Kugonjetsa Kwachinyamata pa Intaneti: Zimene Timadziwa ndi Zimene Sitikuzidziwa-Kusanthula Kwambiri (2019)

LINKANI Phunziro LOPHUNZITSIRA

Clin. Med. 2019, 8(1), 91; do:10.3390 / jcm8010091

Rubén de Alarcón 1 , Javier I. de la Iglesia 1 , Nerea M. Casado 1 ndi Angelo L. Montejo 1,2,*

1 Service Psychiatry, Chipatala Clínico Universitario de Salamanca, Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain

2 University of Salamanca, EUEF, 37007 Salamanca, Spain

Kudalirika

M'zaka zochepa zapitazi, pakhala pali funde lazinthu zokhudzana ndi zizolowezi zikhalidwe; ena mwa iwo amayang'ana kwambiri zolaula za pa intaneti. Komabe, ngakhale kuyesetsa konse, tikulephera kudziwa pomwe kuchita izi kukuchitika. Mavuto omwe amapezeka ndi monga: kukondera mwachitsanzo, kufufuza kwazinthu zothandizira kuzindikira, kutsutsana koyenerana ndi nkhaniyi, komanso kuti chinthuchi chitha kuzunguliridwa mkati mwa chiphunzitso chachikulu (monga, kukondera kugonana) komwe kumatha kudzipangitsa kukhala ndi chizindikiro chosiyana kwambiri. Zokonda zamakhalidwe ophunzitsira zimakhala gawo lopanda maphunziro, ndipo nthawi zambiri limawonetsa mtundu wamavuto ogwiritsa ntchito: kuwongolera, kuwonongeka, komanso kugwiritsa ntchito ngozi. Hypersexual disc imakwanira pamfanizoli ndipo imatha kupangidwa ndi zochitika zingapo zogonana, monga zovuta kugwiritsa ntchito zolaula za pa intaneti (POPU). Kugwiritsa ntchito zolaula pa intaneti kukukulira, ndipo kukhoza kutengera vuto la "katatu" "(kupezeka, kuthekera, kudziwika). Kugwiritsa ntchito kovuta kumeneku kukhoza kukhala ndi zotsatira zoyipa pakulimbikitsa kugona ndi kugonana, makamaka pakati pa achinyamata. Tikufuna kudziwa zambiri zomwe zitha kugwiritsidwa ntchito ngati tikugwiritsa ntchito zolaula pa intaneti. Apa tikuyesera kufotokoza mwachidule zomwe timadziwa za gululi ndikuwunikira madera ena oyenera kufufuza.
Mawu osakira: zolaula pa intaneti; kusuta; cybersex; intaneti; kukakamiza kugonana; Hypersexourse

1. Introduction

Ndi kuphatikizika kwa "Kusokonezeka kwa Kutchova Juga" mu chaputala cha "Kugwiritsa Ntchito Zogulitsa Ndi Zowonjezera" mu DSM-5 [1], APA idavomereza pang'onopang'ono zodabwitsazi. Kuphatikiza apo, "Internet Gaming Disorder" idayikidwa Gawo 3- zoyenera kuphunzira.
Izi zikuimira kusintha kosasintha kwa paradigm m'magulu azinthu zomwe zimagwirizana ndi zizolowezi, ndipo zimatsegulira njira yofufuzira yatsopano chifukwa cha kusintha kwa chikhalidwe komwe kunayambitsidwa ndi matekinoloje atsopanowo.
Pali zozizwitsa zomwe zilipo [2] ndi zachilengedwe [3] nthaka pakati pamavuto osiyanasiyana osokoneza bongo, kuphatikiza kugwiritsa ntchito mankhwala osokoneza bongo ndi machitidwe osokoneza bongo; izi zitha kuwonetsa ngati pakukula kwa zinthu zonse ziwiri [4].
Phenomenologically, anthu omwe amakonda kugwiritsa ntchito mankhwala osokoneza bongo nthawi zambiri amawonetsa mtundu wamavuto ogwiritsira ntchito zovuta: kuwongolera mphamvu (mwachitsanzo, kulakalaka, kuyesa kulephera kuchita zinthu), kuwonongeka (mwachitsanzo, kuchepa kwa zokonda, kunyalanyaza mbali zina za moyo), komanso kugwiritsa ntchito ngozi (kupitiliza kudya ngakhale kuzindikira kwa zowonongeka zamaganizidwe). Kaya mikhalidwe iyi imakwanilitsanso zikhalidwe zokhudzana ndi kusuta (kulekerera, kusiya) ndizokambirana zambiri [4,5,6].
Hypersexual disorder nthawi zina imawonedwa ngati imodzi mwamakhalidwe olowerera. Amagwiritsidwa ntchito ngati ambulera yomwe imaphatikizapo zochitika zosiyanasiyana zovuta (maliseche owonjezera, cybersex, kugwiritsa ntchito zolaula, kugonana kwa patelefoni, kugonana ndi akuluvomerezi, kuchezera makalabu ndima, etc.) [7]. Kuchuluka kwa kuchuluka kwake kukuchokera ku 3% mpaka 6%, ngakhale ndizovuta kudziwa chifukwa palibe tanthauzo latsatanetsatane la vutoli [8,9].
Kusowa kwa chidziwitso chokwanira cha sayansi kumapangitsa kuti kafukufuku, malingaliro, komanso kuwunika kukhale kovuta, zomwe zimabweretsa malingaliro osiyanasiyana kuti afotokoze, koma nthawi zambiri zimagwirizanitsidwa ndi zovuta zambiri, manyazi ndi kusokonezeka kwa malingaliro [8], komanso zizolowezi zina [10Ndipo imathandizira kuti anthu azifunsa mayeso mwachindunji.
Munthawi yomweyo, kuwonjezeka kwa matekinoloje'wa kwathandizanso kuti munthu akhale ndi vuto losokoneza bongo, makamaka lotha kugwiritsa ntchito intaneti. Izi zimatha kuyang'ana pa intaneti (masewera, kugula, kubetcha, cybersex ...) [11] ndi kuthekera kwakachitidwe koopsa; pankhani iyi, imakhala ngati njira yowonetsera kachitidwe kogwidwa [4,12]. Izi zikutanthauza kuchuluka kosaletseka, kupereka malo ogulitsa atsopano komanso kuyesa anthu (chifukwa cha kuchuluka kwachinsinsi, kapena mwayi) omwe sakanachita nawo kale mikhalidwe iyi.
Kugwiritsa ntchito zolaula pa intaneti, zomwe zimadziwikanso kuti kugwiritsa ntchito zolaula pa intaneti kapena cybersex, zitha kukhala imodzi mwamakhalidwe omwe amapezeka pa intaneti omwe ali pachiwopsezo chofuna kusiya. Ndizofanana ndi kugwiritsa ntchito intaneti kuchita zinthu zosiyanasiyana zosangalatsa zogonana [13], pakati pomwe pakuyimira kugwiritsa ntchito zolaula [13,14] yomwe ili ntchito yotchuka kwambiri [15,16,17] ndi kuchuluka kosawerengeka kwa zachiwerewere zomwe zilipo [13,18,19,20]. Kugwiritsidwa ntchito kopitilira izi nthawi zina kumabweretsa mavuto azachuma, azamalamulo, akuntchito, komanso azovuta [6,21] kapena mavuto anu, okhala ndi mavuto osiyanasiyana. Kumva kulephera kudziletsa ndikugwiritsa ntchito mosasamala kanthu zotsatirapo zoyipazi zimabweretsa "kukakamizidwa kuchita zogonana pa intaneti" [22] kapena Mavuto Ogwiritsa Ntchito Zolaula paintaneti (POPU). Mtundu wamavuto ogwiritsira ntchito vutoli umapindula ndi "Triple A" zinthu [23].
Chifukwa cha mtunduwu, maliseche okhudzana ndi zolaula atha kukhala ochulukirapo masiku ano, koma sikuti ichi ndichizindikiro [21]. Tikudziwa kuti achinyamata ambiri amagwiritsa ntchito intaneti kuti awonere zolaula [24,25]; M'malo mwake, ndi amodzi mwa magwero awo a thanzi lachiwerewere [26]. Ena anena zakukhosi ndi izi, pothetsa kusiyana pakati pa pomwe zolaula zadyedwa nthawi yoyamba, komanso kugonana komwe kungachitike; mwachindunji, momwe zakale zingakhudzire chitukuko cha kugonana [27] monga chilakolako chonyansa kwambiri pakudya zolaula pa intaneti [28] ndi kusokonekera kwa erectile, komwe kudakwera kwambiri pakati pa amuna achichepere zaka zingapo zapitazo poyerekeza ndi makumi angapo apitawo [29,30,31,32,33].
Tidasanthula mwadongosolo zolemba zomwe zidalipo pamutu wa POPU kuyesa ndikuwunikira mwachidule zomwe zachitika posachedwa malinga ndi miliri ya matenda, mawonetseredwe azachipatala, umboni wamatsenga womwe umathandizira njira iyi yogwiritsira ntchito zovuta, malingaliro ake okhudzana ndi matenda osokoneza bongo, malingaliro ake ofufuzira zida ndi njira zamankhwala.

