Shin halayen jima'i ne za a dauka azabar? (2016)

TAMBAYOYI: An buga wannan takarda a ƙarƙashin "Muhawara" a cikin mujallar 'Jaraba'. Babban raunin shi shine cewa yana nufin magance halayen halayen jima'i (CSB), laima mai magana wanda ke rufe duk abin da ya shafi jima'i. Misali, “CSB” na iya haɗawa da luwadi ko “jarabar jima’i” kuma yana iya haɗawa da irin waɗannan halaye kamar su cin amana ko aikatawa tare da karuwai. Duk da haka yawancin masu amfani da batsa ba sa yin jima'i, kuma suna iyakance halayensu na tilasta yin amfani da batsa na intanet. "Jaraba da jima'i," da kuma bincike a kai, ana buƙatar yin la'akari daban da jarabar batsa ta Intanet. Latterarshen ƙananan ƙananan abubuwa ne Yanar-gizo buri. Duba -

Abin da ya fi ban takaici game da wannan takarda shi ne cewa "Bayanin matsalar" da kuma "Bayyana CSB" sassan game da "luwadi ne," yayin da karatun da ke tallafawa tushen kwayar cutar ta CSB kusan ke kan masu amfani da batsa na intanet. Irin wannan shubuha yana haifar da rikicewa fiye da tsabta, saboda yana buƙatar lafazin taka tsantsan game da bincike kan masu amfani da batsa na intanet, don haka yana jinkirta karɓar shaidar ƙarfi (da girma) cewa Kwarewar yanar-gizon ba shakka ba ne da kuma cin zarafin yanar gizo na yanar-gizon wani batu ne.

Shane W. Kraus1, 2, *, Valerie Voon3 da Marc N. Potenza2,4

Mataki na farko da aka buga a layi: 18 FEB 2016

Journal: Addiction

DOI: 10.1111 / add.13297

ABDRACT

Neman: Don bincika tushen shaida don ƙaddamar da halayen jima'i (CSB) a matsayin abin da ba shi da ma'ana ko kuma 'cin hanci'.

Hanyar: Bayanan da aka samo daga yankuna masu yawa (misali annoba, ilimin halitta, asibiti, nazarin halittu) ana dubawa kuma an yi la'akari da su game da bayanai daga abu da kuma cin abincin caca.

results: Akwai fasali a tsakanin CSB da abubuwan da ke amfani da kayan abu. Kwayoyin baƙi na yau da kullum zasu iya taimakawa wajen magance matsalar CSB da kuma amfani da kayan abu, da kuma binciken da ba a yi ba a kwanan nan ya nuna alamomin da suka danganci sha'awar sha'awa da sha'awa. Magungunan maganin maganin magani da magunguna na iya zama daidai ga CSB da ƙwarewar abubuwa, ko da yake babba a cikin ilimin yanzu yana wanzu.

Ƙarshe: Duk da yawan binciken binciken da ke tattare da halayen jima'i (CSB) zuwa jarabawar abubuwa, ƙananan haɓaka cikin fahimtar ci gaba da haifar da rarraba CSB a matsayin buri.

HALITTA MAI TSARKI: Addini, haɓaka hali, halayyar halayyar halayya, haɗin kai, neurobiology, cututtukan ƙwaƙwalwar ƙwayar cuta, halayyar jima'i, cin zarafin jima'i

SABATAR DA KUMA

Fassarar Daftarin Bayanai da Bayanan Lissafi (DSM-5) [1] ya canza fassarar jaraba. A karo na farko, DSM-5 ta haɗu da wani rashin lafiya ba tare da amfani da kayan abu ba (cuta ta caca) tare da maganin rashin amfani da kayan abu a cikin wani sabon nau'i mai suna: 'Matakan da ke ciki da ƙari'. Kodayake masu bincike sun yi gargadi a baya don jinsin su (2-4), maimaitawar ta haifar da muhawara, kuma ba a bayyana ko dai irin wannan tsari zai faru a 11th edition of the International Classification of Diseases (ICD-11) ) [5]. Bugu da ƙari, idan aka la'akari da matsalar caca a matsayin rashin jituwa, wasu kwamiti na DSM-5 sunyi la'akari da cewa wasu yanayi kamar labarun cinikayyar Intanet ya kamata a la'anta su kamar yadda 'Xaxox' behavioral [6]. Ko da yake ba a hada da rikici na Intanet a DSM-5 ba, an ƙara shi zuwa Sashe na 3 don nazarin. Sauran cututtuka sunyi la'akari, amma ba a cikin DSM-5 ba. Musamman ma, an tsara ka'idoji da aka tsara don rashin daidaituwa ta mazauni (7), suna samar da tambayoyi game da ganowar makomar matsala / matsanancin hali na jima'i. Abubuwan da yawa sun iya taimakawa wajen yanke shawara, tare da rashin bayanai a manyan wuraren da zasu iya taimakawa [8].

