Ukucatshungulwa kwenkcazo Prause et al., I-2015 (okuyi-citation 87)
Uphononongo olusebenzisa i-EEG, oluqhutyelwa ngu-Prause kunye noogxa, lucetyiswa ukuba abantu abaziva bexinekile malunga noonografi babo basebenzise, xa kuthelekiswa neqela elilawulayo abangaziva bacinezelekanga malunga nokusetyenziswa kwabo koononografi, bangadinga ukubonakala okubonakalayo / okubonakalayo ukukhupha ubuchopho [87]. Abathathi-nxaxheba be-Sexualhood-abantu bahlangabezana neengxaki ezilawula ukujonga kwabo imifanekiso yesondo '(MIiyure ze-3.8 ngeveki) -bonakaliswe ukusebenziswa okungaphantsi kwe-neural (kulinganiswa ngethuba elibonakalayo kwi-EEG signal) xa kuboniswe kwimifanekiso yesondo kunokuba iqela elifanisayo xa liboniswe kwimifanekiso efanayo. Ngokuxhomekeke ekuchazeni isicatshulwa ngokwesini (njengesiqhelo okanye umvuzo; ngokuba ngaphezulu ubone iGlal et al. [4]), iziphumo ziyakwazi ukuxhasa ezinye iimboniselo ezibonisa iziphumo zokubamba izilingo [4]. Kwi-2015, i-Banca kunye noogxa baqaphele ukuba amadoda anama-CSB akhetha umdlalo wezesondo kunye nomboniso wokufumana iziphakamiso zenkcubeko kwi-DACC xa evezwe ngokuphindaphindiweyo kwimifanekiso efanayo [88]. Iziphumo zezifundo ezikhankanywe ngasentla zibonisa ukuba ukusetyenziswa koonografi rhoqo kunokunciphisa umonakalo wemivuzo, mhlawumbi ekhokelela ekwandiseni ukunyamezela nokunyamezela, ngaloo ndlela kuphuculwe imfuneko yokuvuselela ngakumbi ukuvuselelwa ngokwesondo. Nangona kunjalo, uphando lwexesha elide luboniswa ukuba luhlolisise oku kwenzeka. Kuthathwe ndawonye, uphando lwe-neuroimaging kuze kube yimini lunike inkxaso ngenkxaso yokuba i-CSB ibelana ngokufana nezidakamizwa, ukugembula kunye nokuzilawula kwezemidlalo ngokubhekiselele kumanethiwekhi eengqondo kunye neenkqubo, ezibandakanya ukukhuthaza nokuhlala.
IMIBUZO: Ababhali bovavanyo lwangoku bayavumelana namanye amaphepha ahlaziywe ngoontanga- Iingcaphephe ezihlaziyiweyo zontanga Prause et al., 2015: Ukufunda okuphantsi kwe-EEG kuthetha ukuba izifundo zihlawula ingqalelo emininzi imifanekiso. Babenxunguke (bajwayele okanye banqabile). Umbhali okhokelayo (uNicole Prause) uyaqhubeka efuna ukuba le miphumo "debunk umlutha wezobisi", kodwa abanye abaphandi abavumelani nemibono yakhe phezulu. Kufuneka uzibuze - "Yintoni usosayensi osemthethweni bangaba bathi ukufundwa kwabo okungahambisani nokuhlambulukileyo kuye kwasusa a kwintsimi efunyenweyo yokufunda? ".
- Umdumo uN, uSteele VR, uSteley C, uSabatinelli D, uProudfit GH. Ukumodareyithwa kwezinto ezinokuthi zenzeke ngokukhawuleza ngeemifanekiso zesondo kubasebenzisi beengxaki kunye nokulawula okuhambelaniyo "nokuluthwa koonwabo". Biol Psychol. 2015; 109: 192-9.
Abstract
Injongo yohlolo: Ukuhlaziywa kwangoku kushwankathela ukufunyaniswa kwangoko malunga neendlela ze-neurobiological ze-compulsive disorder behavior disorder (CSBD) kwaye inikeza iingcomo zophando oluthile malunga nolwahlulo lwezifo.
Ukufunyanwa kwangoku: Okwangoku, uphando oluninzi lwe-neuroimaging ngokuziphatha ngokunyanisekileyo kwezesondo lubonelele ubungqina beendlela ezigqithisileyo ezibangelwa ukuziphatha okubi ngokwesondo kunye neziyobisi ezingekho zesondo. Ukuziphatha ngokunyanisekileyo ngokwesondo kuhambelana nokusebenza okutshintshileyo kwingingqi yengqondo kunye noonxibelelwano olubandakanyekayo ekukhuliseni, ukuhlala, ukuguqulwa komtsalane, kunye nokuhlaziywa komvuzo kwiipatheni ezinjengezinto, ukugembula, kunye nemilutha yokudlala. Iingingqi eziphambili zengqondo ezixutywe kwiimpawu ze-CSB ziquka i-cortices yangaphambili neyexeshana, i-amygdala, kunye ne-striatum, kuquka ne-nucleus accumbens.
isishwankathelo: Nangona uphando olunzulu lwe-neuroscience lufumana ukufana okuninzi phakathi kwe-CSBD kunye nezidakamizwa zokuziphatha, iNdibano yezeMpilo iquka i-CSBD ICD-11 njengengxaki yokulawula ingqondo. Nangona uphando lwangaphambili luye lwanceda ekugqibeleni iinkqubo ezithile ezisemgangathweni zolu meko, uphando olongezelelweyo lufunekayo ukuqonda ngokupheleleyo le ngxaki kunye nokulungisa iziganeko zokuhlukanisa i-CSBD.
