Macmacaan Soomaliyeed oo Soogalooti ah: Waxa aan ognahay iyo waxa aanaan sameyneyno-Dib u eegis nidaamsan (2019)

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

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

1 Adeega Cilmi-nafsiga, Isbitaalka Clínico Universitario de Salamanca, Machadka Cilmi-baarista Biomedical ee Salamanca (IBSAL), 37007 Salamanca, Spain

2 Jaamacadda Salamanca, EUEF, 37007 Salamanca, Spain

aan la taaban karin

Sanadihii ugu dambeeyay, waxaa jiray mowduucyo qoraallo la xidhiidha macaamilka akhlaaqda; qaar iyaga ka mid ah ayaa diirada saaraya isticmaalka mukhadaraadka sawir-qadka online-ka ah. Si kasta ha ahaatee, inkastoo dadaal kasta, haddana weli ma awoodi karno in aan kudhaqaaqno marka uu ku lug yeesho habdhaqankan inuu noqoto mid jiran. Dhibaatooyinka caadiga ah waxaa ka mid ah: isir nacaybka, raadinta qalabka baaritaanka, ka soo horjeeda qiyaasta xaalada, iyo xaqiiqda ah in santuukani laga yaabo in uu ku jiro baaritaanka weyn ee cudurku (sida, galmada khamriga) oo laga yaabo in uu soo bandhigo astaamo aad u kala duwan. Kantaroolka dabeecadda wuxuu abuuraa daraasad ballaadhan oo aan la ogaan karin, oo badanaana waxay muujisaa qaabka isticmaalka dhibaatada ah: lumista xakamaynta, laxaad la'aanta, iyo isticmaalka khatarta ah. Ciladda sirta ah waxay ku habboon tahay qaabkan waxaana laga yaabaa inay ka kooban tahay dhowr dabeecado jinsi ah, sida isticmaalka dhibaatada pornography online (POPU). Isticmaalka pornography online ayaa ku jirta kor u kaca, oo leh karti-u-qaadis la tixgelinayo "Saacadaha A" saameyn (helitaanka, awood-u-lahaansho, magac la'aan). Isticmaalkan dhibaatada ah ayaa laga yaabaa inuu saameyn xun ku yeesho horumarinta galmada iyo shaqada galmada, gaar ahaan dadka dhalinyarada ah. Waxaannu dooneynaa inaanu ku soo aruurinno aqoonta jirta ee ku saabsan isticmaalka daroogada internetka ee dhibaatada ah ee loo isticmaalo sida qaybta neefta. Halkan waxaan isku daynaa in aan soo koobno ​​waxa aan ka ogaanno shirkadan waxaanan muujineynaa aagagga qaar ka mid ah oo u qalma cilmi baaris dheeraad ah.
Erayoxul: sawir-gacmeedyada; qabatimo; cybersex; internetka; dabeecadaha galmada ee qasabka ah; sarreysa

1. Hordhac

Iyadoo lagu darayo "Khamaarista Khamaarista" ee ku jirta "Isticmaalka Isticmaalka Daroogada iyo Isticmaalka Khalkhalka" qaybta DSM-5 [1], APA waxay si cad u qiratay dhacdooyinka aaladda dabiiciga ah. Waxaa intaa dheer, "Gamma Cudurka Isku-dhafka" waxaa lagu meeleeyay Qaybta 3- Caqabadaha daraasad dheeraad ah.
Tani waxay ka dhigan tahay isbedelka joogtada ah ee isbedbeddelka ee ku saabsan mukhadaraadka la xidhiidha dabeecadaha la qabatimay, iyo udub dhexaad u ah cilmi-baaris cusub oo ku saabsan iftiinka dhaqameed ee ay keeneen tiknoolajiyada cusub.
Waxaa jira muuqaal guud oo ah nuucobojeed [2] iyo deegaan [3] dhulka oo ka dhexeeya noocyada kala duwan ee xannibaadda, oo ay ku jiraan labadaba isticmaalka mukhaadaraadka iyo dabeecadaha la qabatimay; tani waxay u muuqan kartaa inay tahay mid isku dhafan labada hay'adood [4].
Xiisadda dhaqaale ahaan, shakhsiyaadka dabeecad ahaan loo adeegsado ayaa si joogta ah u muujiya qaabka isticmaalka dhibaatooyinka: Naqshad xumida (tusaale ahaan, rabsho, iskuday la isku dayo in lagu yareeyo habdhaqanka), naafanimada (tusaale ahaan, yaraynta danaha, dayacaadda meelaha kale ee nolosha), iyo isticmaalka khatarta wacyigelinta dhibaatooyinka maskaxeed). Haddii dabeecadahaani ay sidoo kale kulmaan shuruudaha nafsaaniga ah ee la xariira takoorka (dulqaadka, ka-noqoshada) waa kuwo la xalin karo [4,5,6].
Xanuunka hypersexual waxaa mararka qaarkood loo tixgeliyaa mid ka mid ah waxyaabaha la xariira akhlaaqda. Waxaa loo isticmaalaa sida dallad dhisma oo ku jira dabeecadaha kala duwan ee dhibaatooyinka leh (nacaybka xad-dhaafka ah, cybersex, isticmaalka jaahwareerka, galmada telefoonka, dabeecadda galmada ee dadka waaweyn, ogolaansho kooxeed, iwm.) [7]. Heerarka ugu sarreeya waxay kala duwan yihiin 3% ilaa 6%, in kastoo ay adagtahay in la ogaado maadaama aysan jirin qeexitaan rasmi ah oo ku saabsan xanuunka [8,9].
Fududeynta xogta cilmi-baarista oo xoogan ayaa ka dhigaysa cilmi-baaris, fikradeed, iyo qiimeyn adag, taasoo keenaysa soo jeedinnooyin kala duwan oo lagu sharraxayo, laakiin inta badan waxay la xiriirtaa dhibaatada weyn, dareenka xishoodka iyo xakameynta nafsaaniga ah [8], iyo sidoo kale dabeecadaha kale ee la qabatimo [10] waxayna u oggolaatay baaritaanka tooska ah.
Isla mar ahaantaana, kor u kaca tiknoolajiyada cusub ayaa sidoo kale furay baaxadda habdhaqanka khatarta ah, badanaa Internet Addiction. Takhatarkani wuxuu diiradda saarayaa codsi gaar ah oo ku saabsan internetka (ciyaaraha, dukaamaysiga, sharafka, cybersex ...) [11] oo leh karti u leh dabeecadaha khatarta leh; kiiskan, wuxuu u dhaqmi lahaa sida kan loogu talagalay waxqabadyada la taaban karo ee dhaqanka la sheegay [4,12]. Tani waxay ka dhigan tahay kororka aan loo baahnayn, iyada oo la siinayo goobo cusub oo loogu talagalay dadka la dhisay iyo sidoo kale dadka jilicsan (sababtoo ah sirta gaarka ah ee kordhaya, ama fursada) kuwaas oo aan hore u lahayn habdhaqankan.
Isticmaalka sawir-gacmeedka "pornography online", oo loo yaqaan 'pornography internet' ama 'cybersex', waxay noqon kartaa mid ka mid ah dabeecadaha Internet-ka gaarka ah ee khatarta u ah inay qabatimaan. Waxay u dhigantaa isticmaalka internetka si ay uga qayb galaan hawlaha galmada ee kala duwan [13], oo ka mid ah isticmaalka sawir-gacmeedka [13,14] kaas oo ah hawlaha ugu caansan [15,16,17] oo leh tiro aan xadidnayn oo ah dhacdooyinka galmada la heli karo [13,18,19,20]. Isticmaalka joogtada ah ee marxaladani mararka qaarkood waxay ku keentaa dhibaato dhaqaale, sharci, shaqo, iyo dhibaatooyin xiriirka [6,21] ama dhibaatooyinka shakhsi ahaaneed, oo leh cawaaqib kala duwan. Dareemidda luminta xakamaynta iyo isticmaalka joogtada ah inkastoo natiijooyinkan liidata ay ka dhigan tahay "isdhaafsiga galmada ee internetka" [22ama Isticmaalka Pornography Online Problems (POPU). Tani waxay faa'iido u tahay isticmaalka mashaakilaadka macaamiisha ee "Saacadaha A"23].
Sababtoo ah noocan ah, masturbayada la xidhiidha filimada sawirka waxaa laga yaabaa inay noqoto mid aad u badan, laakiin tani ma aha mid calaamad u ah cudurka pathology [21]. Waxaan ognahay in qeyb ka mid ah saamiga aadka u yar ee dhalinyarada ah in ay internetka u galaan isticmaalka sawirrada "24,25]; Xaqiiqdii, waa mid ka mid ah ilaha muhiimka ah ee caafimaadka galmada [26]. Qaar waxay muujiyeen walaac ku saabsan arrintan, iyagoo wax ka qabta farqiga wakhtiga u dhexeeya markii la isticmaalo walxaha suufka markii ugu horeysay abid, iyo khibradda dhabta ah ee galmada; gaar ahaan, sida hore ay saameyn ugu yeelan karto horumarinta galmada [27] sida rabitaanka galmada aan caadi ahayn ee hoos u dhaca marka la isticmaalo sawir-gacmeedka [28] iyo cillad aan fiicnayn, taas oo si weyn uga dhexjirtay rag dhallinyaro ah sanadihii la soo dhaafay marka la barbar dhigo dhowr sano ka hor [29,30,31,32,33].
Waxaan si nidaamsan dib u eegeynaa suugaanta jira ee ku saabsan mawduuca POPU si ay u tijaabiyaan una soo koobaan horumarka dhowaanahan la sameeyay ee ka soo baxay xaaladaha cudurka epidemiyoolojiga ah, muujinta kiliinikada, cadeymaha neerobiiga ee taageeraya nooca isticmaalka dhibaatada, fikradda ogaanshaha ogaanshaha ciladda hypersexual, qalabyada iyo xeeladaha daaweynta.

