Khatello ea kelello le ho itšunya-tšunya ha litšoantšo tsa bootsoa ka inthanete
Dan J. Stein, MD, Ph.D.,Donald W. Ntsho, MD,Nathan A. Shapira, MD, Ph.D., leRobert L. Spitzer, MD
E phatlalalitsoe marang-rang: 1 Oct 2001 https://doi.org/10.1176/appi.ajp.158.10.1590
Ho sireletsa ho se tsejoe ka mokuli, nyeoe e hlahisitsoeng mona e kenyelletsa likarolo tsa bakuli ba babeli ba arohaneng, 'me liphetoho tse ling tsa lintlha li entsoe ho pata lebitso.
Tlhahiso ea pale
Mong A e ne e le monna ea lilemo li 42 ea nyetseng, setsebi sa thuto ea sechaba, ea ileng a bonoa a e-na le tletlebo e ka sehloohong ea ho tepella maikutlo ho sa feleng, leha a ntse a phekoloa khafetsa le moemeli oa khatello ea maikutlo. O bontšitse hore leha kalafo e nang le fluoxetine, 20 mg / ka letsatsi, e ne e atlehile ho phekola khatello e kholo ea maikutlo nakong e fetileng, likhoeling tsa morao tjena, ha e bapisoa le khatello e ncha ea bophelo ba hae, maikutlo a hae a tepelletseng a khutlile. Sena se ne se tsamaisana le ho teneha, koatsi, ho fokotseha ho tsepamisa mohopolo, le liphetoho boroko le takatso ea lijo.
Ha a ntse a phenyekolla hape, Mong A o boetse a senola hore nakong ena o ne a eketsa ts'ebeliso ea Marang-rang, a qeta lihora tse 'maloa ka letsatsi a batla litšoantšo tse litšila tse tsosang takatso ea boitšoaro bo bobe. O hlalositse ka ho hlaka khatello ea maikutlo mabapi le tahlehelo ea taolo eo a e behileng ho eena mme a ba a hlokomela hore o sebelisa chelete e ngata ho latedisa Inthanete ho feta kamoo a ka khonang. Boitšoaro ba hae bo ne bo boetse bo bakile ho fokotseha ho hlahisang tlhahiso ea lipatlisiso, empa o ne a tumme e le mosuoe ea hloahloa, 'me ho ne ho se na kotsi ea ho lahleheloa ke mosebetsi. O ne a ikutloa hore kamano ea hae ea lenyalo e ne e sa senyehe, leha a ne a ipholla litho tsa botšehali mots'eare hangata a ne a sa khone ho etsa li-orgasm haeba eena le mosali oa hae ba ne ba etsa thobalano bosiung boo.
Nalane ena hang-hang e hlahisa mathata a 'maloa a fapaneng. Ho ea ka pono e makatsang, "ts'ebeliso e mpe" ea inthanete haufinyane e hlalositsoe ka har'a lingoliloeng tsa mafu a kelello (1, 2). Le ha hona e le mokhahlelo o mocha oa psychopathology, ts'ebeliso ea methapo ea lisebelisoa tse litšila tse tsosang takatso hammoho le ho ipholla litho tsa botona kapa botšehali ke khale li hlalositsoe. (3, 4). Nalane ea mokuli hang-hang e phahamisa lipotso mabapi le kamano ea tšebeliso ea hae e feteletseng ea inthanete bakeng sa ho shebella litšoantšo tsa bootsoa le ho khutla ha maikutlo a sithabetsang. Ka mokhoa o ts'oanang, ho na le potso ea hore na ho nepahetse joang ho tseba hore na mokhachane ea nang le bothata ba thobalano o na le bothata bofe.
Ho latela pono ea bongaka, ho na le lingoliloeng tse nyane empa e le tsa bohlokoa ka ho khutlisetsoa ha matšoao a sithabetsang ho bakuli ba arabileng ka katleho ho antidepressant le ba tsoetseng pele ho lumellana le kalafo ea tlhokomelo. (5). Mabaka a ketsahalo ena ha a utloisisoe hantle, empa monyetla oa hore keketseho ea khatello ea maikutlo o bapala karolo o na le bopaki bo hlakileng ba sefahleho. Tsamaiso e nepahetseng ea bakuli ba joalo le eona ha e e-so ithutoe hantle, leha keketseho ea tekanyetso ea meriana e na le tšehetso e itseng e matla (5).
