Zomwe zikuwunikira Prause et al., 2015 (yomwe ili ndemanga 87)
Kafukufuku wogwiritsa ntchito EEG, yomwe inachitidwa ndi Prause ndi anzake, inalimbikitsa anthu omwe akuvutika maganizo chifukwa cha zolaula zawo, poyerekeza ndi gulu lolamulira lomwe silikumva chisoni chifukwa cha kugwiritsira ntchito zolaula, zingafunikire kuwonetseratu zochitika zowonongeka kuti zitsatire ubongo. [87]. Ochita zachiwerewere-anthu omwe akukumana ndi mavuto owonetsa momwe amaonera zithunzi zachiwerewere '(M= Maola a 3.8 pa sabata) -kuwonetseratu kutengeka kochepa kwa thupi (kuyerekezedwa ndi mphamvu zotha kusintha mu chizindikiro cha EEG) poyerekeza ndi zojambula zogonana kusiyana ndi momwe gulu lofananirana limawonetsera zithunzi zomwezo. Malinga ndi kutanthauzira zokhudzana ndi kugonana mu phunziro lino (monga chidziwitso kapena mphotho, chifukwa zambiri zimawona Gola et al. [4]), zomwe zapezazi zingathandize zowonjezera zomwe zikusonyeza kuti nthawi zina zimakhala zovuta [4]. Mu 2015, Banca ndi anzake amagwira ntchito kuti amuna omwe ali ndi CSB amasankha malingaliro opatsirana pogonana ndikuwonetsa zomwe zimawoneka kuti zikuwonetsa kachitidwe ka DACC povumbulutsidwa mobwerezabwereza ku zithunzi zomwezo [88]. Zotsatira za maphunziro omwe tazitchulawa zikusonyeza kuti zolaula zimagwiritsidwa ntchito nthawi zambiri zingachepetse mphamvu zowonjezera mphotho, zomwe zingabweretse kuwonjezeka kwa chizoloŵezi ndi kulekerera, motero kuonjezera kufunikira kokakamiza kwambiri kugonana. Komabe, kufufuza kwa nthawi yaitali kumawonetsedwa kuti izi zitheke. Kuphatikizidwa pamodzi, kafukufuku wokhudzana ndi ubongo wazomwe zikuchitika pakadali pano wathandizira kuti lingaliro la CSB lifanane ndi mankhwala, njuga, ndi zisokonezo za masewera pokhudzana ndi mawonekedwe a ubongo ndi ndondomeko, kuphatikizapo kulimbikitsa komanso kukhala ndi chizoloŵezi.
MAFUNSO: Olemba zomwe zaposachedwa akugwirizana ndi mapepala ena owunikiridwa ndi anzawo - Zolemba zotsatiridwa ndi anzawo Prause et al., 2015: Mawerengedwe apansi a EEG amatanthauza kuti nkhani sizingasamalire zithunzizo. Iwo ankatopa (amazoloŵera kapena osasamala). Wolemba wamkulu (Nicole Prause) akupitiriza kunena kuti zotsatira izi "debunk kuledzera", koma ochita kafukufuku ena sagwirizana ndi zonena zake zapamwamba. Iwe uyenera kudzifunsa wekha - "Chiyani wasayansi wodalirika anganene kuti phunziro lawo lokha lauchidwi ladandaula a malo ophunziridwa bwino? ".
- 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 kubwereza: Kuwongosoledwa kwaposachedwapa kumaphatikizapo zomwe zaposachedwapa zokhudzana ndi njira zokhudzana ndi kugwiritsira ntchito njira zokhudzana ndi kugonana (CSBD) ndipo zimapereka malingaliro a kafukufuku wamtsogolo kuti adziwe momwe matendawa angakhalire.
Zotsatira zatsopano: Pakadali pano, kafukufuku wochuluka wokhudzana ndi chiwerewere wakhala akupereka njira zowonongeka zomwe zimachititsa kuti anthu azigonana komanso asamadwale. Mchitidwe wogonana mwachinyengo umagwirizanitsidwa ndi kusintha kwa ntchito m'madera a ubongo ndi magulu okhudzidwa ndi kuwalimbikitsa, kuzoloŵera, kusokoneza maganizo, ndi kupindula mphoto muzochitika ngati zinthu, kutchova juga, ndi zizoloŵezi zosewera. Zigawo zazikulu za ubongo zogwirizana ndi zigawo za CSB zikuphatikizapo ma cortices oyang'anizana ndi am'mbuyo, amygdala, ndi striatum, kuphatikizapo nucleus accumbens.