A cikin takarda na yanzu, halayen jima'i (CSB), ƙayyadadden matsalolin da ba su dace ba ko tsauraran jima'i da jima'i, roƙo / kwarewa ko dabi'un da ke haifar da matsala ta jiki ko ɓarna a cikin aikin yau da kullum, za a yi la'akari, kamar yadda zai yiwu dangantaka da caca da kuma jarabacin abu. A cikin CSB, hanzari da jima'i na jima'i, jigilar / kwarewa ko halayya na iya kara yawan lokaci kuma an danganta su ga lafiyar jiki, psychosocial da interpersonal [7,9]. Kodayake binciken da aka riga ya samo kamance tsakanin jima'i da jima'i, matsala ta jima'i / rikici da jima'i da halayyar jima'i, zamu yi amfani da kalmar CSB don tunawa da wani nau'i mai mahimmanci na halin jima'i da ke ci gaba da duk waɗannan kalmomi.

Takarda na yanzu yana dauke da samfurin CSB ta hanyar nazarin bayanai daga yankuna masu yawa (misali annobar cutar, ilimin halitta, asibiti, nazarin halittu) da kuma magance wasu batutuwan da aka gano da ba a amsa ba. Yawanci, ya kamata CSB (ciki har da jima'i da yawa, kallon hotunan batsa da / ko al'aura) ya zama abin da ke fama da cutar, kuma idan haka ne, ya kamata a ƙaddara shi a matsayin jaraba na hali? Bisa ga binciken da ake ciki yanzu a kan nazarin CSB, mun ƙaddara da shawarwari don bincike da hanyoyin da za a gudanar a nan gaba inda bincike zai iya sanar da kwarewar bincike mafi kyau da kuma magance jiyya ga mutanen da ke ganin taimakon CSB.

Kashe CSB

A cikin shekarun da suka wuce, wallafe-wallafen da ake rubutu game da CSB sun karu (Fig. 1). Duk da yawan binciken da ake samu, ƙananan masu bincike da magunguna sunyi la'akari game da definition da gabatarwa na CSB [10]. Wasu suna la'akari da matsala / wuce kima akan halayen jima'i a matsayin wani ɓangare na rashin daidaituwa ta maza da mata (7), CSB wanda ba a ba shi ba, [11], yanayin rashin lafiyar jiki irin su cututtukan kwakwalwa [12] ko a matsayin ma'anar 'hali' (13,14). Ana kuma la'akari da CSB a matsayin abin da aka gano a cikin ɓangaren ƙwayar cuta a cikin aikin ICD-11 [5].

A cikin shekaru goma da suka gabata, masu binciken da likitoci sun fara tunanin CSB a cikin tsarin matsalolin jima'i. A cikin 2010, Martin Kafka ya gabatar da wani sabon cututtukan da ake kira 'rashin' yanci 'don nazarin DSM-5 [7]. Duk da gwaji da aka goyi bayan tabbatar da amincin ka'idoji ga rashin daidaituwa tsakanin mazauni [15], Ƙungiyar Harkokin Ƙwararrun Ƙwararrun Amurka ta haramta rashin daidaituwa tsakanin mazauna DSM-5. An damu da damuwa dangane da rashin bincike ciki har da siffar hoto da aikin aiki, kwayoyin kwayoyin halittu, ilimin lissafi, cututtuka da kuma bincike na neuropsychological [8]. Wasu sun nuna damuwar cewa rashin daidaituwa tsakanin mata da maza za su iya haifar da cin zarafi ko kuma haifar da zane-zane na gaskiya, saboda rashin bambancin bambanci tsakanin al'ada na al'ada da nauyin sha'awar jima'i da halaye [16-18].

