Kumenya chandamale: Zoganizira za Kuzindikira Mosiyanasiyana Mukamathandizira Anthu Omwe Angagwiritse Ntchito Bwino Zithunzi Zolaula (2018). (Kufufuza kwa mtundu wa Grubbs wamakhalidwe osayenera)

Zilembedwa Zotsatira Zogonana

, Voliyumu 48, Nkhani 2 , tsamba 431–435 |

https://link.springer.com/article/10.1007%2Fs10508-018-1301-9

Shane W. Kraus, Patricia J. Sweeney

Grubbs, Perry, Wilt, ndi Reid ( 2018a ) adapereka chitsanzo chomvetsetsa mavuto a anthu ndi zolaula chifukwa cha kusalingana kwa makhalidwe (PPMI). Makamaka, amanena kuti ogwiritsa ntchito zolaula ena amakumana ndi mavuto amisala komanso mavuto ena chifukwa machitidwe awo sakugwirizana ndi zomwe amakonda (monga kusalingana kwa makhalidwe), ndipo kafukufuku wakale wapereka chithandizo cha chitsanzo chomwe chaperekedwachi (Grubbs, Exline, Pargament, Volk, & Lindberg, 2017 ; Grubbs, Wilt, Exline, Pargament, & Kraus, 2018b ; Volk, Thomas, Sosin, Jacob, & Moen, 2016 ).

Mu nkhani yawo, Grubbs et al. ( 2018a ) adapereka njira ziwiri zogwiritsira ntchito zolaula molakwika. Njira 1 ikuwonetsa kuti mavuto okhudzana ndi zolaula amayamba chifukwa cha kusokonezeka kwa malingaliro (monga kugwiritsa ntchito mokakamiza), ndipo Njira 2 ikufotokoza mavuto okhudzana ndi zolaula chifukwa cha kusalingana kwa makhalidwe. Njira zonsezi zimaganizira za zomwe zimachitika munthu akamavutika zomwe timavomereza kuti ndi nkhani yofunika kwambiri yothetsera anthu omwe akufuna chithandizo chifukwa chogwiritsa ntchito zolaula molakwika. Mu ntchito yathu yachipatala, tapeza kuti zomwe zimachitika munthu akamavutika, zomwe zimachokera ku kuphatikiza kwa nkhawa, manyazi, ndi/kapena kudzimva kuti ndi wolakwa, nthawi zambiri zimakhala zoyambitsa makasitomala omwe akufuna thandizo. Komabe, kuti tipereke malangizo oyenera a chithandizo kwa anthu, kuphatikizapo omwe amadzizindikiritsa kuti ndi "okonda zolaula," tifunika kudziwa momwe angalamulire khalidwe lawo logonana. Tapeza kuti makasitomala ambiri omwe akufuna chithandizo chifukwa chogwiritsa ntchito zolaula molakwika amanena kuti akuvutika kwambiri pamodzi ndi zoyesayesa zambiri zolephera kuchepetsa kapena kupewa khalidweli, zomwe zimachitika chifukwa cha zotsatirapo zoyipa kapena zoyipa zomwe agwiritsa ntchito, ndikupitiliza kugwiritsa ntchito kwawo ngakhale kuti sakusangalala nazo kwenikweni.

Njira yodziwira matenda okhudza khalidwe logonana mokakamiza (CSB) yakhala ikukambidwa kwambiri m'zaka zaposachedwa (Kraus, Voon, & Potenza, 2016b ). CSB yaonedwa ngati chizolowezi chogonana (Carnes, 2001 ), hypersexuality (Kafka, 2010 ), chilakolako chogonana (Bancroft & Vukadinovic, 2004 ) kapena chizolowezi chogonana (Kor, Fogel, Reid, & Potenza, 2013 ). Pamene mkanganowu ukupitirira, tazindikira nkhawa zomwe ofufuza angapo adapereka (Moser, 2013 ; Winters, 2010 ) zokhudzana ndi kuthekera kochita zinthu zogonana mopitirira muyeso, ndichifukwa chake timakhulupirira kuti ndikofunikira kuyang'ana kukhalapo kwa machitidwe kapena zizindikiro zina zosonyeza kuti zochitika zogonana nthawi zambiri zimakhala zovuta komanso zosalamulirika (Kraus, Martino, & Potenza, 2016a ).