intshayelelo
Indlela yokuziphatha ngokwesondo (CSB) sihloko esixutyushwayo esaziwa ngokuba ngumlutha wezocansi, ukuxhatshazwa ngokwesini, ukuxhomekeka ngokwesondo, ukunyanzelana ngokwesini, i-nymphomania, okanye ukuziphatha okungahambisani nokuziphatha ngokwesondo [1-27]. Nangona amazinga acacileyo angacacanga ngokunikezwa ngophando olunefuthe lwe-epidemiological, i-CSB iqikelelwa ukuba ifuthe i-3-6% yabantu abadala kwaye ixhaphake kubantu kunabesifazane [28-32]. Ngenxa yoxinzelelo kunye nokuphazamiseka okubangelwa ngabantu kunye nabasetyhini abane-CSB [4-6, 30, 33-38], iNhlangano yezeMpilo yehlabathi (i-WHO) icebise ukuquka i-Compulsive Sexual Disorder Disorder (CSBD) kwikhompyutha ezayo ye-11th Ulwahlulo lwaMazwe ngamazwe ngezifo (6C72) [39]. Oku kufakwa kufuneka kuncedise ukwandisa ukufikelela kwonyango kubantu abangabikhoyo, ukunciphisa ihlazo kunye neentloni ezinxulumene nokufuna uncedo, ukukhuthaza iinzame zophando, kunye nokwandisa ingqalelo kwilizwe jikelele [40, 41] .Sivuma ukuba kwiminyaka yokugqibela ye-20 kukho izichaso ezahlukeneyo ezisetyenziselwa ukuchaza ukuziphatha kakubi ngokwesondo zihlala zibonakalisa ukubandakanyeka ngokugqithiseleyo kwimisebenzi yezocwangciso ezingaselwanga (eg, ukulala ngokungaqhelekanga / ukungabonakali ngesondo, ukusetyenziswa kakubi kwezonografi). Ukuhlaziywa kwangoku, siya kusebenzisa i-CSB njengexesha eliqhelekileyo lokuchaza ingxaki, ukuziphatha okubi ngokwesondo.
I-CSB icatshulwa njengengxaki yokunyanzelisa-ingxaki, i-disorder-control control, okanye i-addictive behavior [42, 43]. Iimpawu ze-CSBD zinjengezo zicetywayo kwi-2010fort DSM-5 ukuxilongwa kwe-hypersexual disorder [44]. Ingxaki yokuxhatshazwa kobuxhakaxhaka ekugqibeleni yayingabandakanywa nguMbutho wezeMpilo waseMerika ukusuka DSM-5 ngezizathu ezininzi; Ukungabikho kwezifundo ze-neurobiological kunye nezofuzo kwakuphakathi kwezona zizathu ezichaziweyo [45, 46]. Ngoku kutshanje, i-CSB ifumene ingqwalasela enkulu kwiinkcubeko zentlalo kunye nezentlalo zentlalo, ngokukodwa ukunikezelwa kwempilo echaphazelekayo echaphazela umngcipheko kunye namaqela angalondoloziwe. Nangona ukwanda okwenziwe kwizifundo ze-CSB (kubandakanywa nabafundi "ukuxhatshazwa ngokwesini," "ukuxhatshazwa ngokwesini," "ukunyanzelisa isondo"), uphando oluncinane luye lwahlola i-neural underpinnings ye-CSB [4, 36]. Eli nqaku lijonga iindlela ze-neurobiological ze-CSB kwaye linika iingcebiso malunga nophando lwexesha elizayo, ngokukodwa njengento ehambelana nokuhlelwa kwezifo ze-CSBD.
I-CSB njengengxaki yokuTyala
Iindawo zeBongo ezibandakanyekayo ekusebenziseni imivuzo kubalulekile ukuba kuqondwe imvelaphi, ukubunjwa, nokugcinwa kweziphathamandla zomlutha [47]. Izakhiwo ngaphakathi kwindlela ebizwa ngokuba 'inkqubo yokuvuza' isebenze ngokunyusa ukunyusa ama-stimuli, njengeziyobisi eziluthayo kwizidakamizwa. I-neurotransmitter enkulu ebandakanyekayo ekusebenzeni umvuzo i-dopamine, ngokukodwa ngaphakathi kwendlela ye-mesolimbic ebandakanya indawo ye-ventral tegmental (VTA) kunye nokudibanisa kwayo ne-nucleus accumbens (NAc), kunye ne-amygdala, i-hippocampus kunye ne-prefrontal cortex [48]. Ama-neurotransmitter eyongezelelweyo kunye neendlela zibandakanyeka ekusebenziseni umvuzo kunye nokuzonwabisa, kwaye ezi ziqinisekiso zibonelelwe ukuba i-dopamine iye yaxutyushwa kwizigaba ezahlukeneyo kwizidakamizwa kunye nokuziphatha kakubi kubantu [49-51].
Ngokomgaqo-mfundiso wokukhuthaza abantu, iindlela ezahlukeneyo zobuchopho zichaphazela ukuba bafumane umvuzo ('bafuna') kunye namava owona mvuzo ('uthanda') [52]. Nangona 'ukufunwa' kungabandakanywa ngokusondeleyo kwi-neurotransmission ye-dopaminergic kwi-ventral striatum (VStr) kunye ne-orbitofrontal cortex, amanxibelelwano anikezelwe ekudaleni izizathu ezifunayo kunye neemvakalelo ezimnandi zinzima kakhulu [49, 53, 54].
