MAFUNSO: Pepala ili lidasindikizidwa pansi pa gawo la "Mgwirizano" m'nyuzipepalayi 'Kuledzera'. Kufooka kwake kwakukulu ndikuti imayesetsa kuthana ndi chizolowezi chogonana (CSB), ambulera yomwe imakhudza chilichonse chogonana. Mwachitsanzo, "CSB" imatha kuphatikiza chiwerewere kapena "chizolowezi chogonana" ndipo itha kuphatikizaponso machitidwe ngati kusakhulupirika kapena kuchita zachiwerewere ndi mahule. Komabe ambiri ogwiritsa ntchito zolaula samachita zachiwerewere, ndipo amachepetsa zizolowezi zawo pakompyuta. "Kugonana," komanso kafukufuku wake, ayenera kuganiziridwa mosiyana ndi zolaula za pa intaneti. Yotsirizayi ndi gawo laling'ono la Internet kuledzera. Onani -
- Kugonana Kwachiwerewere Siko Kugonana- Ndipo Chifukwa Chake Kuli Kofunika
- Sayansi ya Zithunzi zolaula pa intaneti: Kukonzanso ndi Kuonjezera (2015).
Chomwe chimakhumudwitsa kwambiri papepalali ndikuti magawo a "Statement of the vuto" komanso "Defining CSB" akukhudzana ndi "chiwerewere," pomwe maphunziro omwe amathandizira CSB ali pafupifupi onse ogwiritsa ntchito zolaula pa intaneti. Kusamvetseka kwamtunduwu kumabweretsa chisokonezo kuposa kumveka bwino, chifukwa kumafunikira chilankhulo chochenjera mosamala pakufufuza kwa ogwiritsa ntchito zolaula pa intaneti, zomwe zimachedwetsa kuzindikira umboni wamphamvu (ndikukula) N'zoonekeratu kuti kuledzera kwa intaneti n'koona ndipo kuwononga zolaula pa intaneti ndi gawo.
Shane W. Kraus1, 2, *, Valerie Voon3 ndi Marc N. Potenza2,4
Nkhani yoyamba yofalitsidwa pa intaneti: 18 FEB 2016
Journal: Chizolowezi
DOI: 10.1111 / kuwonjezera.13297
ZOKHUDZA
Zolinga: Kuwongolera umboni wokhudzana ndi khalidwe lachiwerewere (CSB) monga chosalimba kapena 'khalidwe' loletsa.
Njira: Deta kuchokera kumadera osiyanasiyana (mwachitsanzo, matenda, matenda, zochitika zamakono, zamoyo) zikuwerengedwanso ndikugwiritsidwa ntchito pokhudzana ndi deta kuchokera ku mankhwala ndi kutchova njuga.
Results: Zikuphatikizana zilipo pakati pa CSB ndi matenda ogwiritsira ntchito mankhwala. Machitidwe omwe amachititsa kuti anthu asagwiritse ntchito matendawa amathandizira CSB ndi matenda ogwiritsira ntchito mankhwala, ndipo kafukufuku wamakono omwe akuchitika posachedwapa akusonyeza kufanana komwe kumakhudzana ndi chilakolako chofuna kukhumba. Mankhwala ofanana ndi mankhwala ndi psychotherapeutic angagwiritsidwe ntchito kwa CSB ndi mankhwala osokoneza bongo, ngakhale kuti pali mipata yambiri mu chidziwitso pakalipano.
Zotsatira: Ngakhale kuti kafukufuku wochulukirapo ukugwirizanitsa chizolowezi chogonana (CSB) ku zoledzeretsa zakuthupi, mipata yayikulu mukumvetsetsa ikupitirizabe kupondereza magawo a CSB monga mowa.
MAWU OTHANDIZA: Kuledzera, zizoloŵezi zokhudzana ndi khalidwe la kugonana, khalidwe logonana, chiwerewere, matenda okhudza ubongo, matenda a maganizo, chiwerewere, kugonana
ZOKHUDZA KWA VUTO
Kutulutsidwa kwa Buku Lophatikiza ndi Mawerengedwe (DSM-5) [1] kunasinthidwa kusokoneza bongo. Kwa nthawi yoyamba, DSM-5 inayambitsa matenda osagwiritsa ntchito mankhwala (kutchova njuga) pamodzi ndi vuto la kugwiritsira ntchito mankhwala m'gulu latsopano lotchedwa: 'Matenda Okhudzana ndi Matenda ndi Addictive Disorders'. Ngakhale kuti ochita kafukufuku adalimbikitsa kale kuti ali ndi zizoloŵezi zoledzera [2-4], kukonzanso kachiwiri kwachititsa kuti pakhale mpikisano, ndipo sizikuwonekeratu ngati mndandanda wofananowo udzachitika m'kabuku la 11th la International Classification of Diseases (ICD-11 ) [5]. Kuwonjezera pa kulingalira za vuto lakutchova njuga monga mankhwala osokoneza bongo, adembala a DSM-5 amalingalira ngati zifukwa zina monga vuto la masewera a pa Intaneti liyenera kutchedwa "khalidwe loletsa" [6]. Ngakhale vuto la masewera a intaneti silinali mu DSM-5, linawonjezeredwa ku Gawo 3 kuti lipitirize kuphunzira. Matenda ena adalingaliridwa, koma osaphatikizidwa mu DSM-5. Mwachindunji, zofunikira zoyenera za matenda okhudza kugonana kwa [7] zinatulutsidwa, zomwe zimapanga mafunso okhudza tsogolo lachidziwitso la makhalidwe oipa okhudza kugonana. Zifukwa zambiri zakhala zikuthandizira paziganizo izi, ndi deta yosakwanira mu madera ofunikira omwe mwachiwonekere amapereka [8].
