Category: Health & Safety

Recognizing Abuse, Neglect & Unsafe Relationships

Abuse is not limited to hitting or causing visible injuries. It can include threats, intimidation, humiliation, sexual pressure, financial control, isolation, stalking, neglect, exploitation, or any repeated behavior used to frighten, control, punish, or take advantage of another person.

It can happen in a marriage, dating relationship, friendship, family, caregiving arrangement, workplace, school, group home, nursing facility, or online relationship. Children, adults, older adults, and people with disabilities can all experience abuse.

Recognizing what is happening may be difficult, especially when the person causing harm is also someone the victim loves, depends on, lives with, or trusts. Abuse may develop gradually and be mixed with apologies, affection, gifts, promises, or periods when the relationship seems peaceful.

You do not need absolute proof before asking questions, offering support, or reporting a reasonable concern to the appropriate agency. If someone is in immediate danger, seriously injured, being threatened with a weapon, or unable to reach safety, call 911 or your local emergency number.

Abuse Is About More Than Anger

People sometimes describe abuse as someone “losing control.” However, abuse often involves a pattern of gaining power and control over another person.

The person causing harm may:

• Decide where the other person can go
• Control whom they see or speak with
• Monitor their phone, vehicle, or online activity
• Control money, medication, food, transportation, or housing
• Punish attempts to become more independent
• Threaten children, pets, relatives, or caregivers
• Make the victim feel responsible for the abuse
• Behave differently when other people are watching
• Alternate between cruelty and affection
• Use a person’s disability, immigration status, age, or financial dependence against them

A relationship does not need to include physical violence to be abusive or unsafe.

Physical Abuse

Physical abuse includes the intentional use of force that causes—or could cause—pain, injury, fear, or physical control.

Examples include:

• Hitting, punching, slapping, kicking, or biting
• Shoving or throwing someone
• Choking or strangling
• Burning
• Pulling hair
• Grabbing or twisting an arm
• Blocking a doorway
• Preventing someone from leaving
• Throwing objects
• Using or threatening to use a weapon
• Restraining someone inappropriately
• Handling a child, older adult, or person with a disability roughly
• Giving unnecessary medication to make someone easier to control
• Refusing needed medication as punishment

Possible warning signs include:

• Unexplained bruises, burns, cuts, fractures, or other injuries
• Injuries at different stages of healing
• Frequent emergency-room visits
• Explanations that do not match the injury
• Delay in seeking medical care
• Wearing clothing that conceals injuries
• Flinching when someone approaches
• Fear of a particular person
• A caregiver who refuses to leave the person alone with a professional

Not every injury means abuse has occurred. However, repeated injuries, inconsistent explanations, fear, or controlling behavior should be taken seriously.

Strangulation Is an Emergency

Strangulation occurs when pressure interferes with breathing or blood flow through the neck. People often call this “choking,” but strangulation is the more accurate term when another person applies pressure to the neck.

A person can have a serious internal injury even when there are no visible marks.

Call 911 or seek emergency medical care after strangulation, especially if the person has:

• Difficulty breathing or swallowing
• Neck pain or swelling
• A hoarse or changed voice
• Confusion or memory problems
• Dizziness
• Loss of consciousness
• Weakness or numbness
• Vision changes
• Vomiting
• A severe headache
• A seizure
• Loss of bladder or bowel control

Do not assume the person is safe because they can speak or because the incident happened several hours earlier.

Emotional and Psychological Abuse

Emotional abuse can damage a person’s confidence, independence, and sense of safety.

Examples include:

• Constant criticism
• Insults or humiliation
• Threats
• Intimidation
• Name-calling
• Deliberately frightening someone
• Treating an adult like a child
• Telling someone that no one else will believe or want them
• Denying events that clearly occurred
• Blaming the victim for the abusive behavior
• Threatening suicide to prevent someone from leaving
• Threatening to reveal private information
• Punishing someone with silence, isolation, or abandonment
• Destroying meaningful belongings
• Controlling sleep, food, clothing, or personal routines

Possible warning signs include:

• Sudden anxiety, depression, or withdrawal
• Loss of confidence
• Appearing afraid to speak
• Looking to another person before answering
• Apologizing constantly
• Becoming unusually quiet around a particular person
• Changes in sleep, appetite, or behavior
• Believing that they deserve mistreatment
• Being unable to make ordinary decisions without permission

Emotional abuse is serious even when there are no physical injuries.

Coercive and Controlling Behavior

Coercive control is a pattern of behavior that restricts another person’s freedom and independence.