2. Hababka

Waxaan samaynay dib-u-eegis nidaamsan kadib tilmaamayaasha PRISMA (Jaantuska 1). Marka la eego cadaymaha cusub ee caddaynta ee ku saabsan mawduucaan, waxaan dib u eegnay dib-u-eegis aan lahayn waqti-go'an oo gaar ah. Mudnaanta waxaa la dhigay dib u eegista suugaanta iyo maqaallada la daabacay iyada oo la cusbooneysiiyey habka ugu da'da yar ee habka ugu da'da weyn, oo doorbidaysa dib u eegista horay loo daabacay mawduuca. PubMed iyo Cochrane waxay ahaayeen xogta ugu muhiimsan ee loo isticmaalo, inkasta oo tiro ka mid ah maqaallada lagu soo ururiyey iyada oo loo marayo gudbinta iskudhafka.
Jcm 08 00091 g001 550
Jaantus 1. Jaantuska socodka PRISMA.
Tan iyo markii aan diiradda saarnay fara-xumeyn online ah iyo dabeecad galmo oo la qabatimay, waxaan ka reebnay waxyaalahan oo kaliya oo ay ku dhex jireen raadinteenna oo kaliya: kuwa iyagu diirada saaraya isticmaalka internetka ee guud, kuwaas oo ujeedka muuqaalka filimka ee kala duwan ee paraphilias, iyo kuwa mawduucan ka soo jeeday aragti bulsheed.
Shuruudaha raadinta soo socda iyo waxyaalahooga ayaa loo isticmaalay isku-dhafan kala duwan: cybersex, porn * (ikhtiyaarka ah "filimada" iyo "pornographic"), addict * (u ogolaato labadaba "takoorid" iyo "addictive"), online, internet , lab / dheddig, jinsi qasab ah, sarreysiin. Qalabka maareynta tixraaca ee Zotero waxaa loo isticmaalay in la dhiso xogta dhammaan macluumaadka la tixgeliyey.

3. Natiijooyinka

3.1. Epidemiology

Isticmaalka sawir-maskaxeedka ee dadweynaha guud waxay cadeyneysaa in ay adag tahay in la qiyaaso si ku filan, gaar ahaan tan kor u qaadka Internetka iyo "saddex-gees" oo ah qodobbada u oggolaanaya labadaba asturnaanta iyo sahlanaanta helitaanka. Daraasada Wright ee ku saabsan isticmaalka sawir-qaadidda ee dadka Maraykanka lab ah oo isticmaalaya Sahanka Guud ee Bulshada (GSS) [34], iyo daraasaddaha qiimaha (oo kor u qaadaya Wright's by farqiga u dhexeeya da'da, qowlka, iyo saameynta muddada) [35] waxay ka kooban yihiin qaar ka mid ah kuwa yaryar, haddii aysan ahayn kuwa kaliya, ilaha jira ee raadinaya sawir-maskaxeed ee dadweynaha guud. Waxay muujinayaan isticmaalka isticmaalka badanaa ee filimada sawirrada sanadaha badanaa, gaar ahaan dadka ragga ah ee ka soo horjeeda dumarka. Tani waxay si gaar ah ugu dhex jirtaa dhallinyarada qaangaarka ah, waxayna si joogto ah u yareysaa da'da.
Qaar ka mid ah xaqiiqooyinka xiisaha leh ee ku saabsan dareenka isticmaalka sigaarka ayaa istaagaya. Mid ka mid ah iyaga ayaa ah in kooxda 1963 iyo 1972 labaduba ay muujinayaan oo kaliya hoos u dhac yar oo ku yimid isticmaalka sanadka 1999, oo soo jeedinaya in isticmaalka sigaarku ka mid yihiin kooxahan ay si joogto ah u ahaayeen tan [35]. Qeybta kale waa 1999 sidoo kale waa sanadka ujeedka Haweenka 18 ee 26 si ay u isticmaasho filimada sawir qaadidda saddex jeer sida ay u badan tahay kuwa udhigma 45 illaa 53, halkii laba jeer laga yaabo in ay noqdaan ilaa laga gaaro ilaa [35]. Labadan xaqiiqeed waxay la xiriiri karaan isbaddallada isbeddelka ee khatarta fara badan oo lagu isticmaalo tiknoolajiyada (iyadoo laga beddelayo xaalada deg dega ah ee loo adeegsado isticmaalka internetka), laakiin waa suurtagal in la ogaado xaqiiqada tan iyo markii xogta asalka ahi aysan ka tarjumayn farqiga u dhaxeeya labadaba offline iyo online kala duwan marka la raadinayo isticmaalka suuqyada.
Sida POPU, ma jirto xog cad oo la isku halleyn karo oo ku jira buugan dib loo eegay kaas oo bixin kara qiyaas adag oo ku saleysan baahidiisa. Ku darista ujeedooyinka horay loo soo sheegay ee la'aanta xogta ku saabsan isticmaalka fara-xumeynta guud, qayb ka mid ah waxay ka dhigi kartaa dabeecada la fahmi karo ee mawduuca ay gacanta ku hayso ka qaybgalayaasha suurtogalka ah, qalab qiimeyn oo badan oo ay isticmaalaan cilmi-baarayaasha, iyo la'aanta fikradda ku saabsan waxa dhab ahaantii ka dhigan isticmaalka neefta ee filimada, kuwaas oo dhammaan arrimaha ay dib u eegaan warqaddan.

Daraasadda ugu badan ee ku saabsan POPU ama habdhaqanka habdhaqanka ayaa waxay isticmaalaan shaybaarka fududeynta si ay u cabbiraan, badanaa helitaanka, inkastoo farqiga farqiga, in dadka isticmaala aad u yar ay tixgeliyaan cibaadadan mukhaadaraad, iyo xataa marka ay sameeyaan, xitaa wax yar ka fiirso in tani ay noqon karto mid xun saameyn ku yeeshaan. Tusaalooyinka qaarkood:

(1) Daraasad lagu qiimeeyo mabaa'diida akhlaaqda ee isticmaalayaasha maandooriyeyaasha, waxay ogaatay in 9.80 kaliya% ka mid ah ka qaybgalayaasha 51 ay tixgeliyeen inay haystaan ​​cabsi galmo galmo ama fara-xurun [36].

(2) Daraasad iswiidhish ah oo kaqeybgashay ka qaybgalayaasha 1913 iyada oo loo marayo waraysiga websaydhka, 7.6% ayaa ka warbixiyay dhibaatooyinka galmada ee internetka iyo 4.5% muujiyeen dareemid 'la qabatimo' internetka jacayl iyo ujeedo galmo, taasina waxay ahayd 'dhibaato wayn' [17].

(3) Daraasad Isbaanish ah oo ka timid arday ka timid college College 1557 waxay ogaatay in 8.6% ay halis ugu jirtey in ay samayso isticmaalka qaabka loo isticmaalo daaweynta filimada internetka, hase yeeshee in dadka isticmaala cudurka neefta ee dhabta ahi ay ahaayeen 0.7% [37].

Daraasadda kaliya ee lala yeesho tijaabada wakiil ilaa taariikh waa Australian mid ah, oo leh muunad ka qaybgalayaasha 20,094; 1.2% dumarka la daraaseeyay ayaa loo tixgeliyey inay yihiin kuwa la qabatimay, halka ragga ay ahaayeen 4.4% [38]. Natiijooyinka la midka ah sidoo kale waxay ku khuseeyaan dabeecada ciriiriga ah ee ka baxsan suuqyada [39].
Waxyaabaha qarsoodiga ah ee habdhaqanka galmada iyo isticmaalka pornography ayaa ah, dadka oo dhan: ahaanshaha nin, da 'yaryar, diin, isticmaalka internetka oo badanaaba, xaaladaha niyadda xun, iyo ujeeda jilicsan,17,37,40,41]. Qaar ka mid ah arrimahan khatarta ah ayaa sidoo kale ay wadaagaan bukaanka dabeecadaha 'hypersexual behavior' [39,42].

