UDaniel Schöttle, MD*
UDaniel Schöttle, iSebe le-Psychiatry and Psychotherapy, iZiko lezoNyango leYunivesithi yaseHamburg-Eppendorf, eHamburg, eJamani;
I-Peer Briken, MD
I-Peer Briken, iZiko loPhando lwezesondo kunye ne-Forensic Psychiatry, iZiko lezoNyango leYunivesithi yaseHamburg-Eppendorf, eHamburg, eJamani;
Oliver Tüscher, MD
U-Oliver Tüscher, iSebe le-Psychiatry kunye ne-Psychotherapy, i-University Medical Centre Mainz, i-Mainz, eJamani;
UDaniel Turner, MD, PhD
UDaniel Turner, iZiko loPhando lwezesondo kunye ne-Forensic Psychiatry, iZiko lezoNyango leYunivesithi yaseHamburg-Eppendorf, eHamburg, eJamani; iSebe leNgqondo kunye neNgqondo yeNgqondo, iZiko lezoNyango leYunivesithi iMainz, iMainz, eJamani;
Abstract
Njengabantu abadala abangachaphazelekanga, abantu abane-autism spectrum disorders (ASDs) babonisa lonke uluhlu lweendlela zokuziphatha ngokwesondo. Nangona kunjalo, ngenxa yeempawu ezingundoqo ze-spectrum yokuphazamiseka, kubandakanya ukusilela kwizakhono zentlalo, i-hypo- kunye ne-hypersensitivities, kunye nokuziphatha okuphindaphindayo, abanye abantu be-ASD banokukhula ngokomndilili ongaphezulu okanye ongaqhelekanga wokuziphatha ngokwesondo kunye nomdla. Emva kokuphonononga uncwadi olufanelekileyo malunga nokwabelana ngesondo kubantu abasebenza kakhulu kwi-ASD, sibonisa izinto ezintsha ezifunyenweyo malunga nokuphindaphindwa kokuziphatha okuqhelekileyo ngokwesondo kunye nezo zimalunga novavanyo lweengcinga ze-hypersexual kunye ne-paraphilic kunye nokuziphatha kwabantu be-ASD kwisifundo sethu. Abantu abanoluphazamiseko babonakala benokwabelana ngesondo okugqithisileyo kunye nemibono yeparaphilic kunye nokuziphatha kunokuba uphando lubonisa. Nangona kunjalo, oku kungangqinelani kuqhutywa ikakhulu kuqwalaselo lwamadoda athatha inxaxheba anoluphazamiseko. Oku kungenxa yokuba abasetyhini abanoluphazamiseko badla ngokuqhelana nentlalontle kwaye babonisa iimpawu ezimbalwa zoluphazamiseko. Iimpawu zokuziphatha ngokwesondo kwizigulana zoluphazamiseko kufuneka zithathelwe ingqalelo zombini kwimfundo yezesondo kunye neendlela zonyango.
intshayelelo
Iziphazamiso ze-Autism spectrum (ASD) luphazamiseko lwe-neurodevelopmental oluquka iqela elingafaniyo leemeko, eziphawulwa kukonakala kwintsebenziswano yoluntu kunye nonxibelelwano, kunye nomdla ophindaphindiweyo kunye neengcamango kunye nokuziphatha.1 Izinga elixeliweyo lokuxhaphaka linyuke ngokuphawulekayo kumashumi eminyaka akutshanje (ukuya kuthi ga kwi-1% yokuphila ubomi bonke), kwaye baya besanda abantu abadala abafunyaniswa bene-ASD.2 Kucingelwa ukuba umlinganiso wendoda-kumfazi uphakathi kwe-3 kunye ne-4 ukuya ku-1,3 kwaye kukho iiyantlukwano zesini kuluphazamiseko.4 Nangona phantse isiqingatha sabantu abanoluphazamiseko bengekho krelekrele kwaye benezakhono eziqhelekileyo zokusebenzisa ingqondo nolwimi (njengabantu abanoluphazamiseko olusebenzayo okanye iAsperger Syndrome), unxibelelwano lwentlalo kunye nonxibelelwano lunengxaki kunye nobunzima ekuboneni imbono yabanye kunye nokuqonda ngokuqonda iimpawu zentlalo zenza imiqobo efihlakeleyo kuphuhliso lobudlelwane bothando kunye nokwabelana ngesondo.5,6 Iingxaki ezinxulumene nokwabelana ngesondo zinokuvela, ngakumbi ekuqaleni kokufikisa, ixesha apho ukukhula kwezakhono zoluntu zoluphazamiseko zingakwazi ukumelana nokwanda kweemfuno zentlalo, kwaye imiceli mngeni yokwenza ubudlelwane bezothando kunye nokwabelana ngesondo ibonakale ngakumbi.7
Izifundo ngesondo kubantu abanoluphazamiseko
Malunga neminyaka eyi-10 emva kokungena ngokusemthethweni kwe-autism kuhlelo lwesithathu lwe Incwadi yokuHlola kunye neNkcazo yeNgqondo yeNgqondo (DSM-III) ngo-1980, izifundo zokuqala ezicwangcisiweyo malunga nokwabelana ngesondo kwezigulane ezinoluphazamiseko zapapashwa.8-11 Imeko yangoku yophando ngamava esondo, indlela yokuziphatha ngokwesondo, isimo sengqondo sezesondo, okanye ulwazi lwezesondo lwabantu abane-ASD kunokuba luxutywe, kunye nophononongo oluthile lufumana umahluko kulawulo olusempilweni (HCs) ngelixa abanye bengakwenzi. Nangona kunjalo, ngenxa yendalo engafaniyo yespektrum yokuphazamiseka kunye neendlela ezahlukeneyo zenzululwazi zezifundo, oku akumangalisi. Uphononongo lwangaphambili luye: (i) luquke abaguli ababhinqileyo kunye/okanye abangamadoda kwiindawo zokuhlala ezinomonakalo othe chatha kunye namathuba amancinci amava ngesondo; (ii) igxininise kubantu abaphazamiseke ngokwasengqondweni okanye ezinye iziphene zokukhula, nto leyo ekhokelela kwiziphumo ezibhidayo; (iii) kusetyenziswe uphando lwe-intanethi apho abantu abakwizinga eliphezulu kuphela abathatha inxaxheba; (iv) ethembele kwiingxelo ezivela kumalungu osapho nakubanonopheli okanye kwizigulana ngokwazo; kunye (v) novavanyo lwabantu abanoluphazamiseko ngokweminyaka yobudala.
