I-Porn kunye ne-DSM-5: Ngaba i-Political Politics Play? (2012)

EZIPHAKATHI:

  1. Umlingo woTywala / wesondo? Eli phepha liluhlu Izifundo ze-55 ze-neuroscience (I-MRI, i-FMRI, i-EEG, i-neuropsychological, i-hormonal). Banikela ngenkxaso enamandla kwimodeli yoxilongo njengoko iziphumo zabo zibonakalisa iziphumo zeengqondo ezichazwe kwizifundo zokuxhatshaliswa kweziyobisi.
  2. Iingcamango zangempela zeengcali zoononongo / isondo? Olu luhlu luqulethe 30 Ukuphononongwa koncwadi kwangoku kunye neenkcazo ngenye yezinzulu zenzululwazi kwihlabathi. Yonke inkxaso ngenkxaso yomzobo.
  3. Iimpawu zokuxhatshazwa kunye nokunyuka kwamanqaku angaphezulu? Izifundo ezingaphezu kwe-55 zokubika iziphumo zihambelane nokukhula kwezilwanyana (ukunyamezela), ukuhlala kwimiba yezononophelo, kunye nokukhutshwa kweempawu (zonke iimpawu kunye neempawu ezinxulumene nomlutha).
  4. Ukuxilongwa ngokusemthethweni? Incwadi yokusetyenziswa kwezifo zonyango ngokubanzi, Ulwahlulo lwaMazwe ngamazwe (ICD-11), iqulethe uvavanyo olutsha ezifanele ukuxhatshazwa koonwabo: "Ukuxhatshazwa kwezesondo ngokunyanisekileyo. "

KUFUNDO: Ngaba unomdla wokufumana ubunzima kwiphonografi ye-Intanethi / umlutha we-cybersex?

INcwadana yamva nje yoDiagnostic kunye neStatistical Manual (DSM-5) sele iza kubekwa etyeni. Owesithathu kunye umjikelo wokugqibela wezimvo iphela nge-15 kaJuni ka-2012. Ngumsebenzi wakhe wonke umntu ukujonga ngenyameko le ncwadana. Nangona uninzi lweengcali zokhathalelo lwempilo ngokungakhathaliyo zizibhengezo zeDSM xa zivavanya kwaye zinyanga abathengi kunye nezigulana, iintatheli. kunye neenkampani zeinshorensi yithathele njengebhayibhile yengqondo.

Ngokungaqhelekanga, i DSM-5 ngoku uye wakhupha zombini ukuphazamiseka okujongana nokulutha kwi-Intanethi kwi-appendix-ethiywe ngegama elithi "iCandelo III" (izinto ezifuna uphando olongezelelweyo). Ezi ziphazamiso zimbini Ingxaki yokusetyenziswa kwe-Intanethi kwaye I-Hypersexual Disorder (i-cybersex kunye neeponografi ezigqithisileyo). Eli nyathelo lithetha ukuba ezi aziyomiqathango esemthethweni ngokumalunga noogqirha base-DSM.

Ewe, ufunda loo nto ngokuchanekileyo. I-Intanethi ye-Highspeed yenye yezona zinto zibalulekileyo zakha zabetha ingqondo yomntu. Izifundo ezininzi zesayensi epapashwe kule minyaka imbalwa idlulileyo zibonisa ukuba umlutha we-Intanethi yinto ngokomzimba umlutha. Ukanti abo banoxanduva lokukhokela abaqeqeshi bezempilo ekuxilongeni ukuphazamiseka kokulutha banyule ukujula-ezintandathu kuzo zonke iindawo ezifanelekileyo zeDSM.

Ngokubhidayo, ezi ziphazamiso zimbini azikho phantsi kweqela elisebenzayo elinye, okanye zifumaneka kwisahluko esinye. Izihloko zazo zombini nazo ziyalahlekisa ngandlel’ ithile. Ingxaki yokusetyenziswa kwe-Intanethi iyaliphikisa igama layo, izinikele ngononophelo kwi-Intanethi midlalo endaweni yokubandakanya umlutha wephonografi kwi-Intanethi, umlutha wemidiya yoluntu, njl.njl. Ngaphambi kokugxothwa, bekukwisahluko. Ukusetyenziswa kweziyobisi kunye nezigulo zokulutha. I-Hypersexual Disorder, edwelisa i-cybersex kunye nephonografi, ayize ikhankanye igama elithi "umlutha" kwaphela, ishiya nayiphi na ingcali okanye intatheli exhomekeke kwi-DSM entsha ngengcamango yokuba i-intanethi ye-intanethi ayinakho. Kwakunjalo ngaphambili Ukungasebenzi kakuhle ngokwesondo isahluko.

Ngamafutshane, iqela elisebenzayo le-DSM lizimisele ukuthathela ingqalelo (kodwa defer) ukuba likhoboka le-Intanethi ukuba nje kuphela “umdlalo” ukhankanyiwe. Kutheni kungekho mlutha wokudlala kwi-Intanethi, kunye izifundo zophando ezininzi ezikhanyisayo ukuyichaza, kwincwadana eyiyo? Kutheni abantu abanezinye iziyobisi ze-Intanethi (i-Facebook, ukukhangela okunyanzelekileyo) bashiywe ngaphandle ngaphandle kwenani elikhulayo Izifundo zokuxilisa i-Intanethi ubonisa utshintsho lwengqondo olunxulumene nokukhobokisa?

Kwaye kutheni, xa ezi zifundo zokulutha kwi-Intanethi ngokubanzi zibandakanya ukusetyenziswa koburheletya, ngaba iqela lee-Sexual Identity Disorders workgroup lisusa igama elithi "umlutha?" Ngaba kunokwenzeka ukuba iqela elisebenzayo lifuna inqanaba eliphezulu lobungqina bomlutha we-porn kwi-Intanethi kunokuba bekuyimfuneko ukwenza ngokusemthethweni uninzi lweengxaki esele zikhona le DSM-5 Ukungasebenzi kakuhle ngokwesondo isahluko?