Mapepala omwe alipo panopa, khalidwe lochita zachiwerewere (CSB), lomwe limatanthauzidwa kuti ndi lovuta kuthetsa malingaliro olakwika okhudzana ndi kugonana, zikhumbo / zikhumbo kapena makhalidwe omwe amachititsa kuvutika maganizo kapena kukhumudwa m'ntchito zawo za tsiku ndi tsiku, zidzalingaliridwa, monga momwe zidzakhalire ndi maubwenzi ndi njuga ndi zoledzeretsa zakumwa. Mu CSB, malingaliro okhudzana ndi kugonana mobwerezabwereza, obwereza / zikhumbo kapena makhalidwe angapitirire pa nthawi ndipo zakhudzana ndi kuwonongeka kwa thanzi, maganizo ndi zosiyana pakati pa anthu [7,9]. Ngakhale kuti maphunziro apitalo asanakhalepo ofanana pakati pa kugonana, vuto lachiwerewere / vuto la hypersexual ndi chilakolako chogonana, tidzagwiritsa ntchito CSB kuti tisonyeze gulu lalikulu la machitidwe okhudzana ndi kugonana omwe amavomereza zonsezi.
Mapepala amasiku ano akuwonetsa malemba a CSB powerenga deta kuchokera kumadera osiyanasiyana (mwachitsanzo, matenda, matenda, matenda, chilengedwe) komanso kuthana ndi mavuto ena omwe amapezekabe osayankhidwa. Pakati pa anthu, kodi CSB (kuphatikizapo kugonana kosayenera, kuyang'ana zolaula ndi / kapena kuseweretsa maliseche) iyenera kuonedwa kuti ndiyo matenda osokoneza bongo, ndipo ngati ndi choncho, kodi iyenera kuonedwa ngati khalidwe loledzera? Chifukwa cha zovuta zomwe tafufuza panopa pa phunziro la CSB, timagwirizana ndi ndondomeko za kafukufuku komanso njira zomwe kafukufuku angapangire zowunikira bwino komanso njira zothandizira anthu omwe akuwona thandizo la akatswiri kwa CSB.
KUCHISITSA CSB
Zaka makumi angapo zapitazo, zofalitsa zomwe zafotokozedwa pa CSB zawonjezeka (mkuyu 1). Ngakhale kuti kafukufuku akukula kwambiri, akatswiri ofufuza ndi madokotala akugwirizana pankhani ya kufotokoza ndi kufotokoza kwa CSB [10]. Ena amaganizira zovuta zokhudzana ndi kugonana monga mbali ya matenda a hypersexual [7], CSB [11] yosagwirizana ndi disaphilic, matenda osokonezeka maganizo monga bipolar disorder [12] kapena 'khalidweal' [13,14]. CSB ikugwirizananso ngati chinthu chodziŵika m'kati mwa matenda a impulsecontrol ku ICD-11 ntchito [5].
Zaka khumi zapitazi, ofufuza ndi madokotala adayamba kuganiza za CSB mkati mwazovuta zogonana. Mu 2010, Martin Kafka anakonza vuto latsopano la matenda opatsirana pogonana lotchedwa 'hypersexual disorder' kwa DSM-5 kulingalira [7]. Ngakhale kuti mayesero amtunduwu akuthandizira kutsimikizirika ndi kuvomereza kwa zovuta za matenda opatsirana pogonana [15], bungwe la American Psychiatric Association linaletsa matenda a hypersexual ku DSM-5. Ankadandaula chifukwa cha kusowa kwa kafukufuku kuphatikizapo kufotokozera zamaganizo ndi zogwira ntchito, ma genetic molecular, pathophysiology, epidemiology ndi mayesero a m'maganizo [8]. Ena amawadandaula kuti vuto lachiwerewere lingayambitse chiopsezo chachipongwe kapena kuwonetsa mabodza olakwika, chifukwa chakuti palibe kusiyana kosiyana pakati pa zilakolako zamagonana ndi zizoloŵezi zakugonana [16-18].