3.2. Qodobada udubdhexaadka ah iyo Qalabka Cilmi-baarista ee Itoobiya

Fikradda habdhaqanaha dabeecadda ayaa weli ah caqabad maanta. Inkasta oo dhowr jeer isku dayey in la sameeyo habdhaqan aan caadi ahayn, haddana la'aanta xogta hufan ee hadda jirta ayaa sharxaysa xaqiiqda ah inaysan jirin wax isla ogolaansho ah oo ku saabsan arrintan [9]. POPU waxay ka kooban tahay dabeecado gaar ah oo ku saabsan dabeecadaha galmada ee ku lug leh tiknoolijiyada. Isticmaalka tiknoolojiga dhibaatada leh (gaar ahaan tiknoolajiyada internetka) oo dhowaan la soo dhaafay, waxaan u baahannahay inaan marka hore ka hadalno anshax xumada aan la xiriirin tiknoolajiyada si loo fahmo meesha lagu galo sawir-maskaxeedda internetka.
Jinsi ahaan sida dabeecadiisu tahay mid aad u qallafsan, iyo kooxdeeda wadnaha ee suurtogalka ah ayaa la soo bartay qarniyo [43]. Sidaa darteed, waxay u taagan tahay caqabadaha moodeelooyinka isku dayaya in ay si ku filan u qeexaan, maaddaama ay ku dari karto waxqabadyo kala duwan oo ka soo jeeda khayaaliga ujeeda rabshadaha galmada [21]. Waxa kale oo ay adagtahay in la qeexo waxa ka mid ah cillad dhabta ah oo laga maamulo si looga fogaado si xun u isticmaalka suurtogalka ah ee qeexidda si loo canaanto loona baadho shakhsiyaadka [44]. Tusaale ahaan, qaar ayaa xadiday xadka u dhaxeeya dabeecada galmada caadiga ah iyo wadnaha oo ka badan todoba orgaani toddobaadkii [43] (381), laakiin habkani diiradda saaraya tirada ayaa noqon kara mid khatar ah, sababtoo ah waxa ka tarjumaya dabeecadda caadiga ah iyo dabeecadda ayaa si weyn u kala duwanaan kara shakhsiyaadka. Tani waxay la'xaad la'aanta isku midnimada iyo joogteynta kala-soociddeeda waxay caqabad ku noqon kartaa cilmi-baarista mustaqbalka ee ku saabsan baaritaanka habdhaqanka habdhaqanka [45] oo iska indha tiri dhinacyada tayada ee diirada saaraya dareenka xun ee la xiriira [46,47]. Waxaa jira soo jeedin ah in la soo celiyo arrintan iyada oo la adeegsanayo qalabyo gaar ah, oo horey loo soo saaray iyada oo qayb ka ah soo jeedinta cilladda hypersexual loo isticmaalo maxkamadeynta DSM-5 field [43,47].
Dhiirigelinta guud guud ahaan waxay u dhaqmeysaa sida dallad dhisa [7]. Magacaabistiisa wali waa arrin dood ah ilaa maanta, waxana badanaa la kulma shuruudo dhowr ah oo tixraacaya fikrad la mid ah: dabeecad galmo qasab ah, galmada galmada, is-xakameynta jinsiga, dabeecada ciriiriga ah ama cilad maskaxeed. Qaar ka mid ah qorayaashu, iyagoo aqoonsanaya qiimaha ereyada "macaamiishu" iyo "qasab", waxay door bidaan inay fiiro gaar ah u yeeshaan arrimaha la xakameynayo iyo sida loola dhaqmi karo loona yareeyo mabda'a asaasiga ah ee ku saabsan dabeecadda, markaa iyaga oo tixraacaya " dhaqanka galmada "[45,48,49].
Inkasta oo qeexitaanadu aanay ahayn labis, waxay inta badan diirada saaraan inta jeer ama calaamadaha calaamadaha [46] oo ah mid kale oo caadi ah iyo riyooyin, taasi waxay keeni doontaa in wax laga qabto. Tani waxay ka duwan tahay habdhaqanka jinsi ahaaneed, inkastoo baahida loo qabo in si fiican loo caddeeyo kala duwanaanshada suurtogalka, isku midka ah, iyo isku dhejinta labada nooc ayaa weli ku sii jiraya [45].
Caadi ahaan waxaa ku jira dabeecadaha ciriiriga ah waa xajmiga xad-dhaafka ah iyo dabeecadaha kala duwan ee la xiriira galmada, sida ku-tiirsanaanta galmada qarsoodiga ah, ku-celinta jinsiga, internetka,43,44,49,50,51]. Bancroft waxay si gaar ah u aragtay, in isticmaalka internetka, labadaba jimicsiga iyo dhaqdhaqaaqyadan galmoodka ah ay isku kalsoonaan karaan, iyaga oo sheegaya in ragga ay "u isticmaalaan sidii ay u sii dheereeyn lahaayeen xayiraadooda si ay uga fogaadaan anshax xumada".
Inkastoo suurtogalnimada in la ogaado habdhaqanka ku salaysan caadada marwalba la heli karo "jirro jinsi ah oo aan lagu sheegin" DSM [1], Kafka [43] wuxuu isku dayay inuu soo jeediyo sidii xarun lagu ogaanayo DSM-5. Wuxuu soo bandhigay shuruudo aasaas u ah, iyada oo qayb ka ah cutubka jilicsanaanta jinsiga. Noocyada la soo jeediyey waxaa ka mid ah dabeecadaha qumman ee sida: (1) oo lagu dhiirigeliyo galmada, (2) oo ah daroogo anshaxeed, 3) qayb ka mid ah xanuunka 'obsessive-compulsive disorder', (4) qayb ka mid ah xanuunada niyadjabsan, iyo (5) xakamaynta "dabeecadda xad-dhaafka ah ee jinsiga. Soo jeedintaas ayaa ugu dambeyntii loo diiday sababo dhowr ah; ugu weyn waxaa la sheegay in maqnaanshaha xogta cudurrada faafa iyo jimicsiga ee la xidhiidha habdhaqankan [52,53], laakiin sidoo kale suurta galnimada suurtagalnimada xad-gudubka isdaba-marinta, shuruud la'aan qeexan oo lagu ogaanayo shuruudaha ogaanshaha, iyo siyaabaha siyaasadeed iyo bulsho ee suurtagalka ah ee ka hortagaya dabeecadda udub dhexaadka u ah nolosha aadanaha [54]. Waxaa xiiso leh in la isbarbardhigo labadii shuruudood oo kale ee horey loogu soo bandhigay suugaanta dib u eegista, kuwa Patrick Carnes iyo Aviel Goodman [9]. Saddexda oo dhan waxay wadaagaan fikradaha luminta xakamaynta, waqti xad dhaaf ah oo lagu qaato dabeecada galmada iyo cawaaqib xun oo u geysata naftooda / kuwa kale, laakiin waxay ka cararaan waxyaabaha kale. Tani waxay ka tarjumeysaa fara-gelinta ballaaran ee la'aanta fikradda ah in la fahmo habdhaqanka hab-dhaqanka ee sanadaha oo dhan. Waqtigaan, fursadaha ugu muhiimsan waxay soo jeedinayaan habdhaqan ku salaysan aragti ahaan sida kantaroolka xakameynta kicinta amaba anshax xumada [55].
Laga soo bilaabo aragtida xakamaynta kicinta impulsse, dabeecadaha ciriiriga badanaa waxaa loo yaqaan 'Behaviour Behaviour Behavior' (CSB). Coleman [56] waa mid caqli-gal ah ee aragtidaas. Inkasta oo uu ku jiro dabeecadda ficillada ee hoos timaadan ereygan [57], waxaana laga yaabaa inay la wadaagaan kiisaska qaarkood, wuxuu si cad u kala duwanyahay CSB-da nonparaphilic, taas oo ah waxa aan rabno inaan diirada saarno dib-u-eegista. Waxaa xiiso leh, anshax xumada aan caadiga ahayn sida badanaa, sida haddii aan ka badnayn, marka loo eego qaar ka mid ah "paraphilias" [43,58].
Hase yeeshee, qeexitaannada cusub ee CSB badanaa waxay tilmaamayaan dabeecado dhowr ah oo jinsi ah kuwaas oo noqon kara qasab: waa kuwa ugu badan ee la soo sheego inay yihiin xaasidnimo, oo ay raacaan isticmaalka qasabka ah ee fara-xuruufta, iyo jaahwareerka, socodka khasab, iyo xiriiro badan (22-76%) [9,59,60].
