee Look Like After Being Strangled?
This question matters enormously for line managers and wellbeing leads. An employee may attend work following a strangulation incident and appear, on the surface, completely unharmed. They may show no visible bruising or marks. But they may also present with a range of subtle signs that something is wrong.
These can include:
- Dizziness or feeling unsteady
- Persistent headaches
- Difficulty concentrating or following conversations
- Unusual anxiety or jumpiness
- Becoming withdrawn or noticeably quieter than usual
- Changes in mood that seem out of character
None of these signs, individually, confirm what has happened. And that is not the point. Managers are not expected to diagnose. Their role is to notice changes, create a safe, non-judgmental space, respond with care, and know when to refer to appropriate support.
Work is often one of the only places where someone experiencing abuse is physically away from the person harming them. That makes the workplace a uniquely important space. A thoughtful response from a manager or colleague can be the moment a survivor feels safe enough to seek help.
Why Should Employers Prioritise Domestic Abuse Awareness Training?
Domestic abuse affects a significant proportion of the working population. Research suggests that up to 75% of survivors experiencing domestic abuse are targeted at work by their perpetrator, whether through excessive contact, surveillance or interference with employment. The cost to employers is well documented as well. The average cost per survivor due to lost output is estimated at £7,245.
Understanding non-fatal strangulation as part of a broader domestic abuse awareness framework is not a niche concern. It is a core safeguarding and wellbeing issue.
Training helps people across an organisation to:
- Recognise warning signs of domestic abuse, including NFS
- Understand the real risks, including those that are not immediately visible
- Respond in ways that are safe, compassionate and practical
- Challenge harmful myths such as “there were no injuries, so it was not that serious”
- Create psychologically safer workplaces where survivors feel able to disclose
The goal of domestic abuse training is not to turn every manager into a specialist. It is to ensure that those working alongside survivors have the knowledge and confidence to take the right first steps.
What Practical Steps Can Employers Take Right Now?
Organisations at every stage of their domestic abuse awareness journey can take meaningful action. Here are some practical starting points:
Put a domestic abuse policy in place. A clear workplace policy demonstrates that your organisation takes this issue seriously. Domestic Abuse Education offers a template policy that organisations can download and adapt.
Train your managers and line managers. Awareness training gives managers the tools to notice changes in behaviour, hold sensitive conversations and know how to refer safely. This includes understanding non-fatal strangulation and why visible injuries cannot be the benchmark for taking a disclosure seriously.
Establish clear internal referral routes. Employees need to know where to go if they want to disclose. This might be a domestic abuse champion, an HR professional, an occupational health team or a combination of routes.
Provide access to confidential support. Where possible, ensure employees have access to confidential support, whether through an employee assistance programme or signposting to specialist external organisations.
Never dismiss a disclosure because there are no visible injuries. This point deserves to be stated clearly and separately. The absence of visible marks is not evidence that nothing serious happened. It may simply mean that the injuries are internal and the risks are ongoing.
Domestic Abuse Awareness Saves Lives
Understanding non-fatal strangulation is not about alarm. It is about accuracy. When professionals understand the true risks, when they know that visible injuries are often absent, when they know that symptoms may emerge days later, they are far better placed to respond in ways that genuinely support survivors.
Domestic abuse is rarely obvious. But understanding the warning signs can save lives. Through evidence-based workplace training, Domestic Abuse Education helps organisations build the confidence to recognise, respond to, and refer safely.
To find out how we can support your organisation, get in touch with our team:
📞 01223 608244
🌐 https://domesticabuseeducation.co.uk
Frequently Asked Questions
What is non-fatal strangulation in the context of domestic abuse?
Non-fatal strangulation in domestic abuse refers to a perpetrator applying external pressure to the neck or throat of a survivor. It is distinct from choking, which involves an obstruction of the airway. The Institute for Addressing Strangulation (IFAS) encourages professionals to use the term “strangulation” rather than “choking” to accurately describe this form of abuse.
Does non-fatal strangulation always leave visible marks?
No. Many survivors of non-fatal strangulation have no visible external injuries. This is one of the most important and widely misunderstood facts about NFS. Serious internal harm, including brain injury and increased stroke risk, can occur even when there is no visible bruising or marking on the skin.
How common is non-fatal strangulation in England and Wales?
According to IFAS analysis published in 2026, 44,426 cases of strangulation and suffocation were recorded by police in England and Wales from June 2024 to June 2025. This represents a 13% increase on the previous year and an 87% rise since strangulation became a standalone offence under the Domestic Abuse Act 2021.
Is non-fatal strangulation linked to domestic homicide?
Yes. Non-fatal strangulation is recognised as a significant risk factor indicating that domestic abuse may escalate to homicide. The Femicide Census Report “2000 Women” found that strangulation was used in 27% of the killings of 2,000 women in the UK since 2014, with 372 strangled by an intimate partner.
What should a line manager do if they suspect an employee has experienced domestic abuse?
A line manager does not need to investigate or confirm what has happened. Their role is to notice changes in an employee’s behaviour or wellbeing, create a safe and non-judgmental space for conversation, and know how to refer the employee to appropriate support. Training from Domestic Abuse Education equips managers with the knowledge and confidence to take these steps safely.
What can organisations do to prepare for disclosures of domestic abuse, including non-fatal strangulation?
Organisations can put a domestic abuse policy in place, train managers and domestic abuse champions, establish confidential referral routes, and ensure employees can access support. Critically, they should ensure that all staff understand that the absence of visible injuries does not mean an incident was not serious.
Why are recorded strangulation offences rising if the problem is not necessarily getting worse?
The rise in recorded offences reflects improvements in awareness, professional understanding and reporting confidence, as well as more accurate recording practices since strangulation became a standalone offence in 2022. More accurate data allows for better responses, not evidence that the problem has grown.