Suicide/Ligature strangulation

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Strangling is compression of the neck that may lead to unconsciousness or death by causing an increasingly hypoxic state in the brain. Fatal strangling typically occurs in cases of violence, accidents, and as the auxiliary lethal mechanism in hangings in the event the neck does not break. Strangling does not have to be fatal; limited or interrupted strangling is practiced in erotic asphyxia, in the choking game, and is an important technique in many combat sports and self-defense systems.

Ligature strangulation[edit]

Ligature strangulation is a type of strangulation that occurs with the use of a mass that is not the body weight. In other words, ligature strangulation does not require suspension of the physical body. Instead, it requires the use of a cord-like object, such as a rope.

It is an unusual method of suicide, which is nearly always compared (or confused) with hanging, the latter of which is a type of strangulation that does require suspension of the physical body. Part of the confusion with hanging is that it is possible for strangling to occur during the hanging: this is when the neck is not broken during the process of hanging. In roughly 99% of the cases with hanging, the neck does not break (because the drop was not deep enough to bring about the breaking of the neck), resulting in strangling to death instead. Hanging is frequently described as being more painful than ligature strangulation.

Ligature strangulation is also used in fainting games and in erotic asphyxiation and should be painless.

For additional introductory information regarding ligature strangulation, please take a look at this article on Wikipedia.

Ligature strangulation specifications[edit]

Minimal pressure :

  • 3.2 to 5 kg[1][2]( or 6 kg[3] or 10 kg[4]) necessary for closing the carotid arteries;
  • 2 kg necessary for closing the jugular veins;
  • 15 kg necessary for the compression of the airway: this is painful.

"What this means, practically speaking, is that someone who wants – or wants to avoid – a lethal result should be aware that full suspension is quite unnecessary. Death will occur after only a few pounds of pressure on a neck ligature; a sitting or semi-reclining position is sufficient." -- excerpt from Geo Stone's book.

The consequences[edit]

What are the effects of hanging?[edit]

More detailed information regarding the effects of hanging came from a self-experimenter by the name of Minovici. With a 5 kg (11 lbs.) pull on the ligature, loss of consciousness was rapid for him. When he leaned on the rope (incomplete suspension), within 5-6 seconds the following occurred: his eyes blurred, he heard whistling, and his face turned red-violet. With the knot on the side instead of the back of the neck, these effects took 8-9 seconds to appear.[5]

When he tried complete suspension (hanging, not strangulation), as soon as he left the ground, he couldn't breathe or hear his assistant. He experienced such severe pain that he immediately stopped the test. Within 10 minutes, many small hemorrhages could be seen near the site of the rope; these remained visible for 8-11 days. For 10-12 days later he had watering eyes, trouble swallowing, and a sore throat.[6]

Delayed strangling death[edit]

Source : Delayed Hanging Death: A case report[7] In cases of hanging, death usually occurs immediately after strangulation and is caused by ischaemic cerebral damage due to neck compression.[9] But for this victim death was delayed which is not a common occurrence. There are a number of mechanisms by which hanging may cause death. Carotid arteries are less commonly occluded because presence of sternomastoid muscles. In this case, the victim was unconscious which means bilateral carotid arteries are occluded. Vertebral circulation was insufficient to maintain cortical function. The unremitting pressure had cut off the blood supply of the brain for at least 4 minutes in order to have irreversible brain damage. The extent of ligature marks on the skin and depression was consistent with occlusion of carotid arteries more than 4 minutes.[8]

Besides, a period of reflex cardiac arrest by external pressure upon baroreceptors in the carotid sinuses and carotid sheaths can also be the cause of death. This can stimulate afferent stimuli via glosso-pharnygeal nerves to the tenth cranial nucleus in the brainstem. This generates cardio- inhibitory impulses in the nucleus which pass through the vagus nerves to the heart. The victim's face was pale when she was brought to hospital with no congestive or petechial signs. Reflex cardiac arrest was apparently the mechanism. In order to have brain damage, the heart must have been in a period of asystole for at least 4 minutes duration.[10] The ability of the heart to recover and restart functioning after 4 minutes of ischemia is acceptable because the myocardium can easily survive this length of hypoxia. Another mechanism suggested was that external stimuli such as common resuscitation practice might restart the asystolic heart.

Aggarwal et al from Delhi (India) reported a similar case where a 20 year old female survived for nine days in the hospital being unconscious throughout, after a hanging episode and died ultimately due to cerebral anoxia.[11]

In another study from Delhi, an uncommon accidental hanging of an adult male was reported who got trapped in the lift of a building and was accidentally hanged. He also survived for 39 days in the hospital and died.[12]

Earlier, Maxeiner reported a similar case of delayed hanging death in six cases of suicides who were all unconscious throughout till death.[13]

For brain death after hospitalization to occur, there must be paralysis of the cardio-respiratory centres. These centres are more resistant to hypoxia than actual infarction than the neocortex which is the first area of brain to suffer irreversible brain damage. Heart is more resistant than brain to hypoxia; therefore in asphyxia cessation of the heart is the result of failure of brain rather than vice versa.

Just contrary to the above studies, Hausmann and Betz reported a case of delayed death 4 days after an attempted suicide by hanging where the individual was conscious and showed no neurological abnormalities. The cause of death was a cerebral infarction following a traumatic thrombosis of the subtotally ruptured carotid arteries.[9]

The present case had the usual pattern of post mortem hypostasis as because the victim was hospitalized and was on the bed immediately after the episode. If the victim were in vertical position, post mortem hypostasis would have been as the glove and stocking distribution. The classical signs of asphyxia were absent instead a pale face was seen due to compression of the carotid arteries and the feet were off the ground (complete hanging). But if the body is fully supported on the ground (i.e. partial hanging) then the jugular veins are compressed and petechiae are present. Besides, there was no laryngeal fracture which was similar to the findings in literature7, and no hyoid bone fracture or soft tissue haemorrhage because of soft ligature material used, which was a saree.

The methods[edit]

Creating a noose.


  1. hanging
  2. Suicide and Attempted Suicide, Methods and Consequences by Geo Stone. Chapter 23 Hanging and Strangulation (online)
  3. [ 46. Yamasaki S, Takase I, Takada N, Nishi K. Measurement of force to obstruct the cervical arteries and distribution of tension exerted on a ligature in hanging. Leg Med (Tokyo). 2009, Vols. Jul;11(4):175-80 ]
  4. Strangulation Injuries, Stephan Stapczynski, M
  5. Suicide and Attempted Suicide, Methods and Consequences by Geo Stone. Chapter 23 Hanging and Strangulation (online)
  6. Suicide and Attempted Suicide, Methods and Consequences by Geo Stone. Chapter 23 Hanging and Strangulation (online)
  7. Delayed Hanging Death: A case report

External links[edit]