Types of Abuse Fact Sheet

This document is a best practice reference document for use by those in the Church who have a role with children, young people and adults.

It contains information about the types of abuse which can occur and how to recognise them, including physical signs and symptoms as well as behavioural changes that you might observe. Bear in mind that children, young people and adults may be subject to one type of abuse or a combination of types of abuse. It is informed by the definitions available in Working Together 2018 and the Care Act 2014.

The lists of signs and symptoms below are not exhaustive – there may be other signs or symptoms which are not listed below which could be indicators of abuse. Similarly, some of these signs and symptoms will not always be indicators of abuse. The following lists under each category of abuse contain examples of possible indicators. The presence of one or more of these signs or symptoms does not necessarily confirm abuse.

Please note that many types of abuse are also criminal offences and should be treated as such.

Working Together to Safeguard Children 2018 defines abuse as:

A form of maltreatment of a child. Somebody may abuse or neglect a child by inflicting harm or by failing to act to prevent harm. Children may be abused in a family or in an institutional or community setting by those known to them or, more rarely, by others (e.g. via the internet). They may be abused by an adult or adults or another child or children.

Abuse is defined as four categories:

• Physical
• Sexual
• Neglect
• Emotional

2.1. Physical abuse

Physical abuse may or may not cause injury and includes physical ill treatment, causing unjustifiable physical discomfort, for example injury, pain or impairment.

2.2. Sexual abuse

A sexual act carried out without the informed consent (see below) of the other individual is abuse. Such behaviour includes contact and non-contact abuse.

Contact abuse may include rape, indecent assault, being forced to touch another person, sexual intercourse or being pressurised into consenting to sexual acts.

It is also important to remember that it is not just adult men who sexually abuse children – there are increasing numbers of allegations of sexual abuse of children against women and sexual abuse can also be perpetrated by other children or young people.

Age of consent

The age of consent (the legal age to have sex) in England is 16 years old. This applies to both heterosexual and homosexual sex.

The laws are there to protect children from abuse or exploitation, rather than to prosecute under-16s who participate in mutually consenting sexual activity. Underage sexual activity may be a possible indicator of child sexual exploitation.

Statutory agencies have agreed that if 13-16-year-old sexual activity is discovered then an assessment of risk should be carried out.

Risks to be considered include:

- Whether the child is competent to understand, and consent to, the sexual activity they are involved in
- Whether the sexual activity is with someone of a similar age, ability and aptitude
- Whether there is a power imbalance
- Whether there any coercion or bribery, overt aggression, misuse of alcohol or other substances acting as a disinhibitor
- Whether the sexual partner is known by one of the statutory agencies

To help protect younger children the law says anyone under the age of 13 can never legally give consent. This means that anyone who engages in any sexual activity with a child who is 12 or younger is breaking the law. Sexual activity with a child who is under 13 should always result in a child protection referral. The law gives extra protection to young people who are over the age of consent but under 18. It is illegal:

- To take, show or distribute indecent photographs of a child (this is often called sexting).
- To pay for or arrange sexual services of a child.
- For a person in a position of trust (for example teachers or care workers) to engage in sexual activity with anyone under the age of 18 who is in the care of their organization. The Sexual Offences Act 2003 applies in England and Wales. It gives more information about specific offences and the related penalties.

Age of criminal responsibility for children

The age of criminal responsibility in England is 10 years old.

This means a child is considered capable of committing a crime and old enough to stand trial for a criminal offence. Their case will be dealt with by a youth court and if they are convicted, their sentence will take their age into account.

2.2.1. Grooming

Grooming is a form of sexual abuse. It is when someone builds an emotional connection with a child to gain their trust for the purposes of sexual abuse, sexual exploitation or trafficking. Grooming may also include threats or bribes, which persuade the person that it would be impossible to ask for help. It may appear as an unhealthily close friendship which stretches or breaks approved boundaries. Children and young people can be groomed online or face-to-face, by a stranger or by someone they know - for example a family member, friend or professional.

