Recognize the Signs

How do you know if someone is being abused, being trafficked, or has PTSD?  Sometimes, you don't.  Sometimes, there are signs, if you know what to look for.  

Here are some of the most common types of abuse, and their signs.  The list of possible indicators of abuse and examples of behavior, are not exhaustive.  People may be subject to more than one type of abuse at the same time, and may exhibit more than one indicator at the same time. 

Physical abuse types: 

• Assault, hitting, slapping, punching, kicking, hair-pulling, biting, pushing

• Rough handling

• Scalding and burning

• Physical punishments

• Inappropriate or unlawful use of restraint

• Making someone purposefully uncomfortable (e.g. opening a window and removing blankets)

• Involuntary isolation or confinement

• Misuse of medication (e.g. over-sedation)

• Forcible feeding or withholding food

• Unauthorised restraint, restricting movement (e.g. tying someone to a chair)

Signs and indicators: 

• No explanation for injuries or inconsistency with the account of what happened

• Injuries are inconsistent with the person’s lifestyle

• Bruising, cuts, welts, burns and/or marks on the body or loss of hair in clumps

• Frequent injuries

• Unexplained falls

• Subdued or changed behaviour in the presence of a particular person

• Signs of malnutrition

• Failure to seek medical treatment or frequent changes of general practicioner.

Domestic violence or abuse

Domestic violence or abuse can be characterised by any of the indicators of abuse outlined in this briefing relating to:

• psychological

• physical

• sexual

• financial

• emotional.

Signs and indicators: 

• Low self-esteem or low confidence

• Feeling that the abuse is their fault when it is not

• Physical evidence of violence such as bruising, cuts, broken bones

• Verbal abuse and humiliation in front of others

• Fear of outside intervention

• Damage to home or property

• Isolation – not seeing friends and family

• Limited access to money

Domestic violence and abuse includes any incident or pattern of incidents of controlling, coercive or threatening behavior, violence or abuse between those aged 16 or over who are or have been, intimate partners or family members regardless of gender or sexuality. It also includes so called ‘honour’ -based violence, female genital mutilation and forced marriage.

Coercive or controlling behavior is a core part of domestic violence. Coercive behavior can include:

• acts of assault, threats, humiliation and intimidation

• harming, punishing, or frightening the person

• isolating the person from sources of support

• exploitation of resources or money

• preventing the person from escaping abuse

• regulating everyday behaviour.

Sexual abuse

• Rape, attempted rape or sexual assault

• Inappropriate touch anywhere

• Non- consensual masturbation of either or both persons

• Non- consensual sexual penetration or attempted penetration of the vagina, anus or mouth

• Any sexual activity that the person lacks the capacity to consent to

• Inappropriate looking, sexual teasing or innuendo or sexual harassment

• Sexual photography or forced use of pornography or witnessing of sexual acts

• Indecent exposure

Signs and indicators: 

• Bruising, particularly to the thighs, buttocks and upper arms and marks on the neck

• Torn, stained or bloody underclothing

• Bleeding, pain or itching in the genital area

• Unusual difficulty in walking or sitting

• Foreign bodies in genital or rectal openings

• Infections, unexplained genital discharge, or sexually transmitted diseases

• Pregnancy in a woman who is unable to consent to sexual intercourse

• The uncharacteristic use of explicit sexual language or significant changes in sexual behaviour or attitude

• Incontinence not related to any medical diagnosis

• Self-harming

• Poor concentration, withdrawal, sleep disturbance

• Excessive fear/apprehension of, or withdrawal from, relationships

• Fear of receiving help with personal care

• Reluctance to be alone with a particular person

Mental or emotional abuse

• Enforced social isolation – preventing someone accessing services, educational and social opportunities and seeing friends

• Removing mobility or communication aids or intentionally leaving someone unattended when they need assistance

• Preventing someone from meeting their religious and cultural needs

• Preventing the expression of choice and opinion

• Failure to respect privacy

• Preventing stimulation, meaningful occupation or activities

• Intimidation, coercion, harassment, use of threats, humiliation, bullying, swearing or verbal abuse

• Addressing a person in a patronising or infantilising way

• Threats of harm or abandonment

• Cyber bullying

Signs and indicators: 

• An air of silence when a particular person is present

• Withdrawal or change in the psychological state of the person

• Insomnia

• Low self-esteem

• Uncooperative and aggressive behaviour

• A change of appetite, weight loss/gain

• Signs of distress: tearfulness, anger

• Apparent false claims, by someone involved with the person, to attract unnecessary treatment

• Difficulty controlling emotions

• Difficulty making and maintaining relationships

• Extreme behavior such as overly demanding, aggressive, having outburts, or becoming passive. 

