Why the brain is at risk
The carotid arteries carry blood to the brain. It takes about 11 pounds of force to close them, less than it takes to open a can, and once they close a person can pass out within 5 to 10 seconds. The brain is the organ most sensitive to losing oxygen, and losing consciousness from strangulation is treated by researchers as a sign of at least a mild brain injury.
What brain scans found
Researchers at Indiana University compared about 20 young women who had been choked at least four times in the previous 30 days with about 20 women who had never been choked. On memory tests, the two groups showed no significant differences in accuracy or speed, but brain scans showed their brains working differently to produce those results.
Scans of the same women also showed thicker areas of the brain’s outer layer and differences in how brain regions connected at rest. In blood tests of 32 women, those who were choked often had higher levels of S100B, a marker the researchers say may point to inflammation in the brain.
Each woman was measured once, so these studies show that the groups differ. They can’t show that choking caused the differences.
Before and after
A 2025 study measured the same 29 women after sex with choking and after sex without it. Neurofilament light, a protein released when nerve fibers are under stress, rose after sex that involved choking and did not change after sex without it. A related study of 31 women found that a test of eye focusing worsened more after sex with choking than after sex without it (19.9%, compared with 8.1%), and about a third of the women reported symptoms such as a head rush or blurred vision.
Mood and memory
In a survey of 4,352 undergraduates, having been choked was linked with feeling depressed, anxious, sad and lonely (except anxiety among men). A review of 30 studies of strangulation in domestic and sexual violence found reports of seizures, memory loss, stroke and depression, but none of those studies used formal tests of memory and thinking. Researchers are now planning to follow 200 women over time to learn whether the changes seen so far last.
What it means
Nobody knows yet whether being choked many times causes lasting harm, and nobody can tell in the moment how much a particular brain can take. If headaches, memory problems or trouble concentrating continue after being choked, get checked. Signs that being choked might have affected you →
Sources
- Armstrong & Strack, JAMA Otolaryngology–Head & Neck Surgery 142(9) (2016).
- Training Institute on Strangulation Prevention, Physiological Consequences of Strangulation: Seconds to Minute Timeline (2024); letter to medical providers.
- Institute for Addressing Strangulation, There Is No Safe Way to Strangle: position statement (2024, reviewed 2025).
- Bichard et al., Neuropsychological Rehabilitation 32(6) (2022).
- Huibregtse et al., Frontiers in Behavioral Neuroscience 16 (2022).
- Hou et al., Brain and Behavior 13(8) (2023); Hou et al., Journal of Neurotrauma 40(13–14) (2023).
- Huibregtse et al., Journal of Sexual Medicine 22(5) (2025).
- Sweeney et al., Frontiers in Global Women’s Health 6 (2025); Sweeney et al., Journal of Sexual Medicine 23(1) (2026).
- Herbenick et al., Journal of Sex & Marital Therapy 48(3) (2022).
- Kawata et al., PLoS One 21(4) (2026). Study protocol.