Inkasta oo ay jiraan isku xirnaanta dhabta ah ee u dhexeeya hypersexuality iyo shuruudaha sida xanuunka laba-cirifoodka (OCD) iyo cudurrada kale ee kantaroolka ah [61], waxaa sidoo kale jira farqi fara badan oo la tilmaamayo: tusaale ahaan, dabeecadaha OCD kuma lug lahaanayaan abaalmarinta, marka laga reebo dhaqanka galmada. Intaa waxaa dheer, inta lagu guda jiro xayiraadda qasabka waxay keeni kartaa in gargaarka ku meel gaadhka ah ee bukaanka OCD [62], dabeecadda sarreysa ayaa inta badan lala xiriiriyaa dembi iyo qoomameyn ka dib markii ay sameeyeen falka [63]. Sidoo kale, is-beddel la'aanta marxaladaha habdhaqanka bukaanku waa mid aan ku habboonayn qorshaha taxadarka ah ee mararka qaar laga rabo CSB (tusaale, marka la eego galmada) [64]. Goodman waxa uu aaminsan yahay in xanuunada maan-dooriyuhu ay ku dhexjiraan is-goysyada xanuunka compulsive (oo ay ku jirto dhimista welwelka) iyo xanuunada aan fiicnayn (taas oo ka mid ah jahawareerka), calaamadaha lagu yaqaano hababka neurobiological (serotoninergic, dopaminergic, noradrenergic, iyo opioid) [65]. Stein wuxuu ku raacsan yahay tusaaleyaal isku xira dhowr farsamooyin ethiopathogenic wuxuuna soo jeedinayaa habka ABC (Dysregulation, saameynta akhlaaqda, iyo fahamka dontcontrol) si loo baro buugan [61].
Marka laga eego aragtida habdhaqanka ah, dabeecadda ciriiriga ah waxay ku tiirsan tahay in la wadaago qaybaha muhiimka ah ee maandooriyaha. Qodobadan, sida laga soo xigtay DSM-5 [1], tixraac habka adeegsiga dhibaatada ee lagu soo rogay hab dhaqameedka habdhaqanka, labadaba offline iyo online [6,66,67]. Caddaynta dulqaadka iyo ka-bixitaanka bukaannadan waxaa laga yaabaa inay noqdaan furaha sifeynta suugaan ahaan sida xannibaad isdabajis ah [45]. Isticmaalka dhibaatada cybersex sidoo kale waxaa badanaa la fahmi karaa sida takoorka akhlaaqda [13,68].
Ereyga "maandooriye" oo codsanaya ciddaas ayaa weli ku xiran dood weyn. Zitzman wuxuu tixgelinayaa in caabbinta isticmaalka ereyada maandooriyeha "waa mid ka tarjumaya xorriyadda jinsiga iyo oggolaansho la'aanta marka loo eego waxkasta oo aan jirin calaamadaha calaamadaha muuqda iyo calaamadaha lagu ogaanayo noocyada kale ee maandooriyaha" [69]. Si kastaba ha ahaatee, ereyga waxaa loo baahan yahay in la isticmaalo taxaddar, madaama loo fasiri karo sabab cad u ah raadinta mas'uuliyad darrada ah ee raali-gelinta iyo raaxeysiga raaxaysiga ah, oo lagu eedeeyo cawaaqib xumada.
Waxaa jiray muddo dheer doodo u dhexeeya Patrick Carnes iyo Eli Coleman oo ku saabsan baaritaanno ku saabsan dabeecad xumo. Coleman waxay tixgelisay in ay tahay mid aan loo baahnayn in la yareeyo baahida loo qabo in la yareeyo nooca welwelka ah, ee aysan ahayn rabitaan galmo [56] iyagoo ku qeexay todoba subtypes (mid ka mid ah iyaga oo isticmaalaya sawir-gacmeedyada)57], Carnes (oo qeexday maadada 'sida xiriirka jireed ee leh dabeecadda isbedelka dareenka') waxay u egtahay jaantusyada kale ee daroogada akhlaaqda sida khamaarka, diiradda lumitaanka xakameynta iyo dabeecada sii socota in kasta oo ay jirto cillado xun [70].
Dib u eegis dhamaystiran suugaanta by Kraus [71], waxay ku soo gabagabeysay inkasta oo ay jirto tusaalooyinkan, isbeddellada weyn ee fahamka fekerka ayaa sii adkeynaya kala soociddooda sida maandooriye. Waxyaabaha ugu muhiimsani waxay ujeeddadoodu tahay sidii loo heli lahaa tiro xadidan oo ballaaran, tiro dheeraan iyo xog caafimaad (oo lagu qeexo calaamadaha waaweyn iyo xaddidaadaha cudurka), oo ay taageerto nöropsikological, neurobiological, iyo xogta hidda, iyo sidoo kale macluumaad ku saabsan baaritaanka daaweynta iyo ka hortagga, iyo ayaa tilmaamaya farsamada casriga ah ee habdhaqanka habdhaqanka sida barta muhiimka ah ee cilmi baarista mustaqbalka.
Kacsanaanta internetku waxay kordhisaa suurtagalnimada isdhexgalka galmada, iyo ma aha kaliya sawir-qaadashada filimada internetka (websaydhaafka, bogagga internetka ee jinsiga). Xitaa haddii isticmaalka internetku uu metelayo noocyada kale ee dabeecadaha soo noqnoqonaya (tusaale ahaan, habdhaqanka galmada ama khamaarka) ama ka dhigo mid ka duwan kan midigta ah ee iskiis u doodaya [72]. Si kastaba ha noqotee, haddii kiisku yahay mid hore, caddaynadii hore iyo tixgelinnada si aad ah ayaa loogu dabaqi karaa lidigeeda internetka.
Hadda waxaa jira baahi loo qabo waxyaaba xariif ah oo la isku halleyn karo kuwaas oo ku xisaabtamaya qodobo gaar ah oo udubdhexaadinaya internetka (ka horjeeda goobaha) dabeecadaha jinsiga, maadaama badankoodu aysan haysan qaab version oo la barbar dhigi karo [73]. Illaa iyo hadda, waxaa jiray hadalo ku saabsan dhacdo cusub marka la macaamilayo dhaqanka galmada internetka, sida joogitaanka khilaafka online-ka ah [74], taas oo sababaysa "maskax ahaan iyo dareen ahaanba ka dhexjiraan marka ay ku hawlan yihiin, wakhti wakhti go'an ah iyo isqorshiyeyn". Dib udhigaan ayaa hore loogu sharxay marka la eego hawlaha internetka ee kale [75], kaas oo taageera fikradda ah in isticmaalka dhibaatada internetka ee la xidhiidha isticmaalka internetka iyo galmada labadaba [76].
Ugu dambeyntii, waa in aan xusuusannaa in halbeeg lagu ogaanayo oo loo yaqaan "rabsho dabeecad oo galmo oo qasab ah" lagu daro daabacaadda rasmiga ah ee ICD-11, "qaybta xakamaynta kicinta"77]. Qeexidda waxaa lagala tashan karaa https://icd.who.int/dev11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f1630268048.
Kaqeybqaadashada qaybtan oo ku jirta ICD-11 waxaa laga yaabaa inay jawaab u tahay ku-tiirsanaanta arrintaan oo ay ku muujineyso adeegga bukaan-socodka, halka xogta sii kordheysa laakiin weli aan si aan fiicnaynba looga hortagayo in aan si habboon u qoondeyno sida maskaxda caafimaadka maskaxda [72]. Waxaa la aaminsan yahay in ay bixiso qalab ka fiican (weli habka hagaajinta) si looga hadlo baahida daaweynta bukaanka iyo daaweynta suurtagalka ah ee la xiriira [78], waxaana laga yaabaa inay ka tarjumeyso doodaha socda ee ku saabsan qaabeynta ugu haboon ee CSB iyo xaddidnaanta xaddidan ee macluumaadka meelaha qaarkood [55,71] (Shaxda 1). Ka mid noqoshadani waxay noqon kartaa tallaabada ugu horreysa ee lagu ogaanayo arintan iyo balaarinta, taas oo ah hal dhibic oo muhiim ah oo shaki la'aan ah.
Jadwalka 1. DSM-5 iyo ICD-11 waxay ku wajahan yihiin kala soocidda dabeecadaha lafdhabarashada.
Shaxda

3.3. Cilmi-baadhistu

Calaamadaha kiliiniga ee POPU waxaa lagu soo koobi karaa saddex qodob oo muhiim ah:

  • Kala-bax la'aan Erectile: halka daraasadaha qaarkood ay heleen caddayn yar oo ku saabsan xiriirka ka dhexeeya isticmaalka suuqyada isticmaalka iyo xakameynta galmada [33], kuwa kale waxay soo jeediyaan in kororka isticmaalka suuqyada ay noqon karto asaaska muhiimka ah ee sharaxaya kororka fiiqan ee ku yaraanta erectile ee dhalinyarada [80]. Mid ka mid ah daraasadda, 60 boqolkiiba bukaannada ka soo jeeda jinsiga oo la jilay lamaanaha dhabta ah, si khaas ah uma aysan helin dhibaatadan sino [8]. Qaar ayaa ku doodaya in sababta keentay isticmaalka suuqyada iyo fara-xumeeynta galmada ay adagtahay in la dhiso, maaddaama kontaroolada dhabta ah ee aan la ogaanin inay ka muuqdaan sawir-maskaxeed ay dhif u yihiin inay helaan [81] waxayna soo jeediyeen naqshad cilmi-baaris oo suurtagal ah oo arrinkan ku saabsan
  • Qanacsanaan la'aanta maskaxeed: isticmaalka pornography wuxuu la xiriiraa qanacsanaanta galmada iyo kufsiga jinsiga, labadaba lab iyo dhedigba [82], in aad uga sii daran tahay qofka jirkiisa ama lammaanaha, cadaadiska waxqabadka kordhay iyo jinsi aan yarayn [83], oo leh lammaane galmo oo dheeraad ah oo ku lug leh dhaqanka jinsiga lacag bixinta [34]. Saameyntan waxaa si gaar ah loogu qeexay cilaaqaadka marka uu yahay hal dhinac [84], oo si la mid ah u isticmaasha marijuana isticmaalaan, wadaagaan arrimaha muhiimka ah sida sarreeya [85]. Daraasadahaan waxay ku saleysan yihiin isticmaalka jimicsiga aan caadiga aheyn ee loo yaqaan 'pornography', laakiin sawir-gacmeedka 'pornography' ayaa laga yaabaa inaanay saameyn xun ku yeelan,24]. Tani waxay sharxi kartaa xidhiidhka ka dhexeeya isticmaalka suuq-galka dumarka iyo natiijooyinka wanaagsan ee haweenka [86].
  • Dhibbanayaasha: dabeecadda suuxdinta leh waxay la xiriirtaa xanuunka welwelka, oo ay ku xigto xanuunka niyadjabka, xanuunka isticmaalka mukhaadaraadka iyo kufsiga jilicsan [87]. Natiijooyinkani waxay sidoo kale khuseeyaan POPU [88], oo sidoo kale la xiriira sigaar cabidda, khamriga ama qaxwada, isticmaalka mukhaadaraadka [41] iyo isticmaalka qalabka casriga ah ee dhibaatada leh [89,90].
In aad haysatid qaar ka mid ah danaha qayaxan ee pornographic ayaa la xiriiriyay kororka dhibaatooyinka la soo sheegay [17]. Waxaa laga dooday haddii sifooyinka bukaan-socodka ay yihiin natiijada ka dhalan karta xadgudubka tooska ah ama maadooyinka dhab ahaantii u arkaan in ay yihiin dad [91].

3.4. Caddaynta Taageerida Maandooriyaha ee Taageerada Nuuryjiyada

Uruurinta caddaynta ku saabsan POPU waa geedi socod aad u adag; xogta muhiimka ah ee mawduucan ayaa weli xaddidan tirade yar ee tirooyinka yar yar, shaybaarka labka iyo dheddiga labka ah ee labka ah iyo naqshado dhinacyo kala duwan ah [71], oo aan ku filneyn daraasadaha neuroimaging iyo dareenka neurada [4], laga yaabo inay sabab u yihiin caqli-celinta, maaliyadda iyo caqabadaha. Intaa waxaa dheer, iyada oo walxaha mukhaadaraadka lagu daaweyn karo laguna moodeyn karo xayawaanka tijaabada ah, ma sameyn karno arintan musharaxnimada dabeecadda; Tani waxay xadayn kartaa daraasaddeenna ku aaddan cilmiga neurobiological [72]. Fursadaha hadda jira ee ku saabsan cilmi-baarista dabeecadaha cakiran, iyo sidoo kale hababka suurtagalka ah ee wax looga qabanayo, ayaa si khaas ah u daboolay oo lagu soo koobay maqaalkii Kraus [71]. Daraasadaha intooda badan ee laga helay cilmi-baaristeenu waxay kudhisan yihiin dabeecadaha qarsoodiga ah, oo ay ka muuqato sawir-gacmeedyada oo kaliya hal ka mid ah alaabta la xisaabiyay.
Caddeynta Tani waxay ku saleysan tahay faham sii kordhaya oo ku saabsan geedi socodka neerfaha ee isbeddelada neuroplasticity ee la xidhiidha walwalka. Heerarka Dopamine ayaa qayb muhiim ah ka qaata niyadjabka abaalmarintan galmada, sida horayba loo ogaaday waallida hore iyo daawada pro-dopaminergic ee cudurka Parkinson ee la xidhiidha dhaqanka galmada [92,93].
Nidaamka la qabatimay ee ka muuqda sawir-gacmeedka "pornography" waxaa laga yaabaa in lagu kordhiyo fariinta dardargelinta iyo "kicinta supranormal stimulus" (xilligaa oo ay ku xirantahay abaalmarinta Nobel Prize Nikolaas Tinbergen) taas oo ka dhigta suuq-galka internetka [94]. Xaaladdani waxay u malaynaysaa in ay sameeyaan dareemo macquul ah (kiiskan, pornography sida ugu badan ee loo isticmaalo maanta, foomka internetka) ayaa ka hor istaagay jawaab-celinta hidda-socodka. Ujeedadu waxay tahay in ay suurtagal tahay in ay dhaqaajiyaan nidaamkeenna abaalmarinta dabiiciga ah heerar ka sareeya waxa awoowayaashu sida caadiga ah la kulmaan maaddaama maskaxdayadu ay noqotey mid u horseeday in ay u bedesho hab hanjabaad ah [2]. Haddii aan ka fiirsano porno internett ka ah aragtidan, waxaan ku bilaabi karnaa isu-simanaanta dadka walxaha qaata ee caadiga ah.

Isbedelada maskaxda ee la arko ee ku saabsan walxaha daroogada ayaa aasaas u ah hawsha cilmi baarista mustaqbalka ee dabeecadaha la qabatimay [95], oo ay ku jiraan:

  • Dareemis [96]
  • Maqnaanshaha [97]
  • Xuduudaha horay loo yaqaan 'hypofrontality' [98]
  • Nidaamka cadaadiska ee aan fiicnayn [99]
Maskaxdan ayaa isbeddel lagu arkay bukaanku waxa ay la xidhiidhaan bukaanada leh habdhaqan la xidhiidha habdhaqanka ama pornography oo ku saabsan qiyaastii 40 daraasadaha noocyada kala duwan: sawirista magnetka, sawirka elektroensefalography (EEG), neuroendocrine, iyo neuropsychological.
Tusaale ahaan, waxaa jira faraqyo cad oo maskaxeed oo u dhexeeya bukaanno leh habdhaqan galmo qasab ah iyo xakameyn, taas oo muraayad u ah dadka daroogada ah. Marka la soo bandhigo sawirrada galmada, maadooyinka 'hypersexual' waxay muujiyeen kala duwanaansho u dhexeeya likaan (marka loo eego kantaroolka) iyo rabitaanka (rabitaanka galmada), taas oo ka weyn [8,100]. Si kale haddii loo dhigo, maadooyinkan waxaa jira rabitaan dheeraad ah oo kaliya cyo-jinsi gaar ah, laakiin aan ahayn baahida jinsiga ah. Tani waxay ina tusaysaa in cuna qabatinka lafteeda ay markaa loo arko abaalmarin [46].
Caddeynta waxqabadka caannaanta ee muujinaya rabitaanku waxay si gaar ah ugu muuqdaan koontooyinka hore ee [101] iyo amygdala [102,103], inaad noqoto caddayn dareen ah. Dhaqdhaqaaqyada gobollada maskaxda ah waa xusuusin abaalmarin dhaqaale [104] waxaana laga yaabaa inay qaaddo saameyn la mid ah. Waxaa intaa dheer, waxaa jira akhristayaasha sare ee EEG ee ka mid ah dadka isticmaala, iyo sidoo kale dardar-galinta jinsiga leh lamaane, laakiin ma ahan in la naqdiyo si ay u noqoto sino [105], wax ka tarjumaya farqiga tayada qalabka [8]. Tani waxaa loo tixgelin karaa calaamad muujinaysa in aan loo baahneyn. Si kastaba ha ahaatee, daraasadda Steele waxay ka kooban tahay dhowr farsamo oo qallafsan (tixgelin mawduuc ah, baaritaan la'aanta cudurrada maskaxda ama xayiraadaha, maqnaanshaha kooxda xakamaynta, iyo isticmaalka waraaqaha aan loo ansixin isticmaalka sigaarka) [106]. Daraasad ay soo saartay Prause [107], waqtigan la joogo kooxda xakamaynta, waxay ku celiyeen waxyaalahan soo-baxa. Doorka dabiiciga ah ee wax ka qabashada iyo ku qanacsanaanta horumarinta isticmaalka cybersex maandooriyaha ayaa lagu caddeeyey haweeneyda heterosexual [108] iyo shaybaarka qaniisiinta [109].
Falanqaynta arrimahaani waxay u badan tahay in qofku uqaabilsan yahay [110], laakiin soo noqoshada soo noqnoqoshadu waxay muujinaysaa in si qalad ah loo [111,112]. Tani macnaheedu waa hoos u dhigidda nidaamyada abaal-marinta, oo laga yaabo inay dhexdhexaadiso qoryaha waaweyn ee [107,113,114]. Maadaama miisaanka qoorta ah ee ku lug leh uu ku lug leeyahay abaal-marinta iyo ka-jawaabidda dhacdooyinka cusub, hoos u dhac ku yimaada waxqabadka ka dib markii soo noqnoqodka soo noqnoqdayna wuxuu ina tusayaa horumarinta hab-nololeedkii hore. Tani waxay keenaysaa doorbid aan fiicnayn oo la xoojiyay oo loo cusbooneysiiyo jinsiga [115], taas oo muujin karta isku daygeeda inay ka gudubto habdhaqanka iyo udeedid la'aanta iyada oo loo marayo raadinta pornography oo dheeraad ah (cusub) oo ah habka ku qanacsanaanta jinsiga, doorashada habdhaqanka halkii jinsi ahaaneed [20].
Iskudeylkan cusub ee raadinta ra'yiga waxa laga yaabaa in lagu dhexdhexaadiyo iyada oo loo marayo fal-celinta jirka ee foosha [116] iyo amygdala [117]. Waxaa la ogyahay in aragtida sawir-gacmeedka dadka badanaa ay sidoo kale la xiriirto dhaqdhaqaaqa neerfaha [99], gaar ahaan marka laga hadlayo qanjidhka [116,118] taas oo kaalin weyn ka ciyaareysa abaalmarinta abaalmarinta [119].
Si kastaba ha noqotee, isku-xirnaanta udhexeeya calaamadeynta ventral-ka iyo kiliyaha prefrontal ayaa hoos u dhacay [103,113]; hoos u dhac ku yimaada isku xirnaanta kortex doorbid iyo amygdala ayaa sidoo kale lagu arkay [117]. Waxaa intaa dheer, maaddooyinka 'hypersexual' ayaa muujiyay in ay hoos udhigeen xiriirka shaqo ee u dhexeeya caleate iyo xarigaha kortexyada, iyo sidoo kale miisaanka maqaarka ee meelahaas [120]. Dhamaan isbeddelladani waxay sharxi karaan awood la'aanta lagu xakameyn lahaa dabeecadaha galmada.
Intaa waxaa dheer, maaddooyinka 'hypersexual' waxay muujiyeen koror mug leh amygdala [117], marka loo eego kuwa qaba daba dheeraaday walax, taas oo muujinaysa mugga hoos u dhaca amygdala [121]; Farqigaas waxaa lagu sharxi karaa saameynta neurotoxic ee macquulka ah. Maaddooyinka 'hypersexual', hawlaha kordhaya iyo miisaanku waxay ka tarjumi karaan waxyaabo badan oo la xidhiidha daroogada maandooriyaha (gaar ahaan taageerida fikradaha dhiirigelinta dhiirigelinta) ama inay noqdaan natiijooyinka hababka cadaadiska bulsheed ee daba dheeraatay, sida habdhaqanka akhlaaqda [122].
Isticmaalayaashaasi waxay sidoo kale muujiyeen jawaab-celin aan fiicneyn oo culeys badan, oo badiba dhexdhexaadiyay iyada oo loo marayo axmed hypothalamus-pituitary-adrenal [122] si ay u eegaan kuwa isbeddelka lagu arko walxaha daroogada. Isbedeladani waxay noqon karaan natiijada isbeddelada epigenetic ee dhexdhexaadiyeyaasha barbar-dhigga ee caadiga ah ee wata mukhadaraadka, sida corticotropin-release factor factor (CRF) [123]. Qodobadan tilmaamaya ficil-celinta ficil-celinta (epigenetic hypothesis) waxay tixgeliyaan natiijooyinka dhaqameedka iyo anhedonic labadaba ugu yaraan qayb ahaan ay saameeyeen hidaha dopaminergic, iyo suuragal ahaanta kale oo ah musharax hiddesid ku salaysan neurotransmitter-ku xiran polymorphisms [124]. Waxaa sidoo kale jira caddaynta astaamaha necrosis (TNF) ee ka badan kuwa adduunka galmada ah, oo leh xiriir xoog leh oo u dhaxeeya heerarka TNF iyo dhibcaha sare ee cabbirka qiyaasta hypersexuality [125].

3.5. Caddeynta Naasnuujinta

Marka la eego muuqaallada isbeddellada ku dhaca habdhaqanka galmada, baaritaannada badankooda cilmi baarista waxay muujinayaan nooc ka mid ah natiijooyinka tooska ah ama tooska ah ee shaqada fulinta [126,127], waxaa suurtogal ah in ay sabab u tahay kortex celin jireed horay [128]. Marka lagu dabaqo sawir-gacmeedka "pornography online", waxay kudartaa horumarinta iyo dayactirka [129,130].
Waxyaabaha ka soo baxa howlahan fulinta saboolka ah waxaa ka mid ah:131,132], garashada garashada oo xannibaysa geeddi-socodka barashada ama awoodda loo leeyahay in loo jeedo fiiro [120,133,134], caddaalad darro iyo go'aan sameynta [130,135], faragelinta awoodda xasuusta shaqada [130], cilladaha ku jira shuruucda dareenka, iyo ka feejignaanta xad-dhaafka ah ee galmada [136]. Natiijooyinkani waa kuwo xusuusinaya waxyaabaha kale ee daroogada akhlaaqda (sida khamaarka wadnaha) iyo habdhaqanka ku-xirnaanta walaxaha [137]. Daraasadaha qaarkood waxay si toos ah uga horimaanayaan natiijooyinkan [58], laakiin waxaa jiri kara qaar ka mid ah xaddidaadaha habka loo yaqaan 'methodology' (tusaale, cabbir yar oo yar).
Marka la eego arrimaha keena doorka horumarinta dabeecadaha cakiran iyo cybersex, waxaa jira tiro ka mid ah. Waxaan ka fekeri karnaa dabeecada-jawaab celinta, xoojinta wanaagsan iyo barashada isku-dhafan [104,109,136,138,139] sida farsamooyinka asaasiga ah ee horumarinta maandooriyaha. Si kastaba ha noqotee, waxaa jiri kara arrimo ku saabsan astaamaha asaasiga ah [140], sida: (1) doorka jimicsiga jinsiga ah iyo kicinta aan caadiga ahayn ee shakhsiyaadka qadarin leh [40,141,142,143] haddii ay tahay natiijo ka dhalan karta dabacsanaanta [144,145] ama dawlad la'aan ah [146], iyo habka (2) ee hababka / ka-hortagga [147,148,149].

3.6. Saadaasha

Daraasadaha intooda badani waxay tilmaamaan maadooyinka isticmaalka leh ee mudada dheer ku jira sawir-gacmeedka [34,81,113,114], sidaa daraadeed muuqaalkeeda kiliinikada ayaa u muuqda inuu yahay natiijo toos ah oo saamigal ah oo ku lug leh ku dhaqanka habdhaqan la'aanta. Waxaannu ku adkeynay in aanu helno kantaroolyo si aan u dhigno sabab, laakiin warbixinnada qaarkood waxay soo jeedinayaan in yareynta ama ka tagidda dabeecadani waxay horseedi kartaa horumarinta fara-xumeynta-oo sabab u ah cillad galmo iyo cillad maskax ahaaneed [79,80] iyo xataa soo kabashada buuxda; Tani waxay muujinaysaa in isbeddeladii hore ee maskaxda lagu xusay ay yihiin qaar wax laga beddeli karo.