Ka'idoji masu yawa don rashin daidaituwa tsakanin mazauna mata suna daidaita daidaitarsu tare da waɗanda ke amfani da cuta masu amfani (Table 1) [14]. Dukansu sun haɗa da sharuddan da suka shafi kulawar rashin ƙarfi (watau ƙoƙarin da bai dace ba don matsakaici ko barin) da kuma amfani mai amfani (watau amfani / hali yakan haifar da yanayin haɗari). Ka'idoji sun bambanta ga rashin daidaituwa na zamantakewa tsakanin haɗin kai da kuma amfani da kayan amfani. Abubuwa suna amfani da ma'aunin rashin daidaituwa sun hada da abubuwa biyu da ke nazarin dogara ga jiki (watau haƙuri da janyewa), kuma ka'idoji don rashin daidaituwa ta ruwayiya ba. Musamman ga rashin daidaituwa tsakanin mazauna mata (game da maganganu masu amfani da abubuwa) sune ka'idodi guda biyu dangane da yanayin jin dysphoric. Wadannan ka'idoji sun nuna matakan halayyar mata da maza suna iya nuna mahimmanci dabarun maganin cutar, maimakon hanyar yin watsi da bayyanar cututtuka (misali damuwa da alaka da janye daga abubuwa). Ko mutum ya sami rabuwar ko haƙuri wanda ya shafi wani halayen jima'i yana tattaunawa, ko da yake an nuna cewa yanayin jihohin dysphoric na iya nuna alamar bayyanar cututtuka ga mutanen da ke tare da CSB waɗanda suka dakatar da baya ko kuma sun daina yin aiki a cikin al'amuran jima'i [19]. Bambanci na karshe tsakanin rashin jituwa tsakanin maza da mata da kuma amfani da kayan amfani ya hada da bincike na bincike. Musamman, abu mai amfani da kayan abu yana bukatar ma'auni guda biyu, yayin da rashin daidaituwa tsakanin mazauna mata yana buƙatar guda hudu daga cikin ma'aunin 'A' da za a sadu. A halin yanzu, ana buƙatar ƙarin bincike don ƙayyade ƙofa gano mafi dacewa ga CSB [20].

Hanyoyin Clinical na CSB

Akwai cikakkun bayanai akan CSB. Yawancin bayanan al'umma game da kimantawa adadin kuɗi CSB sun rasa, suna san yadda ba'a san CSB ba. Masu bincike sunyi kiyasta kudaden daga 3 zuwa 6% [7] tare da balagagge maza da suka hada da mafi rinjaye (80% ko mafi girma) na wadanda aka cutar [15]. Babban nazarin daliban jami'a a Amurka sun gano cewa CSB ya zama 3% ga maza da 1% don mata [21]. Daga cikin rundunar soja na soja na Amurka, an kiyasta cewa za a kusa da 17% [22]. Amfani da bayanan daga Cibiyar Nazarin Harkokin Kiwon Lafiyar Jama'a na Amurka kan Alcohol da Related Related (NESARC), an gano yawan jima'i na jima'i, wani nau'in CSB, ga maza (18.9%) fiye da mata (10.9%) [23]. Kodayake muhimmancin, muna jaddada cewa irin wannan layi a cikin ilmi bai hana gabatarwar caca ba a cikin DSM-III a 1980 ko hada hada-hadar Intanet ta 3 na DSM-5 (duba yawan zangon da aka kwatanta daga 1 zuwa 50% , dangane da yadda ake amfani dasu amfani da Intanet da kuma rufe [6]).

CSB yana nuna yawanci tsakanin maza idan aka kwatanta da mata [7]. Misali na [jami'o'i na 21, 24] da mabiyoyin al'umma [15, 25, 26] sun nuna cewa maza, idan aka kwatanta da mata, zasu iya neman magani ga CSB [27]. Daga cikin ma'aikatan CSB, yawancin mutanen da ke da rahoton yadda ya shafi ƙananan cututtuka suna da matukar damuwa, yin amfani da batsa, jima'i / rashin jima'i tare da baƙo, masu yin jima'i da kuma jima'i [15, 28, 29]. Daga cikin mata, matsayi mai yawa, yawancin jima'i da hotunan batsa suna hade da CSB [30].

A gwajin gwaji don rashin daidaituwa na mazauna mata, 54% na marasa lafiya sun ruwaito cewa suna fama da dysregulated jima'i, roko da kuma hali kafin girma, bayar da shawarar da wuri farkon. Kusan kashi arba'in da biyu na marasa lafiya da suka kamu da cutar suna fama da ciwon halayyar rashin daidaituwa ta maza da mata a cikin watanni ko shekaru [15]. Ci gaba da matsalolin jima'i a tsawon lokaci yana haɗuwa da ƙananan matsala da rashin aikin aiki a duk wuraren rayuwa mai mahimmanci (misali sana'a, iyali, zamantakewa da kuma kudi) [31]. Ma'aurata na iya samun haɓaka don samun kwarewa fiye da motsin zuciyar kirki, da kuma mummunar tasirin kai (misali kunya, rashin amincewa) zai iya taimakawa wajen kiyaye CSB [32]. Bada la'akari da ƙididdiga da ƙididdigar gauraye, babu tabbacin cewa CSB yana haɗi da raunin yanke shawara / mai gudanarwa [33-36].