Ukuphinda usebenze kwakhona okunxulumene nomvuzo kwi-VStr kuye kwafundwa kwiziphazamiso ezinjengotywala, icocaine, ukuphazamiseka kokusetyenziswa kweopioid, kunye nengxaki yokungcakaza [55-58]. IVolkow kunye noogxa bachaza izinto ezine ezibalulekileyo zokulutha: (1) uvakalelo olubandakanya ukwenziwa kwakhona kwe-cue kunye nokunqwenela, (2) ukungafuneki kokubandakanya ukuhlala, (3) ukungazenzisi, kunye (4) neenkqubo zoxinzelelo ezingasebenzi kakuhle [59]. Ukuza kuthi ga ngoku, uphando lwe-CSB lujolise ikakhulu ekusebenzeni kwakhona kwe-cue, umnqweno, kunye nokuhlala. Izifundo zokuqala ze-neuroimaging ze-CSB zazigxile ekuhloleni ukufana okunokwenzeka phakathi kwe-CSB kunye neziyobisi, kugxilwe ngakumbi kwithiyori yenkuthazo esekwe kulwazelelo lwe-neural sensitization olunxulumene notshintsho kwiinkqubo ezinomdla ezinxulumene nedopamine [60]. Kule modeli, ukubonakaliswa okuphindaphindiweyo kwiziyobisi ezinokubakho kunokutshintsha iiseli zengqondo kunye neesekethe ezilawula ukubonakaliswa kwesikhuthazo kwisikhuthazo, eyinkqubo yengqondo ebandakanyeka kukuziphatha okukhuthazayo. Ngenxa yokuvezwa, imijikelezo yobuchopho inokuba ne-hypersensitive (okanye yonyuswe), ngaloo ndlela inegalelo kuphuhliso lwamanqanaba e-pathological of incentive salience yezinto ekujoliswe kuzo kunye neendlela ezinxulumene nazo. Inkuthazo yenkuthazo ('yokufuna') iziyobisi inokuhlala iminyaka, nokuba ukusetyenziswa kweziyobisi kuyekiwe. Inokubandakanya ukungacacanga (ukufuna ukungazi) okanye iinkqubo ezicacileyo (ukunqwenela ukuqonda). Imodeli yenkuthazo iye yacetyiswa ukuba inokuba negalelo kuphuhliso kunye nokugcinwa kwe-CSB [1, 2].
Iinkcukacha zenkxaso zenkxaso yesimo se-sentience se-CSB. Umzekelo, iVoon kunye noogqirha bahlola umsebenzi owenziwe ngeculo kwi-corsulate cortex yangaphakathi (i-DACC) -Vstr -amygdala inethiwekhi yomsebenzi [1] .Men ne-CSB xa kuthelekiswa nalabo abangenawo ngaphandle babonise ukwandisa i-VStr, i-DACC kunye neempendulo ze-amygdala kwividiyo yezononografi umboniso. Ezi ziphumo kumxholo weencwadi ezininzi zibonisa ukuba ubulili kunye nokusetyenziswa kweziyobisi zibandakanya iziganeko ezinkulu kunye nezixhumo [61, 62]. Amadoda ane-CSB xa kuthelekiswa nalabo abangenanto bavakaliswe ngokuphezulu (umnqweno wesondo othobelayo) we-pornography kunye nokuthanda okungaphantsi okuhambelana nenkolelo yokukhuthaza i-1]. Ngokufanayo, iMechelmans kunye nabalingane bafumene ukuba amadoda anama-CSB xa kuthelekiswa namadoda ngaphandle angabonakalisa ukunyanzeliswa kwangaphambili kwintsebenzo engacacanga ngesondo kodwa kungabandakanyekanga [2]. Ezi ziphumo zibonisa ukuba kufana nokugqithiswa kwenkcazo ebonakalayo kwiziphumo zophando lwezilwanyana kwizidakamizwa.
Ku-2015, uSeok noSohn bafumanisa ukuba phakathi kwamadoda anama-CSB xa kuthelekiswa nalabo abangenalo, umsebenzi omkhulu wawuboniswa kwi-cororx ye-preforeal cortex (dlPFC), i-caudate, i-gyrus engaphantsi kwe-lobe ye-parietal lobe, i-DACC kunye ne-thalamus ekuphenduleni kwizesondo [63]. Kwakhona bafumanisa ukuba ubunzima beempawu ze-CSB behambelana nokusebenziselwa ukukhutshwa kwe-dlPFC kunye ne-thalamus. Kwi-2016, iBrith kunye nabalingane babone ukusebenza okukhulu kwe-VStr kwizinto eziphathekayo zoononophala xa kuthelekiswa nezinto ezingafaniyo zoononopopasho phakathi kwabantu abane-CSB kwaye bafumanisa ukuba umsebenzi we-VStr wawuxhomekeke ngokuqinisekileyo kunye neempawu ezizimeleyo zokusetyenziswa kwezilonda zoononografi ze-intanethi (ezihlolwe Uvavanyo olufutshane lwe-Intanethi ye-Intanethi luguqulelwe kwi-cybersex (i-IATsex). [64, 65].
I-klucken kunye noogqirha baqaphele nje ukuba abathathi-nxaxheba be-CSB xa kuthelekiswa nabathathi-nxaxheba ngaphandle kokubonisa ukusebenze okukhulu kwe-amygdala ngexesha lokuboniswa kweziqulatho ezimiselweyo (izikwere zemibala) ziqikelele imifanekiso engabonakaliyo (imivuzo) [66]. Ezi ziphumo zinjengezo zivela kwezinye iincwadi ezihlola ukusebenzisiswa kwe-amygdala phakathi kwabantu abaneengxaki zokusebenzisa izidakamizwa kunye namadoda ane-CSB abukela ividyo kliphu zevidiyo (1, 67) .Usebenzisa i-EEG, uSteele kunye noogxa bajonga ukuphakama kweP300 kwimifanekiso yesondo (xa kuthelekiswa imifanekiso engathathi hlangothi) phakathi kwabantu abathile abazibandakanyekayo abaneengxaki ze-CSB, ukubonisana nophando olululo ngaphambi kokucwangcisa izilwanyana ezibonakalayo kwizidakamizwa [68, 69].