Olu phononongo lucebisa ukuba abantu abaninzi abanoluphazamiseko bafune ubudlelwane bezesondo kunye nobudlelwane obufana nobo bantu bangengabo ASD12,13 kwaye ube nawo wonke amava kunye nokuziphatha ngokwesondo.12-18 Nangona kunjalo, kusekho iingcamango kunye neenkolelo zasekuhlaleni malunga nabantu abanoluphazamiseko, kubhekiselwa kubo njengabangenamdla kubudlelwane bentlalo kunye nokuthandana kunye nokuba ngabantu abangenasini.10,19,20 Itheyibhile I ibonelela ngamagqabantshintshi ngezifundo ezivavanya imiba eyahlukeneyo yesini kubantu abadala abancinci nabadala abaneAutism esebenza kakhulu, ngokwesiseko semibuzo yokuzixela.11,12,15,21-33 Sigxininise ngakumbi kuphononongo loncwadi kwezi zifundo kuba indlela yokusebenza kwazo ihambelana nendlela yophando esetyenziswe kuphononongo olunikezelwe apha. Izifundo ziboniswe kwi Itheyibhile I qinisekisa ukuba ulwabelana ngesondo lubalulekile kubantu boluphazamiseko, kwaye kuyacaca ukuba yonke imiba yezesondo kunye nokuziphatha imelwe kweli qela.11-13,15,20-31
Uninzi lophando olukhoyo ukuza kuthi ga ngoku lugxile emadodeni, kwaye izifundo ezimbalwa ziye zajongana nemiba ethile ngokwesini malunga nentlalo, imvakalelo, kunye nemimandla yokuqonda, kwaye zimbalwa izifundo ezikhoyo ezivavanya isini ngokuzimeleyo kumadoda nabasetyhini abaneASD.12,13,20,32 Iingqwalasela ezimbalwa zeklinikhi32 kunye neqela elincinane lophononongo olucwangcisiweyo lubonisa ukuba abasetyhini abanoluphazamiseko bangabonakalisa intsilelo yentlalo nonxibelelwano kwaye babe nomdla okhethekileyo ohambelana nomdla woontanga babo.33-36 Ngaphaya koko, abasetyhini abanoluphazamiseko babonakala besebenzisa iindlela zokuhlangabezana, ezinjengokuxelisa izakhono zentlalo zoontanga babo abangeyo ASD, ngoko ke bangabinamdla ekuhlaleni.34 Ngokuphathelele kwimiba ephathelele kwisini, abasetyhini abanoluphazamiseko babonakala benezinga eliphantsi ekusebenzeni ngokwesondo ngokubanzi, baziva bephantsi kubudlelwane bezesondo kunamadoda anoluphazamiseko, kwaye basemngciphekweni omkhulu wokuba lixhoba lokuxhatshazwa ngokwesondo okanye gadalala.37 Amadoda anoluphazamiseko kufunyaniswe ukuba abandakanyeka kwizenzo zokwabelana ngesondo zodwa.11-14,18,37 kunye nokuba nomnqweno omkhulu wobudlelwane bezesondo kunye nobudlelwane bothando20; Nangona kunjalo, kukho ubungqina bokuba abasetyhini abanoluphazamiseko, nangona banomnqweno ongephi wokwabelana ngesondo, badla ngokubandakanyeka kubudlelwane obudala.13
Nangona abantu abane-ASD befuna amava ngesondo kunye nobudlelwane, uphuhliso kunye nokugcinwa kobudlelwane bothando kunye nokwabelana ngesondo kuchatshazelwa kakhulu kukunqongophala kwezakhono zentlalo kunye nonxibelelwano kunye nobunzima bokuqonda iindlela zokusebenzisana ezingabonakaliyo okanye ezifihlakeleyo kunye nengqondo (ithetha ukukwazi ukuqonda kunye nezimo zengqondo zabanye, umz. iimvakalelo, iminqweno, ukuqonda abantu abanjalo.6 Ngaphaya koko, abantu abaninzi abanoluphazamiseko abayifumani imfundo yezesondo ethathela ingqalelo iimpawu zabo zokuziphatha, kwaye abafane bafumane ulwazi ngesondo kwimithombo yezentlalo.5,22,38
Enye ingongoma emayiqwalaselwe yimidla ethintelweyo kunye nephindaphindwayo, enokuthi ingabi nasondo ebuntwaneni kodwa inokutshintsha ibe yimpembelelo yezesondo kunye nokuziphatha ngokwesondo xa umntu emdala. Ngaphaya koko, uvakalelo oluhlala luxelwa rhoqo lunokukhokelela ekuphenduleni ngokugqithisileyo okanye ekuphenduleni ngaphantsi kwe-sensory stimuli kumxholo wamava ngesondo.39 Kubantu abane-hypersensitive, ukubamba okuthambileyo komzimba kunokuba namava njengento engathandekiyo; Kwelinye icala, abantu abane-hyposensitive banokuba neengxaki ekuvukeni nasekufikeleleni kwi-orgasm ngokuziphatha ngokwesondo.20 Xa zidibene, ezona mpawu zoluphazamiseko zidibene nolwazi olunqongopheleyo lwezesondo kunye nokungabinamdla wokuthandana nokwabelana ngesondo kunokubangela ukuba abanye abantu abanoluphazamiseko babe neengxaki zokuziphatha ngokwesondo.22,38 ezifana ne-hypersexual kunye nokuziphatha kwe-paraphilic, kunye nokukhubekisa ngokwesondo.