3.7. Qalabka Qiimaynta

Qaar ka mid ah qalabka wax lagu baaro ayaa jira oo wax looga qabanayo CSB iyo POPU. Dhammaantood waxay ku tiirsan yihiin daacadnimada iyo daacadnimada jawaab bixiyaha; laga yaabee in ka badan marka la eego baaritaannada baaritaanka dhimirka ee joogtada ah, maaddaama jimicsiga galmada ay yihiin kuwa ugu jilicsan sababtoo ah dabeecadooda gaarka ah.
Marka la eego hypersexityity, waxaa jira wareysiyo baaritaan ah 20 iyo wareysiyada daaweynta. Qaar ka mid ah kuwa ugu muhiimsan waxaa ka mid ah Imtixaanka Baaritaanka Galmada ee Ku-takoorka (SAST) ee ay soo jeedisay Carnes [150], iyo dib-u-cusbooneysiinta dambe ee SAST-R [151], Astaanta Habdhaqanka Isku-xirka Isku Galmoodka (CSBI) [152,153] iyo Hoos-u-Eegista Sawirka Ba'an ee Hoos-u-Dhaca (HDSI) [154]. HDSI waxaa markii hore loo isticmaalay baaritaanka kiliinikada ee soo jeedinta dalabka DSM-5 oo ah xanuunka hypersexual. Inkastoo baaritaanno dheeraad ah oo ku saabsan saameynta xoogga leh ee ku saabsan shuruudaha iyo dib u soo celinta dhibcaha dhimista ayaa loo baahan yahay, hadda waxay haysataa taakulaynta ugu xoogan ee cilmi nafsiga ah waana qalabkii ugu fiicnaa ee lagu cabbiro qiyaasta xanuunka 'hypersexual disorder [151].
Sida pornography online, qalabka ugu badan ee loo isticmaalo waa baadhitaanka Internetka ee Sexual Screening (ISST) [155]. Waxay qiimeysaa shan dabeecadood oo kala duwan (isdhaafsiga galmada ee internetka, dabeecada galmada internetka-bulshada, dabeecada galmada ee internetka, kharashka galmada ee internetka iyo xiisaha dhaqanka galmada internetka) iyada oo loo marayo su'aalo ku saabsan 25 dichotomic (haa / maya). Si kastaba ha noqotee, alaabtarkeeda cilmi-nafsiyeedka waxaa laga helaa oo kaliya falanqayn lagu sameeyey, iyada oo la adeegsanayo ansaxin badan oo Spanish ah [156] kaas oo u adeegay sidii qorshe loogu talagalay waxbarashada hore [157].
Qalabka kale ee la ogaan karo waa miisaanka isticmaalka maskaxda ee dhibaatada leh (PPUS) [158] oo cabbiraya afar dhinac oo POPU ah (oo ay ka mid yihiin: dhibaatooyinka iyo dhibaatooyinka shaqada, isticmaalka xad-dhaafka ah, xakamaynta dhibaatooyinka iyo isticmaalka ka-baxsiga / ka-hortagga dareen-celinta xun), tijaabada yareynta bogga gaaban ee internetka loogu talagalay hawlaha galmada ee internetka (s-IAT-sex) [159], su'aal 12-wax lagu qiyaaso laba cabbirood oo ah POPU, iyo isticmaalka sawir-qaadashada sawir-qaadiga (CPUI-9) [160].
CPUI-9 waxay qiimaysaa saddexda cabbirood: (1) dadaalka helitaanka, (2) oo loo arko isku-qasidda, iyo (3) niyad xumo. Markii ugu horeysay ee loo tixgeliyo in ay leeyihiin hantiilayaal qancin ah [9], qodobadani waxay dhawaanahan caddeeyeen inaanay noqon mid aan la isku hallayn karin: ku darista "dareenka niyad-jabka" ee cabiraadda heerarka caddaaladda iyo gafka, oo aan ka tirsanayn qiimeynta mukhaadaraadka oo sidaas daraadeed kor uqaaday dhibcaha [161]. Codsashada liistada iyada oo aan loo eegin cabbirkan waxay u muuqataa in ay si sax ah u muujinayso ilaa xad sida isticmaalka filimada jilicsan.
Mid ka mid ah kuwa ugu dambeeyay ayaa ah qiyaasta isticmaalka dhibaatada maskaxda (PPCS) [162], oo ku saleysan qaabka loo yaqaan 'Griffith model model'163], inkasta oo aysan cabirin maandooriyaha, kaliya isticmaalka dhibaatada pornography oo leh guryaha nafsaaniga ah.
Qiyaaso kale oo POPU ah oo aan loogu talagelin in lagu cabbiro isticmaalka filimada sawir-qaadka ee internetka laakiin la ansaxiyey iyadoo la adeegsanayo isticmaalayaasha qaawan ee internetka ee [9], ku dar Tusmada Lacagta Cunugaaga (PCI) [164,165], Miisaaniyadda Isticmaalka Qodobada Dumarka (Compulsive Score) (CPCS) [166] iyo Su'aalaha Waalidiinta ee Xayeysiinta ah (PCQ) [167] kaas oo qiimeyn kara kiciyeyaasha macquulka ah ee ka mid ah noocyada kala duwan ee isticmaalka suuqyada.
Waxaa sidoo kale jira qalab lagu qiimeeyo dadka isticmaala filimada 'diyaargarowga si looga tago dhaqanka iyada oo loo marayo istiraatiijiyad isdaba-joog ah [168] iyo qiimeynta natiijada daaweynta ee sidaasi sameyneysa [169], oo qeexaya gaar ahaan saddexda suurtogalnimada soo noqoshada suurtagalnimada: (a) jinsiga / jilicsanaanta / fursada galmada, (b) miyirka / goobaha / sahlanaanta fudud, iyo (c) dareenka xun.

3.8. Daaweynta

Marka la eego in su'aalo badani ay weli ku saabsanyihiin fikradda, qiimeynta, iyo sababaha dabeecadaha cakiran iyo POPU, waxaa jiray isku day yar oo isku dayey in lagu baaro ikhtiyaarka daaweynta suurtogalka ah. Daraasadaha daabacan, qiyaasta tirada ayaa caadi ahaan yar yahiin, sidoo kale qoyskooda, koontaroolka kiliinikada ah ayaa ka maqan, iyo hababka cilmi baarisku u kala firdhisan yihiin, aan la isku hallayn karin, oo aan dib loo noqon karin [170].
Caadi ahaan, isku daridda cilmi-nafsiga, cilmi-nafsiga, cilmi-nafsiga, iyo hababka dawooyinka fayodhowrka waxaa loo tixgeliyaa sida ugu wax-u-qabashada daaweynta galmada, laakiin habkan aan gaar aheyn wuxuu ka tarjumayaa la'aanta aqoonta mawduuca [9].

3.8.1. Hababka Faragelinta

Daraasaduhu waxay ku salaysan yihiin paroxetine iyo naltrexone ilaa hadda. Hal taxane kiis oo ku lug leh paroxetine on POPU waxay gacan ka geysatay hoos u dhigidda heerarka welwelka, laakiin ugu dambeyntii ku fashilmay in ay dabeecad ahaan u yareeyso [171]. Intaa waxaa dheer, isticmaalka SSRIs si ay u abuuraan xinjir jinsi ah iyada oo la adeegsanayo saameyntooda dhinaca daaweyntu maaha kuwo waxtar leh, iyo marka la eego waayo-aragnimada bukaan-socodka ayaa faa'iido leh oo keliya bukaanka qaba cudurrada maskaxda dhimirka [172].
Afar warbixinno oo kiis oo la xidhiidha naltrexone si loogu daaweeyo POPU ayaa lagu sharaxay. Natiijooyinka hore waxay soo jeediyeen in naltrexone ay noqon karto daweyn suurtogal ah oo ah daaweynta habdhaqanka iyo xanuunka 'hypersexual disorder' [173,174], asal ahaan waxay yareyneysaa jahawareerka iyo dhiirigelinta adoo joojiya dabaaldega la xiriira dabeecadda. Inkastoo aysan weli jirin tijaabo kontoroolka la xakameeyey oo leh naltrexone maadooyinkan, waxaa jira afar warbixino oo kiis. Natiijooyinka laga helay yaraynta isticmaalka suuqyada ayaa ka duwan kala duwanaanta [175,176,177] si dhexdhexaad ah [178]; ugu yaraan mid ka mid ah bukaanka ayaa sidoo kale helay sertraline, sidaa daraadeed lama caddeeyn karo intee le'eg ayaa loo saari karaa naltrexone [176].