Methods of making contact online via social networking and chat-based applications (often used on mobile phones) are often used for this, although grooming can take place face-to-face. When grooming takes place online it is easy for potential abusers to disguise their identity, including their gender, location and age.

Signs of grooming

The signs of grooming aren't always obvious, and groomers will often go to great lengths not to be identified. If a child is being groomed they may:

• Be very secretive, including about what they are doing online
• Have older boyfriends or girlfriends
• Go to unusual places to meet friends
• Have new things such as clothes or mobile phones that they can't or won't explain
• Have access to drugs and alcohol In older children

In older children, signs of grooming can easily be mistaken for 'normal' teenage behaviour, but you may notice unexplained changes in behaviour or personality, or inappropriate sexual behaviour for their age.

How grooming happens

Grooming happens both online and in person. Groomers will hide their true intentions and may spend a long time gaining a child's trust. Groomers may try to gain the trust of a whole family to allow them to be left alone with a child and if they work with children they may use similar tactics with their colleagues.

Groomers do this by:

• Pretending to be someone they are not, for example saying they are the same age online
• Offering advice or understanding
• Buying gifts
• Giving the child attention
• Using their professional position or reputation
• Taking them on trips, outings or holidays

2.2.2. Child Sexual Exploitation

Child sexual exploitation is a form of child sexual abuse. Sexual abuse may involve physical contact, including assault by penetration (for example, rape or oral sex) or non-penetrative acts such as masturbation, kissing, rubbing and touching outside clothing. It may include non-contact activities, such as involving children in the production of sexual images, forcing children to look at sexual images or watch sexual activities, encouraging children to behave in sexually inappropriate ways or grooming a child in preparation for abuse (including via the internet).

The definition of child sexual exploitation is as follows:

Child sexual exploitation is a form of child sexual abuse. It occurs where an individual or group takes advantage of an imbalance of power to coerce, manipulate or deceive a child or young person under the age of 18 into sexual activity (a) in exchange for something the victim needs or wants, and/or (b) for the financial advantage or increased status of the perpetrator or facilitator. The victim may have been sexually exploited even if the sexual activity appears consensual. Child sexual exploitation does not always involve physical contact; it can also occur through the use of technology.

Like all forms of child sexual abuse, child sexual exploitation:

• Can affect any child or young person (male or female) under the age of 18 years, including 16 and 17-year olds who can legally consent to have sex
• Can still be abuse even if the sexual activity appears consensual
• Can include both contact (penetrative and non-penetrative acts) and non-contact sexual activity
• Can take place in person or via technology, or a combination of both
• Can involve force and/or enticement-based methods of compliance and may, or may not, be accompanied by violence or threats of violence
• May occur without the child or young person’s immediate knowledge (through others copying videos or images they have created and posting on social media, for example)
• Can be perpetrated by individuals or groups, males or females, and children or adults. The abuse can be a one-off occurrence or a series of incidents over time and range from opportunistic to complex organised abuse
• Is typified by some form of power imbalance in favour of those perpetrating the abuse. Whilst age may be the most obvious, this power imbalance can also be due to a range of other factors including gender, sexual identity, cognitive ability, physical strength, status, and access to economic or other resources

Possible indicators of CSE

The following list of indicators is not exhaustive or definitive, but it does highlight signs which can assist in identifying possible CSE:

• Keeping secrets
• Inappropriate sexual or sexualised behaviour
• Sexually risky behaviour
• Repeat sexually transmitted infections
• Repeat pregnancy, abortions, miscarriage
• Receiving unexplained gifts or gifts from unknown sources
• Having multiple mobile phones and worrying about losing contact via mobile.
• Having unaffordable new things (clothes, mobile) or expensive habits (alcohol, drugs)
• Changes in the way the person dresses
• Going to hotels or other unusual locations to meet friends
• Contact with known perpetrators
• Involved in abusive relationships, intimidated and fearful of certain people or situations
• Unexplained changes in behaviour or personality – e.g. mood swings, volatile behaviour, emotional distress
• Self-harming, suicidal thoughts, suicide attempts, overdosing, eating disorders
• Drug or alcohol misuse
• Getting involved in crime
• Injuries from physical assault, physical restraint, sexual assault
• The adult may create special relationships with a particular person or have difficulties in keeping to boundaries. They may try to have secrets from others in the group.