A controlling person may:

• Demand passwords
• Read messages or emails
• Track someone’s location
• Control clothing or appearance
• Set rules about friends and family
• Prevent someone from working or attending school
• Control access to transportation
• Require constant check-ins
• Accuse the person of cheating without reason
• Interfere with medical care
• Threaten to report someone to immigration authorities
• Threaten to take away children
• Threaten to place an older adult in a facility
• Use a person’s disability or support needs to control them

The National Domestic Violence Hotline explains that abusive relationships often involve repeated methods of establishing power and control. Abuse may be emotional, sexual, financial, technological, or physical. National Domestic Violence Hotline

Sexual Abuse

Sexual activity requires consent. Consent must be voluntary, informed, and given by someone who has the ability to make the decision.

Sexual abuse can include:

• Sexual contact without consent
• Pressuring, threatening, or forcing someone into sexual activity
• Continuing after someone says no or asks to stop
• Sexual contact with someone who is unconscious or too intoxicated to consent
• Sexual contact with a child
• Sexual contact with someone who cannot understand or consent
• Removing or refusing agreed-upon protection
• Taking or sharing sexual images without permission
• Using housing, money, medication, employment, or care as leverage for sexual access
• Forcing someone to watch sexual activity
• Unwanted sexual comments, exposure, or touching

Marriage, dating, past consent, or previous sexual activity does not create permanent consent.

Possible warning signs include:

• Unexplained genital injuries, bleeding, pain, or infections
• Torn or stained clothing
• Pregnancy or a sexually transmitted infection
• Fear of a particular person
• Sudden changes in mood or behavior
• Nightmares or sleep problems
• Avoidance of touch
• Sexual knowledge or behavior that is not appropriate for a child’s age
• Anxiety about bathing, dressing, toileting, or receiving personal care

A person who reports sexual abuse should be believed, supported, and offered medical care. Avoid pressing for unnecessary details or asking questions that suggest blame.

Financial Abuse and Exploitation

Financial abuse occurs when someone takes, misuses, controls, or withholds another person’s money, property, benefits, or financial information.

Examples include:

• Stealing cash or possessions
• Using a debit or credit card without permission
• Forging checks or signatures
• Pressuring someone to change a will
• Adding a name to an account through pressure or deception
• Taking Social Security, disability, or pension payments
• Preventing someone from accessing their own money
• Opening accounts or loans in someone else’s name
• Misusing a power of attorney
• Charging for care that was not provided
• Pressuring someone to sign documents they do not understand
• Controlling all household money to prevent someone from leaving
• Demanding payment in exchange for basic care
• Exploiting someone through a romance or caregiver relationship

Warning signs may include:

• Unexplained withdrawals
• Missing money or property
• Unpaid bills despite available funds
• Sudden changes in banking
• New names added to financial documents
• Changes to a will or beneficiary
• Utilities being disconnected
• A caregiver displaying unusual interest in the person’s finances
• Someone preventing the person from speaking privately with bank staff
• The person seeming confused or frightened about a transaction

The Administration for Community Living defines exploitation as the illegal taking, misuse, or concealment of an older person’s funds, property, or assets for someone else’s benefit. Administration for Community Living

Neglect

Neglect occurs when a responsible person fails to provide necessary care, supervision, protection, or basic needs.

Neglect may involve failure to provide:

• Food or water
• Safe housing
• Clean clothing
• Hygiene assistance
• Needed medication
• Medical or dental care
• Appropriate supervision
• Protection from dangerous conditions
• Mobility assistance
• Toileting or personal care
• Heat, electricity, or working utilities
• Appropriate educational care for a child

Possible warning signs include:

• Dehydration or unusual weight loss
• Persistent hunger
• Poor hygiene
• Untreated injuries
• Missed medical appointments
• Medication errors
• Pressure injuries or bedsores
• Soiled clothing or bedding
• Unsafe or unsanitary living conditions
• Lack of working heat, water, or electricity
• A person repeatedly left alone without necessary support
• A child frequently absent from school
• Lack of needed eyeglasses, hearing aids, mobility devices, or medical equipment

Neglect may be intentional, or it may happen when a caregiver is overwhelmed, impaired, untrained, or unable to provide the required care. Whatever the cause, the person’s safety and needs still require attention.

Self-Neglect

Self-neglect occurs when an adult cannot or does not meet essential needs and the situation threatens their health or safety.

Possible signs include:

• Severe poor hygiene
• Lack of food or water
• Untreated medical problems
• Unsafe accumulation of trash
• Animal waste in living areas
• Fire hazards
• Utilities being disconnected
• Confusion about medication
• Wandering
• Repeated falls
• Inability to manage money
• Living in dangerous temperatures
• Refusing help while appearing unable to understand the consequences

Self-neglect is not the same as choosing an unusual lifestyle. Adults generally have the right to make their own decisions when they understand the choices and consequences. However, serious cognitive, medical, or mental health problems may affect a person’s ability to protect themselves.

Adult Protective Services may be able to evaluate the situation and connect the person with support.