Hambisa-ungalahleki

Kuthekani ngale ngcamango endaweni yoko? Hambisa yonke into enxulumene nokulutha kwi-Intanethi (umdlalo, i-cybersex, imidiya yoluntu kunye nephonografi) ukuya Ukusetyenziswa kweziyobisi kunye nezigulo zokulutha kwaye uyibeke phantsi kolawulo lweqela elisebenzayo leengcali zokukhobokisa eziqondayo ukuba umlutha yimeko enye. Enyanisweni, mhlawumbi abanye oogqirha ukusuka I-American Society of Addiction Medicine inokunceda kumsebenzi.

Sele, ukukhotyokiswa kokungcakaza kuye kwafudukela Ukusetyenziswa kweziyobisi kunye nezigulo zokulutha. Ngokufanelekileyo, zonke iziyobisi zokuziphatha ziya kutshintshelwa kwesi sahluko kwaye zifunyanwe ngokufanelekileyo. Ubuncinci, nangona kunjalo, zonke iziyobisi ze-Intanethi kufuneka zidityaniswe, zifuduswe, kwaye zihlangulwe ekutyeshelweni kweCandelo le-III.

Nangona xa ujonga kuqala i-intanethi ye-intanethi kunye ne-cybersex iziyobisi zinokubonakala ngathi ziziyobisi zesini, zingaphezulu kwayo yonke into, Internet Iziyobisi kuninzi lwabaguli. Bavela kwi esingaqhelekanga inikwe yinto ekhethekileyo ye-Intanethi ekhawulezayo, eqhuba ukusetyenziswa kakhulu, okukhokelela kutshintsho olunxulumene nobuchopho. Nokuba ngaba umlutha we-Intanethi ngumdlalo, uncokole, ukhangele, okanye ujonge ukugqithisa, umlutha wabo kuqala kwinoveli. pixels, naxa iqiniswe ngovuthondaba.

Indawo engaboniyo yokuba likhoboka le-Intanethi yonakalisa ababukeli abancinci

Ukuba okudlulileyo kukho nasiphi na isikhokelo, kwiminyaka eyi-15-20 ezayo uluntu lwethu luya kuthwala isali DSM-5, kunye neentatheli kunye neenkampani zeinshorensi ngokumfamekileyo zithembele kuyo. Okwangoku, i DSM-5's ukunqongophala ukuqondwa imingcipheko yokusetyenziswa iphonografi Internet kudala indawo enkulu imfama kubahlohli, abakhathaleli, abasebenzisi kunye neentatheli. Ngaphandle kwesikhokelo esivakalayo, abafana bacinga ukuba ngenxa yokuba i-masturbation iphilile akukho xabiso lokusetyenziswa kwe-intanethi ye-intanethi ayinampilo. Abaninzi abaqondi ukuba iimpawu zabo zinxulunyaniswa neminyaka yokusetyenziswa koonografi ngesantya esiphezulu de bayeke.

Inyaniso yokuba ingqondo yokufikisa banomdla wokugqithisa kunokuba ingqondo yabantu abadala ivume ukuba likhoboka le-Intanethi DSM-5 konke kunyanzelekile. Uninzi lwabasebenzisi abancinci be-porn namhlanje abanakukwazi ukulinda de i-DSM elandelayo ijongane neentlungu zabo ezinxulumene nokulutha. Kwabanye, imeko imaxongo.

Ngokomzekelo, kwiveki nje ephelileyo amanqaku alandelayo aphuma elumkisa ngokungasebenzi kakuhle ngokwesondo okubangelwa ngamanyala kubafana. (Ngokuqinisekileyo oko kubangelwa kukungakhathali komvuzo wobuchopho, utshintsho olunxulumene nokukhotyokiswa.) Zonke ezi ziqwenga zenziwa ziingcali okanye zinika ingxelo ngoqwalaselo lweengcali:

Umgca osezantsi: Akunaxanduva ukukhupha i-DSM entsha ngaphandle indlela ecetywayo yokuxilonga kwiziyobisi ze-Intanethi. Izifundo sele zifumene amazinga okulutha kwi-Intanethi ukusuka kwi-3% ukuya phezulu ukuya kuthi ga kwi-25% (kumadoda aseyunivesithi).

Ezopolitiko ngokwesondo kunye neempazamo zembali

I-Hypersexual Disorder yingqondo yeengcali zezesondo kwiqela lokusebenza leZiphazamiso zeSini kunye neSini. Izazi ngesondo mhlawumbi zithathwa njengeengcali ekusebenziseni iphonografi kuba ibandakanya ukuphulula amalungu esini, ukanti uninzi lwezazi ngesondo zikholelwa ngokuqinileyo ukuba. “Imikhwa yesini” ayikho—ngaphandle kokuba mhlawumbi kwabo banezigulo zengqondo. Kwaye abavumi ukuba ukuhanjiswa kwe-porn ye-Intanethi kunye nemikhwa yabasebenzisi bayo (umzekelo, ukujonga kwiminyaka yangaphambili) yenza ukuba yahluke kakhulu kwi-porn yexesha elidlulileyo malunga nemiphumo enokubakho kwingqondo.