2. Njira

Tidayendera mwatsatanetsatane kutsatira malangizo a PRISMA (Chithunzi 1). Popeza tapeza umboni watsopano wokhudza nkhaniyi, tinayang'ananso osaganizira nthawi. Makamaka anaikirapo kwambiri pa kuwunika kolemba mabuku komanso zolemba zomwe zidafalitsidwa kudzera njira yatsopano kwambiri, makamaka kuwunika kolemba kale pankhaniyi. PubMed ndi Cochrane ndizochitika zazikuluzikulu zomwe zidagwiritsidwa ntchito, ngakhale kuti zolemba zingapo zidapangidwa kudzera pazolowera pamtanda.
Jcm 08 00091 g001 550
Chithunzi 1. Chithunzi cha PRISMA flow.
Popeza cholinga chathu chinali makamaka zolaula za pa intaneti komanso zikhalidwe zokhudzana ndi kugonana, sitinachotseko zolembedwazo zomwe zinali ndi chiyanjano chapadera pokha pofufuza: zomwe zimayang'ana kwambiri zosokoneza za intaneti, zomwe zimayang'ana zofananira zolaula, anafikira pamfundoyi monga momwe timacheza.
Mawu osakira awa ndi zomwe amachokera zimagwiritsidwa ntchito pophatikiza mitundu yambiri: cybersex, porn * (kulola zonse zolaula ndi "zolaula"), addict * (kulola onse "osokoneza bongo" ndi "osokoneza bongo"), pa intaneti, intaneti , kugonana, kugonana kokakamiza, hypersexourse. Chida chowongolera zida Zatero chinagwiritsidwa ntchito popanga nkhokwe ya zolembedwa zonse zomwe zimaganiziridwa.

3. Zotsatira

3.1. Epidemiology

Kugwiritsa ntchito zolaula kwa anthu ambiri kumatsimikizira kukhala kovuta kuyerekezedwa mokwanira, makamaka kuchokera pa intaneti komanso zinthu zitatu zomwe zapangitsa kuti anthu azitha kukhala achinsinsi. Kafukufuku wa Wright wokhudza kugwiritsa ntchito zolaula mzimayi aku US ogwiritsa ntchito General Social Survey (GSS) [34], ndi Phunziro la Price (lomwe limakula pa Wright's ndikusiyanitsa zaka, cohort, ndi zotsatira zama nyengo) [35] amapanga ena mwa owerengeka, ngati si okhawo, omwe alipo omwe amayang'anira zolaula pa anthu ambiri. Amawonetsa kuchuluka kwa zolaula pazaka zambiri, makamaka mwa amuna amuna mosiyana ndi akazi. Izi ndizofala makamaka pakati pa achinyamata, ndipo zimachepera pang'onopang'ono ndi zaka.
Pali mfundo zina zosangalatsa zokhudzana ndi zolaula. Chimodzi mwazomwezi ndikuti chiwonetsero cha amuna XXUMX ndi 1963 chawonetsa kuchepa kochepa kwambiri pakugwiritsa ntchito kwawo kuyambira chaka cha 1972 mtsogolo, ndikuwonetsa kuti kugwiritsa ntchito zolaula pakati pamagulu awa akhala mosalekeza kuyambira [35]. Inanso ndikuti 1999 ndi chaka chomwe akazi azaka za 18 kupita ku 26 kudya zolaula adayamba katatu kuposa omwe anali ndi zaka 45 kupita ku 53, m'malo mopitilira kawiri momwe zimakhalira mpaka pomwe [35]. Zambiri izi zitha kukhala zokhudzana ndi kusintha kwa zizolowezi zolaula zomwe zimalimbikitsidwa ndi ukadaulo (kusintha kuchoka pa intaneti kupita ku njira yakanema), koma sizingatheke kudziwa chifukwa chidziwitso sichimayambira pamasamba komanso pa intaneti zosiyanasiyana mukamayang'ana kugwiritsa ntchito zolaula.
Ponena za POPU, palibe chidziwitso chotsimikizika komanso chodalirika m'mabuku omwe adawunikiridwa omwe angapereke kuyerekeza kolimba kwa kuchuluka kwake. Kuphatikiza pazolinga zomwe zanenedwa kale za kusowa kwa chidziwitso pa zolaula zolaula, gawo lina lingachokere pamwambowu womwe anthu omwe akutenga nawo mbali angakwanitse, zida zambiri zowunika zomwe akatswiri ofufuza amafufuza, komanso kusagwirizana pakugwirizana pazomwe zimapanga kugwiritsa ntchito zolaula, zomwe ndi nkhani zonse zomwe zimafotokozedwanso mu pepala ili.

Maphunziro ambiri okhudzana ndi POPU kapena machitidwe omwe amakhala ndi vuto la kuchuluka kwa thupi amagwiritsa ntchito zitsanzo kuti azitha kuyerekezera, kupeza, ngakhale pali kusiyana kwa kuchuluka kwa anthu, kuti owerenga ochepa okha amawona chizolowezi ichi, ndipo ngakhale atatero, ochepa amawona kuti izi zitha kukhala zopanda vuto zikhudze iwo. Zina mwa zitsanzo:

(1) Kafukufuku woyeserera zikhalidwe pakati pa ogwiritsa ntchito mankhwala osokoneza bongo, adapeza kuti 9.80% yokha mwa omwe adatenga nawo 51 ndi omwe amawaganizira kuti ali ndi vuto logonana kapena zolaula [36].

(2) Kafukufuku waku Sweden yemwe adalemba anthu omwe akhala nawo pa 1913 kudzera pafunso la pawebusayiti, 7.6% idafotokoza zovuta zina zakugonana pa intaneti ndipo 4.5% idawonetsa kumverera 'kusowa' pa intaneti chifukwa cha chikondi komanso zogonana, ndikuti ichi chinali 'vuto lalikulu' [17].

(3) Kafukufuku waku Spain ndi zitsanzo za ophunzira aku koleji ya 1557 adapeza kuti 8.6% ili pachiwopsezo chotenga njira yogwiritsira ntchito zolaula za pa intaneti, koma kuti njira yeniyeni yogwiritsa ntchito maupangiri inali 0.7% [37].

