ຫຼັກຖານຂອງ Pudding ແມ່ນໃນການລົດຊາດ: ຂໍ້ມູນຈໍາເປັນຕ້ອງມີການທົດສອບແບບແລະການປະສົມປະສານທີ່ກ່ຽວຂ້ອງກັບພຶດຕິກໍາທາງເພດທີ່ຂັດຂວາງ (2018)

ຈົດໝາຍເຖິງບັນນາທິການ

Gola, Mateusz, and Marc N. Potenza.

ຮວບຮວມຂອງພຶດຕິກໍາທາງເພດສໍາພັນ: 1-3.

Walton, Cantor, Bhullar, and Lykins (2017) recently reviewed the state of knowledge on problematic hypersexuality and presented a theoretical model of compulsive sexual behaviors (CSBs). Of note, their literature search was completed in September 2015 and multiple advances have been made since that time. Importantly, while multiple theoretical models and hypotheses have been forwarded over time regarding CSB and related behaviors, many models and hypotheses still await formal empirical evaluation. Nonetheless, recent studies have suggested future lines of investigation to formally test the models and hypotheses proposed. In this Letter, we focus on some of the questions raised by Walton et al. based on recent findings and indicate important unanswered questions which warrant research consideration to promote systematic progress.

ຄໍາຖາມທີ່ບໍ່ໄດ້ຮັບຄໍາຕອບ

What is the prevalence of CSB?

Walton et al., similar to other authors (Carnes, 1991), say that the estimated prevalence of CSB is between 2 and 6% of the general adult population. Unfortunately, definitions regarding what constitutes CSB remain debated, complicating the precise estimates of the prevalence of CSB. A similar situation existed for internet gaming disorder (IGD) where prevalence estimates ranged widely prior to the introduction of formal proposed criteria in the fifth edition of the ຄູ່ມືການວິນິດໄສແລະສະຖິຕິຂອງຄວາມຜິດພາດທາງຈິດ (DSM-5; APA, 2013; Petry & O’Brien, 2013). Furthermore, no nationally representative data to date have been published to provide estimates of CSB, with existing data typically relying on convenience samples (Odlaug et al., 2013). It is very important to collect data from representative samples in order to understand the prevalence (and ideally impact) of CSB in the general population, and how it may differ between jurisdictions and across different groups (e.g., with respect to age, gender, culture). Such information may help us understand how specific factors (e.g., access to pornography, cultural values or norms, religious beliefs) may relate to specific types or forms of CSB.

A related question involves potential differences between clinical and subclinical populations. One example may relate to Walton et al.’s discussion of a role for religiosity in CSB. Two studies (Grubbs, Exline, Pargament, Hook, & Carlisle, 2015a; Grubbs, Volk, Exline, & Pargament, 2015b) provide support that religiosity and moral disapproval of pornography use may contribute to self-perceptions of porn addiction. On the other hand, Reid, Carpenter, and Hook (2016) found that religiosity was unrelated to self-reported measures of hypersexuality. Possible explanation for seeming discrepancies may involve methodological aspects (e.g., relating to how CSB is defined and assessed), differences in the populations studied, or other factors. With respect to the populations studies, Grubbs et al. focused on non-clinical (non-treatment-seeking) individuals while Reid et al. assessed subjects meeting criteria for hypersexual disorder (Kafka, 2010). In our recent study (Gola, Lewczuk, & Skorko, 2016a), we examined whether religiosity may contribute differently in these two populations in Poland. Using structural equation modeling, we examined relationships between amount of pornography use, negative health correlates of pornography use, religiosity, and treatment-seeking status for CSB. We collected data from 132 males seeking treatment for problematic pornography use, referred by clinical psychologists (and meeting criteria for HD), and 437 males using pornography on a regular basis but never seeking treatment. We found that religiosity was associated with self-perceived negative symptoms of pornography use in the non-treatment-seeking males but not in the treatment-seeking males. We also observed that while amount of pornography use did not statistically predict treatment-seeking status, severity of pornography-use-related negative symptoms did. These findings were observed despite similar levels of religiosity between the treatment-seeking and non-treatment-seeking populations (Gola et al., 2016a). Furthermore, findings may differ for women, as we recently observed that religiosity and amount of pornography use related to treatment-seeking for CSB among women (Lewczuk, Szmyd, Skorko, & Gola, 2017). These findings highlight the importance of studying CSB topics in a gender-informed fashion with additional considerations extending to cis- and transgendered populations and heterosexual, homosexual, bisexual, polyamorous, and other groups.