Ngenxa yoko, okwangoku DSM-5 iyingozi abakhotyoki. Masithi usempilweni ngokwasengqondweni kwaye ulikhoboka lephonografi kwi-Intanethi. Uthunyelwa kwi-sexologist ebambelela kwi DSM-5. Ujongene nokukhetha kukaHobson malunga noxilongo / uvavanyo: Nokuba "awunangxaki" kwaye kufuneka uqhubeke nokulandela izibongozo zenkqubo ye-limbic yengqondo egqithisiweyo de ube wena. baye uphazamiseko, okanye unengxaki yengqondo, apho udinga iziyobisi zengqondo kunye neengcebiso. Nokuba yeyiphi na indlela, umboneleli wakho wezempilo akajongani nentlungu yakho yokwenyani: umlutha we-Intanethi. Ngokwahlukileyo koko, ukuba ubunomlutha wokungcakaza, uya kufunyaniswa ukuba ulikhoboka eliphantsi kwe DSM-5 kwaye ibonelele ngamaqhinga okubuyisela.

Ngenzeka, uxanduva oluphambili lwe-Sexual kunye ne-Gender Identity Disorders workgroup kukuvelisa izikhokelo zokuphatha imiba enje. i-pedophilia kunye neentlobo ezahlukeneyo zamakhubalo anemibala, ukujongwa kokulibaziseka, kunye nabantwana abazama ukuqonda bayintoni na ngokwesini. Ukujonga ngokukhawuleza oogqirha abasebenza kwi Iziphazamiso zeSazisi ngokwesondo kunye nesini Iqela lomsebenzi libonisa ubunzulu obuchukumisayo kufundo lwabaphuli-mthetho ngokwesondo, i-orgasm yabasetyhini, imicimbi ye-transsexual, njalo njalo, kodwa akukho gqirha omnye ubonakala enemvelaphi eyomeleleyo kwi-neuroscience yokulutha.

Aba gqirha banokubona izigulo zengqondo, kodwa umlutha awukho kwi-radar yabo. Le ndawo ayiboniyo yaqala emva kwiminyaka engama-20 eyadlulayo—xa i kwenziwa impazamo kwicandelo lamayeza. Xa uMbutho wezoNyango waseMelika wavuma ubungcali bamayeza okukhobokisa, waqingqa ukuziphatha ngokwesondo ngaphandle koluhlu lwezinto ezinokubakho.

Ukwabelana ngesondo kwakungabandakanywanga ngenxa yezizathu zezopolitiko, nangona ubungqina bokuba kufuneka bufakwe, kunye nokungabikho kwezizathu zesayensi zokuyishiya. (Enjalo besiphaluka yengqondo ilawula zombini isini kunye neziyobisi. Zonke iziyobisi, ukuziphatha kunye neekhemikhali, lawula le sekethe—ngoko ukuquka neentlobano zesini kwakungeyongxaki.)

Ngeli xesha, nangona kunjalo, iphonografi ye-Intanethi kunye ne-cybersex zazisekwikamva loluntu, kwaye amakhoboka okwenyani ngokwesini ayembalwa, ngoko ke ukulalanisa kwakubonakala kusengqiqweni. Owu, ngokwembono yenzululwazi yokulutha, kuye kwacaca ngakumbi ukuba oku kuthomalalisa kube yimpazamo. Ngokufika kwe-intanethi ye-highspeed, i-blunder ibuyele luma isizukulwana siphela…nzima.

Ngoku, sijongene nemeko engenakuphenduleka: I DSM-5's sexologists izuze ilifa umsebenzi wokuphanda i-cybersex kunye nokuphazamiseka kwephonografi kwi-Intanethi, kodwa kubonakala ngathi bagcina ukukholelwa-ukuphumla kwimbali-yokuba ukuziphatha ngokwesondo. akakwazi babe likhoboka (ngaphandle kokuba isigulana sinesifo sengqondo esele sikhona). Nokuba i-paradigm yabo yokugula ngengqondo inokubamba ii-frotteurs kunye nababonisi, akukho sizathu sokucinga ukuba ibambele abantu abancinci abasebenzisa i-Intanethi namhlanje.

Ngaba iqela lokusebenza limisele ibha yokungqina ubukho bomlutha we-porn we-Intanethi uphezulu kakhulu? Bubuphi ubungqina obufunekayo ukuze kuqinisekiswe ukuba yivoyeur (ukuphazamiseka in incwadi)? Ukungakwazi ukuyeka ukuphazamisa ubumfihlo babanye ngaphandle kwemiphumo emibi, akunjalo? Nangona kunjalo xa ikhoboka le-intanethi lingakwazi ukuyeka ngaphandle kwemiphumo emibi, kwaye amashumi eminyaka yokuskena kwengqondo kunye neemvavanyo zokuxilonga zidibanisa ukucacisa ukuba kutheni, imeko yakhe ihanjiswe kwicandelo lophando.

Ngaba ucela iingcali ngesondo ukuba ziphande ngeziphumo ezinokuba yingozi ze-intanethi ye-erotica efana nokucela izazinzulu zecuba-inkampani ukuba iphande umlutha wecuba?

"Kutheni ufunda ii-unicorns?"

Kusenokwenzeka ukuba iqela lokusebenza le-Sexual kunye ne-Gender Identity Disorders lisacinga ukuba ubungqina bokukhotyokiswa, kokubini isayensi kunye nokunye, abunamsebenzi. "Kutheni ufunda ii-unicorns?" wabuza isazi ngesondo sezemfundo xa ingqalelo yakhe yayibhekiswa kwi iimpawu ezinzima kwaye iimpawu ezibonisa ukuba likhoboka ukuba amakhoboka e-Intanethi anamhlanje anika ingxelo.

Ilungu leqela lokusebenzela uMartin P. Kafka, MD unikezela ngaphantsi kwephepha kwizinto ezinokubakho kwi-addiction neuroscience kuphononongo lwakhe olubanzi luka-2009. I-Disorder Sex Disorder: I-Diagnosis ye-DSM-V. Ekukhuseleni kukaKafka, uphando olutsha oluninzi olucacisa indima yomvuzo wesekethe kubudlelwane bezesondo kunye nokulutha kwabantu kuye kwaphuma emva kokuphononongwa kwakhe-kunye nezifundo ezininzi malunga neziyobisi ze-Intanethi zeentlobo ezahlukeneyo. Okuvuyisayo kukuba, i-DSM-5 isenonyaka wokunyuka ngokukhawuleza kolu phando lubalulekileyo ngaphambi kokukhulula incwadana entsha.