Monga momwe Kraus et al. ( 2018 adafotokozera ), kafukufuku wowonjezereka wokhala ndi deta yolimba akufunika kuti athandizire kupanga njira yolondola yodziwira matenda a CSB, kuphatikizapo kugwiritsa ntchito kwambiri zolaula (Gola & Potenza, 2018 ; Walton & Bhullar, 2018 ). Kuphatikiza apo, tikugwirizana ndi Grubbs et al. ( 2018a ) kuti kumvetsetsa kwamakono kwa chizolowezi chowonera zolaula kuli ndi malire achikhalidwe popeza maphunziro am'mbuyomu adachitika makamaka m'maiko akumadzulo, otukuka omwe ali ndi zitsanzo zachikhristu kwambiri. Ichi ndi malire ofunikira kuganizira momwe kugwiritsa ntchito zolaula zovuta kumatanthauzidwira ndikuchiritsidwa popeza miyambo, machitidwe abwino, ndi zokumana nazo za anthu ochokera kumadera ena zitha kusiyana ndi malingaliro a Western Judeo-Christian omwe aphunziridwa bwino pankhani yogwiritsa ntchito zolaula ndi machitidwe ena ogonana. Kafukufuku wowonjezereka pakugwiritsa ntchito zolaula zovuta akufunika kuti zitsimikizire kuti njira zodziwira matenda sizolondola zokha komanso zitha kumasuliridwa m'zikhalidwe zosiyanasiyana.

Kusokoneza Magwiridwe Okhudzana ndi Kugonana (CSBD): Zoganizira za kusiyana kwa chiwerewere

Posachedwapa, bungwe la World Health Organization ( 2018 ) linalimbikitsa kuphatikiza CSBD mu kope la 11 la International Classification of Diseases (6C72) lomwe likubwera. Njira yosamala idatengedwa, ndipo CSBD idayikidwa m'gulu la matenda oletsa kugwedezeka chifukwa umboni wofufuza sunakhale wolimba mokwanira kuti upereke ngati khalidwe losokoneza. Chifukwa chake, miyezo ya CSBD ikuphatikizapo izi:

CSBD imadziwika ndi kulephera kulamulira zilakolako zakugonana kapena zilakolako zakugonana zomwe zimabwerezabwereza zomwe zimapangitsa kuti munthu azichita zinthu zogonana mobwerezabwereza. Zizindikiro zake zingaphatikizepo kuchita zinthu zogonana mobwerezabwereza kukhala chinthu chofunikira kwambiri pa moyo wa munthuyo mpaka kufika ponyalanyaza thanzi lake ndi chisamaliro chake kapena zinthu zina, zochita zake ndi maudindo ake; kuyesetsa kochuluka kolephera kuchepetsa kwambiri khalidwe lake logonana mobwerezabwereza; komanso kupitiriza kuchita zinthu zogonana mobwerezabwereza ngakhale kuti zotsatira zake ndi zoipa kapena kusakhutira kwenikweni. Kulephera kulamulira zilakolako zakugonana kapena zilakolako zakugonana zomwe zimadza chifukwa cha khalidwe lake logonana mobwerezabwereza kumaonekera kwa nthawi yayitali (monga miyezi 6 kapena kuposerapo), ndipo kumayambitsa mavuto aakulu kapena kusokonekera kwakukulu m'magawo a munthu payekha, m'banja, pagulu, pamaphunziro, pantchito, kapena m'malo ena ofunikira pa ntchito. Mavuto omwe amagwirizana kwathunthu ndi zigamulo zamakhalidwe abwino komanso kusavomereza zilakolako zakugonana, zilakolako, kapena makhalidwe ake sikokwanira kukwaniritsa izi (World Health Organization, 2018 ).

