IZIMVO: Eli phepha lapapashwa phantsi kwecandelo "leNgxoxo" kwijenali 'Iziyobisi'. Ubuthathaka bayo obuphambili kukuba ijongana nokujongana nokuziphatha okunyanzelekileyo ngokwesondo (i-CSB), igama lesambrela eligubungela yonke into ngokwesondo. Umzekelo, "i-CSB" ingabandakanya ukuxhatshazwa ngokwesini okanye "ukuxhatshazwa ngokwesondo" kwaye kunokubandakanya ukuziphatha okunjengokungathembeki ngokulandelelana okanye ukulingisa noonongogo. Nangona kunjalo abasebenzisi abaninzi be-porn abanyanzelekileyo abenzi ngokwesondo, kwaye banciphise indlela yabo yokuziphatha ngokunyanzelwa ekusebenziseni i-intanethi. "Ukuxhatshazwa ngokwesondo," kunye nophando kuwo, kufuneka kuthathelwe ingqalelo ngokwahlukileyo kwi-Intanethi. Eyokugqibela sisiqendwana se Internet likhoboka. Bona -
- Isiyobisi esingamanyala asisiSex Addiction- Kwaye Kutheni kubalulekile
- I-neuroscience ye-Intanethi yezoLimo: Ukuhlaziywa kunye nokuhlaziywa (2015).
Eyona nto iphazamisayo kweli phepha kukuba "Ingxelo yengxaki" kunye ne "Ukuchaza i-CSB" malunga ne "hypersexuality," ngelixa izifundo ezixhasa isiseko se-neurobiological se-CSB phantse zonke zikwi-intanethi yabasebenzisi be-porn. Olu hlobo lokungaqondakali lubangela ukudideka ngakumbi kunokucaca, kuba kunyanzelisa ukuba kubekho ulwimi olulumkileyo ngokumalunga nophando lwabasebenzisi be-intanethi, oko ke kunciphisa ukuqina kobungqina obuqinileyo (kunye nobukhulayo) bokuba Izilwanyana ze-intanethi aziqinisekanga kunye ne-intanethi ye-intanethi yi-subtype.
Shane W. Kraus1, 2, *, Valerie Voon3 kunye noMarc N. Potenza2,4
Inqaku lokuqala lipapashwe kwi-intanethi: 18 FEB 2016
Umbhalo: Umlutha
INGXELO: 10.1111 / yongeza.13297
KWI-ABSTRACT
Iinjongo: Ukuphonononga ubungqina bobuqhetseba bokuhlelela ukuziphatha okubi ngokwesondo (CSB) njengento engeyiyo into okanye ukuziphatha okubi.
Iindlela: Iinkcukacha ezivela kwimimandla emininzi (umz. I-epidemiological, i-phenomenological, iiklinikhi, i-biological) ihlaziywa kwaye iqwalaselwe ngokubhekiselele kwiinkcukacha ezivela kwizinto kunye nokungcakaza komngcipheko.
iziphumo: Iimpawu ezigqithisiweyo zikhoyo phakathi kwe-CSB kunye neengxaki zokusetyenziswa kweziyobisi. Iinkqubo eziqhelekileyo ze-neurotransmitter zinokufaka isandla kwi-CSB kunye neengxaki zokusetyenziswa kweziyobisi, kwaye uphando olutshanje lwe-neuroimaging lubonisa ukufana okumalunga nokukhanga nokukhathazeka. Uhlobo oluthile lwezonyango lwezonyango nolwazi lwe-psychotherapeutic lungasebenza kwi-CSB kunye nokulutha kweziyobisi, nangona izikhelo ezininzi zolwazi zikhoyo.
Izigqibo: Nangona umzimba okhulayo wophando udibanisa ukuziphatha okubi ngokwesondo (CSB) kwizidakamizwa zeziyobisi, iimpembelelo ezibonakalayo ekuqondeni ziyaqhubeka nokunyanzelisa ukwenziwa kohlobo lwe-CSB njengomlutha.
