Il-Prova tal-Pudina tinsab fit-Togħma: Hemm bżonn ta 'dejta biex jiġu ttestjati l-mudelli u l-Ipoteżi Relatati ma' Imgieba Sesswali Compulsivi (2018)

Ittra lill-Editur

Gola, Mateusz, and Marc N. Potenza.

Arkivji ta 'Komportament Sesswali: 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.

Mistoqsijiet mingħajr tweġiba

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 Manwal Dijanjostiku u Statistiku ta 'Disturbi Mentali (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?

Kif deskritt x'imkien ieħor (Kraus, Voon, & Potenza, 2016a), hemm numru dejjem jikber ta 'pubblikazzjonijiet fuq CSB, li jilħqu aktar minn 11,400 fl-2015. Madankollu, mistoqsijiet fundamentali dwar il-kunċettwalizzazzjoni ta' CSB jibqgħu mingħajr tweġiba (Potenza, Gola, Voon, Kor, & Kraus, 2017). Ikun relevanti li jiġi kkunsidrat kif id - DSM u l - IP. \ T Klassifikazzjoni Internazzjonali tal-Mard (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, 2006; 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., 2014; 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).

Fost l-oqsma li jistgħu jissuġġerixxu xebh bejn CSB u disturbi ta ’dipendenza hemm studji newroimaging, b’diversi studji riċenti li tħallew barra minn Walton et al. (2017). Studji inizjali spiss eżaminaw CSB fir-rigward ta ’mudelli ta’ vizzju (riveduti f’Gola, Wordecha, Marchewka, & Sescousse, 2016b; Kraus, Voon, & Potenza, 2016b). Mudell prominenti - it-teorija ta ’l-inċentiv (Robinson & Berridge, 1993) - jiddikjara li f'individwi b'vizzji, indikazzjonijiet assoċjati ma 'sustanzi ta' abbuż jistgħu jakkwistaw valuri qawwija ta 'inċentiv u jevokaw xenqa. Reazzjonijiet bħal dawn jistgħu jkunu relatati ma 'attivazzjonijiet ta' reġjuni tal-moħħ implikati fl-ipproċessar tal-premju, inkluż l-istriatum ventrali. Kompiti li jivvalutaw ir-reattività tal-indikazzjoni u l-ipproċessar tal-premju jistgħu jiġu modifikati biex tinvestiga l-ispeċifiċità tal-indikazzjonijiet (eż., Monetarja kontra erotika) għal gruppi speċifiċi (Sescousse, Barbalat, Domenech, & Dreher, 2013), u aħna reċentement applikajna dan ix-xogħol biex tistudja kampjun kliniku (Gola et al., 2017). Aħna sibna li individwi li qed ifittxu trattament għal użu ta 'pornografija problematika u masturbazzjoni, meta mqabbla ma' mqabbla (skond l-età, sess, dħul, reliġjon, ammont ta 'kuntatti sesswali ma' msieħba, tqajjim sesswali) suġġetti ta 'kontroll b'saħħtu, urew reattività ventrali striatali għal cues ta' erotic premjijiet, iżda mhux għal premjijiet assoċjati u mhux għal flus u premjijiet monetarji. Dan il-mudell ta 'reattività tal-moħħ huwa konformi mat-teorija tal-inċentività tas-saljenza u jissuġġerixxi li fattur ewlieni tas-CSB jista' jinvolvi reattività tal-CU or jew effetti tax-xenqa kkaġunati minn informazzjoni inizjalment newtrali assoċjata ma 'attività sesswali u stimoli sesswali. Dejta addizzjonali tissuġġerixxi li ċirkwiti u mekkaniżmi oħra tal-moħħ jistgħu jkunu involuti fis-CSB, u dawn jistgħu jinkludu ċingulat ta 'quddiem, hippocampus u amygdala (Banca et al., 2016; Klucken, Wehrum-Osinsky, Schweckendiek, Kruse, & Stark, 2016; Voon et al., 2014). Fost dawn, għandna l-ipoteżi li ċ-ċirkwit estiż ta 'amygdala li jirrelata ma' reattività għolja għal theddid u ansjetà jista 'jkun partikolarment klinikament rilevanti (Gola, Miyakoshi, & Sescousse, 2015; Gola & Potenza, 2016) ibbażat fuq osservazzjoni li xi individwi ta ’CSB preżenti b’livelli għoljin ta’ ansjetà (Gola et al., 2017) u s-sintomi ta 'CSB jistgħu jitnaqqsu flimkien ma' tnaqqis farmakoloġiku fl-ansjetà (Gola & Potenza, 2016). However, these studies currently involve small samples and additional research is needed.

konklużjoni

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.