Leha tlhahlobo e nepahetseng le taolo ea mokuli enoa e kanna ea ba e sa hlaka hanghang, ho bonahala ho na le tlhoko e hlakileng ea ho kena lipakeng. Ts'ebeliso e ngata ea inthanete mosebetsing ka mabaka a amanang le mosebetsi e ne e se, ka mokhoa o makatsang, e amanang le tlhahiso e fokotsehileng. Mokuli o ne a ka ba kotsing ea ho qosoa ka molao ke mohiri oa hae haeba liketso tsa hae li ka be li hlakile. Matšoenyeho ao a bileng le 'ona a bile lehlohonolo ka litsela tse ling, kaha ho ne ho bonahala eka a tlatselitse qeto ea hae ea ho batla kalafo.
Ha a botsa hape, Mong A o bontšitse hore lekhetlo la pele a ba le ketsahalo ea khatello ea maikutlo e hlokang ho phekoloa le antidepressant e etsahetse ha e le moithuti oa koleche ea lilemo li 18, maemong a karohano ea moithuti kamano. Ho bile le liketsahalo tse latelang tsa khatello ea maikutlo, mme o ne a qetile lilemo tse 3 a ntse a nka fluoxetine. Ho botsa lipotso ka hloko ho senola nalane ea liketsahalo tsa hypomanic kapa manic kapa maemo a mang a axis I. Taba ke hore, matšoao a hae a mangata a sithabetsang a ne a atile; ha a sithabetse maikutlo o ne a rata ho ja ho feta mme a robala ho feta, mme ho ne ho e-na le bopaki ba ho qhekella.
Le ha Mong A a ne a amehile haholo ka lisebelisoa tsa bootsoa ha a ne a sithabetse maikutlo, tšebeliso e kholo ea litšoantšo tsa bootsoa tsa inthanete e ne e le teng leha maikutlo a hae a ne a arabetse kalafong. Le ha a ne a natefeloa ke ho ruta le ho etsa lipatlisiso 'me a atleha mosebetsing oa hae, ka linako tse ling ha mosebetsi o ne o sithabetsa maikutlo haholo. Mosali oa hae o ne a sa khone ho ba le bana, 'me ebile ha ba utloe ba batla ho ba le ngoana. Leha ho le joalo, mosebetsi oa hae o ne o hloka hore a tsamaee libeke tse 'maloa ka selemo,' me ka linako tsena o ne a ikutloa a le bolutu, a na le nako e eketsehileng matsohong a hae, mme o ne a ka ipholla litho tse ling hape. Ho joalo, ka linako tse ling bophelong bohle ba hae o ne a tšepile ho ipholla litho tsa botona kapa botšehali ho fumana phomolo, ka linako tse ling khafetsa a ipholla litho ka makhetlo a mararo kapa ho feta ka letsatsi. Leha ho le joalo, sena se ne se sa mo sitise mesebetsing ea hae kapa setjhabeng ho fihlela a fumane ts'ebetso e nepahetseng ea litšoantšo tsa bootsoa inthaneteng.
Ho haella ha mokuli hypomania le mania ho bohlokoa, hobane ho ba le tšoaetso ho ka ba letšoao la maemo ana. Keketseho e totobetseng ea boits'oaro bo amanang le khatello ea maikutlo nakong ea khatello ea maikutlo e khahla ho latela litlhahiso tse fetileng hore boits'oaro bo joalo e kanna ea ba matšoao a khatello ea maikutlo mme bo ka arabela ho litlhare tse loantšang khatello ea maikutlo. (6). Ho tlosa tšebeliso e mpe ea lithethefatsi ho bohlokoa hape, haholo hobane ts'ebeliso ea koae e ka baka matšoao a tšoaetso (7). Kamora nako, bakuli ba nang le matšoao a hypersexual ba ka ba le maemo a fapaneng a comorbid, ho kenyelletsa le obsessive-activive disorder (OCD) le lefu la Tourette (8), ka hona ho loketse ho busa tsena.
