Ukuxhatshazwa koThutho lwe-intanethi: Yintoni esiyayaziyo kunye nento esiyiyiyo-Ukuhlolwa kweNkqubo (2019)

LINK UKUFUNDA EZIQHELELEYO

I klinikhi. Med. 2019, 8(1), i-91; ikhonkco:10.3390 / jcm8010091

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

1 I-Psychiatry Service, Isibhedlele iClínico Universitario de Salamanca, i-Institute of Biomedical Research yaseSalamanca (IBSAL), i37007 Salamanca, eSpain

2 Yunivesithi yeSalmanca, EUEF, 37007 Salamanca, eSpain

Abstract

Kwiminyaka embalwa edlulileyo, kuye kwaba nomjelo wamaqaku anxulumene nezilingo zokuziphatha; Abanye babo bagxininisekile kwi-intanethi yoxilongo. Nangona kunjalo, nangona zonke iinzame, asikwazi ukufikelela kwiprofayili xa ukubandakanyeka kule mpawu kuba yintsholongwane. Iingxaki eziqhelekileyo zibandakanya: i-sampula ye-sampula, ukukhangela izixhobo zokuxilonga, ukuchasana nokuqhathaniswa nombandela, kunye nenyaniso yokuba le nto ingabandakanywa ngaphakathi kwezilwanyana ezinkulu (oko kukuthi, ukuxhatshazwa ngokwesondo) ezingabonakala ngezibonakaliso ezahlukeneyo. Izilingo zendlela yokuziphatha zenza insima enkulu yokufunda, kwaye ngokuqhelekileyo ibonisa indlela yokusebenzisa ingxaki: ukulahleka kolawulo, ukuphazamiseka, nokusetyenziswa kakubi. Ingxaki yokuxhatshazwa kobuxhakaxhakaxhaka ifanelana nale modeli kwaye inokuyilwa neendlela ezininzi zokuziphatha ngokwesondo, njengokusetyenziswa kweengxaki zoononografi kwi-intanethi (POPU). Ukusetyenziswa koononografi ku-intanethi kuphakanyisiwe, kunye nokuxhamla umlutha ngokubhekiselele kwimpembelelo "kathathu" (ukufikeleleka, ukufikelela, ukungaziwa). Ukusetyenziswa kolu ngxaki kunokuba nemiphumo emibi ekuphuculweni ngokwesini kunye nokusebenza ngokwesondo, ngakumbi phakathi kolutsha. Sijonge ukuqokelela ulwazi olukhoyo kwiinkcukacha zoononopopasho ze-intanethi ezisetyenziselwa ukusetyenziswa njengeziko lentsholongwane. Apha sizama ukufingqa into esiyayaziyo malunga nale nkampani kwaye sicacise ezinye iindawo ezifanele ukuphanda phambili.
Amagama abalulekileyo: i-pornography e-intanethi umlutha; kwi-cybersex; intanethi; yokuziphatha ngokwesondo; noxhatshazo

1. intshayelelo

Ngokubandakanywa kwe "Ingxaki yokuGembula" kwiSahluko se-DSM-5 "1], i-APA esidlangalaleni yavuma ukugqithiswa kokuziphatha. Ukongezelela, "I-Intanethi yeMidlalo yeMaha" yafakwa Icandelo 3Imiqathango yokuqhubela phambili isifundo.
Oku kubonisa ukuguqulwa kweparadigm eqhubekayo kwintsimi yobunzima ehambelana nokuziphatha komlutha, kwaye ivula indlela yophando olutsha ngokubhekiselele kutshintsho lwezenkcubeko ezibangelwa ubuchwepheshe obutsha.
Kukho ngokucacileyo ukuba i-neurobiological [2] kunye nokusingqongileyo [3] phakathi kweziphazamiso ezichasene nezidakamizwa, kuquka ukusetyenziswa kakubi kweziyobisi kunye nokuziphatha komlutha; oku kungabonakalisa njengokuba ukugqitywa kwezinto zombini [4].
Ukuqhelanisa, ukuziphatha ngokugqithiseleyo kwabantu kubonisa ukuba umzekelo wokusetyenziswa kweengxaki: ukulawulwa kakubi (umz., Ukuthanda, ukuzama ukunciphisa ukuziphatha), ukungonakali (umzekelo, ukunciphisa iminqweno, ukungahoywa kwezinye iindawo zobomi), kunye nokusetyenziswa okungengozini (ukuhlala okuqhubekayo nangona ukuqaphela ukulimaza iziphumo zengqondo). Ingaba ezi ziziganeko zidibanisa imilinganiselo yezinto eziphathekayo ezinxulumene nokulutha (ukunyamezela, ukuhoxiswa) kunokuxhatshazwa [4,5,6].
Ngezinye iinkathazo ukuxhatshazwa kobuxhatshaxhaka kuthethwa ngenye yezobisi zokuziphatha. Isetyenziselwa njengokwakhiwa kwe-ambulula equka ukuziphatha okuxhatshazayo (i-masturbation ngokweqile, i-cyber yobulili, ukusetyenziswa koonografi, ucingo lwezonxeba, ukuziphatha ngokwesondo kunye nabantu abadala, ukuvakashelwa kwebhola, njl njl.) [7]. Amanani ayo okusukela kwi-3% ukuya ku-6%, nangona kunzima ukucacisa ekubeni akukho nto ichazwe ngxaki yesifo [8,9].
Ukungabikho kolwazi olunzulu lwezesayensi kwenza ukuba uphando, ukuqonda kunye novavanyo lube nzima, okukhokelela kwiintlobo ezahlukeneyo zeziphakamiso zokuzichaza, kodwa ngokuqhelekileyo zihambelana nokukhathazeka okukhulu, iimvakalelo zentloni kunye nokungasebenzi kwengqondo [8], kunye nezinye iimpawu zokulutha [10] kwaye ifunwa ukuhlolwa ngokuthe ngqo.
Ngokukhawuleza, ukunyuka kobuchwepheshe obutsha kuye kwavula i-pool ye-behavior addictive behavior, ikakhulukazi i-Internet Addiction. Esi sigxina singagxininisa kwisicelo esithile kwi-intanethi (ukudlala, ukuthenga, ukubheja, i-intanethi ...) [11] kunye neendlela ezinokubangela umngcipheko wokuziphatha; Kule meko, iya kuba njengesitishi sokubonakaliswa kwekhonkrithi yendlela yokuziphatha [4,12]. Oku kuthetha ukunyuka okungenakukuphepha, ukubonelela izitsha ezitsha ezisemthethweni kunye nezilingo zabantu (ngenxa yokwandisa ubumfihlo, okanye ithuba) abangazange baqhube phambili kulezi ziphatho.
Ukusetyenziswa koononografi e-intanethi, eyaziwa ngokuba yi-intanethi yokusebenzisa i-intanethi okanye i-cybersex, ingaba enye yezo ziphatha ze-Intanethi zengozini yokulutha. Ihambelana nokusetyenziswa kwe-intanethi ukubandakanya kwimisebenzi eyahlukileyo yezesondo [13], phakathi kwelo limela ukusetyenziswa koononografi [13,14] ngowona msebenzi ogqithiseleyo [15,16,17] kunye nenani elingapheliyo leengxaki zesondo ezifikelelekayo [13,18,19,20]. Ukusetyenziswa okuqhubekayo ngale ndlela ngezinye izikhathi kuvela kwimali, ngokomthetho, emsebenzini, kunye nolwalamano lwengxaki [6,21] okanye iingxaki zomntu, kunye nemiphumo eyahlukileyo. Imiva yokulahleka kolawulo kunye nokusetyenziswa okuqhubekayo nangona ezi ziphumo ezimbi zibandakanya "ukunyanzeliswa kwezesondo kwi-intanethi" [22] okanye iNgxaki zeNgcaciso kwi-Internet Sebenzisa (POPU). Le ndlela yokusetyenziswa kweengxaki ezixhamlayo kwi-"Triple A" iimeko [23].
Ngenxa yalo mzekelo, ukuhlambalaza ngokugqithiseleyo okufana neentlobano zesono ezingamanyala, kunokuba kubekho kakhulu namhlanje, kodwa oku akusiyo impawu yezilwanyana [21]. Siyazi ukuba inani elincinane labantu abancinci abasebenzisa i-Intanethi yokusetyenziswa kwezithombe ezingcolileyo [24,25]; Enyanisweni, ngenye yezinto eziphambili zempilo yesondo [26]. Abanye baye bathetha ukukhathazeka ngale nto, ukujongana nexesha eliphakathi kwexesha xa izinto eziphathekayo zoononophelo zidlalwa okokuqala ngethuba, kunye namava okuqala ngokocansi; ngokukodwa, indlela yangaphambili inokuchaphazela ngayo uphuhliso lwezesondo [27] njengesifiso esingaqhelekanga sesondo xa uchitha izithombe zoononografi kwi-intanethi [28] kunye ne-erectile dysfunction, eye yabetha ngokuphawulekayo phakathi kwamadoda ambalwa kwiminyaka embalwa edlulileyo xa kuthelekiswa neminyaka emibini edlulileyo [29,30,31,32,33].
Sihlolisise ngokucwangcisiweyo iincwadi ezikhoyo kwi-POPU ukuzama nokufingqa intsebenziswano eyahlukeneyo yakutshanje eyenziwe ngokwemiba ye-epidemiology, ukubonakaliswa kwe-kliniki, ubungqina be-neurobiological obuxhasa le ndlela yokusebenzisa ingxaki, ukuqonda kwayo ukuxilonga ngokuphathelele ukuphazamiseka kwe-hypersexual, ukuhlolwa kwayo okucetywayo. izixhobo kunye nezicwangciso zonyango.

