Madeeha Syed

Tobacco, cannabis, and meth are among common addictions. Psychiatrists at Meri Sehat recommend rehabilitation centers to save young adults from substance abuse.

A Short Guide to Local Addictions

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A Short Guide To Local Addictions

AL SHIFA CLINIC KARACHI

Syed Intisar Hussain

Domestic Violence And Its Impact On The Child

Introduction

Two words: domestic violence. In all probabilities, the first person to spring to our minds and the focus of the entirety of the thought process that follows is the victim. Were they physically attacked? Did they suffer any injury? In more extreme cases, did they survive? A handful of us would consider if they suffered psychologically or emotionally.&nbsp; 
&nbsp;

But most of us would overlook the single most important person in the whole scenario - the child(ren) who are witnessing those two adults, people they are close to; one engaged in an act of violence, with the other at the receiving end, cowering or simply motionless. We don&rsquo;t take into account the kind of injury these kids receive, how they&rsquo;re scarred physically and mentally. 
&nbsp;

Before diving deep into the topic about the <a href="https://merisehat.pk/article/how-does-familial-conflict-or-domestic-violence-affect-children">impact of domestic violence on a child</a> we should first understand what domestic violence really is.&nbsp;

&nbsp;

Domestic violence is also known as &#39;intimate partner violence&#39; and it can be defined as a set of behavior in a relationship that is used to assert control and power over a close partner or spouse.&nbsp; 
&nbsp;

Domestic violence comes in many forms &ndash; physical, psychological, sexual, economic, and/or emotional &ndash; and the aim of such acts is to dominate over one&#39;s partner and to threaten them<a href="#accordion">[1]</a>. 
&nbsp;

The individual (male or female) who initiates violence does so by threatening, abusing, frightening, humiliating, terrorizing, or injuring their partner. The least it does is to rob the victim of their self-esteem and confidence.&nbsp; 
&nbsp;

<h5>What It&rsquo;s Not</h5>

Apologizing afterwards does not absolve the perpetrator of the crime. Abuse in any form is NOT love.&nbsp;

&nbsp;

Understanding The Impact Of Domestic Violence On Children

There is no denying that the primary victim is the one tremendously at risk of the negative consequences of the violence, but these abusive episodes negatively impact the children too, who share the same environment.&nbsp; 
&nbsp;

Caregivers, whether it&rsquo;s the mother or the father who endure domestic violence, become unavailable and distant from their kids. Their unresponsiveness to the child&#39;s demands paves way to a range of unresolved emotions in the young one who starts to feel neglected.

&nbsp;

<ul>
	<li>Serious psychological aftermath in children who are exposed to it.</li>
	<li>The place these children call home, the place meant to nurture them with affection, love, and care along with providing safety, becomes a breeding ground of insecurity and fear as a consequence of domestic violence.&nbsp;</li>
	<li>It leaves a lasting impact on their mind and personalities; the events get imprinted on their memories and stress becomes a core component of their lives.&nbsp;</li>
	<li>Children who live in an environment where domestic violence is common develop a certain set of traits such as being short-tempered, becoming habitual at lying, being frustrated, and being emotionally distracted<a href="#accordion">[2]</a>.&nbsp;</li>
	<li>When these children become adults, all their life choices including relationships are greatly influenced by this past trauma. Their beliefs stem from the fear of abandonment, sadness, excessive worry, guilt, and lack of empathy they experienced in their childhood. 
	&nbsp;</li>
</ul>

Hence, when children witness violence at home, they are not merely passive onlookers; rather, they are a part of the equation, the indirect (and perhaps unintentional) victims of it. And this &lsquo;past&rsquo; continues to haunt them throughout their lives. So, the physical and mental health of children living in such households is as much a matter of concern as that of the primary victim.

According to the Centers for Disease Control and Prevention (CDC), where domestic violence is a norm, there are 40% &ndash; 60% chances of children also receiving abuse. It&rsquo;s important to mention here that these rates are 15 times higher than the average<a href="#accordion">[2]</a>.&nbsp;

It is estimated that roughly 10 million people in the United States are affected by domestic violence. A study revealed that 1 in 15 children were exposed to domestic violence, and 1 out 3 experienced the act of violence themselves<a href="#accordion">[3]</a>. In Pakistan, around 70-90% of women experience domestic violence, which is a significant number<a href="#accordion">[4]</a>.

&nbsp;

Kids who witness intimate partner violence at their homes exhibit a range of symptoms:&nbsp; 
&nbsp;

<ul>
	<li>Increased episodes of insomnia&nbsp;</li>
	<li>Bed wetting</li>
	<li>Verbal, cognitive, and motor issues</li>
	<li>Indulgence in activities of self-harm&nbsp;</li>
	<li>Experience learning difficulties&nbsp;</li>
	<li>Aggressive behavior&nbsp;</li>
	<li>Antisocial behavior</li>
	<li>Experience depression and anxiety&nbsp; 
	&nbsp;</li>
</ul>

Children of different age groups react differently to such tense situations. 
&nbsp;

<ul>
	<li>Preschool Children: When these kids experience domestic violence, they revert to a few years and adopt activities that they did when they were younger. For instance, they start thumb-sucking, bed-wetting, crying, and whining.&nbsp;</li>
</ul>

They may also present with symptoms of separation anxiety such that they may have difficulty sleeping and wake up startled from their sleep<a href="#accordion">[5]</a>. 
&nbsp;

<ul>
	<li>School-Going Children: These children often feel deeply ashamed and guilty of the circumstances at home, because they blame themselves for the domestic violence. They have low self-esteem and frequently experience headaches and stomachaches.</li>
</ul>

Children in this age group don&#39;t participate in the class actively. They also lag behind in studies because of their inability to concentrate<a href="#accordion">[5]</a>.&nbsp; 
&nbsp;

<ul>
	<li>Teenagers: Teens who witness domestic violence react in a plethora of negative ways. They miss school and fight with family members. They also have trouble making friends, and suffer from very low self-esteem.&nbsp;</li>
</ul>

Affected teens tend to get involved in risky activities, such as using drug or alcohol, and having unprotected sex. They get involved in fighting and bullying, which puts them at risk of getting caught by the law. Teen boys are more likely to get involved in this kind of behavior, as they react more outwardly to the domestic violence at home. Whereas, teenage girls often become socially withdrawn and experience depression by keeping their feelings to themselves<a href="#accordion">[5]</a>.