Matenda ambiri okhudzana ndi matenda a hypersexual amagawana zofanana ndi zomwe zimagwiritsidwa ntchito molakwika (Table 1) [14]. Zonsezi zimaphatikizapo zofunikira zowonongeka (kupyolera mwa kuyesayesa kuyeserera kapena kusiya) ndi kugwiritsa ntchito pangozi (mwachitsanzo kugwiritsa ntchito / khalidwe kumabweretsa mavuto). Zolinga zimasiyanasiyana ndi kusiyana pakati pa kugonana ndi kugwiritsira ntchito mankhwala. Mankhwala amagwiritsira ntchito ndondomeko za chisokonezo zimaphatikizapo zinthu ziwiri zomwe zimayang'ana kugonjera kwa thupi (ie kulekerera ndi kuchotsa), komanso zovuta zokhudzana ndi matenda a hypersexual. Matenda opatsirana pogonana (pokhudzana ndi vuto la kugwiritsira ntchito mankhwala) ndizofunikira ziwiri zokhudzana ndi matenda a maganizo. Izi zimasonyeza kuti matenda okhudzana ndi chiwerewere amatha kugwiritsira ntchito njira zothetsera vuto, osati njira zothetsera zizindikiro zowononga (mwachitsanzo, nkhawa yokhudzana ndi kuchotsa zinthu). Kaya munthu amakumana ndi zolepheretsa kapena kulekerera zokhudzana ndi khalidwe la kugonana, amatsutsana, ngakhale kuti zanenedwa kuti matenda ozunguza maganizo amatha kusonyeza kuti anthu omwe ali ndi CSB amatha kusiya kapena kusiya kuchita nawo chiwerewere [19]. Kusiyana komaliza pakati pa matenda a hypersexual ndi vuto la kugwiritsira ntchito mankhwala kumaphatikizapo kugonana kosatha. Mwapadera, vuto la kugwiritsiridwa ntchito kwa mankhwala likufunikira zosachepera ziwiri, pamene vuto la hypersexual limafuna anayi mwa asanu a 'A' zofunika kuti akwaniritsidwe. Pakalipano, kufufuza kwina kuli kofunika kuti mudziwe malo oyenerera odwala matenda a CSB [20].
Zochitika zachipatala za CSB
Deta yosakwanira ilipo pokhudzana ndi kufalikira kwa CSB. Dera lalikulu la chiwerengero chokhudzana ndi kuchuluka kwa chiwerengero cha CSB kulibe, kuchititsa kufalitsa kwenikweni kwa CSB kusadziwika. Ochita kafukufuku amawonetsa mitengo ya 3 yopita ku 6% [7] ndi amuna akuluakulu omwe ali ambiri (80% kapena apamwamba) a anthu okhudzidwa [15]. Kuphunzira kwakukulu kwa ophunzira ku yunivesite ya US kunapeza chiwerengero cha CSB kukhala 3% kwa amuna ndi 1% kwa akazi [21]. Pakati pa asilikali achimuna ankhondo a ku United States, asilikaliwa anali pafupi ndi 17% [22]. Pogwiritsira ntchito deta kuchokera ku US National Epidemiologic Survey pa Mowa ndi Zochitika Zowonjezereka (NESARC), kuchuluka kwa nthawi ya moyo wa chilakolako chogonana, chiwerengero chokwanira cha CSB, chinapezeka kuti chiposa amuna (18.9%) kuposa akazi (10.9%) [23]. Ngakhale zili zofunika, timatsindika kuti mipata yofanana ndiyi sinapewe kutchova njuga ku DSM-III mu 1980 kapena kuphatikizapo vuto la kusewera kwa intaneti ku Gawo 3 la DSM-5 (onani kuchuluka kwa kuchuluka kwa chiwerengero kuyambira pafupifupi 1 mpaka 50% , malingana ndi momwe vuto la intaneti likugwiritsidwira ntchito molakwika [6]).
CSB ikuwoneka mobwerezabwereza pakati pa amuna poyerekeza ndi akazi [7]. Zitsanzo za anthu a ku yunivesite [21, 24] ndi anthu ammudzi [15, 25, 26] amasonyeza kuti amuna, poyerekeza ndi akazi, amatha kupeza chithandizo chamankhwala kwa CSB [27]. Pakati pa abambo a CSB, khalidwe lodziwika bwino lomwe limapweteketsa anthu odwala matendawa limakhala lopweteka kwambiri, zithunzi zolaula zimagwiritsidwa ntchito, kugonana kosadziwika kapena kosadziwika ndi anthu osadziwika, ogonana ndi anthu ambirimbiri komanso kugonana kwachangu [15, 28, 29]. Pakati pa amai, chiwerewere chokwanira, chiwerengero cha anthu ogonana komanso zithunzi zolaula zimagwirizanitsidwa ndi CSB [30].
Kuyezetsa kwa matenda a hypersexual, odwala 54% adanena kuti ali ndi malingaliro okhudzana ndi kugonana, zolimbikitsana ndi makhalidwe omwe asanakhale akuluakulu, akusonyeza kuti ayamba kumayambiriro. Odwala makumi asanu ndi awiri ndi awiri pa anthu odwala akusimba kuti akukumana ndi matenda opatsirana pogonana kwa miyezi kapena zaka [15]. Kuwonjezeka kwa zilakolako za kugonana pakapita nthawi kumakhudzana ndi zovuta zaumwini komanso kuwonongeka kwapadera pa madera akuluakulu a moyo (monga ntchito, banja, chikhalidwe ndi ndalama) [31]. Anthu ochita zachiwerewere angakhale ndi zowonjezereka kuti awonongeke kwambiri kuposa momwe amamvera, komanso kudzidetsa nkhawa (mwachitsanzo, manyazi, kudzidana) zingathandize kusamalira CSB [32]. Kupatsidwa maphunziro ochepa ndi zotsatira zosiyana, sizikudziwikanso ngati CSB ikugwirizana ndi zoperewera zopanda chisankho / ntchito yaikulu [33-36].