A cikin DSM-5, an ƙaddara 'sha'awar' a matsayin ma'auni na gano maganin cuta mai amfani [1]. Hakazalika, sha'awar yana nuna dacewa da kima da kula da CSB. Daga cikin matasan mutane, sha'awar batsa ya danganta da alamun cututtukan zuciya, halayyar jima'i da kuma rashin karfin cybersex [37-41]. Matsayi mai mahimmanci don neman sha'awar sake dawowa ko sakamako na asibiti.

A cikin masu kula da marasa lafiya, daliban jami'a, da mabiya al'umma, CSB ya fi kowa a cikin mutanen Turai / fari idan aka kwatanta da wasu (misali Afrika Amurkan, Latino, Asian Americans) [15, 21]. Bayanan bayanai sun nuna cewa mutane suna neman magani ga CSB na iya kasancewa mafi girman yanayin zamantakewa da tattalin arziki idan aka kwatanta da waɗanda ke fama da cutar psychiatric [15, 42], ko da yake wannan binciken zai iya nuna mafi girma ga samun magani (ciki har da kulawar masu zaman kansu da aka ba da iyakancewa a cikin inshora ɗaukar hoto) don mutane da haɓaka masu girma. Har ila yau, an samu daga cikin maza da suka yi jima'i da maza [28, 43, 44], kuma suna haɗar da halayyar cutar shan kwayar cutar (misali zangon kwakwalwa maras amfani) [44, 45]. da ma'aurata da maza da mata ba tare da nuna bambanci ba.

Psychopathology da CSB

CSB yana faruwa akai-akai tare da wasu cututtuka na psychiatric. Game da rabi na mazauna mata da maza suna biyan ka'idojin akalla daya yanayin DSM-IV, damuwa, amfani da kayan aiki, rikici ko yanayin hali [22,28,29,46]. A cikin 103 maza da ke neman maganin batsa masu amfani da batsa da kuma / ko halayen jima'i, 71% sun daidaita ma'auni don rashin lafiyar yanayi, 40% don cuta mai rikitarwa, 41% don maganin rashin amfani da kayan aiki da 24% don maganin rikicewar cuta [47] . Rahotanni masu kiyasta na CSB da hada-hadar caca daga 4 zuwa 20% [25, 26, 47, 48]. Jima'i yana iya haɗuwa da ƙwayar magungunan ƙwayar cuta a tsakanin jima'i, musamman ma mata. Daga cikin mata idan aka kwatanta da maza, jima'i da halayyar haɗin gwiwar sun hada da labarun zamantakewar al'umma, maganin cututtuka na shan barasa da ɓarna, schizotypal, antisocial, borderline, narcissistic, kaucewa da rikice-rikice-rikice hali na hali [23].

KASHIN KASA NA CSB

Ganin ko CSB ya ba da alaƙa da kwayoyin halitta tare da (ko bambance-bambance) daga amfani da abu da kuma caca batsa zai taimaka wajen sanar da ayyukan ICD-11 da maganin magance ta. Dopaminergic da serotonergic hanyoyi na iya taimakawa wajen bunkasa da kuma kiyaye CSB, ko da yake wannan bincike ne a cikin shakka a cikin jariri [49]. Sakamakon binciken da ya dace don citalopram a cikin ɗakin shafuka masu saurin kaifi na CSB a tsakanin samfurin maza yana nuna yiwuwar srosfoction [50]. Naltrexone, mai tayar da hankali, zai iya zama tasiri a rage duka matsalolin da kuma halayen da ke da dangantaka da CSB, daidai da matsayi a cikin abu da kuma cin abincin caca da kuma daidai da tsarin samar da hanyoyin haɓaka na aikin dopaminergic a cikin hanyoyi na mesolimbic [51-53].

Shaida mafi rinjaye tsakanin dopamine da CSB sun shafi cutar ta Parkinson. Magunguna masu maye gurbin kwayar cutar (misali levodopa da dopamine agonists irin su pramipexole, ropinirole) an hade da halayyar rikici da cuta (ciki har da CSB) tsakanin mutane da cutar Xinikan 54-57. Daga cikin 3090 Parkinson na cutar marasa lafiya, amfani da kwayar cutar kwayoyi da aka haɓaka da 2.6 da yawa na samun CSB [57]. CSB tsakanin cutar Parkinson ya kamu da cutar marasa lafiya bayan an dakatar da shan magani [54]. Haka kuma Levodopa ya hade da CSB da sauran cututtuka na cuta a cikin cutar Parkinson, yayin da akwai wasu dalilai masu yawa (misali wurin geographic, matsayin aure) [57].