&nbsp;

These children are likely to become offenders or victims as adults, repeating the cycle that they were part of.&nbsp;Rarely, they are able to break themselves free from the cycle of abuse and violence. In those rare instances, they adopt a healthy and holistic approach towards life and relationships, because they don't want someone else to go through the terrible phase of domestic violence that they went through as a kid.&nbsp;

The impact of domestic violence on a child is evident in the short as well long term. In the subsequent paragraphs, the article sheds light on what are the challenges faced by these kids.&nbsp; 
&nbsp;

<ul>
	<li>
	<h5>Anxiety&nbsp;</h5>
	</li>
</ul>

Children who have witnessed domestic violence are hypersensitive about their surroundings. They feel like they are living on an edge or walking on eggshells, as they fear that any action of theirs could trigger another episode of domestic violence at home. It is not surprising that these children somehow manage to blame themselves for all the violence. This belief in return bruises their self-esteem and robs them of their self-confidence<a href="#accordion">[3].</a>&nbsp; 
&nbsp;

<ul>
	<li>
	<h5>Depression&nbsp;</h5>
	</li>
</ul>

Staying in a toxic household where domestic violence is common triggers anxiety in children and their mental health deteriorates. The young ones struggle with sadness, low mood, difficulty concentrating, and other symptoms that hint towards depression. As they grow older, these children become depressed adults. This unfortunate situation continues, unless a therapeutic intervention is made by a therapist<a href="#accordion">[3]</a>.&nbsp; 
&nbsp;

<ul>
	<li>
	<h5>Post-Traumatic Stress Disorder&nbsp;</h5>
	</li>
</ul>

One of the most detrimental effects of domestic violence is that children develop post-traumatic stress disorder (PTSD). Just witnessing violence is enough to make them enter a downward spiral of PTSD which includes stress, insomnia, having frequent nightmares, experiencing flashbacks, and being unable to concentrate<a href="#accordion">[3]</a>. 
&nbsp;

<ul>
	<li>
	<h5>Physical Effects&nbsp;</h5>
	</li>
</ul>

Domestic violence has a physical effect on the health of children. These children frequently experience headaches and stomachaches that are linked with episodes of violence at home.&nbsp; 
&nbsp;

<ul>
	<li>
	<h5>Physical Abuse</h5>
	</li>
</ul>

Caregivers, who are either offenders or endurers of domestic violence, are not able to provide their child with the safety they need from his or her parents. In fact, such parents can even hurt their children in multiple ways either emotionally, verbally, or physically. In this way, children become the primary victim of violence. It shatters their personality, and breaks them from within<a href="#accordion">[3]</a>.&nbsp; 
&nbsp;

<ul>
	<li>
	<h5>Aggressive Behavior&nbsp;</h5>
	</li>
</ul>

As mentioned earlier, it is not unexpected that children from violent households become aggressive and are often short tempered. They become reckless and get involved in multiple risky activities like skipping school and getting in trouble with the law.&nbsp; 
&nbsp;

<ul>
	<li>
	<h5>Health Issues</h5>
	</li>
</ul>

As adults, these children develop a myriad of health problems such as obesity, hypertension, diabetes. These health problems are usually linked with chronic stress and abuse, which is the case of children living in an environment where domestic violence is sadly prevalent.&nbsp;

&nbsp;

It is integral to help our children recover if they have been an (in)direct victim of domestic violence<a href="#accordion">[5]</a>:

<ul>
	<li>Leave the abusive relationship for the safety of children.</li>
	<li>Help the children open up about their fears.</li>
	<li>Educate them about healthy relationships, and help them differentiate what is a healthy relationship and what is not.</li>
	<li>Help them learn about boundaries. Teach them that no one is allowed to touch them or make them feel uncomfortable. Similarly, they should not make others feel uncomfortable by doing any unacceptable activity.&nbsp;</li>
	<li>Find a therapist who can be a counsellor and a support system to back the child, and help them navigate through their journey as they unlearn the negative effects that violence had on them.</li>
	<li>Get the affected child cognitive behavioural therapy (CBT), as it is known to be an effective treatment option for people undergoing depression or anxiety due to any cause.&nbsp;</li>
</ul>

&nbsp;

There are multiple organizations that offer services to children who are negatively impacted by violence, abuse, or neglect. These organizations include: 
&nbsp;

<ul>
	<li>Center For Violence And Injury Prevention - Funded by the Centers for Disease Control and Prevention (CDC), this organization aims to promote healthy young adults by advancing violence prevention strategies backed by evidence<a href="#accordion">[6]</a>. 
	&nbsp;</li>
	<li>American Professional Society On The Abuse Of Children - This is a nonprofit organization that offers services to children who receive maltreatment at their homes<a href="#accordion">[7]</a>.&nbsp; 
	&nbsp;</li>
	<li>American Psychological Association - This is for children who have experienced youth violence, abuse, or maltreatment<a href="#accordion">[8]</a>. 
	&nbsp;</li>
	<li>Protection And Help Of Children Against Abuse And Neglect (PAHCHAAN) &ndash; It is a not-for-profit child&#39;s rights and protection organization working to enhance and better the future of several families in Pakistan, by providing family support, provision of necessary training and knowledge for parents and alternative carers<a href="#accordion">[9]</a>.&nbsp; 
	&nbsp;</li>
	<li>Sahil &ndash; This is an Islamabad-based organization working on child protection, especially child sexual abuse, by providing free counselling and legal aid for victims of sexual abuse<a href="#accordion">[10]</a></li>
</ul>

&nbsp;

Conclusion

Domestic violence is a painful dilemma not only for the primary victim but also for the child that witnesses it. To mitigate the mental and physical damage that domestic violence causes to these children, seek help from mental health professionals. They can help children overcome their fears and challenges and enable them to live life as healthy individuals.&nbsp;

&nbsp;

Key Points

<ul>
	<li>Domestic violence is also known as intimate partner violence, and comes in multiple forms. In the setting of domestic violence, one partner threatens and overpowers the other by one or all means: emotional, psychological, sexual, and physical.</li>
	<li>Children coming from a background of domestic violence have disrupted personalities, and their mental health is in a feeble state.</li>
	<li>These children become anxious and depressed. They can also suffer PTSD, and experience physical effects after episodes of violence.</li>
	<li>Children who have been indirect victims of domestic violence find it hard to concentrate and suffer academically.</li>
	<li>These children also become aggressive and get involved in reckless activities.</li>
	<li>Support from caregivers and seeking professional treatment by a therapist are ways to overcome the negative effects of domestic violence.</li>
	<li>There are several national and international organizations that offer services ranging from counselling to legal advice, to children facing these issues.</li>
</ul>

&nbsp;

[1] "What Is Domestic Abuse? - the United Nations."