AMAZWI ENKQUBO: Ukutshabalala, izilingo zokuziphatha, ukuziphatha okubi ngokwesondo, ukuxhatshazwa ngokwesini, i-neurobiology, ingxaki yengqondo, ukuziphatha ngokwesondo, ukunyanzelisa ngokwesini
INGXELO YOMTHETHO
Ukukhutshwa kweNcwadana yokuHlola kunye neSatisatisti (DSM-5) [1] ukuguqulwa kwezilwanyana. Ngethuba lokuqala, i-DSM-5 iqokelele ingxaki engabandakanyi ukusetshenziswa kwezinto ezisetyenziswayo (ingxaki yokugembula) kunye neengxaki zokusetyenziswa kweziyobisi kwinqanaba elitsha elinesihloko esithi: 'Izinto ezinxulumene neziyobisi kunye neengxaki zoMlutha. Nangona abaphengululi beye baxela ngaphambili ukuba kuluhlu lwe-addiction [2-4], ukuhlaziya kwakhona kuye kwabangela ingxoxo, kwaye akucaci ukuba isigaba esifanayo siya kwenzeka kwi-11th edition ye-International Classification of Diseases (ICD-11 ) [5]. Ukongezelela ekuqwalaseleni ingcaka yokungcakaza komngcipheko njengengxaki yokungahambisani neziyobisi, iikomiti zekomiti ye-DSM-5 ziqwalasele ukuba ezinye iimeko ezifana ne-intanethi yokudlala i-Intanethi kufuneka zibhekiswe njengezilingo zokuziphatha (6]. Nangona ingxaki yokudlala ye-intanethi ayizange ifakwe kwi-DSM-5, yongezwa kwiCandelo 3 ukuze iqhutywe phambili. Ezinye iziphazamiso zaziqwalaselwa, kodwa zingabandakanywa kwi-DSM-5. Ngokukodwa, iiprogram ezicetywayo zokuphazamiseka kwe-hypersexual [7] zazingabandakanywa, zivelisa imibuzo malunga nekamva lokuxilongwa kweengxaki zokuziphatha zesondo kunye neengxaki. Izizathu ezininzi ziye zafaka isandla kulezi zigqibo, ngeenkcukacha ezinganeleyo kwimimandla ebalulekileyo ekuncedeni [8].
Kwiphepha langoku, ukuziphatha okubi ngokwesondo (CSB), echazwa njengengxaki ekulawuleni ukucinga okungenakulungeleka okanye okugqithisileyo ngokwesondo, ukukhuthaza / ukuthanda okanye ukuziphatha okuvelisa uxinzelelo okanye ukukhubazeka ekusebenzeni kwansuku zonke, kuya kuthathwa ingqalelo, njengoko kuya kwenza ulwalamano olunokwenzeka nokugembula kunye neziyobisi. Kwi-CSB, iingcamango ezinzulu kunye nokuphinda ziphindaphindiweyo zesini, unxusa / izifiso okanye ukuziphatha kunokunyusa ngaphezu kwexesha kwaye zidibaniswe nokukhubazeka kwempilo, kwengqondo kunye nokuchasene phakathi kwabantu [7,9]. Nangona uphando oluphambili luye lwafumana ukufana phakathi kokuxhatshazwa ngokwesondo, ukuxhatshazwa kweengxaki zobunxubexhakaxhaka / uxhatshazo lwe-hypersexual kunye nokunyanzelisa ngokwesondo, siya kusebenzisa i-CSB yekota ukuba sibonise uluhlu olubanzi lweendlela zokuziphatha zesondo ezithintekayo okanye ezigqithiseleyo.