Mu DSM-5, 'chilakolako' chinawonjezeredwa ngati chidziwitso cha matenda okhudzana ndi kugwiritsa ntchito mankhwala [1]. Mofananamo, chilakolako chikuwoneka choyenera kuwonetsetsa ndi chithandizo cha CSB. Pakati pa amuna akuluakulu, chilakolako choonera zolaula chimagwirizana bwino ndi zizindikiro za maganizo / maganizo, kugonana ndi kupsinjika kwa chiwerewere [37-41]. Cholinga chofuna kukwaniritsa kubwereza kapena zotsatira za chipatala.
Odwala ofunafuna chithandizo, ophunzira a yunivesite, ndi anthu ammudzi, CSB ikuwoneka mofala pakati pa anthu a ku Ulaya ndi oyera poyerekeza ndi ena (mwachitsanzo African American, Latino, Asia America] [15, 21]. Zingakhale zapamwamba komanso zachuma poyerekeza ndi omwe ali ndi matenda ena a maganizo [15, 42], ngakhale kuti kupeza izi kungawononge mwayi wochuluka wa mankhwala (kuphatikizapo chithandizo chapayekha choperekedwa paokha pa inshuwalansi) kwa anthu omwe ali ndi ndalama zambiri. amapezekanso pakati pa amuna omwe amagonana ndi amuna [28, 43, 44], ndipo amagwirizanitsidwa ndi makhalidwe opatsirana pogonana (mwachitsanzo, kugonana kosakwatirana) [44, 45]. anthu amtundu uliwonse omwe sagonana amuna kapena akazi okhaokha, omwe amawonetseredwa ndi miyezo yapamwamba ya kachilombo ka HIV komanso matenda ena opatsirana pogonana.
Psychopathology ndi CSB
CSB imapezeka kawirikawiri ndi matenda ena a maganizo. Pafupi theka la anthu okhudzana ndi kugonana ndi anthu amodzi amakumana ndi zizindikiro zosachepera chimodzi cha DSM-IV, nkhawa, kugwiritsa ntchito mankhwala, kuyendetsa mphamvu kapena kusokonezeka kwa umunthu [22,28,29,46]. M'madera a 103 ofuna chithandizo cha zolaula amagwiritsa ntchito kapena / kapena zachiwerewere zachiwerewere, 71% anakumana ndi zovuta za matenda a maganizo, 40% chifukwa cha matenda a nkhawa, 41% chifukwa cha matenda osokoneza bongo ndi 24% chifukwa cha vuto loletsa kugonana [47] . Mitengo yamakono ya CSB yothandizana nayo komanso kutchova njuga kuyambira 4 mpaka 20% [25, 26, 47, 48]. Chilakolako cha kugonana chimagwirizanitsa ndi matenda ambiri a matenda opatsirana pogonana, makamaka kwa amayi. Pakati pa akazi poyerekeza ndi amuna, chilakolako cha kugonana chinkagwirizanitsidwa kwambiri ndi chikhalidwe cha anthu, chizolowezi chogwiritsa ntchito mowa ndi kuperewera, schizotypal, kusagwirizana ndi anthu, malire, malire, kusagwirizana ndi zovuta zaumunthu [23].
NEUROBIOLOGICAL BASIS YA CSB
Kumvetsetsa ngati CSB ikugawana zokhudzana ndi matendawa ndi (kapena kusiyana kwa) kugwiritsa ntchito mankhwala ndi kutchova juga kungawathandize kudziwitsa zoyenera zokhudzana ndi ICD-11. Dopaminergic ndi serotonergic njira zingathandize kuti chitukuko ndi kukonzekera kwa CSB, ngakhale kuti kafukufukuyu ali ndi chiyambi [49]. Zotsatira zabwino za citalopram m'magulu awiri a blindbo omwe amayendetsedwa bwino ndi CSB pakati pa anthu omwe amasonyeza kuti angathe kugwiritsidwa ntchito poyambitsa serotonergic [50]. Naltrexone, wotsutsa opioid, angakhale othandiza pochepetsa zofuna ndi makhalidwe omwe amapezeka ndi CSB, ogwirizana ndi ntchito ndi kutchova njuga komanso mogwirizana ndi njira zogwiritsira ntchito opioid zomwe zimagwiritsidwa ntchito ndi dopaminergic m'masolimbic njira [51-53].