2.3. Neglect

Neglectful behaviour is any pattern of activity by another person, which seriously impairs an individual.

2.4. Emotional abuse

Emotional abuse is the persistent emotional ill treatment of an individual causing severe and persistent effects on the person’s emotional and psychological well-being and for children impacting negatively on emotional development.

Some level of emotional abuse is involved in most types of abuse although emotional abuse may occur alone.

2.5. Domestic abuse

Included in the four categories of child abuse and neglect above, are a number of factors relating to the behaviour of the parents and carers which have significant impact on children such as domestic violence. Research analysing Serious Case Reviews has demonstrated a significant prevalence of domestic abuse in the history of families with children who are subject of Child Protection Plans. Children can be affected by seeing, hearing and living with domestic violence and abuse as well as being caught up in any incidents directly, whether to protect someone or as a target. It should also be noted that the age group of 16 and 17-year olds have been found in recent studies to be increasingly affected by domestic violence in their peer relationships. See adult domestic abuse.

2.6. Bullying and cyber-bullying

Bullying is behaviour that hurts someone else – such as name calling, hitting, pushing, spreading rumours, threatening or undermining someone. It can happen anywhere – at school, at home or online. It’s usually repeated over a long period of time and can hurt a child both physically and emotionally. Bullying that happens online, using social networks, games and mobile phones, is often called cyberbullying. A child can feel like there’s no escape because it can happen wherever they are, at any time of day or night.

There are many different types of abuse and they all result in behaviour towards a person that deliberately or intentionally cause harm. It is a violation of an individual’s human and civil rights and in the worst cases can result in death.

The types of abuse are:

• Physical abuse
• Sexual abuse
• Psychological or emotional abuse
• Financial or material abuse
• Modern slavery
• Discriminatory abuse
• Domestic violence or abuse
• Organisational or institutional abuse
• Neglect or acts of omission
• Self-neglect

3.1. Physical abuse

3.2. Sexual abuse

3.3. Psychological abuse

3.4. Financial/material abuse

The wilful extortion or manipulation of the vulnerable person’s legal or civil rights must be construed as abuse. Such activity may include misappropriation of monies or goods, the misuse of finances, property or possessions, or withholding money, the exploitation of a person’s resources or embezzlement. Such abuse may involve the use of a position of authority or friendship to persuade a person to make gifts, to leave legacies or change a will.

3.5. Modern slavery

Modern slavery encompasses:

• 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

3.5.1. Possible indicators of modern slavery

• 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

Further Home Office information on identifying and reporting modern slavery

3.6. Discriminatory abuse

Discriminatory abuse is 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). It may be persistent conduct or an isolated incident.

The indicators of discriminatory abuse may take the form of any of the other types of abuse already mentioned. The difference lies in that the abuse is motivated by discriminatory attitudes, feelings or behaviour towards an individual.

3.7. Domestic abuse

The cross-government definition of domestic violence and abuse is: any incident or pattern of incidents of controlling, coercive, threatening behaviour, violence or abuse perpetrated by those aged 16 or over who are, or have been, intimate partners or family members regardless of gender or sexuality. The abuse can encompass, but is not limited to:

• Psychological/emotional

For example, shouting; swearing; frightening; blaming; ignoring or humiliating someone; blackmailing them; threatening harm to children or pets if they misbehave; ridiculing every aspect of their appearance and skills; keeping them deliberately short of sleep; being obsessively and irrationally jealous; keeping them isolated from friends and family; threatening suicide or self-harm.

