Abuse: what it is, recognising it and categories of abuse

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Signed: October 2026
To be reviewed: October 2027

What is abuse?

Abuse is a violation of a person’s human and civil rights by any other person(s). Abuse now also includes self-neglect (see categories below). Abuse is varied and it is open to interpretation, but could:

Consist of a single act or repeated acts
Be an act of neglect or an omission to act
Be intentional or unintentional and can result from lack of knowledge
Occur when an adult with care and support needs is persuaded to enter into a financial arrangement or sexual relationship to which they have not, or could not have, consented

Some forms of abuse may also be a crime. Exploitation may be a common theme in the experience of abuse. Abuse can take place anywhere, and BDEF will work to prevent abuse of adults at risk both within and outside its own services and premises.

It is important to look beyond single incidents to identify patterns of harm. Repeated incidents of poor care may indicate institutional abuse

All abuse must be reported; it is not up to a staff member to decide if something is abusive.

Recognising signs of abuse

All staff have a key role in recognising any welfare concern they have about anyone who uses a service they work with, including suspected abuse. The quality of relationships staff develop with service users is vital in helping to understand unexplained changes in behaviour and/or personality. Small as well as more obvious unexplained changes may indicate a cause for concern.

Effective safeguarding means that all welfare concerns need to be taken seriously. If staff have any concerns about a persons’ welfare, they should act on them immediately by recording and reporting to the DSL. Suspected abuse is extremely serious and should always be reported to the DSL on the same day that it is noted.

Staff are not responsible for diagnosing or investigating abuse. However, they do have a clear responsibility to be aware that all is not well with someone who uses a service and to be able to recognise the signs of abuse (concerns arising from the appearance and the behaviour of the adult at risk and/or the abuser).

Not all concerns about service users relate to abuse; there may well be other explanations or other welfare concerns that do not meet safeguarding thresholds. It is important that staff keep an open mind and treat every concern with the utmost seriousness. They should never assume that someone else will take action.

Although some signs do not necessarily indicate that abuse is actually taking place, they may help staff and volunteers recognise that something is wrong. The possibility of abuse should be reported if there are a number of these signs or any of them to a marked degree.

Many of the indicators listed below are generic ones that social workers and others work with. However, it is important to consider them within a Disability Equality framework. Many Disabled people may seem to have some of these indicators, but they may actually relate to their impairment e.g. bruising or falling may be due to a particular physical condition.

In addition, some of the listed indicators like isolation, low self-esteem etc. may arise from disabling barriers people face. Therefore, every situation should be considered individually with a good knowledge of the person and their circumstances, involving them in all discussions so they can explain their situation.

Categories and indicators of abuse

Physical abuse

This includes assault, hitting, slapping, pushing, misuse of medication, force feeding, poor manual handling, deprivation of liberty, restraint or inappropriate physical sanctions. Possible indicators of physical abuse include:

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 GP

Domestic Abuse (DA)

DA (formerly called Domestic Violence) is the abuse of one person over another who is, or has been, in a relationship. The abuse may be verbal, sexual, physical, emotional or financial, and is usually, but not exclusively, perpetrated by men against women. It occurs in all groups and sections of society and may be experienced differently to, and compounded by racism, sexuality, disability, age, religion, culture or class. The current government definition (Domestic Abuse Act 2021) describes DA as:

‘Any behaviour between two people aged 16 or over who are ‘personally connected’ to each other, where the behaviour is abusive.’

Domestic Abuse also includes so called ‘honour-based violence’ and forced marriage. If there are concerns that an adult at risk (male, female or gender diverse) is in danger of being forced into a marriage they do not or cannot consent to, staff should report to the DSL on the same day the concern is noted.

The DSL must always notify the Police in such cases where it is agreed there is a substantive risk as urgent action must always be taken. All those involved should bear in mind that mediation as a response to forced marriage can be extremely dangerous. Refusal to go through with a forced marriage has, in the past, been linked to so-called ‘honour-based violence’ including murder, rape and serious physical and emotional abuse.

Coercive or controlling behaviour is often a core part of Domestic Abuse. Coercive behaviour 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 their behaviour

Possible indicators of Domestic Violence or Abuse include:

Low self-esteem
Low self-esteem
Feeling that the abuse is their fault
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
Victim tries to hide injuries, or minimises their extent or cause, appears frightened, overly anxious or depressed and/or is submissive or afraid to speak in front of the partner;
Partner always attends unnecessarily and may refuse to leave, and/or may be aggressive or dominant

If BDEF has serious concerns about a victim’s situation, they should refer the case to the local Independent Domestic Violence Advisor (IDVA) who can refer to the Multi-Agency Risk Assessment Conference (MARAC), or to the Police.

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, sexual abuse through social media (e.g., sexting, inappropriate images) indecent exposure and sexual assault or sexual acts to which the adult has not consented or was pressured into consenting.

This includes exploitative situations, contexts and relationships where the adult receives affection, inclusion or some sort of reward (often food, drugs, alcohol, gifts or money) as a result of performing sexual activities.