Mabapi le ho kenella ha pharmacotherapeutic, ho ba teng ha matšoao a sithabetsang ho atypical ho na le litlamorao tsa bohlokoa. Ho na le bopaki bo matla ba hore li-menamine oxidase inhibitors (MAOIs) tse ke keng tsa fetoloa li sebetsa hantle ho feta li-antidepressants tsa tricyclic kalafong ea matšoao a joalo (9). Ka lebaka la tšitiso ea ts'ebetso ea ts'ebetso ea MAOI ea ho itšireletsa mafung, lingaka tse ikhethileng tsa serotonin reuptake inhibitors (SSRIs) ke meriana e sebetsang ea mola oa pele. Ehlile, ho bonahala ha bona ba sebetsa hantle kalafong ea khatello e kholo ea mokuli ho lumellana le karolo e nahannoeng ea serotonin ho hypersomnia le hyperphagia le ka liphumano tsa litlaleho tse ling tsa pejana tsa hore SSRIs e sebetsa hantle ho phekola khatello ea maikutlo (10).
Univesithi e ne e file basebeletsi ba marang-rang monyetla oa ho kena inthaneteng ho lilemo tsohle tsa 3 pejana. Pele, Mong A o ne a sebelisitse sena haholo bakeng sa lipatlisiso. Leha ho le joalo, ka linako tse ling o ne a qeta nako a le mecheng ea puisano ea ho kopanela likobo Inthaneteng, a tloaetse ho shebahala e le motho ea fapaneng, ea neng a bapisoa ka matla le ea hae ea hlonameng le ea ikhethileng.
Kamora nako, leha ho le joalo, bongata ba ts'ebeliso ea hae ea inthanete bo ne bo ikemiselitse ho batla mefuta e meng ea lifoto tsa bootsoa; Tsena li ne li kenyelletsa monna eo a neng a utloa eka o sefahleho kapa o busa ka tsela e itseng ka thobalano le mosali. O ne a tla sebelisa setšoantšo sena e le motheo oa papali ea thobalano eo ho eona e neng e le molekane ea matla oa basali setšoantšong, 'me o ne a ipholla litho tsa botona le botšehali. Lilemong tse fetileng o ne a kile a etela mabenkeleng a litšoantšo tsa bootsoa ho ea batla mefuta ea litšoantšo, empa hangata o ne a qoba tsena hobane a tšaba hore e mong oa liithuti tsa hae o tla mo bona.
Litoro tsa thobalano, hammoho le litoro, esale e le tse ling tsa litsela tse bohlokoa tsa ho utloisisa batho ba sa tsebeng letho. Ngaka e tla batla ho utloisisa hore na hobaneng khatello e phethile karolo ea bohlokoa bophelong ba kelello ba mokuli. Le ha litakatso tse mabifi e kanna ea ba tsa lefats'e, ho utloisisa nalane ea bophelo ba mokuli le litlamorao tse sa utloahaleng ho kanna ha ba ha ba molemo ho hlahiseng leano la kalafo. E ne e tla ba ho loketseng ho botsa ka liphihlelo tsa pele tsa thobalano le ka tlhekefetso ea thobalano bongoaneng, e ka amanang le boits'oaro bo feteletseng ba ho ba le thobalano. (2).
Hoa thahasellisa ho hlokomela hore lintlha tsa moetlo, e leng ntlafatso ea marang-rang, li bonahala li tlatselitse haholo mathateng a matšoao a mokuli. Le ha marang-rang a ka fana ka lingaka le bakuli ba bona menyetla ea bohlokoa bakeng sa thuto ea kelello le tšehetso (11), e kanna ea fana ka monyetla bakeng sa papali ea chelete ea ho becha le mefuta e meng ea boitšoaro bo sa sebetseng (1, 2).
Mong A o boletse hore ho fumana mofuta o nepahetseng oa setšoantšo ka linako tse ling ho ka nka lihora tse ngata. Monna ea setšoantšong o ne a hloka ho ba matla, empa Mong A ha a ka a tsosoa haeba ho na le bopaki ba hore mosali eo o ne a utloisoa bohloko. Ha a se a fumane foto e neng e “nepahetse,” o ne a ipholla litho tsa botšehali ho itlosa bolutu. E ne e le khale a khahloa ke mofuta ona oa setšoantšo mme o na le pokello ea lifoto tse ts'oanang, empa o ne a lula a batla lingoliloeng tse ncha.
