Signs of Abuse in Adults

When most people hear the term “abuse” in adults, they tend to think of either physical or sexual abuse. But abuse can take many forms and although some are less well known they are nevertheless just as serious.

Some of the most common forms of abuse in adults include:

• Physical Abuse.
• Sexual Abuse.
• Domestic Abuse.
• Emotional Abuse and Psychological Abuse.
• Neglect.
• Self-neglect.
• Financial or Material Abuse.
• Modern Slavery.
• Organisational Abuse.
• Discriminatory Abuse.

Abuse is when someone does or says something which causes harm. It can happen to anyone, at any age, in any culture, no matter what their gender, income or religion. It can be a single one-off act or something that happens over weeks, months or even years. It can be accidental or deliberate. No-one has the right to abuse others; it is always unacceptable and, in many cases, a crime.

Some statistics for adult abuse in the UK

According to the Crime Survey for England and Wales (CSEW) year ending March 2020, an estimated 5.5% of adults aged 16 to 74 years, that is 2.3 million people, experienced domestic abuse in the last year. Indicators from a range of data sources show an increase in offences flagged as domestic abuse-related during the coronavirus (COVID-19) pandemic, although final figures are not yet available. The national charity Women’s Aid report that 46.2% of women in refuges had spent between two and 10 years in the abusive relationship and that 17% of women had endured a violent relationship for more than 10 years.

Most sexual abuse isn’t reported, detected or prosecuted, however, the Office for National Statistics (ONS) estimates suggest that overall, 0.1% of men and 0.8% of women aged over 16 were victims of these crimes in the year to March 2020. More than four in ten, 44%, were victimised by their partner or ex-partner.

In the UK, 8.7 million people, that is 16% of adults, say that they have experienced economic/financial abuse, with 85% of those people also experiencing other forms of domestic abuse including physical, sexual and emotional abuse according to a 2020 report by Refuge.

In the year to March 2020, there were 7,779 modern slavery crimes recorded by the police, a 59% increase from 4,897 in the year to March 2019. The force recording most modern slavery crimes was the Metropolitan Police, accounting for 30%, 2,334, of all crimes.

Statistics for other forms of adult abuse are much harder to ascertain primarily due to the often hidden nature of these abuses and crimes.

What are the signs of abuse in adults?

Abuse and neglect can happen in a variety of circumstances and can be defined in many different ways; there can be no exhaustive list of the signs to look out for. Here are some of the most common signs to be aware of.

Physical abuse

The most visible form of abuse by far is physical abuse. The most common forms of this abuse include hitting, slapping, kicking, throwing things, scalding and even suffocation. Much of this abuse goes unnoticed or unreported.

Signs of physical abuse might include:

• Unexplained or inappropriately explained injuries including:
  – Cuts or scratches to mouth, lips, gums, eyes or external genitalia.
  – Bruising to the face, torso, arms, back, buttocks, thighs, in various stages of healing.
  – Collections of bruises that form regular patterns which correspond to the shape of an object or which appear on several areas of the body.
  – Burns on unlikely areas of the body, e.g. soles of the feet, palms of the hands, back, immersion burns from scalding in hot water/liquid, rope burns, burns from an electrical appliance.
  – Fractures at various stages of healing to any part of the body.
• Exhibiting untypical self-harm.
• Medical problems that go unattended.
• Evidence of over/under-medication.
• Flinching at physical contact.
• Appearing frightened or subdued in the presence of particular people.
• Asking not to be hurt or repeating what the person causing harm has said such as – “Shut up or I’ll hit you”.
• Reluctance to undress or uncover parts of the body or wearing clothes that cover all parts of their body or specific parts of their body.

Violence and physical abuse can cause long-term physical and mental health problems. It affects not just the “victim” involved but can also affect any children, the family, and even the wider community through such things as inability to work, additional use of the NHS and homelessness.

Sexual abuse

This includes rape, indecent exposure, sexual harassment, inappropriate looking or touching, sexual teasing or innuendo, sexual photography, subjection to pornography or witnessing sexual acts, indecent exposure and sexual assault or sexual acts to which the adult has not consented or was pressured into consenting.