Chidule cha nkhaniyi: Ngakhale kuti kufufuza kwakukulu kwa sayansi kumaphatikizapo kufanana kochuluka pakati pa CSBD ndi mankhwala ndi zoledzera, bungwe la World Health Organization linaphatikizapo CSBD mu ICD-11 monga matenda odziletsa. Ngakhale kafukufuku wapitalo wathandizira kufotokoza njira zina zofunikira za chikhalidwechi, kufufuza kwina kuli kofunika kuti mumvetsetse bwino chochitika ichi ndi kuthetsa nkhani zachigawo zokhudzana ndi CSBD.
Introduction
Chizoloŵezi chogonana (CSB) ndi nkhani yotsutsana yomwe imadziwikanso kuti kugonana, kugonana, kugonana, kugonana, nymphomania, kapena khalidwe logonana [1-27]. Ngakhale kuti ndondomeko yeniyeni yodziwika bwino siidziwika bwino kafukufuku wodwala matenda, matenda a CSB akuti akukhudzidwa ndi 3-6% mwa anthu akuluakulu ndipo amapezeka kwambiri mwa amuna kuposa akazi [28-32]. Chifukwa cha mavuto omwe amachitika ndi amuna ndi akazi omwe ali ndi CSB [4-6, 30, 33-38], World Health Organization (WHO) yalimbikitsa kuti kuphatikizapo zovuta zokhudzana ndi kugonana kwapachibale (CSBD) muzotsatira za 11th Chigwirizano cha Mayiko cha Matenda (6C72) [39]. Kuphatikizidwa kumeneku kumathandizira kuwonjezera chithandizo cha mankhwala kwa anthu osapulumutsidwa, kuchepetsa manyazi ndi manyazi omwe akugwirizana ndi kufunafuna, kulimbikitsa ntchito zofufuza, komanso kuonjezera chidwi cha mdzikoli [40, 41]. Timavomereza kuti m'zaka zapitazi za 20 kumeneko zamasamba osiyanasiyana zomwe zimagwiritsidwa ntchito pofotokozera khalidwe losagwirizana ndi kugonana nthawi zambiri zimadziwika kuti zimagwiritsidwa ntchito mopitirira muyeso mwa zochitika zogonana (monga mwachitsanzo, kugonana kosadziwika / kosadziwika, kugwiritsira ntchito zolaula). Kwawongosoledwe wamakono, tidzagwiritsa ntchito CSB monga nthawi yowonjezereka pofotokozera vuto, khalidwe logonana.
CSB yakhala ikudzidzimutsa ngati matenda osokoneza bongo, matenda osokoneza maganizo, kapena khalidwe losokoneza bongo [42, 43]. Zizindikiro za CSBD zikufanana ndi zomwe zimafotokozedwa mu 2010forthe DSM-5 matenda a hypersexual [44]. Matenda opatsirana pogonana anachotsedwa ndi American Psychiatric Association kuchokera DSM-5 pa zifukwa zingapo; Kuperewera kwa maphunziro a ubongo ndi maumuna kunali pakati pa zifukwa zodziwika kwambiri [45, 46]. Posachedwapa, CSB yanyalanyaza kwambiri miyambo komanso masayansi ambiri, makamaka chifukwa cha kusiyana kwa thanzi lomwe limakhudza magulu omwe ali pangozi komanso osasamala. Ngakhale kuwonjezeka kwakukulu kwa maphunziro a CSB (kuphatikizapo omwe amaphunzira "kugonana," "kugonana," "kugonana"), kafukufuku wochepa wafufuza za neural underpinnings ya CSB [4, 36]. Nkhaniyi ikufotokoza njira zokhudzana ndi matenda a ubongo wa CSB ndipo imapereka malangizo othandizira kafukufuku wamtsogolo, makamaka monga okhudzana ndi 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, yomwe inachitidwa ndi Prause ndi anzake, inalimbikitsa anthu omwe akuvutika maganizo chifukwa cha zolaula zawo, poyerekeza ndi gulu lolamulira lomwe silikumva chisoni chifukwa cha kugwiritsira ntchito zolaula, zingafunikire kuwonetseratu zochitika zowonongeka kuti zitsatire ubongo. [87]. Ochita zachiwerewere-anthu omwe akukumana ndi mavuto owonetsa momwe amaonera zithunzi zachiwerewere '(M= Maola a 3.8 pa sabata) -kuwonetseratu kutengeka kochepa kwa thupi (kuyerekezedwa ndi mphamvu zotha kusintha mu chizindikiro cha EEG) poyerekeza ndi zojambula zogonana kusiyana ndi momwe gulu lofananirana limawonetsera zithunzi zomwezo. Malingana ndi kutanthauzira kwa zokhudzana ndi kugonana mu phunziro ili (monga chidziwitso kapena mphotho, chifukwa zambiri zimawona Gola et al. [4]), zotsatirazi zikhoza kuthandizira maumboni ena omwe amasonyeza zotsatira za zizoloŵezi [4] .Mu 2015, Banca ndi anzake adawona kuti amuna omwe ali ndi CSB amakonda kusankha zochitika zogonana ndi zochitika zokhudzana ndi kugonana ndikuwonetsa zomwe zapeza zikuwonetsa kachitidwe ka dACC povumbulutsidwa mobwerezabwereza ku mafano omwewo [88]. Zotsatira za maphunziro omwe tazitchulawa zikusonyeza kuti zolaula zimagwiritsidwa ntchito nthawi zambiri zingachepetse mphamvu zowonjezera mphotho, zomwe zingabweretse kuwonjezeka kwa chizoloŵezi ndi kulekerera, motero kuonjezera kufunikira kokakamiza kwambiri kugonana. Komabe, kufufuza kwa nthawi yaitali kumawonetsedwa kuti izi zitheke. Kuphatikizidwa pamodzi, kafukufuku wokhudzana ndi ubongo wazomwe zikuchitika pakadali pano wathandizira kuti lingaliro la CSB lifanane ndi mankhwala, njuga, ndi zisokonezo za masewera pokhudzana ndi mawonekedwe a ubongo ndi ndondomeko, kuphatikizapo kulimbikitsa komanso kukhala ndi chizoloŵezi.
