Domestic violence may leave bruises on its victims, but abuse doesn't have to be physical to leave deep, long-lasting emotional scars.

Molly Woeltje, education/outreach coordinator at the Safe House for Women in Cape Girardeau, says she meets plenty of women who don't think they're being abused unless it's physical.

"I've had clients say before that, 'He's never hit me, but ... I'm not allowed to leave the house, or he always tells me how ugly, stupid and worthless I am.' That's domestic violence, too. Just because it hasn't gotten to the physical stage yet doesn't mean you are not a victim," Woeltje says.

Woeltje says emotional or psychological abuse is the most prevalent type of nonviolent abuse, and it comes in the form of constant yelling, name-calling, belittling and isolation.

"It's a tool used by the abuser to make somebody feel the lowest of the low," she says. "Oftentimes it is co-occurring with physical abuse. Emotional may be how it starts, but it can ratchet up to physical."

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That "constant degrading" sticks with a person, Woeltje says, eventually tearing down his or her confidence and feeling of self-worth.

"The victim may know it's not true, but it becomes their inner dialogue," she explains. "It's still in the framework of, 'This person loves me, so what they're saying must be true.' It can get their self-esteem so low they will not reach out for help because they don't think they're worth it."

Because verbal abuse leaves no symptoms or evidence, it's usually not reported, says Misty Lukefahr, a mental health counselor at Beacon Health Center.

"In most cases, verbal abuse is taken by the victim and internalized with self-blame," she says.

Abuse can also be financial. If a person is not allowed to work or continue their education or has no control over their money and how it's spent, these are signs of financial abuse, Woeltje says.

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Stalking is another common type of abuse, especially with the explosion of social media, texting and even cellphone apps that can track a person or monitor their cellphone use.

"The block button can only go so far. They can always make a new profile account or use someone else's," Woeltje says.

All types of abuse -- physical, sexual, emotional, financial, stalking -- have a large emotional impact, says Woeltje, and she believes that's the most damaging thing of all.

"When you're constantly carrying around the horrible things that have been said to you, it becomes who you are and you start to think that about yourself," she says. And, she adds, "It's not very often that we see a physical act not partnered with emotional abuse."

Says Lukefahr, "Nonphysical abuse has lasting effects on a person's self-esteem, self-confidence, outlook on life, mental health (depression, suicidal thoughts, anxiety, paranoia), social and overall functioning."

Signs of abuse may include negative self-statements, depression, anxiety, social phobia, suicidal thoughts or statements, binge drinking or drug usage, wearing long sleeves and pants to cover potential bruises or marks or wearing larger clothes to hide one's body, Lukefahr says.

If you notice a friend seems down, won't look you in the eye and changes her mood and behavior -- maybe she isolates herself, skips out on your weekly coffee dates and seems more sensitive than usual, or she slacks on her hair and makeup when she used to look so put together -- there's no harm in asking if everything's OK, Woeltje says.

"Even it's just a little hint of something different or odd or out of the norm, it's always worth it to ask," she says. "It's always worth the question of, 'I'm worried about you, I've noticed you're not quite yourself, can I help you with anything, is there anything you want to talk about?'"

If you are the one being abused, Woeltje encourages you to contact the Safe House, whether you need shelter from a dangerous situation or just want to talk with a counselor or advocate. It's important to put words and knowledge to what you're feeling and going through, she says.

"Domestic violence thrives when it's kept silent and in the shadows," Woeltje says. "You don't have to live like that. As down as somebody can feel, as helpless as they can feel, there are places like the Safe House and other people that care and can help you. It's very difficult to leave situations, but take a step, whether it's telling a friend or calling a hotline. Talk to someone. Don't hold it in or keep it to yourself. Take any step you can to getting help."

__For help, call the Safe House for Women Crisis Line at (573) 651-1416, the National Domestic Violence Hotline at (800) 799-7233 or the Adult Sexual Assault and Rape Crisis Hotline at (877) 820-6278.__