Inqanaba langoku leqela lomsebenzi libonakala kwingxoxo-mpikiswano engenamveliso ebisoloko iqhuba malunga nokuba yintoni enokwenza "i-hypersexual."

Kubonakala ngathi kukho inkxalabo enzulu yokuba nayiphi na ingcebiso yokuba indlela yokuziphatha eququzelela uvuthondaba lwezesondo inokukhokelela ekubeni likhoboka lotywala iya kubangela ukujongwa okungafunekiyo kunye nokuleyibhelishwa kwemikhwa yesondo yabantu abahenyuzayo. Uloyiko olunjalo beluya kuphosakele. Igama elithi “ikhoboka” alithethi kuthi umntu onento yokwenza nokuziphatha kakubi or ukugula ngengqondo. Kuthetha ukuba umntu ufuna uncedo lokutshintsha indlela aziphatha ngayo engasafuniyo ukuze ajike utshintsho olukhathazayo lobuchopho beplastiki.

Olu lutshintsho lwengqondo ekufuneka umsebenzisi we-Intanethi oselula namhlanje funda ukubona ixesha elide ngaphambi kokuba babe likhoboka elipheleleyo. Ukuba ezi miqondiso ibilulwazi lukawonke-wonke, uninzi lwabasebenzisi abancinci be-Intanethi banokuzibuyisela umva ngaphandle kokufuna unyango. Kutheni kungenjalo DSM-5 ukukhuthaza lo mgudu ubalulekileyo wemfundo? Kutheni ingajongi indlela yokunceda amakhoboka e-Intanethi atshintshe indlela yokuziphatha ukubakhathaza kunye nefuthe elibi kwindlela abaqhuba ngayo ngokwesondo?

Ngaba i-DSM-5 iqhubela phambili ngempazamo i-ajenda yezopolitiko egunyazisa ukugcinwa kwemeko ekhoyo? Ngokuqinisekileyo, akukho sizathu "sokufunda ngakumbi" ukuqhubeka nokuchaza "ubulili obufanayo." Emva kwayo yonke loo nto, i-hypersexuality ayisoloko i-pathological; umlutha uhlala unjalo. Isigqibo sokuhambisa izifundo ze-cybersex kunye nephonografi ngaphandle kwencwadana kwi-appendix yangaphambili (iCandelo le-III) ngokufanelekileyo igcina yonke into kwi-limbo, kunye nokugxila kude neyona ndlela ithembisayo yokuhlalutya: umlutha.

Le ntshukumo inzima kakhulu ukuyikhusela kuba eyona mpazamo yembali (eyayikrola "isondo" ngaphandle kobukhoboka bomlutha) ngoku iye yalungiswa ngoogqirha abangama-3000 bezonyango. I-American Society of Addiction Medicine (ASAM). Ngo-2011, i-ASAM yabhengeza ukuba likhoboka eziphambili isigulo (akukho sigulo sengqondo esele sikhona ngaphambili), kwaye ichazwe ngokuthe ngqo ukuba ukuziphatha ngokwesondo kunye nokulutha kokutya kuyinyani, kwaye kuchazwa lutshintsho lwengqondo, hayi indlela yokuziphatha. Ingxelo yayo yoluntu isekwe kumashumi eminyaka yophando lwe-neuroscience.

Amalungu eqela le-DSM le-DSM ye-Sexual Identity Disorders ayihoyi iingcali zokulutha ze-ASAM. Ngenxa yoko, ilizwi elisemthethweni le-AMA (the DSM-5) ayibonisi inzululwazi yangoku yokulutha. Okumangalisayo kukuba, iziyobisi ze-Intanethi azikho kwaukuziphatha ngokwesondo, njengoko kuchaziwe ngasentla. Iphonografi kwi-Intanethi kunye nokulutha kwi-cybersex ziziyobisi zesikrini. Thatha isikrini kwaye indlela yokuziphatha imkile, efana nemidlalo yevidiyo.

Ukukhobokisa sesinye sezona zigulo zixilongayo

Eyona nto imangalisayo yokutshixa yonke imiba yokulutha kwi-Intanethi kumhadi wokufunda ngakumbi (iCandelo III), kukuba injongo yeDSM yokuqala yayikukuphucula ukuthembeka koxilongo, ngoko ke iingcali zempilo yengqondo zinokuvelisa iziphumo ezingaguqukiyo, eziphindaphindwayo, ezisemthethweni ngokwesayensi. Kunqabile kwimbali yonyango lwengqondo ine-etiology ye ikhona ukubandezeleka kuye kwaqondwa njengokukhobokisa. Njengoko ukuthembeka koxilongo yi DSM-5's mission, kufuneka yamkele ukuhambisa zonke iziyobisi kwi-Intanethi Ukusetyenziswa kweziyobisi kunye nezigulo zokulutha njengombandela wesayensi.

Ukuba ufundile ukuza kuthi ga ngoku, unokubulela ukuphinda kufumaneke okufunyaniswe kwi-neuroscience yakutsha nje: Kangangeminyaka, abaphandi bakwazile ukukhuthaza umlutha kwiimodeli zezilwanyana ngokuthanda kwaye bafunde ubuchopho babo nzulu. Uninzi lwamanqaku aqondwa kakuhle kwaye amanye anokubonwa kwaye alinganiswe ebantwini.

Emva koko, abaphandi bacenga yokuziphatha Iziyobisi kwizilwanyana, ukusebenzisa ivili lokubaleka kunye nokukhotyokiswa kokutya. (Uxolo abasebenzisi be-porn, izazinzulu azikwazi ukukhuthaza iigundane ukuba zifumane iipikseli, kodwa zinokusebenzisa iigundane ukuqonda ikhonkco phakathi kwesondo kunye nokulutha. Bona ngezantsi.)