3.8.2. Muujinta maskaxda

Shaki la'aan, teraabiyada cilminafsiga waxay noqon kartaa qalab muhiim ah oo si buuxda u fahma oo loo bedelo dabeecadda. Inkastoo daaweynta dabeecadda garashada-cilaaqaadka (CBT) ay tixgeliso dhakhaatiir badani inay faa'iido u leeyihiin daaweynta xanuunka 'hypersexual disorder' [179], daraasad ay ku lug leeyihiin dadka isticmaala filimada internetka ee dhibaatada leh ayaa ku fashilmay in ay gaaraan hoos u dhaca dhaqanka [180], xitaa haddii darnaanta calaamadaha niyadjabsan iyo tayada guud ee nolosha. Tani waxay keenaysaa fikradda dulsaar ee ah in yareynta isticmaalka qaylada filimka ah inaysan metelin ujeeddada daaweynta ugu muhiimsan [170]. Hababka kale ee la adeegsan karo CBT si loo daaweeyo POPU ayaa la sameeyey, laakiin dib-u-eegista dhibaatooyinka mihnadeed ee aaggan ayaa naga horjoogsanaya soo-saarka gabagabada saxda ah [181,182].
Daweynta maskaxda ee cilmi-nafsiga iyo kuwa kale sida daaweynta qoyska, daaweynta lamaanaha iyo daaweynta nafsaaniga ah ee la qaabeeyey ka dib markii barnaamijyada tallaabada 12 ay muhiim u yihiin marka la xalinayo mawduucyada ceebta iyo dambiga iyo dib u soo celinta kalsoonida ee xiriirrada ugu dhow ee dadka isticmaala [170,172]. Maxkamad la kantaroolay oo kaliya oo la xaddiday oo la socota dadka isticmaala filimada internetka ee dhibta ah ayaa diiradda saara aqbalaadda iyo Daaweynta Ballanqaadka (ACT) [183], oo ka soo raynaya taxane kiis 2010 [184], taas oo ahayd daraasadda tijaabada ugu horeysay ee si gaar ah wax looga qabto POPU. Daraasadu waxay muujisay natiijooyin wax ku ool ah, laakiin way adag tahay in la barbaariyo maadama miisaanku uu aad u yaryahay oo diiradda lagu saarayo dad gaar ah.
Guuleysiga la soo sheegey ee CBT, daaweynta isku dhafan iyo ACT ayaa ku tiirsan xaqiiqda ku saleysan maskaxda iyo qaabka aqbalaadda; Iyadoo ay ku xiran tahay macnaha, sii kordhinta qaylada sawir qaadashada waxay u egtahay mid isku mid ah ama ka muhiimsan yareynta isticmaalka [170].

4. Wadahadal

Waxay u muuqataa in POPU aysan ahayn kaliya hal nooc oo ah xanuunka 'hypersexual disorder', hase yeeshee imminka waa kan ugu ba'an sababtoo ah waxay sidoo kale inta badan ku lug leedahay masturbayada. In kasta oo tani ay adagtahay in si sax ah loo go'aamiyo iyada oo la tixgelinayo aqoonsiyada aan la aqoonsan iyo waxyaabaha la heli karo ee keena filimada sawir-qaadashada maanta, haddana waxaan u-xaqiijin karnaa in kor-u-qaadista isticmaalka pornography ay isbeddeshay qiyaastii tobankii sano ee la soo dhaafay. Ma aha wax caqli-gal ah in laga yaabo inay qaataan noocyada kala-duwan ee internetka ay saameyn weyn ku yeesheen macaamiisheeda, iyo in seddexaad Cilmi-baarisyo ay kor u qaadaan khatarta iman karta POPU iyo dabeecadaha kale ee galmada.
Sida aan ku soo sheegney, qarsoodiintu waa qodob halis ah oo ku saabsan dabeecaddaan galmada si ay u abuuraan dhibaato. Waxaan u baahannahay in aan maskaxda ku hayno in tirakoobka ku saabsan dhibaatadani ay si cad u xadidan tahay dadka da'da sharciga ah si loo galo dhaqdhaqaaqa galmada, online ama haddii kale; laakiin ma naga cararayso in dhaqdhaqaaqyada galmada ay marar dhif ah bilowdaan ka dib markaan bilawdo, waxaana jira fursado ay dadka da 'yar oo weli ku jira geedi socodka habdhaqanka galmada ay yihiin dad si gaar ah u nugul. Xaqiiqadu waxay tahay in isku raacsanaan xooggan oo ku saabsan waxa dabeecadda jinsiga ah ee asaasiga ah, labadaba offline iyo online, waxay lagama maarmaan tahay in si ku filan loo cabbiro habka wakiilka oo loo xaqiijiyo inta ay dhibaatadu ka jirto bulshada maanta.
Ilaa hadda sida aynu ognahay, tiro cilmi-baarisyo ah ayaa taageeraya shirkadan iyada oo ahmiyad la leh calaamadaha kiliinikada ee muhimka ah sida cillad jinsi ah iyo qanacsanaan la'aanta nafsaaniga ah. Inta badan shaqooyinka hadda jira waxay ku salaysan yihiin cilmibaaris la mid ah oo lagu sameeyay maaddada walxaha daroogada, oo ku saleysan aragtida sawir-gacmeedka 'pornography' oo ah 'kicin macquul ah' oo ku xiran maaddada dhabta ah, iyada oo la isticmaalayo isticmaalka joogtada ah, waxay keeni kartaa jirro khaldan. Si kastaba ha noqotee, fikradaha sida dulqaadka iyo ka-go'naanta aan weli si cad u qotonin inay ku haboon yihiin calaamadeynta mukhaadaraadka, taasina waxay ka dhigan tahay qayb muhiim ah oo ka mid ah cilmi-baarista mustaqbalka. Xilligan, hay'ad ciladeysan oo ka koobnayd dabeecadda jinsiga ayaa lagu darey ICD-11 sababtoo ah tayada daaweynta ee hadda jirta, waana hubaal in ay isticmaali doonaan si wax looga qabto bukaannada qaba calaamadaha kuwaas oo weydiiso dhakhaatiirta caawimaadda.
Qalab kala duwan oo qiimeyn ah ayaa jira si loo caawiyo dhakhtarka caadiga ah ee leh hababka cudurka dabiiciga ah, laakiin soocaya waxa dhabta ah ee neefta oo aan habooneyn ayaa weli ah dhibaato socda. Ilaa hadda, qayb muhiim ah oo ka mid ah saddexda shuruudood ee ay soo jeediyeen Carnes, Goodman, iyo Kafka waxaa ka mid ah fikradaha muhiimka ah ee luminta xakameynta, waqti xad dhaaf ah oo lagu qaato dabeecada galmada iyo cawaaqib xun ee naftooda iyo kuwa kale. Qaar ka mid ah qaababka ama kuwa kaleba, waxay sidoo kale ku jiraan inta badan baaritaanka qalabka dib loo eegay.
Waxay noqon karaan qaab ku filan oo lagu dhiso. Qodobo kale, oo loo tixgeliyo heerar kala duwan oo muhiim ah, waxay u maleynayaan inay naga dhigayaan inaan tixgelinno shakhsiyaadka shakhsi ahaaneed. Qalabaynta qalabka qiimeynta oo haya heerarka qaar ka mid ah dabacsanaanta iyada oo ay sidoo kale muhiim u tahay go'aaminta waxa dhibaatada ah waa hubaal kale oo ka mid ah caqabadaha hadda jira ee aan la kulanno, waxaana suura gal ah in aan gacanta ku galno cilmi baaris dheeri oo dheeri ah oo naga caawiya inaan si fiican u fahanno marka cabbir gaar ah nolol caadi ah oo bani'aadam ah ayaa ka beddelan dhaqanka caadiga ah ee cudurka.
Sida xeeladaha daaweynta, hadafka ugu weyn ee hada la joogo wuxuu diiradda saarayaa yareynista isticmaalka sawir-gacmeedka 'pornography' ama uu ka tago guud ahaan, maadaama muraayada bukaan-eegtada u muuqato inay noqoto mid laaban. Habka lagu gaari karo arrintaani way u kala duwan tahay bukaanka waxaana laga yaabaa inay ubaahan tahay dabacsanaan shakhsi ah oo istiraatiijiyadeed oo la adeegsanayo, iyada oo maskaxda iyo daaweynta cilmi-nafsiga ee ku salaysan aqbalaadda si isku mid ah ama ka muhiimsan habka daaweynta fayo-dhowrka xaaladaha qaarkood.

Maalgelinta

Daraasadani ma aysan helin maaliyad dibadeed.

Khilaafaadka Danta

Rubén de Alarcón, Javier I. de la Iglesia, iyo Nerea M. Casado oo aan sheegin wax khilaaf ah. AL Montejo waxay heshay khidmado la talin ama shahaadooyin sharafeed / shahaadooyin cilmi baaris shantii sano ee ugu dambeysey ee Boehringer Ingelheim, Pharmaceuticals, Rovi, Servier, Lundbeck, Otsuka, Janssen Cilag, Pfizer, Roche, Instituto de Salud Carlos III, iyo Junta de Castilla y León .

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