Kwararrun kwayoyin cutar CSB, a halin yanzu ana fahimta, ana bincike ne a cikin jiki. Dysregulated hypothalamic-pituitary-adrenal axis aiki da aka nasaba da addictions kuma aka gano kwanan nan a cikin CSB. Ma'aikatan CSB sun fi yiwuwar mutanen da ba su da CSB su zama gwagwarmaya-maganin gwajin wadanda ba su da magunguna kuma suna da matakan hormone masu girma adrenocorticotrophic. Tsarin hypothalamic-pituitary-adrenal a cikin mutane na CSB zai iya zama da sha'awar kuma al'amuran CSB da ke da alaka da batutuwa masu kwakwalwa ta jiki (58).

Nazarin neuroimaging a halin yanzu sun mayar da hankali ne a kan mayar da hankali ga haɓakawa. Cue-reactivity yana dacewa da maganin ƙwayar cuta, yana taimakawa ga sha'awar, kwadago da sakewa [59]. Wani rahoto-bincike na baya-bayan nan ya ba da labari tsakanin taba, hawan cocaine da kuma maye gurbi a cikin kwakwalwa na kwakwalwa, ƙwayoyin cingulation na baya (AC) da amygdala da ke da alaka da magungunan miyagun ƙwayoyi da kuma nuna sha'awar mutum, yana nuna cewa waɗannan yankuna na kwakwalwa na iya zama ainihin kewaye da miyagun ƙwayoyi a duk abin da ake ji dadi [60]. Shaidar motsi na jaraba ya nuna cewa jaraba ya danganci karfin haɓakawa na karfafawa ga maganin haɗari da miyagun ƙwayoyi wanda zai haifar da kamawa da hankali, halin kirki, tsinkaya da kuma motsa jiki (ko "son") don kwayoyi. [61, 62]. Wannan ka'idar ta shafi CSB [63].

A kolejojin mata na mata [64], bambance-bambance daban-daban a cikin labarun ɗan adam da aka haifa a cikin mahallin yana karawa a kan abincin abinci da jima'i wanda ya danganci matukar samun karuwar kayan aiki da 6 watanni a baya. Sakamakon sakamako mai kyau a cikin kwakwalwa don abinci ko jima'i an haɗa shi da cin zarafi da haɓakawa da jima'i, yana nuna cewa wani nau'in ƙwayar hanyoyi ne wanda ke hade da halayen ƙira. Yayin da ake yin amfani da hotuna na bidiyo mai ban mamaki (fMRI), shafukan yanar gizo na hotuna masu ban sha'awa idan aka kwatanta da bidiyon ban sha'awa na mazajen CSB da ke da dangantaka da wadanda ba su da CSB sun haɗu da haɓakawa a cikin dorsal cingulate, ventral striatum da amygdala, yankuna da ake amfani da kwayoyi. Karancin karɓan karɓa a cikin maganin ƙwayar cuta (63). Haɗin aiki na waɗannan yankuna an hade da sha'awar jima'i na ainihi ga alamun, amma ba mai son ba, tsakanin maza da CSB. A nan, an dauki buƙatar a matsayin alamar "son" idan aka kwatanta da 'ƙauna'. Mutanen da ke tare da CSB tare da waɗanda ba tare da sun bayar da rahoton sun ba da sha'awar jima'i ba kuma sun nuna cewa suna da yawa a cikin kungiyoyi na baya da kuma kunnawa don amsawa ga hotuna hotuna [65].

Mutanen CSB sun kwatanta da waɗanda ba tare da sun nuna sha'awar da suka fi dacewa da ra'ayoyin jima'i ba, suna mai da hankali kan yadda za a mayar da martani game da batutuwa masu ban sha'awa [66]. Ma'aikatan CSB sun nuna fifiko mafi kyau ga ra'ayoyinsu da suka shafi jima'i da matsalolin kudi idan aka kwatanta da maza ba tare da CSB [67] ba. Mafi girman hankali da hankali ga jima'i an hade da halayyar dabi'un da suka shafi halin jima'i, don haka yana goyon bayan ka'idoji na jaraba. Har ila yau, batutuwa na CSB sun nuna fifiko ga labarun jima'i da kuma yawan labarun da ake yiwa duniyar da ake nunawa zuwa hotuna na jima'i, tare da matsayi na halayyar da ke haɓakawa tare da ingantaccen zaɓi na jima'i na 67. Samun damar yin jima'i na jima'i na iya zama ƙayyadadden samfuran kayan aiki na kan layi.