Phunziro lokhalo lokhala ndi mayeso oyimira kufikira pano ndi a ku Australia, omwe ali ndi zitsanzo za omwe ali ndi 20,094; Amayi a 1.2% omwe adawafufuza adadzilingalira kuti ndiwodwala, pomwe amuna anali 4.4% [38]. Zotsatira zofananazi zimagwiranso ntchito pa zochitika zokhudzana ndi zojambulajambula kunja kwa zolaula [39].
Zoneneratu zokhudzana ndi vuto la kugonana ndi kugwiritsa ntchito zolaula zili, ponseponse: kukhala bambo, zaka zazing'ono, chipembedzo, kugwiritsa ntchito intaneti pafupipafupi, malingaliro osalimbikitsa, komanso kukhala wokonda zolaula, komanso kufunafuna zatsopano [17,37,40,41]. Zina mwazovuta izi zimagawanidwanso ndi odwala omwe amachita zinthu zoopsa [39,42].

3.2. Ethopathogenical and Diagnostic Conceptualization

Kuganiza zamakhalidwe azikhalidwe zimapitilizabe kukhala zovuta masiku ano. Ngakhale kuyesedwa kangapo kokhudzana ndi chikhalidwe chogonana, kusowa kwa zinthu zolimba monga pano kufotokozera kuti palibe mgwirizano pankhaniyi [9]. POPU ilinso ndi mndandanda wamakhalidwe omwe amagwiritsa ntchito ukadaulo. Chifukwa chogwiritsa ntchito ukadaulo wazovuta (makamaka ukadaulo wa pa intaneti) posachedwa, tiyenera kukambirana za zamakhalidwe osagwirizana ndi ukadaulo kuti timvetsetse malo omwe ali ndi zolaula pa intaneti.
Kugonana ngati mkhalidwe kumakhala kwakukulu kwambiri, ndipo mbali zake zakuchipatala zaphunziridwa kwazaka zambiri [43]. Chifukwa chake, chikuyimira chovuta kwa zitsanzo zomwe zimayesera kufotokoza momveka bwino, chifukwa zimatha kuphatikiza zochitika kuyambira pakuganiza zokhazokha mpaka kuchitira nkhanza zachiwerewere [21]. Komanso ndizovuta kutanthauzira chomwe chimapangitsa kusowa kwenikweni ndi kusamalira kuti tipewe kugwiritsidwa ntchito molakwika kwa matanthauzowa kuti tisanyoze ndi kupatutsa anthu [44]. Mwachitsanzo, ena amaika malire pakati pa machitidwe oyenera komanso azikhalidwe zogonana pamitundu yoposa isanu ndi iwiri pa sabata [43] (p. 381), koma njira iyi yoganizira kuchuluka kwake ikhoza kukhala yoopsa, chifukwa zomwe zimachitika mwazomwe zimachitika komanso momwe zimakhalira zimatha kusiyanasiyana pakati pa anthu. Kuperewera konseku komanso kusasinthika kapangidwe kake kumatha kulepheretsa kafukufuku wamtsogolo pofufuza za hypersexual [45] ndikunyalanyaza mawonekedwe omwe amayang'ana kwambiri pamalingaliro osavomerezeka omwe ali nawo [46,47]. Pakhala pali malingaliro kuti abwezere nkhaniyi pogwiritsa ntchito zida zina, zopangidwa kale ngati gawo la lingaliro la vuto la Hypersexual lomwe limagwiritsidwa ntchito poyesa gawo la DSM-5 [43,47].
Hypersexuality nthawi zambiri imakhala ngati ambulera yopanga [7]. Matchulidwe ake akadali nkhani yotsutsana mpaka pano, ndipo nthawi zambiri amakumana ndi mawu angapo omwe amatanthauza lingaliro lomwelo: kugonana kokakamiza, chisangalalo cha kugonana, kukakamizidwa kugona naye, machitidwe a hypersexual kapena vuto la hypersexual. Olemba ena, pozindikira kufunika kwa mawu oti "kukopeka" ndi "kukakamizidwa", amakonda kuyang'ana kwambiri pankhani yolamulira komanso kutayika kwake kapena kunyalanyaza ngati lingaliro lalikulu pazokhudza mchitidwewu, motero amadzitcha kuti "sizingatheke mchitidwe wogonana ”[45,48,49].
Ngakhale matanthauzidwe samakhala ofanana, nthawi zambiri amayang'ana kwambiri pafupipafupi kapena kukula kwa zizindikiro [46] Zolakalaka zabwinobwino ndi malingaliro olakwika, zomwe zingayambitse kusokonezeka. Izi zimasiyanitsa ndi machitidwe azakugonana, ngakhale kufunikira kwa kufotokozerana bwino kwa kusiyana komwe kungakhalepo, kufanana, ndi kudutsana pakati pa mitundu iwiriyi kumapitirirabe [45].
Nthawi zambiri zomwe zimaphatikizidwa ndi kuchita masewera olimbitsa thupi ndi kuseweretsa maliseche mopitirira muyeso ndi machitidwe osiyanasiyana okhudzana ndi kugonana, monga kudalira kugonana kosadziwika, kubwerezabwereza, zolaula za intaneti, kugonana pafoni, ndi kuchezera makwerero [43,44,49,50,51]. Bancroft makamaka adaganiza kuti, pogwiritsa ntchito intaneti, maliseche komanso zochitika zachiwerewerezi zitha kulumikizana, akunena kuti abambo "amawagwiritsa ntchito ngati njira yowonjezera yopumira pakuwongolera maliseche".
Ngakhale kuthekera kozindikira machitidwe olakwika mwanjira zonse kumapezeka ndi "vuto la kugonana lomwe silinafotokozedwe mwanjira ina" mu DSM [1], Kafka [43] anayesera kuti ichitidwe ngati chidziwitso cha DSM-5. Adanenanso njira zake, monga gawo la mavuto azakugonana. Mitundu yofunikirayi idaphatikizapo chikhalidwe cha hypersexual monga: (1) chilimbikitso chogonana, (2) chizolowezi chogwiritsa ntchito, (3) gawo la vuto lodziwika bwino, (4) gawo lazovuta zamkokomo, ndi (5) " osawadziwa ”machitidwe ogonana opambanitsa. Malingaliro awa adakanidwa chifukwa cha zifukwa zingapo; chachikulu chimanenedwa kukhala kusowa kwa deta yolumikizana yolimbana ndi matenda52,53], komanso kuthekera kochitiridwa nkhanza zamtsogolo, njira yodziwika bwino yotsimikizira, komanso zandale komanso zachitukuko zokhudzana ndi matenda a pathologizing gawo lofunikira la moyo wamunthu [54]. Ndizosangalatsa kuyerekezera ndi njira ziwiri zam'mbuyomu zomwe zalembedwera, zomwe ndi za Charles Carnes ndi Aviel Goodman [9]. Onsewa amagawana malingaliro a kutayika kwa kudziwongolera, nthawi yochulukirapo yomwe amagwiritsidwa ntchito pazakugonana komanso zotsatira zoyipa pa iye / ena, koma amasiyana pazinthu zina. Izi zikuwonetsa mu mikwingwirima yochepa kusowa kwa mgwirizano mu conceptualizing hypersexual makhalidwe pazaka. Pakadali pano, njira zikuluzikulu zimafotokozera zamakhalidwe olimbitsa thupi monga vuto la kuwongolera kapena chizolowezi [55].
Kuchokera ku vuto lachidziwitso choletsa kugonana, khalidwe lachiwerewere limatchedwa Compulsive Sexual Behavior (CSB). Coleman [56] ndi wothandizira mfundoyi. Ngakhale kuti akuphatikizapo khalidwe la paraphilic pansi pano [57], ndipo angakhalepo nthawi zina, amasiyanitsa bwino ndi a CSB omwe sali aparaplic, zomwe ndizo zomwe tikufuna kuziganizira pazokambirana izi. Chochititsa chidwi, kuti khalidwe losayerekezereka lachiwerewere limakhala lofala nthawi zambiri, osati kuposa,43,58].
