A mother from Queensland said she wakes up choking with the constant fear the arteries in her neck will "collapse on themselves" after she was strangled by her partner 18 months ago.
Sue* shared a horrific account of the domestic violence that almost killed her and left her with a plethora of ongoing medical issues with news.com.au to highlight a major and widely misunderstood red flag that often leads to death.
That red flag is strangulation, which disturbingly often leaves no external signs of injury and can kill victims months after the attack. It also increases your odds of being murdered by 750 per cent.
Because she was strangled by her partner, Sue has been left to live with PTSD, two crushed discs in her back, major muscle tears, intestinal problems, memory loss, vocal cord dysfunction, blurry vision, panic attacks and anxiety and depression. She even has pain in her right foot from the back damage she was dealt over several attacks.
"Not all my injuries are visible," she told news.com.au. "It's a big list of thing to live with for the rest of my life."
The horrific ordeal of being strangled has also left Sue mentally scarred.
"It's a very personal, very intimate form of domestic violence because you become aware of your own mortality," she said. "And if you don't fight, your life will end.
"The look in the eyes of your perpetrator haunts you for the rest of your life. In reality, you get a life sentence in that moment — a life sentence of betrayal, trauma and lifelong injuries both mentally and physically."
Sue doesn't even know how many times she was strangled because of the "massive black spots" in her memory, which leaves her wondering to this day how long she lay lifeless after her partner had finished with her.
One thing she can't forget after regaining consciousness is the words of an attending police officer, who told her "if you don't remember, it didn't happen" as she tried to recall details of the attack.
"Even now I struggle with that, and I will struggle with that for the rest of my life," she said. "It was soul-destroying."
Despite the red lines around her neck and bruises she doesn't remember receiving, Sue said she felt "invisible" as she encountered a toxic mix "stigma, bias and ignorance" on every level of authority she encountered.
To her horror she found out the crucial arteries in her neck could collapse at any given moment up to a year after the attack had taken place.
"If there's a paramedic there when that happens, you might survive, but for most people that happens to, you just die," she said.
Eighteen months later, Sue's nightmare is ongoing.
She has to wait until November for a scan that will tell her if she received traumatic brain injury from the strangulation.
Because of her vocal cord damage, she always has a lump in her throat, and her voice can suddenly cut out for minutes at a time.
She was shocked at the misunderstanding of strangulation by medical professionals who treated her.
Because clots become dislodged and arteries develop tears during the act, blood vessels can collapse many months after the attack has taken place.
"No one told me the side effects (of strangulation), no one told me I could die in my sleep," she said.
"I used to wake up choking, thinking, 'Oh my god, there's something wrong with me'. But, not one person told me that was a side effect and your throat can just collapse on itself."
Now she believes everyone involved in the process of dealing with domestic violence, from the police officers and first responders through to doctors and nurses, needs to be trained to recognise the risks involved in cases of strangulation.
Betty Taylor, the chief executive of the Red Rose Foundation that works to end domestic and family violence deaths, has heard many horror stories like Sue's.
She has heard from strangulation victims who have suffered miscarriages as a result of their attack and strokes later in life because their brains have become starved of oxygen.
"I've worked in this space for 30 years and the impact of non-fatal strangulation has been hidden," she said. "No one knew, or they weren't talking about how this act affects victims.
"They thought victims just got on with life, and we just got through it as if it was another form of physical violence.
"But 50 per cent of victims don't have any sort of physical injury, and the damage was being done."
Now she says it's time for Australia to wake up to the risks and have a conversation about this disturbingly common form of domestic violence — overwhelmingly used by abusive men towards their female partners.
Red Rose points to several studies from the US that show police and prosecutors often overlook symptoms or rely too heavily on the visible signs of choking attacks.
And because most victims of strangulation have no visible injuries or their injuries are too minor to photograph, opportunities for higher level criminal prosecution are missed.
The statistics from these studies show 68 per cent of women at high risk of domestic violence will experience near-fatal strangulation from their partner — and 70 per cent of them believed they were going to die.
Even if they survive, the odds of them being murdered increase by 750 per cent compared with victims who've never been strangled.
Worryingly, only 50 per cent of victims have visible injuries, and only 15 per cent of those can be photographed.
State-by-state, Australia is moving towards recognising the seriousness of non-fatal strangulation as a stand-alone offence.
This month, the Victorian Government announced it would join Queensland, New South Wales, South Australia and the ACT in committing to a new and specific strangulation offence.
Queensland was first to make strangling, choking and suffocating in a domestic violence setting an offence in May 2016, with a maximum penalty of seven years imprisonment.
The state's Sentencing Advisory Council analysis shows from June 2016 to June 2018 more than 400 cases were sentenced for the non-fatal strangulation offence.
In just under half those cases, the non-fatal strangulation was also a breach of a domestic violence protection order.
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Nearly all offenders were male (98 per cent). The oldest offender was 60 and the youngest 15 — and most received a prison sentence (76 per cent).
NSW introduced a new strangulation offence last year, and South Australia followed suit at the start of this year.
A quarter of all NSW murder victims had suffered a strangulation attack prior to their deaths. Ms Taylor echoed Sue's call for better recognition and treatment of strangulation in the health system — saying victims can die up six to 12 months after an attack.
This lack of research is just one area that will be addressed as part of a new national institute to prevent strangulation — which will be set up by domestic violence experts next month.
The institute is being formed in partnership with San Diego's Training Institute on Strangulation Prevention.
It will advocate for consistent strangulation legislation across every state, a body of experts who can give testimony in court, specialist training for authorities and the creation of a specialist strangulation trauma centre for victims.
If you're in danger now:
• Phone the police on 111 or ask neighbours of friends to ring for you.
• Run outside and head for where there are other people.
• Scream for help so that your neighbours can hear you.
• Take the children with you.
• Don't stop to get anything else.
• If you are being abused, remember it's not your fault. Violence is never okay
Where to go for help or more information:
• Women's Refuge: Free national crisis line operates 24/7 - 0800 refuge or 0800 733 843 www.womensrefuge.org.nz
• Pet Refuge petrefuge.org.nz
• Shine, free national helpline 9am- 11pm every day - 0508 744 633 www.2shine.org.nz
• Shakti: Providing specialist cultural services for African, Asian and Middle Eastern women and their children. Crisis line 24/7 0800 742 584
• It's Not Ok: Information line 0800 456 450 www.areyouok.org.nz