Daga cikin cututtukan Parkinson na batutuwa, shafukan yanar-gizon da ke tattare da jima'i sun kara sha'awar jima'i a cikin wadanda ke tare da CSB idan aka kwatanta da waɗanda ba tare da [68] ba; Ayyukan ingantaccen aiki a cikin limbic, layi, layi, occipital, somatosensory da yankuna na farko wanda aka sanyawa a cikin hankalin mutum, tunani, kwance, gani da kuma motsa jiki. Ma'aikata na CSB sun kara haɓaka sha'awar jima'i tare da ƙara yawan abubuwan da ke kunshe a cikin kwakwalwa na kwakwalwa da kuma cingulate da magungunan kamfanonin kobitofrontal [68] .Wannan binciken ya kasance tare da waɗanda ke shan maganin ƙwayoyi wanda aka kara ƙaruwa a cikin yankunan da suka shafi sakamako dangane da abubuwan da suka danganci musamman jaraba, ta bambanta da amsoshin da aka samu ga biyan kuɗi ko na kudi [69, 70]. Sauran nazarin kuma sun shafi yankuna na gaba; a cikin ƙananan nazarin hotunan nazarin hoto, CSB da wadanda basu da CSB sun nuna mahimmanci na gaba [71].

Ya bambanta, wasu nazarin da ke mayar da hankalin mutane ba tare da CSB sun karfafa muhimmancin haɓaka ba. A cikin mutanen da ba CSB ba, an yi amfani da tarihin batsa mai tsawo akan batsa tare da ƙananan haɓakar ƙananan labarun hotunan batsa, suna nuna yiwuwar lalatawa [72]. Hakazalika, a cikin wani binciken da ya shafi al'amuran da maza da mata ba tare da CSB ba, wadanda ke yin amfani da batutuwan batsa masu amfani da batsa suna da mummunar tasiri ga hotuna masu hotunan da ke da alaka da wadanda ba su yin amfani da matsala. Ana iya tasowa marigayi moriyar mai yawa don amsa tambayoyin miyagun ƙwayoyi a cikin nazarin buri (73). Wadannan binciken sun bambanta da, amma ba su dace da, rahoton na ingantaccen aikin a cikin nazarin fMRI a al'amuran CSB; nazarin ya bambanta a cikin irin abubuwan da suka faru, irin yadda ma'auni da yawan mutane ke nazarin. An yi amfani da bincike na CSB da aka nuna bidiyon bidiyo idan aka kwatanta da hotuna; an nuna nauyin kunnawa ya bambanta da bidiyo tare da hotuna da halin da ake ciki zai bambanta dangane da abubuwan da suka faru. Bugu da ƙari kuma, a cikin wadanda suke yin amfani da matsala a cikin binciken da ake ciki, yawancin lokuta da aka yi amfani da su sun kasance kamar ƙananan [matsala: 3.8, bambanci na gaskiya (SD) = 1.3 a kan iko: 0.6, SD = 1.5 hours / mako] idan aka kwatanta da binciken CSM fMRI (CSB: 13.21, SD = 9.85 da iko: 1.75, SD = 3.36 hours / mako). Saboda haka, haɗuwa zai iya danganci amfani da kowa, tare da yin amfani mai tsanani wanda zai iya haɗuwa da haɓaka mai karuwa. Bugu da kari ana buƙatar ƙarin nazari don bincika waɗannan bambance-bambance

Genetics na CSB

Bayanan kwayoyin da suka danganci CSB sunyi nisa. Ba'a gudanar da bincike akan ƙungiyar CSB ba. Nazarin ma'aurata na 88 tare da CSB sun sami ƙananan halayen digiri na farko da suka haɗa da maganin cututtukan abu (40%), ciwon abinci (30%) ko wasan caca (7%) [74]. Nazarin jima'i da aka ba da gudummawar da aka ba da gudummawa ta ƙididdiga ta 77% na bambancin da ke shafi matsalolin masturbatory matsaloli, yayin da 13% na iya haifar da abubuwan muhalli ba tare da raba su ba [75]. Ƙananan gudummawar gwargwadon gudummawa sun wanzu don magunguna da karuwancin caca [76, 77]. Yin amfani da bayanan twin [78], ƙayyadadden adadin bambancin da ke da alhakin matsalar caca saboda raunin kwayoyin halitta kamar 50%, tare da mafi girma da aka gani don matsaloli masu tsanani. Abubuwan da aka danganci impulsivity na iya wakiltar alamar damuwa don ci gaba da magungunan abu (79); duk da haka, ko waɗannan abubuwa ƙara ƙwarewar ƙaddamar da CSB ba a riga an binciko su ba.

GASKIYA DA GARANTAR CSB

A cikin shekaru goma da suka wuce, bincike game da ganewar cutar da maganin CSB ya karu [80]. Masu bincike daban-daban sun ba da ka'idojin bincike [13] da kuma inganta kayan aikin kwarewa [81] don taimaka wa likitoci a maganin CSB; duk da haka, amincin, amincin da mai amfani da yawa daga cikin waɗannan Sikeli ya kasance ba a bayyana ba. Ƙananan matakan da aka inganta, yana iyakance rashin daidaituwa ga aikin likita.