Iphepha lamanje lijonga ukuhlelwa kwe-CSB ngokuqwalasela idatha kwiindawo ezininzi (umzekelo, iziganeko ze-epidemiological, i-phenomenological, iikliniki, i-biological) kunye nokujongana neminye imiba yokuxilonga kunye neyohlengahlengayo engaphendulwa. Kwiminyaka, kufuneka i-CSB (kuquka ukulala ngokwesondo ngokungaqhelekanga, ukujonga izinto ezingcolileyo kunye / okanye ukuhlambalaza umzimba) kuthathwa njengengxaki yokuxilongwa kwaye, ukuba kunjalo, ingabe kufuneka ibekwe njengomlutha wokuziphatha? Ukunikezelwa kwezikhalazo zophando ngokufunda i-CSB, siphetha ngeengcebiso malunga nophando lwexesha elizayo kunye neendlela apho uphando lunokukwazi ukuvavanya uvavanyo lokuxilonga nokuphuculwa kweziluntu kubantu ababona uncedo lwezakhono kwi-CSB.
UKUCHAZISA i-CSB
Kwiminyaka emininzi edlulileyo, iimpapasho ezibhekiselele ekufundeni i-CSB zandile (umzobo 1). Nangona uphando lophando olusakhulayo, akukho mbono phakathi kwabaphandi kunye neeklinikhi malunga nencazelo kunye nokunikezwa kwe-CSB [10]. Abanye babona ukubandakanyeka okunzima / okugqithiseleyo kwiimpawu zokuziphatha ngokwesondo njengengxube ye-hypersexual disorder [7], i-CSB engekho ye-paraphilic [11], ingxaki yesimo sengqondo efana ne-bipolar disorder [12] okanye 'ukuziphatha okubi' [13,14]. I-CSB iphinda iqwalaselwe njengento yokuxilonga ngaphakathi kwinqanaba leengxaki zokunyanzelisa i-ICD-11 umsebenzi [5].
Kwiminyaka elishumi edlulileyo, abaphandi kunye neeklinikhi baye baqala ukuqonda i-CSB ngaphakathi kwenkqubo yokuxhatshazwa koxhatshazo. Kwi-2010, uMartin Kafka ucebise isifo esitsha sengqondo esibizwa ngokuba yi-'xpersexual disorder 'ye-DSM-5 ingqwalasela [7]. Nangona uvavanyo lwentsimi luxhasa ukuthembeka kunye nokuchaneka kwemigqaliselo yecala lokuxhatshazwa kwe-hypersexual [15], uMbutho we-Psychiatric waseMelika wawungabandakanyi ukuphazamiseka kwe-hypersexual evela kwi-DSM-5. Ukukhathazeka kwaphakanyiswa ngokungabikho kophando kubandakanya i-imagy anatomical and functional imaging, i-genetics ye-molecular, i-pathophysiology, i-epidemiology kunye novavanyo lwe-neuropsychological [8]. Abanye bachaza ukuba ukuxhalaba kwe-hypersexual kungaholela ekusebenziseni kakubi ukusetyenziswa kakubi okanye ukuvelisa ukuxilongwa kwamanga, ngenxa yokungabikho kokucacileyo phakathi kwezigaba eziqhelekileyo kunye nezifo zesifo sezesondo kunye nokuziphatha [16-18].