Kwi-2017, i-Gola kunye nabalingane bayashicilela iziphumo zesifundo ngokusebenzisa i-imagination magnontic resonance imaging (fMRI) ukuhlola iimpendulo ze-Vstr kwi-stiroli ye-erotic kunye nemali phakathi kwabantu abafuna unyango lwe-CSB kunye namadoda ngaphandle kwe-CSB [6]. Abathathi-nxaxheba babandakanyeka emsebenzini wokulibazisa [54, 70, 71] ngelixa behlaselwa i-fMRI. Ngethuba lo msebenzi, bafumana umvuzo okhuselekileyo okanye wemali olandelwa ngaphambili. Amadoda aphethe i-CSB ahluke kwalabo abangenawo kwiimpendulo ze-VStr ukubhekiselele ekuqaliseni imifanekiso engabonakaliyo, kodwa kungekhona kwiimpendulo zabo kwimifanekiso yomsindo. Ukongezelela, amadoda aphethe i-CSB ngokungafani ne-CSB abonise ukusebenze okukhulu kwe-VStr ngokukodwa ngokubhekiselele kwimifanekiso engabonakaliyo kwaye kungekhona abo baqikelela ukufumana umvuzo wemali. Ubuninzi bobudlelwane kunye neziganeko (ukuqikelela iifoto ezithandanayo kunye nokuzuza kweemali) kufumaneke ukuba zihambelana nokunyuka kwezinto zokuziphatha ezibonakalayo (ukufuna), ubuninzi be-CSB, inani lezithombe ezingcolileyo ezisetyenziswe ngeveki, kunye nokuphindaphinda kwe-weekly masturbation. Ezi ziphumo zibonisa ukufana phakathi kwe-CSB kunye nezilingo, inendima ebalulekileyo kwiziphumo ezifundwayo kwi-CSB, kwaye iindlela ezinokuthi zonyango zifikeleleke, ngokukodwa iindlela zokungenelela zijolise kwizakhono zokufundisa kubantu ukuba bahlangabezane ngokuphumelelayo nezifiso / unxusa [72]. Ukongezelela, ukuqhutyelwa kwendawo kungabonakaliswa ngokunciphisa ububele obunomdla ngokuqhelekileyo, kwaye kunokuchaphazela impendulo kwimibandela yesondo kuquka ukubukela iphonografi ukubukela kunye nobudlelwane bezesondo [1, 68]. Ukuhlala kwenzelwe kwakhona kwizinto eziphathekayo kunye nokuziphatha okubi [73-79].
Ku2014, Kuhn noGallinat baphawula ukunciphisa i-VStr reactivity ekuphenduleni imifanekiso engabonakaliyo kwiqela labathathi-nxaxheba bebukela iphonografi ngokuphindaphindiweyo, xa kuthelekiswa nabathathi-nxaxheba bebukela iphonografi ngokukhawuleza [80] .Ukuhlanganiswa kokusebenza phakathi kwe-dlPFC kunye ne-VStr ekunene kwagcinwa kwakhona. Ukuphazamiseka kwimijikelezo ye-fronto-bereatal kuhambelana nokukhetha okungalunganga okanye ukungalunganga kokuziphatha kungakhathaliseki ukuba kungabikho miphumo engalunganga kunye nokulawulwa kakubi kokufuna ukuxhatshazwa kweziyobisi [81, 82]. Abantu abathile abane-CSBmay banciphise ukulawula okulawulayo xa bebonakaliswe kwizinto eziphathekayo zobulili (83, 84]. U-Kuhn noGallinat bafumanisa ukuba imvalo yegreyiti ye-striatum eyiyo (i-cucate nucleus), eye yabandakanyeka ekusebenzisaneni nokuzibandakanya kunye nokuxhomekeke kumazwe achaphazelayo anxulumene nothando lomthandane, yayinxulumene kakubi kunye nobude be-intanethi ekhangayo [80, 85, 86]. Ezi ziphumo ziphakamisa ukuba ukusetyenziswa rhoqo kweentlophu zoonografi kunokunciphisa ukuqhutyelwa kwengqondo ekuphenduleni isenzo sezesondo kunye nokwandisa ubuqhetseba kwimifanekiso yesondo nangona uphando lwexesha elide ludinga ukukhuphela ezinye iimeko.
Uphononongo olusebenzisa i-EEG, oluqhutyelwa ngu-Prause kunye noogxa, lucetyiswa ukuba abantu abaziva bexinekile malunga noonografi babo basebenzise, xa kuthelekiswa neqela elilawulayo abangaziva bacinezelekanga malunga nokusetyenziswa kwabo koononografi, bangadinga ukubonakala okubonakalayo / okubonakalayo ukukhupha ubuchopho [87]. Abathathi-nxaxheba be-Sexualhood-abantu bahlangabezana neengxaki ezilawula ukujonga kwabo imifanekiso yesondo '(MIiyure ze-3.8 ngeveki) -bonakaliswe ukusebenziswa okungaphantsi kwe-neural (kulinganiswa ngethuba elibonakalayo kwi-EEG signal) xa kuboniswe kwimifanekiso yesondo kunokuba iqela elifanisayo xa liboniswe kwimifanekiso efanayo. Ngokuxhomekeke ekuchazeni isicatshulwa ngokwesini (njengesiqhelo okanye umvuzo; ngokuba ezinye zibona iGola et al. [4]), iziphumo zinganceda ezinye iimbonakaliso ezibonisa iziphumo zengxakini kwizilweliso [4] .2015, Banca kunye noogxa waqaphela ukuba amadoda anama-CSB akhetha umdlalo wezesini kunye nokubonakalisa iziphumo ezibonisa ukukhwabanisa kwi-DACC xa evezwe ngokuphindaphindiweyo kwimifanekiso efanayo [88]. Iziphumo zezifundo ezikhankanywe ngasentla zibonisa ukuba ukusetyenziswa koonografi rhoqo kunokunciphisa umonakalo wemivuzo, mhlawumbi ekhokelela ekwandiseni ukunyamezela nokunyamezela, ngaloo ndlela kuphuculwe imfuneko yokuvuselela ngakumbi ukuvuselelwa ngokwesondo. Nangona kunjalo, uphando lwexesha elide luboniswa ukuba luhlolisise oku kwenzeka. Kuthathwe ndawonye, uphando lwe-neuroimaging kuze kube yimini lunike inkxaso ngenkxaso yokuba i-CSB ibelana ngokufana nezidakamizwa, ukugembula kunye nokuzilawula kwezemidlalo ngokubhekiselele kumanethiwekhi eengqondo kunye neenkqubo, ezibandakanya ukukhuthaza nokuhlala.
