Is Choking the Same as Strangulation?

Both Impair Air Flow but in Different Ways

man doing heimlich maneuver on woman

Science Photo Library / Getty Images

The word choking has been misused for so long it's become an accepted way of describing strangulation. But they're not the same thing. Both terms refer to a restriction of air caused by something other than a disease. The key difference is that choking is an internal event, while strangulation is caused by external forces.


Choking is also known as a foreign body airway obstruction. It occurs when something is physically in the way of air moving in and out of the trachea (windpipe).

In most cases, choking is caused by food, which gets stuck in the trachea and directly blocks airflow. But it's also possible that something can get lodged in the esophagus, the tube that transports food to the stomach, and squeeze the trachea from behind. Either way, the object is inside the body when it causes choking.

Treatment for choking depends on the severity of the situation—for instance, mild choking may be resolved by encouraging the person to cough forcefully. Treatment also depends on the age of the patient.

Infant choking is treated differently than choking in adults and children older than 1. In this group, severe choking—when the person can't speak, cry, cough, or breathe—is best treated by giving five sharp blows between the person's shoulder blades with the heel of your hand or by performing the Heimlich maneuver.


Whether it occurs intentionally or accidentally, strangulation is when anything compresses the neck enough to restrict airflow to the trachea. It's incorrect to say that someone was "choked" by another person; the correct terminology would be "strangled."

Strangling cuts off the flow of oxygen to the brain in one or more ways. Strangulation compresses the carotid artery or jugular veins, resulting in cerebral ischemia. It can also compress the laryngopharynx, larynx, or trachea, causing asphyxia. It can also stimulate the carotid sinus reflex, causing bradycardia, hypotension, or both.

The treatment for strangulation is the immediate removal of the device or object that's impairing breathing. Then, call 911.

A medical evaluation is crucial if someone's been strangled. An injury to the trachea may not appear to be serious right away, but swelling in the tissues around the trachea can lead to a secondary restriction of airflow a few minutes after the neck is free.

There are three main types of strangulation:

  • Manual strangulation uses the fingers, other extremities, or an object to block the airflow and is sometimes referred to as throttling. Chokeholds used in martial arts are a type of manual strangulations.
  • Ligature strangulation is using a cord-like object around the neck such as rope, wire, or shoelaces. Also called garroting, this method either partially or fully circumferences the neck to block the airflow without suspension.
  • Hanging is using ligature strangulation to suspend the body, using the bodyweight to restrict airflow.

Choking Games

Temporary strangulation can lead to a brief high when oxygen rushes back to the brain. Some people abuse self-strangulation to get this rush. While it is referred to as a choking game, it is actually strangulation. This is a dangerous practice that can lead to death.

The choking game challenges often spread through the internet and are also known as the pass-out game, space monkey, the fainting game, scarf game, space cowboy, California choke, the dream game, cloud nine, and purple hazing.

Some couples also engage in choking during sex play, known as erotic asphyxiation. While many people refer to it as choking, it is actually strangulation. Choking games during sex is dangerous and should only be done with caution.

Domestic Abuse

Strangulation is often used in domestic abuse situations. According to the National Domestic Violence Hotline, It is one of the most lethal forms of domestic violence because unconsciousness may occur within seconds and death within minutes.

Many people who have been strangled by a domestic partner may minimize the act and not press charges or report the incident because it is not seen as being as violent as hitting.

Research suggests roughly 10 percent of domestic violence victims are strangled. In fact, non-fatal strangulation is a significant predictor for future violence, and people who were strangled by their partner are at a 6 to 10 times greater risk of being murdered by their abuser.

If you have been strangled by your partner, the National Domestic Violence Hotline can help connect you to local resources. Call 1-800-799-7233 to speak to someone today.

Was this page helpful?

Article Sources

  1. Duckett SA, Roten RA. Choking. Treasure Island, Fl: StatPearls Publishing; 2019.

  2. Dunn RJ, Lopez RA. Strangulation Injuries. Treasure Island, Fl: StatPearls Publishing; 2019.

Additional Reading