Zomwe zikuwunikira Prause et al., 2015 (yomwe ili ndemanga 87)
Kafukufuku wogwiritsa ntchito EEG, wochitidwa ndi Prause ndi anzake, adawonetsa kuti anthu omwe akumva chisoni ndi zolaula zawo amagwiritsa ntchito, poyerekeza ndi gulu lolamulira lomwe silikumva chisoni ndi kugwiritsa ntchito kwawo zolaula, angafunike kusonkhezeredwa kwambiri/kwakukulu kuti ayambe kuyankha muubongo [87] . Ochita nawo zachiwerewere—anthu omwe akukumana ndi mavuto owongolera momwe amaonera zithunzi zogonana '( M = maola 3.8 pa sabata)—adawonetsa kuchepa kwa mphamvu ya mitsempha (yomwe imayesedwa ndi kuthekera kwabwino kwa chizindikiro cha EEG) akamawonetsedwa pazithunzi zogonana kuposa gulu loyerekeza lidawonetsedwa pazithunzi zomwezo. Kutengera kutanthauzira kwa zolimbikitsa kugonana mu kafukufukuyu (monga chizindikiro kapena mphotho; kuti mudziwe zambiri onani Gola et al. [4]), zomwe zapezekazi zitha kuthandizira zomwe zapezeka zina zomwe zikusonyeza zotsatira za zizolowezi [4]. Mu 2015, Banca ndi anzake adawona kuti amuna omwe ali ndi CSB amakonda zolimbikitsa zatsopano zogonana ndipo adawonetsa zomwe zapezeka zikusonyeza chizolowezi mu dACC akamawonetsedwa mobwerezabwereza pazithunzi zomwezo [88]. Zotsatira za kafukufuku amene tatchulawa zikusonyeza kuti kugwiritsa ntchito zolaula pafupipafupi kungachepetse kukhudzidwa ndi mphotho, zomwe zingayambitse chizolowezi chowonjezeka ndi kulolerana, motero kukulitsa kufunikira kolimbikitsira kwambiri kuti munthu ayambe kugonana. Komabe, maphunziro a nthawi yayitali akuwonetsedwa kuti afufuze izi mozama. Ponseponse, kafukufuku wokhudza ubongo mpaka pano wapereka chithandizo choyamba cha lingaliro lakuti CSB imafanana ndi mankhwala osokoneza bongo, kutchova juga, ndi chizolowezi cha masewera okhudzana ndi maukonde ndi machitidwe osinthika a ubongo, kuphatikizapo kuzindikira ndi chizolowezi.
NDEMANGA: Olemba ndemanga yaposachedwa akugwirizana ndi mapepala ena ambiri owunikidwa ndi anzawo - Ndemanga zowunikidwa ndi anzawo za Prause et al ., 2015 : Kuwerenga kwa EEG kotsika kumatanthauza kuti anthu sakusamala kwambiri zithunzi. Anali otopa (ozolowereka kapena osakhudzidwa). Wolemba wamkulu (Nicole Prause) akupitiliza kunena kuti zotsatirazi "zikutsutsa chizolowezi cha zolaula", koma ofufuza ena sagwirizana ndi zomwe ananena. Muyenera kudzifunsa nokha - "Ndi wasayansi wovomerezeka uti amene anganene kuti kafukufuku wawo wokhawo wosadziwika bwino wathetsa gawo lodziwika bwino la maphunziro ?".
- Pemphero N, Steele VR, Staley C, Sabatinelli D, Proudfit GH. Kusinthasintha kwazomwe zingatheke posachedwa ndi zionetsero za kugonana kwa ogwiritsa ntchito ndi zovuta zomwe sizikugwirizana ndi "zolaula". Biol Psychol. 2015; 109: 192-9.
Kudalirika
Cholinga cha ndemanga: Ndemanga yomwe ilipo pano ikufotokoza mwachidule zomwe zapezeka posachedwa zokhudzana ndi njira za neurobiological za vuto la khalidwe lokakamiza kugonana (CSBD) ndipo imapereka malingaliro a kafukufuku wamtsogolo wokhudzana ndi magulu a matenda a matendawa.
Zomwe zapezeka posachedwapa: Mpaka pano, kafukufuku wambiri wokhudza ubongo wokhudza khalidwe logonana mokakamiza wapereka umboni wa njira zogwirizanitsa zomwe zimayambitsa khalidwe logonana mokakamiza komanso zizolowezi zosagonana. Khalidwe logonana mokakamiza limagwirizanitsidwa ndi kusintha kwa magwiridwe antchito m'madera a ubongo ndi maukonde omwe amakhudzidwa ndi kukhudzidwa, chizolowezi, kusokonezeka kwa malingaliro, ndi kukonza mphotho m'njira monga mankhwala, kutchova juga, ndi zizolowezi zamasewera. Madera ofunikira muubongo olumikizidwa ndi mawonekedwe a CSB akuphatikizapo ma cortices akutsogolo ndi a nthawi, amygdala, ndi striatum, kuphatikiza ma nucleus accumbens.
Chidule: Ngakhale kuti kafukufuku wambiri wa sayansi ya ubongo adapeza kufanana kwakukulu pakati pa CSBD ndi zizolowezi zoledzera ndi zosokoneza bongo, bungwe la World Health Organization linaphatikiza CSBD mu ICD-11 ngati vuto lolamulira malingaliro. Ngakhale kuti kafukufuku wakale wathandiza kuwonetsa njira zina zomwe zimayambitsa vutoli, kufufuza kwina kumafunika kuti timvetsetse bwino vutoli ndikuthetsa mavuto okhudza magulu okhudza CSBD.