2. Iindlela

Senze uhlolo oluchanekileyo emva kwezikhokelo ze-PRISMA (Umzobo 1). Njengoko ubu bungqina obutsha malunga nalo mbandela, siqhube ukuhlaziywa kwethu ngaphandle kwexesha elithile-ukudibanisa. Okuphambili kwafakwa ekubuyiselweni kwincwadi kunye namanqaku atyhulwa ngeyona ndlela entsha kunendlela yokudala, ngokukhethekileyo malunga neengxelo ezipapashwe ngokutsha kweso sifundo. I-PubMed ne-Cochrane yimiba eyona nto ibalulekileyo esetyenzisiweyo, nangona inani lamanqaku ahlanganiswe ngokubhekiselele kumnqamlezo.
Jcm 08 00091 g001 550
Umzobo 1. I-PRISMA umzobo wokuhamba.
Ekubeni ukugxilwa kwethu kwimizila engamanyala e-intanethi kunye nokuziphatha kakubi kwezesondo, asizange sikhankanye loo maqendu ayenayo kuphela inxulumano kunye naso ekukhangekeni kwethu: abo bajolise kwi-intanethi ye-intanethi, abaxhomekeke kwi-pornography efana neyohlukeneyo ye-paraphilias, kunye nabo sondela kwesi sifundo kwintlalo yoluntu.
La magama alandelayo aphando kunye neziphumo zabo ezifunyenweyo zisetyenziselwa ukudibanisa ezininzi: i-intanethi, i-porn * (ukuvumela ukuba zombini "uonografi" kunye "noonografi"), umlutha * (ukuvumela ukuba zombini "umlutha" kunye "nomlutha"), kwi-intanethi, kwi-intanethi. , ngokwesondo, ukuziphatha ngokwesini, ukuxhatshazwa kwabantu ngokwesini. Isixhobo sokulawula i-Zotero sisetyenziselwe ukwakha idatha yamanqaku athathwa ngawo.

3. Iziphumo

3.1. Epidemiology

Ukusetyenziswa koonografi kubantu abaninzi kubonakala kunzima ukulinganiselwa ngokwaneleyo, ngakumbi ukususela ekukhuleni kwe-intanethi kunye "nezinto ezintathu" eziye zavumela ukuba zibucala kwaye zikwazi ukufikelela. Ucwaningo lukaWright malunga nokusetyenziswa koononografi kubantu base-US abasebenzisa i-General Social Survey (GSS) [34], kunye noThutho lweeNcwadi (ezithengisa iWright ngokuhlukanisa phakathi kweeminyaka, amaqela kunye nemiphumo yexesha) [35] zenza ezinye zezinto ezimbalwa, ukuba azinjalo kuphela, imithombo ekhoyo elandelwayo ngokusetyenziswa koonobumba. Zibonisa ukusetyenziswa kokugqithiswa kweentlophu zoononophelo kwiminyaka, ngakumbi phakathi kwabantu besilisa ngokungafani nabesifazane. Oku kubaluleke kakhulu phakathi kwabantu abadala, kwaye ngokukhawuleza kwehla ngokukhula.
Ezinye iinkalo ezithandekayo malunga neentlobo zoononophala zokusetyenziswa kwamandla zibonakala. Enye yazo kukuba iqela le-1963 ne-1972 libonisa kuphela ukuhla kwehle kakhulu ekusebenziseni kwabo kunyaka lwe-1999 phambili, kubonisa ukuba ukusetyenziswa koononophelo phakathi kwala maqela kuye kwahlala kunjalo ukususela ekubeni [35]. Enye enye yiyo i1999 nayo yonyaka ukuthambekela kwabasetyhini abaneminyaka engama-18 ukuya kwi-26 ukuba badle i-pornography yaba ngamaxesha amathathu kunokuba abantu abaneminyaka eyi-45 ukuya kwi-53, kunokuba babe ngamaxesha aphindwe kabini nje ngokuba bebenokuda ukufikelela kude [U35]. Ezi zinto zibini zinokuthi zihlobene nokutshintsha ukutyekela kwiinkqubo zoononophala ezibangelwa yi-teknoloji (ukusukela kwi-intanethi ukuya kwi-intanethi yokusetyenziswa kwe-intanethi), kodwa akunakwenzeka ukwazi ngokuqinisekileyo kuba idatha yangaphambili ayibhaliseki ngokungafaniyo kokungaxhunyiwe kwi-intanethi nakwi-intanethi iindidi xa ulandelela ukusetyenziswa kwezithombe ezingamanyala.
Ngokubhekiselele kwi-POPU, akukho datha ecacileyo kwaye ethembekileyo kwiincwadi ezihlaziyiweyo ezinganikela ubungqiqo obuqinileyo bentsholongwane yazo. Ukongeza kwiinjongo ezisele zikhankanywe ngokusweleka kwedatha kwindlela yokusetyenziswa kwezonyango eziqhelekileyo, inxalenye yayo ingase ivela kwizinto ezibonakalayo eziphathekayo zezihloko ezikhoyo ngabafundi abathatha inxaxheba, uluhlu olubanzi lwezixhobo zokuhlola ezisetyenziswe ngabaphandi, nokungabikho kwemvumelwano ngokubhekiselele ekusebenziseni i-pathological of pornography, ezo zonke iimeko ziphinda zihlaziywe phambili kweli phepha.

Uninzi lwezifundo ezichaphazela i-POPU okanye ukuziphatha ngokuxhaphaza ngokobuxhakaxhaka basebenzisa iisampulu ezilula ukuyilinganisa, ngokuqhelekileyo ukufumana, nangona ulwahlulo lwentlupheko, bambalwa abasebenzisi abakujonga ukuba lo mkhwa ube ngumlutha, kwaye nangona xa bekwenza, bambalwa ukuba le nto ingaba nefuthe ziphumo kubo. Eminye imizekelo:

(1) Uphononongo lokuhlola izilingo zokuziphatha phakathi kwabasebenzisi bendalo, kufumaniswe ukuba kuphela i-9.80% yabathathi-nxaxheba be-51 babecinga ukuba banomdla wokulala ngesondo okanye uonografi [36].

(2) Isifundo seSweden esasifumana isampuli se-1913 abathathi-nxaxheba kwi-questionnaire yewebhu, i-7.6% yabika ingxaki yesini ye-intanethi kwaye i-4.5% ibonise 'ukuxhatshazwa' kwi-intanethi yothando kunye neenjongo zezesondo, kwaye le nto 'yingxaki enkulu' [U17].

(3) Ukufundwa kweSpeyin kunye nesampula yabafundi beekholeji ze-1557 zifumene ukuba i-8.6% yayisengozini yokuphuhlisa ukusetyenziswa kwezilwanyana ezingcolileyo kwi-intanethi, kodwa ukuba ukuxhaphaka komsebenzisi we-pathological 0.7% [37].

