Types of Abuse

1. Physical Abuse

Physical abuse is arguably the most obvious form of abuse, and the one most people think of regarding abuse. 

It is, however, often hidden and index for suspicion should be low when injuries can not be adequately explained, or the child is dependent (through age or disability). 

Physical abuse injuries may masquerade as innocent injuries, or may be in places that are covered by clothing. Certain types of injury have characteristic patterns. There are also some less well known forms of physical abuse to be aware of. 

Physical abuse includes:

• Hitting (either with hands or an object)
• Shaking
• Throwing
• Poisoning
• Scalding
• Biting
• Immersion in water

Signs of physical abuse:

• Bruises, particularly in non-prominent places such as behind the ears
• Burn marks
• Broken bones
• Bite marks
• Signs/effects due to poison/head injury/immersion in water
• Changes in the abused person such as becoming withdrawn
• Injuries in children that aren't independently mobile

Shaken Baby Syndrome:

• Broken bones
• Visual Disturbances
• Seizures
• Brain Damage
• Death

Fabricated or Induced Illness:

• FII is when a caregiver causes illness in a child or makes up symptoms so that the child receives unnecessary treatment
• Hard to spot

Female Genital Mutilation:

• Usually carried out under the age of 15
• Also known as female circumcision or cutting, and by other terms, such as Sunna, gudniin, halalays, tahur, megrez and khitan
  
• Comprises all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons
• Often done by people with no medical training but in some countries is carried out by medical professionals

References

NSPCC - Physical Abuse

WHO - Female Genital Mutilation

NHS - Female Genital Mutilation

2. Emotional Abuse

Similarly to physical abuse, emotional abuse has many forms and is unfortunately very common. Emotional abuse of a child can be direct, at the child themselves, or indirect, occurring around the child, i.e. Parents verbally abusing each other.

Name Calling: 

• Using derogatory or insulting names.
• Demeaning labels that undermine self-worth.

• Verbal intimidation to instill fear.
• Threats of physical harm or other consequences.

• Raising one’s voice excessively.
• Use of aggressive tone to intimidate.

• Sarcasm and belittling comments.
• Making fun of someone's thoughts, feelings, or behaviours.

• Unrelenting negative feedback.
• Undermining accomplishments and abilities.

• Manipulating someone to question their reality or sanity.
• Denying facts or feelings to create confusion.

• Publicly or privately embarrassing someone.
• Making someone feel worthless or unlovable.

• Invalidating someone’s feelings or experiences.
• Refusing to acknowledge their perspective or emotions.

• Using language to dominate or dictate behavior.
• Telling someone what they can or cannot do.

• Using guilt, fear, or obligation to manipulate.
• Threatening withdrawal of love or support.

NSPCC - What is Emotional Abuse

OSCP- Emotional Abuse

3. Sexual Abuse

Sexual abuse is another major consideration in safeguarding. There are common signs across all subsets of this form of abuse, but some are more specifically found in instances of domestic sexual violence, child sexual exploitation (CSE), or grooming:

General Signs of Sexual Abuse:

• Unexplained injuries or bruises in genital areas
• Sexually transmitted infections (STIs)
• Changes in hygiene or wearing inappropriate clothing
• Withdrawal or sudden changes in behavior
• Increased anxiety, depression, or mood swings
• Inappropriate sexual knowledge or behaviours for age
• Nightmares or difficulty sleeping
• Changes in appetite or eating habits

• Bruises or injuries, particularly in sensitive areas
• Frequent unexplained absences or injuries
• Fearfulness around a partner or excessive vigilance
• Sudden changes in self-esteem or confidence
• Depression or anxiety
• Isolation from friends and family

• Signs of drug or alcohol use
• Frequent absences from school or unexplained reasons for missing
• Engaging in risky behaviours or sexualized behaviour
• Associating with older individuals or groups
• Low self-esteem or feelings of worthlessness
• Displaying fear of certain individuals or situations

• Establishing a close relationship with the victim or their family
• Offering gifts or special attention to the child
• Gradually introducing sexualised talk or behaviours
• Isolating the victim from friends or family
• Making the victim feel guilty or responsible for the abuse
• Using secrecy and threats to maintain control

• Loss of interest in previously enjoyed activities
• Sudden changes in friendships or social circles
• Decline in academic performance or school attendance
• Difficulty concentrating or completing assignments

NSPCC- Sexual Abuse

4. Neglect

Physical Signs:

• Unkempt appearance, body odour, or dirty clothing
• Untreated medical issues or frequent illness
• Sudden weight loss or extreme weight gain
• Signs of dehydration, such as dry skin or sunken eyes
• Lack of basic needs (food, heat, water)
• Hazardous home environment (e.g., clutter, unsanitary conditions)

• Avoidance of social interactions or activities
• Increased signs of anxiety or depression
• Reliance on others for basic care needs
• Difficulty managing daily tasks or routines

• Signs of hopelessness or worthlessness
• Emotional distress over living conditions
• Fear of caregivers or certain environments
• Increased agitation or irritability

• Neglecting bathing, grooming, or dental care
• Wearing dirty or inappropriate clothing for the weather
• Untreated medical conditions or irregular medication management
• Signs of malnutrition or dehydration

• Loss of interest in hobbies, social interactions, or self-care
• Increasing isolation from family and friends
• Difficulty managing daily tasks or responsibilities
• Living in cluttered, unsanitary environments.

• Expressing feelings of sadness, hopelessness, or worthlessness
• Increased feelings of loneliness or despair
• Forgetfulness or confusion regarding basic tasks
• Difficulty making decisions or solving problems

NSPCC- Neglect is also Child Abuse

5. Other

There are other forms of abuse, some less relevant to children but worth knowing about both in the context of Medics & Me, and as future Doctors.

Financial Abuse:

Definition: Financial abuse involves the illegal or improper use of an individual’s funds or resources.

• Sudden changes in financial situation, such as lack of money for basic needs
• Unexplained withdrawals or transfers from accounts
• Unpaid bills or lack of basic necessities despite available funds
• Reluctance to discuss financial matters or unusual secrecy around finances

• Frequent injuries or unexplained bruises, especially in sensitive areas
• Withdrawal from friends, family, or activities
• Fearfulness or anxiety around a partner
• Control over daily activities, including finances, social interactions, or personal choices

• Changes in behaviour, such as increased secrecy or withdrawal
• Associating with older individuals or known gang members
• Signs of substance abuse or engaging in risky behaviours
• Sudden possession of new items (e.g., clothing, electronics) without explanation

• Signs of abuse or neglect
• Frequent changes in guardianship or living arrangements
• Lack of appropriate clothing or belongings
• Unexplained absences from school or frequent traveling with unknown adults

• Emotional distress, flashbacks, or trauma symptoms
• Reluctance to engage in certain topics or situations
• Physical signs of past abuse, such as scars or injuries
• Changes in behavior or mental health issues that arise after discussing past experiences

NSPCC- Domestic Abuse

NSPCC- Criminal Exploitation and Gangs 

NSPCC- Child Trafficking 

NSPCC- Non-Recent Abuse

AgeUK- Financial Abuse