A Comparative Forensic Assessment of Hanging and Strangulation with Reference to Autopsy Findings

Abstract – Hanging and strangulation are the two most frequently encountered forms of asphyxial death in forensic practice, yet their differentiation remains a critical medico-legal challenge with profound implications for determining the manner of death. Hanging results from suspension of the body by a ligature, where the constricting force is the weight of the body, whereas strangulation is caused by external compression of the neck independent of body weight, either by a ligature or by manual force. Both mechanisms share overlapping external and internal features, often complicating interpretation at autopsy. This review synthesizes current evidence from 2022–2025 to provide an integrated, evidence-based framework for distinguishing hanging from strangulation. Epidemiological data highlight hanging as the most common method of asphyxial suicide worldwide, including in India, while strangulation is more often associated with homicide. Mechanistic differences give rise to characteristic patterns of ligature marks, internal neck injuries, and associated trauma. Recent advances, including multivariate statistical analyses, postmortem imaging, histopathology, and immunohistochemical evaluation of biomarkers such as heat-shock proteins (HSP27, HSP70, HSP90), ubiquitin, caspases, and hypoxia-related markers (HIF 1α, VEGF), have significantly improved the objective assessment of wound vitality and antemortem neck compression. Strangulation is typically associated with pronounced localized stress, ischemia, and apoptotic markers, whereas hanging more often demonstrates markers of generalized hypoxic response. The combined interpretation of molecular findings with gross autopsy features and scene investigation enhances diagnostic accuracy, even in decomposed bodies. A multimodal approach is essential to reduce subjectivity, strengthen medico-legal conclusions, and ensure accurate classification of the manner of death, thereby supporting justice delivery, public health surveillance, and family closure.