Chizindikiro cha CSBD ndi kulephera mobwerezabwereza kuwongolera kapena kuletsa khalidwe la munthu logonana lomwe limayambitsa kuvutika kwakukulu ndi kulephera kugwira ntchito, ndipo "kuvutika maganizo chifukwa cha khalidwe logonana lokha sikupangitsa kuti munthu adziwe matenda a CSBD" (Kraus et al., 2018 , p. 109). Izi ndi mfundo zofunika kuziganizira muzochitika zachipatala komwe zinthu zofunika kwambiri pakuganiza bwino za milandu ndi dongosolo la chithandizo zimayamba ndi kuwunika bwino komanso kuzindikira koyenera kosiyana. Tapanga njira yolumikizirana mu Chithunzi 1 kuti tithandize asing'anga kulingalira njira zodziwira matenda ndi njira zochiritsira makasitomala omwe akugwiritsa ntchito zolaula molakwika.

Kuti tithandizire kumvetsetsa, tsopano tikambirana zitsanzo zitatu za makasitomala enieni omwe adafuna chithandizo cha zolaula ku Dipatimenti ya Veterans Affairs (VA) yachipatala yopita kuchipatala. Zitsanzo zonse zakhala zikudziwika kuti ziteteze chinsinsi cha makasitomala.

Mkuyu 1

Zithunzi zolaula zimagwiritsa ntchito njira zochizira matenda

Aliyense ndi PPMI ndi CSBD

A S ndi amuna, amuna kapena akazi okhaokha, amuna okhaokha azaka 20 omwe amagwira maganyu pomwe amapita ku koleji. Akuchiritsidwa kuchipatala cha VA chifukwa chazisokonezo zomwe zidachitika atakumana ndi zankhondo. A S adapemphanso chithandizo chifukwa adadzizindikiritsa kuti ndi "zolaula komanso zolaula" ndipo adati adayamba zolaula kuyambira ali wachinyamata. Ananena kuti amagwiritsa ntchito zolaula tsiku lililonse. Adafotokoza zoyesayesa zingapo zosiya zolaula komanso kuchita zachiwerewere ndi anzawo komanso omwe amagula nawo zogonana. A S adadzinena kuti ndi Mkhristu wolalikira yemwe wasintha ndipo adati zolaula zake amagwiritsa ntchito komanso zikhalidwe zina zogonana zinali "zochititsa manyazi" komanso "zoyipa" kwa iye zomwe zidamupangitsa kukhala wamavuto akulu amisala. A S adakana kulandira chithandizo cham'mbuyomu cha CSBD koma akuti adapezeka mgulu la amuna achipembedzo kuti amuthandize chifukwa chogwiritsa ntchito zolaula.

Pa nthawi yomwe chipatalacho chinkalandira chithandizo, mayankho a a S pa njira yowunikira adatsatira njira yapakati yomwe ili mu Chithunzi 1. Anavomereza PPMI popeza machitidwe ake ogonana sanali ogwirizana ndi zikhulupiriro zake zachipembedzo. Malinga ndi mbiri yake komanso lipoti la mavuto omwe anali nawo pakadali pano, adakwaniritsanso zofunikira zonse za CSBD. Mwatsoka, a S sanachite chithandizo china ndi chipatala chathu chifukwa cha chidwi chawo chofuna thandizo kudzera mu tchalitchi chawo chokha. Asanachotsedwe msanga, malangizo a chithandizo kwa a S adaphatikizapo kupereka mankhwala (naltrexone) kuti athetse chilakolako chawo ndikupereka chithandizo chamaganizo kuti athetse zikhulupiriro ndi machitidwe omwe adapangitsa kuti azigwiritsa ntchito zolaula mokakamiza.

Munthu aliyense ndi CSBD yekha

A D ndi nzika za ku Caucasus, amuna kapena akazi okhaokha, amuna okwatirana omwe ali ndi zaka zoyambirira za 30 ali ndi mbiri yakukhumudwa omwe adadziwika kuti ndi "osokoneza bongo." Anayamba kugwiritsa ntchito zolaula nthawi zonse ali ndi zaka zaunyamata ndipo amachita zolaula nthawi yayitali pazaka 10 zapitazi, makamaka akuwona zolaula kwa nthawi yayitali pomwe mkazi wake amapita kukagwira ntchito. Adanenanso zakugonana kokwanira ndi mkazi wake ngakhale amadzimva kuti zolaula zake zimasokoneza ubale wake ndi ubale wake. A D adanenanso kuti zolaula zake ndizokakamiza ndipo sanakhutire nazo. Adanenanso zakukhudzidwa kwambiri kuti aonere zolaula patadutsa masiku angapo akusowa zomwe zidamupangitsa kuti agwiritse ntchito.