Denial of a sexual life to consenting adults is also considered abusive practice as is any sexual relationship that develops between adults where one is in a position of trust, power or authority in relation to the other by, for example, a teacher or tutor, social, residential, care or health worker etc.

Sexual exploitation

The sexual exploitation of adults with care and support needs involves exploitative situations, contexts and relationships where adults with care and support needs or a third person or persons, receive “something”, for example food, accommodation, drugs, alcohol, cigarettes, affection, gifts, money as a result of performing sexual activities, and/or others performing sexual activities on them.

Sexual exploitation can occur through the use of technology without the person’s immediate recognition. This can include being persuaded to post sexual images or videos on the internet or a mobile phone with no immediate payment or gain, or being sent such an image by the person alleged to be causing harm. In all cases those exploiting the adult have power over them by virtue of their age, gender, intellect, physical strength, and/or economic or other resources.

Signs of either abuse or exploitation might include:

• Depression.
• Withdrawal from regular activities, unusually subdued, or poor concentration.
• Unexplained fear or anxiety.
• Urinary tract infections, vaginal infections or sexually transmitted diseases that are not otherwise explained.
• Experiencing pain, itching or bleeding in the genital/anal area.
• Exhibiting significant changes in sexual behaviour or outlook.
• Torn, stained or bloody clothing and/or underclothing.
• A woman who lacks the mental capacity to consent to sexual intercourse becomes pregnant.

Sexual abuse in adulthood is a traumatic experience, and it can have a tremendous negative impact on the survivor. These impacts may be felt immediately by some survivors, while in others it may manifest months or years later. For some survivors, the impact of sexual abuse may be short-lived while, for others, it could stay with them for the rest of their lives. Typically, sexual abuse affects adults on three levels: the impact on their physical and sexual health; the psychological impact the abuse leaves behind; and the social and relational impact on the individual.

Domestic abuse

The Home Office definition of domestic abuse is an incident or pattern of incidents of controlling, coercive or threatening behaviour, violence or abuse by someone who is or has been an intimate partner or family member regardless of gender or sexuality. This includes psychological, physical, sexual, financial, emotional abuse; so-called ‘honour-based’ violence; female genital mutilation; and forced marriage. The term Domestic Abuse is applied at age 16 years; under 16 years it is Child Abuse.

Family members are defined as:

• Mother.
• Father.
• Son.
• Daughter.
• Brother.
• Sister.
• Grandparents.
• In-laws.
• Step-family.

Signs of domestic abuse might include:

• Physical injuries (as described above in physical abuse).
• Making excuses for frequent injuries.
• Stress, anxiety or depression.
• Absence from work and/or social occasions.
• Personality changes such as being jumpy or nervous.
• Low self-esteem.
• Lack of self-respect or self-worth.
• Lack of independent communication.
• Self-blame.
• Increased alcohol or drug use.
• Lack of money.
• Damage to property.

Domestic and family violence tears lives apart. Violence and the threat of violence at home create fear and can destroy family environments and lead to the break-up of families. Emotional and psychological trauma can have a devastating impact on an individual’s physical, mental and emotional health including depression, shame, anger and suicide.

Emotional and psychological Abuse

Emotional and psychological abuse may not leave physical marks, but they can be just as destructive as physical abuse. Like physical abuse, they are primarily a means of control and a way for the abuser to feel superior. They are also more insidious because emotional and psychological abusers are evasive and often make you believe you are at fault. Distinguishing emotional abuse from psychological abuse is tricky because emotions generally fall under the umbrella of psychology.

However, some people find it useful to separate the two:

Psychological abuse is typically characterised by distorting someone’s sense of reality; this is also called gaslighting. The goal of the psychological abuser is to convince the victim that they are crazy or incompetent. A psychological abuser will distort facts with the intent of undermining their confidence and making them more pliable.