Imilinganiselo emininzi yeengxaki ze-hypersexual share share with those disorders (Itheyibhile 1) [14]. Bobabini zibandakanya iimpawu ezinxulumene nokulawulwa kakubi (oko kukuzame ukuphumeza ukulungelelanisa okanye ukuyeka) kunye nokusetyenziswa kengozi (oko kukusebenzisa / ukuziphatha kuholele kwiimeko ezinobungozi). Iimpawu ezihlukileyo zentlupheko yentlalo phakathi kokuxhatshazwa koxhatshazo kunye nokusetyenziswa kwezidakamizwa. Iindlela zokusebenzisa izilungiso zengxaki zibandakanya izinto ezimbini ezivavanya ukuxhomekeka komzimba (oko kukunyamezela kunye nokuhoxiswa), kunye nemigangatho yokuphazamiseka kwe-hypersexual. Ingqungquthela yokuxhatshazwa kwe-hypersexual (ngokubhekiselele kwiingxaki zokusetyenziswa kweziyobisi) ziinkalo ezibini ezinxulumene nezimo zesimo sengqondo se-dysphoric. Ezi ngqinisiso zibonisa ukuba imvelaphi yeengxaki zokuxhatshazwa kweengxaki zengqondo zingabonakalisa izicwangciso zokuxhatshazwa kwe-maladaptive, kuneendlela zokukhusela iimpawu zokurhoxisa (umzekelo, ukuxhalabisa okubandakanyeka nokurhoxiswa kwezinto). Kungakhathaliseki ukuba umntu ulahlekelwa ukuxhatshazwa okanye ukunyamezela okuhambisana nokuziphatha ngokwesini, uyaxutyushwa, nangona kuye kwacetyiswa ukuba i-dysphoric mood ithi ingabonakalisa iimpawu zokuzihoxisa abantu abane-CSB abasandul 'umva okanye bayeke ukubandakanyeka kwiindlela zokuziphatha zesini (19]. Ukwahlula kokugqibela phakathi kweengxaki ze-hypersexual kunye nokusetyenziswa kwezidakamizwa kubandakanya ukuxilongwa. Ngokuchanekileyo, ukuphazamiseka kwezidakamizwa kudinga ubuncinci beendlela ezimbini, kanti ingxaki yokuxhatshazwa kwexualsex ifuna ezine kwiintetho ze-'A 'eziza kudibana. Okwangoku, uphando olongezelelweyo lufunekayo ukucacisa umgca we-diagnostic ye-CSB [20].
Impawu zeklinikhi ze-CSB
Idatha engekhoyo ngokuphathelele ukukhula kwe-CSB. Idatha yoluntu yoluntu ngokubanzi malunga nokuqikelelwa koxinzelelo lwe-CSB ayilahlekanga, okwenyathelo oluqhelekileyo lwe-CSB alukwazi. Abaphandi baqikelela amaxabiso avela kwi-3 ukuya kwi-6% [i-7] kunye nabesilisa abadala abenza ininzi (i-80% okanye ngaphezulu) yabantu abachaphazelekayo [15]. Ucwaningo olukhulu lwabafundi baseYunivesithi base-US bafumana ukuqikelelwa kwe-CSB ukuba yi-3% yamadoda kunye ne-1% yabasetyhini [21]. Phakathi kwezilwanyana zamabutho ezempi zamabutho ase-United States, ukuxhatshazwa kwacatshangelwa ukuba kusondele kwi17% [22]. Ukusetyenziswa kwedatha evela kwi-US National Epidemiologic Survey kwi-Alcohol kunye neemeko ezihambelanayo (i-NESARC), amazinga okukhula kwexesha lokuphila ngokwesenzo sokuziphatha ngokwesini, ubungakanani be-CSB, bufunyenwe buphakamileyo kubantu (18.9%) kunabesifazane (10.9%) [23]. Nangona kubalulekile, sigxininisa ukuba iimpembelelo ezifanayo zolwazi azithinteli ukungeniswa kwengcakazo kwi-DSM-III kwi-1980 okanye ukufakwa kwe-Intanethi ye-Intanethi ye-XMUMX ye-DSM-3 (jonga ukuqikelelwa kwamanani amaninzi ukusuka kwi-5 ukuya kwi-1% , kuxhomekeka kwindlela ukusetyenziswa kwe-intanethi engxaki kuyichazwa kwaye ibinwe [50]).
