Ukukhuthaza uqeqesho lwezemfundo, ulwahlulo, unyango, kunye nemigaqo-nkqubo Inkcazo kwi: Ukukhubazeka kokuziphatha ngokwesondo kwi-ICD-11 (Kraus et al., 2018)

KHAWUZE UKUFUNDA

Gola Mateusz

In an era of unfettered Internet access on mobile devices, such behaviors as pornography use, searching for paid sexual services, and casual sexual encounters (so called hook-ups) appear to have become more prevalent. Everyday common and clinical observations indicate that for some individuals, these new forms of sexual behaviors have become problematic and prompted treatment seeking (IGola, iLebczuk, kunye neSkorko, 2016). Given such cases, terms such as “sex addiction” exist in the mass media and public discussion. However, despite the high social importance and interest in this phenomenon, compulsive sexual behaviors (CSBs) for years have arguably remained at the margin of systematic scientific investigation and psychiatric classification (Kafka, 2014; IKraus, Voon, kunye nePotenza, 2016; Potenza, Gola, Voon, Kor, kunye neKraus, 2017).

Decades of scientific and clinical discussions regarding CSBs, hypersexsuality, and sex addiction have generated multiple ideas, but in comparison to other psychiatric behaviors and disorders, relatively little data exist to test them (IGola kunye nePotenza, ngo-2018). On one hand, insufficient data may have hindered the inclusion of CSB disorder or related constructs [i.e., hypersexual disorder (Kafka, 2010)] in the fifth edition of I-Diagnostic and Statistical Manual of Disabilities (DSM-5; Umbutho we-Psychiatric Association, i-2013), despite the results of a DSM-5-related field trial of hypersexual disorder (Reid et al., 2012). On the other hand, the absence of an official diagnostic entity with specified criteria may have hindered research, data collection, and educational efforts relating to CSBs. Fortunately, important recent advances in understanding significant facets of CSBs have occurred.

Kraus et al. (2018) described criteria for CSB disorder as proposed for inclusion in ICD-11. In our opinion, the World Health Organization’s decision for proposing CSB disorder for inclusion in the upcoming ICD-11 is a very important step from the perspective of individuals seeking treatment for CSBs; clinicians providing such treatment; researchers interested in studying this topic; and society raising questions and receiving answers, which should ultimately inform policy efforts. We would like to briefly present perspectives on these four areas and voice most important issues that we believe are worth future investigation.

For many individuals who experience persistent patterns of difficulty or failures in controlling intense, repetitive sexual impulses or urges that result in sexual behavior associated with marked distress or impairment in personal, family, social, educational, occupational, or other important areas of functioning, it is very important to be able to name and identify their problem. It is also important that care providers (i.e., clinicians and counselors) from whom individuals may seek help are familiar with CSBs. During our studies involving over 3,000 subjects seeking treatment for CSB, we have frequently heard that individuals suffering from CSB encounter multiple barriers during their seeking of help or in contact with clinicians (UDhuffar kunye noGriffiths, ngo-2016). Patients report that clinicians may avoid the topic, state that such problems do not exist, or suggest that one has a high sexual drive, and should accept it instead of treating (despite that for these individuals, the CSBs may feel ego-dystonic and lead to multiple negative consequences). We believe that well-defined criteria for CSB disorder will promote educational efforts including development of training programs on how to assess and treat individuals with symptoms of CSB disorder. We hope that such programs will become a part of clinical training for psychologists, psychiatrists, and other providers of mental health care services, as well as other care providers including primary care providers, such as generalist physicians. (ugxininiso olongeziweyo)