[2]  Alarming Effects of Children's Exposure to Domestic Violence." 26 Feb. 2019,

[3] "How Witnessing Domestic Violence Affects Children - Verywell Mind." 17 Nov. 2021,

[4] "Review Articles - JPMA - Journal Of Pakistan Medical Association."

[5] "Effects of domestic violence on children - Office on Women's Health." 15 Feb. 2021,

[6] "Organizations Providing Family/Domestic Violence Information."

[7] “American Professional Society on the Abuse of Children.”

[8] “American Psychological Association.”

[9] “PAHCHAAN (Protection and Help of Children Against Abuse and Neglect).”

[10] “Sahil”

Nawal Adnan

Unmasking The Unseen Wounds: How To Recognize Signs Of Emotional Abuse

Overview

Emotional abuse is a subtle but devastating form of mistreatment that can leave deep psychological scars. Unlike physical abuse, its wounds are not visible, but its impact can be just as severe. Recognizing signs of emotional abuse is crucial in order to protect oneself or others from its detrimental effects. This article sheds light on the intricacies of emotional abuse, its manifestations, and offers guidance on how to recognize its hidden signs. 
&nbsp;

Understanding Emotional Abuse

Emotional abuse is a pattern of behaviour designed to undermine an individual&#39;s self-esteem, confidence, and sense of self-worth. This type of abuse doesn&#39;t involve physical harm, but it can be just as damaging, if not more so, because its effects are internal and insidious. Perpetrators of emotional abuse often manipulate, belittle, and control their victims, leaving them feeling powerless and trapped. 
&nbsp;

Signs Of Emotional Abuse

<ol>
	<li>Constant Criticism: A hallmark of emotional abuse is relentless criticism. An abuser might criticize every aspect of their victim&#39;s life, from appearance to choices, in an effort to erode self-confidence.</li>
	<li>Isolation: Emotional abusers often isolate their victims from friends and family, making them solely dependent on the abuser for emotional support. This isolation creates an environment where the victim feels trapped and unable to seek help.</li>
	<li>Gaslighting: <a href="https://merisehat.pk/article/how-to-recognise-gaslighting-and-get-help">Gaslighting</a> involves distorting reality to make the victim doubt their perception of events. Abusers may deny their actions, manipulate situations, or even question the victim&#39;s sanity, causing confusion and self-doubt.</li>
	<li>Undermining Achievements: An emotional abuser may belittle their victim&#39;s achievements or downplay their successes. This tactic is used to make the victim feel inadequate and unworthy of recognition.</li>
	<li>Control And Manipulation: Abusers exercise control over their victims by making decisions for them, monitoring their activities, and even dictating their thoughts and emotions. Manipulation is employed to maintain dominance and subjugate the victim&#39;s autonomy.</li>
	<li>Humiliation And Insults: Public humiliation, name-calling, and insults are tactics used to demean the victim and lower their self-esteem. This behaviour reinforces the abuser&#39;s power dynamic.</li>
	<li>Emotional Withdrawal: Abusers may intentionally withhold affection, attention, or emotional support, causing the victim to constantly seek validation and approval.</li>
	<li>Threats And Intimidation: Emotional abusers may use threats, intimidation, or even violence to maintain control. This creates an atmosphere of fear and submission. 
	&nbsp;</li>
</ol>

Recognizing emotional abuse can be challenging due to its subtle nature. Victims may initially dismiss or downplay the signs, attributing them to stress or misunderstandings. However, paying attention to one&#39;s emotional state and seeking external perspective is vital.

<ol>
	<li>Trust Your Instincts: If something doesn&#39;t feel right in a relationship, it&#39;s important to trust your gut feelings. If you find yourself constantly anxious, fearful, or emotionally drained, it might be a sign of emotional abuse.</li>
	<li>Observe Patterns: Look for consistent patterns of behaviour, rather than isolated incidents. Emotional abuse is characterized by repetitive tactics aimed at maintaining control.</li>
	<li>Seek Support: Share your experiences with a trusted friend, family member, therapist, or counsellor. Their outside perspective can help you better understand if you&#39;re in an emotionally abusive situation.</li>
	<li>Document Instances: Maintain a record of instances where you&#39;ve felt belittled, controlled, or manipulated. This documentation can serve as evidence if you decide to seek help or take legal action. 
	&nbsp;</li>
</ol>

Bottom Line

Emotional abuse can be incredibly damaging, leaving long-lasting scars on an individual&#39;s self-esteem and mental well-being. Recognizing the signs of emotional abuse is the first step toward breaking free from its cycle and seeking help. Trust your instincts, seek support, and prioritize your emotional well-being. No one deserves to be subjected to emotional abuse, and everyone has the right to live a life free from manipulation, control, and mistreatment.

Umna Salah

Unseen Scars: Navigating The Depths Of Emotional Abuse's Impact

Imagine a wound that leaves no visible mark but aches relentlessly, affecting every facet of your life. This is the nature of <a href="https://merisehat.pk/article/unmasking-the-unseen-wounds-how-to-recognize-signs-of-emotional-abuse">emotional abuse</a>. Often underestimated, emotional abuse leaves a profound mark on victims, impacting both their short-term well-being and long-term mental health. In this article, we&#39;ll embark on a journey to uncover the hidden repercussions of emotional abuse, shedding light on its short- and long-term effects with a friendly and engaging tone. 
&nbsp;

Emotional Abuse's Impact

Emotional abuse doesn&#39;t leave bruises, but it leaves an indelible mark on a person&#39;s emotional landscape. The short-term effects are like ripples on a pond, with each one impacting a different area of life.