Types of sexual abuse include:

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

Possible indicators of sexual abuse include:

Foreign bodies in genital or rectal openings
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
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

Psychological Abuse

This is defined as the persistent emotional maltreatment of a person such as to cause severe and adverse effects on their emotional development. It may involve conveying to a person that they are worthless or unloved, inadequate, or valued only insofar as they meet the needs of another person.

It may include threats of harm or abandonment, rejection, deprivation of contact, humiliation, blaming, controlling, intimidation, coercion, harassment, verbal abuse, cyber bullying, isolation or unreasonable and unjustified withdrawal of services or supportive networks. Some level of emotional abuse is involved in all types of maltreatment of adults at risk, although it may occur alone.

Types of psychological or emotional abuse include:

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

Possible indicators of psychological or emotional abuse include:

An air of silence when a particular person is present
Threats of harm or abandonment
Cyber bullying
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

Financial or material abuse

This includes theft, fraud, telephone and internet scamming, coercion in relation to an adult’s financial affairs or arrangements, including in connection with Wills, property, inheritance or financial transactions, misuse of others benefits, or the misuse or misappropriation of property, possessions or benefits.

Types of financial or material abuse include:

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

Possible indicators of financial or material abuse include:

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 (see also BDEF’s Policy for more detail)

Modern Slavery is a serious crime. It encompasses slavery, servitude, and forced or compulsory labour and human trafficking. Modern slavery victims can often face more than one type of abuse and slavery, for example if they are sold to another trafficker and then forced into another form of exploitation. A person is trafficked if they are brought to (or moved around) a country by others who threaten, frighten, hurt and force them to do work or other things they don’t want to do.

The Universal Declaration of Human Rights 1958, states that: “No one shall be held in slavery or servitude; slavery and the slave trade shall be prohibited in all their forms.” There is a national framework to assist in the identification of victims and referral to services known as the National Referral Mechanism (NRM) and any staff suspecting slavery or trafficking should report to this.

Types of modern slavery include:

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 of trafficking include people who:

Are not in possession of a passport, identification or travel documents;
Act as if instructed or coached by someone else or allow others to speak for them when spoken to directly;
Recruited for one purpose and forced to engage in some other job;
Have transport paid for by facilitators, whom they must pay back through providing services;
Receiving little or no payment for their work - someone else was in control of their earnings;
Forced to perform sexual acts;
Do not have freedom of movement;
Threatened with harm if escapes;
Under the impression they are bonded by debt, or in a situation of dependence;
Harmed or deprived of food, water, sleep, medical care or other life necessities;
Cannot freely contact friends or family; and
Limited social interaction or contact with people outside their immediate environment.

Possible indicators of modern slavery include:

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

There is no typical victim of slavery. Victims can be men, women and children of all ages and cut across the population, but it is normally more prevalent amongst the most vulnerable, minority or socially excluded groups. The Home Office predicts that there may be as many as 13,000 victims in the UK alone. Further Home Office information on identifying and reporting modern slavery can be found at Modern slavery: how to identify and support victims.

Discriminatory Abuse

Discriminatory Abuse occurs when values, beliefs or culture result in a misuse of power that denies opportunity to some groups or individuals. It can feature in an abuse of an adult at risk where the abuse is motivated by the perpetrator’s prejudice towards that adult’s gender, ethnicity, disability, gender identity, age, sexuality, religion, culture, class etc.

Types of discriminatory abuse include:

Unequal treatment based on age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion and belief, sex or sexual orientation (known as ‘protected characteristics’ under the Equality Act 2010
Verbal abuse, derogatory remarks or inappropriate use of language related to a protected characteristic
Denying access to communication aids, not allowing access to an interpreter, signer or lip-reader
Harassment or deliberate exclusion on the grounds of a protected characteristic
Denying basic rights to healthcare, education, employment and criminal justice relating to a protected characteristic
Substandard service provision relating to a protected characteristic

Possible indicators of discriminatory abuse include:

Organisational or Institutional Abuse

This includes neglect and poor care practice within an institution or specific care setting such as a hospital or care home, for example, or in relation to care provided in one’s own home. It may also include policies and procedures This may range from one off incidents to on-going ill-treatment. It can be through neglect or poor professional practice that deny human rights e.g., lack of privacy, dignity, hygiene facilities, misuse of medication, denial of medical care as a result of the structure, policies, processes and practices within an organisation.

Types of organisational or institutional abuse include:

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
Failure to recognise and refer medical needs appropriately
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

Possible indicators of organisational or institutional abuse include:

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

This includes ignoring medical, emotional or physical care needs, failure to provide access to appropriate health, care and support or educational services, the withholding of the necessities of life, such as medication, adequate nutrition and heating.

Types of neglect and acts of omission include:

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

Possible indicators of neglect and acts of omission include:

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 organisations
Accumulation of untaken medication
Uncharacteristic failure to engage in social interaction
Inappropriate or inadequate clothing

Self-neglect

This covers a wide range of behaviour neglecting to care for one’s personal hygiene, health needs or surroundings and includes behaviour such as hoarding.