I-CSB ibonakala rhoqo rhoqo phakathi kwamadoda xa kuthelekiswa nabasetyhini [7]. Iimviwo zeeminyaka ephakamileyo ye-yunivesithi [21, 24] kunye namalungu asekuhlaleni [15, 25, 26] ibonisa ukuba amadoda, xa kuthelekiswa nabasetyhini, amathuba okufuna unyango lwezobuchwepheshe kwi-CSB [27]. Phakathi kwabesilisa be-CSB, ininzi yokuziphatha okuxinzelelekileyo kwikliniki iyimpoqo yokugonywa, ukusetyenziswa koonografi, ukulala ngesondo kunye nomntu ongaziwayo, kunye namaqabane amaninzi ezesondo kunye nokuhlawula ngokwesondo [15, 28, 29]. Phakathi kwabasetyhini, ukuhlaziya i-masturbation frequency, inani labalingani bezesondo kunye nokusetyenziswa koonografi kunxulumene ne-CSB [30].
Kwimeko yesilingo yesifo sokuxhatshazwa kwezesondo, i-54% yezigulane zibikwe zijongene neengcamango zesondo zesifo esicatshungulwayo, isinxusa kunye nokuziphatha ngaphambi kokuba zikhulile, ziphakamisa ukuba ziqale. Amashumi amabini anesibini ekhulwini kwezigulane zibikwe ukuba ziqhubela phambili ngokunyuka kweempawu zokugula ngengqondo engaphezu kweenyanga okanye iminyaka [15]. Ukunyuka kweengcinga zesondo emva kwexesha kudibaniswa noxinzelelo lomntu kunye nokukhubazeka okusebenzayo kwimimandla yobomi ebalulekileyo (umz. Umsebenzi, intsapho, ezentlalo kunye nemali) [31]. Abantu abanomntu ongcolileyo bangaba neempembelelo zokuba neengxaki ezingaphezulu kuneemvakalelo ezintle, kunye nefuthe elizichaphazelayo (umzekelo, ukuzihlazisa, ukuzondla) kunokuncedisa ukugcinwa kwe-CSB [32]. Ukunikezelwa kwezifundo ezincinci kunye neziphumo ezixubekileyo, akucaci ukuba i-CSB idibene neentsilelo ekusebenziseni izigqibo / ukulawula okusemthethweni [33-36].
Kwi-DSM-5, 'ukulangazelela' kwongezwa njengendlela yokuxilongwa kweengxaki zokusebenzisa izidakamizwa [1]. Ngokufanayo, ukukhanga kubonakala kuhambelana nokuhlolwa kunye nokunyangwa kwe-CSB. Phakathi kwamadoda amadala aselula, ukulangazelela iifoto zoononografi ezihambelana kakuhle kunye neempawu zengqondo / zeengqondo, ukunyanzeliswa ngokwesini kunye nobunzima be-cybersex addiction [37-41]. Inxaxheba ebalulekileyo yokukhanga ukubikezela ukuphindaphinda okanye iziphumo zonyango.
Kwizigulane ezifuna unyango, abafundi beyunivesithi kunye namalungu omphakathi, i-CSB ibonakala ixhaphake kakhulu kubantu baseYurophu / abamhlophe ngokuthelekiswa nabanye (umzekelo, ama-American American, Latino, ama-Asia aseMerika] [15, 21]. ingaba yindawo ephakamileyo yentlalo-qoqosho ngokuthelekiswa nalabo abanezinye izifo zengqondo [i-15, i-42], nangona oku kufumaneka kungabonakalisa ukufikelela okukhulu kunonyango (kubandakanywa unyango lwangasese lwabiwo lwabantu abanemali engenayo). Kwakhona kwafunyanwa kubantu abelana ngesondo kunye namadoda [28, 43, 44], kwaye idibene ne-HIV yokuthatha ingozi (umz. abantu bobulili obuziintlobo zesini kunye nabantu abangafaniyo, kubonakaliswe kwizinga eliphezulu eliphezulu le-HIV kunye nezinye izifo zesondo.