What data are needed to inform conceptualizations of CSB?

ດັ່ງທີ່ໄດ້ອະທິບາຍຢູ່ບ່ອນອື່ນ (Kraus, Voon, & Potenza, 2016a), ມີ ຈຳ ນວນການພິມ ຈຳ ໜ່າຍ ທີ່ເພີ່ມຂື້ນກ່ຽວກັບ CSB, ບັນລຸຫຼາຍກວ່າ 11,400 ໃນປີ 2015. ເຖິງຢ່າງໃດກໍ່ຕາມ, ຄຳ ຖາມພື້ນຖານກ່ຽວກັບແນວຄວາມຄິດຂອງ CSB ຍັງບໍ່ທັນໄດ້ຮັບ ຄຳ ຕອບ (Potenza, Gola, Voon, Kor, & Kraus, 2017) ມັນຈະມີຄວາມກ່ຽວຂ້ອງກັບການພິຈາລະນາວິທີການ DSM ແລະ ການຈັດປະເພດໂລກຂອງພະຍາດ (ICD) operate with respect to definition and classification processes. In doing so, we think it is relevant to focus on gambling disorder (also known as pathological gambling) and how it was considered in DSM-IV and DSM-5 (as well as in ICD-10 and the forthcoming ICD-11). In DSM-IV, pathological gambling was categorized as an “Impulse-Control Disorder Not Elsewhere Classified.” In DSM-5, it was reclassified as a “Substance-Related and Addictive Disorder.” The rationale for this reclassification was based on existing data supporting similarities in multiple domains, including phenomenological, clinical, genetic, neurobiological, therapeutic, and cultural (Petry, 20061 Potenza, 2006), as well as differences in these domains with respect to competing models like obsessive–compulsive-spectrum classification (Potenza, 2009). A similar approach should be applied to CSB, which is currently being considered for inclusion as an impulse-control disorder in ICD-11 (Grant et al., 20141 Kraus et al, 2018). However, questions exist as to whether CSB is more similar to addictive disorders than the other impulse-control disorders (intermittent explosive disorder, kleptomania, and pyromania) proposed for ICD-11 (Potenza et al., 2017).