Komabe, kutanthauzira kwatsopano kwa CSB kaŵirikaŵiri kumatanthawuza makhalidwe ambiri okhudzana ndi kugonana omwe angakhale okakamiza: omwe amadziwika kuti amakhala amaliseche, akutsatiridwa ndi kugwiritsira ntchito zolaula, chiwerewere, kuyenda mofulumira, ndi maubwenzi ambiri (22-76%) [9,59,60].
Ngakhale pali zovuta zenizeni zogonana pakati pa kugonana ndi zochitika monga matenda ovuta kwambiri (OCD) ndi mavuto ena oletsa kugonana [61], palinso kusiyana kwakukulu kunanenedwa: mwachitsanzo, khalidwe la OCD siliphatikizapo mphotho, mosiyana ndi chiwerewere. Komanso, pamene akukakamizidwa odwala OCD angapezeke mpumulo [62], khalidwe lachiwerewere nthawi zambiri limagwirizanitsidwa ndi chilango ndikumva chisoni pambuyo pochita zomwezo [63]. Ndiponso, kukhudzidwa komwe nthawi zina kumayambitsa khalidwe la wodwalayo sikugwirizana ndi dongosolo lokonzekera lomwe nthawi zina limafunidwa mu CSB (mwachitsanzo, pokhudzana ndi kugonana) [64]. Goodman akuganiza kuti vutoli limakhala pamphambano ya mavuto osokoneza bongo (omwe amaphatikizapo kuchepetsa nkhawa) komanso matenda osokoneza bongo (omwe amakhudza kukondweretsa), ndi zizindikiro zomwe zimayendetsedwa ndi njira za sayansi (serotoninergic, dopaminergic, noradrenergic, ndi opioid systems) [65]. Stein amavomereza ndi chitsanzo chophatikiza njira zingapo zamagetsi ndipo amapereka chitsanzo cha ABC (kugwilitsika, kugwiritsira ntchito chizoloŵezi chochita chizoloŵezi, ndi chidziwitso chakumvetsetsa) kuti aphunzire chinthu ichi [61].
Kuchokera ku chizoloŵezi chokhala ndi chizoloŵezi chogonjetsa, khalidwe lachiwerewere limaphatikizapo kugaŵana mbali zazikulu za kuledzera. Zinthu izi, malinga ndi DSM-5 [1], tchulani chitsanzo chogwiritsidwa ntchito chodetsa nkhaŵa chomwe chikugwiritsidwa ntchito ku khalidwe lachiwerewere, ponseponse ndi pa intaneti [6,66,67]. Umboni wa kulekerera ndi kuchotsedwa kwa odwalawa mwinamwake ndizofunikira pakufotokozera gululi ngati matenda osokoneza bongo [45]. Kugwiritsira ntchito molakwika kwa cybersex kumayambanso kulingalira ngati khalidwe lachiwerewere [13,68].
Mawu oti "bongo" pakugwiritsira ntchito gululi akadali otsutsana kwambiri. Zitzman akuwona kuti kukana kugwiritsa ntchito mawu oti "ndiwonetsero waufulu wazikhalidwe komanso kudziletsa kuposa kulephera kulikonse kwazidziwitso ndi njira zina zodziwitsira"69]. Komabe, mawuwa amafunikira kugwiritsidwa ntchito mosamala, chifukwa amatha kutanthauzira ngati chifukwa chofufuzira mosakondweretsa komanso chisangalalo chazowawa, ndikuwadzudzula chifukwa cha izi.
Pakhala pali mkangano pakati pa a Patrick Carnes ndi Eli Coleman pankhani yodziwitsa za machitidwe ena oopsa. Coleman adawona kuti kukhudzana kwa mtima kumayendetsedwa ndi kufunikira kochepetsera nkhawa zamtundu wina, osati chikhumbo chakugonana [56] atagawa m'magulu asanu ndi awiri (umodzi wawo ukugwiritsa ntchito zolaula pa intaneti) [57], pomwe Carnes (yemwe amatanthauzira kuti "njira yothandizira kuti munthu asinthe malingaliro") amapeza zofananira ndi zizolowezi zina zamtunduwu monga kutchova juga, kuyang'ana kwambiri pa kuwonongeka kwa ulamuliro ndikupitilizabe ngakhale atakhala ndi zotsutsana [70].
Kawunikiridwa bwino mabuku ndi Kraus [71], adazindikira kuti ngakhale izi ndizofanizira, kusiyana kwakukulu pakumvetsetsa kwa malingaliro kumapangitsa gulu lake kukhala lokhazikika. Zovuta zazikulu ndizoyang'anira kuchuluka kwa kuchuluka kwakukulu, kuchuluka kwakanthawi ndi njira zamankhwala (kufotokoza zazikulu komanso malire ake azidziwitso), mothandizidwa ndi neuropsychological, neurobiological, and genetic data, komanso chidziwitso chambiri pakuwunikira komanso kupewa, komanso imalozera kuukadaulo wa digito pamakhalidwe opatsirana ngati chinsinsi pakufufuza kwamtsogolo.
Kukwera kwa intaneti kumachulukitsa mwayi wogonana, osati zolaula za pa intaneti zokha. Ngakhale kugwiritsidwa ntchito pa intaneti kumayimira njira ya mtundu wina wobwerezabwereza (mwachitsanzo, zogonana kapena kutchova njuga) kapena kupanga chinthu china mwa ufulu wake chikadatsutsidwa [72]. Komabe, ngati mlandu ndi wakale, umboni wapoyamba ndi zomwe zingachitike zingagwire bwino ntchito pa intaneti.
Pakufunika njira zoyambira zozikika zomwe zimaganizira zinthu zapadera pa intaneti (zotsutsana ndi intaneti), chifukwa ambiri alibe mtundu womwe ungafanane ndi [73]. Pakadali pano, tafotokozapo za zinthu zatsopano mukamachita zachiwerewere pa intaneti, monga kukhalapo kwa kudzipatula pa intaneti [74], zomwe zimapangitsa "kukhazikika m'malingaliro ndi m'maganizo mukakhala pachiwonetsero, ndi nthawi yosemphana ndi kudzipatula". Kupatukana uku kwalongosoledwa kale pokhudzana ndi zochitika zina pa intaneti [75], yomwe imathandizira lingaliro loti kugwiritsa ntchito zovuta za cybersex zitha kukhala zokhudzana ndi intaneti komanso chiwerewere [76].
Pomaliza, tinene kuti gulu lazachiphuphu lotchedwa "kukakamiza kugona mchitidwe wogonana" likuphatikizidwa ndi mtundu wotsatira wa ICD-11, mu chaputala cha "kusokonekera kwa vuto"77]. Tanthauzoli likhoza kuonedwa ku https://icd.who.int/dev11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f1630268048.
Kuphatikizidwa kwa gululi ku ICD-11 kungakhale kuyankha pakufunika kwa nkhaniyi ndikuwatsimikizira othandizira ake, pomwe deta yomwe ikukula koma komabe yosavomerezeka imatilepheretsa kuigawa bwino monga vuto la thanzi lamisala [72]. Amakhulupilira kuti imapereka chida chabwinoko (komabe pakukonzanso) pothana ndi zosowa za odwala omwe amafunafuna chithandizo chamilandu ndi vuto lomwe lingachitike [78], komanso kuwonetsa makangano omwe akukhalapo okhudza kupezeka koyenera kwambiri kwa CSB ndi kuchuluka kwake kwakadinidwe m'malo ena [55,71] (Gulu 1). Kuphatikiza uku kungakhale gawo loyamba lazindikireni nkhaniyi ndikukulitsa, mfundo imodzi imodzi mosakayikira ndiyotengera zolaula za pa intaneti.
Gulu 1. DSM-5 ndi ICD-11 imayandikira kutsegula machitidwe a hypersexual.
Table