Kutshanje, abaphandi bafunde ukuba umlutha wokuziphatha (utywala, ngcakazo, yokudlala ividiyo kwaye Umlutha we-Intanethi) kunye nokukhotyokiswa ziziyobisi zonke zibandakanya iindlela ezifanayo ezisisiseko, kwaye ikhokelela ku-a ingqokelela yotshintsho ekwabelwana ngalo kwi-brain anatomy kunye nekhemistri. (Gcina ukhumbula ukuba iziyobisi ezikhobokisayo zibangela kuphela umlutha kuba zikhulisa okanye zithintela iindlela sele endaweni yemivuzo yendalo enje ngokuvuselela inkanuko yesini.)

Utshintsho oluphambili olubangela uninzi lwezi nguqu zinxulumene nokukhotyokiswa yiprotheyini DeltaFosB. Ukusetyenziswa ngokugqithisileyo kwe imivuzo yemvelo (isini, iswekile, ephezulu, ukuzivocavoca) okanye ulawulo olungapheliyo lwalo naliphi na iyeza lokusetyenziswa kakubi libangela iDeltaFosB ukuba iqokelele kumjikelo womvuzo. Enyanisweni, njengoko kukhankanyiwe ngasentla, abaphandi baye babonisa ukuba umsebenzi wesondo ibangela ukuqokelelwa kweDeltaFosB, iphucula iimpuku "ubuchule bokwabelana ngesondo."

Yeyiphi enye ingxaki ye-DSM enokuthi iveliswe kwimodeli yezilwanyana, okanye ifunyanwe inokuthembeka njengokuziphatha kakubi? Ngokuqinisekileyo ayizizo iziphazamiso ezininzi ze-fetish ethi iqela le-Sexual kunye ne-Gender Identity Disorders lisacinga ukuba liyaqinisekiswa kwi-DSM-5: i-frotteurism, i-sadomasochism, i-exhibitionism, i-transvestism, njalo njalo. Kukho isayensi enzima ngakumbi kwiziyobisi zokuziphatha kunye novavanyo lwabo (kubandakanya umlutha we-Intanethi), kunye nokuzibona ngakumbi iziyobisi ezingamanyala ezikhalazayo. nemiphumo emibi.

Akukho mfuneko yokulinda uphando olongezelelweyo

Eyangoku DSM-5 ibeka isigwebo esiqatha kumakhoboka e-Intanethi anamhlanje angenazigulo zengqondo kodwa adinga uncedo. Isayensi yomelele ukuba umlutha wokuziphatha yeyona nto iphambili kwaye isisiseko yimeko enye. Umlutha wokungcakaza sele ukwi-DSM-5; Umlutha we-Intanethi ukhona apho. Akukho sizathu sibambekayo sokulinda uphando olongezelelweyo malunga neziyobisi ze-Intanethi.

Ngokuthumela I-Hypersexual Disorder kwaye Ingxaki yokusetyenziswa kwe-Intanethi ukulibala, umsinga DSM-5 Ngu:

  • Ukungahoyi ubungqina beklinikhi, i-anecdotal, kunye novavanyo olukhomba kumlutha we-Intanethi njengomlutha wokwenyani.
  • Ukungahoyi izifundo ezininzi zobuchopho kwi-Intanethi ye-addiction disorder, ebandakanya ukusetyenziswa kwe-porn.
  • Ukukhuthaza intsomi yokuba iimpawu ezinjengomlutha, iimpawu kunye nokuziphatha okuxelwe ngabakhotyoki be-intanethi kunye nabanonopheli babo kufuneka bavele kwezinye iindlela ezingaziwayo ngaphandle kokutshintsha kwengqondo okunxulumene nokulutha (umzekelo, "isifo sengqondo").
  • Ukugxotha uhlalutyo lokulutha-uphando lweengcali zonyango (ASAM).
  • Ukwala ukuvuma ukuba i-erotica ye-Intanethi ayifani ne-erotica yexesha elidlulileyo malunga nokuhanjiswa kunye nendlela esetyenziswa ngayo.

Ukuba unomzuzwana, nceda ukhuthaze i-DSM-5 ukuba ibeke zonke iziyobisi kwi-Intanethi Ukusetyenziswa kweziyobisi kunye nezigulo zokulutha: [imeyile ikhuselwe]

UKUBHALA

I-DSM Ifumana Likhoboka eliLungelo, nge-6 kaJuni ngo-2012

06/07/2012

I-DSM ifumana i-Addiction Right - NY Times

Ngu-HOWARD MARKEL

UAnn Arbor, uMike.

XA sisithi umntu “ulikhoboka” kwisimilo esifana neso ukungcakaza okanye ukutya okanye ukudlala imidlalo yevidiyo, kuthetha ukuthini oko? Ngaba ukunyanzeliswa okunjalo kufana nokuxhomekeka okufana neziyobisi kunye nokukhotyokiswa kotywala - okanye yintetho nje ekhululekileyo?

Lo mbuzo uvele mva nje emva kokuba ikomiti ibhale ushicilelo lwamva nje lwe-Diagnostic and Statistical Manual of Mental Disorders (DSM), umsebenzi wesalathiso oqhelekileyo wezifo zengqondo, ubhengeze iinkcazo ezihlaziyiweyo ze ukuhlukunyezwa kwesiyobisi kunye nokulutha, kubandakanywa nodidi olutsha "lwezinto zokuziphatha." Okwangoku, ekuphela kwengxaki evezwe kolu didi lutsha kukungcakaza kwezifo, kodwa ingcebiso yeyokuba ezinye iziphazamiso zokuziphatha ziya kongezwa ekuhambeni kwexesha. Umlutha we-Intanethi, umzekelo, ekuqaleni wawuthathelwe ingqalelo ukuba ubandakanywe kodwa wagxothwa kwisihlomelo (njengoko kwakunjalo ngokuziphatha ngokwesondo) kulindelwe uphando olongezelelweyo.

