Domestic Abuse Bill

Written evidence submitted by Helen Bichard, Trainee Clinical Psychologist (DAB11)

Submission to Domestic Abuse Bill Committee

The need for an offence of non-fatal strangulation, and to outlaw the use of the ‘rough sex’ defence

1. Summary

I am writing in support of amendments NC4-NC11 to the new Domestic Abuse Bill. These amendments refer to the use of the ‘rough sex’ defence in the case of fatal strangulation, and the characterisation of non-fatal strangulation as a specific offence.

2. Background

I am a Trainee Clinical Psychologist working at the North Wales Brain Injury Service, and an employee of Betsi Cadwaladr University Health Board (BCUHB) within NHS Wales. This is my final year of clinical training , concluding September 2020 . I have recently submitted my doctoral thesis, which was on the intersection of brain injury and violence. Part of this was a systematic review of the evidence for the neuropsychological (neurological, cognitive, psychological, and behavioural) outcomes of non-fatal strangulation in domestic and sexual violence [1] . The paper has been submitted for peer review and publication in the journal Neuropsychological Rehabilitation . This link ( ) will take you through to a pre-print published on the Open Science website. Since being published eight days ago the paper has already been downloaded and read in full 71 times , indicating a significant level of public and scientific interest at this early stage already.

3. Impact of non-fatal strangulation on victims

I would humbly urge you to read the full paper, but to summarise:

· 27 international, peer-reviewed studies were identified , largely based on medical case reports, or analysis of police and forensic records

· Neck structures are fragile: blocking the jugular vein can take less pressure than opening a can of Coke

· In terms of pathology, strangulation was shown to lead to arterial dissection, compromise of blood flow to and from the brain, cerebral swelling, delayed stroke, and miscarriage

· In fact, it is thought strangulation might be the second most common cause of stroke in women under 40

· Strangulation potentially carries all the consequences of other hypoxic-ischaemic injuries such as cardiac arrest (which it can itself provoke), but has its own additional burden

· Neurological consequences include: loss of consciousness (indicating at least mild brain injury), paralysis, movement disorders, altered sensation, speech disorders, incontinence, and seizures

· Cognitive consequences include: amnesia, impaired executive function (decision-making, judgement)

· Psychological consequences include: existential fear, PTSD and other trauma reactions, dissociation, suicidality, depression, anxiety, personality change

· Behavioural consequences include: increased compliant and submissive behaviour, aggression

From this it should be clear that non-fatal strangulation carries with it the very real potential to cause significant and life-changing injury to brain and mind.

4. Strangulation and ‘consent’

I also want to make a specific point about consent. Consent always needs to be informed, and it needs to be able to be withdrawn at any point. Neither of these can possibly pertain in the so-called ‘rough sex’ defence. People do not currently understand the very severe risk s of this behaviour, to inform their decision making when considering consenting : how can they, if the law minimises it so? This equates to having to make an informed decision without having access to the science and knowledge to inform said decision to consent (or not). Furthermore, if consent is provided, the person would not be aware that their consent cannot be withdrawn, because the very organ that is needed to provide consent – the brain – is compromised by the activity to which it applies, i.e. strangulation. Consciousness can be lost in as little as four seconds. In a bizarre and inhumane experiment in the 1940s in which prisoners and psychiatric patients were strangled to observe its physical, biological effects , the lead examiner first tried the equipment on himself [2] . There was an emergency release button. He found himself unable to press it, even when he wanted to. He was unsure whether this was due to forgetting he could (amnesia) or messages from the brain not getting to his hand (dyspraxia). He almost died. Both these impairments were the result of the cognitive compromise being wrought due to altered brain (and mind) functioning by strangulation.

5. Conclusion

I would be extremely grateful if you would consider supporting the amendments. I ask this in both my clinical role, and as a mother of three daughters. This is a gendered crime, and a deadly one. After being strangled, a woman's chance of subsequently being murdered rises eightfold [3] . It is, indeed, the edge of homicide . Finally, though an employee of BCUHB, I am writing in my personal capacity and as a clinician-scientist. M y views do not necessarily reflect those of my employing organisation , although it is worth stating they fully supported my contributing to a BBC Disclosure documentary on strangulation, which is currently paused due to Covid-19

Please do not hesitate to contact me with any questions. 

Helen Bichard [4]

Trainee Clinical Psychologist

May 2020

[1] Bichard, H., Byrne, C., Saville, C. W. N., & Coetzer, R. (2020, May 15). The neuropsychological outcomes of non-fatal strangulation in domestic and sexual violence: A systematic review.

[2] Kabat, H., & Anderson, J. P. (1943). Acute arrest of cerebral circulation in man: Lieutenant Ralph Rossen. Archives of Neurology & Psychiatry, 50(5), 510-528.


[3] Glass, N., Laughon, K., Campbell, J., Block, C. R., Hanson, G., Sharps, P.W., & Taliaferro, T. (2008). Non-fatal strangulation is an important risk factor for homicide of women. The Journal of Emergency Medicine, 35(3), 329-335.


[4] MA (Hons), MSc, and will be a Doctor of Clinical Psychology and a Chartered Psychologist from September this year


Prepared 11th June 2020