Ukufunda kuphela kunye nesampuli esimeleyo namhlanje ngumnye waseAustralia, kunye nesampula yabathathi-nxaxheba be-20,094; I-1.2% yabesifazane abahlolisisiweyo babecinga ukuba banomlutha, ngoxa amadoda ayengama-4.4% [38]. Ukufunyaniswa okufanayo kufana nokuziphatha okuxhatshazwayo ngokobuxhakaxhaka ngaphandle kwezocografi [39].
Ukuqulunqa ukuziphatha okubi ngokwesini kunye nokusetyenziswa koonografi, kubantu abaninzi: ukuba ngumntu, ubudala, inkolo, ukusetyenziswa kwe-Intanethi rhoqo, ukunyamekela, kunye nokwenza izinto ezintle,17,37,40,41]. Ezinye zezinto ezinobungozi zikwabelwana ngokwabelana ngesifo sengqondo (39,42].

3.2. UConotyosical and Diagnostic Conceptualization

Ukuqonda ukuziphatha okuqhubekayo kwimiba enzima namhlanje. Nangona iilingo eziliqela zenziwe malunga nokuziphatha koxhatshazo, ukungabikho kolwazi olunamandla njengokuba ngoku kuchaza ukuba akukho mvumelwano malunga nale ngxaki [9]. I-POPU ibandakanya isethi ekhethekileyo yezenzo zesondo ezibandakanya iteknoloji. Ngenxa yokusetyenziswa kweteknoloji ingxaki (ngokukodwa iteknoloji ye-intanethi) ngokusondeleyo, sifanele siqale ukuthetha ngokuziphatha okungaxhatshazwayo ngokobuxhakaxhaka akuhambelananga neteknoloji ukuze kuqondwe indawo yoonografi kwi-intanethi kuyo.
Ubundlobongela njengendlela yokuziphatha inkulu kakhulu, kwaye isakhono sayo sengqondo se-pathological seyifundwa kangangamakhulu eminyaka [43]. Ngako oko, umele umngeni kwimimiselo ezama ukuyiqonda ngokufanelekileyo, kuba ingaquka iinkqubo ezivela ekuziphatheleni kwedwa kwintlondi yobundlobongela [21]. Kwakhona kunzima ukuchaza ukuba yintoni eyenzekayo kwaye ukulawula ukusetyenziswa kakubi kwelo ncazelo ukugxeka abantu kunye neentsholongwane zabo [44]. Ngokomzekelo, abanye babeka umda phakathi kokuziphatha okuqhelekileyo kunye nokuziphatha kakubi ngokwesondo kwiimpawu ezingaphezulu kweesisixhenxe kwiveki [43] (iphe. 381), kodwa le ndlela ekujoliswe kuyo ubuninzi ingaba yingozi, kuba oko kuyenzeka ukuziphatha okuqhelekileyo kunye nokuziphatha kakubi kunokuhluka phakathi kwabantu. Ukuntuleka kokulingana kunye nokuhambelana nokuhlengahlengiswa kwayo kunokuthintela uphando olusasaza ekuphanduleni ukuziphatha okubi ngokwesini [45] kwaye uyayihoxisa imilinganiselo esemgangathweni egxininisa kwiimvakalelo ezintle ezihambelana nayo [46,47]. Kukho iziphakamiso zokukhulula le ngxaki usebenzisa izixhobo ezithile, sele ziphuhlisiwe njengenxalenye yesiphakamiso seengxaki zokuxhatshazwa kwe-hypersexual esetyenziswe kwi-DSM-5 inkundla yesilingo [43,47].
Ubuninzi bobulili bobuxhatshazo busebenza njengeyambulela yokwakha [7]. Isikhundla salo sisaba ngumcimbi weengxoxo kuze kube yimhla, kwaye rhoqo ukuhlangabezana nemigqaliselo emininzi ebhekisela kwingcamango efanayo: ukuziphatha okubi ngokwesini, ukuziphatha ngokwesini, ukuziphatha kakubi ngokwesondo, ukuziphatha kakubi ngokwesini okanye ukuxhatshazwa koxhatshazo. Abanye abalobi, ngelixa beqonda ukubaluleka kwemiqathango "ukunyanzela" kunye "nokunyanzeliswa", bakhetha ukuqwalasela umba wokulawula kunye nokulahleka kwayo okanye ukunyanzelisa njengento ebalulekileyo malunga nokuziphatha, ngokubhekiselele kuyo "ngaphandle kokulawula ukuziphatha ngokwesondo "[45,48,49].
Nangona iingcaciso azifani, zidla ngokugxininisa kwixesha okanye ubunzulu beempawu [46] ngezinye iinkanuko eziqhelekileyo kunye neengcamango, eziza kubangela ukungasebenzi. Oku kukwahlula kwi-paraphilic yokuziphatha ngokwesini, nangona imfuneko yokucaciswa okubhekiselele kwiimeko ezingafaniyo, ukufana kunye nokungafihli phakathi kwezi ntlobo zibini ziyaqhubeka [45].
Ngokuqhelekileyo kubandakanywa ukuziphatha koxhatshazo ngokwesondo ngokugqithisileyo kunye neendlela ezahlukeneyo zoxhatshazo ngokwesondo, njengokuxhomekeke kwiintlanganiso ezingabonakali zesondo, ukuziphatha okubi ngokuphindaphindiweyo, iifayili zoonografi, ucingo lwezonxeba kunye neekhenkethi zokutyelela [43,44,49,50,51]. I-Bancroft yayicinga ukuba, ekusebenziseni i-intanethi, zombini i-masturbation kunye nale mi sebenzi yezocansi iyakwazi ukudibanisa, ithi amadoda "ayisebenzisa njengokongezwa okungapheliyo kolawulo lwayo lokuziphatha ngokugqithisileyo".
Nangona ithuba lokufumanisa ukuziphatha koxhatshazo lwama-sexualism lwaluhlala lukhona "ngengxaki yesini engacacisiwe ngenye indlela" kwi-DSM [1], Kafka [43] uzame ukuyiphakamisa njengenjongo yokuxilonga ye-DSM-5. Wanikezela i-criteria ye-criteria, njengengxenye yesifo seengxaki zesondo. Le mizekelo ecetywayo ibandakanya ukuziphatha koxhatshazo ngokwesini: (1) ukuxhatshazwa ngokwesini, (2) isilathiso sokuziphatha, (3) inxalenye yenkinga yokunyanzelisa i-spectrum, (4) inxalenye yeengxaki zentlungu-kunye ne-5 " ngaphandle kokulawula "ukuziphatha okubi ngokwesondo. Esi siphakamiso sagqithwa ngenxa yezizathu ezininzi; eyona nto yathethwa ukuba kungabikho kwenkcazelo yokudibanisa i-epidemiological neurosting malunga nokuziphatha [52,53], kodwa kunye nekhono layo lokusebenzisa kakubi ukusetyenziswa kakubi, ukungaxhomeki ngokwaneleyo kwimiqathango yokuxilonga, kunye nemilinganiselo yezopolitiko kunye nentlalo yokudityaniswa kwendawo yokuziphatha yobomi buntu [54]. Kuyathakazelisa ukuyithelekisa nezinye iimbali ezimbini zokugqibela ezikhoyo kwiincwadi ezihlaziyiweyo, ezo zePatrick Carnes kunye no-Aviel Goodman [9]. Bonke abathathu babelana ngeengcamango zokulahlekelwa kolawulo, ixesha elidlulileyo lokusetyenziswa ngokuziphatha ngokwesini kunye nemiphumo emibi ngokwabo / kwabanye, kodwa bahluke kwezinye izinto. Oku kubonakalisa imivalo ebanzi ukungabikho kwemvumelwano ekuboniseni ukuziphatha koxhatshazo lwe-sexualism kwiminyaka yonke. Okwangoku, iinqunto eziphambili ziphakamisa ukuziphatha okubi koxhatshazo okanye njengengxaki yokulawula umonakalo okanye umlutha wokuziphatha [55].
Ukususela kwingcamango yokulawulwa kwengxaki yokulawula ingxaki, ukuziphatha ngokuxhatshaxisayo kubanzi kuthiwa yi-Compulsive Sexual Behavior (CSB). Coleman [56] ngumxhasi weli qhinga. Nangona equka ukuziphatha kweparaphilic phantsi kweli gama [57], kwaye bahlala kunye kwezinye iimeko, uyahlula ngokucacileyo kwi-CSB engekho iparaphili, yinto esifuna ukugxila kulo mbononongo. Ngokuthakazelisayo, ukuziphatha okungaxelwanga ngokobuxhatshazo kudla ngokuqhelekileyo, xa kungenjalo, kuninzi i-paraphilias [43,58].