Abathandabuzayo banenkxalabo yokuba iindlela ezibanzi zokukhobokisa ziya kubangela i-pathologize yokuziphatha eqhelekileyo (ukuba imbi) kwaye ikhokelele kuxilongo olugqithisileyo kunye nonyango olugqithisileyo. Allen J. Frances, unjingalwazi we zengqondo kunye nesayensi yokuziphatha kwiYunivesithi yaseDuke esebenze kwi-DSM, uthe iinkcazo ezintsha zifikelela "kunyango lokuziphatha kwemihla ngemihla" kwaye ziya kudala "iindyikityha zobuxoki." I-inshorensi yempilo Iinkampani zixhalabile kukuba indlela entsha yokuxilonga inokuxabisa inkqubo yokhathalelo lwempilo amakhulu ezigidi zeerandi ngonyaka, njengoko uxilongo lusanda.

Kuhlala kukho ukusetyenziswa kakubi xa iindlela zokuxilonga zandiswa. Kodwa kwinqaku eliphambili lesayensi, abagxeki be-DSM abalunganga. Nanjengoko nabani na oqhelene nembali yokuxilongwa komlutha angakuxelela, utshintsho lwe-DSM lubonisa ngokuchanekileyo ukuqonda kwethu ukuba kuthetha ukuthini ukuba likhoboka.

Ingqikelelo yokuba likhoboka itshintshile kwaye isanda kangangeenkulungwane. Ekuqaleni, yayingeyongcamango yezonyango. KwiRoma yamandulo, “ukukhotyokiswa” kwakubhekisela ekuxhomekekeni ngokusemthethweni: iqhina lobukhoboka elalijoliswa ngababolekisi abanetyala. Ukusukela kwinkulungwane yesibini yeXesha Eliqhelekileyo ukuya koo-1800s, “ukukhotyokiswa” kwachaza utyekelo olubhekiselele kulo naliphi na inani lemikhwa eyingozi, njengokufunda nokubhala ngokugqithisileyo okanye ukuzinikela kobukhoboka kwinto oyithandayo. Eli binzana lalidla ngokuthetha ubuthathaka okanye ukusilela kwimilinganiselo yokuziphatha.

"Umlutha" wangena kwi-lexicon yezonyango kuphela ekupheleni kwekhulu le-19, ngenxa yokugqithiswa kwe-opium kunye ne-morphine ngoogqirha. Apha, ingqikelelo yokukhotyokiswa iye yabandakanya ingcamango yento ephuma ngaphandle ethatyathwe emzimbeni. Ukuqala ekuqaleni kwenkulungwane yama-20, enye into ephambili ekufumaniseni ukuba likhoboka lotywala kukwenzeka kweempawu zokurhoxa ngokwasemzimbeni xa uyeka loo nto kuthethwa ngayo.

Le nkcazo yokulutha yayingasoloko isetyenziswa ngononophelo (ithathe iminyaka ngotywala kunye nicotine ukubekwa kudidi olukhobokisayo, ngaphandle kokulifanelekela ityala), kwaye ayizange ibonakale ichanekile. Khawucinge ngoku inambuzane: ngeminyaka yoo-1980, xa ndandiqeqeshelwa ukuba ngugqirha, intsangu yayigqalwa njengengakhobokiyo kuba umntu otshayayo wayengafane abe neempawu zomzimba xa eyeka. Ngoku siyazi ukuba kwabanye abasebenzisi intsangu inokukhobokisa kakhulu, kodwa ngenxa yokuba ukucocwa kwechiza kwiiseli zamafutha omzimba kuthatha iiveki (endaweni yeeyure okanye iintsuku), ukurhoxa ngokwasemzimbeni kunqabile ukuba kwenzeke, nangona ukurhoxa ngokwasengqondweni kunokwenzeka.

Ngako oko, oogqirha abaninzi baye balwamkela utshintsho kwinkcazo yokulutha, kodwa abaninzi basagcina ukuba kuphela abo bantu batya into engaqhelekanga banokubizwa ngokuba likhoboka. Kule minyaka imbalwa idlulileyo, nangona kunjalo, iqela elikhulayo lobungqina besayensi libonise ukuba into engaphandle ayibalulekanga kangako ekukhobokeni kunenkqubo yesifo ebangelwa yinto engqondweni - inkqubo ephazamisa ukwakheka kwengqondo, inkqubo yokuthumela imiyalezo yeekhemikhali. kunye nezinye iindlela ezinoxanduva lokulawula iingcinga nezenzo.

Ngokomzekelo, ukususela ekuqaleni kweminyaka yee-1990, izazi ngengqondo uKent C. Berridge noTerry E. Robinson kwiYunivesithi yaseMichigan baye bafunda nge-neurotransmitter. dopamine, nto leyo ebangela ukuba umntu anqwenele. Baye bafumanisa ukuba xa uphinda uthatha into efana ne-cocaine, inkqubo yakho ye-dopamine iba yi-hyper-responsive, isenza ukuba iyeza libe nzima kakhulu ukuba ingqondo ekhobokileyo ingahoyi. Nangona iyeza ngokwalo lidlala indima ebalulekileyo ekuqaliseni le nkqubo, iinguqu kwingqondo ziyaqhubeka ixesha elide emva kokuba ikhoboka liyeka ukurhoxa: ukusebenzisa iziyobisi kunye neenkumbulo ziyaqhubeka ukuvusa inkanuko nkqu nakwabakhotyokisiweyo abaye bayeka iminyaka.