Umboni wovuta kwambiri pakati pa dopamine ndi CSB umagwirizana ndi matenda a Parkinson. Dopamine mankhwala othandizira (monga levodopa ndi dopamine agonists monga pramipexole, ropinirole) akhala akugwirizana ndi khalidwe lodziletsa / kuphatikizapo CSB) pakati pa anthu omwe ali ndi matenda a Parkinson [54-57]. Pakati pa odwala a 3090 Parkinson, kugwiritsa ntchito dopamine agonist kunagwirizanitsidwa ndi kuwonjezeka kwa 2.6 kamodzi kokhala ndi CSB [57]. A CSB pakati pa odwala a Parkinson afunsidwa kuti achotsedwe kamodzi kokha mankhwala atatha [54]. Levodopa nayenso wagwirizanitsidwa ndi CSB ndi zovuta zina zowonongeka mu matenda a Parkinson, omwe ali ndi zifukwa zina zambiri (monga malo, chikhalidwe cha banja) [57].
Pathophysiology ya CSB, yomwe ikudziwika bwino, ikufufuzidwa mwakhama. Ntchito yosokonezeka ya hypothalamic-pituitary-adrenal axis yakhala ikugwirizanitsidwa ndi zoledzeretsa ndipo inadziwika posachedwapa ku CSB. Amuna a CSB anali ochuluka kuposa amuna omwe si a CSB kuti akhale dexamethasone kuponderezedwa-osayesayesa osakhala ndi suppressors ndipo ali ndi mazinga oposa adrenocorticotrophic hormone. Mankhwala oopsa a hypothalamic-pituitary-adrenal mu ma CSB amatha kugonjetsa zilakolako ndi ma CSB okhudzana ndi mavutowo omwe amamenyana nawo [58].
Kafukufuku amene akupezekapo akugogomezera makamaka za reactivity. Kuchita-reactivity ndikofunikira ku mankhwala osokoneza bongo, kuwathandiza kulakalaka, kukudandaulira ndi kubwereranso [59]. Kafukufuku wamakono wokhudza kugwiritsira ntchito fodya, cocaine ndi zakumwa za mowa zogwiritsidwa ntchito pa ventral striatum, anterior cingulate cortex (AC) ndi amygdala zokhudzana ndi mankhwala osokoneza bongo komanso zofuna zawo, zomwe zikutanthauza kuti zigawo za ubongo zingakhale zofunikira kwambiri dera la chilakolako chofuna kugwiritsira ntchito mankhwala osokoneza bongo [60]. Chilimbikitso cha chizoloŵezi cha chizoloŵezi choledzeretsa chimachititsa kuti chizoloŵezichi chikugwirizana ndi kulimbikitsidwa kolimbikitsana ndi zovuta zomwe zimagwirizanitsa ndi mankhwala zomwe zimapangitsa kuti zikhale zovuta kwambiri, zoyenera kuchita, zomwe zimawoneka ndi zovuta zokhudzana ndi mankhwala. [61, 62]. Chiphunzitso ichi chagwiritsidwanso ntchito kwa CSB [63].
Ophunzira aakazi a koleji [64], kusiyana pakati pa zochitika za ubongo zomwe zimakhudzana ndi mphotho zomwe zimagwiridwa ndi mphotho zomwe zimagwiridwa ndi mphotho kumbali ya chakudya ndi zithunzi zokhudzana ndi kugonana zokhudzana ndi kulemera ndi kugonana patapita miyezi 6. Kulimbitsa mphotho yowonjezera mu ubongo kuti idye chakudya kapena kugonana kunkagwirizana ndi kudya kwambiri ndi kuchulukitsa kugonana, kutanthauza njira yodzigwirizanitsa yokhudzana ndi chilakolako chogonjetsa. Pogwiritsa ntchito maginito opanga maginito (fMRI), kufotokoza zithunzi zolaula poyerekezera ndi mavidiyo osakondana omwe ali ndi CSB okhudzana ndi amuna omwe si a CSB adagwirizanitsidwa ndi kugwiritsidwa ntchito kwakukulu kumalo osokoneza bongo, ventral striatum ndi amygdala, zigawo zomwe zimagwiritsidwa ntchito ndi mankhwala -pulumutseni kufufuza kwa mankhwala osokoneza bongo [63]. Kulumikizana koyenera kwa madera amenewa kunkagwirizana ndi chilakolako chogonana pazinthu, koma osati kukonda, pakati pa amuna ndi CSB. Pano, chikhumbo chinatengedwa ngati ndondomeko ya 'kufuna' poyerekeza ndi 'kukonda'. Amuna omwe ali ndi CSB akutsutsana ndi iwo omwe alibe popanda chidziwitso adakulitsa chilakolako cha kugonana ndikuwonetsa kuti chiwonongeko chachikulu chotsutsana ndi zithunzi zolaula [65] chimasintha kwambiri.
Amayi a CSB amayerekezera ndi omwe sanawonetsere chidwi kwambiri pazinthu zogonana, zomwe zikusonyeza kuti padzakhala zoyankhidwa zoyambirira zokhudzana ndi zolaula [66]. Azimayi a CSB anasonyezanso zosankha zazikulu zokhudzana ndi zochitika zogonana ndi zachuma poyerekeza ndi amuna opanda CSB [67]. Kuwonetsetsa koyambirira kwa kugonana kunayanjanitsidwa ndi makhalidwe akuluakulu okhudzana ndi kugonana, motero kulimbikitsa ziphunzitso zokhudzana ndi chiwerewere. Nkhani za CSB zinasonyezanso zokonda zithunzi zachiwerewere komanso zachiwerewere zowonjezereka zowonongeka ndi zithunzi zogonana, ndi chizoloŵezi chokhala ndi chizoloŵezi chogwirizana ndi chikhalidwe cha kugonana [67]. Kupeza zowonongeka kwa kugonana kungakhale kosavuta kupezeka pa intaneti za zipangizo zamakono.