<ol>
	<li>Low Self-Esteem And Self-Worth: Constant criticism, belittling, and derogatory comments chip away at a person&#39;s self-esteem. Victims often start believing they are unworthy and incompetent, leading to feelings of inadequacy.</li>
	<li>Anxiety And Fear: Living in a state of uncertainty, victims of emotional abuse often become anxious, fearing the next outburst or negative encounter. This constant unease can manifest physically as well, with headaches, nausea, and even panic attacks.</li>
	<li>Isolation And Loneliness: Emotional abusers often isolate their victims from friends and family, leaving them feeling alone and without a support system. This isolation can lead to a deep sense of loneliness and helplessness.</li>
	<li>Depression: The barrage of negative emotions and manipulation can plunge victims into depression. Feelings of sadness, hopelessness, and a loss of interest in things once enjoyed are common.</li>
	<li>Difficulty Trusting: When someone you trust has betrayed that trust, it becomes challenging to believe in the intentions of others. Victims may become overly cautious and skeptical, making it difficult to form new relationships. 
	&nbsp;</li>
</ol>

While the immediate aftermath of emotional abuse is painful, its echoes can be even more distressing. The long-term effects seep into the core of a person&#39;s identity, influencing their choices, relationships, and mental health.

<ol>
	<li>Complex Post-Traumatic Stress Disorder (C-PTSD): Prolonged emotional abuse can lead to C-PTSD, a more intense version of PTSD. Flashbacks, nightmares, and emotional dysregulation are some of its symptoms.</li>
	<li>Poor Self-Image And Self-Sabotage: Long-term emotional abuse can result in a distorted self-image. Victims may engage in self-sabotaging behaviors, often avoiding opportunities due to a lack of belief in their abilities.</li>
	<li>Difficulty Forming Healthy Relationships: Emotional abuse skews the perception of what constitutes a healthy relationship. Victims might struggle to set boundaries, fear vulnerability, and have a skewed sense of love and respect.</li>
	<li>Impact On Parenting: Those who grew up in emotionally abusive households may find it challenging to break the cycle when they become parents themselves. The learned behaviors can affect their parenting style and the way they nurture their own children.</li>
	<li>Negative Coping Mechanisms: Victims might resort to unhealthy coping mechanisms such as substance abuse, self-harm, or excessive eating to numb the emotional pain they carry.</li>
	<li>Impaired Emotional Regulation: Emotional abuse can hinder the development of healthy emotional regulation skills, leading to difficulty managing and expressing emotions in a balanced manner. 
	&nbsp;</li>
</ol>

While the effects of emotional abuse are profound, they don&#39;t have to be permanent. The journey to healing requires patience, self-compassion, and often the support of professionals.

<ol>
	<li>Therapy And Counseling: Engaging in therapy, particularly cognitive-behavioral therapy (CBT) or trauma-focused therapy, can provide tools to address the negative beliefs and emotions stemming from emotional abuse.</li>
	<li>Building A&nbsp;Support System: Surrounding yourself with people who uplift and support you is essential. Building healthy relationships can help reshape your understanding of trust and love.</li>
	<li>Learning Healthy Boundaries: Establishing and maintaining boundaries is crucial. Learning to say no, communicate effectively, and assert your needs can aid in breaking free from the cycle of abuse.</li>
	<li>Self-Care And Self-Compassion: Practicing self-care and showing self-compassion helps in nurturing your emotional well-being. Engage in activities that bring you joy and remind you of your inherent worth.</li>
	<li>Educating Yourself: Educate yourself about healthy relationships, emotional manipulation, and the effects of emotional abuse. Knowledge empowers you to recognize unhealthy dynamics and make informed choices. 
	&nbsp;</li>
</ol>

Emotional abuse is like a stealthy thief that robs you of your emotional well-being and self-worth. Its short-term and long-term effects can cast a shadow over your life. However, you possess the resilience to overcome its impact. By seeking help, fostering supportive relationships, and practicing self-care, you can heal and rebuild a life that&#39;s defined by your own strength, value, and happiness. Remember, the scars may be unseen, but your strength shines through as you embark on the journey to reclaim your emotional freedom.

Navigating Verbal Abuse: Understanding, Recognizing, And Taking Action

Verbal abuse is a form of emotional mistreatment that uses words to control, demean, and belittle others. Though it doesn&#39;t leave physical scars, its impact can be just as damaging, affecting a person&#39;s mental and emotional well-being. This article delves deep into the world of verbal abuse, shedding light on its nature, helping readers recognize abusive behaviors, and offering guidance on how to take the necessary steps to protect oneself or others. 
&nbsp;

Understanding Verbal Abuse

Verbal abuse is a pattern of behavior where an individual uses derogatory language, insults, threats, and manipulation to exert power and control over another person. It can occur in various settings, including relationships, workplaces, families, and friendships. Verbal abuse takes on many forms and can range from overt aggression to subtle manipulation. 
&nbsp;

<h5>Recognizing Abusive Behaviors</h5>

<ol>
	<li>Name-Calling And Insults: Verbal abusers use derogatory language and insults to demean and belittle the victim, attacking their self-esteem.</li>
	<li>Yelling And Screaming: Raising one&#39;s voice excessively, yelling, or screaming is a way of intimidating and asserting dominance over the victim.</li>
	<li>Threats And Intimidation: Abusers may threaten physical harm, emotional harm, or the end of a relationship to create fear and submission.</li>
	<li>Blame-Shifting: Verbal abusers often deflect responsibility for their actions by blaming the victim for their behavior, making the victim question their actions.</li>
	<li>Gaslighting: Gaslighting involves manipulating the victim&#39;s perception of reality, making them doubt their memories, thoughts, and feelings.</li>
	<li>Withholding Affection: Verbal abusers may use affection as a tool for control, withdrawing it when the victim doesn&#39;t comply with their demands.</li>
	<li>Public Humiliation: Humiliating the victim in front of others is a tactic used to exert power and control while undermining their self-esteem.</li>
	<li>Constant Criticism: Verbal abusers criticize the victim&#39;s appearance, abilities, and choices, eroding their self-confidence. 
	&nbsp;</li>
</ol>

<h5>Recognizing Abusive Relationships</h5>

<ol>
	<li>Feeling Afraid: If you&#39;re afraid of how the other person might react to something you say or do, it&#39;s a sign that the relationship might be verbally abusive.</li>
	<li>Constantly Walking On Eggshells: You find yourself constantly monitoring your behavior to avoid upsetting the other person.</li>
	<li>Feeling Worthless: Verbal abuse often leaves victims feeling worthless, unlovable, and powerless.</li>
	<li>Isolation: Abusers may isolate victims from friends and family, creating an environment where they have full control.</li>
	<li>Inconsistent Behavior: Abusers might alternate between affection and aggression, causing confusion and dependency in the victim. 
	&nbsp;</li>
</ol>

