Umlutha woTyhila: I-Neuroscience Perspective (2011)

CIMALI: (Jonga izixhumanisi zengxoxo kwiibhothi zephepha.) Ingxoxo ephambili apha iyafana nendawo yethu: Nokuba kukuziphatha okanye imichiza, zonke iziyobisi zibandakanya iinkqubo ezifanayo kunye ne-neurocircuitry. Olu luhlengahlengiso olwenziwe yi-neurosurgeon kunye noogxa ojolise ikakhulu kukunganyaniseki, okuthintela kunye nokunciphisa ubungakanani / umsebenzi wee-lobes zangaphambili. Inxulunyaniswa nokuphulukana namandla okulawula iimpembelelo ezivela kwinkqubo yemilenze yengqondo. Le meko (ukungazenzisi) ifumaneka kwiziyobisi, ukutya, kunye neziyobisi. Kukwaxoxwa ngayo yiDeltaFosB, ikhemikhali eyimfuneko kuzo zombini iindlela zokuziphatha kunye neekhemikhali. Uphando lwamva nje lubonisa ukuba i-DeltaFosB inyuka namava ezesondo, kwaye amanqanaba aphezulu ayanyaniswa ne-hypersexual.

Umlutha woTyhila: I-Neuroscience Perspective

UDonald L. Hilton, I-Clark Watts 

  1. Isebe le-Neurosurgery, iYunivesithi yaseTexas yeSayensi yezeMpilo eSan Antonio, eSan Antonio, TX, eU.SA
  2. Isebe le-Neurosurgery, iYunivesithi yase-Texas School of Law, eAustin, TX, eU.SA

Idilesi yoLwazi:
I-Clark Watts
Isebe le-Neurosurgery, iYunivesithi yase-Texas School of Law, eAustin, TX, eU.SA

DOI:10.4103 / 2152-7806.76977

© 2011 Hilton DL Le ngcaciso evulelekileyo yokufikelela ekhutshwe phantsi kwemiqathango yeLayisensi ye-Creative Commons Attribution, evumela ukusetyenziswa, ukuhanjiswa, nokuvelisa okungekho naluphi na umthombo, ukubonelela ukuba umbhali oyimvelaphi kunye nomthombo baxelwe.

Ungacacisa njani eli nqaku: I-Hilton DL, iWatts C. Umlutha woonografi: Umbono we-neuroscience. Ukhuseleko lwe-Neurol Int 21-Feb-2011; 2: 19

Ungacacisa njani le URL: I-Hilton DL, iWatts C. Umlutha woonografi: Umbono we-neuroscience. Ukhuseleko lwe-Neurol Int 21-Feb-2011; 2: 19. Kufumaneka ukusuka: http://surgicalneurologyint.com/surgicalint_articles/pornography-addiction-a-neuroscience-perspective/

I-postulate ebalulekileyo yolu gqabaza kukuba zonke izidakamizwa zenza, ngaphezu kwenguqu yeekhemikhali kwinguqu, iinguquko ze-anatomical kunye neentsholongwane ezenza izibonakaliso ezahlukeneyo ze-cerebral dysfunction ngokubhaliweyo zibizwa nge-hypofrontal syndromes. Kule syndromes, isiphako esingaphantsi, sincitshiswe kwincazelo yaso elula, umonakalo "kwinkqubo yokuqhawula" yengqondo. Ziyaziwa kakhulu kwizonyango ze-neuroscientists, ngakumbi i-neurologists kunye neurosurgeons, kuba nazo zibonwa ngeesisu, izibetho kunye nokuxhwaleka. Enyanisweni, i-anatomically, ukulahlekelwa kwezi nkqubo zolawulo eziphambili zibonakala zilandelayo emva koxinzelelo, okuboniswa yi-atrophy eqhubekayo ye-lobes yangaphambili ebonwe kwi-serial MRI.