I-CSB njengengxaki yokuLawula umxhasi?
Udidi lwe-"Impulse-Control Disorders" Lwase-DSM-IV lwaluyindalo enobunzima kwaye lubandakanya iziphazamiso ezininzi eziye zahlulwa kwakhona njengomlutha (ukungcakaza komngcipheko) okanye ukuxhamla-okunyanzelekileyo (i-trichotillomania) kwi-DSM- 5 [89, 90]. Inqanaba langoku kwi-DSM-5 ijolise ekuphazamiseni, ukulawulwa kwempembelelo kunye nokuphazamiseka kokuziphatha, ngokugqithiseleyo ekujoliseni kwayo ngokubandakanya i-kleptomania, i-pyromania, i-disorder disorder, i-disorder disorder disorder, i-disorder disorder, kunye ne-disorder personality disorder [90]. Udidi lweengxaki zokulawulwa kwefuthe kulo ICD-11iquka ezi ziintathu zokuqala iingxaki kunye ne-CSBD, ukuphakamisa imibuzo malunga nokuhlelwa okufanelekileyo. Ukunikezelwa kwesi sihloko, indlela i-CSBD ehambelana ngayo nokwakhiwa kwezinto ezingabonakaliyo iimvume zokubangela ukunyanzeliswa kwezixhobo kunye neenjongo zeklinikhi.
Ubunzima bungachazwa ngokuthi, "ulungelelwaniso olukhawulezayo, olungalindelekanga kwi-stimuli yangaphakathi okanye yangaphandle ngokunciphisa imiphumo emibi kumntu onomdla okanye kwabanye" [91]. Ubutyebi budibanisene noxhatshazo [92]. Ubutyebi buyakhela iindidi ezahlukeneyo (umz., Ukhetho, impendulo) enokuba nempawu kunye neemeko zesimo [93-97]. Iindlela ezahlukeneyo zokungafuneki zingahlolwa nge-self-ingxelo okanye ngemisebenzi. Ziyakwazi ukudibanisa ngokuthe tye okanye kungekhona zonke, nangonahlobo olufanayo lokungafuneki; Kubalulekile, banokuthi badibanise ngokwahlukileyo kwimpawu zeklinikhi kunye neziphumo [98]. Impendulo yokuphendula ingathatyathwa ngumsebenzi kwimisebenzi yokulawula i-inhibitory, njengesigxina sokuyeka okanye i-Go / No-Go imisebenzi, kanti ukunyanzeliswa kokukhetha kungavanywa ngokulibazisa ukuphuhlisa imisebenzi [94, 95, 99].
Iinkcukacha zibonisa ukungafani phakathi kwabantu abane-CSB kunye neengxelo ezizenzekelayo zokwenza umxhelo [100-103]. Ukongezelela, ukungafuneki kunye nokulangazelela kubonakala kunxulumene nobuqhetseba beempawu zokusetyenziswa koonografi okutyeshelweyo, njengokulahlekelwa kolawulo [64, 104]. Ngokomzekelo, uphando oluthile lufumene impembelelo echaphazelekayo yamanqanaba okungafunekiyo alinganiswe yimibiko-ngokwabo kunye nemisebenzi yokuziphatha ngokubhekiselele kwimpembelelo yokubangela ubunzima be-CSB [104].
Phakathi kweesampula zokufuna unyango, i-48% ukuya kwi-55% yabantu ingabonisa amanqanaba aphezulu okungafunekiyo kwi-Barratt Impulsiveness Scale [105-107]. Ngokwahlukileyo, enye idatha ibonisa ukuba ezinye izigulane ezifuna unyango kwi-CSB azikho ezinye iimpawu zokuzikhusela okanye izidakamizwa ezingadluliyo ngaphaya kobunzima bezenzo zesondo ezihambelana neziphumo ezivela kwi-intanethi enkulu kwi-intanethi yamadoda nabasetyhini abonisa ukuba ubudlelwane obuthathaka phakathi kokushukunyiswa kwamanye iinkalo ze-CSB (ukusetyenziswa kweengcamango ezingcolileyo) kunye nobudlelwane obunamandla nabanye (ubuxhakaxhaka) [108, 109]. Ngokufanayo, kwisifundo usebenzisa amanyathelo ahlukeneyo abantu abaneengxaki zoononophala basebenzisa (ixesha elithethayo loononopophile beveki sebenzisa = imizuzu ye-287.87) kunye nalabo abangenawo (ixesha elithethileyo lezithombe zoonografi sebenzisa = imizuzu ye-50.77) awazange ahluke kwi-self-report (UPPS-P I-Scale) okanye isiseko esisekelwe kumsebenzi (I-Stop Signal Task) yokunyanzelisa [110] .Ngaphezulu, iReid kunye noogxa abazange babone ukungafani phakathi kwabantu abane-CSB kunye nokulawula okunempilo kwiimvavanyo ze-neuropsychological of functional management (oko kukuthi, ukumelana nokuphendula, isivinini seemoto, ukhetho ingqalelo, ukuphaphama, ukuguqulwa kwengqondo, ukubunjwa kwengqondo, ukumisa ukutshintsha), nangona emva kokulungelelanisa ikhono lokuqonda ukuhlalutya [103]. Ngokubambisana, ukufunyaniswa kubonisa ukuba ukunyanzelisa kungabinxulumanisa kakhulu ngokuxhomekeke kwi-hypersexual kodwa kungekho kwiifomu ezithile ze-CSB ezifana nokusetyenziswa koonografi okunengxaki. Iphakamisa imibuzo malunga nokuhlelwa kwe-CSBD njengengxaki yokulawula ingqondo ICD-11 kwaye igxininise imfuneko yokuvavanya ngokuchanekileyo kweefom ezahlukeneyo ze-CSB. Oku kubaluleke ngakumbi kuba uphando oluthile lubonisa ukuba ukungafuneki kunye nezifundo eziphantsi kweengxaki zengqondo zihluke kwiqondo lomqondo kunye ne-pathophysiological level [93, 98, 111].
