8.5 Physical, Sexual, and Psychological Abuse and Neglect Across the Lifespan

Recognizing abuse, neglect, and exploitation is a core clinical skill and a frequent ASWB Clinical exam target. The worker must recognize indicators across the lifespan, assess danger, and respond to the tension between client self-determination and protective obligations.

Child Abuse and Neglect

Four categories — physical abuse, sexual abuse, psychological/emotional abuse, and neglect — each present with physical and behavioral indicators and a caretaker presentation that should raise suspicion.

Perpetrator characteristics and dynamics: most child sexual abuse is by someone known to the child; grooming behaviors (special attention, isolation, boundary-crossing, secrecy) are assessment-relevant. Behavioral indicators often precede disclosure; children rarely fabricate abuse disclosures, and the assessment must take them seriously while avoiding leading questions.

Intimate Partner Violence (IPV)

IPV is coercive control punctuated by physical or sexual violence; the violence is one tactic among many. The Duluth Power and Control Wheel maps tactics: physical and sexual violence; emotional abuse, isolation, minimizing/denying/blaming, using children, economic abuse, male privilege, coercion/threats, and intimidation. Walker's cycle of violence describes (1) tension-building, (2) acute incident, (3) reconciliation/honeymoon, (4) calm — a cycle that typically shortens and intensifies over time.

Lethality assessment identifies risk factors for intimate partner homicide: access to firearms, strangulation history, escalation in frequency/severity, threats to kill, separation (the highest-risk period), stalking, forced sex, substance use, and pregnancy. Strangulation is a particularly strong predictor of future lethality and must be assessed directly.

Vignette

A 34-year-old woman presents with anxiety and 'panic attacks.' On careful assessment she reveals her partner monitors her phone, controls all money, has choked her twice (she lost consciousness once), and threatened to kill her if she leaves. Lethality indicators are severe: strangulation history, threats to kill, financial control, and impending separation. Safety planning, not couples therapy, is the clinical response (see 8.4); leaving must be planned, not impulsive, because the period around separation is the highest-risk for homicide.

Elder Abuse, Neglect, and Exploitation

Elder abuse includes physical, emotional, sexual abuse, neglect, and financial exploitation, most often by family caregivers or trusted others. Indicators vary by type:

• Physical — Unexplained bruising, fractures, restraint marks, repeated 'falls,' medication mismanagement.
• Emotional — Withdrawal, depression, fear of caregiver, deference to caregiver in interview.
• Neglect — Poor hygiene, dehydration, malnutrition, untreated pressure injuries, unsafe living conditions.
• Financial exploitation — Sudden account changes, new 'best friends,' unpaid bills despite adequate funds, altered wills or POAs, missing property, caregiver living beyond apparent means.

Undue influence — the substitution of one person's will for the elder's — is the mechanism behind much financial exploitation, often by an adult child, a 'new friend,' or a paid caregiver. Caregiver stress is a risk factor but not an excuse or a defense: many stressed caregivers do not abuse, and abuse is an act, not an explanation.

Vignette

An 81-year-old widower's adult son has power of attorney and recently moved in. The father has missed two medical appointments, has $40,000 in unexplained transfers from his account, and is deferential in his son's presence — answering questions only after looking at the son. The social worker suspects financial exploitation and emotional control. Assessment includes a private interview with the father, review of financial records, cognitive capacity assessment, and risk planning — including protective services referral where indicated.

Vulnerable-Adult Abuse

Vulnerable adults — those with physical, cognitive, or psychiatric disabilities that limit self-protection — are subject to the same abuse categories as elders. Assessment addresses capacity to consent and to protect oneself, coercion, the role of paid or unpaid caregivers, and the same red flags adapted to the adult's presentation.

Perpetrator Dynamics, Impact, and Safety Assessment

Across the lifespan, perpetrators are usually known to the victim, exercise or seek power, often minimize and deny the abuse, and may shift blame to the victim. Impact includes trauma symptoms, depression, anxiety, shame, self-blame, somatic complaints, and disrupted attachment — all of which feed the biopsychosocial formulation. Safety assessment asks: Is the victim currently safe? What is the immediate danger? What is the plan for escape or for staying safely? What protective resources (shelter, family, protective services, legal remedies) exist?

Self-Determination and Mandated Reporting Tensions

A recurring ASWB scenario: an adult victim of IPV or elder abuse does not want a report made. The social worker faces the tension between client self-determination and protective obligations. The clinical response is to: (1) assess the client's capacity to understand the situation and consequences, (2) provide information about options and consequences, (3) honor the client's wishes where law and capacity permit, (4) follow mandated-reporting law where it applies (some jurisdictions mandate reports of elder abuse or vulnerable-adult abuse even over the victim's objection), and (5) continue safety planning and support rather than abandoning the client for refusing. Reporting mechanics and jurisdiction-specific rules belong in Chapter 4; the recognition and assessment live here. The exam favors answers that both honor self-determination and meet legal duties, rather than answers that sacrifice one for the other.