Across the country, mass shootings like the one at First Baptist Church in Sutherland Springs and Pulse Night Club in Orlando, share a common warning sign. The killer had choked a woman in his past.
The crime can often leave no visible injuries but it has lasting effects, and now advocates are working to raise the alarm.
It's dinner time in Cynthia Nickel's North Richland Hills home, a careful process of pureeing and cooling for her son.
"He can't swallow very well, he won't chew," Nickel said.
Larry is 25-years-old but needs the care of an infant.
"My heart breaks sometimes for him because he can't enjoy the normal things that we take for granted," Nickel said.
Larry has microcephaly and his mother only recently learned an incident with his father when she was five months pregnant is to blame.
"This is because he strangled me," Nickel said.
Strangulation is a clear warning sign of even more serious violence, including mass shootings but it's often underestimated because it can leave no visible injury.
"And you're ignoring the most dangerous offenders that exist," said Casey Gwinn.
Gwinn and his group, the Alliance for Hope International, were recently in Fort Worth training police, doctors, nurses and prosecutors on what to watch for and how to handle strangulation cases.
"If a man places his hand around a woman's neck one time in an intimate relationship, she is 750% more likely to later be killed by him, just one time,” Gwinn said. “Hand to the neck, he's just raised his hand and said he's a killer."
Nickel was there in the crowd, learning more about what her own future could hold.
"I was strangled several times during my relationship and now they’re finding out the long-term effects is dementia, brain damage and all these things," Nickel said.
She's accepted the consequences she lives with every day.
"He is my angel. He's helped me through everything too," Nickel said of her son.
But she wishes she'd understood the danger sooner, to push her to get out faster and now she wants the system to catch on. To connect the dots of violence and trauma and take that common thread seriously.
Tarrant County judges and probation officers also took part in the strangulation training, hoping to spread awareness throughout the whole criminal justice system.