CSB njenge-Obsessive-Compulsive-Spectrum Disorder?
Isimo esisodwa (i-trichotillomania) esichazwe njengengxaki yokulawulwa kwengqondo e-DSM-IV iye yahlonywa kwakhona ngengxaki yokunyanzela (OCD) njengengxaki yokunyanzelisa kunye neyohambelana ne-DSM-5 [90]. Ezinye i-DSM-IV iziphazamiso zokulawulwa kwemingcipheko njengokungcakaza komngcipheko kubonisa ukungafani okukhulu kwi-OCD, ukuxhasa udidi lwabo kwiindidi ezahlukileyo [112]. Ukunyanzeliswa yinto yokwakha i-transdiagnostic ebandakanya, "ukusebenza ngokuphindaphindiweyo nokusebenza kakubi ngaphezu komsebenzi okanye ukuziphatha okungekho ngaphandle komsebenzi oguquguqukayo, owenziwe ngendlela echanekileyo okanye eqhelekileyo, mhlawumbi ngokwemiqathango eqinile okanye njengendlela yokuphepha imiphumo emibi" [93]. I-OCD ibonisa amanqanaba aphezulu okunyanzelisa; nangona kunjalo, ngoko utywala kunye nokuziphatha kakubi njengengxaki yokugembula [98]. Ngokwesiko, ukuphazamiseka okunyanzelekileyo kunye nokungathandabuzeki kwakunjengokulala kwiindawo eziphambene nemida; Nangona kunjalo, idatha ibonisa ukuba kwakhiwa njengendlela yokuziphatha kunye neengxaki ezininzi ezibeka amanqaku aphezulu kwiimilinganiselo zombini kunye nokunyanzeliswa [93, 113]. Ngokubhekiselele kwi-CSB, ukugqithiswa ngokwesini kuye kwachazwa njengexesha elidlulayo kwaye liphazamise kwaye lingadibana ngokuthe ngqo kwi-OCD okanye kwiinkcukacha ezihlobene ne-OCD [114].
Izifundo zakamuva zihlola iimpawu eziphosakeleyo ezisebenzisa i-Obsessive-Compulsive Inventory -Revised (OCI-R) ayizange ibonise ukuphakama phakathi kwabantu abane-CSB [6, 37, 115]. Ngokufanayo, uphando olukhulu lwe-intanethi lufumene iinkalo zobunyanzeliso kuphela ezinxulumene neengxaki zoonografi ezisetyenziswayo [109]. Ngokubambisana, ezi ziphumo azibonisi inkxaso enamandla yokuqwalasela i-CSB njengengxaki ehambelana nokunyanzelisa. Iimpawu ze-Neural eziphantsi kokuziphatha okunyanzelekileyo ziye zachazwa kwaye zahlukana phakathi kwezifo ezininzi [93]. Uphando olongezelelweyo usebenzisa iindlela ze-psychometrically validated and neuroimaging kwiinkqubo ezinkulu zonyango ezifuna iisampuli ziyafuneka ukuba zihlolisise ngakumbi indlela i-CSBD inokubambisana ngayo nokunyanzeliswa kunye ne-OCD.
Utshintsho olusenyakatho lweeNguqulo phakathi kwabakwa-CSB
Kulolu hlobo, uphando oluninzi lwe-neuroimaging lujolise ekuguqulweni komsebenzi kubantu abane-CSB, kwaye iziphumo zibonisa ukuba iimpawu ze-CSB zidibaniswe neenkqubo ezithile ze-neural [1, 63, 80]. Nangona uphando olusekelwe emisebenzini luye lwaphucula ulwazi lwethu malunga nokusebenza kwendawo kunye nokuxhunyeka komsebenzi, iindlela ezongezelelweyo kufuneka zisetyenziswe.
Amanyathelo amhlophe-okanye amakhanda afunde kwi-CSB [102, 116]. Kwi-2009, i-Miner kunye nabalingane bafumene ukuba abantu abane-CSB xa kuthelekiswa nalabo bengakhange baboniswe kummandla ophakamileyo ophezulu baphakamise ukungafani kwaye babonise ukulawulwa kokungabonakali. Kwisifundo samadoda angenawo ngaphandle kwe-CSB esuka kwi-2016, i-volume yamygdala engaphezulu kwesokunxele ibonwe kwiqela le-CSB kunye nokuxinwa okunxulumene nokuphucula ukusebenza kombuso kwagcinwa phakathi kwe-amygdala kunye ne-dlPFC [116]. Ukunciphisa imiqondo yengqondo kwi-lobe ye-temporal, i-lobe yangaphambili, i-hippocampus, kunye ne-amygdala zifunyaniswe zihambelana neempawu zokuxhatshazwa koxhatshazo kwizigulane ezineengqondo zokugula okanye isifo se-Parkinson [117, 118]. Ezi ndlela ezibonakala zichasayo ze-amygdala umqulu ochaphazelekayo kwi-CSB zigqamisa ukubaluleka kokuqwalasela izifo ezibangelwa ukusebenzisana kwe-neuropsychiatric ekuqondeni i-neurobiology ye-CSB.