Nangona izinto eziphambili ze-hypondrontal syndromes-ukunyanzelisa, ukunyanzeliswa, ukunyamekela ngokomzwelo, ukugweba-ukuchazwa kakuhle, kuchazwe kakuhle, ininzi yale nkqubo ayisaziwa. Enye into evelayo yezi zizwe zonyango zifana nokufunyaniswa kwizigulana eziluthayo. Ukujongana nobuxoki, iFowler okqhubekayo. Kuphawulwe ukuba, "uphando lwabaxhamli lubonisa umsebenzi owenziwe umonakalo wee-cellox, indawo yengqondo ... [kuxhomekeka] ... ukwenza isicwangciso, kunokuziphosa, izigqibo. Izigulane ezinobungozi obunzima kule ndawo yengqondo zibonisa iingxaki-ukugwenxa, ukugweba kakubi kwimiphumo yesikhathi esizayo, ukukwazi ukuvimbela iimpendulo ezingafanelekiyo ezifana nezo zifunyenwe ngabaxhaphazi beziyobisi."[ 8 ] (ugxininiso olongeziweyo).

Kwi-2002, isifundo kwi-cocaine umlutha wabonakalisa ukulahlekelwa kwemilinganiselo eninzi kwimimandla yengqondo, kuquka i-lobes yangaphambili. 9 ] Inkqubo yokufunda yayiyi-protocol-based based MRI, i-voxel-based based morphometry (VBM), apho i-1 cub cubes zeengqondo ziqhathaniswa kwaye zifaniswa. Olunye uphando lwe-VBM lupapashwe kwi-2004 kwi-methamphetamine, kunye neziphumo ezifanayo. 27 ] Nangona kunomdla, ezi ziphumo zingenakumangalisa kunoba usosayensi okanye u-layperson, njengoko ezi "ziyobisi zangempela" zisetyenziswe ngokungekho mthethweni. Nangona kunjalo, kwakuphawuleka ukuba umlutha unokuvelisa ukulinganiswa, utshintsho lwe-anatomical kwingqondo.

Okunye okufundisayo kufana nokufunyaniswa okufana nokusetyenziswa kakubi kwezinto eziqhelekileyo zokuziphatha, ukutya, okukhokelela ekubeni umlutha kunye nokukhuluphala. Kwi-2006, isifundo seVBM sashicilelwe ngokubhekiselele ekunyanyeni, kwaye iziphumo zifana kakhulu ne-cocaine kunye ne-methamphetamine. 20 ] Ukutyibilika kwezilwanyana kubonakalisa indawo ezininzi zokulahlekelwa kwexabiso, ngokukodwa kwi-lobes yangaphambili, iindawo ezinxulumene nokugweba nokulawula. Esi sifundo sibalulekileyo ekuboniseni umonakalo obonakalayo kumlingo wokuphela kwemvelo, ngokuchasene nomlingo ogqithisileyo weziyobisi. Ukongezelela, kulula ukuwamkela i-intuitively kuba imiphumo yokutya ngokutya iyakubonakala kumntu ogqithiseleyo.

Ukutya, kunjalo, kubalulekile ekuzisindeni ngabanye, okuyimfuneko yokusinda kwezilwanyana. Olunye umsebenzi oluyimfuneko yokusindiswa kweentlobo ngesini, ukubonwa okukhokelela kwinqanaba lemibuzo enengqiqo evela kumsebenzi wokunyanyisa. Ingaba iziphumo ezibonwayo ekudleni izilwanyana ziya kubonwa ngokuziphatha okubi ngokwesondo? Ngaba isondo singasilutha kumqondo wengqondo? Ukuba kunjalo, ngaba kukho ukudibana nokuguqulwa kwezilwanyana ezinobungozi kwiingqondo ezibonwayo kunye nezinye izilwanyana? Uphononongo olutshanje lusekela ubungqina obukhulayo bokuthi ukuziphatha ngokwesini kunokunyaniseka. Kwi-2007, i-VBM yophando yaseJamani ikhangele ngqo kwi-pedophilia, kwaye yabonisa ukufumana okufanayo malunga ne-cocaine, i-methamphetamine kunye novavanyo lokukhuluphala. [ 25 ] Uphelisa okokuqala ukuba ukunyanzelwa ngokwesondo kunokudala ukuguqulwa ngokomzimba, i-anatomic kwingqondo, umqondiso wokulutha kwengqondo. Uphononongo lokuqala lubonise ukungasebenzi ngokuthe ngqo kwiigulane ezingakwazi ukulawula ukuziphatha kwabo ngokwesondo. [ 16 ] Olu phofu lusetyenziswa ukusabalalisa i-MRI ukuvavanya umsebenzi wokudlulisa i-nerve ngomcimbi omhlophe. Kubonisa ukungavumelekanga kummandla ophezulu, ummandla onxulumene nokunyanzeliswa.