3.3. Mawonetsedwe azachipatala

Mawonetsedwe azachipatala a POPU atha kufupikitsidwa pa mfundo zazikulu zitatu:

  • Kuchepa kwa Erectile: pomwe kafukufuku wina wapeza umboni wocheperako pakati pa ogwiritsa ntchito zolaula ndi vuto lachiwerewere [33], ena akuganiza kuti kukwera kwa ntchito zolaula kungakhale chinthu chofunikira chofotokozera kukwera kwakuthwa kwa kusokonekera kwa erectile pakati pa achinyamata [80]. Kafukufuku wina, 60% ya odwala omwe adakumana ndi vuto logonana ndi wokondedwa weniweni, mwamakhalidwe adalibe vutoli ndi zolaula [8]. Ena amati kusinthana pakati pa kugwiritsa ntchito zolaula ndi vuto lachiwerewere ndizovuta kukhazikitsa, chifukwa zowongolera zenizeni zomwe sizimawonetsedwa pazolaula ndizosowa kwenikweni [81] ndipo afotokoza momwe angapangire kafukufuku pankhaniyi.
  • Kusakhutira kwamagulu ogonana: Kugwiritsa ntchito zolaula kwalumikizana ndi kusakhutira pakugonana komanso kusowa pogonana, kwa amuna ndi akazi onse [82], kukhala wotsutsana kwambiri ndi thupi la mnzawo, kuwonjezeka kwapanikiziro komanso kusachita zogonana kwenikweni [83], kukhala ndi ogonana ochulukirapo komanso kuchita zachiwerewere zolipira [34]. Izi zimakhudzidwa makamaka m'mabwenzi mukakhala mbali imodzi [84], chimodzimodzi ndi kugwiritsa ntchito chamba, kugawana zinthu zazikulu ngati chinsinsi chachikulu [85]. Maphunzirowa adakhazikitsidwa ndikugwiritsa ntchito zolaula zomwe sizimakhala zikhalidwe, koma zolaula za pa intaneti sizingakhale ndi zovulaza pazokha, pokhapokha zitakhala zosokoneza [24]. Izi zitha kufotokozera ubale pakati pa kugwiritsa ntchito zolaula zachimayi ndi zotsatira zabwino zazimayi [86].
  • Comorbidities: Khalidwe la Hypersexual laphatikizidwa ndi nkhawa yamavuto, motsatizana ndi kusokonezeka kwa malingaliro, kusokonezeka kwa mankhwala osokoneza bongo komanso kusokonezeka pogonana [87]. Zotsatira izi zikugwiranso ntchito ku POPU [88], kuphatikizidwanso ndi kusuta, kumwa mowa kapena khofi, kugwiritsa ntchito mankhwala osokoneza bongo [41] ndikugwiritsa ntchito zovuta pavidiyo [89,90].
Kukhala ndi zolaula zokhudzana ndi zolaula zayanjanitsidwa ndi kuchuluka kwa mavuto akunenedwa [17]. Zakhala zikutsutsidwa ngati mawonekedwe azachipatala awa ndi zotsatira za kuzunzidwa mwachindunji kapena chifukwa cha zidziwitso zomwe zimadziwonetsa kuti ndiwerewere [91].

3.4. Umboni wa Neurobiological Othandizira Kusuta Kwambiri

Kusunga umboni pa POPU ndi njira yovuta; deta yayikulu pamutuwu idakali yocheperako ndi zitsanzo zazing'onozing'ono, zitsanzo za amuna okhaokha komanso mawonekedwe amtundu wa [71], yopanda maphunziro okwanira a neuroimaging ndi neuropsychological [4], mwina chifukwa cha zopinga zazovuta, zachuma komanso zovuta. Kuphatikiza apo, ngakhale uchidakwa ungayang'anitsidwe ndikuwonetsedwa mu nyama zoyeserera, sitingachite izi ndi chikhalidwe chamunthu; izi zitha kuchepetsa kuphunzira kwathu zamphamvu zake zamaubongo [72]. Zovuta zomwe zilipo pakalipano pofufuza momwe munthu amagwirira ntchito, komanso njira zothetsera mavutowa, zidafotokozedwa bwino komanso mwachidule m'nkhani ya Kraus [71]. Maphunziro ambiri omwe amapezeka mu kafukufuku wathu amakhudzana ndi kuchita zinthu mosaganizira, ndipo zolaula ndi chimodzi mwazinthu zomwe zidawerengedwa.
Umboniwu ndi wozindikira pakumvetsetsa kwamachitidwe a neural pakati pazosintha zokhudzana ndi bongo. Magawo a Dopamine amatenga mbali yofunika mu chikondwererochi cha mphotho yakugonana, monga momwe akuwonera kale m'mankhwala am'tsogolo komanso matenda a dopaminergic ku matenda a Parkinson omwe akuphatikizidwa ndi chikhalidwe cha kugonana [92,93].
Njira zomwe zimawonetsera zolaula pa intaneti zitha kupitilizidwa ndi zomwe zachitika mwachangu komanso "zoyeserera kwambiri" (zotchulidwa ndi wopambana mphoto wa Nobel Nikolaas Tinbergen) zomwe zimapangitsa zolaula za pa intaneti [94]. Izi zitha kukhala zopangitsa kuti zichitike (pankhani iyi, zolaula momwe zimadyedwera kwambiri masiku ano, mawonekedwe ake ochezera a pa intaneti) zimapangitsa kuti majini asinthe. Chikhulupiriro ndichakuti zimatha kuyambitsa makonzedwe athu achilengedwe pamlingo wambiri kuposa zomwe makolo akale amakumana nazo pomwe ubongo wathu unachokera, zimapangitsa kuti zikhale zosavuta kuchita nawo [2]. Ngati tiona zolaula za pa intaneti motere, titha kuyamba kuwona zofananira ndi anthu omwe amakonda kugwiritsa ntchito mankhwala osokoneza bongo nthawi zonse.

Kusintha kwakukulu kwa ubongo komwe kumawonedwa ndi zosokoneza bongo kumayala maziko a kafukufuku wamtsogolo wamakhalidwe olakwika [95], kuphatikizapo:

  • Kuzindikira [96]
  • Kufafaniza [97]
  • Zosagwirizana mabwalo oyambira (hypofrontality) [98]
  • Malangizo a kupsinjika [99]
Kusintha kwa ubongo kumeneku komwe kumawonetsedwa m'magazi kumalumikizidwa ndi odwala omwe ali ndi vuto la Hypersexual kapena ogwiritsa ntchito zolaula kudzera mu kafukufuku wapafupifupi wa 40 wamitundu yosiyanasiyana: kulingalira kwa maginito, electroencephalography (EEG), neuroendocrine, ndi neuropsychological.
Mwachitsanzo, pali kusiyana kodziwika mu machitidwe aubongo pakati pa odwala omwe ali ndi machitidwe okakamira pakugonana ndi omwe amawongolera, omwe amawonetsera omwe amakhala osokoneza bongo. Mukawonetsedwa pazithunzi zachiwerewere, zolemba zamtunduwu zawonetsa kusiyana pakati pakukonda (motsatira zowongolera) ndi kufuna (chilakolako chogonana), chomwe chinali chachikulu [8,100]. Mwanjira ina, m'maphunzirowa mumakhala chikhumbo chokwanira chazomwe zimadziwika zokha, koma osati chilolezo chogonana. Izi zikutiwonetsera ku chiwerewere chomwe chimadziwika kuti ndiye mphotho [46].
Umboni wa chilakolako ichi chachisindikizo chachisudzo chapamwamba kwambiri chikuwonekera makamaka ku prefrontal cortex [101] ndi amygdala [102,103], pokhala umboni wolimbikitsa. Kugwira ntchito m'zigawo za ubongo uku kukumbukira za ndalama zapadera [104] ndipo zingakhale ndi zotsatira zofanana. Komanso, pali mawerengedwe apamwamba a EEG mwa ogwiritsira ntchitowa, komanso chilakolako chogonana ndi wokondedwa, koma osati kugonana ndi zolaula [105], chinachake chomwe chimasonyezanso kusiyana kwa khalidwe la erection [8]. Izi zikhoza kuonedwa ngati chizindikiro cha deensitization. Komabe, kufufuza kwa Steele kuli ndi zolakwika zingapo zomwe angaganizire (monga kugonana kosatha, kusowa kwa kuyang'ana kwa matenda a m'maganizo kapena kuledzeretsa, kusakhala gulu lolamulira, ndi kugwiritsa ntchito mayankho osatsimikiziridwa pa zolaula) [106]. Phunziro la Prause [107], nthawi ino ndi gulu lolamulira, linayankhulanso zotsatirazi. Udindo wa chidziwitso chokhudzidwa ndi chilakolako cha chitukuko cha kugonana kwa azimayi ogonana ndi azimayi ogonana ndi abambo amathandizidwa kuti azigonana ndi amuna okhaokha [108] ndi zogonana amuna kapena akazi okhaokha [109].
Kukonda chidwi chakugonana kumeneku ndikofunika kwambiri kwa anthu oyambirirawa [110], koma kuwonetsedwa kawiri kawiri kumawonetsa kuyipa [111,112]. Izi zikutanthauza kuchepa kwa machitidwe a mphotho, mwina omwe angapangidwe ndi dorsal cingrate wamkulu [107,113,114]. Popeza dorsal cingulate imatenga nawo gawo kuyembekezera mphoto ndikuyankha zochitika zatsopano, kuchepa kwa zochitika zake pambuyo potiwonetsera mobwerezabwereza kumatidziwitsa kukulitsa kakhalidwe ka zinthu zoyambira kale. Izi zimadzetsa kukondweretsedwa kopitilira muyeso kwakanema [115], zomwe zitha kuwoneka ngati kuyesa kuthana ndi malo okhala komanso kukhumudwa pakufufuza zolaula zatsopano (zatsopano) ngati njira yokhutira ndi zakugonana, kusankha izi mmalo mwa kugonana kwenikweni [20].
Kuyesayesa kopanda chidwi kumeneku kungaphatikizidwe kudzera mwa kubwezeretsanso kwapabwalo [116] ndi amygdala [117]. Zimadziwika kuti kuwonera zolaula kwa ogwiritsa ntchito pafupipafupi kwalumikizananso ndi zochitika zazikuluzikulu [99], makamaka mu ventral striatum [116,118] yomwe imachita gawo lalikulu pakuyembekezera mphoto [119].
Komabe, kulumikizana pakati pa ventral striatum ndi preortalal cortex kumachepa [103,113]; kuchepa kwa kulumikizana pakati pa preortal cortex ndi amygdala kwawonedwanso [117]. Kuphatikiza apo, maphunziro owonjezera a hypersexual awonetsa kuchepetsedwa kolumikizana pakati pa caudate ndi tempor cortex lobes, komanso kuchepa kwa imvi pankhanizi [120]. Kusintha konseku kungafotokozere kulephera kwawongolera zikhumbo zakugonana.
Kuphatikiza apo, mitu yamankhwala oyerekeza kwambiri inawonetsa kuchuluka kwamangdala [117], mosiyana ndi iwo omwe amakhala ndi vuto lalikulu la zinthu, zomwe zimawonetsa kuchuluka kwa amygdala [121]; Kusiyanaku kungafotokozeredwe ndi mphamvu ya chinthu ya neurotoxic. Mu maphunziro oonjezera, kuchuluka ndi kuchuluka kwa mawu kungawonetse kuwonjezereka ndi njira zamavuto (makamaka zothandizira malingaliro olimbikitsanso) kapena kukhala chotsatira chamalingaliro azovuta zamagulu, monga chizolowezi chomangodzikondweretsa [122].
Ogwiritsa ntchito awa awonetsanso kuyeserera kopsinjika kwa nkhawa, makamaka yolumikizidwa kudzera mu hypothalamus-pituitary-adrenal axis [122] m'njira momwe zimawonera kusintha kumene kumaoneka mwa anthu osokoneza bongo. Zosintha izi zitha kukhala kusintha kwa ma epigenetic pamasinthidwe okoka oyendetsa omwe ali ndi vuto loyendetsa, monga corticotropin-releasing-factor (CRF) [123]. Hypothesis ya epigenetic iyi imawona zotsatira za hedonic ndi anhedonic makamaka zimakhudzidwa ndi majini a dopaminergic, komanso mwina ma genotransmitter okhudzana ndi ma gene polymorphisms [124]. Palinso umboni wa zotupa zapamwamba za chotupa necrosis factor (TNF) muzogonana, ndizolumikizana mwamphamvu pakati pa misinkhu ya TNF ndi kuchuluka kwambiri pamiyeso ya hypersexuality rating [125].

3.5. Umboni wa Neuropsychological

Pakuwonetsera kuwonekera kwa kusintha kumeneku muzochitika zakugonana, maphunziro ambiri a neuropsychological akuwonetsa mtundu wina wa zotsatira zosakhudzana kapena zowonekera mwachindunji mu ntchito yayikulu [126,127], mwina monga chotsatira cha kusintha kwakuthupi kwamakedzana [128]. Ikagwiritsidwa ntchito pazolaula za pa intaneti, zimathandizira kukulitsa ndi kukonza [129,130].
Zomwe zakhala zikugwira ntchito yayikuluyi ndi monga: kukhudzidwa [131,132], kuzungulira kwanzeru komwe kumalepheretsa njira zophunzirira kapena kutembenuzira chidwi [120,133,134], kusaganiza bwino komanso kupanga zisankho [130,135], kusokonezedwa kwa mphamvu ya kukumbukira memory [130], zoperewera pamalingaliro am'malingaliro, komanso kutenga kwambiri zogonana [136]. Zotsatira zakumbuyo ndizokumbukira zamakhalidwe ena (monga njuga yam'magazi) ndi machitidwe pamadongosolo azinthu [137]. Kafukufuku ena amatsutsana mwachindunji ndizotsatira izi [58], koma pakhoza kukhala zovuta zina momwe mungagwiritsire ntchito (mwachitsanzo, zitsanzo zazing'ono).
Pofika pazinthu zomwe zimathandizira kukulitsa chikhalidwe cha hypersexual ndi cybersex, pali zingapo. Titha kuganiziranso za kukonzanso kwa cue, kulimbikitsanso komanso kuphunzira komwe kungakhale kophatikizira [104,109,136,138,139] monga njira zazikulu za chitukuko cha zolaula. Komabe, pakhoza kukhala zinthu zina zosavuta kuchita [140], monga: (1) udindo wokhutiritsa zachiwerewere ndikuthana ndi vuto lochita mwa anthu ena odziwika kale [40,141,142,143] kaya ndi chifukwa chakuchotsedwa pamakhalidwe [144,145] kapena kukhudzidwa ndi boma [146], ndi (2) njira / zopewera [147,148,149].