Pakati pa nkhani za matenda a Parkinson, kufotokoza za kugonana kunayambitsa chilakolako cha kugonana kwa omwe ali ndi CSB poyerekeza ndi omwe alibe [68]; ntchito yowonjezereka mu limbic, paralimic, temporal, occipital, magawo amtundu komanso malo omwe anthu amakonda kukondana nawo, okhudzidwa, ozindikira, owonetsa komanso othandizira. Odwala a CSB 'adawonjezereka chilakolako cha kugonana chogwirizana ndi kuwonjezereka kwa ziwalo zogwiritsidwa ntchito pazomwe zimapangitsa kuti zikhale zogwirizana ndi mankhwalawa. zosavuta, mosiyana ndi mayankho omwe sanagwiritsidwe ntchito phindu lalikulu kapena ndalama [68, 69]. Maphunziro ena aphatikizanso m'madera oyandikana nawo; mu kafukufuku wazing'ono zojambulira zojambula, CSB ndi amuna omwe si a CSB anasonyeza kuti apamwamba kwambiri amatanthauza kusiyana [70].
Mosiyana ndi zimenezi, maphunziro ena omwe akuyang'ana pa anthu omwe alibe CSB adatsindika kuti ntchitoyi ndi yofunika kwambiri. M'mabambo omwe si a CSB, mbiri yakale yowonerera zolaula inagwirizanitsidwa ndi mayankho a m'munsi kumbali ya kumanzere kwa zithunzi zolaula, zomwe zikusonyeza kuti mwina zikhoza kuchitidwa [72]. Mofananamo, pa zochitika zokhudzana ndi zochitika zogwirizana ndi amuna komanso omwe alibe CSB, omwe amaonetsa zovuta zolaula anali ndi zochepetsetsa zojambula zithunzi zolimbana ndi anthu omwe sali olemba ntchito zovuta. Zotsatira zabwino zowonjezereka ndizokwera kwambiri poyankhidwa ndi mankhwala osokoneza bongo mu maphunziro oledzera [73]. Zotsatirazi zikusiyana ndi, koma sizigwirizana ndi, lipoti la ntchito yowonjezereka mu maphunziro a fMRI mu maphunziro a CSB; Maphunzirowa amasiyana mosiyana ndi mtundu wachinyengo, mofanana ndi anthu omwe akuphunzira. Kusanthula kwa CSB kunkawonetseratu mavidiyo poyerekeza ndi zithunzi zobwereza; chiwerengero cha kuwonetseratu chawonetsedwa kuti chikusiyana ndi mavidiyo motsutsana ndi zithunzi ndi chizolowezi chingakhale chosiyana malinga ndi zosokoneza. Kuwonjezera apo, pa zovutazo zomwe zimagwiritsidwa ntchito pazochitika zokhudzana ndi zochitika zokhudzana ndi zochitikazo, nambala ya maola ogwiritsira ntchito inali yochepa [vuto: 3.8, kutembenuka kwapadera (SD) = 1.3 motsutsana: 0.6, SD = maola 1.5 / sabata] poyerekeza ndi Sukulu ya CSB fMRI (CSB: 13.21, SD = 9.85 motsutsana ndi: 1.75, SD = Maola 3.36 / sabata). Motero, chizoloŵezi chikhoza kukhala chogwirizana ndi kugwiritsiridwa ntchito kwachizoloŵezi, ndi kugwiritsa ntchito kwakukulu komwe kungagwirizane ndi cue-reactivity yowonjezereka. Maphunziro akuluakulu akufunika kuyesa kusiyana kumeneku.
Genetics ya CSB
Deta yamtundu yokhudza CSB ndi yochepa. Palibe bungwe lothandizira la CSB lomwe lapangidwa. Kafukufuku wa 88 okwatirana omwe ali ndi CSB adapeza maulendo akuluakulu oyambirira omwe ali ndi vuto la kugwiritsira ntchito mankhwala (40%), matenda odwala (30%) kapena kutchova njuga (7%) [74]. Maphunziro awiri amaphatikizapo kuti zopereka za majini zimapanga 77% za kusiyana komwe kumakhudzana ndi makhalidwe ovuta, pamene 13% inkapezeka chifukwa cha zinthu zosiyana ndi zachilengedwe [75]. Zopereka zapamwamba zowonjezera mavitamini zimakhalansopo chifukwa cha mankhwala ndi kutchova njuga [76, 77]. Pogwiritsira ntchito mapasa awiri [78], chiwerengero cha mitundu yosiyanasiyana ya kutchova njuga chifukwa cha majeremusi ndi pafupifupi 50%, ndipamwamba kwambiri kuwonedwa ndi mavuto aakulu. Zinthu zomwe zimagwirizanitsidwa ndi kukhudzidwa kungakhale chizindikiro cha kusatetezeka kwa chitukuko cha matenda osokoneza bongo [79]; Komabe, ngati izi zikuwonjezereka kusokonekera kwa CSB sizinayambe kufufuza.