Nangona kunjalo, iinkcazo zamva nje ze-CSB zidla ngokubhekiselele kwizinto ezininzi zokuziphatha zesondo ezingazinyanzeliswayo: eziqhelekileyo zibizwa ngokuba yi-masturbation, zilandelwa ukusetyenziswa ngokugqithiseleyo koonografi, kunye nokuziphatha okubi, ukuhamba ngokunyanzelisa, kunye nobudlelwane obuninzi (22-76%) [9,59,60].
Nangona kukho ukugqithisa ngokucacileyo phakathi kokuxhatshazwa koxhatshazo kunye neemeko ezinjenge-dispersive disorder disorder (OCD) kunye nezinye iingxaki zokulawula iimpembelelo [61], kukho ezinye iimeko ezahlukileyo ezichazweyo: umzekelo, iziphatho ze-OCD azibandakanyi umvuzo, ngokungafani nokuziphatha ngokwesini. Ngaphezu koko, ngoxa ukubandakanyeka ekunyanzelweni kunokubangela ukuphucula okwethutyana izigulana ze-OCD [62], ukuziphatha koxhatshazo ngokuqhelekileyo kuxhatshazwa yintyala kunye nokuzisola emva kokwenza isenzo [63]. Kwakhona, ukunyamekela okungasoloko kulawula ukuziphatha kwesigulane akuhambelani nokucwangcisa ngokucophelela okufunekayo ngezinye iinkcukacha kwi-CSB (umzekelo, ngokubhekelana nesinibano) [64]. UGoodman ucinga ukuba ukuphazamiseka kwezidakamizwa kubangelwa kwiintlupheko zeengxaki zokunyanzelisa (ezibandakanya ukunciphisa ukuxhalaba) kunye nokuphazamiseka okuphazamisayo (okubandakanya ukunyaniseka), kunye neempawu ezixhaswa yiindlela ze-neurobiological (i-serotoninergic, i-dopaminergic, i-noradrenergic, ne-opioid systems)65]. U-Stein uyavumelana nomzekelo odibanisa iindlela ezininzi ze-ethiopathogenical and proposes a model ABC (i-affective dysregulation, umlutha wokuziphatha, kunye nokuchithwa kwengqondo) ukufunda le nkampani [61].
Ukususela kumbono wokuziphatha umlutha, ukuziphatha koxhatshazo kuxhomekeke ekubambiseni iinkalo eziphambili zobunzima. Le miba, ngokwe-DSM-5 [1], bhe kisela kumzekelo wokusetyenziswa kweengxaki ezikhankanywe kwiindlela zokuziphatha ngokuxhatshazwa koxhatshazo, kokubili ngaphandle kunye nakwi-intanethi [6,66,67]. Ubungqina bokunyamezela kunye nokuhoxiswa kwezi zi gulane mhlawumbi luba luphambili ekubonakaliseni le nkampani njengengxaki yomlutha [45]. Ukusetyenziswa kweengxaki ze-cybersex kudla ngokugqithiseleyo njengengxaki yokuziphatha [13,68].
Igama elithi "umlutha" osetyenziswa kulo mbutho sisengqinelwana enkulu. I-Zitzman ibona ukuba ukunganyangeki ukusetyenziswa kwexesha lokuxhatshazwa "kukubonakalisa ngakumbi ukunyaniseka kwezesondo kunye nokuvumeleka kunokuba naluphi na ukungabikho kolwazi kunye nolwazi lokuxilonga kunye nezinye iindlela zokulutha" [69]. Nangona kunjalo, eli thuba kufuneka lisetyenziswe ngokulumkisa, kuba lingahunyushwa njengesizathu sokukhangela ukungaxhamli nokunyaniseka, kunye nokugxeka iziphumo eziphazamisayo kuyo.
Kudala kube neengxoxo phakathi kukaPatrick Carnes no-Eli Coleman malunga nokuxilongwa kobuxhakaxhaka. UCleman uye wacinga ukuba ukuxhatshazwa koxhatshazo kuqhutyelwa yimfuneko yokunciphisa uhlobo olunexhala, kungekhona ngesifiso sesondo [56] ekwahlule kwiingqimba ezisixhenxe (enye yazo isebenzisa iinthombe zoononografi kwi-intanethi) [57], ngoxa iCarnes (echaza umlutha "njengentsebenziswano yezobuchopho kunye nolwazi oluguquguqukayo lwamava") ufumana izilwanyana kwezinye izilingo zokuziphatha ezifana nokugembula, ugxininise ekulahlekeni kolawulo kunye nokuziphatha okuqhubekayo ngaphandle kwemiphumo emibi [70].
Uhlaziyo olupheleleyo lweencwadi ngu Kraus [71], wagqiba ekubeni nangona ezi zifana, izikhala ezibonakalayo kwingqiqo yeengqiqo ziyanzima ukuhlula i-classified as addiction. Iinkxalabo eziphambili zijoliswe ekubhekeleni ubuninzi bezinga elibanzi lokukhula, idatha yexesha elide kunye neklinikhi (ichaza iimpawu ezisemgangathweni kunye nemida yayo yokuxilonga), exhaswa yi-neuropsychological, neurobiological, kunye ne-genetic data, kunye nolwazi olumalunga nokuhlolwa kwonyango nokukhusela, kwaye ubonisa iteknoloji yedijithali ekuziphatheni kokuxhatshazwa koxhatshazo njengengundoqo ephambili yophando olusasa.
Ukunyuka kwe-intanethi kwandisa amathuba okusebenzisana ngokwesondo, kwaye kungekhona nje i-intanethi ye-intanethi (i-webcamming, i-website yezesondo ezingaqhelekanga). Nokuba ukusetyenziswa kwe-intanethi kubonisa umzila wezinye iintlobo zokuziphatha okuphindaphindiweyo (umz., Ukuziphatha ngokwesondo okanye ukugembula) okanye ukwenza iqela elithile ngokuthe tye lixutyushwa [72]. Nangona kunjalo, ukuba ityala lingaphambili, ubungqina obungaphambili kunye neengcamango zingasetyenziswa kakuhle kumlingani walo we-Intanethi.
Kukho imfuneko yeempawu ezifunyenweyo ezisemgangathweni ezithatha ingqalelo kwiimeko ezizodwa ezibonakalisa i-intanethi (ngokuchasene nokungaxhunyiwe kwi-intanethi) ziphatha ngokwesondo, kuba abaninzi babo abanalo inguqu engaxhunyiwe kwi-intanethi engathelekiswa [73]. Kuze kube ngoku, kukho ukuthethwa kweziganeko ezintsha xa ubhekana nokuziphatha kwezesondo kwi-Intanethi, njengokuba kukho ukuhlukana kwe-intanethi [74], ebangela ukuba "ingqondo kunye neemeko zixhomekeke xa zibandakanyekile, kunye nexesha elichithekileyo kunye nokuxhomekeka kwezinto". Oku kwahlukana kuye kwachazwa ngokumalunga neminye imisebenzi ye-intanethi [75], exhasa ingcamango yokuba ukusetyenziswa kweengxaki zoxinano nge-inthanethi kunokunxulumene nentengiso ye-intanethi kunye nesondo [76].
Ekugqibeleni, kufuneka sicacise ukuba inkampani yokuxilonga ebizwa ngokuthi "ukunyanzelisa ukuziphatha kwengqondo yesifo sengqondo" ifakwe kwiphepha elichanekileyo le-ICD-11, kwisiqendu "sokuphazamiseka kokulawula"77]. Ingcaciso ingaboniswa kuyo https://icd.who.int/dev11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f1630268048.
Ukufakwa kwale nqanaba kwi-ICD-11 inokuba yimpendulo ekubaluleka kwalo mbandela kwaye iqinisekisa ubungqina bayo bekliniki, kanti i-data ekhulayo kodwa engagqibekanga iyasivimbela ukubeka ngokucacileyo njengengxaki yengqondo yengqondo [72]. Kukholelwa ukuba kunika ithuluzi elingcono (okwangoku kwinkqubo yokuhlengahlengiswa) ekujonganeni neemfuno zonyango ezifuna izigulane kunye netyala elinokwenzeka [78], kwaye ingabonakalisa iingxoxo eziqhubekayo ngokubhekiselele kwisigaba esifanelekileyo se-CSB kunye nemali yayo esilinganiselwe kwezinye iindawo [55,71] (1 Table). Oku kufakwa kungaba yinqanaba lokuqala ekuqwalaseleni lo mbandela nokwandisa kuwo, enye ingongoma ephambili ngokuqinisekileyo i-subtype yayo ye-intanethi.
Ithebula 1. I-DSM-5 kunye ne-ICD-11 iindlela zokukhetha ukuziphatha koxhatshazo.
itafile