Ka nako e 'ngoe o ne a hopola litšoantšo tse mo ts'oereng ha eena le mosali oa hae ba ntse ba etsa lerato, empa boholo ba bona ba ne ba na le kamano e sa khetholloeng le e sa thekeseleng ea thobalano, eo ka bobeli ba neng ba e bona e lekane. Nalane e qaqileng ea thobalano e senotse letho ho tsoa ho tloaelehileng. Ho ne ho se na nalane ea tlhekefetso ea bana.
Leha ho le joalo, Mong A o hlokometse hore o thatafalloa ke ho itšepa. Ka mohlala, o ne a rata ho latela litaelo tsa ba bang, leha a ne a sa lumellane le bona. Qetellong, maikutlo a khalefo a ile a phatloha, ka linako tse ling ka litsela tse sa nepahalang. Mohlala, ho fapana le hore a buisane le hlooho ea lefapha ka bothata bo itseng, o ne a tla itšoara ka tsela e poteletseng le e sitisang libokeng tsa basebetsi moo ho neng ho buisanoa ka taba eo. Leqepheng la lipotso tse bobebe tsa sache ea pejana (12), mokuli o ile a holimo holimo linthong tse ngata tsa schema ea tlatsetso.
Poleloana “hantle feela,” eo mokuli a e sebelisang ho hlalosa ho batla ha hae litšoantšo tse tsosang takatso ea boitšoaro bo bobe, e re hopotsa matšoao a OCD. Leha ho le joalo, joalo ka ha ho boletsoe pejana, ho bonahala eka mokuli enoa o ne a sa bonts'e bopaki ba ho ba le bothata bofe kapa bofe ba matšoenyeho. Ho haella ha setsoalle sa ho tsosa takatso ea botona kapa ea botšehali le lintho tse mpe tse nyarosang ke sona se totobatsang ho hlonama hoa thobalano. Ntlha ena e bohlokoa ho totobatsa, ha ho nahanoa hore ho na le pherekano e phahameng lipakeng tsa paraphilias le seo ho thoeng ke mafu a amanang le paraphilia (13).
Young (12) o khothalelitse hore schema ea subjugation e ka hlaha ha polelo ea bongoana ea khalefo e nyahisoa, le hore batho ba baholo ba nang le schema ena ba khona ho hlahisa maikutlo ana ka tsela e sa tobang. Koetliso ea boikoetliso e ka ba ts'ebetso ea mantlha e le ho thusa bakuli ho qala ho hlola schema ea tlatsetso. Phetisetso bakeng sa kalafo ea kelello ho thusa ho fetola li-schemas tsa pele tse mpe le tsona li ka nahanoa. Kamano lipakeng tsa schemas, khatello ea maikutlo, matšoao le maikutlo ha li kenyelle feela ho hlonama ka lehlakoreng le le leng empa, ho e-na le hoo, e kanna ea thatafala.
Mong. Qalong o ile a hana phetisetso ea psychotherapy ke ngaka ea hae ea mafu a kelello, ea neng a etsa haholo mosebetsi oa psychopharmacological, empa a lumela ho eketseha ha fluoxetine ho 40 mg / letsatsi. Libekeng tse 'maloa tse latelang sena se lebisitse ntlafatsong e kholo matšoao a ho feto-fetoha ha maikutlo empa ha se ea fokotseha libido kapa liphetoho leha e le life mokhoeng oa hae oa hypersexual. Likhoeli tse 'maloa hamorao, Mong A o ile a lumela ho buisana le matšoao a hae le setsebi sa kelello.
Ha a latela lilemo tsa 1, o ile a ikutloa hore psychotherapy e bile le thuso ho thusa ka mathata a taolo. Ehlile, joale o ne a ikutloa hore taba ena e bakile khatello ea maikutlo eo a neng a e sebetsa, hammoho le maikutlo a hore o ne a se a sa khone ho laola boitšoaro ba hae ba thobalano, le khatello ea maikutlo ea hae ea pejana. Ho bile le phokotso ea ts'ebeliso ea hae e thata ea marang-rang, leha ka linako tse ling a le khatello ea maikutlo mosebetsing kapa bolutu, o ne a ntse a tloaetse ts'ebeliso e mpe ea litšoantšo tsa bootsoa le ho ipholla litho.