Magungunan jiyya don CSB suna buƙatar ƙarin bincike. Studiesan karatu kaɗan sun kimanta fa'idodi da jurewa na takamaiman magunguna [53, 82-86] da magungunan [87-91] psychotherapeutic don CSB. Thewararrun ƙwararrun ƙwararrun ƙwararrun ƙwararru irin su haɓaka-halayyar halayyar mutum da karɓar yarda-da-sadaukarwa sun bayyana taimako ga CSB [89,91,92]. Hakanan, masu hana maganin sake farfadowa na serotonergic (misali fluoxetine, sertraline da citalopram) da kuma masu adawa da opioid (misali naltrexone) sun nuna ingancin farko a rage alamun CSB da halaye, kodayake manyan gwaje-gwajen da bazuwar sarrafawa ba su da yawa. Karatuttukan karatun likitanci yawanci binciken karatu ne. Studyaya daga cikin binciken ne kawai [50] ya yi amfani da madauri biyu, zane-zane mai sarrafa wuribo lokacin kimanta inganci da jure wa magani (citalopram) a cikin maganin CSB.

Babu manyan gwajin gwagwarmayar da ke tattare da kasancewa a cikin kwarewa akan ingancin ƙwaƙwalwar da ke cikin maganin CSB. Abubuwan da suka shafi ka'idoji sun rage iyakancewar nazarin sakamakon binciken asibiti, kamar yadda yawancin karatu suke amfani da zane-zane masu amfani, sun bambanta a kan ka'idoji / rashin daidaituwa, sun kasa yin amfani da aikin bazuwar don yanayin magani kuma basu haɗa da kungiyoyi masu mahimmanci don su yanke shawarar cewa magani yayi aiki [80] . Ana buƙatar babban gwajin gwagwarmaya marasa amfani don kimanta kwarewa da jurewa da magungunan magungunan ƙwaƙwalwa cikin magance CSB.

Hanyoyin madadin

Rashin ƙaddamar da rashin daidaituwa a halin kirki a matsayin rashin lafiyar jiki ba a yalwace shi ba. An damu da damuwa da cewa lakabi na 'cuta' pathologizes da bambancin al'ada na hali na jima'i mai kyau [93], ko kuma irin wannan hali mai rikitarwa / matsala zai iya zama mafi alhẽri a matsayin bayani akan ƙwayar lafiyar halin kwakwalwa ta yau da kullum ko kuma matakan da ake amfani da shi a cikin matsala. kafa tsarin jihohin da ya shafi mummunan jihohin maimakon cututtuka na musamman [16,18]. Sauran masu bincike sun nuna damuwa da cewa wasu mutane da aka sanya su tare da CSB suna da matsananciyar sha'awar jima'i [18], tare da shawarwari cewa wahalar magance matsalolin jima'i da ƙananan halayen halayen jima'i da kuma sakamakon da ya shafi waɗannan dabi'un za a iya bayyana su a fili sosai kamar yadda ba'a ba da ita ba, bambancin dabi'a na burin jima'i [94].

A cikin babban samfurori na ƙwararren Croatian, bincike na ɓangaren ya gano nau'i biyu masu mahimmanci, wanda yana wakiltar jima'i
da kuma wani mai nuna sha'awar jima'i da kuma jima'i. Wadanda ke cikin wannan matsala suna nuna karin ƙwarewar tunanin mutum idan aka kwatanta da mutane a cikin matsayi mai mahimmanci / aiki mai suna [95]. Wannan yana nuna cewa CSB na iya tsarawa tare da ci gaba da kara yawan karuwar jima'i da damuwa, inda lokuta ƙwayoyin magunguna suke
mai yiwuwa ya faru a saman karshen ci gaba ko girman [96]. Bisa yiwuwar akwai matsala mai yawa tsakanin CSB da sha'awar jima'i, ƙarin bincike yana buƙatar gane siffofin da suka shafi musamman tare da halayyar halayyar jima'i.