Introduction
Khalidwe lokakamiza kugonana (CSB) ndi nkhani yomwe imakambidwanso yomwe imadziwikanso kuti chizolowezi chogonana, hypersexuality, kudalira kugonana, chilakolako chogonana, nymphomania, kapena khalidwe logonana losalamulirika [1-27]. Ngakhale kuti kuchuluka kolondola sikudziwika bwino chifukwa cha kafukufuku wochepa wa epidemiological, CSB ikuyerekezeredwa kuti imakhudza 3-6% ya anthu akuluakulu ndipo imapezeka kwambiri mwa amuna kuposa akazi [28-32]. Chifukwa cha mavuto ndi kuwonongeka komwe kumanenedwa ndi amuna ndi akazi omwe ali ndi CSB [4-6, 30, 33-38], World Health Organization (WHO) yalimbikitsa kuphatikiza Compulsive Sexual Behavior Disorder (CSBD) mu kope la 11 lomwe likubwera la International Classification of Diseases (6C72)[39]. Kuphatikizidwa kumeneku kuyenera kuthandiza kuwonjezera mwayi wopeza chithandizo kwa anthu osalandira chithandizo, kuchepetsa manyazi ndi manyazi okhudzana ndi kufunafuna thandizo, kulimbikitsa khama lofufuza, ndikuwonjezera chidwi cha mayiko pa vutoli [40, 41]. Tikuvomereza kuti m'zaka 20 zapitazi pakhala matanthauzo osiyanasiyana omwe amagwiritsidwa ntchito pofotokoza machitidwe ogonana osagwirizana omwe nthawi zambiri amadziwika ndi kuchita zinthu zogonana mopitirira muyeso (monga kugonana kosasangalatsa/kosadziwika, kugwiritsa ntchito zolaula molakwika). Pa ndemanga yapano, tigwiritsa ntchito mawu oti CSB ngati mawu ofunikira pofotokoza khalidwe logonana lovuta komanso lopitirira muyeso.
CSB yaonedwa ngati vuto la obsessive-compulsive-spectrum disorder, vuto lolamulira maganizo, kapena khalidwe loledzera [42, 43]. Zizindikiro za CSBD zili ngati zomwe zinaperekedwa mu 2010 kuti DSM-5 izindikire matenda a hypersexual [44]. Matenda a hypersexual pamapeto pake adachotsedwa ndi American Psychiatric Association ku DSM-5 pazifukwa zingapo; kusowa kwa maphunziro a neurobiological ndi majini kunali chimodzi mwa zifukwa zodziwika bwino [45, 46]. Posachedwapa, CSB yalandira chidwi chachikulu m'chikhalidwe chodziwika bwino komanso sayansi ya chikhalidwe cha anthu, makamaka chifukwa cha kusiyana kwa thanzi komwe kumakhudza magulu omwe ali pachiwopsezo komanso osayenerera. Ngakhale kuti maphunziro a CSB akuwonjezeka kwambiri (kuphatikizapo omwe amaphunzira "chizolowezi chogonana," "hypersexual," "sexual compulsivity"), kafukufuku wochepa kwambiri wafufuza maziko a mitsempha ya CSB [4, 36]. Nkhaniyi ikuwunikanso njira za neurobiological za CSB ndikupereka malingaliro ofufuza mtsogolo, makamaka okhudzana ndi kugawa matenda a CSBD.
CSB ngati Addictive Disorder
Madera a ubongo omwe akuphatikizidwa pokonza mphoto ndi ofunika kumvetsetsa chiyambi, mapangidwe, ndi kukonzanso makhalidwe osokoneza bongo [47]. Makhalidwe mkati mwa chomwe chimatchedwa 'mphoto system' amachotsedwa mwa kuwongolera kukakamiza, monga mankhwala osokoneza bongo m'zoledzeretsa. Katswiri wamkulu wa mapuloteni omwe amagwira ntchito pokonza mphoto ndi dopamine, makamaka mkati mwa njira yochepetsera mphamvu yomwe imakhalapo ndi ventral tegmental area (VTA) komanso kugwirizana kwake ndi nucleus accumbens (NAc), komanso amygdala, hippocampus, ndi prefrontal cortex [48]. Zowonjezereka za ubongo ndi njira zogwirira ntchito zikuphatikizidwa pokonza mphoto ndi zosangalatsa, ndipo malingaliro awa ovomerezeka aperekedwa kuti dopamine yakhala ikuphatikizidwa ku madigiri osiyana ndi mankhwala osokoneza bongo ndi khalidwe la anthu mwa anthu [49-51].
Malingana ndi chiphunzitso cholimbikitsana, njira zosiyanasiyana za ubongo zimakhudzira zofuna kupeza mphotho ('kufuna') ndi mphotho yeniyeni ya mphotho ('kukonda') [52]. Ngakhale kuti 'kusowa' kungakhale kofanana kwambiri ndi dopaminergic neurotransmission mu ventral striatum (VStr) ndi orbitofrontal cortex, makina opangidwa kuti apangitse zolinga zofuna komanso zosangalatsa zimakhala zovuta kwambiri [49, 53, 54].