Ho arola kalafo pakeng tsa setsebi sa mafu a kelello le setsebi sa kelello ho kenya mathata a mangata; ka sebele maemong a matšoao ao mokuli a utloang a soabisa, mohopolo oa ho tsebisa motho e mocha o ka mpefatsa litaba. Karabelo ea matšoao a sithabetsang ho lethal dose e eketsehang ea fluoxetine e lumellana le bopaki bo tsoang tlalehong e fetileng (5). Le ha ho thoe li-SSRIs li na le thuso ho fokotse ho ipholla litho tsa botona kapa botšehali le matšoao a tšoanang, litlamorao tsa bona ha se matla kamehla (6, 8, 14). Ho feta moo, tekong e laoloang ea clomipramine le desipramine bakeng sa matšoao a joalo, katleho ha ea ka ea fumanoa (15). Hore na li-SSRIs li ka fokotsa khatello ea ho jeoa ke bolutu ha ho se na bothata ba ho feto-fetoha ha maikutlo ke taba e tsosang takatso, eo ho nang le lintlha tse fokolang.
Psychotherapy ho tlalehiloe kalafo e sebetsang bakeng sa ho ipholla litho tsa botona kapa botšehali le matšoao a tšoanang ke bangoli ba bangata (3), mme leha ho na le khaello ea lithuto tse laoloang sebakeng sena se ikhethileng, psychotherapy ka sebele e nahanoa e sebetsa bakeng sa mathata a hlahang hangata a comorbid axis I (joalo ka khatello ea maikutlo), le bakeng sa mathata a itseng a axis II (joalo ka mathata a ts'abo). Ho kenella ha balekane le hona e kanna ea ba ho nahaneloa haeba ho bile le bopaki ba ho se sebetse lenyalong. Ho boetse ho na le monyetla oa hore meriana ea litlhare le psychotherapy li matlafatsane. Leha ho na le sephetho se tloaelehileng sa mokuli enoa, ho bohlokoa hore matšoao a boitšoaro bo bobe ba botona le botšehali a kanna a ba le tsela e sa foleng (2).
Puisano
Mokuli mona o mameloa ke litlhaloso tsa Krafft-Ebbing mabapi le "thobalano ea thobalano" 100 lilemong tse fetileng (16):
E lula e le menahano eohle le maikutlo ohle a hae, e sa lumelle sepheo se seng bophelong, ka mokhoa o tenang, joalo ka mokhoa o batlang o khotsofatsa ntle le ho fana ka maikutlo a boits'oaro bo nepahetseng le bo nepahetseng, mme e ikemisetse ho latellanang ho sa feleng le ho sa feleng ha thobalano. monate oa ho etsa thobalano le setho sa botona kapa botšehali ke koluoa e tšabehang ho motho ea e hlekefetsang, hobane o lula a le kotsing ea ho tlola melao ea naha le ea boits'oaro, ea ho lahleheloa ke tlotla, bolokolohi ba hae esita le bophelo ba hae.
Ho joalo, mecha ea phatlalatso ea sejoale-joale e fana ka mefuta e mengata ea mefuta e meng bakeng sa polelo ea psychopathology. Ka ho khetheha inthanete e tla ba sebaka sa bohlokoa sa ho hlahisa matšoao a fapaneng, ho kenyeletsoa "thobalano ea setho sa botona kapa ea botšehali."
Lipatlisiso tsa morao-rao li bontšitse hore "thobalano ea setho sa botona kapa ea botšehali" e sa tloaeleha ebile e ka amahanngoa le boitšoaro bo hlephileng (3, 17). Boloetse bona bo bonahala bo atile haholo ho banna, mme bakuli ba ka bonoa ba na le mekhoa e mengata e fapaneng, ho kenyelletsoa ho ipholla litho tsa botona kapa botšehali, tšebeliso e feteletseng ea litšebeletso tsa thobalano le batho ba etsang thobalano. Joalo ka mathata a taolo ea tšusumetso, leha matšoao a bona e le a khotsofatsang, ho boetse ho na le karolo ea boteng ba lefutso. Matšoao a Comorbid a kenyelletsa mathata a ho feto-fetoha ha maikutlo, ho tšoenyeha le mathata a tšebeliso ea lithethefatsi. Matšoao a ka ama ka matla lelapa, boiketlo ba motho le mosebetsi, mme litlamorao tse mpe li kenyelletsa tseo tsa lefu le tšoaetsanoang ka thobalano. Ho hlakile hore ho na le tlhoko ea tlhahlobo e nepahetseng ea kalafo le kalafo ea bakuli ba joalo.