<h5>Taking Action</h5>

<ol>
	<li>Set Boundaries: Establish clear boundaries and communicate them assertively. Let the abuser know what behaviors are unacceptable.</li>
	<li>Seek Support: Reach out to friends, family, or a therapist who can provide emotional support and an external perspective.</li>
	<li>Document Instances: Maintain a record of abusive incidents, including dates, times, and descriptions. This can be helpful if legal action is necessary.</li>
	<li>Create An Exit Plan: If you&#39;re in a dangerous situation, create a plan to leave safely. This might involve seeking shelter or assistance from professionals.</li>
	<li>Contact Authorities: If the abuse becomes physical or you fear for your safety, don&#39;t hesitate to involve law enforcement. 
	&nbsp;</li>
</ol>

<h5>Seeking Healing And Recovery</h5>

<ol>
	<li>Therapy And Counseling: A therapist can help you process the trauma, rebuild self-esteem, and develop healthy coping mechanisms.</li>
	<li>Self-Care: Prioritize self-care activities that nurture your emotional well-being and remind you of your worth.</li>
	<li>Education: Educate yourself about healthy relationships, boundaries, and communication to prevent falling into similar patterns in the future.</li>
	<li>Support Groups: Joining support groups for survivors of abuse can provide a safe space to share experiences and insights. 
	&nbsp;</li>
</ol>

Verbal <a href="https://merisehat.pk/article/unmasking-the-unseen-wounds-how-to-recognize-signs-of-emotional-abuse">abuse</a> is a damaging form of mistreatment that can have long-lasting effects on an individual&#39;s mental and emotional health. Recognizing abusive behaviors, understanding the dynamics of abusive relationships, and taking action to protect yourself or others are crucial steps towards breaking free from the cycle of abuse. Remember, everyone deserves to be treated with respect and kindness. By seeking help, setting boundaries, and prioritizing your well-being, you can pave the way for healing, recovery, and the pursuit of healthy relationships.

Unmasking Narcissistic Abuse: 10 Telltale Signs, Psychology Insights, And Pathways To Healing

Narcissistic abuse is a deeply manipulative form of mistreatment that leaves victims grappling with emotional scars. Recognizing the signs of narcissistic abuse is paramount for individuals to break free from its clutches and embark on a journey of healing. In this comprehensive article, we will explore the intricate world of narcissistic abuse, shedding light on its manifestations, delving into the psychology behind narcissistic behavior, and offering actionable guidance on what steps to take when faced with this damaging dynamic. 
&nbsp;

Understanding Narcissistic Behavior

Narcissistic behavior is rooted in an excessive need for admiration, lack of empathy, and an inflated sense of self-importance. When these traits manifest in relationships, they can lead to narcissistic abuse&mdash;a pattern of manipulation, control, and emotional exploitation. 
&nbsp;

<h5>Recognizing The Signs Of Narcissistic Abuse</h5>

<ol>
	<li>Constant Need For Validation: Narcissists demand constant praise and validation, often at the expense of the victim&#39;s own needs.</li>
	<li>Gaslighting And Denial: <a href="https://merisehat.pk/article/how-to-recognise-gaslighting-and-get-help">Gaslighting</a> is a hallmark of narcissistic abuse. The narcissist manipulates the victim&#39;s perception of reality, making them doubt their own memory and sanity.</li>
	<li>Manipulative Behavior: Narcissists use manipulation to control the victim&#39;s emotions, choices, and reactions.</li>
	<li>Lack Of Empathy: They have difficulty empathizing with others, dismissing the victim&#39;s feelings and needs.</li>
	<li>Idealization And Devaluation: Narcissists cycle between idealizing the victim and devaluing them, leaving the victim confused and seeking approval.</li>
	<li>Isolation: It is common for narcissists to isolate the victim from friends and family, diminishing the victim&#39;s support network.</li>
	<li>Blame-Shifting: When faced with accountability, narcissists deflect blame onto others, often the victim.</li>
	<li>Exploitative Behavior: Narcissists exploit others for personal gain, disregarding the victim&#39;s feelings and well-being.</li>
	<li>Emotional Manipulation: Emotional manipulation and guilt-tripping are tactics used to control and maintain power over the victim.</li>
	<li>Triangulation: Narcissists involve third parties to create jealousy and insecurity in the victim, causing them to compete for attention. 
	&nbsp;</li>
</ol>

<h5>The Psychology Behind Narcissistic Behavior</h5>

Narcissistic behavior often stems from deep-seated insecurities and a fragile self-esteem. To compensate for these vulnerabilities, narcissists construct a grandiose facade and manipulate others to gain a sense of control and validation. Their inability to empathize is a defense mechanism to protect their fragile ego. 
&nbsp;

<h5>Taking Steps Toward Healing</h5>

<ol>
	<li>Acknowledge The Abuse: Recognize that you&#39;ve experienced narcissistic abuse. This acknowledgment is the first step toward breaking free.</li>
	<li>Set Boundaries: Establish clear boundaries with the narcissist to protect yourself from further manipulation.</li>
	<li>Seek Professional Help: A therapist can provide guidance, helping you process the trauma, rebuild self-esteem, and develop coping strategies.</li>
	<li>Build A&nbsp;Support System: Surround yourself with friends and family who validate your experiences and offer emotional support.</li>
	<li>Practice Self-Care: Engage in self-care activities that prioritize your mental and emotional well-being.</li>
	<li>Educate Yourself: Understanding narcissism empowers you to navigate future relationships more effectively.</li>
	<li>No Contact Or Limited Contact: Depending on the situation, consider limiting or cutting off contact with the narcissist to regain your autonomy.</li>
	<li>Therapeutic Techniques: Therapies like Cognitive-Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT) can equip you with tools to manage emotions and responses.</li>
	<li>Rediscover Yourself: Reconnect with activities, hobbies, and interests that bring you joy and a sense of identity. 
	&nbsp;</li>
</ol>

Narcissistic abuse is a pervasive pattern that can leave deep emotional scars. By recognizing the signs, understanding the psychology behind narcissistic behavior, and taking proactive steps toward healing, individuals can break free from the cycle of manipulation and regain control of their lives. Remember, you deserve to be treated with respect and kindness. By seeking support, setting boundaries, and prioritizing your well-being, you can navigate a path toward healing, growth, and healthier relationships.