ໃນບັນດາໂດເມນທີ່ອາດຈະສະແດງໃຫ້ເຫັນຄວາມຄ້າຍຄືກັນລະຫວ່າງ CSB ແລະຄວາມຜິດປົກກະຕິເສບຕິດແມ່ນການສຶກສາທາງ neuroimaging, ມີການສຶກສາທີ່ຜ່ານມາຫຼາຍໆຄັ້ງທີ່ຖືກລົບລ້າງໂດຍ Walton et al. (2017). ການສຶກສາໃນເບື້ອງຕົ້ນມັກຈະກວດສອບ CSB ກ່ຽວກັບຮູບແບບຂອງສິ່ງເສບຕິດ (ທົບທວນໃນ Gola, Wordecha, Marchewka, & Sescousse, 2016b; Kraus, Voon, & Potenza, 2016b). ຮູບແບບທີ່ໂດດເດັ່ນ - ທິດສະດີການກະຕຸ້ນທີ່ມີແຮງຈູງໃຈ (Robinson & Berridge, 1993) - ລະບຸວ່າໃນບຸກຄົນທີ່ມີສິ່ງເສບຕິດ, ເຫດຜົນທີ່ກ່ຽວຂ້ອງກັບສານເສບຕິດຂອງການລ່ວງລະເມີດອາດຈະໄດ້ຮັບຄ່າແຮງຈູງໃຈທີ່ເຂັ້ມແຂງແລະຫລີກລ້ຽງຄວາມຢາກ. ປະຕິກິລິຍາດັ່ງກ່າວອາດຈະກ່ຽວຂ້ອງກັບການເຄື່ອນໄຫວຂອງຂົງເຂດສະ ໝອງ ທີ່ມີຄວາມກ່ຽວຂ້ອງໃນການປະມວນຜົນຕອບແທນ, ລວມທັງເສັ້ນເລືອດອອກ. ວຽກທີ່ປະເມີນປະຕິກິລິຍາ cue ແລະການປະມວນຜົນຕອບແທນຂອງລາງວັນອາດຈະຖືກປັບປ່ຽນເພື່ອກວດສອບຄວາມແນ່ນອນຂອງ cues (ຕົວຢ່າງ, ການເງິນທຽບກັບ erotic) ກັບກຸ່ມສະເພາະ (Sescousse, Barbalat, Domenech, & Dreher, 2013), ແລະພວກເຮົາໄດ້ນໍາໃຊ້ວຽກງານນີ້ເພື່ອສຶກສາຕົວຢ່າງດ້ານການທາງດ້ານການຊ່ວຍ (Gola et al, 2017) ພວກເຮົາໄດ້ພົບເຫັນວ່າບຸກຄົນທີ່ກໍາລັງຊອກຫາການປິ່ນປົວສໍາລັບການໃຊ້ຮູບພາບທີ່ຜິດປົກກະຕິແລະການຊໍາລະລ້າງ, ເມື່ອປຽບທຽບກັບການຈັບຄູ່ (ໂດຍອາຍຸ, ເພດ, ລາຍໄດ້, religiosity, ຈໍານວນຂອງການຕິດຕໍ່ທາງເພດສໍາພັນກັບຄູ່ຮ່ວມງານ, ອາລົມທາງເພດ) ຫົວໃຈຄວບຄຸມສຸຂະພາບ, ລາງວັນ, ແຕ່ບໍ່ແມ່ນສໍາລັບລາງວັນທີ່ກ່ຽວຂ້ອງແລະບໍ່ແມ່ນສໍາລັບຄໍາແນະນໍາທາງດ້ານການເງິນແລະລາງວັນ. ຮູບແບບຂອງການຕອບສະຫນອງຂອງສະຫມອງນີ້ແມ່ນສອດຄ່ອງກັບທິດສະດີຂອງການສະຫນັບສະຫນູນການສະຫນັບສະຫນູນແລະຊີ້ໃຫ້ເຫັນວ່າຄຸນນະສົມບັດທີ່ສໍາຄັນຂອງ CSB ອາດປະຕິບັດກັບການຕິຕຽນຫລືຄວາມປາຖະຫນາທີ່ເກີດຂື້ນໂດຍຄໍາແນະນໍາໃນທາງທໍາອິດທີ່ກ່ຽວຂ້ອງກັບກິດຈະກໍາທາງເພດແລະການກະຕຸ້ນທາງເພດ. ຂໍ້ມູນເພີ່ມເຕີມຊີ້ໃຫ້ເຫັນວ່າວົງຈອນແລະກົນໄກຂອງສະຫມອງອື່ນໆອາດຈະມີສ່ວນຮ່ວມໃນ CSB ແລະເຫຼົ່ານີ້ອາດປະກອບມີ cingulate ກ່ອນ, hippocampus ແລະ amygdala (Banca et al, 2016; Klucken, Wehrum-Osinsky, Schweckendiek, Kruse, & Stark, 20161 Voon et al, 2014). ໃນບັນດາສິ່ງເຫຼົ່ານີ້, ພວກເຮົາໄດ້ສົມມຸດວ່າວົງຈອນ amygdala ຂະຫຍາຍທີ່ກ່ຽວຂ້ອງກັບປະຕິກິລິຍາສູງ ສຳ ລັບການຂົ່ມຂູ່ແລະຄວາມກັງວົນອາດຈະກ່ຽວຂ້ອງກັບຫ້ອງການໂດຍສະເພາະ (Gola, Miyakoshi, & Sescousse, 2015; Gola & Potenza, 2016) ໂດຍອີງໃສ່ການສັງເກດວ່າບາງຄົນຂອງ CSB ມີຢູ່ໃນລະດັບທີ່ມີຄວາມກັງວົນສູງ (Gola et al, 2017) ແລະອາການຂອງ CSB ອາດຈະຖືກຫຼຸດລົງພ້ອມກັບການຫຼຸດຜ່ອນຄວາມກັງວົນທາງດ້ານ pharmacological (Gola & Potenza, 2016). However, these studies currently involve small samples and additional research is needed.

ສະຫຼຸບ

In summary, we highlight the importance of empirical validation of models of CSB. Consensus is needed regarding the definition of CSBs and CSB disorder. If CSB disorder is included in ICD-11 as currently proposed, this could provide the foundation for systematic research in multiple domains. Well-designed and conducted longitudinal neuroscientific studies of CSB and non-CSB groups, including investigations allowing measurement of brain activity during actual sexual activity, could be very informative. We believe that such data may be used to test and refine existing models and permit the generation of new theoretical models developed in a data-driven fashion.

ເອກະສານ

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