Abuse of Children

Child abuse may include physical abuse, sexual abuse, emotional abuse, trafficking, exploitation, or neglect.

Warning signs in a child may include:

• Unexplained or repeated injuries
• Fear of going home
• Fear of a particular adult
• Sudden changes in behavior or school performance
• Frequent hunger or poor hygiene
• Clothing that is inappropriate for the weather
• Being left alone at an unsafe age
• Sexual behavior or knowledge that is not age-appropriate
• Running away
• Difficulty walking or sitting
• Sudden bed-wetting
• Nightmares
• Withdrawal, aggression, or extreme watchfulness
• Saying that someone hurt, touched, frightened, or threatened them

A child may disclose abuse indirectly. They might say they do not want to visit someone, that they have a secret, or that a person makes them uncomfortable.

Listen calmly. Do not interrogate the child or ask leading questions. Use simple responses such as:

• “I’m glad you told me.”
• “This is not your fault.”
• “You did the right thing.”
• “I’m going to get help to keep you safe.”

Do not promise secrecy. Explain that you need to tell someone who can help.

Child-abuse reporting rules and agencies vary by state. Contact your state or local child protective services agency. Call 911 if the child is in immediate danger.

Abuse of Older Adults and Adults With Disabilities

Older adults and adults with disabilities may depend on others for personal care, communication, transportation, medication, finances, or access to the community. An abusive person may exploit that dependence.

Examples include:

• Withholding a wheelchair, cane, communication device, or hearing aid
• Refusing help with toileting, bathing, eating, or repositioning
• Overmedicating or withholding medication
• Preventing private communication
• Threatening institutional placement
• Using disability benefits without permission
• Ignoring pain or medical symptoms
• Leaving someone without necessary supervision
• Restricting access to family, friends, advocates, or services
• Speaking for the person without allowing them to participate

Warning signs may include changes in alertness, unusual depression, withdrawal, bedsores, poor hygiene, unattended medical needs, weight loss, unexplained injuries, or sudden financial changes. Administration for Community Living

If immediate danger is not present, concerns involving an older adult or vulnerable adult can usually be reported to Adult Protective Services in the state where the person lives. The Eldercare Locator at 800-677-1116 can help identify the appropriate local agency. Administration for Community Living

Abuse in Care Facilities

Abuse or neglect can occur in nursing homes, assisted-living communities, group homes, rehabilitation centers, hospitals, and other care settings.

Possible warning signs include:

• Unexplained injuries
• Repeated falls
• Medication errors
• Poor hygiene
• Dehydration or weight loss
• Pressure injuries
• Long periods in soiled clothing or bedding
• Staff refusing private visits
• Missing belongings
• Sudden fear of a staff member or resident
• Call bells being placed out of reach
• Excessive sedation
• Rough handling
• Unsafe staffing or supervision
• Retaliation after a complaint

Document the concern and report it to facility leadership when appropriate, but do not rely only on an internal report when someone may be in danger.

Depending on the situation, reports may also be made to:

• Adult Protective Services
• Law enforcement
• The state licensing agency
• The state Long-Term Care Ombudsman
• The agency funding or overseeing the service

A Long-Term Care Ombudsman investigates and helps resolve complaints involving nursing homes and certain other residential-care settings. Administration for Community Living

Technology-Facilitated Abuse and Stalking

Technology can be used to monitor, threaten, embarrass, impersonate, or control someone.

Warning signs include:

• The other person always seems to know the victim’s location.
• Passwords are repeatedly changed.
• Unknown devices appear in account settings.
• The person receives constant calls or messages.
• Private conversations appear to have been monitored.
• Tracking devices are found in a vehicle or belongings.
• Intimate images are shared or threatened.
• The abuser controls phone service or online accounts.
• Smart-home devices are used to frighten or monitor the person.

If monitoring is possible, use a safer device to seek help. Changing passwords or removing tracking software can sometimes alert the abusive person and increase danger. Speak with a domestic-violence advocate about a technology safety plan before making major changes.

The National Domestic Violence Hotline warns that internet use can be monitored and may not be completely erasable. National Domestic Violence Hotline

What to Do if You Are Being Abused

If you are in immediate danger:

• Call 911.
• Move toward an exit if you can.
• Avoid rooms containing weapons or hard surfaces.
• Go to a neighbor, public place, police station, fire station, hospital, or other safer location.
• Take children with you if you can do so safely.
• Do not announce plans that could increase the danger.
• Follow emergency instructions.

If the danger is not immediate:

• Tell someone you trust.
• Contact a domestic-violence or sexual-assault advocate.
• Make a safety plan.
• Identify places you can go.
• Prepare important documents and medication.
• Consider a code word to tell someone you need help.
• Keep emergency numbers somewhere safe.
• Document incidents if doing so will not increase your risk.
• Seek medical care for injuries.
• Learn about local shelter, legal, financial, and counseling resources.

