The seven hidden signs your friend is in an abusive relationship, revealed by a top trauma therapist (plus how you can help)

One often imagines an abusive relationship involves physical violence.

Emotional abuse, however, is equally harmful. It leaves no visible scars but the damage can be devastating and last a lifetime. As a trauma therapist, I have seen the profound impact of emotional abuse on mental and physical health.

Emotional abuse involves behaviours that manipulate, intimidate and undermine the victim's sense of self-worth and mental wellbeing.

Emotional abuse leaves no visible scars but the damage can be devastating and last a lifetime

Because the damage is often inflicted behind closed doors, it is harder for those on the outside to recognise – and even harder to address.

But understanding the signs of emotional abuse and knowing how to support a friend or loved one could be life-saving for them and make a significant difference in their journey to recovery. Here are seven key signs to look out for . . .

1. She often cancels get-togethers

Abusers often control who their partner can see and speak to in a bid to isolate them from support networks, so they have to rely entirely on their abuser and can't ask for help. If your friend seems increasingly distant, it could be a sign of emotional abuse.

The next time she wriggles out of a lunch date, don't get cross. Regularly check in with her. Support can make a significant difference even if she doesn't always reply.

2. He is constantly putting her down

Abusers often control who their partner can see and speak to in a bid to isolate them from support networks

An emotionally abusive partner will criticise and belittle their victim, making them feel worthless and incapable. If your friend tells you she is being put down or made to feel inadequate, or if you see her partner speaking to her in this way, this is a red flag.

Also be aware that it's a big deal if she feels able to share this with you in the first place. Acknowledge her feelings and let her know that it's OK to feel scared, angry or confused. Having her emotions validated is crucial in helping her regain her sense of self.

3. She's always apologising

If your friend seems confused about her own experiences, constantly questions her memory or apologises excessively, she might be experiencing 'gaslighting' at home.

This involves making another person doubt their perception of reality – and thus their sanity. Look out for unnecessary apologies for simple slip-ups.

Because she is so used to recriminations at home, she could be terrified about the same reaction from you.

4. He accuses her of cheating

Abusers often exhibit jealousy and possessiveness, even accusing their partners of infidelity

Abusers often exhibit jealousy and possessiveness, even accusing their partners of infidelity. This can lead to isolation if she feels she shouldn't go out or speak to anyone, just in case he accuses her of flirting or seduction.

5. She's walking on eggshells

If your loved one seems fearful of making their partner angry, this is a sign of emotional abuse. The fear of triggering their partner's anger can be paralysing. This can lead to a state of constant vigilance, where she is always on edge, not knowing when the next outburst might occur.

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She might say: 'He can be so loving, but sometimes he just snaps over the smallest things,' swiftly followed by an excuse such as 'he's just stressed about work'. Be alert for any quiet mention of 'this will make him angry'. She might keep things light and superficial with you, for fear of her abuser finding out she has spoken about his behaviour.

6. She has low self-esteem

If your once-confident friend now doubts her abilities and feels unworthy, it may be a sign she's in an abusive relationship. For instance, she might start avoiding activities she once enjoyed, convinced she is no longer good enough to participate.

Compliments or praise that she used to accept graciously are now met with dismissal or disbelief. She may constantly seek validation and reassurance, expressing feelings of inadequacy and unworthiness. Statements like 'I can't do anything right' or 'I'm not good enough' will pop up in her conversations, reflecting her deepening self-doubt.

If your loved one seems fearful of making their partner angry, this is a sign of emotional abuse

7. She suffers from chronic illness

Ongoing stress can take a significant physical toll. When you are stuck in survival mode, your body will be on perpetual high alert, pumping out the stress hormone cortisol, which can wreak havoc on the body, contributing to heart disease, high blood pressure, digestive problems and weakened immune function.

How you can help...

• Don't try to force her to leave him. It is crucial to handle the situation delicately to avoid escalating the abuse. They know they should leave, but often become stuck and addicted to the small crumbs of attention they receive from their abuser. Give her time and remind her you are always there for her.

• Find places where your friend can go in case of an emergency, such as a friend's house or a local shelter.

• Establish a code word or phrase that your friend can use to signal they need help without alerting the abuser.

How to Heal After Narcissistic Abuse, by Caroline Strawson (£12.99, Hay House), is out now. As told to Louise Atkinson.