Kubwezeretsanso zokhudzana ndi mphotho ya VStr kwawerengedwa pamavuto osokoneza bongo monga mowa, cocaine, zovuta zamagwiritsidwe ntchito a opioid, ndi vuto la kutchova juga [55-58]. Volkow ndi ogwira nawo ntchito amafotokoza zigawo zinayi zofunika kwambiri pakukonda: (1) kulimbikitsidwa kokhudzana ndi cue reactivity ndikukhumba, (2) kukhumudwitsa anthu okhudzana ndi chizolowezi, (3) kusadzionetsera, ndi (4) magwiridwe antchito opanikizika [59]. Pakadali pano, kafukufuku wa CSB adangoyang'ana pa kuyambiranso, kulakalaka, komanso kuzolowera. Kafukufuku woyamba wamalingaliro a CSB adalunjika pakuwunika kufanana komwe kungakhalepo pakati pa CSB ndi zosokoneza bongo, ndikuwunika kwambiri chiphunzitso cholimbikitsana chomwe chimazikidwa pakulimbikitsa kwamphamvu kwamitsempha yokhudzana ndi kusintha kwa zolimbikitsira zokhudzana ndi dopamine [60]. Mwa mtunduwu, kuwonetsedwa mobwerezabwereza ndi mankhwala omwe angakhale osokoneza bongo kumatha kusintha ma cell aubongo ndi mabwalo omwe amayang'anira kupatsa mphamvu zolimbikitsira chidwi, chomwe ndi njira yamaganizidwe okhudzidwa ndi zomwe zimapangitsa. Chifukwa cha kuwululidwa kumeneku, ma circuits aubongo amatha kutengeka kwambiri (kapena kulimbikitsidwa), potero amathandizira kukulitsa magawo azomwe angalimbikitse chidwi cha zinthu zomwe zikuwunikira komanso zomwe amagwirizana nazo. Chilimbikitso chazomwe zimayambitsa ('kufuna') mankhwala osokoneza bongo kumatha kukhala kwazaka zambiri, ngakhale kugwiritsa ntchito mankhwala osokoneza bongo kutatha. Zitha kuphatikizira zochitika zosadziwika (zosazindikira) kapena njira zofotokozera (kulakalaka kuzindikira). Njira yolimbikitsira chidwi yakhala ikuthandizira kuti zithandizire pakukonza ndi kukonza CSB [1, 2].
Zothandizira zapadera zitsanzo zolimbikitsa za CSB. Mwachitsanzo, Othandizira ndi ochita nawo ntchito adafufuza zochitika zomwe zimagwiritsidwa ntchito poyendetsa zida zowonongeka (DACC) -Vstr -amygdala functional network [1] .Zomwe zili ndi CSB poyerekeza ndi anthu omwe sankawonetsera zinawonjezeka VStr, dACC, ndi mayankho a amygdala ku kanema ka zithunzi zolaula masewera. Zomwe zapezeka m'mabuku akuluakulu zimasonyeza kuti kugonana ndi mankhwala osokoneza bongo amachititsa kuti zigawo zambiri komanso zida zowonongeka zikhale zovuta kwambiri [61, 62]. Amuna omwe ali ndi CSB poyerekeza ndi omwe alibe chilakolako chofuna kugonana (zofuna zogonana ndi zofuna zawo) zimalimbikitsa ndi kukonda zomwe zikugwirizana ndi chiphunzitso cholimbikitsana [1]. Mofananamo, a Mechelmans ndi anzawo adapeza kuti amuna omwe ali ndi CSB amawayerekezera ndi amuna popanda kuwonetseratu chidwi choyambirira chokhudzana ndi kugonana koma osati kulowerera ndale [2]. Zofukufukuzi zikusonyeza kufanana poonjezera chidwi chodziwika bwino chomwe chikupezeka m'maphunziro owona za mankhwala osokoneza bongo.
Mu 2015, Seok ndi Sohn adapeza kuti pakati pa amuna omwe ali ndi CSB poyerekeza ndi omwe alibe, ntchito yayikulu inkawonedwa mu dorpateral cortex (dlPFC), caudate, low inferior supramarginal gyrus ya parietal lobe, dACC, ndi thalamus chifukwa cha kugonana [63]. Anapezanso kuti kuopsa kwa zizindikiro za CSB kunkagwirizana ndi kuchitidwa kwa dlPFC ndi thalamus. Mu 2016, Brand ndi anzake adayang'anitsitsa kwambiri VStr chifukwa cha zolaula zomwe amazikonda poyerekeza ndi zolaula zosakondedwa pakati pa amuna ndi CSB ndipo adapeza kuti ntchito ya VStr ikugwirizana kwambiri ndi zizindikiro zozizwitsa zolaula zolaula Mayeso ochepa a Internet Addiction Anasinthidwa pa cybersex (s-IATsex) [64, 65].
Klucken ndi anzawo adapeza kuti ophunzira omwe ali ndi CSB amawayerekezera ndi anthu omwe sagwirizana ndi amygdala panthawi yopereka zithunzi (zojambulajambula) pofotokoza zithunzi zolaula (mphoto) [66]. Zotsatirazi zikufanana ndi zomwe zikuchokera ku maphunziro ena omwe amafufuza amygdala ntchito pakati pa anthu omwe ali ndi vuto la kugwiritsira ntchito mankhwala ndi amuna omwe ali ndi CSB akuwonera kanema zolaula zolaula [1, 67] .Gwiritsani ntchito EEG, Steele ndi anzake akuwona kukula kwa P300 ku zithunzi zogonana (poyerekeza ndi osalowerera ndale) pakati pa anthu odziwika kuti ali ndi vuto ndi CSB, akuyang'ana ndi kafukufuku wam'mbuyo kuti asamangogwiritsa ntchito mankhwala osokoneza bongo [68, 69].