Kwiminyaka elishumi eyadlulayo uDkt. Howard Shaffer eHarvard wabhala wathi, "Ndandibuhlungu kakhulu kubahlobo bam xa ndicebise ukuba ininzi yezilonda zibangelwa ngamava ... ukuphindaphinda, ukuvakalelwa kwamathuba aphezulu, amava aphezulu. Kodwa kuyacaca ukuba ukulungelelanisa-oko kukuthi, utshintsho kwiesekethe zesigqeba esinceda ukuqhubela phambili ukuziphatha-kwenzeka nangaphandle kokusetyenziswa kweziyobisi. "[ 13 ] Kutshanje, wabhala wathi, "Nangona kunokwenzeka ukuxubusha ukuba ngaba sifanele siquke izinto okanye izidakamizwa kwinkqubo yobugqirha, ngokwenene akukho nto ikhethayo. Kanye njengoko ukusetyenziswa kwezinto ezinokugqithiseleyo kunciphisa ama-molecule angamahlaya angena kwiindawo zokufumana ingqondo ngaphakathi kwengqondo, imisebenzi yabantu ivuselela ngokwemvelo ama-neurotransmitters. Umsebenzi walezi zinto eziza kwenzeka ngokwemvelo ziza kuthathwa njengabalulekayo abaninzi beenkqubo zokulutha. "[ 24 ]

Kwi-2005, uDkt. Eric Nestler wabhala iphepha eliphawulekayo elichaza zonke izilwanyana njengengxaki yokungasebenzi kwamagumbi okuvuza. Umlutha uyenzeka xa iindlela zokuzonwabisa / umvuzo zigqitywa ngamachiza angenakuqhathaniswa ne-cocaine okanye i-opioids, okanye ngeenkqubo zendalo eziyimfuneko kwaye zihambelana nokusinda ezifana nokutya kunye nesondo. Iinkqubo ezifanayo ze-dopaminergic zibandakanya indawo yendawo yokuqhafaza kunye neziqalo zayo kwi-nucleus accumbens kunye namanye amaziko angama-statal. Wabhala, "Ukwanda kobungqina kubonisa ukuba i-VTA-NAc indlela kunye neminye imimandla yesigxina ekhankanywe apha ngasentla iyafana, okungenani inxalenye, iimpembelelo ezintle zengqondo zemvelo, ezifana nokutya, isondo kunye nentsebenziswano yoluntu. Ezi ndawo ziye zabandakanywa kwizinto ezibizwa ngokuthi 'izilingo zemvelo' (oko kukuthi, ukusetyenziswa ngokunyanzeliswayo ngenxa yembuyekezo yemvelo) njengento yokudla ngokutya, ukugembula kwezilwanyana kunye nokuxhatshazwa ngokwesondo. Iziphumo zokuqala zibonisa ukuba iindlela ezibandakanyekayo zingabandakanyeka: (umzekelo) ukukhuphaza phakathi kwemvelo kunye nemichiza yokusetyenziswa kakubi. "[ 18 ]

Le ngqalelo kwinkqubo (okanye yemvelo) iyalatha kugxininisa ekusebenziseni ukuxilongwa kwemitha kwiindlela zokwakheka kwe-mesolimbic. Kanye nje ngokuba izidakamizwa ezilawulwa ngokugqithiseleyo zenza ukuba i-dopamine receptors idibanise kwi-nucleus iqokelele ekugqithiseni, ubungqina buxhasa ukusetyenziswa kweendlela zokuphelisa iintsholongwane ezinokuthi zenze i-pathology efanayo.