Types of self-neglect include:

Lack of self-care to an extent that it threatens personal health and safety
Neglecting to care for one’s personal hygiene, health or surroundings
Inability to avoid self-harm
Failure to seek help or access services to meet health and social care needs
Inability or unwillingness to manage one’s personal affairs

Possible indicators of self-neglect include:

Very poor personal hygiene
Unkempt appearance
Lack of essential food, clothing or shelter
Malnutrition and/or dehydration
Living in squalid or unsanitary conditions
Neglecting household maintenance
Hoarding
Collecting a large number of animals in inappropriate conditions
Non-compliance with health or care services
Inability or unwillingness to take medication or treat illness or injury

Female Genital Mutilation (FGM)

FGM is a form of physical abuse against girls and young women. It can have an on-going impact on adult women. However, if a woman over 18 discloses that they have had FGM, this is there is no mandatory reporting requirement. If staff are concerned that a child or young person is at risk of FGM, they must tell the Designated Safeguarding Lead.

FGM is also known as female circumcision or female genital cutting. FGM has no health benefits. It involves removing and damaging healthy and normal female genital tissue and interferes with the natural functions of girls’ and women’s bodies.

The procedure may be carried out when the girl is newborn, during childhood, adolescence, at marriage or during the first pregnancy. However, in the majority of cases FGM takes place between the ages of 5-8 and therefore girls within that age bracket are at a higher risk. It can cause severe bleeding and problems urinating, and later cysts, infections, infertility as well as complications in childbirth. They can also often suffer severe psychological trauma, including flashbacks and depression.

The Female Genital Mutilation Act 2003 made it illegal to: practice FGM in the UK; take girls who are British nationals or permanent residents of the UK abroad for FGM whether or not it is lawful in that country; and aid, abet, counsel or procure the carrying out of FGM abroad. In 2015 the Serious Crime Act came into force and with it new legal powers to deal with FGM.

Anyone who fears that someone is at risk of FGM can apply to a family court for a FGM Protection Order. This includes people who think they could be victims themselves or are already victims, local authorities, teachers, doctors, social workers or other third parties. FGMPOs will help to safeguard girls who are at risk of FGM at home or abroad. If the court makes a FGMPO, the specific conditions could include confiscating passports or travel documents to prevent girls from being taken abroad or stopping someone from bringing a 'cutter' to the UK for the purposes of committing FGM on a girl.

Hate crime

This is a form of discriminatory abuse although it often also includes other abuse such as physical or psychological. It is a criminal offence committed against a person or their property that is motivated by hostility to their protected characteristics (listed below). Hate crime includes lack of respect, exclusion from services, swearing and name-calling, treating someone less favourably due to their protected characteristics.

The characteristics that are protected by the Equality Act 2010 are:

Age
Disability
Gender reassignment
Marriage or civil partnership (in employment only)
Pregnancy and maternity
Race
Religion or belief
Sex
Sexual orientation

Violence Against Women and Girls (VAWG)

This form of abuse covers a range of unacceptable and deeply distressing crimes, many of which are listed above such as domestic violence and abuse, sexual violence and child sexual abuse, stalking, so called ‘honour-based’ violence - including forced marriage and female genital mutilation (FGM), gang related violence, and human trafficking. We recognise that these crimes are disproportionately gendered.

Violence can affect women and girls regardless of their age, race or religion, their socioeconomic background, sexual orientation or marital status. Violence takes place in every locality across the UK and can happen in relationships, in families, and in communities. We will work to ensure that awareness of VAWG is raised within our organisation and work with multi-agency approaches effectively to understand and meet the support needs of victims, survivors and family members, through recovery and on to sustainable, positive life outcomes.

Mate crime

There is an increasing awareness that adults at risk may be targeted by people who they consider to be friends. This may be a particular issue if someone is disabled and has difficulty in understanding the nature of the relationship or recognising abuse, or if there are cultural differences and misunderstandings. Adults at risk may be targeted by people who befriend them in order to abuse them financially or in other ways.

Possible indicators of mate crime include:

An adult at risk suddenly appears to have a new friend or a much larger friendship group and a more active social life. These new people seem to have an undue influence. They may be visiting the adult at risk at home for social gatherings.

The adult at risk comments that his or her friends will be disappointed if a certain activity doesn't take place. They may express worry that they'll lose their friends. They may appear uneasy about the friendship.

The adult at risk may be spending their own money to pay for concert tickets for others or taxi fares or rounds of drinks. They may be buying gifts for other people or giving away precious possessions. They may suddenly change their will.

The adult at risk may unexpectedly change their routine, behaviour or appearance. They may have unexplained injuries, look scruffy or dirty or show signs of mental ill health.

Please note that historical abuse does not come under the Care Act 2014. However, action may still need to be taken via liaison with the appropriate agencies such as Children and Young Peoples Services and the police to protect future victims.

Further detailed information about possible indicators of abuse is available from Bristol Safeguarding.

Cuckooing

The Crime and Policing Act 2026 made cuckooing an explicit illegal offence. This is when a ‘person or group exercises control over another’s dwelling, without their valid consent, for the purposes of using that property to commit or facilitate illegal activities’. It is often adults at risk who are vulnerable (maybe people with learning difficulties or mental health issues) who are ‘cuckooed’ and then get embroiled in illegal activity without informed consent.