Ngaphaya koko, iqela lezazinzulu elikhokelwa nguNora Volkow kwiZiko leSizwe lokuSetyenziswa gwenxa kweZiyobisi lisebenzise iskena se-positron emission tomography (PET) ukubonisa ukuba naxa amakhoboka e-cocaine ebukela nje iividiyo zabantu abasebenzisa i-cocaine, amanqanaba e-dopamine ayanda kwinxalenye yobuchopho babo. ezinxulumene nomkhwa kunye nokufunda. Iqela likaDkt Volkow kunye nezinye izazinzulu ziye zasebenzisa i-PET scans kunye nokusebenza imaginance magnetic resonance ukubonisa ukuphambuka okufanayo kwe-dopamine receptor kubuchopho bamakhoboka eziyobisi, abangcakazi abanyanzelekileyo kunye nabatya kakhulu abatyebe kakhulu.

Isigqibo sokuzoba apha kukuba nangona izinto ezinjenge-cocaine zisebenza kakhulu ekuqaliseni utshintsho kwingqondo ekhokelela ekuziphatheni okukhobokisayo kunye nezibongozo, ayisiyiyo kuphela into enokubakho: malunga nawo nawuphi na umsebenzi oyonwabisa kakhulu-isondo, ukutya, ukusetyenziswa kwe-Intanethi - unakho ukukhobokisa kwaye uyonakalisa.

Iinkcazo zesifo ziyatshintsha ngokuhamba kwexesha ngenxa yobungqina obutsha besayensi. Yile nto yenzekileyo nge-addiction. Kufuneka samkele indlela entsha ye-DSM kwaye sihlasele zonke izinto kunye nokuziphatha okukhuthaza umlutha ngonyango olusebenzayo kunye nenkxaso.

Howard Markel, ugqirha kunye nonjingalwazi wembali yeyeza kwiYunivesithi yaseMichigan, umbhali we "An Anatomy of Addiction: Sigmund Freud, William Halsted, kunye noMmangaliso weziyobisi Cocaine."

Uphuhliso olunomdla olunokuthi ekugqibeleni ludlule i-DSM kunye nezopolitiko zayo, ngelixa ibonelela ngokhathalelo olungcono kwizigulana- kwaye ngaphezu kwayo yonke into yokuqonda ngcono i-physiology ye-mentaldisorders… mhlawumbi kubandakanya umlutha wokuziphatha.

05/05/2013

UThomas Insel, umlawuli we-NIMH, usanda kukhupha le ngxelo iphathelele kwi-DSM5: http://www.nimh.nih.gov/about/director/2013/transforming-diagnosis.shtml.

Nantsi itekisi:

Ukuguqulwa kwesifo

By Thomas Insel Ngo-Apreli 29, 2013

Kwiiveki ezimbalwa, i-American Psychiatric Association iya kukhulula uhlelo lwayo olutsha lwe-Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Lo mqulu uya kulungisa iindidi ezininzi zangoku zokuxilonga, ukusuka kwi-autism spectrum disorders ukuya kwi-mood disorder. Ngelixa uninzi lwezi nguqu ziye zaxambulisana, imveliso yokugqibela ibandakanya uninzi lweenguqulelo ezithobekileyo zohlelo lwangaphambili, olusekwe kwiimbono ezintsha ezivela kuphando ukususela ngo-1990 xa i-DSM-IV yapapashwa. Ngamanye amaxesha olu phando lucebise iindidi ezintsha (umzekelo, ukuphazamiseka kwemood dysregulation) okanye ukuba iindidi zangaphambili zinokuyehliswa (umz., i-Asperger's syndrome).1

Injongo yale ncwadana intsha, njengazo zonke iintlelo zangaphambili, kukubonelela ngolwimi oluqhelekileyo lokuchaza i-psychopathology. Ngelixa i-DSM iye yachazwa njenge "Bhayibhile" yentsimi, eyona nto ingcono, isichazi-magama, idala uluhlu lweelebhile kunye nokuchaza nganye. Amandla ohlelo ngalunye lwe-DSM luye "luthembekile" - uhlelo ngalunye luye lwaqinisekisa ukuba oogqirha basebenzisa amagama afanayo ngeendlela ezifanayo. Ubuthathaka kukunganyaniseki kwayo. Ngokungafaniyo neenkcazo zethu zesifo senhliziyo ye-ischemic, i-lymphoma, okanye i-AIDS, ukuxilongwa kwe-DSM kusekelwe kwimvumelwano malunga namaqela eempawu zeklinikhi, kungekhona nayiphi na injongo yebhubhoratri. Kulo lonke iyeza, oku kuya kulingana nokudala iinkqubo zokuxilonga ezisekelwe kubume bentlungu yesifuba okanye umgangatho wefiva. Ngokwenene, uxilongo olusekwe kwiimpawu, olukhe lwaxhaphakile kwezinye iindawo zonyango, luthatyathelwe indawo ikakhulu kwisiqingatha senkulungwane edlulileyo njengoko siye saqonda ukuba iimpawu zodwa azifane zibonise olona nyango lulungileyo lonyango.

Izigulana ezinokuphazamiseka kwengqondo zifanelwe ngcono. I-NIMH isungule i Iikhrayitheriya zoPhando lweDomain (RDoC) iprojekthi yokuguqula uxilongo ngokubandakanya imfuzo, umfanekiso, inzululwazi yokuqonda, kunye namanye amanqanaba olwazi ukubeka isiseko senkqubo entsha yokuhlela. Ngothotho lweeworkshops kwiinyanga ezili-18 ezidlulileyo, sizame ukucacisa iindidi ezininzi zenosology entsha (jonga ngezantsi). Le ndlela yaqala ngeengcinga ezininzi:

  • Indlela yokuxilonga esekelwe kwibhayoloji kunye neempawu kufuneka inganyanzelwa ziindidi zangoku zeDSM,
  • Ukuphazamiseka kwengqondo kukuphazamiseka kwebhayoloji ebandakanya iisekethe zobuchopho ezibandakanya imimandla ethile yokuqonda, imvakalelo, okanye indlela yokuziphatha,
  • Inqanaba ngalinye lohlalutyo kufuneka liqondwe kuwo wonke umlinganiso womsebenzi,
  • Ukwenza imephu yengqondo, isekethe, kunye nemiba yofuzo yokuphazamiseka kwengqondo kuya kunika iithagethi ezintsha nezingcono kunyango.