Ha lilemo li ntse li feta, ho sebelisitsoe mantsoe a fapaneng ho bua ka bakuli ba joalo, ho kenyelletsa "Don Juanism" le "nymphomania" (18, DSM-III). Leha karolo ea DSM-III-R mabapi le mathata a thobalano e sa hlalosoang ka hosele e kenyelletsa polelo "litheko tsa thobalano tse senang paraphilic," lentsoe lena le tlohile ho DSM-IV. Mohopolo oa "ho qobelloa ho etsa thobalano" (19, 20) e thehiloe khopolong ea hore ho na le phapang e makatsang le ea kelello pakeng tsa setheo sena le OCD. Ka lehlakoreng le leng, ba bang ba sebelisitse polelo ea "ho hohela thobalano" mme ba totobatsa ho ata ha mathata a taolo ea litšusumetso (21, 22). Khopolo ea bokhoba ba thobalano le eona e hlahisitsoe, e boetse e thehiloe ho ts'oanang ho ts'oanang le mathata a lemallo (3, 23). Ho hlalositsoe "lefu le amanang le paraphilia" ka lebaka la pherekano e phahameng le, le ho tšoana ho hoholo ka tsela e tšoanang le, paraphilias. (13).
Ho haella ha nako eo ho lumellanoeng ka eona ho tlatselitse khotsong e kholo ea lipatlisiso sebakeng sena. E 'ngoe le e' ngoe ea mantsoe ana a fapaneng e na le melemo le likotsi. Ehlile ba fana ka maikutlo a mefuta e fapaneng ea maikutlo a ho etsa lipatlisiso tsa nako e tlang sebakeng sena. Leha ho le joalo, ho sa tsotelleng matla le mefokolo ea mekhoa ena, re tiisa hore ho na le lingoliloeng tse fokolang tsa sebaka sena, tse etsang hore ho be thata ho amohela mofuta o le mong oa theory. (17, 24). Ho latela taba ea DSM ea ho hlalosetsa taba ea phenomenology e hlalosoang ho e-na le khopolo e sa tšehelitsoeng, polelo ea "hypersexual disc" mohlomong e loketse haholo.
"Hypersexual disorder" mohlomong e fumana tšehetso ho tsoa ho bopaki bo bontšang hore kantle ho thobalano, e hlalosoang e le palo ea boitšoaro ba thobalano ka beke e fihlang ka mokokotlong, e phahame haholo sehlopheng sena sa bakuli (13), leha tekanyo eo matšoao a kenyeletsang "orgasm" ea 'mele (ho fapana le ho etsa mohlala, litoro le litakatso tsa thobalano) e fapana ho isa ho mokuli. Hoa makatsa hore ebe, lentsoe lena le bua haholo ka liketsahalo tse bonoang 'me le tloha hole le sebopeho sa mohopolo se sa lekaneng. Mokhoa o mong oa khale oa "hypersexuality" ea "pathological" o utloahala o le matla tsebeng ea sejoale-joale.