Ku-2018, uSeok noSohn basebenzisa i-voxel-based based morphometry (VBM) kunye nokuhlaziywa kwe-state-analysis analysis ukuhlola i-gray and state-state measures in CSB [119]. Amadoda aphethe i-CSB abonisa ukunciphisa umgangatho ophezulu we-gray gyrus. Umthamo ophezulu we-temporal gyrus (STG) wawunxulumene kakubi kunye nobunzima be-CSB (oko kukuthi, uvavanyo lweSilual Addiction Screening Test-Uhlaziyiweyo [SAST] kunye neengqondo zokuziphatha koHlonipheko lwe-HBI] [120, 121]. Ukongezwa, ukuguqulwa kwesokunxele kwesigxina se-STG-ngasekhohlo kunye nokushiya kwe-STG-right-caudate connectivities kwagcinwa. Ekugqibeleni, iziphumo zibonise ukulungelelanisa okungahambiyo phakathi kobuqili be-CSB kunye nokuxhuma okusebenzayo kwe-STG ekhohlo ukuya kwi-nucleus efanelekileyo ye-caudate.
Nangona uphando lwe-neuroimaging ye-CSB luye lwakhanyisa, encinane isaziwa malunga neendlela zokutshintshwa kweengqondo kunye nokuxhumano olusebenzayo phakathi kwabantu abakwi-CSB, ngokukodwa kwizifundo zonyango okanye ezinye izinto eziphambili. Ukuhlanganiswa kweziphumo ezivela kwezinye iindawo (umzekelo, i-genetic ne-epigenetic) kuya kuba kubalulekile ukuqwalasela kwizifundo ezizayo. Ukongezelela, ukufunyaniswa ngokuthe ngqo ngokuchaphazelekayo kunye nokubandakanya amanyathelo okutshintshwa kwezibonelelo kuya kuvumela ukuqokelela ulwazi olubalulekileyo oluza kwazisa ulwahlulo nokuphuhliswa kokungenelela kwangoku.
Izigqibo kunye neNcomelo
Eli nqaku liphonononga ulwazi lwezesayensi malunga neendlela ze-neural ze-CSB ukusuka kwiimbono ezintathu: umlutha, ukulawula umtsalane kunye nokunyanzelisa. Ucwaningo oluninzi lubonisa ubudlelwane phakathi kwe-CSB kunye nokwanda komzwelo wokufumana umvuzo okhuselayo okanye ezinye iziganeko zokuqikelela ukuba le mivuzo, kwaye abanye bacetyisa ukuba i-CSB ihambelana nokunyuka kwe-cue-conditioning ye-stimuli ye-erotic [1, 6, 36, 64, 66]. Izifundo zibonisa ukuba iimpawu ze-CSB zidibene nokuxhalaba okuphezulu [34, 37,122]. Nangona kukho ikhefu ekuqondeni kwethu kwe-CSB, iindawo ezingundoqo zeengqondo (kubandakanywa i-frontal, i-parietal kunye ne-cortices yesikhashana, i-amygdala, kunye ne-striatum) idibene ne-CSB kunye nempawu ehambelana nayo.
I-CSBD ifakiwe kwiinguqulelo yangokuICD-11njenge-disorder-control control disorder [39]. Njengoko kuchazwe yi-WHO, 'Izifo zokulawulwa kwempembelelo zibonakaliswa ukungaphumeleli ngokuphindaphindiweyo ukuxhathisa umtsalane, ukuqhuba okanye ukukhuthaza ukuba wenze isenzo esivuyisa kumntu, ubuncinane kwixesha elifutshane, nangona ziphumo ezinjengexesha elide -monakalo kumntu okanye kwabanye, ukukhathazeka okubonakalayo malunga neendlela zokuziphatha, okanye ukuphazamiseka okubalulekileyo kumntu, kwintsapho, kwentlalo, kwimfundo, emsebenzini, okanye kwezinye izinto ezibalulekileyo zokusebenza '[39]. Iziphumo ezikhoyo ziphakamisa imibuzo ebalulekileyo malunga nokuhlelwa kwe-CSBD. Iziphazamiso ezininzi ezibonakaliswe yimpembelelo yokungaziphathi kakuhle zihlelwa kwenye indawo ICD-11 (umzekelo, ukugembula, ukudlala, kunye neengxaki zokusetyenziswa kweziyobisi zihlelwa njengengxaki yokulutha umlutha) [123].
Okwangoku, i-CSBD ibangela ingxaki ephezulu, kwaye ukulungiswa okuqhubekayo kweempawu ze-CSBD kufuneka kuhlukanise phakathi kwamacandelo ahlukeneyo, ezinye zazo ezinokuthi zihambelane nobunzima bezenzo zokuziphatha ngokwesini kubantu abathile [33, 108, 124]. I-Heterogeneity kwi-CSBD inokuthi ichaze into ethile ibonakala ingqinaniyo ebonakalayo kwizifundo. Nangona uphando lwe-neuroimaging lufumana ukufana okungafaniyo phakathi kwe-CSB kunye neziyobisi kunye nokuziphatha kakubi, kukho uphando olongezelelweyo olufunekayo ukuqonda ngokucacileyo indlela i-neurocognition ehambelana ngayo neempawu zekliniki ze-CSB, ngokukodwa ngokubhekiselele kwizenzo zokuziphatha zesini. Izifundo ezininzi ziye zagxila ekusebenziseni iingxaki zobuninzi bezilwanyana ezingcolileyo ezinokuthi zinciphise iziganeko zokuziphatha zesini. Ukuqhubela phambili, iinkqubo zokungeniswa / ukungabandakanywa kwabathathi-nxaxheba be-CSB ziye zahlukahluka kwiinkalo zezifundo, kwanokuphakamisa imibuzo malunga nokuveliswa kwemilinganiselo kunye nokuthelekiswa kwezifundo.