3.3. Ukubonakaliswa kwezonyango

Imiboniso yeklinikhi ye-POPU ingafingqwa ngamanqaku angundoqo amathathu:

  • I-Erectile i-dysfunction: ngelixa ezinye izifundo zifumene ubungqina obuncinane bombutho phakathi kokusetyenziswa koononografi nokusetyenziswa kakubi ngokwesondo [33], abanye baphakamisa ukuba ukunyuka kokusetyenziswa kwezithombe ezingamanyala kungayona nto ibalulekileyo ekuchazeni ukunyuka okukhawulezayo kwintsebenzo erectile phakathi kwabantu abaselula [80]. Kwisifundo esithile, i-60% yezigulane ezithintekayo ngokwesini kunye nomlingani owenene, ngokungafaniyo ayinayo le ngxaki ngezononografi [8]. Abanye bathi ingxaki phakathi kokusetyenziswa koononografi nokusetyenziswa kakubi ngokwesondo kunzima ukusungula, kuba ukulawula okwenyaniso kungabonakali kwizinto ezingcolileyo.81] kwaye zicebise ukuba kusetyenziswe uphando olwenziwe kulo mbandela.
  • Ukungoneleliseki kwengqondo: ukusetyenziswa koonografi kuye kwadibaniswa nokunganeliseki ngokwesondo kunye nokungasebenzi ngokwesondo, kuba babini nababhinqa [82], ngokugqithiseleyo umzimba okanye umlingane wabo, ukunyuswa komsebenzi kunye nokuziphatha okungaphantsi kwesini [83], ukuba neqabane elithile lezesondo kunye nokuziphatha ngokuziphatha ngokwesondo [34]. Le mpe mbelelo ibonakala ngokugqithiseleyo ubudlelwane xa incedwe enye [84], ngendlela efanayo ngendlela yokusebenzisa i-marijuana, ukwabelana ngezinto eziphambili ezifana nomfihlo ophezulu [85]. Ezi zifundo zisekelwe ekusebenziseni imifanekiso engamanyala engaqhelekanga, kodwa iifoto zoononophala kwi-intanethi ayikwazi ukuba nemiphumo emibi ngokwayo, kuphela xa ithe yaba ngumlutha [24]. Oku kunokuchazela ubudlelwane phakathi kokusetyenziswa kweentlobo zoonografi zentombi kunye neempembelelo ezilungileyo kubafazi [86].
  • Ukuziphatha kakubi: ukuziphatha okuxhatshaxisayo kudibaniswe nokukhathazeka kwemixhala, kulandelwa ukuphazamiseka kwemizwelo, ukuphazamiseka kwezidakamizwa kunye nokungasebenzi kwezesondo [87]. Ezi ziphumo zisebenza kwiPOPU [88], kunye nokunxila, ukusela utywala okanye ikhofi, ukusetyenziswa kakubi kweziyobisi [41] kunye nokusetyenziswa kwemidlalo yevidiyo yeengxaki [89,90].
Ukuba nezinto ezinomdla eziphathekayo zoonopopasho ziye zahlanganiswa nokunyuka kwiingxaki ezibikwe [17]. Kuye kwaxutyushwa ukuba le miba yeklinikhi yiphumo lokusetyenziswa kakubi kwe-cybersex okanye ngenxa yezifundo ngokwenene bazibona njengamakhoboka [91].

3.4. Ubungqina be-Neurobiological Supporting Addiction Model

Ukuqokelela ubungqina malunga nePOPU yinkqubo enzima; Idatha ephambili kule ngxaki isagqitywa ngamanqanaba amancinci amancinane, iisampuli zesini kunye namacandelwana ahlukeneyo [71], ngokungenayo ngokwaneleyo i-neuropsychological studies [4], mhlawumbi ngenxa yeengqinamba zengqiqo, zemali kunye nemigomo. Ukongeza, ngelixa utywala lweziyobisi zingabonwa kwaye zihlanjululwe kwizilwanyana zokulinga, asikwazi ukwenza oku kumlutha wokuziphatha komfundi; oku kunokunciphisa ukutadisha kwethu iinjongo ze-neurobiological [72]. Iingxaki ezikhoyo ngokuphathelele uphando lwendlela yokuziphatha ngoxhatshazo, kunye neendlela ezifanelekileyo zokujongana nazo, zichongiwe ngobuchule kwaye zishwankathelwe kwinqaku elithi Kraus '[71]. Uninzi lwezifundo ezifunyenweyo kuphando lwethu lubhekiselele ekuziphatheni okuxhatshaxisayo, kunye neentlophu zoonografi kuba yinye yezinto ezixhasiweyo.
Olu bungqina lusekelwe ekuqondeni ukuguquguquka kwenkqubo ye-neural phakathi kweenguqu ezinxulumene neziyobisi ezithintekayo. Amanqanaba e-Dopamine adlala indima ebalulekileyo kule mivuzo yesigxina sezesondo, njengoko kubonisiwe kakade kwi-dementia ye-frontotemporal kunye neyeza-proopaminergic kwiyeza likaParkinson ezidibene nokuziphatha ngokwesondo [92,93].
Inkqubo yomlingo kunye noonografi ekhompyutheni inokuthi ikhuliswe yintshukumo yokukhawuleza kunye ne "superranormal stimulus" (eliqulunqwe ngumzuzwana weNobel umzuzwana uNikolaas Tinbergen) owenza i-intanethi ye-intanethi [94]. Le ngxaki iya kuthi yenze i-stimuli (okoku, imifanekiso engamanyala ngendlela esetyenziswa ngayo namhlanje, ifom ye-intanethi) ngaphezu kwezinto eziphilayo zenze i-genetic response. Iingcamango kukuba ziyakwazi ukuvuselela inkqubo yethu yomvuzo wemvelo kumazinga aphakamileyo kunokuba kukho okhokho abajamelana nazo njengoko ubuchopho bethu buguqukile, okwenza kubekwe ukutshintsha kwindlela yokulutha [2]. Ukuba sicinga i-intanethi ye-intanethi kule ngcamango, sinokuqala ukubona ukufana nokuxhatshazwa kwezidakamizwa.

Inguqu enkulu yenguqu ephawulwayo kwizinto eziluthayo zomzimba zibeka isiseko sophando lwexesha elizayo malunga nokuziphatha kakubi [95], kuquka:

  • Sensitization [96]
  • Ukuhlengahlengiswa [97]
  • Izijikelezo ezingasebenzi ezingabalulekanga (ulwaphulo-mthetho) [98]
  • Inkqubo yoxinzelelo engasebenzi [99]
Ezi ngqondo ziguqulwa kwiingxaki zidibene nezigulane ezineendlela zokuziphatha ngokuxhatshazwayo okanye abasebenzisi bokugqithisileyo ngokucwangcisa izifundo ze-40 zeentlobo ezahlukeneyo: i-imagination magnetic imagination, i-electroencephalography (i-EEG), i-neuroendocrine kunye neuropsychological.
Ngokomzekelo, kukho ukungafani okucacileyo kwintsebenzo yengqondo phakathi kwezigulane ezinokuziphatha ngokunyanzelisa ukuziphatha ngokwesondo kunye nokulawula, okuzibonakalisa ezo zilutha zamachiza. Xa zibonakaliswe kwimifanekiso yesondo, izifundo ezixhatshaxayo zibonise ukungafani phakathi kokuthanda (ngokuhambelana nokulawula) nokufuna (umnqweno wesondo), owona mkhulu [8,100]. Ngamanye amazwi, kulezi zifundo kunomnqweno omkhulu kuphela kwisigxina esithile sokwabelana ngesondo, kodwa kungekhona isifiso sesini esenziwa ngokubanzi. Oku kusitshoyo kwisigxina sezesondo ngokwaso sibhekwa njengomvuzo [46].
Ubu bungqina bale misebenzi ye-neural yokumisela umnqweno ikakhulukazi kwi-correx ye-prefrontal [101] kunye ne-amygdala [102,103], kuba ubungqina bokukhuthaza. Ukusebenza kule mimandla yengqondo kukukhumbuza umvuzo wemali [104] kwaye inokuthi ithwale impembelelo efanayo. Ngaphezu koko, kukho ukufundwa kwe-EEG ephakamileyo kulaba basebenzisi, kunye nesifiso esinciphile ngesondo kunye nomlingane, kodwa kungekhona ukuphosa isithombeni soonografi [105], into ebonakalayo kumgangatho ophezulu wokwakhiwa komgangatho [8]. Oku kunokuthathwa njengophawu lokwenyusa. Nangona kunjalo, uphando lukaSteele luqulethe iindlela ezininzi zokungaqwalasela (ngokuxhomekeka kwintlupheko, ukungabikho kwengxaki yokukhathazeka kwengqondo okanye ukunyanzeliswa, ukungabikho kweqela lokulawula, kunye nokusetyenziswa kweemibuzo engagunyazisiweyo ekusebenziseni ubulili) [106]. Uphando lwe Prause [107], ngeli xesha kunye neqela elilawulayo, luchaza ezi ziphumo. Inxaxheba yecuac reactivity kunye nesifiso ekuphuhlisweni kwezilwanyana ezinobungozi be-inthanethi ziye zaxhaswa kumfazi wesibini [108] kunye namasampula esithandana [109].
Le nkcazo ekubhekiselele kwizesondo kubaluleke kakhulu kubantu abaqala ukuxhatshazwa ngokwesondo [110], kodwa ukuphindaphinda ngokuphindaphindiweyo kubo kubonisa ukungahambi kakuhle [111,112]. Oku kuthetha ukuhlaliswa kweenkqubo zemivuzo, mhlawumbi unxibelelwano ngongqoqo ophezulu wecala [107,113,114]. Ekubeni i-dorsal cingulate ibandakanyeka ekujoliseni umvuzo kunye nokuphendula kwimicimbi emitsha, ukwehla kwimisebenzi yalo emva kokubhenca ngokuphindaphindiweyo kusikhomba ekuphuhlisweni kweso siqhelo kwizinto ezidlulileyo. Oku kubangela ukhetho olusenyanisiweyo olwenziwe kakubi kwizakhono zesondo [115], onokubonakalisa njengemizamo yokunqoba loo nto yokuziphatha kunye nokuchithwa kobugqwetha ngokusebenzisa uphando olutsha (olutsha) loonografi njengendlela yokwaneliseka ngokwesondo, ukhetha oku kuziphatha esikhundleni sezesondo zangempela [20].
Le mizamo ekufuneni okuqhelekileyo inokuthi idibeneyo ngokusebenzisa i-reactivity ye-intatal [116] kunye ne-amygdala [117]. Kuyaziwa ukuba ukubukela iifotoli ezingasetyenziswayo rhoqo kubasebenzisi baye badibana nomsebenzi omkhulu we-neural [99], ngakumbi kwi-ventral striatum [116,118] odlala indima enkulu ekukulindeni umvuzo [119].
Nangona kunjalo, ukuxhuma phakathi kwe-ventral striatum kunye ne-prefrontal cortex kunciphise [103,113]; ukwehla kwintsebenziswano phakathi kwe-correx ye-prefrontal kunye ne-amygdala iye yabonwa [117]. Ukongezelela, izifundo zokuxhatshazwa kobuxhakaxhaka babonise ukuxhomekeka kokusebenza okunciphise phakathi kwe-cortex ne-temporal cortex lobes, kunye nokulahleka kwezinto ezimnyama kule mimandla [120]. Zonke ezo zinguqu zinokuchaza ukungakwazi ukulawula iimpembelelo zokuziphatha ngokwesini.
Ukongezelela, izifundo zokuxhatshazwa kobuxhakaxhaka babonisa umthamo ophezulu we-amygdala [117], ngokuchasene nalabo abanezifo ezingapheliyo kwizinto ezibonakalayo, ezibonakalisa ukuncipha kwe-amygdala volume [121]; lo mmahluko unokuchazwa ngumphumo ongenayo i-neurotoxic of substance. Kwizifundo ezixhaswa ngokwesini, ukunyuka komsebenzi kunye nomthamo ungabonakalisa ukugqithiswa kweziinkqubo zokulutha (ngokukodwa ukuxhasa iikhothaji zokukhuthaza) okanye kuba ngumphumo wokungapheliyo kwindlela yokuxinwa kwezenhlalakahle, ezifana nokulutha komzimba ngokwawo [122].
Laba basebenzi baye babonisa impendulo engapheliyo yokunyanzeliswa, ngokugqithiseleyo kumlambo nge-hypothalamus-pituitary-adrenal axis [122] ngendlela ebonakalisa ezo ziguqulwa ezibonakalayo kwizidakamizwa zeziyobisi. Ezi zinguqu zinokuba ngumphumo weenguqu ze-epigenetic kwi-mediic inflammatory mediators driving dridictions, njenge-corticotropin-release-factor (CRF) [123]. Lo mgaqo-nkqubo we-epigenetic ucinga ukuba iimpembelelo ze-hedonic kunye neziphumo ze-anhedonic zokuziphatha zincinci zincinci ezichaphazelekayo ngamagciwane e-dopaminergic, kwaye mhlawumbi ezinye iiprogrammphymms eziphathelene ne-neurotransmitter [124]. Kukho ubungqina be-tumor necrosis factor (TNF) kwi-addicts yobulili, kunye nokulungelelanisa okuphakathi kwamanqanaba e-TNF kunye namanqaku aphakamileyo kwimilinganiselo yokulinganisa ngokwesini [125].

3.5. Ubungqina beeuropsychological

Ngokubhekiselele kwimibonakalo yolu tshintsho kwizenzo zesondo, iinjongo ezininzi ze-neuropsychological zibonisa uhlobo oluthile oluchanekileyo okanye oluhambelana nomsebenzi kwisigqeba [126,127], mhlawumbi ngenxa yenguqu ye-prefrontal cortex [128]. Xa isetyenziswe kwiimifanekiso engamanyala e-intanethi, igalelo ekuphuhliseni nasekugcinweni kwayo [129,130].
Iimpawu zolu hlobo olusebenzayo olusebenzayo zibandakanya: ukungahambi [131,132], ukunyaniseka kwengcamango okuphazamisa iinkqubo zokufunda okanye ukukwazi ukutshintsha ingqalelo [120,133,134], isigwebo esifanelekileyo kunye nesinqumo [130,135], ukuphazamiseka komsebenzi wokukhumbula imemori [130], ukusilela kwimimiselo yemoya, kunye nokukhathazeka ngokweqile ngesondo [136]. Ezi ziphumo zikhumbuza ezinye izilingo zokuziphatha (ezifana nokugembula komzimba) kunye nokuziphatha kwizinto ezixhomekeke kuzo [137]. Ezinye izifundo ziphikisana ngqo nezi ziphumo [58], kodwa kunokubakho ukukhawulelwa kwindlela (umzekelo, ubungakanani besampula encinane).
Ukusondela kwizinto ezidlala indima ekuphuhliseni ukuziphatha koxhatshazo kunye ne-cybersex, kukho inani labo. Sinokucinga ngento yokucwangcisa, ukuqinisekiswa okuqinisekileyo kunye nokufundisana [104,109,136,138,139] njengeendlela ezisemgangathweni zokuphuhliswa komlingo wezobisi. Nangona kunjalo, kukho iimeko ezinobungozi obuphantsi [140], njenga: (1) indima yokuxhaswa ngokwesondo kunye nokungasebenzi kakubi kubantu abathile abathandekayo [40,141,142,143] nokuba ngaba ngumphumo wokungahambi kakuhle [144,145] okanye ukungabikho kombuso [146], kunye (2) indlela / ukunyamekela [147,148,149].

3.6. Prognosis

Uninzi lwezifundo ezibhekiselele ekusebenziseni izifundo ngexesha elide lokubonakalisa iinthombe zoononografi kwi-intanethi [34,81,113,114], ngoko ukubonakaliswa kwayo kweklinikhi kubonakala kukungqinelana ngokuthe ngqo kunye nokulinganisela kokubandakanya kule ndlela yokuziphatha kakubi. Sichaza ubunzima ekufumaneni ulawulo ukuseka umonakalo, kodwa ezinye iingxelo zengxelo zibonisa ukuba ukunciphisa okanye ukushiya lo mkhuba kunokubangela ukuphuculwa kwintsebenzo engcolileyo yezesondo kunye nokunganeliseki kwengqondo [79,80] kunye nokufumana ngokupheleleyo; oku kuya kuthetha ukuba ukuguqulwa kwengqondo ekhankanywe ngaphambili kusenokungaguquki.