Na hoa khoneha ho theha mekhoa ea tlhahlobo e khethollang khatello ea maikutlo ho tsoa ho boitšoaro eo e leng sesupo sa bothata bo bong (bo joalo ka khatello ea maikutlo), le boits'oaro bo tloaelehileng ba thobalano? E hloka ho theoa, mohlala, hore ho na le ts'ebetso e feteletseng le litakatso tse tsosang takatso tsa thobalano, litakatso, kapa boits'oaro bo feteletseng ba nako e telele haholo (mohlala, likhoeli tsa 6). Ntle le moo, ho hlokahala hore ho khethoe hore matšoao ha a hlahisoe hamolemo ke lefu le leng la axis I (mohlala, tšibollo ea manic kapa khathatso ea kelello, erotomanic subtype) 'me matšoao ha a bakoe ke litlamorao tse tobileng tsa' mele oa ntho (mohlala, sethethefatsi sa tlhekefetso kapa moriana) kapa boemo bo tloaelehileng ba bongaka. Kamora nako, kahlolo eo mehopolo ea thobalano e khothalletsang, litakatso, kapa boits'oaro bo fetelletseng (ke hore, e emetse psychopathology) e tlameha ho nahana ka phapang e tloaelehileng e le ts'ebetso ea lilemo (mohlala, ho bacha, maemo a phahameng a ho nahana ka takatso ea botona kapa ea botšehali e ka ba a tloaelehileng) le boleng ba subc setso (mohlala, ho bakuli ba ananelang ho se nyaloe, ho ba teng ha litakatso tse ling tsa thobalano le khatello e amanang le tsona e ka ba ntho e tloaelehileng) le boemo boo matšoao a bona a bakang mahlomola kapa a sitisang likarolo tsa bohlokoa tsa ts'ebetso.
Lintlha tsena le mantsoe a sebelisitsoeng mona li lumellana le litlhahiso tse fumanehang lingolong (17, 24). Kahoo, ho tseba hore matšoao ke litoro tsa thobalano, likhothaletso, le boits'oaro bo seng bo ka bapisoang le tlhaiso-leseling ea DSM-IV ea paraphilias; Tsena ke litoro tse etsahalang khafetsa, tse tsosang takatso ea thobalano, litakatso tsa thobalano, kapa boits'oaro bo akaretsang ho kenyelletsa lintho tse senang batho, mahlomola kapa ho tlotloloha ha motho a le mong kapa molekane, kapa bana kapa batho ba bang ba sa rateng. Ha e le hantle, mohopolo oa mona ke hore ho ts'oaetso ea hypersexual, matšoao ke a bonoang mefuteng e tloaelehileng ea bohlola.
Ka mokhoa o ts'oanang, ho bohlokoa ho khetholla hore na matšoao a hypersexual a hlalosoa hantle ke maemo a mang a kelello kapa a bongaka ka kakaretso ho fapana le tlhahlobo e khethehileng ea lefu la hypersexual. Joalokaha ho boletsoe pejana, mohlala, bakuli ba nang le mania kapa tšebeliso ea koae ba ka bontša boitšoaro ba hypersexual. Ho feta moo, boitšoaro bo feteletseng bo ka bonoa maemong a mangata a fapaneng a methapo (7). Nyeoeng e hlahisitsoeng mona, ho ne ho se na bopaki ba hore matšoao a ka bonoa feela ka ho feto-fetoha ha maikutlo kapa ho hloka taolo e itseng, leha maikutlo a (le mohlomong ho hloka tebello) a kanna a mpefatsa matšoao a thobalano mme le ona a mpefatsa le ho feta.
Kamora nako, ho na le mosebetsi o boima oa conceptually oa ho fumanela phapang e tloaelehileng ho psychopathology (25). Mantsoe a sebelisitsoeng ka holimo a totobatsa hore likahlolo tsa kliniki mabapi le psychopathology li lokela ho nahana ka phapang e tloaelehileng le kotsi e bakoang ke matšoao. Kahoo, ka mohlala, litoro tse matla tsa thobalano ho bacha kapa khatello e bakoang ke takatso ea thobalano ho batho ba loanelang ho ba lenyalong hangata ha se psychopathological.
Ho joalo, ho na le lingoliloeng tse ngata tsa filosofi tse lekang ho hlalosa mathata a bongaka le kelello le meeli ea bona ka mokhoa o nepahetseng (26-28); bothata ba ho rarolla phapang e tloaelehileng ho tsoa ho psychopathology bo thata haholo ha, joalo ka boemo ba khatello ea maikutlo, sebopeho sa phenomenology ke (ka tlhaloso) se tloaelehileng. Mantsoe a sebelisitsoeng mona a tsamaisana le maikutlo a bangoli ba bangata ba reng tlhahlobo ea bongaka e kenyeletsa likahlolo tsa tlhahlobo mabapi le semelo sa setso (27, 28).