SABATARWA DA GASKIYA

Tare da sakin DSM-5, matsalar caca da aka yi amfani da shi tare da maganin rashin amfani. Wannan canji ya ƙalubalanci imani cewa farfadowa ya faru ne kawai ta hanyar haɓaka abubuwa masu rikitarwa kuma yana da muhimmiyar tasiri ga tsarin siyasa, rigakafi da magunguna [97]. Data bayar da shawarar cewa kisa a cikin wasu halayen (misali wasan kwaikwayo, jima'i, cin kasuwa) zai iya raba asibiti, kwayoyin halitta, neurobiological da phenomenological da suka hada da abubuwa masu ƙyama (2,14). Duk da kara yawan wallafe-wallafe a kan CSB, raguwa da yawa a ilimin akwai wanda zai taimaka wajen ƙayyade ƙin yarda ko yin kisa da yawa a cikin halayen jima'i zai iya zama mafi girma a matsayin jaraba. A Table 2, za mu lissafa wuraren da ake buƙatar ƙarin bincike don kara fahimtar CSB. Irin wannan bayanai ba tare da cikakkun bayanai ba ne kawai ya dace da rarrabawa, yin rigakafi da kuma magance jiyya. Yayinda yake ba da labari ba daidai ba ne tsakanin jaraba da kayan aiki da CSB, bayanai sun iyakance ne ta hanyar ƙananan samfurin samfurori, kawai samfurorin namiji da maza da samfurori. Ana buƙatar ƙarin bincike don fahimtar CSB a cikin mata, marasa 'yanci da launin fatar / kabilanci,' yan mata, 'yan mata,' yan bisexual da mutane da yawa, wadanda ke da nakasar jiki da na hankali da wasu kungiyoyi.

Wani yankin da ake buƙatar ƙarin bincike ya shafi la'akari da yadda canjin fasahar zai iya rinjayar halin halayyar mutum. Idan aka ba da wannan bayanan yana nuna cewa ana amfani da hotunan jima'i ta hanyar aikace-aikacen Intanit da na fasaha [98-100], binciken da ya kamata ya kamata ya yi la'akari da yadda fasahohin zamani ke danganta da CSB (misali dandalin tarawa ga batsa na Intanit ko jima'i na tattaunawa) da kuma haɗin kai ga halayen jima'i (misali condomless jima'i, masu jima'i da yawa a wani lokaci). Alal misali, ko ƙara samun dama ga batsa na Intanit da kuma amfani da shafukan yanar gizo da aikace-aikace na smartphone (misali Grindr, FindFred, Scruff, Tinder, Pure, da dai sauransu) wanda aka tsara don sauƙaƙe jima'i a tsakanin mai yarda da manya yana haɗuwa da raƙuman rahotanni game da halin halayen halayya. bincike na gaba. Yayin da aka tattara bayanai, an samu ilimi ya zama cikin tsarin ingantaccen tsarin siyasa, rigakafi da magunguna

Godiya

Wannan bincike ya samu tallafi daga Ma'aikatar Harkokin Tsohon Kasuwanci, Cibiyar Nazarin Harkokin Ciwon Bincike na Ma'aikata na 1 da Cibiyoyin Harkokin Gudanarwa, ta Cibiyar Nazarin Harkokin Cutar Gida da Cibiyar Nazarin Harkokin Kasuwanci, da CASAColumbia. Abubuwan da ke cikin wannan takarda ba dole ba ne su kasance daidai da ra'ayi na hukumomin bayar da kuɗi kuma suyi tunanin ra'ayoyin mawallafa. Mawallafa sun bayar da rahoton cewa ba su da wata rikice-rikice na kudi don sha'awar abubuwan da ke cikin wannan takardun.

Bayyana bukatun

Mawallafa sun bayar da rahoton cewa ba su da wata rikice-rikice na kudi don sha'awar abubuwan da ke cikin wannan takardun. MNP ya karbi tallafin kudi ko ramuwa don wannan: ya nemi shawara da kuma shawarci Lundbeck, Ironwood, Shire, INSYS da kuma HealthMend Health; ya karbi tallafin bincike (zuwa Yale) daga Cibiyoyin Kula da Lafiya ta Duniya, Mohegan Sun Casino, Cibiyar Cibiyar Nazarin Kasuwanci ta Duniya da Pfizer pharmaceuticals; ya shiga cikin binciken, wasiku ko tarho na wayar tarho da aka danganta da maganin ƙwayar magungunan ƙwayoyi, matsalolin rikici ko wasu abubuwan kiwon lafiya; ya nemi shawarwari game da caca da kuma hukumomi na shari'a game da abubuwan da suka danganci kulawa; bayar da kulawa na asibiti a cikin Ma'aikatar Harkokin Kiwon Lafiyar Harkokin Kiwon Lafiyar Harkokin Kiwon Lafiyar ta Connecticut; ya bayar da shawarwari na asusun na Cibiyoyin Kula da Lafiya da sauran hukumomi; ya shirya ko mujallolin da aka buga da bita ko sassan labaran; ya ba da laccoci na ilimi a manyan zane-zane, abubuwan CME da sauran wuraren shakatawa ko wuraren kimiyya; kuma ya kirkiro littattafai ko litattafai na masu wallafa na rubutun lafiyar hankali.