Referenzi

  1. Assoċjazzjoni Psikjatrika Amerikana. (2013). Manwal dijanjostiku u statistiku ta ’mard mentali (5th ed.). Arlington, VA: American Psychiatric Press.CrossRefGoogle Scholar
  2. Banca, P., Morris, LS, Mitchell, S., Harrison, NA, Potenza, MN, & Voon, V. (2016). Novità, kundizzjonament u preġudizzju ta 'attenzjoni għall-premjijiet sesswali. Ġurnal tar-Riċerka Psikjatrika, 72, 91-101.CrossRefPubMedPubMedCentralGoogle Scholar
  3. Carnes, P. (1991). M'għandekx sejħa mħabba: Irkupru minn vizzju sesswali. New York: Bantam.Google Scholar
  4. Gola, M., Lewczuk, K., & Skorko, M. (2016a). What matters: Quantity or quality of pornography use? Psychological and behavioral factors of seeking treatment for problematic pornography use. Ġurnal tal-Mediċina Sesswali, 13(5), 815-824.CrossRefPubMedGoogle Scholar
  5. Gola, M., Miyakoshi, M., & Sescousse, G. (2015). Sex, impulsivity, and anxiety: Interplay between ventral striatum and amygdala reactivity in sexual behaviors. Ġurnal ta 'Newroxjenza, 35(46), 15227-15229.CrossRefPubMedGoogle Scholar
  6. Gola, M., & Potenza, M. N. (2016). Paroxetine treatment of problematic pornography use: A case series. Ġurnal tal-Vizzji fl-Imġiba, 5(3), 529-532.CrossRefPubMedPubMedCentralGoogle Scholar
  7. Gola, M., Wordecha, M., Marchewka, A., & Sescousse, G. (2016b). Visual sexual stimuli—Cue or reward? A perspective for interpreting brain imaging findings on human sexual behaviors. Fruntieri fin-Newroxjenza Umana.  https://doi.org/10.3389/fnhum.2016.00402.PubMedPubMedCentralGoogle Scholar
  8. Gola, M., Wordecha, M., Sescousse, G., Lew-Starowicz, M., Kossowski, B., Wypych, M., et al. (2017). Can pornography be addictive? An fMRI study of men seeking treatment for problematic pornography use. Neuropsychopharmacology, 42, 2021-2031.CrossRefPubMedGoogle Scholar
  9. Grant, J. E., Atmaca, M., Fineberg, N. A., Fontenelle, L. F., Matsunaga, H., Janardhan Reddy, Y. C., et al. (2014). Impulse control disorders and “behavioural addictions” in the ICD-11. Psikjatrija Dinjija, 13(2), 125-127.CrossRefPubMedPubMedCentralGoogle Scholar
  10. Grubbs, JB, Exline, JJ, Pargament, KI, Hook, JN, & Carlisle, RD (2015a). Trasgressjoni bħala vizzju: Reliġjożità u diżapprovazzjoni morali bħala tbassir ta 'vizzju perċepit għall-pornografija. Arkivji ta ’Mġieba Sesswali, 44(1), 125-136.CrossRefPubMedGoogle Scholar
  11. Grubbs, JB, Volk, F., Exline, JJ, & Pargament, KI (2015b). Użu ta 'pornografija fuq l-Internet: Vizzju perċepit, dwejjaq psikoloġiku, u l-validazzjoni ta' miżura qasira. Ġurnal tas-Sess u t-Terapija Maritali, 41(1), 83-106.CrossRefPubMedGoogle Scholar
  12. Kafka, MP (2010). Disturb ipersesswali: Dijanjosi proposta għal DSM-V. Arkivji ta ’Mġieba Sesswali, 39(2), 377-400.CrossRefPubMedGoogle Scholar
  13. Klucken, T., Wehrum-Osinsky, S., Schweckendiek, J., Kruse, O., & Stark, R. (2016). Kondizzjonament appetittiv mibdul u konnettività newrali f'suġġetti b'imġieba sesswali kompulsiva. Ġurnal tal-Mediċina Sesswali, 13(4), 627-636.CrossRefPubMedGoogle Scholar