Mu 2017, Gola ndi anzake akufalitsa zotsatira za kafukufuku pogwiritsa ntchito kujambula kokhala ndi maginito (fMRI) kuti ayese mayankho a Vstr ku zovuta zowonongeka ndi zachuma pakati pa amuna omwe akufuna chithandizo kwa CSB ndi amuna popanda CSB [6]. Ophunzira adagwira ntchito yochedwa kuchepetsa [54, 70, 71] pamene akuyesa fMRI. Pa ntchitoyi, adalandira mphoto zowonongeka kapena zamtengo wapatali zotsatiridwa ndi ndondomeko zowonongeka. Amuna omwe ali ndi CSB amasiyana ndi omwe alibe VStr mayankho kuti amvetse zithunzi zolaula, koma osati m'mayankho awo ndi zithunzi zolaula. Kuonjezera apo, amuna omwe ali ndi CSB motsutsana ndi CSB anasonyezeratu kuwonjezereka kwa VStr makamaka kuti adziwe zithunzi zokhudzana ndi zachiwerewere osati za iwo omwe akulosera zapindula za ndalama. Zomwe zimagwiritsidwa ntchito poyesa kugonana (kufotokozera zithunzi zolaula ndi kupindula kwa ndalama) zinapezeka kuti zokhudzana ndi kuwonjezeka kwa makhalidwe omwe amachititsa kuona zithunzi zolaula ('kufuna'), mphamvu ya CSB, kuchuluka kwa zolaula zomwe zimagwiritsidwa ntchito pa sabata, komanso kuchuluka kwa maliseche pamlungu. Zotsatirazi zikusonyeza kufanana pakati pa CSB ndi zoledzeretsa, ntchito yofunika kwambiri yophunziridwa mu CSB, komanso njira zothandizira mankhwala, makamaka njira zomwe zimaphatikizapo luso lophunzitsa anthu kuti athe kuthana ndi zolakalaka / zofuna [72]. Kuwonjezera apo, chizoloŵezi chikhoza kuululidwa mwa kuchepa kwa mphotho kumvetsetsa komwe kaŵirikaŵiri kumachititsanso chidwi komanso kungakhudzitse mphotho yokhudzana ndi kugonana kuphatikizapo kuona zolaula ndi kugonana pakati pawo [1, 68]. Kuzoloŵerana kumatanthauziranso ndi mankhwala osokoneza bongo [73-79].
Mu 2014, Kuhn ndi Gallinat adawona kuti VStr reactivity inachepetsedwa chifukwa cha zolaula m'magulu a anthu omwe amawonera zolaula nthawi zambiri, poyerekeza ndi owonerera oonera zolaula kawirikawiri [80]. Kugwirizana kokwanira pakati pa dlPFC ndi VStr yolondola kunayanjananso. Kuwonongeka kwa kayendetsedwe ka fronto-bereatal kunakhudzana ndi zosayenera kapena zosokoneza kusankha zosasamala mosasamala za zotsatira zoipa zomwe zingatheke komanso kusokonekera kwa chilakolako cha mankhwala osokoneza bongo [81, 82]. Anthu omwe ali ndi CSBmay adachepetsanso maulamuliro akuluakulu poona zolaula [83, 84]. Kuhn ndi Gallinat adapezanso kuti imvi yowona bwino ya striatum (caudate nucleus), yomwe yakhala ikukhudzana ndi makhalidwe oyanjana ndi amzake komanso okhudzana ndi chikondi chomwe chimagwirizana ndi chikondi chachikondi, chinagwirizanitsidwa ndi nthawi yoonera zolaula [80, 85, 86]. Zotsatirazi zikusonyeza kuti kuwonetsa zolaula nthawi zambiri kungachepetse ubongo chifukwa chogonana ndi kuonjezera chizoloŵezi cha zithunzi zachiwerewere ngakhale kuti kufufuza kwa nthawi yaitali kumafunika kuti pasakhalepo mwayi wina.
Kafukufuku wogwiritsa ntchito EEG, wochitidwa ndi Prause ndi anzake, adawonetsa kuti anthu omwe akumva chisoni ndi zolaula zawo amagwiritsa ntchito, poyerekeza ndi gulu lolamulira lomwe silikumva chisoni ndi kugwiritsa ntchito zolaula, angafunike kusonkhezeredwa kwambiri/kwakukulu kuti ayambe kuyankha muubongo [87]. Ochita nawo zachiwerewere—anthu omwe akukumana ndi mavuto owongolera momwe amaonera zithunzi zogonana '( M = maola 3.8 pa sabata)—adawonetsa kuchepa kwa mphamvu ya mitsempha (yoyesedwa ndi kuthekera kwabwino kwa chizindikiro cha EEG) akamawonetsedwa pazithunzi zogonana kuposa gulu loyerekeza lidawonetsa zithunzi zomwezo. Kutengera kutanthauzira kwa zolimbikitsa kugonana mu kafukufukuyu (monga chizindikiro kapena mphotho; kuti mudziwe zambiri onani Gola et al. [4]), zomwe zapezekazi zitha kuthandizira zomwe zapezeka zomwe zikusonyeza zotsatira za zizolowezi [4]. Mu 2015, Banca ndi anzake adawona kuti amuna omwe ali ndi CSB amakonda zolimbikitsa zatsopano zogonana ndipo adawonetsa zomwe zapezeka zomwe zikusonyeza chizolowezi mu dACC akamawonetsedwa mobwerezabwereza pazithunzi zomwezo [88]. Zotsatira za kafukufuku zomwe zatchulidwazi zikusonyeza kuti kugwiritsa ntchito zolaula pafupipafupi kungachepetse chidwi cha mphotho, mwina kumabweretsa chizolowezi chowonjezeka ndi kulolerana, motero kukulitsa kufunikira kolimbikitsira kwambiri kuti munthu ayambe kugonana. Komabe, kafukufuku wa nthawi yayitali akusonyeza kuti akuwunikanso kuthekera kumeneku. Ponseponse, kafukufuku wokhudza ubongo mpaka pano wapereka chithandizo choyambirira cha lingaliro lakuti CSB imafanana ndi zizolowezi za mankhwala osokoneza bongo, kutchova juga, ndi masewera okhudzana ndi maukonde ndi njira zosinthira ubongo, kuphatikizapo kuzindikira ndi kuzolowera.