3.7. Zixhobo zo vavanyo

Kukho izixhobo ezininzi zokuhlola ukujongana ne-CSB kunye ne-POPU. Bonke bathembele kumntu ophendulayo ngokunyaniseka nangokuthembeka; mhlawumbi nangaphezulu kunokuba uvavanyo lweemvavanyo zengqondo rhoqo, kuba izenzo zesondo zizithoba kakhulu ngenxa yobume babo abucala.
Ukuxhatshazwa ngokwesini, kukho i-20 imibuzo yokuphonononga kunye neengxoxo zonyango. Ezinye zezona ziphawulekayo zibandakanya uvavanyo lweSilual Addiction Screening Test (SAST) olucetywayo ngamagqabi [150], kunye nengxelo yayo ehlaziywa emva koko i-SAST-R [151], i-Compulsive Sexual Inventory (CSBI) [152,153] kunye ne-Hypersexual Disorder Inventory Inventory (HDSI) [154]. I-HDSI yasekuqaleni isetyenziselwa ukuhlolisiswa kweklinikhi yesiphakamiso se-DSM-5 yesifo se-sexism. Nangona uphando olongezelelweyo lweempembelelo eziphambili malunga neendlela kunye nokulungiswa kwamanqaku okuhlengahlengayo kuyadingeka, okwangoku ixhasa inkxaso ye-psychometric enamandla kakhulu kwaye iyona sixhobo esisebenzayo esilungileyo ekukulingeni i-disorder sex disorder [151].
Ngokubhekiselele kwimifanekiso engamanyala ekhompyutheni, isixhobo esisisetyenziswa kakhulu kwisicatshulwa se-Intanethi-screening test (ISST) [155]. Ihlola ubungqina bobudlelwane bobulili, inzululwazi ye-intanethi-intlalo-ntlalo, ukuziphatha ngokwezesondo kwi-intanethi-ekuzimeleyo, ukusetyenziswa kwezesondo kwi-intanethi kunye nomdla kwi-intanethi yokuziphatha ngokobulili) ngemibuzo ye-25 (yebo / ayi). Nangona kunjalo, iipropati zayo ze-psychometric ziye zahlaziywa ngenyameko, kunye nokuqinisekiswa okunamandla ngesiSpanish [156] oye walungiselela njengeplani yeengxelo eziphambili [157].
Ezinye izixhobo eziphawulekayo ziinkqubo zoononografi eziyingxaki zisetyenzisiwe (PPUS) [158] owenza amanyathelo amane e-POPU (kubandakanya: uxinzelelo kunye neengxaki zokusebenza, ukusetyenziswa ngokugqithiseleyo, ubunzima bokulawula nokusebenzisa ukuphepha / ukuphepha ukuvavanywa kwemizwa engathandekiyo), uvavanyo olufutshane lwe-addiction ye-intanethi lusetyenziswe kwimisebenzi yezesondo kwi-intanethi (ngesondo-i-IAT-sex)159], i-questionnaire ye-12-mbuzo enokulinganisa ububanzi obubini be-POPU, kwaye i-pornography isebenzisa i-inventory (CPUI-9) [160].
I-CPUI-9 ivavanya ukulinganisa kathathu: (1) imizamo yokufikelela, (2) ukunyanzeliswa okubonakalayo, kunye (3) ukukhathazeka kwengqondo. Ekuqaleni kucatshangelwa ukuba kuneziqulatho ezingqalileyo zengqondo [9], le ncwadana ibonakalise ukungathembeki ngokutsha: ukubandakanywa 'kweengxaki zengqondo' kumanqanaba entloni kunye neetyala, ezingenabo ukuvavanya umlutha kwaye ngokuqinisekileyo izibalo eziphezulu [161]. Ukusebenzisa i-inventory ngaphandle kwesi siqalo kubonakala kubonakalisa ngokuchanekileyo kwindlela ethile yokunyanzelisa i-pornography.
Enye yeyona nto yakutshanje yinkinga yokusetyenziswa kweengxaki zobunzululwazi (PPCS) [162], ngokusekelwe kwiGriffith yomlinganiselo wesithintelo sezinto ezi-6 [163], nangona ayinakulinganisa umlutha, ukusetyenziswa kuphela kweengxaki zoononografi ezinezakhiwo eziphambili ze-psychometric.
Amanye amanyathelo e-POPU awayeklanyelwe ukulinganisela ukusetyenziswa koonografi kwi-intanethi kodwa asetyenziswe ngokusebenzisa abasebenzisi bezoonografi kwi-intanethi [9], ndakanya i-Consumer Inventory Inventory (PCI) [164,165], i-Compulsive Consumer Rate Scale (CPCS).166] kunye nePowula yeCafeography Craving Questionnaire (PCQ) [167] onokuvavanya iimeko ezisemgangathweni phakathi kweentlobo ezahlukeneyo zomsebenzisi ongcolileyo.
Kukho nezixhobo zokuvavanya ukulungelelaniswa kwabasebenzisi boonografi ukuyeka ukuziphatha ngokucwangcisa izixhobo [168] kunye nokuvavanywa kwenkqubo yesiphumo sokwenza oko [169], ukuchonga ngokukhethekileyo okuthintela ukuphindaphinda kwezinto ezintathu: (a) ukuvusa isondo / ukuxhalabisa / ithuba, (b) ukuxhatshazwa / indawo / ukufikelela okulula, kunye (c) neemvakalelo ezimbi.

3.8. Unyango

Ngenxa yokuba kusekho imibuzo emininzi ngokuphathelele ukucinga, ukuhlola, kunye nezizathu zokuziphatha koxhatshazo kunye ne-POPU, bekukho iinzame ezimbalwa zokuzama ukuphanda ukhetho olululo. Kuphando olushicilelweyo, ubungakanani beesampuli zihlala ziyingcinci kwaye zihamba ngokufanayo, ukulawulwa kweeklinikhi kunqongophala, kwaye iindlela zophando ziyahlakazeka, zingabonakali, kwaye zingaphenduli [170].
Ngokuqhelekileyo, ukudibanisa kwengqondo, ingqondo-yokuziphatha, i-psychodynamic, kunye neendlela ze-pharmacologic kuthathwa njengeyona ndlela ichanekileyo kunyango lwezilonda zesondo, kodwa le ndlela engeyona ndlela ibonisa ukungabi nalwazi malunga nesihloko [9].

3.8.1. Iindlela zoPhakamiso

Ezi zifundo zijolise kwi-paroxetine kunye ne-naltrexone kude kube ngoku. Elinye iimeko ezibandakanya i-paroxetine kwi-POPU yanceda ukunciphisa amaxhala, kodwa ekugqibeleni akakwazanga ukunciphisa ukuziphatha ngokwawo [171]. Ukongezelela, ukusebenzisa ii-SSRIs ukudala ukungasebenzi kwezesondo ngeempembelelo zabo zecala kubonakala kungasebenzi, kwaye ngokubhekiselele kumava eekliniki kuncedo kuphela kwizigulane ezineengxaki zokugula ngengqondo [172].
Iingxelo ezine ze-naltrexone zokuphatha iPOPU zichaziwe. Iziphumo ezidlulileyo ziphakamisile ukuba i-naltrexone ingaba yonyango lwezilingo zokuziphatha kunye nengxaki yokuxhatshazwa koxhatshazo [173,174], ngokukhawuleza ukunciphisa izifiso kunye nokucebisa ngokuthintela ukuthokoza okuhambisana nokuziphatha. Nangona kungekho sisilingo esilawulwa ngokungahleliwe kunye ne-naltrexone kwezi zifundo, kukho iingxelo ezine. Iziphumo ezifunyenwe ekunciphiseni iifoto zoononophala zisebenzisa ezahlukeneyo kwizinto ezilungileyo [175,176,177] ukumodareyitha [178]; ubuncinane kwelinye laso isigulane safumana i-sertraline, ngoko kuyacaca ukuba ingaba yintoni enokuthi ithathwa ngokuba yi-naltrexone [176].