I-Psychopathology ne-CSB
I-CSB ivela rhoqo kunye nezinye izifo zengqondo. Phantse isiqingatha se-hypersexual people meet the criteria for least one-DSM-IV, ixhala, ukusetyenziswa kweziyobisi, ukulawula amandla okanye ukuphazamiseka komntu [22,28,29,46]. Kwi-103 amadoda efuna unyango lokusebenzisa iifrafikhi ngokunyanisekileyo kunye / okanye ukuziphatha kakubi ngokwesini, i-71% idibanise imigaqo yesifo sengqondo, i-40% yesifo sokuxhalabisa, i-41% yesifo sokusetyenziswa kweziyobisi kunye ne-24% ye-disorder control control [47] . Ireyithi eqikelelweyo ye-CSB kunye nebala lokungcakaza komngcipheko ukusuka kwi-4 ukuya ku-20% [25, 26, 47, 48]. Ukunyanzelana ngokwesondo kudibaniswa neengxaki ezininzi zeengqondo kwizondo, ngokukodwa kubasetyhini. Phakathi kwabasetyhini xa kuthelekiswa nabesilisa, ukunyanzelana ngokwesini kuhlanganiswe ngakumbi kunye ne-social phobia, ukusetyenziswa kakubi kotywala kunye ne-paranoid, i-schizotypal, i-antitycial, imida, i-narcissistic, i-23].
I-BASEBENZI YENKQUBO YENKQUBO YOKUBHALA
Ukuqonda ukuba i-CSB ikwabelana nge -urobiological kunye (okanye ukungafani) nokusetyenziswa kweziyobisi kunye neengcaka zokungcakaza kunokuncedisa ukwazisa imizamo enxulumene ne-ICD-11 kunye nokunyangwa kwamanyango. Iindlela ze-Dopaminergic kunye ne-serotonergic zinganceda ekuphuhliseni nasekugcinweni kwe-CSB, nangona olu uphando lunokuthi lusebuncinaneni [49]. Iziphumo ezintle ze-citalopram kwi-placebo eyimfama ebingaboniyo yokufunda i-CSB phakathi kwesampulu yamadoda icetyisa ukuba kunokusebenza kakubi kwe-serotonergic [50]. I-Naltrexone, ophikisana ne-opioid, inokusebenza ekunciphiseni kokubongoza kunye nokuziphatha okuhambelana ne-CSB, ehambelanayo nemisebenzi kwizinto ezinobungcakaza nokugembula kwaye zihambelana neendlela ezicetywayo zokumodareyitha ezihlobene ne-opioid ye-dopaminergic imisebenzi kwi-mesolimbic pathways [51-53].
Ubungqina obunamandla kakhulu phakathi kwe-dopamine kunye ne-CSB bubhekisela kwisifo sika-Parkinson. I-Dopamine yokuguqulwa kwezifo (umzekelo, i-levodopa kunye ne-dopamine agonists ezifana ne-pramipexole, i-ropinirole) zidibaniswe nokuziphatha okuphazamisayo / ukuphazamiseka (kuquka i-CSB) phakathi kwabantu abane-Parkinson isifo [54-57]. Phakathi kwezigulane zezifo ze-3090 Parkinson, ukusebenzisa i-dopamine i-agonist kwakudibene nokunyuka kwe-2.6 kwinqanaba le-CSB [57]. I-CSB phakathi kwezigulane ze-Parkinson izigulane nazo ziye zaxelwa ukuba zikhuphe kanye emva kokuba unyango luye lwacinywa [54]. I-Levodopa iye yadibaniswa ne-CSB kunye nezinye iziphazamiso zokulawula umonakalo kwisifo sika-Parkinson, njengoko kuneminye imiba eminye (umz. Indawo yokuhlala, isimo somtshato) [57].
I-pathophysiology ye-CSB, okwangoku ingaqondwa kakuhle, iphandwa ngokuphandle. Umsebenzi odibeneyo we-hypothalamic-pituitary-adrenal axis umsebenzi uye wadibaniswa nezilwanyana kwaye wathathwa ngokutsha kwi-CSB. Amadoda ase-CSB ayenamathuba amaninzi kunamadoda angewona ama-CSB ukuba asebenze uvavanyo lwe-dexamethasone non-suppressors kwaye anamazinga aphezulu e-horrenocorticotrophic hormone. I-hypotactive hypothalamic-pituitary-adrenal axis kuma-CSB amadoda angaphinda afune ukuziphatha kunye nokuziphatha kwe-CSB ephathelele ukulwa nomoya we-emotion [58].