CSB ngati Matenda a Impulse-Control?
Gulu la "Matenda Oletsa Kugwedezeka Osagawidwa Kwina Konse" mu DSM-IV linali losiyana kwambiri ndipo linali ndi matenda ambiri omwe adatchulidwanso kuti ndi osokoneza bongo (matenda otchova njuga) kapena okhudzana ndi kukakamizidwa (trichotillomania) mu DSM-5[89, 90]. Gulu lomwe lili pano mu DSM-5 limayang'ana kwambiri pa matenda osokoneza, oletsa kugwedezeka komanso machitidwe, ndipo limakhala lofanana kwambiri poganizira za kleptomania, pyromania, matenda ophulika nthawi zina, matenda otsutsa, matenda oletsa kusokonezeka, komanso matenda osagwirizana ndi anthu [90]. Gulu la matenda oletsa kugwedezeka mu ICD-11 limaphatikizapo matenda atatu oyamba awa ndi CSBD, zomwe zimapangitsa mafunso okhudza magulu oyenera kwambiri. Poganizira izi, momwe CSBD imagwirizanirana ndi kapangidwe ka transdiagnostic ka impulsivity imafuna kuganiziranso kwina pamagulu komanso zolinga zachipatala.
Kutengeka kungatanthawuze ngati, "kukonzekeretsa mofulumira, kuchitidwa kosakonzekera kuchitetezo cha mkati kapena kunja komwe kumakhala kocheperapo pa zotsatira zovulaza kwa munthu wopupuluma kapena ena" [91]. Kuchita zachiwerewere kwakhala kugwirizana ndi kugonana kosayenera [92]. Kutengeka ndikumanga kwa mitundu yosiyanasiyana (mwachitsanzo, kusankha, yankho) zomwe zingakhale ndi makhalidwe ndi zikhalidwe za boma [93-97]. Mitundu yosiyanasiyana ya kukhudzidwa ingayesedwe kudzera payekha -poti kapena ntchito. Zingathe kugwirizanitsa zofooka kapena osati zonse, ngakhale mwa mtundu womwewo wa kukhumba; zofunikira, zikhoza kufotokoza mosiyana ndi zochitika zamankhwala ndi zotsatira [98]. Kuchita zowonongeka kungakhale kuyesedwa ndi ntchito zowononga zoletsa, monga chizindikiro choyimira kapena Go / No-Go, pamene chisankho chofuna kusankhidwa chikhoza kuyesedwa mwa kuchepetsa kuchepetsa ntchito [94, 95, 99].
Deta imasonyeza kusiyana pakati pa anthu omwe alibe ndi CSB pazinthu zowonongeka komanso zochitika zokhuza mtima [100-103]. Komanso, kukhumba ndi kukhumba zikuwoneka kuti zikugwirizana ndi kuopsa kwa zizindikiro za zolaula zomwe zimawonetsedwa, monga kutaya mphamvu [64, 104]. Mwachitsanzo, kafukufuku wina anapeza zotsatira zokhudzana ndi kukhudzidwa komwe kunayesedwa ndi kudzipangitsa kudziwika ndi ntchito zawo zokhudzana ndi zotsatira zowonjezereka pa chidziwitso cha CSB [104].