I-Royal Society yaseLondon ehloniphekileyo, esekelwe kwi-1660s, ipapasha i-journalist yesayensi ede kakhulu kunazo zonke emhlabeni. Kwimagazini yakutshanje Iinkcukacha zezobuGcisa zeRoyal Society, imeko yangoku yokuqonda umlutha yaxelwa njengoko yaxoxwa ngenye yezinto ezikhokelela ekugqibeleni i-addicted world in the meeting of the Society. Umxholo wephepha lephephabhenge ingxelo yokubanjelwa kwintlanganiso "I-neurobiology ye-addiction-entsha vistas." Okubalulekileyo kukuba, ngamaqaku e-17, ababini babandakanyeka ngokukodwa ngobungqina bokwemvelo: i-pathologic gambling [ 23 ] kunye nokutya. 28 ] Kwiphepha lesithathu, ejongene nemifanekiso yezilwanyana yezilwanyana kunye nokulutha kwemvelo, ehlobene neDeltaFosB. [ 19 ] I-DeltaFosB yiprothini efundwa yiNestler ebonakala ibhalwe ngaphezulu kwi-neurons yezifundo ezinomlutha. Kwafunyanwa kuqala kwi-neurons yezilwanyana ezifundwayo kwiziyobisi [ 17 ] kodwa ngoku sele ifunyenwe kwi-nucleus accumbens ehambelana nokusetyenziswa kwexesha lomvuzo wendalo. 18 ] Iphepha elikufutshane eliphanda i-DeltaFosB kunye nendima yalo ekusebenziseni ngaphezulu kwemivuzo emibini, yokutya kunye nokuziphatha ngokwesini, iqukumbela: ... umsebenzi owenziwa apha ubonisa ubungqina bokuba, ngaphezu kwezilwanyana zokusetyenziswa gadalala, imivuzo yemvelo yenza ukuba ama-FosB amanqanaba e-Nac ... iziphumo zethu ziphakamisa ukuba kungenzeka ukuba i-DFF ibandakanyeke kwi-NAc ingabambisani nje kuphela imiba ephambili yokuxhatshazwa kweziyobisi, kodwa kunye nemiba yezinto ezibizwa ngokuba ngumlutha wezinto eziphilayo ezibandakanya ukusetyenziswa kwemimiselo yendalo. 29 ]

 

Okubaluleke nakakhulu ngamaphepha amva nje ashicilelwe kwi-2010 echaza umphumo wesini ngo-neuroplasticity. Kuhlolisiso olulodwa, amava ezesondo sele aboniswe ukuba enze utshintsho kwi-neurons ephakathi kwe-nucleus eqokelelanayo efanayo neyabonwa ngamachiza okusetyenziswa kakubi. 21 ] Olunye uphando lufumanise ukuba ubulili buyandisa kakhulu i-DeltaFosB kwi-nucleus accumbens, kwaye inendima njengomlamli kwimemori yomvuzo wemvelo. Olu pho nonongo lufumene ukuba ukunyanzeliswa kweDeltaFosB kwenzelwe i-hypersexual syndrome. [ 22 ] Njengoko uDkt. Nestler uthe, i-DeltaFosB inokuthi ibe "yi-biomarker ukuvavanya imeko yokusebenza komsebenzi wesiphaluka somntu, kunye nesantya apho umntu 'angumlutha', zombini ngexesha lokuphuhliswa komlingo kunye nokuhamba kwayo ukunqunyulwa ngexesha lokuxothwa kwenyango okanye unyango. "[ 22 ]