Emotional abuse is more wide-ranging and, some would say, encompasses psychological abuse. Emotional abusers aim to manipulate other people by undermining their self-esteem or resorting to coercive behaviours. Emotional abusers may be prone to shouting or name-calling. They may behave in a disparaging or patronising way to make you feel stupid or incompetent. They may withhold affection until they get their way. Some may go so far as to control the money or hold your things hostage so you will do what they want. They may invade your privacy by going through your things or reading your mail, email or text messages. The abuser often confines a person or isolates them by preventing them from having visits from family and friends or by denying them the chance to attend doctor or other personal care appointments.

Bullying, both in person and via social networking internet sites is a form of emotional and psychological abuse.

Signs of emotional and psychological abuse might include:

• Change in appetite.
• Low self-esteem.
• Deference.
• Passivity and resignation.
• Unexplained fear.
• Defensiveness.
• Ambivalence.
• Emotional withdrawal.
• Sleep disturbance.
• Self-harming behaviours.

People who suffer emotional and/or psychological abuse might at first be in denial. It can be shocking to find yourself in such a situation and it is natural to hope you are wrong. Severe emotional and/or psychological abuse can be as powerful as physical abuse and over time, both can contribute to low self-esteem and depression. Some researchers surmise that emotional and/or psychological abuse may contribute to the development of conditions such as post-traumatic stress disorder (PTSD), chronic fatigue syndrome and fibromyalgia.

Neglect

This is caused by an adult, supervisor or caregiver failing to provide food, proper health or sanitary care, clothing or sufficient care. This is a common form of abuse of older people.

Signs of neglect might include:

• Unexplained weight loss or malnutrition.
• Untreated medical problems.
• Bed sores.
• Confusion.
• Over-sedation.
• Poor personal hygiene.
• Deprivation of meals which may constitute “wilful neglect”.

The effects of neglect are often a fast deterioration in the victim’s physical and mental health.

Self-neglect

This form of self-abuse is growing and is challenging to treat and manage. This covers a wide range of neglecting behaviours from care for one’s personal hygiene, health or surroundings and includes behaviour such as hoarding. A decision on whether a response is required under safeguarding will depend on the adult’s ability to protect themselves (mental capacity) by controlling their own behaviour. There may come a point when they are no longer able to do this, without external support.

Signs of self-neglect might include:

• Poor personal hygiene.
• Poor domestic hygiene.
• Disregard to personal health issues.
• Hoarding.
• Obsessional behaviour.

For many people, self-neglect becomes a lifestyle choice and careful attention is needed to avoid long-term harm.

Financial or material abuse

This form of abuse is rarely spoken about and financial and material abuse has similarities to identity theft. There are cases where a person’s bank cards have been abused when details are entrusted to a caregiver, but there are also cases where entire estates have been lost via a power of attorney.

The elderly are often the main victims of this kind of abuse, but that is not to say younger people are not equally vulnerable. It often takes place where there is an unequal balance of power. Other examples include internet scamming, coercion in relation to an adult’s financial affairs or arrangements, including in connection with wills, property, inheritance or financial transactions, or the misuse or misappropriation of property, possessions or benefits.

Signs of financial or material abuse might include:

• Unexplained withdrawals from the bank.
• Unusual activity in the bank accounts.
• Unpaid bills.
• Unexplained shortage of money.
• Unexplained or sudden changes to Wills.
• The person with responsibility for the funds is reluctant to provide basic food and clothes etc. or is evasive or non-responsive.
• Loss of personal items such as jewellery.
• Unusual interest shown by family or others in the person’s assets.
• Purchase of items that the person does not require or use.

In the short term the victim of financial or material abuse may have the stress of paying bills and not having adequate means to pay, incurring interest and fees on charges, and creating a spiral of debt. In the longer term this will impact on their credit score, savings, and in turn their ability to access alternative safe accommodation. The emotional impact of this type of abuse should not be overlooked: feelings of disempowerment, financial pressures, loss of trust in people and loss of faith in their own judgement.

Modern slavery

This includes slavery, human trafficking, forced and compulsory labour and domestic servitude. Traffickers and slave masters use whatever means they have at their disposal to coerce, deceive and force individuals into a life of abuse, servitude and inhumane treatment.