Pakati pa zitsanzo zofunafuna chithandizo, 48% mpaka 55% ya anthu akhoza kusonyeza kuchuluka kwa chilakolako chofuna kuchita zinthu mopitirira muyeso pa Barratt Impulsiveness Scale [105-107]. Mosiyana ndi zimenezi, deta ina imasonyeza kuti odwala ena omwe akufuna chithandizo cha CSB alibe makhalidwe ena osafuna kuchita zinthu mopitirira muyeso kapena zizolowezi zina zosayenera kuchita zinthu mopitirira muyeso kuposa momwe amavutikira ndi makhalidwe ogonana, zomwe zikugwirizana ndi zomwe zapezeka kuchokera ku kafukufuku wamkulu wa pa intaneti wa amuna ndi akazi omwe akusonyeza kuti pali ubale wofooka pakati pa chilakolako chofuna kuchita zinthu mopitirira muyeso ndi zina mwa zinthu za CSB (kugwiritsa ntchito zolaula zovuta) ndi ubale wolimba ndi ena (hypersexuality) [108, 109]. Mofananamo, mu kafukufuku wogwiritsa ntchito miyeso yosiyanasiyana ya anthu omwe ali ndi vuto la kugwiritsa ntchito zolaula (nthawi yapakati yogwiritsira ntchito zolaula sabata iliyonse = mphindi 287.87) ndi omwe alibe (nthawi yapakati yogwiritsira ntchito zolaula sabata iliyonse = mphindi 50.77) sanasiyane pa zomwe adadzinenera (UPPS-P Scale) kapena miyeso yochokera ku ntchito (Stop Signal Task) [110]. Kuphatikiza apo, Reid ndi anzake sanawone kusiyana pakati pa anthu omwe ali ndi CSB ndi owongolera athanzi pa mayeso a neuropsychological a magwiridwe antchito (monga, kuletsa kuyankha, liwiro la magalimoto, chisamaliro chosankha, kusamala, kusinthasintha kwa chidziwitso, kapangidwe ka malingaliro, kusinthasintha kwa seti), ngakhale atasintha luso la kuzindikira mu kusanthula [103]. Pamodzi, zomwe zapezeka zikusonyeza kuti kutengeka kungagwirizane kwambiri ndi hypersexuality koma osati ndi mitundu inayake ya CSB monga kugwiritsa ntchito zolaula zovuta. Zimadzutsa mafunso okhudza kusankhidwa kwa CSBD ngati vuto lolamulira kukhudzidwa mu ICD-11 ndipo zikuwonetsa kufunikira koyesa kolondola kwa mitundu yosiyanasiyana ya CSB. Izi ndizofunikira kwambiri chifukwa kafukufuku wina akusonyeza kuti kusakhazikika maganizo ndi magawo ang'onoang'ono a vuto la kulamulira kusinthasintha maganizo zimasiyana malinga ndi mulingo wa malingaliro ndi matenda [93, 98, 111].
CSB ngati Obsessive-Compulsive-Spectrum Disorder?
Matenda amodzi (trichotillomania) omwe amadziwika ngati matenda opatsirana mu DSM-IV akhala akugwiritsidwa ntchito ndi matenda osokoneza bongo (OCD) monga matenda osokoneza maganizo komanso okhudzana ndi vuto la DSM-5 [90]. Mavuto ena a DSM-IV omwe amawoneka ngati kutchova njuga amasonyeza kusiyana kwakukulu kuchokera ku OCD, kumathandiza kuti akhale osiyana m'magulu osiyanasiyana [112]. Kumangokhalira kukakamizika ndi ntchito yomangika, yomwe imaphatikizapo, "kubwereza mobwerezabwereza komanso kupweteketsa khalidwe mopitirira muyeso popanda kugwira ntchito mosavuta, kumagwiritsidwa ntchito mosasinthika kapena mwachizoloŵezi, malinga ndi malamulo okhwima kapena njira zopeŵera zotsatira zoipa" [93]. OCD ili ndi zifukwa zambiri zowakakamiza; Komabe, zimakhala zoledzeretsa ndi zizoloŵezi zokhudzana ndi kutchova njuga [98]. Mwachizoloŵezi, mavuto okhwimitsa ndi osakanikirana anali ophatikizana kumbali yotsatizana; Komabe, chidziwitso chimaonetsa kuti kumangokhala kovuta ndi zovuta zambiri zomwe zimapangitsa kuti munthu asamangokhalira kumangokhalira kuchita zinthu monyanyira komanso kukakamiza [93, 113]. Ponena za CSB, zovuta zogonana zanenedwa kuti zimakhala nthawi yambiri ndipo zimasokoneza ndipo zingagwirizane ndi OCD kapena zokhudzana ndi OCD [114].
Kafukufuku waposachedwapa akuyang'ana zochitika zowonongeka zogwiritsa ntchito Obsessive-Compulsive Inventory -Zowonongeka (OCI-R) sizinasonyeze zapamwamba pakati pa anthu omwe ali ndi CSB [6, 37, 115]. Mofananamo, kufufuza kwakukulu pa intaneti kunawona kuti zinthu zovuta zokhudzana ndi zolaula zimagwiritsa ntchito [109]. Zonsezi, zotsatilazi sizimasonyeza chitsimikizo champhamvu choganizira za CSB ngati matenda osokoneza maganizo. Zochitika za Neural zomwe zimayambitsa zizoloŵezi zobwezeretsa zafotokozedwa ndipo zikugwirizanitsa kudutsa matenda osiyanasiyana [93]. Maphunziro ena ogwiritsira ntchito njira zogwiritsira ntchito podzitetezera m'magulu akuluakulu okhudzana ndi chithandizo chachipatala akufunika kuti aone momwe CSBD ikukhudzira kukhudzidwa ndi OCD.
Kusintha kwachisinthiko cha Neural pakati pa CSB Anthu
Pakalipano, kafukufuku wamaganizo ambiri adayang'ana kusintha kwa anthu omwe ali ndi CSB, ndipo zotsatira zimasonyeza kuti zizindikiro za CSB zimagwirizanitsidwa ndi njira zinazake zazitsulo [1, 63, 80]. Ngakhale kuti maphunziro apadera awonjezera ntchito yathu pokhudzana ndi kukonzekera kumadera ndi kugwirizanitsa ntchito, njira zina zowonjezera ziyenera kugwiritsidwa ntchito.