UGqirha uNora Volkow, iNtloko yeSizwe soMhlaba ekuDlwengulweni kweziyobisi (NIDA), kunye nenye yezona zenzululwazi ezipapashwe kwaye zihlonishwayo kwintsimi yokuxhatshazwa kukuba, ekuqapheliseni utshintsho ekuqondeni ukuxilwa kwemvelo, ukukhuthaza ukutshintsha igama I-NIDA kwiSizwe soZwelonke malunga nezifo zoLungiso, njengoko kucatshulwe kwiphephancwadi inzululwazi: "UMlawuli we-NIDA uNora Volkow naye uvakalelwa kukuba igama lakhe leziko kufuneka libandakanye izilwanyana ezinjengezoconografi, ukugembula kunye nokutya, uthi umeluleki we-NIDA uGlen Hanson. 'Ungathanda ukuthumela umyalezo othi [sifanele] sibheke kwintsimi yonke.' "[ 7 ] (ugxininiso olongeziweyo).

Ngobungqina obandayo bokuthi ukutya ngokutya kunokuba ngumlutha wangempela njengoko kuchaziwe ngenguqu ezinokulinganiswa, ezinokuqinisekiswa kwiziko lezandla zomlenze, ingqalelo yethu kule ngxaki ikhula ngokukhawuleza. Nangona kunjalo, ukuziphatha ngokwesini, kunye nokuziphatha kwayo, kuthathwa ngokungathandeki ngokucacileyo kwiingxoxo zesayensi. Oku kwacaca emva kwesifundo se-Hogg esashicilelwe kwi-1997, esibonisa ukunyuka kwe-20 ngonyaka ekulindelekeni kobomi besini esinikwa ngabantu besini. 12 ] Ababhali, ngokusoloko beva noxinzelelo lwezenhlalakahle, banikezele ukucacisa ukuphepha ukubhala oko babibiza ngokuthi "ukuzondla abantu." [ 11 ] Ukuba iphephandaba lezesayensi liza kushicilela ukuxolisa kwezihlobo kukwaphawuleka kwakhona. Siyakholwa, nangona kunjalo, ngesiseko esandulelayo sekuyisikhathi sokuqala iingxoxo ezinzulu malunga nokuxhatshazwa ngokwesondo kunye nezinto zayo ezifana noonografi.

I-DSM-5 ekhethiweyo, ekhethiweyo yokupapasha ngoMeyi we-2014, iqulethe kule ntsha entsha yokongeza ukuxilongwa kwe-Hypersexual Disorder, equka inkathazo, ukusetyenziswa koonografi okuphosakeleyo. 1 ] UBostwick noBucci, kwingxelo yabo ngaphandle kweMayo Clinic ngokuphatha unyango lwe-intanethi ngo-naltrexone, wabhala "... ukulungelelaniswa kweselula kwi-pornography ye-addict's PFC kubangela ukunyuka kwezinto ezinxulumene neziyobisi, ukunciphisa ubuchule bokungabikho kweziyobisi. , kunye nokunciphisa umdla ekuqhubekeni kwimigqaliselo ejoliswe ekujoliswe kuyo. "[ 3 ]