Whilst usually associated with organised crime groups, modern slavery is also committed by individual opportunistic perpetrators and even family members. Signs of various types of slavery and exploitation are often hidden, making it hard to recognise potential victims.

Signs of modern slavery might include:

• Not being in possession of legal documents such as passport, identification and bank account details as they are being held by someone else.
• Old or serious untreated injuries, and they are vague, reluctant or inconsistent in explaining how the injury occurred.
• Looking malnourished, unkempt, or appearing withdrawn.
• Owning few personal possessions and often wearing the same clothes and what clothes they do wear may not be suitable for their work.
• Being withdrawn or appearing frightened, unable to answer questions directed at them or speak for themselves and/or an accompanying third party speaks for them. If they do speak, they are inconsistent in the information they provide, including basic facts such as the address where they live.
• Appearing under the control or influence of others, rarely interacting, or appearing unfamiliar with their neighbourhood or where they work.
• Unable to speak English.
• Fearful of authorities.
• Perceiving themselves to be in debt to someone else or in a situation of dependence.

Modern slavery takes various forms and affects people of all ages, gender and races. The emotional scars of modern slavery run very deep, with many survivors suffering from ongoing feelings of being dehumanised, depression and anxiety.

Organisational abuse

Abuse of power in care homes, hospitals and a variety of other institutions often comes from those entrusted most to provide care. It can stem from inflexible and non-negotiable policies, systems and routines that override the needs of those they are created to help, or they are let down by the people that are there to care for them.

When an institution compels individuals to sacrifice their preferred lifestyle and cultural diversity to the needs of that institution, by for example, requiring everyone to eat together at specified times, limiting bathing to times to suit staff, not providing doors on toilets, the institution could be abusing its power over individuals.

 Signs of organisational abuse might include:

• Lack of respect shown to individuals.
• Lack of adequate physical care, an unkempt appearance.
• Sensory deprivation, for example denial of use of spectacles or hearing aids.
• Denial of visitors or phone calls.
• Restricted access to toilet or bathing facilities.
• Restricted access to appropriate medical or social care.
• Failure to ensure appropriate privacy or personal dignity.
• Lack of flexibility and choice, for example mealtimes and bedtimes, choice of food.
• Lack of personal clothing or possessions.

Organisational abuse violates the person’s dignity and represents a lack of respect for their human rights. The emotional distress that organisational abuse can cause has an effect on a person’s mental and physical wellbeing, which often goes into decline.

Discriminatory abuse

This form of abuse can be experienced as violence, harassment, insults or similar actions due to race, religion, gender, gender identity, age, disability and sexual orientation (protected characteristics), and is often referred to as a “hate crime”.

Discriminatory abuse can also link into all other forms of abuse when values, beliefs or culture result in a misuse of power or denial of mainstream opportunities to some groups or individuals because of their protected characteristics. Excluding a person from activities or services on the basis they are “not liked” is also discriminatory abuse.

As a result the signs of discriminatory abuse might be associated to acts of other forms of abuse listed above, but may also include:

• Signs of a sub-standard service offered to an individual.
• Deliberate exclusion from rights afforded to others.
• Rules or arrangements in place that apply to everyone, but that put someone with a protected characteristic at an unfair disadvantage.
• Unequal treatment.
• Inappropriate use of language.
• Lack of respect.
• Verbal abuse.
• Slurs.
• Bullying and harassment.

People become marginalised by discriminatory abuse, and the mental and physical effects of discrimination are vast. Individuals may begin to suffer from anxiety or depression because of their treatment. Others may even reject their own cultural background and/or racial origin or other personal beliefs, sexual practices or lifestyle choices in order to “fit in”.

In conclusion

Abuse is a violation of an individual’s human and civil rights by any other person or persons and, as we have seen, abuse can take many forms. If you suspect someone to be at risk of or suffering from harm or abuse you can ask for help and advice from, for example:

• NHS 111.
• Hourglass charity focused on the abuse and neglect of older people, telephone 0808 808 8141.
• Citizen’s Advice.
• Victim Support telephone 0808 1689 111.
• The Police 999.