KUPHUNZITSA NDI KUCHITSA NTCHITO YA CSB
Zaka khumi zapitazi, kafufuzidwe kafukufuku ndi chithandizo cha CSB chawonjezeka [80]. Akatswiri ofufuza apeza njira zothandizira [13] ndi zida zowunika [81] kuthandiza othandizira odwala CSB; Komabe, kudalirika, kutsimikizirika ndi kugwiritsidwa ntchito kwa miyeso yambiriyi sikunayambe ntchito. Zigawo zochepa chabe zatsimikiziridwa, zolepheretsa kuti azitha kuchitapo kanthu.
Njira zothandizira CSB zimafunikira kafukufuku wina. Kafukufuku wowerengeka adasanthula momwe mphamvu ndi kulekerera kwa mankhwala enaake [53, 82-86] ndi psychotherapeutic [87-91] mankhwala a CSB. Ma psychotherapies aumboni monga chidziwitso-machitidwe othandizira ndi kulandira ndi kudzipereka akuwoneka othandiza kwa CSB [89,91,92]. Momwemonso, serotonergic reuptake inhibitors (mwachitsanzo fluoxetine, sertraline ndi citalopram) ndi ma opioid antagonists (mwachitsanzo naltrexone) awonetsa kuyambiranso koyambirira pakuchepetsa zizindikilo ndi machitidwe a CSB, ngakhale mayesero akulu olamulidwa mosasinthika akusowa. Kafukufuku wamankhwala omwe alipo nthawi zambiri amakhala maphunziro. Kafukufuku m'modzi yekha [50] adagwiritsa ntchito mapangidwe owongoleredwa ndi placebo pofufuza kuyenera ndi kulekerera kwa mankhwala (citalopram) pochiza CSB.
Palibe mayesero akuluakulu omwe ali ndi mayesero omwe amawoneka bwino omwe alipo omwe akuyesa kuwona momwe mphamvu za maganizo zimagwirira ntchito pochiza CSB. Zomwe zimapangitsa kuti zikhale zovuta zitha kuchepetsa zochitika zapamwamba za maphunziro, monga momwe kafukufuku ambiri amagwiritsira ntchito zofooka za njira zosiyana siyana, zosiyana ndi njira zochotsera / zosamveka, kulephera kugwiritsa ntchito ntchito zopanda chithandizo pa zochitika za mankhwala ndipo siziphatikizapo magulu olamulira omwe amafunikira kuti agwire kuti mankhwalawa [80] . Mayesero akuluakulu, omwe amayendetsedwa mosavuta, amafunikira kuti awonetse mphamvu ndi kulekerera kwa mankhwala ndi maganizo opatsirana pogwiritsira ntchito CSB.
Njira zina
Cholinga cha matenda a hypersexual monga matenda opatsirana maganizo sichinavomerezedwe mofananamo. Zimakhala zovuta kuti chidziwitso cha 'matenda' chimasokoneze mitundu yosiyanasiyana ya khalidwe labwino la kugonana [93], kapena kuti khalidwe lotayirira / lovuta la kugonana lingathe kufotokozedwa bwino ngati kuwonjezereka kwa matenda omwe alipo kale omwe alipo m'maganizo kapena njira zosagwiritsiridwa ntchito zolimbana kulamulira zovuta zomwe zimakhudza zimatanthauza osati kusiyana ndi matenda osokonekera maganizo [16,18]. Ofufuza ena anadandaula kuti anthu ena olembedwa ndi CSB angangokhala ndi chilakolako chogonana [18], ndi malingaliro omwe amavuta kuthetsa zilakolako za kugonana ndi machitidwe apamwamba a kugonana ndi zotsatira zokhudzana ndi zizoloŵezizi zingathe kufotokozedwa momveka bwino ngati osakhala ndi- Kusiyana kwakukulu kwa chilakolako chachikulu cha kugonana [94].
Pakati pa anthu akuluakulu achiCroatia, kusanthula masitepe kunazindikiritsa magulu awiri ofunika, omwe akuyimira zovuta zogonana
ndipo wina akuwonetsa chilakolako chachikulu cha kugonana komanso kugonana mobwerezabwereza. Anthu omwe ali m'gulu la masewera ovuta kwambiri amanena kuti matenda a psychopathology amatha kufanana ndi anthu omwe ali ndi magulu akuluakulu omwe amakonda kwambiri [95]. Izi zikusonyeza kuti CSB ikhoza kukhazikitsidwa palimodzi potsata zowonjezereka za kugonana ndi nkhawa, momwe milandu yachipatala ndi yowonjezera
zomwe zingathe kuchitika kumapeto kwapitirizabe kapena mbali [96]. Popeza kuti pali mwayi waukulu pakati pa CSB ndi chilakolako chachikulu cha kugonana, kufufuza kwina kuli kofunika kuti mudziwe zinthu zomwe zimakhudzana kwambiri ndi zovuta za kugonana.