3.6. Kuzindikira

Ambiri mwa maphunziro omwe amatanthauzirawa amagwiritsa ntchito maphunziro omwe atenga nthawi yayitali zolaula pa intaneti [34,81,113,114], chifukwa chake mawonetsedwe ake azachipatala amawoneka kuti ali achindunji komanso zotsatirapo zake pakuchita nawo izi zoyipa. Tanena za zovuta kupeza njira zoyambira zopezera kukhazikika, koma malipoti ena akusonyeza kuti kuchepetsa kapena kusiya mchitidwewu kungapangitse kusintha kwazomwe zimapangitsa kuti azigonana komanso kusakhutira ndi amuna kapena akazi anzawo [79,80] ngakhale kuchira kwathunthu; izi zitha kutanthauza kuti kusintha kwa ubongo komwe kwatchulidwa kale kumatha kusintha.

3.7. Zida Zoyezera

Pali zida zingapo zowunikira CSB ndi POPU. Onse amadalira kuyankha ndi kuwona mtima; mwina kwambiri kuposa kupimidwa kwapafupipafupi kuyeza mayeso, chifukwa zogonana ndizomwe zimatsitsidwa kwambiri chifukwa cha chibadwa chawo.
Kwa Hypersexeness, pali zopitilira muyeso za 20 zowunika komanso zoyankhulana zamankhwala. Zina mwazodziwika bwino ndizophatikiza mayeso a sex Addiction Screening Test (SAST) ofunsidwa ndi Carnes [150], ndipo mtundu wake wokonzedwanso waposachedwa SAST-R [151], Compulsive kugonana Behaeve Inventory (CSBI) [152,153] ndi Hypersexual Disorder Screening Inventory (HDSI) [154]. HDSI poyambirira idagwiritsidwa ntchito pakuwunika kachipatala ka DSM-5 shamba yofunsira hypersexual disorder. Pomwe kuwunika kwina kukuwonetsa mphamvu zokhudzana ndi njira komanso kukonzanso kwa zinthu zina zofunikira, kumakhalabe ndi chithandizo champhamvu kwambiri chothandizira kwambiri ndipo ndi chida chothandiza kwambiri pakuyeza matenda oopsa [151].
Ponena za zolaula za pa intaneti, chida chogwiritsidwa ntchito kwambiri ndi kuyesa pa intaneti kwa kugonana pa intaneti (ISST) [155]. Imawunikira magawo asanu osiyana (kukakamizidwa kuchita zachiwerewere pa intaneti, machitidwe achiwerewere pa intaneti, chikhalidwe cha anthu omwe ali pa intaneti, kugwiritsa ntchito ndalama zogonana pa intaneti ndikukhala ndi chidwi chogonana pa intaneti) kudzera pa 25 dichotomic (inde / ayi) mafunso. Komabe, mawonekedwe ake a psychometric sanangowunikiridwa mofatsa, ndi chitsimikiziro champhamvu kwambiri ku Spain [156] yomwe yagwira ntchito ngati cholembera cha maphunziro amtsogolo [157].
Zida zina zodziwika ndizovuta za kugwiritsa ntchito zolaula (PPUS) [158] yomwe imayeza magawo anayi a POPU (kuphatikiza: mavuto ndi ntchito, kugwiritsa ntchito kwambiri, kuwongolera zovuta ndikugwiritsira ntchito kuthawa / kupewa malingaliro oyipa), kuyesa kwakanthawi kochepa kwa intaneti komwe kumagwirizana ndi zochitika zogonana pa intaneti (s-IAT-sex) [159], funso lazinthu za 12-zomwe zimayeza magawo awiri a POPU, komanso zojambula zolaula za cyber-zolaula (CPUI-9) [160].
CPUI-9 imawunika magawo atatu: (1) zoyeseza zolowera, (2) kuzindikira kukakamizidwa, ndi (3) kuvutikira m'maganizo. Poyamba amaganiza kuti ali ndi katundu wogwira mtima wa psychometric [9], kufufuza kumeneku kwatsimikizira posadalirika: kuphatikizidwa kwa gawo la "kuvutikira m'maganizo" magawo a manyazi ndi kudziimba mlandu, omwe sakhala mu mayeso osokoneza bongo ndipo potero amasenda zambiri kumtunda [161]. Kugwiritsa ntchito chipangizochi popanda malirewa kukuwoneka bwino ndikuwonetsa zolaula.
Chimodzi mwazomwe zaposachedwa kwambiri ndi kuchuluka kwa zolaula zamagetsi (PPCS) [162], kutengera mtundu wa zisanu ndi chimodzi cha Griffith163], ngakhale sichiyesa chizolowezi, zovuta zokhazokha zolaula zokhala ndi katundu wolimba wa psychometric.
Njira zina za POPU zomwe sizapangidwire kuyesa kugwiritsa ntchito zolaula pa intaneti koma zakhala zikugwiritsidwa ntchito pogwiritsa ntchito zolaula pa intaneti [9], phatikizani ndi zolaula za zolaula za zolaula (PCI) [164,165], Compulsive Pornograph Consuse Scale (CPCS) [166] ndi Pepala la Mafunso Pazaka Zolaula ”(PCQ) [167] yomwe imawunika zomwe zimayambitsa pakati pa ogwiritsa ntchito zolaula.
Palinso zida zowunikira kukonzekera kwa ogwiritsa ntchito zolaula kuti asiye khalidwe lawo pogwiritsa ntchito njira zodziyambitsa nokha [168] ndi kuwunika kwa zotsatira za chithandizo pochita izi [169], kuzindikira zomwe zingalimbikitse kuyambiranso: (a) Kugonana / kugona / mwayi, (b) kuledzera / malo / malo osavuta, ndi (c) malingaliro osalimbikitsa.

3.8. Chithandizo

Popeza mafunso ambiri akadali okhudzana ndi conceptualization, kuwunika, ndi zomwe zimayambitsa matenda oopsa komanso POPU, pakhala kuyesayesa kochepa chabe pakufufuza njira zomwe zingagwiritsidwe ntchito pochiritsa. M'maphunziro osindikizidwa, zitsanzo zazikulu zimakhala zazing'ono komanso zochepa kwambiri, zowongolera zamankhwala zimasowa, ndipo njira zakufufuzira zimabalalika, sizingalephereke, komanso sizoyenera kuchita [170].
Nthawi zambiri, kuphatikiza njira zama psychosocial, chidziwitso, chikhalidwe, malingaliro, komanso njira zamankhwala zimawerengedwa kuti ndizothandiza kwambiri popewa kugonana, koma njira yosakhala yodziwikirayi imawonetsa kusazindikira kwa nkhaniyi [9].

3.8.1. Njira Zamachitidwe

Maphunzirowa adakhazikika pa paroxetine ndi naltrexone pakadali pano. Nkhani zingapo zokhudzana ndi paroxetine pa POPU zidathandizira kuchepetsa nkhawa, koma pamapeto pake adalephera kuchepetsa mkhalidwewo [171]. Kuphatikiza apo, kugwiritsa ntchito ma SSRIs kuti apange kusowa pogonana kudzera munthawi yake sikuwoneka kothandiza, ndipo malinga ndi zomwe takumana nazo kuchipatala ndizothandiza kwa odwala omwe ali ndi vuto la matenda amisala [a comorbid psychiatric [172].
Malipoti anayi okhudza naltrexone kuchitira POPU afotokozedwa. Zotsatira zam'mbuyomu zafotokoza kuti naltrexone imatha kukhala njira yochizira matenda osokoneza bongo komanso vuto la hypersexual [173,174], akuchepetsa zolakalaka ndi kukakamiza poletsa chisangalalo chokhudzana ndi khalidweli. Ngakhale pakadali pano sipangakhale yesero lolamulidwa mwachisawawa ndi naltrexone m'maphunzirowa, pali malipoti anayi a milandu. Zotsatira zopezeka pakuchepetsa zolaula zimasiyana pazabwino [175,176,177] kusinthitsa [178]; osachepera m'modzi mwa iwo wodwalayo adalandiranso sertraline, kotero sizikudziwika kuti ndiwotrexone angati [176].