Amagama ahlukeneyo asetyenzisiwe ukuchaza indlela yokuziphatha ngokwesondo ngokobuninzi obungaphezulu komndilili obandakanya ukukhotyokiswa ngokwesondo, ukunyanzeliswa ngokwesondo, ukuzixakekisa ngokwesondo, kunye nokulalana. Kweli nqaku, siza kusebenzisa amagama okuziphatha ngokwesondo ngokugqithisileyo okanye i-hypersexuality ebhekiselele kwiminqweno yesondo eqhelekileyo, umnqweno wesini, kunye nokuziphatha.40,41 Nangona kunjalo, umntu kufuneka aqaphele ukuba ubukho nje bokuziphatha okungaphezulu komndilili wesondo akufanelanga ukufumana ukuxilongwa kwengqondo (njengokuphazamiseka kwe-hypersexual okanye ukuphazamiseka kokuziphatha ngokwesondo okunyanzelekileyo). U-Kafka ucebise ukuba i-diagnostic criteria ye-hypersexual disorder disorder ifakwe kuyo I-DSM-5. 40 Ezi ndlela zichaza i-hypersexual disorder njengeengcamango zesondo eziphindaphindiweyo kunye nezinzulu, izibongozo, okanye ukuziphatha ngokwesondo ubuncinane ubuncinane kwiinyanga ze-6, ezibangela uxinzelelo olubalulekileyo lweklinikhi, kwaye alukho ngenxa yezinye izinto okanye iimeko zonyango; kwakhona, umntu kufuneka abe neminyaka eyi-18 ubuncinane.40,42 Nangona uReid kunye noogxa bakhe babonise ukuba ukuphazamiseka kwe-hypersexual disorder kunokuhlolwa ngokufanelekileyo nangokuthembekileyo ngokusetyenziswa kwezi ndlela zokuxilonga, i-American Psychiatric Association nangona kunjalo ikukhabile ukusetyenziswa okunjalo ngenxa yemeko yophando olungonelanga, ifuna uphando olungakumbi malunga novavanyo lwenkcubeko yenkcubeko. Ukuphazamiseka, kwizifundo ezimele ze-epidemiological, kunye nezifundo nge-etiology kunye neempawu zebhayoloji ezinxulumeneyo.43
Kuhlelo olucetywayo lweshumi elinanye lwe Ulwahlulo lwamazwe ngamazwe lweZifo (ICD-11), le nkcazo ilandelayo yokuxilongwa kwengxaki yokuziphatha ngokwesondo okunyanzelekileyo41 kuqwalaselwa:
Ukuphazamiseka kokuziphatha ngokwesondo okunyanzelekileyo kubonakala ngokuzingisa kunye nokuphindaphinda iminqweno yesini okanye iminqweno enamava njengengenakuthintelwa okanye engalawulekiyo, ekhokelela ekuphindaphindweni kokuziphatha ngokwesondo, kunye nezalathi ezongezelelweyo ezifana nezenzo zesondo zibe yeyona nto iphambili kubomi bomntu ukuya kuthi ga kwinqanaba lokutyeshela impilo. kunye nokunyamekela komntu okanye ezinye izinto, iinzame ezingaphumeleli zokulawula okanye ukunciphisa ukuziphatha ngokwesondo, okanye ukuqhubeka nokuziphatha ngokuphindaphindiweyo ngokwesondo ngaphandle kwemiphumo emibi (umzekelo, ukuphazamiseka kobudlelwane, imiphumo yomsebenzi, impembelelo embi kwimpilo). Umntu ufumana amava okwandisa uxinzelelo okanye ukuvuswa okuchukumisayo kwangoko phambi komsebenzi wesondo, kunye nokukhululeka okanye ukuphelisa ukuxinezeleka emva koko. Ipateni yeempembelelo zesini kunye nokuziphatha kubangela uxinzelelo oluphawulekayo okanye umonakalo omkhulu kumntu, usapho, intlalontle, imfundo, umsebenzi, okanye ezinye iindawo ezibalulekileyo zokusebenza.
Ngokubhekiselele kwi-paraphilias, i DSM-5 ngoku yahlula phakathi kwe-paraphilias kunye nokuphazamiseka kwe-paraphilic, ngaloo ndlela ijolise ekujongeleni phantsi imidla yesondo engaqhelekanga kunye nokuziphatha okungabangeli uxinzelelo okanye ukwenzakala emntwini okanye ukwenzakala kwabanye.42 Kwi I-DSM-5, I-paraphilias ichazwa “njengawo nawuphi na umdla onzulu nozingisileyo wezesondo ngaphandle komdla wesondo ekuvuseleleni amalungu angasese okanye ukulungiselela ukubambana ngendlela eqhelekileyo, eqolileyo ngokwasemzimbeni, evumelana namaqabane abantu” (bona Ibhokisi 1 kuluhlu lweengxaki zeparaphilic ezibandakanyiweyo DSM-5). 44 Nangona iindlela ezicetywayo zokuphazamiseka kweparaphilic kwi ICD-11 zifana nezo ze I-DSM-5, Umahluko omnye omkhulu phakathi kwezi ncwadana zimbini zokuxilonga kukususwa kweengxaki ze-paraphilic ezifunyaniswe ngokuyintloko ngokwesiseko sokuziphatha okuvumayo okungekho kwaye ngokwazo ezinxulumene noxinzelelo okanye ukungasebenzi kakuhle. Oku kwakhokelela ekubeni ICD-11 ngaphandle kwe-fetishistic, i-masochism yezesondo, kunye nokuphazamiseka kwe-transvestic,41,45 Iindlela zokuziphatha ezixeliweyo kubantu boluphazamiseko.
Ibhokisi 1. Amagqabantshintshi eengxaki zeparaphilic ezibandakanyiweyo kwiincwadana zangoku zokuxilonga.
Ukuphazamiseka kokubonisa
• Ukuvuseleleka ngokwesondo ngokuveza amalungu akhe obuni okanye amalungu esini kumntu ongavumiyo.
Ukuphazamiseka kweFetistics *
• Ukuvuseleleka ngokwesondo ngokudlala ngezinto ezingaphiliyo.
Ukuphazamiseka kweFrotteuristic
• Ukuvuseleleka ngokwesondo ngokuphulula amalungu akhe esini kumntu ongavumanga.