Elder Abuse: Unveiling The Shadows, Recognizing The Signs, And Taking Action

As our society ages, the unfortunate reality of elder abuse becomes increasingly relevant. Elder abuse encompasses a range of harmful actions targeting older adults, often perpetrated by individuals in positions of trust. This insidious issue can take many forms, from physical violence to emotional manipulation, and even financial exploitation. In this comprehensive blog post, we&#39;ll delve into the disturbing world of elder abuse, shed light on how to spot its subtle signs, and equip you with the knowledge to put an end to it. 
&nbsp;

Understanding the Spectrum of Elder Abuse

Elder abuse is not limited to a single form; it can manifest in various ways, each leaving lasting scars on the victims:

<ol>
	<li>Physical Abuse: This involves inflicting physical pain or injury on an older adult. Unexplained bruises, broken bones, or repeated injuries could be telltale signs.</li>
	<li>Emotional Abuse: Emotional abuse takes a toll on an elder&#39;s mental well-being, causing distress, anxiety, and depression. Humiliation, isolation, and intimidation are common tactics employed by abusers.</li>
	<li>Financial Exploitation: Abusers take advantage of an elder&#39;s financial resources, coercing them to give away money, property, or assets. Sudden and unexplained changes in financial status may be red flags.</li>
	<li>Neglect: Caregivers who fail to provide adequate care for an older adult&#39;s basic needs, such as food, hygiene, and medical attention, are guilty of neglect. Unsanitary living conditions and untreated health issues are signs of neglect.</li>
	<li>Sexual Abuse: <a href="https://merisehat.pk/article/sexual-abuse-vs-assault-whats-the-difference">Sexual abuse</a> of older adults is a deeply distressing issue that is often underreported. Signs may include unexplained infections or injuries in genital areas. 
	&nbsp;</li>
</ol>

<h5>Spotting The Signs Of Elder Abuse</h5>

Recognizing the signs of elder abuse is crucial in putting an end to this pervasive problem:

<ol>
	<li>Physical Signs: Look for unexplained injuries, bruises, welts, or marks. Frequent falls or fractures can also be indicators of potential abuse.</li>
	<li>Emotional Changes: Watch for sudden shifts in behavior, withdrawal from social activities, or a noticeable increase in fear or anxiety.</li>
	<li>Financial Irregularities: Keep an eye out for unexpected changes in financial circumstances, such as missing money, altered wills, or sudden transfers of assets.</li>
	<li>Neglected Living Conditions: A neglected elder may have poor hygiene, bedsores, inadequate clothing, or live in unsanitary surroundings.</li>
	<li>Isolation And Unusual Behavior: Elder abuse often involves isolating the victim from friends and family. Be wary of caregivers who prevent or monitor visits and phone calls. 
	&nbsp;</li>
</ol>

<h5>Taking Action To Stop Elder Abuse</h5>

<ol>
	<li>Report Suspected Abuse: If you suspect elder abuse, report it to the appropriate authorities, such as Adult Protective Services or law enforcement. They have the expertise to investigate and intervene.</li>
	<li>Support The Elder: If you suspect someone is being abused, offer emotional support and encourage them to talk about their experiences. Assure them that help is available.</li>
	<li>Involve Professionals: If financial exploitation is suspected, involve financial professionals, lawyers, or banks to safeguard the elder&#39;s assets.</li>
	<li>Seek Legal Assistance: If the situation demands, consult legal experts who specialize in elder law to explore options for restraining orders or guardianship.</li>
	<li>Educate And Raise Awareness: Spread awareness about elder abuse within your community. Host workshops, seminars, or awareness campaigns to educate others about spotting the signs and taking action.</li>
	<li>Promote Strong Relationships: Building strong connections with older adults in your life can reduce their vulnerability to abuse. Check in regularly, listen to their concerns, and create a safe space for them to express themselves. 
	&nbsp;</li>
</ol>

<h5>Preventing Future Elder Abuse</h5>

Prevention is a powerful tool against elder abuse. By promoting education, awareness, and support, we can work towards a future free from this troubling issue:

<ol>
	<li>Education Programs: Implement educational programs in schools and communities to raise awareness about elder abuse and its various forms.</li>
	<li>Caregiver Training: Provide caregivers with proper training on the responsibilities and ethical obligations of caring for older adults.</li>
	<li>Legislation And Policy: Advocate for stronger legislation and policies that protect the rights and well-being of older adults, making elder abuse less likely to occur.</li>
	<li>Regular Health Check-Ins: Regular health check-ups can help detect physical and emotional changes in older adults, making it easier to identify potential abuse. 
	&nbsp;</li>
</ol>

Elder abuse is a silent epidemic that thrives in the shadows of our society. By recognizing the signs and taking action, we can become advocates for those who may not have a voice. The key lies in spreading awareness, educating ourselves and others, and providing unwavering support to older adults. Together, we can shine a light on the darkness of elder abuse and pave the way for a future where all seniors live with dignity, respect, and security.

Sexual Abuse Vs Assault: What’s The Difference?

In a world where discussions surrounding <a href="https://merisehat.pk/article/coping-with-sexual-violence-and-assault-a-guide-to-healing-and-recovery">sexual violence</a> are increasingly prevalent, it&#39;s essential to differentiate between two critical terms: sexual abuse and sexual assault. While these phrases may seem synonymous, they carry distinct connotations and legal implications. This article aims to clarify the differences between sexual abuse and sexual assault, providing readers with a deeper understanding of these sensitive issues. 
&nbsp;

Understanding the differences between sexual abuse and assault

<ul>
	<li>Understanding The Scope: Sexual abuse encompasses a wide range of non-consensual sexual behaviors, making it a broad and inclusive term. This category includes actions such as unwanted touching, harassment, voyeurism, and non-consensual sexting. Sexual abuse can occur in various settings, such as domestic, workplace, or institutional environments. 
	&nbsp;</li>
	<li>Emotional Impact: Survivors of sexual abuse often grapple with emotional distress, including feelings of violation, guilt, and shame. These experiences can have long-lasting psychological consequences, affecting an individual&#39;s mental health and overall well-being. 
	&nbsp;</li>
</ul>