Financial or material abuse

• Theft of money or possessions

• Fraud, scamming

• Preventing a person from accessing their own money, benefits or assets

• Employees taking a loan from a person using the service

• Undue pressure, duress, threat or undue influence put on the person in connection with loans, wills, property, inheritance or financial transactions

• Arranging less care than is needed to save money to maximise inheritance

• Denying assistance to manage/monitor financial affairs

• Denying assistance to access benefits

• Misuse of personal allowance in a care home

• Misuse of benefits or direct payments  in a family home

• Someone moving into a person’s home and living rent free without agreement or under duress

• False representation, using another person’s bank account, cards or documents

• Exploitation of a person’s money or assets, e.g. unauthorised use of a car

• Misuse of a power of attorney, deputy, appointeeship or other legal authority

• Rogue trading – e.g. unnecessary or overpriced property repairs and failure to carry out agreed repairs or poor workmanship

Signs and indicators: 

• Missing personal possessions

• Unexplained lack of money or inability to maintain lifestyle

• Unexplained withdrawal of funds from accounts

• Power of attorney or lasting power of attorney (LPA) being obtained after the person has ceased to have mental capacity

• Failure to register an LPA after the person has ceased to have mental capacity to manage their finances, so that it appears that they are continuing to do so

• The person allocated to manage financial affairs is evasive or uncooperative

• The family or others show unusual interest in the assets of the person

• Signs of financial hardship in cases where the person’s financial affairs are being managed by a court appointed deputy, attorney or LPA

• Recent changes in deeds or title to property

• Rent arrears and eviction notices

• A lack of clear financial accounts held by a care home or service

• Failure to provide receipts for shopping or other financial transactions carried out on behalf of the person

• Disparity between the person’s living conditions and their financial resources, e.g. insufficient food in the house

• Unnecessary property repairs

Modern slavery or Trafficking

• Human trafficking

• Forced labour

• Domestic servitude

• Sexual exploitation, such as escort work, prostitution and pornography

• Debt bondage – being forced to work to pay off debts that realistically they never will be able to

Signs and indicators: 

• Signs of physical or emotional abuse

• Appearing to be malnourished, unkempt or withdrawn

• Isolation from the community, seeming under the control or influence of others

• Living in dirty, cramped or overcrowded accommodation and or living and working at the same address

• Lack of personal effects or identification documents

• Always wearing the same clothes

• Avoidance of eye contact, appearing frightened or hesitant to talk to strangers

• Fear of law enforcers

Organisational or institutional abuse

• Discouraging visits or the involvement of relatives or friends

• Run-down or overcrowded establishment

• Authoritarian management or rigid regimes

• Lack of leadership and supervision

• Insufficient staff or high turnover resulting in poor quality care

• Abusive and disrespectful attitudes towards people using the service

• Inappropriate use of restraints

• Lack of respect for dignity and privacy

• Failure to manage residents with abusive behaviour

• Not providing adequate food and drink, or assistance with eating

• Not offering choice or promoting independence

• Misuse of medication

• Failure to provide care with dentures, spectacles or hearing aids

• Not taking account of individuals’ cultural, religious or ethnic needs

• Failure to respond to abuse appropriately

• Interference with personal correspondence or communication

• Failure to respond to complaints

Signs and indicators: 

• Lack of flexibility and choice for people using the service

• Inadequate staffing levels

• People being hungry or dehydrated

• Poor standards of care

• Lack of personal clothing and possessions and communal use of personal items

• Lack of adequate procedures

• Poor record-keeping and missing documents

• Absence of visitors

• Few social, recreational and educational activities

• Public discussion of personal matters

• Unnecessary exposure during bathing or using the toilet

• Absence of individual care plans

• Lack of management overview and support

Neglect and acts of omission

• Failure to provide or allow access to food, shelter, clothing, heating, stimulation and activity, personal or medical care

• Providing care in a way that the person dislikes

• Failure to administer medication as prescribed

• Refusal of access to visitors

• Not taking account of individuals’ cultural, religious or ethnic needs

• Not taking account of educational, social and recreational needs

• Ignoring or isolating the person

• Preventing the person from making their own decisions

• Preventing access to glasses, hearing aids, dentures, etc.

• Failure to ensure privacy and dignity

Signs and indicators: 

• Poor environment – dirty or unhygienic

• Poor physical condition and/or personal hygiene

• Pressure sores or ulcers

• Malnutrition or unexplained weight loss

• Untreated injuries and medical problems

• Inconsistent or reluctant contact with medical and social care organizations

• Accumulation of untaken medication

• Uncharacteristic failure to engage in social interaction

• Inappropriate or inadequate clothing