Ukuphazamiseka kwe-Sexual masochism *
• Ukuvuseleleka ngokwesondo ngokubotshwa, ukubethwa, okanye ukwenziwa intlungu emzimbeni okanye ukuthotywa.
Ukuphazamiseka ngokwesondo ngokwesondo
• Ukuvuseleleka ngokwesondo ngokubangela intlungu ngokwasengqondweni okanye ngokwasemzimbeni okanye intlungu kwiqabane ngesondo.
Ukuphazamiseka kweTransvestic*
• Ukuvuselela inkanuko yesini ngokunxiba kunye nokwenza isimbo okanye ngendlela eqhelekileyo enxulumene nesini esahlukileyo.
Ukuphazamiseka kweVoyeuristic
• Ukuvuseleleka ngokwesondo ekujongeni abanye xa behamba ze okanye besenza izenzo zokwabelana ngesondo.
Ukuphazamiseka kwePedophilic
• Umtsalane wesondo osisiseko okanye okhethekileyo kubantwana abangekafiki.
*Iimeko ezibonisayo ezisekelwe kukuziphatha okuvumayo kwaye ngokuqhelekileyo azibandakanyi abanye abangavumanga kwaye azikho kwaye zona ngokwazo ziyayanyaniswa noxinzelelo okanye ukungasebenzi kakuhle. IQela eliSebenzayo kuLwahlulo lweZiphene zezeSondo kunye neMpilo yezeSondo licebise ukuba kususwe ezi meko I-ICD-11.
Ukuza kuthi ga ngoku, zimbalwa kakhulu izifundo eziye zavavanya i-hypersexual okanye paraphilic behaviour kubantu abanoluphazamiseko, kwaye uninzi lwazo ziingxelo zengxelo malunga noluphazamiseko olubonisa ukuphulula amalungu esini ngokugqithisileyo.46-50 imiboniso yokuziphatha,51 Iingcinga ze-pedophilic okanye ukuziphatha,52,53 Iingcamango zefetishistic okanye ukuziphatha,54,55 i-sadomasochism,50 okanye ezinye iintlobo zeparaphilias.56 Nangona kunjalo, kulwazi lwethu, zonke izifundo ezidlulileyo malunga ne-hypersexual kunye ne-paraphilic behaviors ziye zaqhutywa emadodeni kwaye kwiimeko ezininzi ngabantu abane-ASD abangakwazi ukuqonda.
Emva kokuphonononga uncwadi, sijonge ukuphanda iindlela zokuziphatha ngokwesini kunye neengcinga zeparaphilic kunye nokuziphatha kwisampulu enkulu yabaguli be-ASD yamadoda nabasetyhini xa kuthelekiswa neeHCs ezihambelana nesini, iminyaka kunye nenqanaba lemfundo.
tindlela
nxaxheba
Ukufumana ulwazi oluthe ngqo kubantu abanoluphazamiseko kunye nokufunda isampulu ekhethwayo ifana nqwa, sibandakanya abantu abadala abanoluphazamiseko ngokwasengqondweni. Ingqiqo yokubandakanya kuphela abantu abane-autism esebenzayo okanye i-Asperger syndrome yayikukunciphisa umphumo onokuthi udideke wokukhubazeka kwengqondo kwaye ngoko ke bakwazi ukufunda ngokuthe ngqo impembelelo ye-ASD kwisini. Ngokwesiseko sokuzixela, zonke izigulana zafunyaniswa ngugqirha wengqondo onamava okanye isazi wezengqondo (n=90, i-Asperger syndrome; n = 6, i-autism engaqhelekanga); iminyaka yobudala apho izigulane zifumene ukuxilongwa kwe-ASD yayiyi-35.7 iminyaka (i-standard deviation [SD] = iminyaka eyi-9.1; uluhlu = 17 ukuya kwiminyaka eyi-55). Iqela lezigulane ze-ASD (intsingiselo yamanqaku [M] = 26.7; SD = 4.9) yayinamanqaku aphezulu kakhulu kune-HCs (M = 6.4; SD = 3.3) kwi-German version ye-Autism Spectrum Quotient Short Form (AQ-SF; P<0.001).57 Zonke izigulana ze-ASD kwaye akukho nanye kwi-HCs efumene amanqaku angaphezu kwexabiso elicetywayo lokunqunyulwa lamanqaku ali-17.57 Abathathi-nxaxheba kuwo omabini amaqela bafaniswe ngokwesini, ubudala. kunye neminyaka yemfundo (Uluhlu II).
Procedure
Ibhodi yophononongo lweenqobo ezisesikweni yeBhunga lezoNyango laseHamburg yamkele inkqubo yokufunda. Ukuze kufunyanwe abantu abanoluphazamiseko, amaqela okuzinceda kulo lonke elaseJamani aqhagamshelwana nawo kwaye acelwa ukuba asasaze incwadana yophononongo phakathi kwabathathi-nxaxheba. Abanye abathathi-nxaxheba baye bagaywa kwiziko le-autism kwi-University Medical Centre eHamburg-Eppendorf, eJamani. Ii-HCs zaye zagaywa ngeentengiso kwiZiko lezoNyango leYunivesithi i-Hamburg-Eppendorf kunye neYunivesithi yeZiko lezoNyango i-Mainz eJamani, kudederhu lweevenkile zasekuhlaleni, nangoqhagamshelwano lobuqu lwabaphandi.