<ul>
	<li>Understanding The Scope: Sexual assault, on the other hand, refers to any non-consensual sexual contact or penetration. This can range from unwanted groping to rape, involving physical force, threats, or incapacitation. Sexual assault is a criminal offense and is prosecuted as such in most jurisdictions. 
	&nbsp;</li>
	<li>Legal Consequences: Sexual assault is a severe crime, and those found guilty can face substantial penalties, including imprisonment. Legal definitions and consequences for sexual assault vary by jurisdiction, but it is universally considered a crime against the victim&#39;s autonomy and bodily integrity. 
	&nbsp;</li>
</ul>

<ul>
	<li>Scope: Sexual abuse encompasses a broader range of non-consensual sexual behaviors, while sexual assault specifically involves non-consensual sexual contact or penetration. 
	&nbsp;</li>
	<li>Legal Implications: Sexual assault is a criminal offense with defined legal consequences, while sexual abuse may or may not lead to criminal charges, depending on the severity and context of the behavior. 
	&nbsp;</li>
	<li>Emotional Impact: Both sexual abuse and sexual assault can have profound emotional effects on survivors, but the emotional toll may differ based on the nature and severity of the incident. 
	&nbsp;</li>
</ul>

Distinguishing between sexual abuse and sexual assault is crucial for fostering a better understanding of these complex issues. Clear terminology and respectful discourse are essential to support survivors, advocate for justice, and raise awareness. Whether it&#39;s through legal channels or support networks, addressing these forms of harm is vital for creating a safer and more compassionate society.

Staff Writer

Understanding The Dynamics: Why Family Members Take Sides In Sexual Abuse Cases

<a href="https://merisehat.pk/article/sexual-abuse-vs-assault-whats-the-difference">Sexual abuse</a> within families is a painful and distressing issue that can shatter the very core of a household. One particularly challenging aspect of such cases is the tendency for family members to take sides, often leading to divided loyalties. This article aims to uncover the underlying reasons behind why some family members support the survivor while others side with the perpetrator. 
&nbsp;

supporting factors For survivors

<ol>
	<li>&nbsp;Loyalty To The Perpetrator: Some family members may have a deep-seated loyalty to the perpetrator, making it difficult for them to accept the reality of the abuse. Loyalty may stem from long standing relationships, familial bonds, or a sense of denial to protect the family&#39;s reputation.</li>
	<li>&nbsp;Fear Of Consequences: Family members may fear the consequences of acknowledging the abuse. This includes potential legal actions, public humiliation, or the disruption of the family unit. This fear can drive them to side with the perpetrator as a means of self-preservation. 
	&nbsp;</li>
</ol>

1. Protecting The Family Image: Cognitive dissonance, a psychological phenomenon where individuals hold contradictory beliefs, can play a significant role. Some family members may choose to side with the perpetrator to maintain the illusion of a perfect family, even when faced with evidence of abuse.

2. Self-Justification: Siding with the perpetrator may help family members justify their inaction or ignorance regarding the abuse. It allows them to avoid feelings of guilt or responsibility for failing to protect the survivor. 
&nbsp;

1. Concern For Family Unity: The fear of tearing the family apart can lead some members to take sides. They may believe that supporting the survivor would only deepen the rift within the family, and they may prioritize maintaining harmony over addressing the abuse. 
&nbsp;

1. Emotional Manipulation: Perpetrators of sexual abuse can be skilled manipulators. They may use emotional blackmail, threats, or coercion to sway family members to their side, making it difficult for them to see the truth.

2. Emotional Attachment To The Perpetrator: In some cases, family members may have a strong emotional attachment to the perpetrator, such as a parent or sibling. This attachment can cloud their judgment and lead them to defend the abuser. 
&nbsp;

The dynamics of family members taking sides in cases of sexual abuse are deeply complex and often rooted in a range of psychological and emotional factors. Recognizing these reasons is essential for understanding the challenges that survivors and their advocates face when seeking justice and support within their own families. Breaking the silence and encouraging open dialogue about sexual abuse is a crucial step towards addressing this issue and providing survivors with the help and validation they deserve.

Drug addiction is defined as &lsquo;a neuropsychological disorder leading to intense and persistent urge to use a substance.&rsquo; It overrides a person&rsquo;s self-control and his or her awareness of harmful effects by altering their brain function.&nbsp; 
Addiction is thus identified as a brain disorder and not a personal failure on the part of the individual. Much of the conversation around drug addictions needs to be remodeled based on these principles.&nbsp; 
When we talk about substance abuse in Pakistan our mind immediately conjures up a very particular image of cachectic men huddled in street corners trying to have their most recent hit. This, however, is not the whole picture.&nbsp; 
&nbsp;

Guide to Local Addictions

In recent years, drugs have become not only much more readily available but also cheaper. The youth of Pakistan from all classes and social strata has found themselves using one thing or another at some point. Those who manage to stay away from it have still been impacted by it in some way. Road accidents, broken <a href="https://merisehat.pk/article/love-in-a-long-term-relationship">relationships</a>, lagging behind in school and sports, overall health suffering as a result of these addictions, are just a few examples. Factors such as gender, age, class etc influence this and so does peer pressure and accessibility.&nbsp; 
 
Some of the most common local addictions we have are as follows, this list however is in no way comprehensive:&nbsp; 
&nbsp;

The most popular, most easily available, and a favorite amongst those who indulge. The psychoactive substance here is THC (tetrahydrocannabinol). Two forms of cannabis are available; hashish (hash) and charas (weed). The difference between both is the form they come in and the concentration of THC.&nbsp;

Hash has a more concentrated form of THC. It&rsquo;s either smoked by rolling in a cigarette or inhaled as a vapor by heating it up in a bong. Bhang is a mixture of cannabis and milk and is also widely consumed. Then there are cannabis teas, capsules, vapes and edibles.