Inzuzo ye-pornography yehlabathi ye-2006 yayiyi-dollar eyi-97, ngaphezu kwe-Microsoft, i-Google, i-Amazon, eBay, i-Yahoo, i-Apple kunye ne-Netflix. 14 ] Oku akusiyo into eyenzekayo, ingqungquthela engabonakaliyo, kodwa kukho ukuthambekela ekunciphiseni iimpembelelo zentlalo kunye nezityalo ze-biologic. Ishishini lesondo liye labonisa ngempumelelo nayiphi na inkcaso yokujonga imifanekiso engamanyala njengoko ivela kwindlela yokwenkolo / yokuziphatha; Emva koko bayakugxotha ezi zichaso njengeSichibiyelo sokuQala okuPhezulu. Ukuba ukugqithiswa koonografi kubonwa ngokuchanekileyo, ubungqina bubonisa ukuba ngokwenene kubangela ukulimala kubantu ngokubhekiselele kubambiswano. 2 ] Ulungelelaniso (i-85%) phakathi kokubukela iinthombe zoonografi kunye nokuthatha inxaxheba kwiintlobano zesini zesini kunye nabantwana kuboniswa nguBourke noHernandez. [ 4 ] Ubunzima kwiingxoxo ezihloliswe ngontanga zolu ngxowa uphinde uchazwe ngokuzama ukukhutshwa kwale data kwiindawo zentlalo. [ 15 ] I-meta-uhlalutyo lwakutshanje nguHald okqhubekayo. ixhasa ngokucacileyo kwaye icacise idatha edlulileyo ibonisa ukulungelelaniswa ngokubhekiselele kwimiba yecalografi ekunciphiseni iinjongo zobudlobongela malunga nabasetyhini. [ 10 ] Ngeenkcukacha ezinxulumeneyo ezinjalo, akunakuziphendulela ukujongana nokuba kungenzeka ukuba kubekho umbandela kule ndawo. Ukuphonononga olu datha kumxholo weepateni zokusetyenziswa ngoku ngokubanzi; I-87% yamadoda asekholejini abona iiporografi, i-50% yeveki kunye ne-20 imihla ngemihla okanye yonke imihla, kunye ne-31% yabesifazane ababukelayo. [ 5 ] Iimpembelelo zokuqhelaniswa kweentlobano zesini ngokuziphatha ngokwesondo nakwiintsholongwane ziye zaboniswa. [ 6 ]

Ngokuqinisekileyo indima yethu njengabaphangi ibonisa ukuba sinokwenza okungakumbi ukuphanda nokuphatha unyango oluntu oluhambelana nalo mbutho olutsha lwenkqubo okanye umlutha wendalo, ngokukodwa ngokunikezwa ubungqina obunzima bokuxhasa ubungqina be-neural yazo zonke iinkqubo zokulutha. Njengoko sibheka ukutshabalala kokutya njengokuba nesiseko sezinto eziphilayo, singekho sigama sokuziphatha okanye isigama-mali esinexabiso, lixesha esilubonayo kwiimifanekiso engamanyala kunye nezinye iintlobo zesilingo soxhatshazo ngokwesini. Okwangoku, iingcinezelo zentlalo zixhomekeke ekulawuleni izithombe zoonografi ngokukodwa kwiinkqubo zoluntu okanye kwiindawo zolwaphulo-mthetho. 26 ] Le nkcazo ayikho isikhalazo sokutshintsha ezo zenzo naliphi ixesha kungekudala. Ingxelo efuna ukukhuthaza uviwo ngamachiza ngokubanzi kunye neengcali zeklinikhi ezizodwa ngokukhethekileyo kwendima yonyango ekwenzeni unyango lwezilwanyana ezingcolileyo.

Ekugqibeleni le ngcamango, iProfayili yezeMpilo yezobuNgcono ingasiluncedo. Naliphi na iphrofayili enjalo ngohlobo lwayo luya kuba yinto ehamba phambili ngenxa yesimo samanje solwazi loxinzelelo kunye nokusingqongileyo apho kwenzeka khona. 1 Table inzame yokubonelela ngolu hlobo lwenkcazo, ngokusebenzisa imodeli yophando lwe-cholera eLondon kwi-1854, xa ukuqonda kweMpilo kaRhulumente yefuthe yekholera ngamachiza mhlawumbi kwakunjengobunqabileyo njengoko namhlanje. Ngoxa bebonga igalelo elikhulu ngoshishino lwezinto eziphathekayo zoonografi eziya kudingeke zibhekiswe kwiimithombo ezingekho kwemida, ikwabonisa nokuba indawo yonyango ekulawuleni umlutha.

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