Amanyathelo
I-Autism Spectrum Quotient Short Form, inguqulelo yesiJamani
Inguqulelo yesiJamani ye-Autism Spectrum Quotient Short Form (AQ-SF) questionnaire57 yayisetyenziselwa ukuvavanya iimpawu ze-autistic kubo bonke abathathi-nxaxheba. Umlinganiselo we-17 utyunjwe njengexabiso elifanelekileyo lokunqunyulwa kweenjongo zokuhlola kwaye uvelise uvakalelo lwe-88.9% kunye ne-specific ye-91.6% kunye nommandla ongaphantsi kwe-curve ye-receiver yeempawu zokusebenza ze-0.92 kwisampuli yokuqinisekisa yaseJamani.58
Uluhlu lwe-Hypersexual Behaviour (HBI-19)
I-Inventory ye-Hypersexual Behaviour (HBI-19)58,59 iqulethe izinto ze-19 kwaye ivavanya ukuziphatha kwe-hypersexual. Zonke izinto kufuneka ziphendulwe kwinqanaba le-5-point Likert kwaye zichazwe ngokwesini ngokungathathi hlangothi. Abathathi-nxaxheba abanamanqaku angaphezu kwama-49 badla ngokuhlelwa njenge-hypersexual. Inguqulelo yesiJamani yoluhlu lwemibuzo ivelise ukuhambelana okugqwesileyo kwangaphakathi kwe-α=0.90 kumanqaku ewonke.60
Uluhlu lwemibuzo malunga namava ngokweSondo kunye nokuziphatha (QSEB)
Uluhlu lwemibuzo malunga namava ngokweSondo kunye nokuziphatha (QSEB)61 iqulethe izinto ezili-120 kwaye ivavanya ulwazi malunga nemvelaphi yosapho, ukuhlalisana ngokwesondo, indlela yokuziphatha ngokwesondo, kunye neendlela ezahlukeneyo zesini. Ngaphaya koko, uluhlu lwemibuzo luvavanya ulwazi malunga neengcinga zesini kunye nokuziphatha (kubandakanywa nemibono yesondo kunye nokuziphatha). Uninzi lwezinto zibhekiselele kwixesha lokujonga iinyanga ezili-12; kwizinto ezifanelekileyo zeklinikhi, i-questionnaire icela abathathi-nxaxheba ukuba bachaze ubude bexesha apho uphawu lwekliniki lukhona. Kolu phononongo lwangoku, kuphela izinto ezibhekiselele kuphindaphindo lokuphulula amalungu esini kunye nezenzo zesondo ezidibeneyo, kunye neengcinga zeparaphilic kunye nokuziphatha, zahlalutywa.
Ucatshulwa
Umahluko wamaqela uhlalutywe kusetyenziswa u-Χ 2 iimvavanyo kwiindidi zecategorical, kunye t-uvavanyo lweesampulu ezizimeleyo kwiinguqu eziqhubekayo. Ngenxa yokuba iimvavanyo ezininzi zezibalo zenziwa kwiseti yedatha efanayo, silawule izinga lokubaluleka kokuqokelela impazamo yohlobo lwe-I ngokusebenzisa umlinganiselo wokufumanisa ubuxoki (FDR) ngokusekelwe kwindlela eyaphuhliswa nguBenjamin! kunye nellochberg.62 Ukulawula uvavanyo oluninzi kukhokelela ekunciphiseni P-umda wexabiso. Kwisifundo esikhoyo, ukulungiswa P-value threshold was 0.0158, oku kuthetha ukuba kuphela P-amaxabiso angaphantsi kwesi sikelo kufuneka athathwe njengento ebalulekileyo. Ngaloo ndlela, i-FDR ayinyangeki kangako kunolungiso olusetyenziswa ngokwesiko lweBonferroni; kunjalo, kutsha nje, kwacetyiswa ukuba i-FDR kufuneka ifumane ukhetho ngaphezu kwendlela ye-Bonferroni, ngakumbi kwizifundo zempilo kunye nezonyango.63
iziphumo
Ubume bobudlelwanehi enye
Kubantu abanoluphazamiseko, abasetyhini abaninzi (n=18; 46.2%) kunamadoda (n=9; 16.1%) bebekubudlelwane ngoku.P<0.01). Akukho mahluko ubonakalayo ufunyenweyo kwinani labasetyhini (n=ll; 27.5%) kunye namadoda (n=8; 14.3%) anoluphazamiseko achaze ukuba nabantwana babo. Xa sithelekisa abantu be-ASD kunye neeHCs, siye saqaphela ukuba abasetyhini abaninzi beHCs (n=31; 79.5% ; P>0.01) kunye namadoda amaninzi eHC (n=47; 82.4% ; (P>0.01) ngaphezu kwabantu abanoluphazamiseko bebekubudlelwane ngoku. Akukho mahluko ubonwe kwinani labathathi-nxaxheba abanabantwana babo (HCs: n= 7; I-7.3%).
Ukuziphatha ngokwesondo yedwa kunye ne-dyadic
Abafazi
Njengoko kuboniswe kuyo Uluhlu III, akukho mahluko afunyenweyo phakathi kwabathathi-nxaxheba besetyhini kwixesha lokuphulula amalungu esini (P>0.05). Nangona kunjalo, ii-HCs zabasetyhini zibonise ukuba neentlobano zesini rhoqo kunezigulane ze-ASD zabasetyhini (P<0.05). Kwafunyaniswa ipateni efanayo malunga nombuzo othi "unqwenela kangaphi ukuba neentlobano zesini," ebonisa ukuba abafazi be-HC babenomnqweno omkhulu wokwabelana ngesondo kunabalingane babo be-ASD.P<0.05).
Amadoda
Ngokubhekiselele kumaxesha okuphulula amalungu esini emadodeni, abathathi-nxaxheba be-ASD besilisa baxele ukuphulula amalungu esini rhoqo kune-HCs zamadoda.P<0.01). Xa kuthelekiswa namaxesha okwabelana ngesondo, ipateni echaseneyo yafunyanwa, kunye nee-HCs ezinika ingxelo ephezulu yokwabelana ngesondo kunabantu be-ASD. Amadoda e-ASD achaze umnqweno omkhulu wesondo wokwabelana ngesondo kunabalingane babo be-HC (P<0.05, Uluhlu III).