Pa nthawi yomwe chipatalacho chinalandira mankhwala, a D sanavomereze kuti akumane ndi mavuto chifukwa cha PPMI koma anakumana ndi mavuto poletsa kugwiritsa ntchito zolaula. Anayesedwa ndipo anapezeka kuti akukwaniritsa zofunikira zonse za ICD-11 za CSBD monga momwe zasonyezedwera pa Chithunzi 1. A D adapatsidwa mankhwala (naltrexone, 50 mg/tsiku), ndipo adatenga nawo mbali pazochitika zapadera za chithandizo chamaganizo cha matenda ogwiritsa ntchito mankhwala osokoneza bongo zomwe zidasinthidwa kuti zithetse vuto lake logwiritsa ntchito zolaula. Pa nthawi yonse ya chithandizo, a D adachepetsa kugwiritsa ntchito zolaula ndipo adalimbana bwino ndi zilakolako zake. Adanenanso za kuwonjezeka kwa kuchita zinthu zosangalatsa ndi mkazi wake ndi anzake monga kuyenda pansi ndi kuyenda.

Munthu aliyense ndi PPMI Yekha

Bambo Z ndi nzika zaku Caucasus, amuna kapena akazi okhaokha omwe ali ndi zaka zoyambirira za 40 omwe akhala m'banja zaka zingapo. Amagwira ntchito ndipo ali ndi mwana m'modzi. A Z adanenapo za kukhumudwa komanso kugwiritsa ntchito zolaula nthawi yayitali pazaka 20 zapitazi zomwe zidadzetsa mikangano ndi omwe amakonda kukondana nawo, kuphatikiza mkazi wawo wapano. Anakana kugwiritsa ntchito zolaula panthawi yomwe anali kugonana ndi mkazi wake, koma anati sanakhale naye pachibwenzi zaka zingapo. Pakadali pano, amawonera zolaula kamodzi kapena kawiri pamlungu kuti achite maliseche koma adakana zovuta zilizonse zoletsa kapena kuchepetsa. Adanenanso kuti amagwiritsa ntchito zolaula makamaka chifukwa choti alibe njira ina yachiwerewere, koma kugwiritsa ntchito zolaula kumamupangitsa kuti akhale "woipa" komanso "wonyansa" chifukwa machitidwe ake anali osagwirizana ndi zikhulupiriro zake zamomwe amuna "amayenera kuchitira" munthawi yaukwati. Adakumana ndi mavuto akulu, makamaka kukhumudwa, komwe kumakhudzana ndi kuchuluka kwa kusakhazikika pakati pazikhalidwe zake komanso machitidwe ake ogonana.

Pa nthawi yomwe chipatalacho chinalandira chithandizo, a Z anati sanafunepo chithandizo cha vutoli kale. Anavomereza zochitika zamaganizo zokhudzana ndi kuvutika maganizo chifukwa cha PPMI ndipo anakwaniritsa njira zodziwira matenda a kuvutika maganizo komanso nkhawa koma osati CSBD monga momwe zasonyezedwera mu Chithunzi 1. Chithandizo cha munthu payekha chinayang'ana kwambiri kuchepetsa nkhawa za a Z pankhani yogonana ndi mkazi wake. a Z ndi mkazi wake nawonso adatenga nawo mbali mu chithandizo cha maanja pomwe katswiriyo adapereka zochita zosasangalatsa zogonana kuti awiriwa azichita komanso kuwonjezera kulumikizana kwawo. a Z adanenanso kuti kugwiritsa ntchito zolaula kunachepa pamene iye ndi mkazi wake adayambiranso kugonana. Adanenanso kuti kulankhulana ndi mkazi wake kunawonjezeka komanso kuchepa kwa kuvutika maganizo ndi nkhawa zomwe zidamupangitsa kusiya chithandizo.