3.8.2. Iingcali zengqondo

Ngokungathandabuzekiyo, i-psychotherapy ingaba yinto ebonakalayo ekuqondeni ngokupheleleyo nokuguqula indlela yokuziphatha. Nangona i-ctnitive-behavioral therapy (CBT) ithathwa njengabakliniki abaninzi ukuba luncedo ekuphatheni ingxaki yokuxhatshazwa koxhatshazo [179], isifundo esabandakanyekayo abasebenzisi be-pornography abanobuchopho behlulekile ukufikelela ekunciphiseni ukuziphatha [180], nangona ukuba ubunzima beempawu zokudandatheka kunye nekhwalithi epheleleyo yobomi bephuculwe. Oku kuvelisa umdla wokwenza umdla wokunciphisa ukusetyenziswa koonobumba obungasayi kubonisa injongo ebalulekileyo yokonyango [170]. Ezinye iindlela ezisebenzisa i-CBT ukuphatha i-POPU zenziwe, kodwa iingxaki zeendlela zesiganeko kule ndawo zithintela ukuba siphume izigqibo ezithembekileyo [181,182].
I-Psychodynamic Psychotherapy kunye nabanye njengokonyango lwezentsapho, unyango lwezitshato, kunye nezokwelapha zonyango emva kweenkqubo zeNkqubo ze-12 zingabonakalisa ukubaluleka xa zijongana neentloni zentlonelo kunye nokubuyisela ukuthembela phakathi kobudlelwane obusondeleyo babasebenzisi [170,172]. Ulingo olulodwa olulawulwa ngokungahleliwe olukhoyo olujongene neengxaki zobuninzi boonografi abasebenzisi be-intanethi ligxile kwi-Acceptance and Commitment Treatment (ACT) [183], uphuculo oluvela kwi-series ye-2010 [184], okwakusisifundo sokuqala sokuhlola ukujongana ngqo nePOPU. Uphononongo lubonise iziphumo eziphumelelayo kodwa kunzima ukuphucula ngaphandle kokuba isampuli yayisaphantsi kakhulu kwaye igxininise kubemi abathile.
Impumelelo echaziweyo kunye ne-CBT, unyango kunye ne-ACT lithembele kwinqanaba elisekelwe kwizikhokelo zengqondo kunye nokwamkelwa; kuxhomekeke kumongo, ukwandisa iifoto zoononophelo zisebenzisa ukuwamkela kunokulinganayo okanye kubaluleke kunokunciphisa ukusetyenziswa kwayo [170].

4. Ingxoxo

Kubonakala ngathi i-POPU ayikho enye i-subtype enye ye-hypersexual disorder, kodwa okwangoku ixhaphake kakhulu kubakho nayo iquka ukuhlaziya i-masturbation. Nangona oku kunzima ukucacisa ngokuchanekileyo ukunikezwa ngokungachazwanga kunye nokufikeleleka kwezinto ezibonisa ukusetyenziswa koononografi namhlanje ngokubanzi, sinokwenza okungenani sinokuqinisekisa ukuba umgcini wokusetyenziswa kwezinto eziphathekayo zoonografi ushintshile malunga nokugqibela kweminyaka elishumi. Ngeke kube yinto engafanelekanga ukuba ithathe i-variant ye-intanethi ibe nempembelelo ebalulekileyo kubathengi bayo, kwaye ukuba izinto ezi-triple ziphakamisa umngcipheko omkhulu wePOPU kunye nezinye iindlela zokuziphatha ngokwesini.
Njengoko sikhankanywe, ukungaziwa kuyinto ebalulekileyo yengozi yale ndlela yokuziphatha ngokwesondo ukuba ibe yingxaki. Kufuneka sihlale sikhumbula ukuba iinkcukacha malunga nale ngxaki ngokucacileyo ziphela kubantu abaneminyaka yobudala bokubandakanyeka kwimisebenzi yesondo, kwi-intanethi okanye ngenye indlela; kodwa akusibaleki ukuba umsebenzi wezesondo ungaqali ukuqala emva kwalo mqathango, kwaye kukho amathuba okuba abantwana abasesebenza kwinkqubo yokuphucula ukuhlaselwa ngokwesondo ngabahlali abasemngciphekweni. Inyaniso kukuba ukuvumelanisa ngokunamandla malunga nokuziphatha okubi ngokwesondo, kubangaphandle kokungaxhunyiwe kwi-intanethi, kuyimfuneko ukulinganisa ngokwaneleyo ngendlela engummeli kwaye uqinisekise ukuba yingxaki engakanani kuluntu namhlanje.
Njengokuba sisazi, iinjongo zezifundo zakutshanje zixhasa le nkampani njengomlutha kunye nemibonakalo ebalulekileyo yekliniki ezifana nokungaxhatshazwa ngokwesondo kunye nokunganeliseki kwengqondo. Ubuninzi bomsebenzi okhoyo usekelwe kuphando olufanayo olwenziwe kwizilonda zomzimba, ngokusekelwe kwingcamango yecalografi ekhompyutheni njengento ephakamileyo yezinto eziphathekayo, eziqhubekayo, ezinokuthi ziqhubeke nokusetyenziswa, zingabangela ingxaki yomlutha. Nangona kunjalo, iingcamango ezifana nokunyamezela kunye nokuziyeka azikabi ngokucacileyo ukuba zilungele ukubethelwa komlingo, kwaye ngoko ke zibangela inxalenye ebalulekileyo yophando. Okwangoku, i-diagnostic entity ebandakanya ukuziphatha ngokuziphatha ngokwesondo ifakiwe kwi-ICD-11 ngenxa yokubaluleka kwayo kweklinikhi yangoku, kwaye kuya kuqinisekiswa ukuba iyakusetyenziswa ukujongana nezigulane ezinempawu ezicela uncedo lwabahlengikazi.
Kukho izixhobo ezahlukeneyo zokuvavanya ukukhokelela ukliniki oqhelekileyo kunye neendlela zokuxilonga, kodwa ukunciphisa into enokwenene kwaye ingekho ngendlela echanekileyo isengxaki eqhubekayo. Kuze kube ngoku, inxalenye ebalulekileyo yeetekethi zeendlela ezicetywayo yiCarnes, Goodman, kunye neKafka ziquka iingcamango ezisisiseko zokulahlekelwa kolawulo, ixesha elidlulileyo ekusebenziseni ukuziphatha ngokwesondo kunye nemiphumo emibi kubo kunye nabanye. Ngandlela-thile okanye kwezinye izinto, zikhona kwiindawo ezininzi zokuphonononga izixhobo.
Zingaba nesakhiwo esaneleyo sokwakha kuso. Ezinye izinto, ezicatshangelwayo kunye namazinga ahlukeneyo obalulekileyo, mhlawumbi sisisigxina ukuba sithathe izinto ezithile kwi-akhawunti. Ukuqwalasela isixhobo sokuvavanya esinezinga elithile lokuguquguquka ngexesha lokwabaluleka ekunqumeni into eyinkathazo ngokuqinisekileyo enye yeengxaki ezikhoyo esizijongene nayo, kwaye mhlawumbi ziya kuhamba kunye nophando olongezelelweyo lwe-neurobiological olusinceda ukuba siqonde ngakumbi xa umlinganiselo othile Ubomi bomntu obuqhelekileyo uguquka kwisenzo esiqhelekileyo kwisifo.
Ngokuphathelele izicwangciso zonyango, iinjongo eziphambili ngoku zijolise ekunciphiseni ukusetyenziswa koonografi okanye ukuyiyeka ngokupheleleyo, kuba ukubonakaliswa kweklinikhi kubonakala kuphendulwa. Indlela yokufezekisa le nto ihluka ngokuhambelana nesigulane kwaye ingaphinda ifune ukuguquguquka komntu kwizicwangciso ezisetyenzisiweyo, nge-psychotherapy esekelwe ngqondweni nangokwamkelwa ngokulinganayo okanye ebaluleke ngaphezu kweendlela zokwenza imithi kwiimeko ezithile.

Inkxaso

Olu phando alutholanga mali yangaphandle.

Iimbambano Zomdla

URubén de Alarcón, uJavier I. de la Iglesia, kunye no-Nerea M. Casado bathengisa ukuba akukho mpikiswano. U-AL Montejo ufumene iimali zokucebisa okanye i-grammarry / i-grants yenkxaso kwiminyaka emihlanu edlulileyo ukusuka eBoehringer Ingelheim, i-Forum Pharmaceuticals, i-Rovi, i-Servier, iLundbeck, i-Otsuka, i-Janssen Cilag, i-Pfizer, i-Roche, i-Instituto de Salud iCarlos III, kunye neJunta de Castilla y León .

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