Le ha ho ka ba bonolo ho kenyelletsa "hypersexual disorder" karolong ea DSM mabapi le mathata a taolo ea thobalano, ho bonahala e le karolo ea likarolo tsa mathata a thobalano. Sena se tsamaisana le tatellano ea mekhatlo e meng e ratehang e kang bulimia (e nang le litšobotsi tse sa qhekelleheng empa e aroloa e le bothata ba ho ja).
Ho hlaha ha morao tjena ha mefuta e fapaneng ea boitsoaro bo tlase ho "ts'ebeliso e mpe ea ts'ebeliso ea Inthanete" ho hlahisa potso ea hore na, hona, e lokela ho ba tlhahlobo ea mafu a kelello (29, 30). Lithuto tse peli (1, 2) e bontšitse hore litlamorao tsa ts'ebeliso e joalo li hlile li ka fihla hole, ha lithuto tse ngata li sa robale, li lieha ho ea mosebetsing, li hlokomoloha boikarabelo ba lelapa, 'me li le mathateng a lichelete le molao. Taba e tloaelehileng lithutong tsena e ne e le lilemong tsa hae tse tlase ho isa bohareng ba 30, o ne a bile a e-na le thuto e itseng ea koleche, a qeta lihora tse ka bang 30 ka beke ts'ebeliso ea inthanete ea "e seng ea bohlokoa", mme a e-na le maikutlo, ho tšoenyeha, ts'ebeliso ea lithethefatsi kapa botho ho hloka kelello. Ka lebaka la hore inthanete e lumella ho fihlella ka potlako linthong tsa thobalano esita le balekane ba thobalano (31), Boitšoaro ba thobalano ntlheng ena bo bohlokoa ka ho khetheha (32). Ho bonahala ho utloahala ho fana ka maikutlo a hore nalane ea boitšoaro ba inthanete e kenyelelitsoe e le karolo ea tlhahlobo e tloaelehileng ea kelello. Leha ho le joalo, ho latela hore matšoao a joalo a kanna a utloisisoa hangata ho latela tlhahlobo e teng (ho kenyeletsa hypersexual disc), ho na le lebaka la ho ba hlokolosi ka ho etsa tlhahlobo ea tšebeliso ea marang-rang e nang le bothata. Ho lumellana ha polelo ea tlhahlobo le mekhoa ea boits'oaro bo matlafatsang ho ka khothaletsa lipatlisiso tse ling tse tla re thusa ho utloisisa bakuli bana mme, ho ts'episoa, ho fana ka tlhokomelo e betere. Le ha ho na le liphatlalatso tse ngata tse fapaneng tse 'nileng tsa etsoa mabapi le etiology ea hypersexual disc (3, 17), ho na le datha tse 'maloa tse matlafatsang ho tšehetsa maikutlo a itseng. Mekhoa e mengata ea lingaka e khothalelitsoe e na le thuso, 'me ho shebane haholo le li-SSRI, empa ho na le tlhokahalo ea liteko tse laoloang. Ka mokhoa o ts'oanang, psychotherapy e khothalletsoa khafetsa le ha ho na le ts'ehetso e fokolang ea lipatlisiso. Leha ho le joalo, baoki ba sebetsanang le ho sebetsana le lefu la ho ferekanya kelello ba na le ts'epo ea hore bakuli ba bangata ba ka thusoa ka tlhokomelo e nepahetseng ea bongaka. (33).
E amohetse Julayi 24, 2000; Litlhahlobo li amohetse Jan. 19, April 13, le May 22, 2001; e amohetse May 23, 2001. Ho tsoa Lefapheng la Psychiatry, Univesithi ea Stellenbosch; Lefapha la Psychiatry, Univesithi ea Iowa, Iowa City; Lefapha la Psychiatry, Univesithi ea Florida, Gainesville; le Setsi sa Psychiatric sa New York State, Lefapha la Psychiatry, Univesithi ea Columbia, New York. Ho shebana le likopo tsa phetisetso ho Dr. Stein, Setsi sa Mathata a ho Tšoenyeha, Lekhotla la Patlisiso ea Bongaka, Lefapha la Psychiatry, Univesithi ea Stellenbosch, PO Box 19063, Tygerberg 7505, Cape Town, Afrika Boroa; [imeile e sirelelitsoe] (imeile) .Dr. Stein o tšehelitsoe ke Lekhotla la Patlisiso ea Bongaka Afrika Boroa.
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