Ukuziphatha ngokwesini
Kwi-HBI, izigulana ze-ASD (HBIisixa=35.1; I-SD=13.7) yayinamanqaku aphezulu kakhulu kune-HCs (HBIisixa=29.1; SD=8.7; P<0.001), kwaye ngokuphawuleka ngakumbi abantu abane-ASD babenamanqaku ngaphezulu kwexabiso elicetywayo lokunqunyulwa lamanqaku angama-49 kwaye ke banokuchazwa njenge-hypersexual (P<0.01). Njengoko kubonisiwe kwi Uluhlu IV, amadoda anoxilongo lwe-ASD anike ingxelo yokuziphatha okungaphezulu kwe-hypersexual, ngelixa bekungekho mahluko unjalo phakathi kwabaguli ababhinqileyo abane-ASD kunye neeHCs zabasetyhini. Ngaphaya koko, ngelixa abantu abangamadoda ali-17 abane-ASD bafumene amanqaku angaphezulu kwexabiso le-49 kwaye banokuchazwa njenge-hypersexual, ngamadoda amabini kuphela e-HCs afumene amanqaku ngaphezulu kwe-cutoff ecetywayo.P<0.001). Akukho mahluko ufunyenweyo phakathi kwezigulane ze-ASD zabasetyhini kunye nee-HCs kwizinga le-hypersexuality.
Iingcamango zeParaphilic kunye nokuziphatha
Lilonke, i-paraphilic yesondo kunye nokuziphatha kuye kwaxelwa rhoqo kwizigulana zamadoda ezine-ASD kune-HCs zamadoda. Emva kokulungiswa kovavanyo oluninzi, umahluko omkhulu wawusekhona kwinani labantu abaxela iingcinga ezihlekisayo, iintelekelelo ezilusizi, iingcamango ze-voyeuristic kunye nokuziphatha, iingcamango ze-frotteuristic kunye nokuziphatha, kunye neengcamango ze-pedophilic kubantwana abangabasetyhini (bona Uluhlu IV). Izigulana ezingamabhinqa ezine-ASD azikhange zibonise mahluko kumaxesha amaninzi eengcamango ze-paraphilic okanye indlela yokuziphatha xa kuthelekiswa noogxa babo be-HC, ngaphandle kokuphindaphindeka kokuziphatha kwe-masochistic, apho ii-HCs zabasetyhini abaninzi zibonise ukuziphatha kwe-masochistic kunezigulana ze-ASD zabasetyhini.
ingxoxo
Ngokolwazi lwethu, olu luphononongo lokuqala lokuphonononga imiba ethe ngqo yesini se-hypersexual kunye ne-paraphilic fantasies kunye nokuziphatha kwiqela labantu abasebenza kakhulu abanoluphazamiseko xa kuthelekiswa neqela elihambelanayo lolawulo. Ezona ziphumo zethu ziphambili zezokuba abantu abanoluphazamiseko babonisa i-hypersexual kunye ne-paraphilic fantasies kunye nokuziphatha kune-HCs.
Uphando lwangaphambili lucebise ukuba kubantu abanoluphazamiseko, nangona bejongwa njengabantu abathandana nesini esahlukileyo,18 Bekukho amazinga aphezulu (ukuya kutsho kwi-15% ukuya kwi-35%) yabantu abathandana besini esifanayo okanye abathandana nesini esibini kunabo bangengobantu boluphazamiseko.14,64 Kuphononongo olukhoyo kwakhona, bambalwa abantu abanoluphazamiseko abaxele ukuba bathandana nesini esahlukileyo kune-HCs; nangona kunjalo, kufuneka kuqatshelwe ukuba zonke ii-HCs bezithandana nesini esahlukileyo kwaye ke azinakuthelekiswa nabemi ngokubanzi. KuPhando lwe-Global Online Sexuality, i-10% iyonke yabathathi-nxaxheba ibonise ubufanasini.65 Iingqikelelo ezahlukeneyo zenziwe malunga noluhlu olubanzi loqhelaniso lwezesondo kuluntu loluphazamiseko. Mhlawumbi isini akubalulekanga ekukhetheni iqabane, ngenxa yokufikelela okulinganiselweyo kubudlelwane bothando okanye ngokwesondo kunye namava anqongopheleyo kunye nokutshintshiselana ngokwesini kunye noontanga babo. Ngokudityaniswa nolwazi oluncinci lwezesondo, oku kunokukhokelela ekuqondeni okulinganiselweyo malunga nesini okanye ukhetho.33,35,37 Ngaphaya koko, kukho ubungqina bokuba abantu abane-ASD banokunyamezela ngakumbi kubudlelwane besini esifanayo,15 kwaye kusenokwenzeka ukuba abantu boluphazamiseko bakhethe izinto abazikhethayo ngokwesondo ngaphandle kokwamkelekileyo okanye okufunwayo ekuhlaleni, mhlawumbi ngenxa yokungakhathali kwizithethe okanye iindima zesini.15
Ngokubalulekileyo ii-HCs ngaphezu kwabantu abanoluphazamiseko baye baxela ukuba babenobudlelwane neeyantlukwano zesini. Abasetyhini abaninzi kunamadoda anoluphazamiseko babekubudlelwane. Iziphumo zolunye uphononongo oluvavanya iyantlukwano ngokwesini kubume bobudlelwane azingqinelani, kodwa kukho ubungqina bokuba nangona amadoda enqwenela ubudlelwane be-dyadic ngaphezu kwabasetyhini, abafazi be-ASD bahlala bethandana kunye nobudlelwane bezesondo.11,31 Oku kungabangelwa kukukwazi kwabasetyhini ukuba babize iindlela eziphucukileyo zokuhlangabezana (umzekelo, ukuxelisa izakhono zentlalo zoontanga babo abangengabo ASD), nto leyo ekhokelela ekuthotyweni kwentlalontle.33-36 Malunga nokuphindaphindeka kokuziphatha ngokwesondo, abasetyhini abanoluphazamiseko baye baxela ukuba bodwa kunendlela yokuziphatha ejoliswe emntwini kunye nomnqweno omncinci wokuba neentlobano zesini neqabane kunoogxa babo abangengabo ASD. Ipateni efanayo ifunyenwe kwi-ASD yamadoda, ehambelana nezinye izifundo.12,23,24,33