It has been labeled as a gateway drug which means that the individuals indulging in this are open to experimenting with harder drugs in the future.&nbsp;

Locally, several cases have been reported where people (both children and adults) started out with smoking cannabis and ended up with addictions to harder drugs such as heroin and crystal meth.&nbsp;

In some areas the country, it&rsquo;s a part of the local culture, and happy occasions like weddings even call for it.&nbsp;

The main effects of cannabis are a feeling of euphoria and relaxation. Then there might sense of time slowing down, increased appetite, heightened senses and even paranoia and anxiety. All of these vary dramatically depending on the form, method and the person using it.&nbsp; 
&nbsp;

Pakistan has the largest cigarette-smoking populations in the world. In the era of harder drugs being accessible, cigarettes aren&rsquo;t even considered a taboo. People of all ages, genders and social strata partake in this and nicotine addiction is a major issue our population suffers from.&nbsp;

Nicotine is considered to be the culprit when it comes to forming a habit of smoking. However, it has been postulated that it is the unique combination of other chemicals added to cigarettes that may actually be facilitating the process.&nbsp;

Cigarettes contain over 7,000 chemicals and most of them are carcinogenic, what we fail to focus on is the fact that they also contain monoamine oxidase inhibitors (MAOIs). This compound is used in antidepressants and this is what leads to the characteristic &lsquo;smoker&rsquo;s high&rsquo;. A smoker&rsquo;s high is when you have increased serotonin in your brain making you feel happier.

Nicotine has other detrimental effects on the body, such as an increased heart rate and blood pressure, your blood vessels shrinking and of course the very obvious toxins introduced into the lungs. All this works together to wreak havoc on the body of the smoker while making sure that they never stop. Then there is the problem of second-hand smoke (which is very harmful for those inhaling it) which is a whole different beast of its own.&nbsp; 
&nbsp;

This is a sweet or savory mixture of crushed areca nut, tobacco, catcechu, paraffin wax, slaked lime and spices such as turmeric, cardamom, cloves, saffron. This is pretty much casually consumed by people usually belonging to the lower socio-economic classes.&nbsp;

They believe that it helps with digestion and killing germs. It also leads to a sense of euphoria, sweating, salivation, palpitation, feelings of warmth, alertness, tolerance to hunger, and a higher stamina for work.&nbsp;

Apart from the nicotine addiction this causes, gutka is a major cause of cancers of the lip, mouth, tongue, throat and esophagus. Supari is areca nut consumed on its own and is also linked with oral cancers some of which simply don&rsquo;t have a cure, such as oral submucous fibrosis. 
&nbsp;

This is derived from the poppy plant (papaver somniferum). Pakistan is a part of the golden crescent where, along with Afghanistan and Iran, 90 percent of the world&rsquo;s non-pharmaceutical grade opium is produced.&nbsp;

It is then transported through the region which makes it so readily available that can get it for as cheap as Rs10, which is cheaper than getting food here. Pakistan has therefore been called the most heroin-addicted country in the world. The active compound in the drug is morphine which has a soporific effect, hence the name. This is the main ingredient in many opioids, including heroin.&nbsp;

It can be smoked, eaten, taken as a pill or most commonly; injected. Sometimes in desperation and sometimes as a sign of brotherhood, needles are shared among the addicts. Around 92percent of PWID (people who inject drugs) were reported to practice &lsquo;booting&rsquo; or &lsquo;registering&rsquo; where blood is first jerked into the syringe and then this mixture is injected back into the system. These syringes are then shared.&nbsp; 
 
This leads to the rise of blood-borne infections and the main reason behind the HIV/AIDS crisis in the country. Hepatitis B and C are also on the rise and have the same etiology. Practices such as &lsquo;flashblood&rsquo; [khoon bozee] where another&rsquo;s opium laden-blood is injected into the body in times of scarcity, or to share the high, worsen this issue.&nbsp;

 
Harmful on its own, it is also added to marijuana joints and a mixture of marijuana, opium and heroin is also injected by some. People suffering from this particular affliction develop intense physical and psychological dependence on the drug. This has implications far and wide starting from health, work, family and ending with an added burden on the healthcare system.&nbsp; 
 
When brought to hospitals on account of either accidents or poor health requiring pain management, the bodies of these addicts fail to respond to the prescription drugs leading to severe physical and psychological distress. Helpless doctors try everything in their power to mitigate the condition but the only thing that works is what they have gotten used to. 
&nbsp;

Pakistan is one of the top 10 countries in the world where people are addicted to opioid analgesics or narcotics. These are strong prescription drugs used for pain management. Taking these in order to achieve feelings of general relaxation, happiness and a high which makes one feel as if they are weightlessly floating through life is what leads to addictions. 
 
Abusing these drugs can lead to severe adverse effects, however, the least of this is nausea, vomiting, reduced peristalsis hence constipation and the worst being respiratory depression leading to death.&nbsp; 
&nbsp;

This is an illegally brewed alcoholic drink made by fermenting sugar cane or wheat husk. Mostly consumed by teenagers, this is essentially a poison. The process happens in remote fields and has no check and balance. The hazardous effects of this are the usual alcohol-mediated liver damage but what&rsquo;s worse is that it leads to a loss of eye-sight as well.&nbsp; 
&nbsp;

Methamphetamine is a highly addictive nervous system stimulant and a recently growing addiction in a younger, more educated demographic. It can either be smoked, injected, snorted or taken by mouth. The feelings derived from this are your usual sense of euphoria but, most commonly, it leads to irritability and paranoia on the part of the user. 
 
People have reported increased focus and no loss of inhibition on this as well but most of this data is purely anecdotal. We know that this is a highly dangerous compound and can lead to strokes, convulsions and even death. It&rsquo;s also very difficult to treat meth addiction. 
&nbsp;

Pakistan&rsquo;s Drug Abuse Control Master Plan 2010-14 had the lofty aspiration of making the country drug-free by 2020, this has clearly not been executed. A pragmatic approach is needed.&nbsp;

The Lancet (a weekly peer-reviewed general medical journal) reported a government official saying that the relapse rate in Pakistan is 90 percent. The UN Office of Drugs and Crime (UNODC) published a Technical Summary Report back in 2013 which reported that 6.45 million people (aged 15-64) in Pakistan were using drugs.&nbsp;

Things are much graver now and worsened by the fact that treatment and rehabilitation efforts are underfunded. Treatment centers that are cheap are overburdened, while others charge too much for an everyday man to afford. Tertiary care hospitals with psychiatry wards refuse to admit drug addicts and consider it a waste of time and resources. There is also a lack of training and staff. Much of the responsibility is relegated to the social welfare systems which fail to accommodate the sheer weight of the issue.&nbsp;

The best way to proceed would be a coordinated effort where treatment by the health department and rehabilitation by the social welfare system is provided. However, we are still lacking such efforts. Developing an effective response will require an in-depth understanding of the issue. We must raise awareness, fund efforts, stabilize the socio-economic condition of the region strict border control, conduct studies and surveys to assess the real magnitude of the issue (the last national survey dates back to 2013).&nbsp;