What are the signs of abuse
Types and Signs of Abuse
It has been estimated that roughly two-thirds of those harming a vulnerable adult are family members, most often the victim’s adult child or spouse. Research has shown that in most instances the abuser is financially dependent on the vulnerable adult’s resources and have problems related to alcohol and drugs.
Stay alert to the different types of abuse
The word abuse covers many different ways someone may harm a vulnerable adult.
Physical abuse is intentional bodily injury. Some examples include slapping, pinching, choking, kicking, shoving, or inappropriately using drugs or physical restraints. Signs of physical abuse.
Sexual abuse is nonconsensual sexual contact (any unwanted sexual contact). Examples include unwanted touching, rape, sodomy, coerced nudity, sexual explicit photographing. Signs of sexual abuse.
Mental mistreatment or emotional abuse is deliberately causing mental or emotional pain. Examples include intimidation, coercion, ridiculing, harassment, treating an adult like a child, isolating an adult from family, friends, or regular activity, use of silence to control behavior, and yelling or swearing which results in mental distress. Signs of emotional abuse.
Exploitation occurs when a vulnerable adult or his/her resources or income are illegally or improperly used for another person's profit or gain. Examples include illegally withdrawing money out of another person’s account, forging checks, or stealing things out of the vulnerably adult’s house. Signs of exploitation.
Neglect occurs when a person, either through his/her action or inaction, deprives a vulnerable adult of the care necessary to maintain the vulnerable adult’s physical or mental health. Examples include not providing basic items such as food, water, clothing, a safe place to live, medicine, or health care.
Signs of neglect.
Self-neglect occurs when a vulnerable adult fails to provide adequately for themselves and jeopardizes his/her well-being. Examples include a vulnerable adult living in hazardous, unsafe, or unsanitary living conditions or not having enough food or water. Signs of self-neglect.
Abandonment occurs when a vulnerable adult is left without the ability to obtain necessary food, clothing, shelter or health care. Examples include deserting a vulnerable adult in a public place or leaving a vulnerable adult at home without the means of getting basic life necessities.Signs of abandonment.
Signs of physical abuse
- bruises, black eyes, welts, lacerations, and rope marks
- broken bones
- open wounds, cuts, punctures, untreated injuries in various stages of healing
- broken eyeglasses/frames, or any physical signs of being punished or restrained
- laboratory findings of either an overdose or under dose medications
- individual's report being hit, slapped, kicked, or mistreated
- vulnerable adult's sudden change in behavior
- the caregiver's refusal to allow visitors to see a vulnerable adult alone
Signs of sexual abuse
- bruises around the breasts or genital area
- unexplained venereal disease or genital infections
- unexplained vaginal or anal bleeding
- torn, stained, or bloody underclothing
- an individual's report of being sexually assaulted or raped
Signs of mental mistreatment/emotional abuse
- being emotionally upset or agitated
- being extremely withdrawn and non communicative or non responsive
- unusual behavior usually attributed to dementia (e.
g., sucking, biting, rocking) - nervousness around certain people
- an individual's report of being verbally or mentally mistreated
Signs of neglect
- dehydration, malnutrition, untreated bed sores and poor personal hygiene
- unattended or untreated health problems
- hazardous or unsafe living condition (e.g., improper wiring, no heat or running water)
- unsanitary and unclean living conditions (e.g., dirt, fleas, lice on person, soiled bedding, fecal/urine smell, inadequate clothing)
- an individual's report of being mistreated
Signs of self-neglect
- dehydration, malnutrition, untreated or improperly attended medical conditions, and poor personal hygiene
- hazardous or unsafe living conditions
- unsanitary or unclean living quarters (e.g., animal/insect infestation, no functioning toilet, fecal or urine smell)
- inappropriate and/or inadequate clothing, lack of the necessary medical aids
- grossly inadequate housing or homelessness
- inadequate medical care, not taking prescribed medications properly
Signs of exploitation
- sudden changes in bank account or banking practice, including an unexplained withdrawal of large sums of money
- adding additional names on bank signature cards
- unauthorized withdrawal of funds using an ATM card
- abrupt changes in a will or other financial documents
- unexplained disappearance of funds or valuable possessions
- bills unpaid despite the money being available to pay them
- forging a signature on financial transactions or for the titles of possessions
