Recent research has confirmed that cutting off the blood from the brain can potentially cause physical harm, such as brain damage or cardiac arrest. Being choked can also cause harm to people’s mental health, including causing them to feel depressed, sad, lonely, and may cause anxiety. Repeated choking seems to compound these harms, increasing the risk of impairing your working memory for verbal and visual tasks.
Signs of Injury: Up to 40% of fatal strangulations have no signs of injury (de Boos, 2019).
Risk of death: Many people don’t realize that unconsciousness or “fainting” is ultrahazardous behavior that can cause death quickly or a few days after being choked (Ramowski, 2012; Schori, 2022)
Memory issues: Those who have been choked show a need for more neural resources to do memory tests (Huibregtse, 2022; Valera, 2022).
Motor control: Multiple experiences of sexual choking/strangulation are associated with an imbalance in neural activation pattern and hyperconnectivity between the brain regions related to motor control, consciousness, and emotion (Hou, 2023).
Brain Damage: Compressing or blocking the blood vessels or airway leads to decreased blood flow to the brain, both of which can induce brain damage with only minimal force (de Boos, 2019; Bichard et al., 2021).
Mental Health: Women who had been choked more than five times in the past month were more likely to feel sad, lonely, anxious, and depressed compared to women who haven’t been choked (Herbenick et al., 2021, Valera, 2022).
Structural Brain Damage: There is no 3-4 second “rule.” Once blood flow is stopped and then re-established, the brain tissue suffers from damaging proteins and lipids, and pro-inflammatory mediators are produced, triggering cell death (Busl and Greer, 2010).
Education: Most choking participants (88.9%) agreed/strongly agreed that people could die from being choked during sex, yet 37.5% endorsed choking as safe and half (49.6%) reported knowing how to engage in choking safely (Herbenick et al., 2025)
References
Bichard, H., Byrne, C., Saville, C. W. N., & Coetzer, R. (2022). The neuropsychological outcomes of non-fatal strangulation in domestic and sexual violence: A systematic review. Neuropsychological rehabilitation, 32(6), 1164–1192. DOI: 10.1080/09602011.2020.1868537
De Boos, J. (2019), Review article: Non-fatal strangulation: Hidden injuries, hidden risks. Emergency Medicine Australasia, 31: 302-308. DOI: 10.1111/1742-6723.13243
Busl, K.M., & Greer, D.M. (2010). Hypoxic-ischemic brain injury: pathophysiology, neuropathology and mechanisms. NeuroRehabilitation, 26 1, 5-13. DOI: 10.3233/NRE-2010-0531
Herbenick, D., Fu, Tc., Miller, O. et al. Sources of Learning about Sexual Choking and Their Associations with Perceived Safety and Risk: Findings from a U.S. College Campus-Representative Survey. Sex Res Soc Policy 22, 1614–1628 (2025). https://doi.org/10.1007/s13178-024-01072-6
Herbenick, D., Fu, T. C., Kawata, K., Eastman-Mueller, H., Guerra-Reyes, L., Rosenberg, M., & Valdivia, D. S. (2022). Non-Fatal Strangulation/Choking During Sex and Its Associations with Mental Health: Findings from an Undergraduate Probability Survey. Journal of sex & marital therapy, 48(3), 238–250. https://doi.org/10.1080/0092623X.2021.198502
Herbenick, D., Fu, Tc., Eastman-Mueller, H. et al. Frequency, Method, Intensity, and Health Sequelae of Sexual Choking Among U.S. Undergraduate and Graduate Students. Arch Sex Behav 51, 3121–3139 (2022). https://doi.org/10.1007/s10508-022-02347-y
Herbenick D, Patterson C, Beckmeyer J, Gonzalez YRR, Luetke M, Guerra-Reyes L, Eastman-Mueller H, Valdivia DS, Rosenberg M. (2021) Diverse Sexual Behaviors in Undergraduate Students: Findings From a Campus Probability Survey. J Sex Med. 2021 Jun;18(6):1024-1041. doi: 10.1016/j.jsxm.2021.03.006.
Hou, J., Huibregtse, M. E., Alexander, I. L., Klemsz, L. M., Fu, T. C., Fortenberry, J. D., Herbenick, D., & Kawata, K. (2023). Association of Frequent Sexual Choking/Strangulation with Neurophysiological Responses: A Pilot Resting-State fMRI Study. Journal of neurotrauma, 10.1089/neu.2022.0146. https://doi.org/10.1089/neu.2022.0146
Huibregtse, M. E., Alexander, I. L., Klemsz, L. M., Fu, T. C., Fortenberry, J. D., Herbenick, D., & Kawata, K. (2022). Frequent and Recent Non-fatal Strangulation/Choking During Sex and Its Association With fMRI Activation During Working Memory Tasks. Frontiers in behavioral neuroscience, 16, 881678. https://doi.org/10.3389/fnbeh.2022.881678
Ramowski, S.K., Robert J. Nystrom, Kenneth D. Rosenberg, Julie Gilchrist, Nigel R. Chaumeton; Health Risks of Oregon Eighth-Grade Participants in the “Choking Game”: Results from a Population-Based Survey. Pediatrics May 2012; 129 (5): 846–851. 10.1542/peds.2011-2482
Schori, A., Jackowski, C., & Schön, C. A. (2022). How safe is BDSM? A literature review on fatal outcome in BDSM play. International journal of legal medicine, 136(1), 287-295.
Valera, E.M., Colantonio, A., Daugherty, J.C., Scott, O.C., Berenbaum, H. (2022) Strangulation as an Acquired Brain Injury in Intimate–Partner Violence and Its Relationship to Cognitive and Psychological Functioning: A Preliminary Study. Journal of Head Trauma Rehabilitation, Volume 37, Number 1, January/February 2022, pp. 15-23(9)