• Physical

For example, hitting; slapping; burning; pushing; restraining; giving too much medication or the wrong medication; assault with everyday implements such as kitchen knives; kicking; biting; punching; shoving; smashing someone’s possessions; imprisoning them; or forcing them to use illegal drugs as a way of blackmailing and controlling them.

• Sexual

For example, forcing someone to take part in any sexual activity without consent, e.g. rape or sexual assault; forcing them or blackmailing them into sexual acts with other people; forcing children to watch sexual acts; sexual name calling; imposition of dress codes upon a partner; involvement in the sex trade or pornography; knowingly passing on Sexually Transmitted infections; controlling access to contraception.

• Neglect

For example, a failure to provide necessary care, assistance, guidance or attention that causes, or is reasonably likely to cause a person physical, mental or emotional harm or substantial damage to or loss of assets.

• Financial

For example, the illegal or unauthorized use of someone’s property, money, pension book or other valuables; forcing them to take out loans; keeping them in poverty; demanding to know every penny they spend; refusing to let them use transport or have money to pay for it.

• Spiritual

For example, telling someone that God hates them; refusing to let them worship (e.g. not allowing a partner to go to church) or compelling them to worship; using faith as a weapon to control and terrorize them for the abuser’s personal pleasure or gain; using religious teaching to justify abuse (e.g. ‘submit to your husband’), or to compel forgiveness.

• Digital

For example, the use of technology (e.g. texting and social networking) to bully, harass, stalk or intimidate a partner. Though it is perpetuated online, this type of abuse has a strong impact on a victim's real life. For example, the ‘revenge porn’ offence i.e. disclosing private sexual photographs via digital media with an intended to cause distress ^[1] .

Controlling behaviour

Controlling behaviour is a range of acts designed to make a person subordinate and/or dependent by isolating them from sources of support, exploiting their resources and capacities for personal gain, depriving them of the means needed for independence, resistance and escape and regulating their everyday behaviour.

Coercive behaviour

Coercive behaviour is an act or a pattern of acts of assault, threats, humiliation and intimidation or other abuse that is used to harm, punish, or frighten their victim ^[2] .

3.8. Organisational or Institutional Abuse

Organisational or Institutional Abuse can be defined as abuse or mistreatment by a regime as well as by individuals within any setting where care is provided. The Care Act 2015 states:

Including 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. This may range from one off incidents to on-going ill-treatment. It can be through neglect or poor professional practice as a result of the structure, policies, processes and practices within an organisation. Neglect and poor professional practice need to be taken into account. This may be in the form of isolated incidents of poor or unsatisfactory professional practice, at one end of the spectrum, through to pervasive ill treatment or gross misconduct at the other. Repeated instances of poor care may be an indication of more serious problems.

3.9. Neglect and acts of omission

3.10. Self-neglect

There are certain risk factors that may place individuals at particular risk of being abused. The presence of one or more of these factors does not automatically imply that abuse will result but increases the likelihood:

• Where there exists an imbalance of power and control
• Where there is a dependency on other(s)
• The need for help with intimate personal care e.g. managing incontinence, washing and dressing
• Strain of prolonged caring at the expense of care-giver’s own needs/high stress levels
• Difficult carer/service-user relationship
• Role reversal and the need for intimate personal assistance, e.g. daughter or son providing personal assistance for a parent
• Living in the same household as a known abuser
• Where there is a history of family abuse
• People with a history of alcohol, drug or other substance abuse
• Unsuitable or dangerous environment, e.g. lack of personal space
• People who have independent support (i.e. no-one/no outside body monitoring this)
• Absence of support
• Lack of awareness of the rights of a service user or of what constitutes abuse or dignity
• Staff shortages, lack of staff awareness, training and supervision
• Lack of privacy
• Financial problems
• Where there is a change in the lifestyle of a member of the household, e.g. employment, unemployment, illness
• Cultural differences and language barriers
• Emotional or social isolation
• Communication difficulties
• Where the individual’s behaviour is challenging or unpredictable or difficult to manage
• Revenge and/or anger
• A reduction in physical, mental or emotional capacity caused by external events, such as bereavement or previous abuse or other traumatic incidents