Kuye kwacaca ngokukhawuleza ukuba asikwazi ukuyila inkqubo esekelwe kwi-biomarkers okanye ukusebenza kwengqondo kuba siswele idatha. Ngale ndlela, i-RDoC sisikhokelo sokuqokelela idatha efunekayo kwi-nosology entsha. Kodwa kubalulekile ukuqonda ukuba asinakuphumelela ukuba sisebenzisa iindidi ze-DSM "njengomgangatho wegolide."2 Inkqubo yokuxilongwa kufuneka isekelwe kwidatha yophando oluvelayo, kungekhona kwiindidi zangoku ezisekelwe kwiimpawu. Khawucinge ngokuthatha isigqibo sokuba ii-EKGs bezingeloncedo kuba izigulana ezininzi ezineentlungu zesifuba bezingenayo utshintsho lwe-EKG. Yiloo nto ebesiyenza amashumi eminyaka xa sisala i-biomarker kuba ayiboni udidi lwe-DSM. Kufuneka siqale ukuqokelela i-genetic, imaging, physiologic, kunye nedatha yokuqonda ukubona indlela yonke idatha - kungekhona nje iimpawu - iqoqo kunye nendlela ezi qela zihambelana ngayo nempendulo yonyango.

Kungenxa yoko le nto i-NIMH iya kuphinda iqhelanise uphando lwayo kude neendidi zeDSM. Ukuqhubela phambili, siya kuxhasa iiprojekthi zophando ezijonge kwiindidi zangoku - okanye ukwahlula-hlula iindidi zangoku - ukuqalisa ukuphuhlisa inkqubo engcono. Kuthetha ntoni oku kubafaki-zicelo? Ulingo lwezonyango lunokufunda zonke izigulana kwikliniki yeemvakalelo kunezo zidibana neendlela ezingqongqo zoxinzelelo olukhulu loxinzelelo. Uphononongo lweempawu zebhayoloji "zoxinzelelo" lunokuqala ngokujonga kuzo zonke iziphazamiso ezininzi nge-anhedonia okanye ukuthambekela kovavanyo lweemvakalelo okanye ukudodobala kwengqondo ukuqonda ukujikeleza okuphantsi kwezi mpawu. Kuthetha ntoni oku kwizigulana? Sizimisele kunyango olutsha nolungcono, kodwa sivakalelwa kukuba oku kuya kwenzeka kuphela ngokuphuhlisa inkqubo yoxilongo echane ngakumbi. Esona sizathu silungileyo sokuphuhlisa i-RDoC kukufuna iziphumo ezingcono.

I-RDoC, okwangoku, yinkqubo yophando, kungekhona isixhobo seklinikhi. Le yiprojekthi yeminyaka elishumi esandula ukuqalisa. Abaphandi abaninzi be-NIMH, esele begxininiswe kukuncitshiswa kwebhajethi kunye nokhuphiswano olunzima lwenkxaso-mali yophando, abayi kwamkela olu tshintsho. Abanye baya kubona i-RDoC njengomsebenzi wezemfundo oqhawule umtshato kwiklinikhi. Kodwa abaguli kunye neentsapho kufuneka balwamkele olu tshintsho njengenyathelo lokuqala eliya “mayeza ochanekileyo,” intshukumo eye yaguqula ukuxilongwa nonyango lomhlaza. I-RDoC ayisiyonto ingaphantsi kwesicwangciso sokuguqula ukwenziwa kweklinikhi ngokuzisa isizukulwana esitsha sophando ukwazisa indlela esixilonga ngayo kunye nokunyanga ukuphazamiseka kwengqondo. Njengoko iingcali ezimbini ezidumileyo zemizila yengqondo kutshanje ziye zaqukumbela ngelithi, “Ekupheleni kwenkulungwane ye-19, kwakusengqiqweni ukusebenzisa indlela elula yoxilongo eyayinikela ubungqina obusengqiqweni. Ekuqaleni kwenkulungwane yama-21, kufuneka sibeke izinto esizibonayo phezulu.”3

Ezona ndawo ziphambili zophando lweRDoC:

IiNkqubo zeValence eziNcedayo
IiNkqubo zeValence eziPositive
IiNkqubo zoQoqosho
IiNkqubo zeeNkqubo zeNtlalo
IiNkqubo zokuVusa/zoModyuli

Ucaphulo

1Impilo yengqondo: Kwi-spectrum. UAdam D. Indalo. 2013 Apr 25; 496 (7446): 416-8. doi: 10.1038/496416a. Akukho bungqina bukhoyo. PMID: 23619674

2Kutheni kuthathe ixesha elide kangaka ukuba i-biological psychiatry iphuhlise iimvavanyo zeklinikhi kwaye wenze ntoni ngayo? Kapur S, Phillips AG, Insel TR. Mol Psychiatry. 2012 Dec;17(12):1174-9. doi: 10.1038/mp.2012.105. Epub 2012 Aug 7.PMID:22869033

3I-Kraepelinian dichotomy-iyahamba, ihamba… kodwa ayihambanga. UCraddock N, uOwen MJ. U-Br J Psychiatre. 2010 Feb;196(2):92-5. doi: 10.1192/bjp.bp.109.073429. PMID: 20118450