3.8.2. Njira Zowerengetsera Maganizo

Mosakayikira, psychotherapy ikhoza kukhala chida chofunikira pakumvetsetsa kwathunthu ndikusintha chikhalidwe. Ngakhale chidziwitso cha machitidwe othandizira (CBT) amawonedwa ndi madotolo ambiri kuti ndi othandiza pochiza matenda oopsa [179], Kafukufuku yemwe adakhudza ogwiritsa ntchito zolaula pa intaneti adalephera kukwaniritsa izi:180], ngakhale kuwopsa kwa zizindikiro za kukhumudwitsa kwa comorbid ndi machitidwe wamba a moyo adakonzedwa. Izi zimabweretsa lingaliro lachidwi kuti kungochepetsa kugwiritsa ntchito zolaula sikungayimire cholinga chofunikira kwambiri chamankhwala [170]. Njira zina zogwiritsa ntchito CBT pochiza POPU zidapangidwa, koma kubwereza mavuto obwera mwadzidzidzi m'derali kumatilepheretsa kuzindikira zodalirika [181,182].
Psychodynamic psychotherapy ndi ena monga chithandizo cha mabanja, chithandizo cha maanja, ndi chithandizo cha m'maganizo chojambulidwa pambuyo pazokambirana za 12 zitha kukhala zofunikira mukamawunikira mitu yamanyazi komanso kudziimba mlandu ndikubwezeretsa kudalirana pakati pa ogwirizana omwe ali nawo [170,172]. Chiyeso chokhacho chomwe chimalamulidwa mwachisawawa chomwe chimakhala ndi ogwiritsa ntchito zolaula pa intaneti chikuyang'ana pa Kuvomereza ndi Kudzipereka Therapy (ACT) [183], kusintha kochokera mu mndandanda wawo wama 2010 [184], komwe kunali kafukufuku woyesera woyamba kutchula POPU. Kafukufukuyu adawonetsa zotsatira zabwino koma ndizovuta kutulutsa chifukwa zitsanzozo zinali zochepa kwambiri ndipo zimangoyang'ana anthu ochepa.
Kupambana komwe kunaperekedwa ndi CBT, conjoint therapy ndi ACT kungadalire kuti ndizokhazikika pamalingaliro ndi kuvomereza; kutengera ndi nkhaniyo, kuvomereza kugwiritsira ntchito zolaula kungakhale kofanana kapena kofunikira kuposa kuchepetsa kugwiritsidwa ntchito kwake [170].

4. Kukambirana

Zikuwoneka kuti POPU sikungokhala vuto limodzi lokha, koma pakali pano ndilo lofala kwambiri chifukwa nthawi zambiri limakhudzanso kuseweretsa maliseche. Ngakhale izi ndizovuta kudziwa molondola chifukwa cha kusadziwika komanso kupezeka kwa zinthu zomwe zimapangitsa kuti zolaula zizipezeka masiku ano, titha kutsimikiza kuti woyang'anira zolaula wasintha pafupifupi zaka khumi zapitazi. Sichingakhale kopanda nzeru kuganiza kuti mitundu yake yapaintaneti yathandizira kwambiri makasitomala awo, ndikuti zinthu zitatu izi zimathandizira kuwopsa kwa POPU ndi machitidwe ena ogonana.
Monga tanena, kusadziwika ndi njira yayikulu yomwe ingachititse kuti kugonana kugwe muvuto. Tiyenera kudziwa kuti ziwerengero zokhudzana ndi vutoli ndizowonekera kwa anthu azaka zovomerezeka kuti azichita zachiwerewere, pa intaneti kapena panjira; koma sichingatipulumutse kuti zochitika zogonana siziyamba pambuyo popumira, ndipo pali mwayi woti ana omwe akadali ndi vuto logonana ndi omwe ali pachiwopsezo chambiri. Chowonadi ndi chakuti mgwirizano wamphamvu pazomwe zimachitika kuti munthu azigonana, komanso azikhala pa intaneti, ayenera kuziyeza moyenera komanso moyenera kuti zikuvuta bwanji.
Monga momwe tikudziwira, kafukufuku wina wam'mbuyomu akuthandizira gululi kukhala chidakwa ndi mawonetseredwe ofunikira ofunikira monga kusokonezeka kwa kugonana ndi kusakhutira kwa kugonana. Ntchito zambiri zomwe zikupezekapo zimachokera ku kafukufuku wofanana ndi wochitidwa mankhwala osokoneza bongo, pogwiritsa ntchito malingaliro owonetsa zithunzi zolaula monga "supranormal stimulus" mofanana ndi chinthu chenichenicho chomwe, kupyolera mukudya, chingayambitse matenda osokoneza bongo. Komabe, malingaliro monga kulekerera ndi kudziletsa sizinakhazikitsidwe mokwanira kuti ziyenera kulemba kuledzeretsa, ndipo motero ndi mbali yofunika kwambiri ya kafukufuku wamtsogolo. Pakali pano, gulu lachidziwitso lomwe limaphatikizapo khalidwe la kugonana laphatikizidwa ku ICD-11 chifukwa cha zomwe akufunikira panopa, ndipo zitha kukhala zothandiza kuthetsa odwala omwe ali ndi zizindikiro zomwe amapempha madokotala kuti awathandize.
Pali zida zingapo zowunikira zomwe ziripo kuti zithandizire wazachipatala wamba njira zodziwira, koma kudziwitsa zomwe zili zenizeni komanso zosagwirizana ndi vuto lidakali vuto. Pakadali pano, gawo lofunikira mwa magawo atatu a mfundo zomwe Carnes, Goodman, ndi Kafka akuphatikiza ndi lingaliro lalikulu la kutaya kudziwongolera, nthawi yochulukirapo yomwe imagwiritsidwa ntchito pakugonana komanso zotsatira zoyipa kwa iwo ndi ena. Mwanjira ina kapena ina, amapezekanso pazida zambiri zowunikira.
Atha kukhala malo oyenera kumangapo. Zinthu zina, zomwe zimawerengedwa mosiyanasiyana, mwina zimatiwonetsera kuti tiganizire mofananamo. Kupanga chida chowunikira chomwe chimasinthasintha kusintha kwinaku ndikofunikira kuti tidziwe zovuta ndizovuta zina zomwe tikukumana nazo, ndipo mwina zikugwirizana ndi kafukufuku wina wamanjenje omwe amatithandiza kumvetsetsa bwino Moyo wamba wamunthu umasinthasintha kuchoka pamakhalidwe oyenera kupita ku chisokonezo.
Ponena za njira zamankhwala, cholinga chachikulu pakali pano chikuchepetsa kugwiritsa ntchito zolaula kapena kusiya zonse, popeza mawonekedwe azachipatala amawoneka ngati asintha. Njira yokwaniritsira izi imasiyanasiyana monga wodwala ndipo ingafunike kusintha kosiyanasiyana m'malingaliro omwe agwiritsidwa ntchito, ndi malingaliro komanso kuvomereza kochokera ku psychotherapy komwe kumakhala koyenera kapena kofunikira kuposa njira yachipatala nthawi zina.

ndalama

Kafukufukuyu sanalandire ndalama zopezeka kunja.

Mikangano ya Chidwi

Rubén de Alarcón, Javier I. de la Iglesia, ndi Nerea M. Casado alengeza kuti palibe kusokonezeka kwa chidwi. AL Montejo alandila ndalama zolangizira kapena ma honorca / zopereka zofufuzira zaka zisanu zapitazi kuchokera ku Boehringer Ingelheim, Forum Pharmaceuticals, Rovi, Servier, Lundbeck, Otsuka, Janssen Cilag, Pfizer, Roche, Instituto de Salud Carlos III, ndi Junta de Castilla y León .

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