4.1. Additional Signs and Symptoms of Abuse

Other indications that abuse may be occurring:

• The vulnerable adult or child may not be allowed to speak for themselves, or see others, without the parents or caregivers being present
• Attitudes of indifference or anger towards the child or vulnerable adult
• Family member or caregiver blames the child or vulnerable adult (e.g. accusation that incontinence is a deliberate act)
• Aggressive behaviour (threats, insults, harassment) by the parent or caregiver towards the child or vulnerable adult
• Previous history of abuse of others on the part of the caregiver
• Inappropriate display of affection by the caregiver
• Flirtations, coyness, etc. which might be possible indicators of an inappropriate sexual relationship
• Social isolation of the family or restriction of activity of the child or vulnerable adult by the caregiver
• Conflicting accounts of incidents by the family, caregivers or the child or vulnerable adult
• Inappropriate or unwarranted defensiveness by the caregiver
• Indications of unusual confinement (closed off in a room, tied to furniture, change in routine or activity)
• Obvious absence of assistance or attendance

5.1. Complex abuse

Complex abuse, sometimes also known as ‘organised’ or ‘multiple’ abuse, is abuse involving one or more abusers and a number of related or non-related children or vulnerable adults. The abusers may be acting in networks to abuse or may operate in isolation. They may use an institutional framework or position of authority or trust to children or vulnerable adults for abuse. They may use children or vulnerable adults themselves to recruit others.

Such abuse occurs both as part of a network of abuse across a family or community and within institutions such as residential settings, in day care and in other provisions such as voluntary groups. There may also be cases of people being abused via the use of the internet.

5.2. Honour based violence or abuse^[3]

The Forced Marriage Unit at the Home Office defines this as:

So-called honour based violence is a crime or incident, which has or may have been committed to protect or defend the honour of the family and/or community

Honour Based Violence can manifest in many different ways and often presents with accompanying criminal offences, domestic abuse or the civil offence of forced marriage. If incidents include domestic abuse, child abuse or other serious crime then it should be read in conjunction with the relevant policies and procedures on these subjects.

Honour Based Violence can include:

• Physical Abuse
• Sexual Abuse
• Emotional and Psychological Abuse
• Financial Abuse
• Forced Marriage
• Female Genital Mutilation

‘Honour’ is normally associated with cultures and communities from Asia, the Middle East and Africa as well as the Travelling Community. However, it is important to note that in reality it cuts across all cultures, nationalities, faith groups and communities and transcends national and international boundaries.

The ‘honour code’ means that females generally, but sometimes males, must follow rules that are set at the discretion of the male relations and which are interpreted according to what each male family or community member considers acceptable.

Any suspicion or disclosure of violence or abuse against a vulnerable adult in the name of honour should be treated as seriously as any other suspicion or disclosure of significant harm against a vulnerable adult, however there are differences in the immediate response. A child at risk of abuse in the name of honour is at significant risk of physical harm (including being murdered) and/or neglect and may also suffer significant emotional harm through the threat of violence.

It must be noted that in most cases, the Police will take the lead for any Honour Based Abuse incidents. It is important that you do not ‘turn the individual away’. Try to ensure their immediate safety and support them to make urgent and safe contact with the Police. It is important to remember the ‘one chance’ rule. That is, that there may only be one chance to speak to the potential victim and thus only one chance to intervene.

5.3. Forced marriage

The Home Office definition of forced marriage is:

A marriage without the consent of one or both parties and where duress is a factor.

The Court of Appeal clarified that duress is:

[When] the mind of the applicant has been overborne, howsoever that was caused

An arranged marriage is very different from a forced marriage. An arranged marriage is entered into freely by both people, although their families take a leading role in the choice of partner.