Imibuzo ebalulekileyo malunga nendlela engcono yokucinga ngayo ingxaki ye-CSB kunye nokubonelela ngonyango olufanelekileyo kufuneka iqwalaselwe. Isiphakamiso samanje sokuhlenga isifo se-CSB njengengxaki yokulawulwa kwempembelelo ingquzulwano njengemizekelo eminye eceliwe (Kor, Fogel, Reid, & Potenza, 2013). Kukho idatha ebonisa ukuba i-CSB yabelana ezininzi izinto kunye nezilingo (UKraus et al., 2016), kubandakanywa nedatha yakutshanje ebonisa ukunyuka kwe-reactivity yeziganeko zobuchopho ezinxulumene nomvuzo ekuphenduleni iziqulatho ezinxulumene nesishukumiso esithintekayo (Brand, Snagowski, Laier, kunye neMaderwald, 2016; IGola, iLizwiecha, iMarchewka, kunye neSescousse, 2016; UGola et al., 2017; IKlucken, Wehrum-Osinsky, iSchweckendiek, iKruse, kunye neStark, 2016; IVoon et al., 2014). Ukongezelela, idatha yokuqala ibonisa ukuba i-naltrexone, iyeza kunye nezibonakaliso zeengxaki zokusetyenziswa kotywala kunye ne-opioid, zinokuba luncedo ekuphatheni ii-CSB (IKraus, Meshberg-Cohen, Martino, Quinones, kunye nePotenza, 2015; URaymond, uGrant, kunye noColeman, ngo-2010). Ngokubhekiselele kwisigaba se-CSB sokuhlengahlengiswa kwesifo njengengxaki yokulawulwa kwempembelelo, kukho idatha ebonisa ukuba abantu abafuna unyango lwenkqubo enye ye-CSB ingxaki, ukusetyenziswa koonografi okuyingxaki, ayifani ngokungahambelani ngokubanzi kwabantu. Kunoko kunikwe ukuxhalabisa (IGola, iMiyakoshi, kunye neSescousse, 2015; UGola et al., 2017), kwaye unyango lwezonyango olujolise kwiimpawu ezixhalabisa lunokuba luncedo ekunciphiseni iimpawu ezithile ze-CSB (IGola kunye nePotenza, ngo-2016). Nangona kungenakwenzeka ukuba ufumane izigqibo ezichanekileyo malunga nokuhlelwa, ukwaziswa oku ngakumbi kubonakala kukuxhasa ulwahlulo njengengxaki yomlutha xa kuthelekiswa nengxaki yokulawula umtsalane (UKraus et al., 2016), kwaye uphando olongezelelweyo lufunekayo ukuhlolisana ubudlelwane kunye nezinye izimo zengqondo (Potenza okqhubekayo., 2017).

Like other psychiatric conditions, CSB disorder is likely heterogeneous with multiple contributory mechanisms. The form of CSB may represent an important factor to consider with respect to disorder heterogeneity. For example, distinctions may exist relating to participating predominantly in interpersonal sexual behaviors (e.g., risky casual sex with other people or paid sexual services) versus solitary behaviors (e.g., binge pornography use and masturbation; Efrati kunye neMikulincer, 2017). It is possible that the former may relate to high levels of impulsivity and sensation-seeking, and the latter may relate to high levels of anxiety, with each having different neural correlates as has been proposed for risky alcohol-use behaviors (Coleman, 1991, 2015; UGola et al., 2015; Stark & Klucken, 2017); however, this possibility warrants direct examination.

Pharmacological and psychological treatment strategies for CSB disorder and possible subtypes should be examined. Currently, there are few systematic studies of CSB disorder, especially with consideration of potential subtypes like problematic pornography use. Such studies will need support from funding agencies (Potenza, Higuchi, & Brand, 2018). The study of non-substance or behavioral addictions like gambling disorder does not receive governmental support the way that disorders like mood, anxiety, psychotic substance use, and most other psychiatric do (Editorial, 2018). Given individual and public health concerns related to CSBs, we hope that governmental agencies and other stakeholders (including but not limited to producers and distributors of pornography, Internet providers, and digital device manufacturers) will support research into major questions related to the prevalence of CSB disorder and its subtypes, development of culturally informed and psychometrically validated screening and assessment instruments, potential impact of Internet pornography (particularly with respect to youth exposure and developmental trajectories), and identification of vulnerability factors that may place individuals at risk for problems with CSBs. These and other questions warrant attention to improve prevention, treatment, and policy efforts in order to promote sexual health at individual and societal levels. (emphasis added)

In our opinion, clear diagnostic criteria for CSB disorder as proposed for inclusion in ICD-11 set an important foundation for a long journey to address socially important questions. Addressing and answering such questions should provide an improved understanding of people suffering from and affected by those with CSB disorder and lead to improved sexual health for the general public.