Zoyeretsa zoyera kapena zoyera zaphunziridwa mu CSB [102, 116]. Mu 2009, Wachinyamata ndi anzake adapeza kuti anthu omwe ali ndi CSB amawayerekezera ndi omwe alibe malo apamwamba kwambiri omwe akuwonekera kumadera akutali omwe amawoneka kuti ndi ofunika kwambiri. Pofufuza amuna omwe alibe ndi CSB kuchokera ku 2016, mbali yayikulu yotsalira ya amygdala idawonetsedwa mu gulu la CSB ndipo kugwirizanitsa kwabwino kwa boma kunkachitika pakati pa amygdala ndi dlPFC [116]. Kuchepetsa mavoti a ubongo m'ng'onoting'ono ka msana, kumaso kwapadera, hippocampus, ndi amygdala amapezeka kuti akugwirizana ndi zizindikiro za kugonana kwachiwerewere kwa odwala omwe ali ndi matenda a maganizo olakwika kapena matenda a Parkinson [117, 118]. Zizindikiro zooneka ngati zotsutsana za amygdala voliyumu ya CSB zimatsindika kufunikira kokambirana zovuta zomwe zimachititsa kuti matenda a neuropsychiatric ayambe kumvetsetsa matenda a neurobiology a CSB.
Mu 2018, Seok ndi Sohn amagwiritsa ntchito ma voxel based based morphometry (VBM) ndi kugwirizanitsa kayendedwe ka boma kuti aone njira zoyenera komanso zopuma mu CSB [119]. Amuna omwe ali ndi CSB adawonetsa kuchepa kwakukulu kwa grey. Vuto lapamwamba lamanzere la gyrus (STG) linali losemphana kwambiri ndi kuopsa kwa CSB (mwachitsanzo, Kugonana Kwachilendo Kuyeza-Revised [SAST] ndi Hypersexual Behavior Inventory [HBI] ziwerengero] [120, 121]. Kuwonjezera apo, kusinthidwa kumanzere kumanzere kwa STG kumanzere ndi kumanzere kumene kumagwirizanitsa zizindikiro za STG zinawonedwa. Potsirizira pake, zotsatira zavumbulutsa mgwirizano waukulu pakati pa CSB ndi kugwirizanitsa ntchito kwa STG ya kumanzere kupita ku nkhono yolondola.
Ngakhale kuti maphunziro a khungu la CSB akhala akuunikira, pang'ono ndi apo amadziwika za kusintha kwa ziwalo za ubongo ndi kugwirizanitsa ntchito pakati pa anthu a CSB, makamaka kuchokera ku maphunziro a mankhwala kapena zojambula zina zakutali. Kuphatikiza kwa zofufuza kuchokera kumadera ena (mwachitsanzo, ma genetic ndi epigenetic) zidzakhalanso zofunikira kuziganizira m'tsogolo. Kuonjezera apo, zofufuza zomwe zikuwonekeratu zovuta zapadera ndikuphatikizapo njira zowonongeka zimathandiza kuti pakhale zofunikira zofunika kuti zidziwitse zomwe zikuchitika komanso zomwe zikuchitika panopa.
Zotsatira ndi Malangizo
Nkhaniyi ikufotokoza za sayansi zokhudzana ndi njira zachitsulo za CSB kuchokera kuzinthu zitatu: kusuta, kudziletsa, ndi kukakamiza. Kafukufuku wambiri amasonyeza kuti pali mgwirizano pakati pa CSB ndi kuwonjezereka mphamvu zokhudzana ndi zolaula, ndipo ena amati CSB ikugwirizana ndi chikhalidwe chochulukirapo chokhudzana ndi zochitika zonyansa [1, 6, 36, 64, 66]. Kafukufuku amasonyezanso kuti zizindikiro za CSB zimakhala ndi nkhawa yaikulu [34, 37,122]. Ngakhale kuti pali mipata kumvetsa kwathu kwa CSB, malo ambiri a ubongo (kuphatikizapo mapepala am'tsogolo, a parietal and temporal, amygdala, ndi striatum) agwirizanitsidwa ndi CSB ndi zina zokhudzana nazo.
CSBD yaphatikizidwa mu mtundu waposachedwa wa ICD-11 ngati vuto lolamulira zinthu zosafunikira [39]. Monga momwe bungwe la WHO linafotokozera, 'Matenda olamulira zinthu zosafunikira amadziwika ndi kulephera mobwerezabwereza kukana chilakolako, chilakolako, kapena chilakolako chochita chinthu chomwe chimapindulitsa munthuyo, kwakanthawi kochepa, ngakhale zotsatira zake monga kuvulaza munthuyo kwa nthawi yayitali kapena kwa ena, kuvutika maganizo chifukwa cha khalidwe lake, kapena kuwonongeka kwakukulu m'mabanja, m'magulu, m'maphunziro, kuntchito, kapena m'magawo ena ofunikira pantchito' [39]. Zomwe zapezeka pano zikubweretsa mafunso ofunikira okhudza kugawa kwa CSBD. Matenda ambiri omwe amadziwika ndi kulephera kulamulira zinthu zosafunikira amagawidwa kwina mu ICD-11 (monga kutchova juga, masewera, ndi matenda ogwiritsira ntchito mankhwala osokoneza bongo amagawidwa ngati matenda osokoneza bongo) [123].