Nangona kunjalo, ukungahoywa kwezithethe zentlalo kunye nezakhono ezithintelweyo zentlalo kunye ne-hyposensitivities okanye i-hypersensitivities kunokonyusa umngcipheko wokubandakanyeka ekuziphatheni okungaqhelekanga okanye okungaphezulu komndilili wesondo.22,38 Ukugxininisa le ngcinga, safumanisa ukuba ukuziphatha kwe-hypersexual bekuxelwa rhoqo kubantu abane-ASD kune-HCs; nangona kunjalo, le yantlukwano yayiqhutywa ikakhulu ngabaguli abangamadoda be-ASD, kwaye akukho mahluko phakathi kwamaqela abasetyhini owabonwayo. Ngokwesiseko sokusebenza ngokuchanekileyo kokuziphatha kwe-hypersexual, izifundo zangaphambili zifumene uqikelelo lokuxhaphaka ukusuka kwi-3% ukuya kwi-12% kwizifundo zamadoda ezisempilweni.66-68 Kuphando lwe-intanethi malunga ne-9000 yamadoda aseJamani, u-Klein kunye noogxa bafumene ukuxhaphaka kokuziphatha kwe-hypersexual (echazwe njenge-orgasms engaphezu kwesixhenxe ngeveki kwixesha le-1 inyanga) ye-12%.69 Ngokucacileyo, oku kubonisa ukuba uninzi lwezifundo ze-ASD zamadoda kuphononongo lwethu lubonise indlela yokuziphatha ngokwesini ngokugqithisileyo kunolu qikelelo lusekwe ebantwini. Ukuza kuthi ga ngoku, nguFernandes kuphela kunye noogxa bakhe abaye bavavanya indlela yokuziphatha ngokwesini kubantu abane-ASD kwaye bafumana amaxabiso asezantsi kunathi.70 Kubantu abangama-55 abasebenzayo be-ASD yamadoda avavanyiweyo, i-7% ichaze malunga nokuziphatha kwe-hypersexual, echazwa njengezenzo ezingaphezu kwesixhenxe zesondo ngeveki, kwaye i-4% yenza imisebenzi yesondo ngaphezu kweyure ye-1 ngosuku, ngokucacileyo ngaphantsi kwamanani. ifunyenwe kuphononongo lwangoku. Nangona kunjalo, uFernandes et al akazange akhankanye indlela abayichaza ngayo imisebenzi yesondo, kwaye kunokwenzeka ukuba abathathi-nxaxheba kwisifundo sabo balinganise kuphela imisebenzi yesondo ye-dyadic, echaza inani eliphantsi lokuziphatha kwe-hypersexual.70 Izizathu ezinokuthi zenzeke kumazinga aphezulu e-hypersexuality kumadoda e-ASD zihlala zingacacanga, kodwa kunokucingelwa ukuba ziyinxalenye yokuziphatha okuphindaphindiweyo okanye ziphenjelelwa yizinto ezikhethekileyo. Ngenxa yokuba asizange sihluke phakathi kokuziphatha okujoliswe kumntu kunye nokuziphatha ngokwesondo, izinga eliphezulu lokuziphatha kwe-hypersexual kumadoda e-ASD linokuthi libe yimbonakaliso yokuphulula i-masturbation ngokugqithiseleyo, efunyenwe kwezinye izifundo kunye neengxelo zecala. Kwacetyiswa ukuba ukuziphatha ngokugqithisileyo kwe-masturbatory kunokubonakalisa umnqweno wokulala ngesondo nangona ungenakukwazi ukufezekisa oku ngenxa yeengxaki ezibandakanya ubudlelwane besondo be-dyadic ngenxa yezakhono zentlalo ezilinganiselweyo.14,46-48,52 Ngokubhekiselele kubasetyhini, uphando oluncinci luye lwenziwa malunga nokuphindaphindwa kokuziphatha kwe-hypersexual, kwaye ngenxa yobungakanani besampulu ezincinci, uqikelelo lokuxhaphaka lusuka kwi-4% ukuya kwi-40% kubemi ngokubanzi.60 Kuphononongo lokuqinisekisa lwaseJamani lwe-HBI, i-4.5% yabasetyhini abaphantse babe li-1000 ababandakanyiweyo kumanqaku angaphezulu kwesindululo esicetywayo sokuziphatha ngokwesini.59 Njengengxenye ye DSM-5 Izilingo zentsimi ye-hypersexual disorder, kwafunyaniswa ukuba i-5.3% yazo zonke izigulana ezifuna uncedo kwiziko elikhethekileyo lokunyamekela izigulane zangaphandle yayingabasetyhini,43 ebonisa ukuba izinga lokuziphatha kwe-hypersexual linokuba lisezantsi kakhulu kwabasetyhini kunamadoda. Njengoko abaguli ababhinqileyo be-ASD babonakala beqhelana ngcono nentlalontle kwaye bahlala bebonisa iimpawu ze-ASD ezingachazwanga kakhulu (umz., ukungaphindaphindi ukuziphatha), ayimangalisi into yokuba izimilo zokwabelana ngesondo ngokugqithisileyo kolu phononongo zifunyenwe kancinci kwabasetyhini kunakumadoda o-ASD.