CSB ngati Matenda a Impulse-Control?
Gawo la "Impulse-Control Disorders Salipo Pang'ono Pakati" mu DSM-IV linali losiyana kwambiri ndi chilengedwe ndipo linaphatikizapo mavuto ambiri omwe adatchulidwanso kuti akuwongolera (kutchova njuga) kapena okhudzidwa kwambiri (trichotillomania) mu DSM- 5 [89, 90]. Gawo lomwe likupezeka mu DSM-5 limafotokoza zovuta zowonongeka, zowonongeka komanso zoyambitsa khalidwe, zomwe zimagwirizana kwambiri ndi kleptomania, pyromania, matenda osokoneza maganizo, otsutsana ndi matenda osokoneza bongo, vuto la khalidwe, komanso matenda osokoneza bongo [90]. Mutu wa mavuto odzidzimutsa ku ICD-11imaphatikizapo mavuto atatu oyambirirawa ndi CSBD, ndikukambirana mafunso okhudza zoyenera kwambiri. Malinga ndi nkhaniyi, momwe CSBD ikukhudzidwira ndi zomangamanga zowonjezereka zowonjezereka zofunikiranso zowerengera komanso zofuna 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 zofuna zothandizira, 48% mpaka 55% ya anthu angasonyeze kutengera kwakukulu kwa Barratt Impulsiveness Scale [105-107]. Mosiyana ndi zimenezi, deta ina imasonyeza kuti odwala omwe akufuna chithandizo cha CSB alibe zochitika zina zosayenerera kapena zovuta zowonongeka kuposa momwe amachitira ndi zochitika zogonana zomwe zimagwirizana ndi zomwe zimachitika kuchokera kufukufuku waukulu pa intaneti za amuna ndi akazi zomwe zikusonyeza kuti pali kusiyana kochepa pakati pa kukhudzidwa mtima ndi ena mbali za CSB (zovuta zolaula zimagwiritsidwa ntchito) komanso maubwenzi amphamvu ndi ena (kugonana kwachisawawa) [108, 109]. Mofananamo, mu phunziro pogwiritsa ntchito njira zosiyana za anthu omwe ali ndi vuto lowonetsa zolaula amagwiritsa ntchito (nthawi yowonetsera zolaula pamasabata ntchito = maminiti 287.87) ndipo omwe alibe (nthawi yeniyeni ya zolaula amagwiritsidwa ntchito = 50.77 maminiti) sanali osiyana ndi enieni (UPPS-P Zowonjezera) kapena zochitika za Stop Stopal Task [za 110] .Chulukanso, Reid ndi anzake sadaone kusiyana pakati pa anthu omwe ali ndi CSB ndi kulamulira bwino pa mayesero a mphuno za machitidwe apamwamba (mwachitsanzo, kukaniza, kuthamanga, kuyendetsa galimoto, kusankha kuyang'anitsitsa, kuonetsetsa, kusinthasintha malingaliro, kulingalira kwa maganizo, kusuntha), ngakhale atasintha njira yodziwa kulingalira mu kulingalira [103]. Pamodzi, kafukufuku amasonyeza kuti kusakhudzidwa mtima kungagwirizanitse kwambiri kugonana kwachiwerewere koma osati ku mitundu yeniyeni ya CSB ngati zovuta zolaula zimagwiritsidwa ntchito. Zimayambitsa mafunso okhudza chiwerengero cha CSBD monga vuto lodziletsa ICD-11 ndipo akuwunikira kufunikira kwa kufufuza kwachindunji za mitundu yosiyanasiyana ya CSB. Izi ndizofunikira makamaka popeza kafukufuku wina amasonyeza kuti zovuta ndi zolemba zapadera za matenda opatsirana mofulumira zimasiyana ndi malingaliro ndi ziphunzitso za thupi (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 yakhala ikuphatikizidwa m'mawu omwe alipo tsopanoICD-11monga matenda osokoneza maganizo [39]. Monga momwe WHO inanenera, 'Matenda oletsa kuponderezedwa amadziwika ndi mobwerezabwereza kulephera kuganiza, kuyendetsa galimoto, kapena