Ndemanga Zomaliza

Cholinga chathu ndi Ndemanga iyi ndikupitiliza kukambirana kofunikira pankhani yokhudza matenda kwa makasitomala omwe akufuna chithandizo cha kugwiritsa ntchito zolaula molakwika. Monga momwe Grubbs et al. ( 2018a adafotokozera ), nkhani yokhudza kusalingana kwa makhalidwe ndi yofunika kwambiri podziwa ngati kasitomala yemwe ali ndi vuto logwiritsa ntchito zolaula akukwaniritsa zofunikira za ICD-11 za CSBD. Umboni ukusonyeza kuti anthu ena amanena za mavuto akuluakulu okhudza kugwiritsa ntchito zolaula zomwe zimapangitsa kuti pakhale mavuto ndi kuwonongeka m'mbali zambiri za magwiridwe antchito amisala (Kraus, Potenza, Martino, & Grant, 2015b ). Popeza CSBD ikhoza kuphatikizidwa mu ICD-11 komanso kuchuluka kwa kugwiritsa ntchito zolaula m'maiko ambiri akumadzulo, tikuyembekeza kuti anthu ambiri adzafuna chithandizo cha vuto logwiritsa ntchito zolaula mtsogolo. Komabe, si onse omwe akufuna chithandizo cha vuto logwiritsa ntchito zolaula adzakwaniritsa zofunikira za CSBD. Monga tafotokozera kale, kumvetsetsa zifukwa zomwe makasitomala amasankhira kufunafuna thandizo pa vuto logwiritsa ntchito zolaula kudzakhala kofunikira kwambiri kuti adziwe bwino matenda ndi kukonzekera chithandizo kwa makasitomala.

Monga momwe zitsanzo za makasitomala athu zasonyezera, ndikofunikira kufotokoza momwe zithunzi zolaula zimagwiritsidwira ntchito kuti zimveke bwino komanso kuti pakhale malangizo oyenera ochiritsira. Mankhwala angapo apangidwa kale ndikuyesedwa a CSB, kuphatikizapo kugwiritsa ntchito zolaula molakwika. Umboni woyamba umathandizira kugwiritsa ntchito chithandizo chamaganizo (Hallberg, Kaldo, Arver, Dhejne, & Öberg, 2017 ), chithandizo chodzipereka chovomerezeka (Crosby & Twohig, 2016 ) kapena njira zoganizira (Brem, Shorey, Anderson, & Stuart, 2017 ; Reid, Bramen, Anderson, & Cohen, 2014 ). Kuphatikiza apo, pali umboni wina wothandizira njira zamankhwala (Gola & Potenza, 2016 ; Klein, Rettenberger, & Briken, 2014 ; Kraus, Meshberg-Cohen, Martino, Quinones, & Potenza, 2015a ; Raymond, Grant, & Coleman, 2010 ). Monga momwe tawonetsera mu zitsanzo za makasitomala athu ndi Chithunzi 1 , makasitomala omwe ali ndi vuto logwiritsa ntchito zolaula ali ndi mafotokozedwe osiyanasiyana azachipatala komanso zifukwa zofunira thandizo. Chifukwa chake, kafukufuku wamtsogolo amafunika kuti apange chithandizo chomwe chimayang'ana bwino zovuta ndi zovuta zamavuto omwe amayambitsa kugwiritsa ntchito zolaula molakwika.

zolemba

ndalama

Ntchitoyi imathandizidwa ndi Dipatimenti ya Veterans Affairs, Veterans Health Administration, VISN 1 New England Mental Illness Research, Education, ndi Clinical Center.

Kugwirizana ndi Makhalidwe Abwino

Kusamvana kwa chidwi

Olembawo alibe zovuta zowonjezera kufotokozera zomwe zili mu phunziro la tsopano. Malingaliro omwe akufotokozedwa ndi awa a olemba ndipo sizikutanthauza kwenikweni udindo kapena ndondomeko ya Dipatimenti ya Veterans Affairs, USA.

Kuvomerezeka kwa Ethical

Zotsatira zonse zokhudzana ndi chikhalidwe zinatsatiridwa ndizofunika ndi Dipatimenti ya Veteran Affairs. Nkhaniyi ilibe maphunziro aliwonse ndi nkhani za anthu kapena zinyama zomwe zimapangidwa ndi olemba onse. Kugwiritsiridwa ntchito kwa zolembedweratu zolembedwera zinaphatikizidwa pa maphunziro okha.

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