York Safeguarding Adults Board
Types of Abuse and Possible Indicators of Abuse

What Constitutes Abuse?
‘Abuse is a violation of an individual’s human and civil rights by any other person or persons’ [No Secrets DH 2000]
Abuse may consist of a single act or repeated acts. It may be physical, verbal or psychological, it may be an act of neglect or an omission to act, or it may happen when a vulnerable person is persuaded to enter into a financial or sexual transaction to which he or she has not consented, or cannot consent.
Abuse can happen in any relationship and may result in significant harm to, or exploitation of, the person subjected to it. For information about assessing significant harm,
An accepted definition of significant harm is:
"…ill-treatment (including sexual abuse and forms of ill treatment that are not physical); the impairment of, or an avoidable deterioration in, physical or mental health; and the impairment of physical, emotional, social or behavioural development". [Law Commission 1995]
Signs and Indicators of Abuse
Please note that these indicators are a guide only. All situations must be discussed with the appropriate line manager. A full investigation and assessment is required to establish the existence of abuse leading to the significant harm of a vulnerable adult. Typically an abusive situation will involve indicators from a number of groups in combination.
Physical Abuse
Physical injuries which have no satisfactory explanation or where there is a definite knowledge, or a reasonable suspicion that the injury was inflicted with intent, or through lack of care, by the person having custody, charge or care of that person, including hitting, slapping, pushing, misuse of or lack of medication, restraint, or inappropriate sanctions.

Possible Indicators of physical abuse:
• history of unexplained falls or minor injuries
• unexplained bruising – in well protected areas, on the soft parts of the body or clustered as from repeated striking
• unexplained burns in unusual location or of an unusual type
• unexplained fractures to any part of the body that may be at various stages in the healing process
• unexplained lacerations or abrasions
• slap, kick, pinch or finger marks
• injuries/bruises found at different stages of healing or such that it is difficult to suggest an accidental cause
• injury shape similar to an object
• untreated medical problems
• weight loss – due to malnutrition or dehydration; complaints of hunger
• appearing to be over medicated
Psychological Abuse
Psychological, or emotional abuse, includes the use of threats, fears or bribes to negate a vulnerable adult’s choices, independent wishes and self esteem; Cause isolation or over-dependence (as might be signalled by impairment of development or performance) or prevent a vulnerable adult from using services, which would provide help.
Possible Indicators of psychological abuse:
• Ambivalence about carer
• Fearfulness expressed in the eyes; avoids looking at the carer, flinching on approach
• Deference
• Overtly affectionate behaviour to alleged perpetrator
• Insomnia/sleep deprivation or need for excessive sleep
• Change in appetite
• Unusual weight gain/loss
• Tearfulness
• Unexplained paranoia
• Low self-esteem
• Excessive fears
• Confusion
• Agitation

Sexual Abuse
Sexual acts which might be abusive include non-contact abuse such as looking, pornographic photography, indecent exposure, harassment, unwanted teasing or innuendo, or contact such as touching breasts, genitals, or anus, masturbation, penetration or attempted penetration of vagina, anus, mouth with or by penis, fingers or other objects.
Possible Indicators of sexual abuse:
• a change in usual behaviour for no apparent or obvious reason
• sudden onset of confusion, wetting or soiling
• withdrawal, choosing to spend the majority of time alone
• overt sexual behaviour/language by the vulnerable