Izikhokelo zexesha elizayo
Kufuneka kuqatshelwe imingcele emininzi ngokuphathelele kwizifundo ezikhoyo ze-neuroimaging kwaye ziqwalaselwe xa zicwangcisa uphando oluzayo (jonga i-Table 1). Umlinganiselo osisiseko uquka amancinci amancinci amancinci ayenabantu abamhlophe, abesilisa kunye nobudlelwane obufanayo. Uphando olungakumbi lufunekayo ukufumana amaninzi amakhulu, amasampuli ahlukeneyo ngamadoda kunye nabasetyhini abane-CSB kunye nabantu ngabanye bobuqhetseba bolwazi ngokwesini. Ngokomzekelo, akukho uphando lwenzululwazi oluye lwacwangcisa uphando lweenkqubo ze-CSB kubasetyhini. Izifundo ezinjalo zifunekayo zinikezelwe iinkcukacha ezixhomekeke ekuthandaneni ngokwesini ngo-psychopathology enkulu kubasetyhini xa kuthelekiswa namadoda kunye nolunye ulwazi olubonisa ukungafani kwezesini kwiindawo zempilo kunye ne-CSB [25, 30]. Njengokuba abafazi kunye namadoda anomdaka angabonisa izizathu ezahlukeneyo (umz., Ngokubhekiselele ekungqineni okungahambisani nokuziqinisa) ukubandakanya ukuziphatha okuluthayo kwaye ubonise ukungafani koxinzelelo kunye nokunyangwa kwezidakamizwa, iinjongo ze-neurobiological ezizayo kufuneka ziqwalasele iinkqubo zokuxininisa kunye neenkqubo ezinxulumene nolwabelana ngesini uphando lwe-CSBD lunikezelwa ngoku ICD-11 njengengxaki yengqondo yengqondo [125, 126].
Ngokufanayo, kukho isidingo sokwenza uphando olusisigxina ngokubhekiselele kwiincinci zesini kunye nolwabelana ngesondo ukucacisa ukuqonda kwethu kwe-CSB phakathi kwala maqela. Izixhobo zokucoca ze-CSB ziye zavanywa kwaye ziqinisekiswe kumadoda amhlophe aseYurophu. Ngaphezu koko, iinjongo ezikhoyo zijolise kakhulu kwizidalwa zesini. Uphando olongezelelweyo luhlola iimpawu zeklinikhi ze-CSB phakathi kwamadoda abesilisa nabasetyhini kunye nabasetyhini kuyadingeka. Uphando lwe-neurobiological ngamacandelo athile (i-transgender, i-polyamorous, i-kink, enye) kunye nemisebenzi (ukubukela iinthombe zoonografi, ukukrexeza ngokunyanzela, ukulala ngesondo, kunye nezinye) kuyafuneka. Ngenxa yokulinganiselwa okunjalo, iziphumo ezikhoyo kufuneka zichazwe ngokucophelela.
Ukuthelekiswa ngokuthe ngqo kwe-CSBD kunye nezinye izifo (umzekelo, ukusetyenziswa kweziyobisi, ukugembula, ukudlala kunye nezinye izifo) kufuneka, njengoko kubandakanywa kweminye imodalities (umz., I-genetic, epigenetic) kunye nokusetyenziswa kwezinye iindlela zokucinga. Iindlela ezifana nepositron ukukhishwa kwe-tomography nazo zinokunika ingqiqo ebalulekileyo kwi-neurochemical underpinnings ye-CSBD.
Ukugqithiswa kwe-CSB kukwacaciswa kwakhona ngokuphonononga ngokucophelela kwimiba yeekliniki engayifumana inxalenye evela kuphando olulinganiselayo njengeendlela zokuhlola iindlela ze-orariary [37]. Uphando olunjalo lunokunika ingqiqo ngemibuzo engapheliyo njengokuba ingxaki yokusebenzisa iifoto zoonopopasho ingabangela ukungazibandakanyi ngokwesondo, kwaye ukudibanisa ukuhlolwa kwe-neurocognitive kwizifundo ezinjalo kunokunika ingqiqo kwiindlela ze-neurobiological. Ukongezelela, njengoko iindlela zokuziphatha kunye nezobugcisa zonyango zivivinywa ngokweenzame zabo zokuphatha i-CSBD, ukuhlanganiswa kovavanyo lwe-neurocognitive kunokunceda ukuchonga iindlela zokwenza unyango oluchanekileyo kwi-CSBD kunye nabanokuba ngababi bemvelo. Ingongoma yokugqibela ingabalulekanga ngokukhethekileyo kuba ukufakwa kwe-CSBD kuyo ICD-11 kuya kukwandisa inani labantu abafuna unyango lwe-CSBD. Ngokukodwa, ukufakwa kwe-CSBD kuyo ICD-11 kufuneka kuphakanyiswe izigulane, ababoneleli kunye nabanye kwaye banokususa ezinye izithintelo (umz., ukubuyisela imali evela kubanikezeli be-inshurensi) okwangoku ikhona kwi-CSBD.
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