kukakamiza kuchita chinthu chomwe chimapindulitsa munthuyo, panthawi yochepa, ngakhale zovuta monga nthawi yaitali -kupweteka munthu kapena ena, kuvutika maganizo pa khalidwe, kapena kuwonongeka kwakukulu payekha, banja, chikhalidwe, maphunziro, ntchito, kapena mbali zina zofunika pakugwira ntchito [39]. Zofukufuku zamakono zimadzutsa mafunso ofunika okhudza chigawo cha CSBD. Matenda ambiri omwe amadziwika kuti ali ndi vuto lotha kugwiritsidwa ntchito molakwika amagawidwa m'madera ena ICD-11 (mwachitsanzo, kutchova njuga, masewera, ndi vuto la kugwiritsira ntchito mankhwala amagwiritsidwa ntchito 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
Zingapo zing'onozing'ono ziyenera kuzindikiridwa pokhudzana ndi kafukufuku wamakono omwe ali ndi zokhudzana ndi ubongo ndi kulingalira pakukonzekera kafukufuku wamtsogolo (onani Table 1). Choyambirira chimakhala ndi kukula kwazing'ono zomwe zimakhala zoyera, zachimuna, komanso zogonana. Kafufuzidwe kafukufuku amafunika kuti apeze anthu akuluakulu, amitundu osiyanasiyana a amuna ndi akazi omwe ali ndi CSB ndi anthu omwe ali ndi ziwalo zosiyana zogonana ndi zolinga. Mwachitsanzo, palibe kafukufuku wodabwitsa wa sayansi amene adafufuzira njira zowonongeka za CSB kwa amayi. Maphunziro oterowo amafunika kupatsidwa deta yolumikiza chilakolako cha kugonana kwa azimayi osiyana maganizo poyerekezera ndi amuna ndi zina zomwe zimasonyeza kusiyana pakati pa amuna ndi akazi ndi CSB [25, 30]. Monga amayi ndi amuna omwe ali ndi chizoloŵezi choledzeretsa angasonyeze zifukwa zosiyana (mwachitsanzo, zokhudzana ndi zosayenera zowonjezera) pochita zizoloŵezi zosokoneza bongo ndikuwonetsanso kusiyana pakati pa kupsinjika maganizo ndi kusamalidwa kwa mankhwala osokoneza bongo, maphunziro okhudza ubongo wamtsogolo ayenera kuganizira zochitika zapanikizika ndi njira zokhudzana ndi kugonana kufufuza kwa CSBD kunaperekedwa pakali pano ICD-11 monga matenda a matenda a maganizo [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.
Kusagwirizana kwa CSB kungathenso kufotokozedwa mwa kuyang'anitsitsa zochitika zachipatala zomwe zingapezedwe mwazigawo kuchokera kufukufuku wamakhalidwe monga njira zowunika njira zowunika [37]. Kufufuza koteroko kungathenso kumvetsetsa mafunso a longitudinal ngati ngati zovuta zolaula zikugwiritsidwa ntchito zingayambitse kugonana, ndipo kuphatikizapo kufufuza kwadzidzidzi m'maphunziro otero kungathandize kuzindikira njira zogwiritsira ntchito matendawa. Kuwonjezera apo, monga njira zothetsera machitidwe ndi zamagetsi zimayesedwa bwino kuti zitha kuchitapo kanthu pochiza matenda a CSBD, kuyanjanitsidwa kwa mayeso okhudzidwa ndi matendawa kungathandize kupeza njira zothandizira zothandizira matenda a CSBD komanso zowonongeka. Mfundo yomalizira ikhoza kukhala yofunika kwambiri chifukwa kuphatikiza kwa CSBD ICD-11 zikhoza kuonjezera chiwerengero cha anthu omwe akufuna chithandizo kwa CSBD. Makamaka, kuphatikiza kwa CSBD mu ICD-11 ayenera kuwalimbikitsa odwala, opereka, ndi ena ndipo angathe kuchotsa zolepheretsa zina (mwachitsanzo, kubwezera kwa opha inshuwalansi) omwe angakhalepo kwa CSBD.