Ukuza kuthi ga ngoku, akukho phantse zonke izifundo ezicwangcisiweyo malunga neeparaphilias kuluntu loluphazamiseko64,70; uninzi lolwazi luvela kwizifundo zophando. Ngaphaya koko, phantse zonke iimeko zophononongo ezijongene nokuziphatha kweparaphilic kumadoda oluphazamiseko lokuqonda; ngoko ke, ukuthelekisa okufunyenweyo kolu phando kunqongophele ngokucacileyo. Kuphononongo lukaFernandes kunye noogxa bethu (kulwazi lwethu ekuphela kophononongo lwangaphambili olujongene ne-paraphilias kumadoda asebenza kakhulu kwi-ASD), i-paraphilias efunyenwe rhoqo yayiyi-voyeurism kunye ne-fetishism.70 Iingcinga zeVoyeuristic kunye nokuziphatha zikwaphakathi kwezona paraphilias zifumaneka rhoqo kumadoda nabafazi beASD kolu phononongo. Ngaphaya koko, ii-paraphilias ebezisoloko zixelwa ibiziingcamango ze-masochism kunye neengcamango ezilusizi kunye nokuziphatha. Kwakhona, oku kunokuba yimbonakaliso ye-hyposensitivity kuluntu lwe-ASD, ebonisa ukuba abantu abanjalo bafuna uvuselelo olungaphezulu kwe-avareji ukuze bavukele ngokwesondo. Ngaphaya koko, uFernandes et al wafumanisa ukuba ukwenzeka kweparaphilia kunxulunyaniswa neempawu ezininzi ze-ASD, amanqanaba asezantsi okukwazi kwengqondo, kunye namanqanaba asezantsi okusebenza okuguquguqukayo, ebonisa ukuba ubuchule obuphantsi bokuqonda bubonakala buyinto ebalulekileyo kwi-etiology ye-paraphilic fantasies. kunye nokuziphatha kuluphazamiseko.70 Kunokucingelwa ukuba ulwazi lwezithethe zentlalo kunye nokuzeyisa kusezantsi kakhulu kubantu abanoluphazamiseko lwengqondo, icacisa izinga eliphezulu lokuziphatha kwe paraphilic. Nangona uninzi lwabantu boluphazamiseko kuphononongo lwangoku bebenemibono ephangaleleyo, bambalwa kakhulu abantu ababonakalise ukuziphatha okugqithisileyo, bexhasa uluvo lokuba abantu abasebenza kakhulu boluphazamiseko banokuba nobuchule bokuzibamba obuphezulu kunezigulana ezinoluphazamiseko lwengqondo. Ulwazi malunga neeparaphilias kuluntu ngokubanzi lukwanqongophele, uninzi lwezifundo ezibandakanya amadoda, ikakhulu agaywe kwiisetingi zeklinikhi okanye zenkundla.71 Kubantu ngokubanzi, izinga lokuxhaphaka kwayo nayiphi na i-paraphilia ithathwa ukuba iphakathi kwe-0.4% kunye ne-7.7%. 72-75 Kwakhona, usebenzisa i-QSEB, u-Ahlers et al wafumana umlinganiselo we-59% kuyo nayiphi na ingcamango ye-paraphilic kunye nesantya se-44% kuyo nayiphi na i-paraphilic yokuziphatha kwisampuli yabo yabemi be-367 yaseJamani, kunye neengcamango eziqhelekileyo ze-paraphilic yi-voyeuristic (35 %), i-fetishistic (30%), kunye neengcamango ezibuhlungu (22%).61 Kuphononongo lwangoku, ingakumbi kumadoda o-ASD, amazinga eentelekelelo zeparaphilic kunye nokuziphatha ebephezulu kunoqikelelo lokuxhaphaka olufunyenwe kuninzi lwezifundo zabemi ngokubanzi. Kwakhona, siye safumanisa umahluko ngokwesini ngokuphindaphindiweyo kweengcamango zeparaphilic kunye nokuziphatha kuluntu lwethu lwe-ASD. Ingcaciso enokubakho malunga nale yantlukwano kukuba i-sex drive enamandla kumadoda e-ASD inokulamla ubukho be-paraphilias ngokusebenzisa amandla aphezulu ekwenzeni ukuthanda kwabo ngokwesondo okanye ukuba abo banokwabelana ngesondo okuphezulu baqhube lula ngakumbi kwimisebenzi ethile, ngaloo ndlela bekhokelela kubo. ukuzama ukwenza izinto ezintsha.71,76,77 Ngaphaya koko, i-hypersexuality inokukhokelela kwisiseko esisezantsi sokuzonyaniswa ngokwesondo okanye ukucaphukela kwiingcamango ze-paraphilic okanye indlela yokuziphatha ecacisa ikhonkco phakathi kwezinga eliphezulu le-hypersexual, kunye ne-paraphilic, ukuziphatha.77
Iziphumo zophononongo lwethu zikhawulelwe ngenxa yokuba zisekelwe kuphela kwingxelo yobuqu, kwaye umntu akanakuqiniseka ukuba bonke abathathi-nxaxheba bafunyenwe ngugqirha wengqondo oqeqeshiweyo okanye ugqirha wengqondo. Nangona kunjalo, bonke abathathi-nxaxheba be-ASD bafumene amanqaku angaphezulu kwexabiso lokunqunyulwa kwenguqulelo yesiJamani ye-AQ, beqinisekisa ukuba babonisa iimpawu ze-ASD. Ngaphaya koko, bonke abathathi-nxaxheba baye bagaywa ngokwamaqela okuzinceda nge-ASD okanye amaziko ononophelo lwangaphandle lwe-ASD, ebonisa ukuba ukunxibelelana kwabo nenkqubo yezonyango kungenxa yeempawu zabo. Iziphumo zethu zophononongo zikwathintelwa ngamandla okuba abantu abanomdla ophezulu kwimiba enxulumene nesondo, kwaye mhlawumbi nabo baneengxaki zesondo ezingaphezulu, kungenzeka ukuba bazivolontiya bathathe inxaxheba, ngaloo ndlela bechaphazela abantu bophononongo. Oku bekungakhokelele kuqikelelo olugqithisileyo lolona qondo lokwenyani lwe-hypersexual kunye ne-paraphilic fantasies kunye nokuziphatha kwiqela le-ASD. Nangona kunjalo, ukuba yinyani, oku bekufanele ukuba kwenzeke kwiqela leHC.
Uphononongo lwangoku lolokuqala ukuvavanya i-hypersexual kunye ne-paraphilic fantasies kunye nokuziphatha kwisampulu enkulu yabantu abakwi-ASD yamadoda nabasetyhini xa kuthelekiswa neqela elihambelanayo lolawulo, ebonisa ukuba nangona abantu be-ASD benomdla kakhulu ekuziphatheni ngokwesondo, ngenxa yokuba izithintelo zabo ezithile ekusebenzeni kwezentlalo nezothando, uninzi lwazo lunika ingxelo yeempawu zesini.
Imibulelo
Sifuna ukubulela uStefanie Schmidt owenze umsebenzi omhle ekuxhaseni ukufunwa kwabathathi-nxaxheba. Ngaphaya koko, sifuna ukubulela onke amaqela azinceda athe avuma ukusasaza isimemo sethu sokufunda kwabo bathatha inxaxheba. Akukho nkxaso-mali ifunyenweyo yolu phando.
IZALATHISO