Pakalipano, CSBD imayambitsa matenda osokoneza bongo, ndipo kukonzanso koyenera kwa CSBD ziyenera kusiyanitsa pakati pa zigawo zosiyana siyana, zina zomwe zingagwirizane ndi kusagwirizana kwa zovuta za kugonana kwa anthu payekha [33, 108, 124]. Kusagwirizana pakati pa CSBD kungapangitse mbali zina kufotokozera ngati zikusemphana ndi zomwe zikuwonekera pa maphunziro. Ngakhale kuti maphunziro okhudza ubongo amatha kupeza kufanana kofanana pakati pa CSB ndi mankhwala oledzeretsa, kufufuza kwina n'kofunika kuti mumvetsetse bwino momwe chidziwitso chimagwirizanirana ndi machitidwe a chipatala cha CSB, makamaka pokhudzana ndi makhalidwe ogonana. Kafukufuku wambiri wagwiritsa ntchito zovuta zowonongeka zomwe zingathe kuchepetsa zochitika zina zogonana. Kuwonjezera apo, zofunikiranso / zochotsedweratu za ophunzira a CSB zakhala zikusiyana ndi maphunziro, komanso kufunsa mafunso okhudzana ndi chidziwitso komanso kufanana pakati pa maphunziro.
Malangizo Otsogolera
Zoletsa zingapo ziyenera kudziwika ponena za maphunziro a neuroimaging omwe alipo pano ndipo ziyenera kuganiziridwa pokonzekera kafukufuku wamtsogolo (onani Gome 1). Choletsa chachikulu chimakhudza kukula kwa zitsanzo zazing'ono zomwe makamaka ndi zachizungu, zachimuna, komanso zachikazi. Kafukufuku wowonjezereka akufunika kuti apeze zitsanzo zazikulu, zosiyanasiyana za amuna ndi akazi omwe ali ndi CSB ndi anthu osiyana siyana okhudzana ndi kugonana. Mwachitsanzo, palibe maphunziro asayansi omwe adafufuza njira zodziwira matenda a CSB mwa akazi. Maphunziro oterewa amafunikira chifukwa cha deta yolumikiza chilakolako chogonana ndi matenda amisala akuluakulu mwa akazi poyerekeza ndi amuna ndi deta ina yomwe imasonyeza kusiyana kokhudzana ndi kugonana pakati pa anthu azachipatala omwe ali ndi CSB [25, 30]. Popeza akazi ndi amuna omwe ali ndi zizolowezi zoledzera angasonyeze zifukwa zosiyanasiyana (monga zokhudzana ndi kulimbitsa thupi koyipa poyerekeza ndi zabwino) kuti azichita zinthu zoledzera ndikuwonetsa kusiyana kwa kupsinjika maganizo ndi kuyankha mankhwala osokoneza bongo, maphunziro amtsogolo a neurobiological ayenera kuganizira machitidwe opsinjika maganizo ndi njira zokhudzana nazo pakufufuza kokhudzana ndi kugonana kwa CSBD chifukwa cha kuphatikizidwa kwake mu ICD-11 ngati matenda amisala [125, 126].
Mofananamo, palinso kufunika kofufuza kachitidwe koganizira za anthu amitundu yochepa komanso achiwerewere kuti afotokoze kumvetsetsa kwathu kwa CSB pakati pa magulu awa. Zida zojambulira za CSB zakhala zikuyesedwa kwambiri ndipo zatsimikiziridwa pa amuna oyera a ku Ulaya. Komanso, kafukufuku wamakono akugwiritsidwa ntchito makamaka pa amuna ogonana. Kafufuzidwe kafukufuku wowonjezera machitidwe a kachipatala a CSB pakati pa amuna ndi akazi ogonana ndi amuna kapena akazi okhaokha amafunika. Kafukufuku wa sayansi ya magulu osiyana siyana (transgender, polyamorous, kink, zina) ndi zochitika (kuonerera zolaula, kugonana monyanyira, kugonana kosadziwika, ndi zina) n'kofunikanso. Chifukwa cha zoperewera zoterezi, zotsatira zomwe zilipo ziyenera kumasuliridwa mosamala.
Kuyerekeza kwachindunji kwa CSBD ndi mavuto ena (mwachitsanzo, kutchova njuga, kutchova juga, masewera, ndi mavuto ena) n'kofunika, monga kuikidwa kwa njira zina zopanda kulingalira (mwachitsanzo, majini, epigenetic) ndi kugwiritsa ntchito njira zina zoganizira. Njira zamakono monga positron emission tomography zingathenso kumvetsetsa kofunika kwambiri pa matenda a khungu la CSBD.
Kusiyana kwa CSB kungamvekenso bwino mwa kuwunika mosamala zinthu zachipatala zomwe zingapezeke kuchokera ku kafukufuku wodziwika bwino monga njira zowunikira zamagulu okhazikika [37]. Kafukufuku wotereyu angaperekenso chidziwitso pa mafunso a nthawi yayitali monga ngati kugwiritsa ntchito zolaula zovuta kungayambitse kusokonezeka kwa kugonana, ndipo kuphatikiza kuwunika kwa mitsempha m'maphunziro otere kungapereke chidziwitso pa njira za neurobiological. Kuphatikiza apo, pamene njira zochitira zinthu ndi zamankhwala zimayesedwa mwalamulo kuti zigwire bwino ntchito pochiza CSBD, kuphatikiza kuwunika kwa mitsempha kungathandize kuzindikira njira zochizira bwino za CSBD ndi zizindikiro zomwe zingatheke. Mfundo yomaliza iyi ikhoza kukhala yofunika kwambiri chifukwa kuphatikizidwa kwa CSBD mu ICD-11 mwina kudzawonjezera chiwerengero cha anthu omwe akufuna chithandizo cha CSBD. Makamaka, kuphatikizidwa kwa CSBD mu ICD-11 kuyenera kudziwitsa odwala, opereka chithandizo, ndi ena ndipo mwina kuchotsa zopinga zina (monga kubweza ndalama kuchokera kwa opereka inshuwalansi) zomwe zingakhalepo pakali pano za CSBD.