A forced marriage is where one or both people do not (or in some cases of people with learning or physical disabilities, cannot) consent to the marriage and pressure or abuse is used.

Marriage without consent is not valid in UK law and a child under 16 years old is not considered to be competent to consent to marriage.

The pressure put on people to marry against their will can be physical (including threats, actual physical violence and sexual violence) or emotional and psychological (for example, when someone is made to feel like they’re bringing shame on their family). Financial abuse (taking your wages or not giving you any money) can also be a factor.

Marriage within communities that believe protecting the ‘honour’ of their family is a significant event. Marriage contracts will often be drawn up when children are young and are seen as a binding arrangement between the two families. If one or both parties then seek to disengage from the contract it is seen as bringing great shame on the family and very contentious.

Involving family members in cases of forced marriage is dangerous as it may increase the risk of serious harm to the victim as the victim may also then be punished for seeking help.

Forced marriages can occur in this country or abroad, often in their country of origin. There is further information available regarding Forced Marriage on the government web-pages.

5.4. Female genital mutilation

Female genital mutilation ^[4] (FGM) is a collective term for illegal procedures which include the removal of part or all external female genitalia for cultural or other non-therapeutic reasons. The practice is not required by any religion and is medically unnecessary, painful and has serious health consequences at the time it is carried out and in later life.

The procedure is typically performed on girls of any age but is also performed on new born infants and on young women before marriage/ pregnancy. A number of girls die as a direct result of the procedure, from blood loss or infection.

FGM may be practised illegally by doctors or traditional health workers in the UK, or girls may be sent abroad for the operation.

FGM is illegal in this country by the Female Genital Mutilation Act 2003, except on specific physical and mental health grounds ^[5] .

The victim may be seriously at risk if any knowledge of the disclosure is mishandled.

Further information is available on the government web-pages.

5.5. Spiritual abuse^[6]

Spiritual abuse is not covered by the standard statutory definitions of abuse but is of concern both within and outside faith communities including the Church of England.

Churches need to be sensitive so that they do not, in their pastoral care, attempt to ‘force’ religious values or ideas onto people, particularly those who may be vulnerable to such practices. Within faith communities harm can be caused by the inappropriate use of religious belief or practice; this can include the misuse of the authority of leadership or penitential discipline, oppressive teaching, or intrusive healing and deliverance ministries, which may result in vulnerable people experiencing physical, emotional or sexual harm. If such inappropriate behaviour becomes harmful it should be referred for investigation in the usual way. Careful supervision and mentoring of those entrusted with the pastoral care of adults should help to prevent harm occurring in this way. Other forms of spiritual abuse include the denial to vulnerable people of the right to faith or the opportunity to grow in the knowledge and love of God.’

A particular aspect of Spiritual Abuse relating to children has been addressed in the Department of Health Safeguarding Children from Abuse Linked to a Belief in Spirit Possession (2007).

The term ‘belief in spirit possession’ is defined as the belief that an evil force has entered a child and is controlling him or her. Sometimes the term ‘witch’ is used and is defined as the belief that a child is able to use an evil force to harm others. There is also a range of other languages that is connected to such abuse. This includes black magic, kindoki, ndoki, the evil eye, djinns, voodoo, obeah, demons, and child sorcerers. In all these cases, genuine beliefs can be held by families, carers, religious leaders, congregations, and the children themselves that evil forces are at work. Families and children can be deeply worried by the evil that they believe is threatening them, and abuse often occurs when an attempt is made to ‘exorcise’, or ‘deliver’ the child. Exorcism is defined as attempting to expel evil spirits from a child. Whilst the number of identified cases is small, the nature of the child abuse can be particularly disturbing and the impact on the child is substantial and serious. (DoH Safeguarding Children from Abuse Linked to a Belief in Spirit Possession, 2007).