You do not have to make every decision at once. An advocate can help you consider your options without forcing you to leave before you are ready.

The National Domestic Violence Hotline is available 24 hours a day at 800-799-SAFE (7233). You can also text START to 88788 or use live chat at thehotline.org.

If the abusive person monitors your phone or internet activity, contact support from a safer device when possible.

Making a Safety Plan

Leaving an abusive relationship can be a particularly dangerous period. Avoid confronting the abusive person or announcing that you plan to leave without considering the possible risks.

A personalized safety plan may include:

• A safe place to go
• Several possible exit routes
• A trusted person who knows what is happening
• A code word or signal
• Emergency transportation
• Copies of important documents
• Medication and medical supplies
• Keys
• Money or a separate account
• Clothing and essential items
• Plans for children, pets, or dependent adults
• School or workplace safety arrangements
• A safer phone or email account
• A list of emergency contacts
• Instructions for when someone should call 911

Store emergency items somewhere the abusive person is unlikely to find them, or with a trusted person outside the home.

A domestic-violence advocate can help you create a plan based on your circumstances.

How to Help Someone Else

Choose a private time when the suspected abusive person is not nearby.

You might say:

• “I’ve noticed that you seem afraid around this person.”
• “I’m concerned about your safety.”
• “You don’t deserve to be treated this way.”
• “I believe you.”
• “This is not your fault.”
• “How can I support you?”
• “Would you like help contacting an advocate?”

Listen without judgment. Respect that the person may not be ready or able to leave.

Do not:

• Blame the victim.
• Demand that they leave immediately.
• Confront the suspected abuser.
• Post about the situation online.
• Contact the victim in a way that may expose them.
• Make promises you cannot keep.
• Withdraw support because the person returns to the relationship.
• Conduct your own investigation.

Someone may stay because of fear, financial dependence, disability, children, pets, housing, immigration concerns, religious pressure, love, threats, or lack of safe alternatives. Leaving is not always a simple or immediately safe choice.

Documenting Concerns

Documentation can be helpful, but safety comes first.

If it is safe and lawful, record:

• Dates and approximate times
• What you observed
• The person’s exact words
• Injuries or damaged property
• Names of witnesses
• Relevant messages, emails, or voicemails
• Medical visits
• Police or agency report numbers

Keep descriptions factual. Write “bruise approximately two inches wide on the left arm” rather than “obviously beaten.”

Store documentation somewhere the abusive person cannot access. Do not secretly record conversations without understanding the laws in your state.

Reporting Abuse or Neglect

Reporting requirements depend on the person’s age, level of vulnerability, setting, your profession, and state law.

Possible reporting agencies include:

• 911 or local law enforcement
• Child Protective Services
• Adult Protective Services
• A state licensing agency
• A Long-Term Care Ombudsman
• A school safeguarding official
• A healthcare facility’s patient advocate
• A domestic-violence or sexual-assault program

Certain professionals are mandated reporters, meaning the law requires them to report suspected abuse involving certain people. If you are a healthcare worker, teacher, therapist, social-service professional, direct-support worker, or other mandated reporter, follow your professional and state reporting requirements. Do not delay a required report while trying to prove what happened.

For competent adults who are not covered by mandatory-reporting laws, respect their choices whenever possible while continuing to offer support. Immediate danger, child abuse, and abuse of certain vulnerable adults may require a different response.

A Safety Checklist

If you suspect abuse or neglect:

• Determine whether anyone is in immediate danger.
• Call 911 for immediate threats, serious injuries, or medical emergencies.
• Speak with the person privately if it is safe.
• Listen without judgment.
• Avoid blaming or interrogating the person.
• Do not confront the suspected abuser.
• Document factual observations when safe.
• Contact the appropriate protective or advocacy agency.
• Follow mandatory-reporting rules that apply to you.
• Help create a safety plan.
• Use a safer device if technology may be monitored.
• Continue offering support without taking over the person’s decisions.

Abuse often becomes harder to recognize when it is mixed with love, dependence, apologies, or periods of calm. Pay attention to patterns of fear, control, injury, exploitation, and unmet needs. You do not need to solve the entire situation yourself. Recognizing the warning signs, taking the person seriously, and connecting them with safe support can be an important first step.

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Important Health & Safety Notice

The information in this guide is provided for general educational purposes only. Independence Answers is not a medical provider, and this content is not a substitute for professional medical advice, diagnosis, treatment, or supervision. Always follow the instructions of your doctor, pharmacist, or other qualified healthcare professional, especially if you have a medical condition, take medication, or are unsure whether an action is safe for you.

Do not ignore or delay seeking professional care because of something you read here. If you believe someone may be experiencing a serious or life-threatening emergency, call 911 or your local emergency number immediately.