SUMMARY AND CONCLUSIONS
Pokhala kumasulidwa kwa DSM-5, vuto lakutchova njuga linakhazikitsidwa ndi mavuto osokoneza bongo. Kusintha kumeneku kunatsutsa zikhulupiliro kuti kuledzera kumachitika kokha mwa kuwonjezera zinthu zomwe zimasintha maganizo ndipo zimakhudza kwambiri njira zothetsera ndondomeko, zothandizira ndi zachipatala [97]. Deta imasonyeza kuti kuchita zinthu mopitirira muyeso machitidwe ena (mwachitsanzo, kusewera, kugonana, kukakamiza kugula zinthu) kungagawane zachipatala, zam'thupi, za neurobiological ndi zozizwitsa zomwe zikufanana ndi mankhwala osokoneza bongo [2,14]. Ngakhale kuchuluka kwa mabuku a CSB, pali mipata yambiri yodziwa zomwe zingathandize kudziwa momveka bwino ngati kukhala ndi chizoloŵezi chogonana muzochita zogonana kungawonongeke kukhala chidakwa. M'ndandanda wa 2, timalembetsa malo omwe kufufuza kwina kuli kofunika kuti timvetsetse CSB. Zosakwanira zokwanira za deta, zofuna kupewa ndi kuchiza. Ngakhale deta yokhudzana ndi mafilimu akusonyeza kuti kufanana pakati pa mankhwala osokoneza bongo ndi CSB, deta ndi yochepa ndi kukula kwake kwazing'ono, zokhazokha zogonana amuna kapena akazi okhaokha komanso zojambula. Kafukufuku wowonjezera amafunika kuti amvetsetse CSB kwa amai, magulu osowa kwambiri, amitundu / amitundu, achiwerewere, achiwerewere, amuna omwe ali ndi zibwenzi komanso amuna ophwanya malamulo, omwe ali ndi zilema zakuthupi ndi zamagulu ndi magulu ena.
Gawo lina lomwe likusowa kufufuza zambiri limaphatikizapo kulingalira momwe kusintha kwazamakono kungakhudzire makhalidwe a kugonana kwaumunthu. Chifukwa chakuti deta imasonyeza kuti kugonana kumayendetsedwa kudzera pa intaneti ndi ma foni yamakono [98-100], kufufuza kwina kuyenera kulingalira momwe matekinoloje a digito amagwirizanirana ndi CSB (mwachitsanzo, kupanikiza maliseche kumalo oonera zolaula pa Intaneti) kugonana, kugonana nthawi zambiri). Mwachitsanzo, ngati kuwonjezeka kwa zolaula pa Intaneti ndi kugwiritsa ntchito mawebusaiti ndi mafoni a mafoni (mwachitsanzo, Grindr, FindFred, Scruff, Tinder, Pure, ndi zina zotero) zomwe zathandiza kuti anthu azigonana mosagonana pakati pa anthu akuluakulu akugwirizana ndi mauthenga owonjezeka a makhalidwe okhudzana ndi kugonana komwe akuyembekezera kafukufuku wamtsogolo. Ngati deta ikusonkhanitsidwa, chidziwitso choyenera chiyenera kumasuliridwa kuti apange njira zothandizira ndondomeko, njira zothandizira komanso zachithandizo
Zothokoza
Phunziroli linalandizidwa ndi kuthandizidwa ndi Dipatimenti ya Veterans Affairs, VISN 1 Mental Illance Research Research and Clinical Center, National Center for Gaming Responsable, ndi CASAColumbia. Zomwe zili m'bukuli sizitanthauza malingaliro a mabungwe opereka ndalama ndikuwonetsa maganizo a olembawo. Olembawo akunena kuti alibe mavuto a zachuma omwe ali nawo pokhudzana ndi zomwe zili m'bukuli.
Chidziwitso cha zofuna
Olembawo akunena kuti alibe mavuto a zachuma omwe ali nawo pokhudzana ndi zomwe zili m'bukuli. MNP walandira thandizo lachuma kapena malipiro a zotsatirazi: Afunsana ndi kuwalangiza Lundbeck, Ironwood, Shire, INSYS ndi RiverMend Health; walandira thandizo lofufuzira (ku Yale) kuchokera ku National Institutes of Health, Mohegan Sun Casino, National Center for Responsible Gaming ndi Pfizer pharmaceuticals; watenga nawo mbali pafukufuku, mauthenga kapena ma telefoni okhudzana ndi mankhwala osokoneza bongo, matenda osokoneza maganizo kapena nkhani zina zaumoyo; afunsira njuga ndi mabungwe alamulo pa nkhani zowonongeka; amapereka chithandizo kuchipatala ku Connecticut Department of Health mentally ndi Addiction Services Problem Gambling Services Program; wapereka ndemanga zopereka thandizo kwa National Institutes of Health ndi mabungwe ena; ili ndi makope okonzedwa kapena alendo omwe asinthidwa kapena zolemba; wapereka nkhani zamaphunziro pafupipafupi, zochitika za CME ndi malo ena azachipatala kapena asayansi; ndipo wapanga mabuku kapena magawo a mabukhu kwa ofalitsa a matenda a maganizo.