  14. Kraus, S., Krueger, R., Briken, P., First, M., Stein, D., Kaplan, M., …, Reed, G. (2018). Compulsive sexual behaviour disorder in the ICD-11. World Psychiatry, 17(1), 109-110.Google Scholar
  15. Kraus, S. W., Voon, V., & Potenza, M. N. (2016a). Neurobiology of compulsive sexual behavior: Emerging science. Neuropsychopharmacology, 41(1), 385-386.CrossRefPubMedGoogle Scholar
  16. Kraus, SW, Voon, V., & Potenza, MN (2016b). L-imġieba sesswali kompulsiva għandha titqies bħala vizzju? Vizzju, 111, 2097-2106.CrossRefPubMedPubMedCentralGoogle Scholar
  17. Lewczuk, K., Szmyd, J., Skorko, M., & Gola, M. (2017). Tfittex trattament għal użu problematiku tal-pornografija fost in-nisa. Ġurnal tal-Vizzji fl-Imġiba, 6(4), 445-456.CrossRefPubMedGoogle Scholar
  18. Odlaug, B., Lust, K., Schreiber, L., Christenson, G., Derbyshire, K., Harvanko, … Grant, J.E. (2013). Compulsive sexual behavior in young adults. Annals of Clinical Psychiatry, 25(3), 193-200.Google Scholar
  19. Petry, N. M. (2006). Should the scope of addictive behaviors be broadened to include pathological gambling? Vizzju, 101(s1), 152 – 160.CrossRefPubMedGoogle Scholar
  20. Petry, N. M., & O’Brien, C. P. (2013). Internet gaming disorder and the DSM-5. Vizzju, 108(7), 1186-1187.CrossRefPubMedGoogle Scholar
  21. Potenza, MN (2006). Id-disturbi tal-vizzju għandhom jinkludu kundizzjonijiet mhux relatati mas-sustanza? Vizzju, 101(s1), 142 – 151.CrossRefPubMedGoogle Scholar
  22. Potenza, M. N. (2009). Non-substance and substance addictions. Vizzju, 104(6), 1016-1017.CrossRefPubMedPubMedCentralGoogle Scholar
  23. Potenza, M. N., Gola, M., Voon, V., Kor, A., & Kraus, S. W. (2017). Is excessive sexual behaviour an addictive disorder? Lancet Psychiatry, 4(9), 663-664.CrossRefPubMedGoogle Scholar
  24. Reid, R. C., Carpenter, B. N., & Hook, J. N. (2016). Investigating correlates of hypersexual behavior in religious patients. Dipendenza Sesswali u Kompulsività, 23(2-3), 296-312.CrossRefGoogle Scholar
  25. Robinson, T. E., & Berridge, K. C. (1993). The neural basis of drug craving: an incentive-sensitization theory of addiction. Reviżjonijiet tar-Riċerka tal-Moħħ, 18(3), 247-291.CrossRefPubMedGoogle Scholar
  26. Sescousse, G., Barbalat, G., Domenech, P., & Dreher, J. C. (2013). Imbalance in the sensitivity to different types of rewards in pathological gambling. Moħħ, 136(8), 2527-2538.CrossRefPubMedGoogle Scholar
  27. Voon, V., Mole, TB, Banca, P., Porter, L., Morris, L., Mitchell, S., et al. (2014). Korrelati newrali ta 'reattività ta' cue sesswali f'individwi bi u mingħajr imgieba sesswali kompulsivi. PLOS ONE, 9(7), e102419.CrossRefPubMedPubMedCentralGoogle Scholar
  28. Walton, M. T., Cantor, J. M., Bhullar, N., & Lykins, A. D. (2017). Hypersexuality: A critical review and introduction to the “sexhavior cycle”. Arkivji ta ’Mġieba Sesswali, 46(8), 2231-2251.CrossRefPubMedGoogle Scholar