- sudden appearance of previously uninvolved relatives claiming rights to a vulnerable adult’s possessions
- unexplained sudden transfer of assets to a family member or someone outside the family
- providing services that are not necessary
- individual's report of exploitation
Signs of abandonment
- deserting a vulnerable adult in a public place
- deserting a vulnerable adult in his/her own home or living space
- individual's report of being abandoned
Signs & Symptoms | Child Abuse
- infants excessive crying or developmental delay
- fear, anxiety, clinging
- phobias
- nightmares, sleeping problems
- bed wetting
- social withdrawal
- hyperactivity
- poor concentration/distractibility
- decreased school performance
- chronic school absenteeism
- speech disorders
- regressive behavior for age
- seems afraid of parent
- eating issues
- depression, passivity
- increased verbal abuse or physically aggressive behavior with others
- destroys or injures objects or pets
- substance abuse
- self-harm such as cutting
- sexualized behavior
- symptoms of PTSD
- avoidance of undressing
- withdrawal to touch, afraid of exam
- overly compliant, especially with difficult or painful parts of the exam
- headaches
- abdominal pain, chronic
- abdominal pain, acute – blunt trauma may not show external marks – look for distention, tenderness, absent bowel sounds
- vague somatic complaints, often chronic
- worsening medical problems, such as asthma
- frequent, unexplained sore throat
- abnormal weight gain or loss
- reluctance to use an extremity
- difficulty walking or sitting
- genital discomfort or painful urination or defecation
- unexplained symptoms - look for poisoning, forced ingestion of water, salt (Munchausen by proxy)
- vomiting, irritability or abnormal respiration may represent head trauma
- poor hygiene
- dressed inappropriately for weather
- failure to thrive, poor weight gain, malnutrition
- lack of care of medical needs; wound care, medication
- see fractures
- dislocations
- see bruising
- defensive injuries on forearms
- bites - human bites are more superficial than animal, and show up better 2-3 days later
- burns – (in 6-20% of abused children) cigarette, rope, immersion, or shape of hot object
- is the severity of the burn consistent with length of contact by history?
- cigarette burns circular, 8-10mm deep, heaped margin - may be confused with impetigo or moxibustion
- stun gun burns occur in pairs, 0.
5cm diameter and 5cm apart - immersion burns have sharp line of demarcation without drip or splash marks
- signs of restraints on axilla or extremities
- trauma to ear
- lacerations
- traumatic hair loss
- facial injuries without good explanation
- oral/dental injuries, such as torn or bruised frenulum, lips, teeth, palate, tongue or oral mucosa
- injuries from non-ambulatory child may be "bottle jamming"
- lacerations or tissue damage to oral structures may come from eating utensils, scalding or caustic liquids
- scarring/bruising at corners of mouth from being gagged
- oral injuries/STDs from forced oral sex
- head injury, mental status change
- retinal hemorrhage
- subdural hematoma
- intra-abdominal trauma, usually to multiple organs
- bruising, tearing, bleeding, discharge from genital or rectal area
- diagnosed STD or pregnancy
[Adapted from multiple sources listed in Resources and References]
Warning!
Parents may seem evasive or inconsistent in their story due to language or cultural differences, or to being embarrassed or afraid relating to some other issue.
Cultural/language difficulties may also lead to delayed care.
What are age-appropriate normal sexual behaviors?
Children may be injured by domestic violence via:
- being too small to get out of the way
- trying to intervene
- becoming an object of abuse
- being neglected by the abused parent, who may be focused on their own fear or depression
Red flags with injuries:
- explanation doesn’t fit the injury as to pattern, timing, or developmental ability of child
- explanation keeps changing
- child is consistently blamed as cause of repeated injuries
- significant injuries attributed to a young sibling
- delay in seeking medical care
- history of multiple ED visits
- frequent change of primary care provider
Parental risk factors:
- rigid, severe discipline
- strongly responds to negative behaviors, ignores child's positive behaviors
- ridicules child in public
- isolates child socially or from other family members
- seems overprotective or jealous
- unrealistic expectations of child development or behavior for age
- parent is caregiver for child with significant cognitive, physical or emotional disabilities
- child unwanted, unplanned
- lack of emotional interaction with child
- inappropriate over or under concern about injury
- partial confession
- depression
- difficulty controlling emotions, esp.
anger - substance abuse
- teen parenthood
- family stress such as divorce, job loss
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