Izifundo ezikhoyo ze-neuroimaging zijolise ngokukodwa kwi-reactivity yokukhangela. I-Cue-reactivity ikhathalelekile kwiikliniki kwizidakamizwa zeziyobisi, inomdla ekufuneni, ikhuthaza kwaye ibuyele kwakhona [59]. Uhlalutyo lwama-meta lwakutshanje lugqithwa phakathi kokutya iteksi, i-cocaine kunye ne-alcohol-caculate-statx (AC) kunye ne-amygdala ehlobene ne-drug-reactivity kunye nokufuna ukuzithemba, ezibonisa ukuba ezi ndawo zengqondo zingabangela isiphaluka sezilwanyana ezinqwenelekayo kwizidakamizwa [60]. I-incentive i-motivation theory of addictions iphakamisa ukuba umlutha uhambelana nokukhuthazwa okukhuthazayo okubangelwa yiziyobisi ezibangelwa ukubethelwa ngokugqithiseleyo, indlela yokuziphatha, ukulinda nokuxhaswa kwezilwanyana (okanye 'ukufuna') iziyobisi. [61, 62]. Le ngcamango iphinde isetyenziswe kwi-CSB [63].
Kwi-eklasini yabafundi besetyhini [i-64], ukungafani komntu kwimisebenzi yengqondo yengxaki yomntu kwi-nucleus iqokelele ekuphenduleni ukutya kunye nemifanekiso yesondo ehambelana nokufumana isisindo somzimba kunye nesenzo sezesondo emva kweenyanga ze-6. Ukuphakanyiswa kokuphendula umvuzo kwingqondo ekudleni okanye kwizesondo zahlanganiswa nokutya ngokutya kunye nokwandiswa komsebenzi wesondo, kuphakamisa indlela eqhelekileyo ye-neural ehambelana nokuziphatha okuphazamisayo. Ngethuba lokucatshulwa kwamagnetic emontic (fMRI), ukubonakaliswa kweengcamango zevidiyo zoononophelo eziqhathaniswa namavidiyo angabonayo ngokwesini kuma-CSB amadoda ahlobene namadoda angewona ama-CSB ahlanganiswe nokusebenza okukhulu kwiindawo eziphambili zangaphandle, i-ventral striatum kunye ne-amygdala, iindawo ezibandakanyekayo kwiziyobisi -ncedisa izifundo zokusetyenziswa kwezidakamizwa [63]. Ukuqhagamshelana okusebenzayo kwezi mimandla kwakudibaniswa nesifiso sokuziphatha ngokwesini, kodwa kungathandi, phakathi kwabantu abane-CSB. Apha, umnqweno uthathwa njengesalathiso 'sokufuna' xa kuthelekiswa 'nokuthanda'. Amadoda ane-CSB ngokuchasene nalabo abangenawo abuye achazwe umnqweno wesini kunye nokubonakalisa ukukhutshwa komsebenzi ophezulu kunye nokwahlukana komzimba ekuphenduleni imifanekiso engamanyala [65].
Amadoda e-CSB athelekiswa kunye nalawo angaphandle angabonakali ngakumbi kwizinto ezibhekiselele kwisondo, ebonisa inxaxheba kwimpendulo ekujoliswe kuyo ngokukhawuleza kwimiyalezo yezocwangco [66]. Amadoda e-CSB aphinde abonise ukhetho olukhethiweyo oluphezulu olubhekiselele kwizobini zesini kunye neemali eziqhathaniswa namadoda ngaphandle kwe-CSB [67]. Ukugqithiseleka kokuqala kweengcamango zesondo kwahlanganiswa neendlela eziphambili zokuziphatha ngokubhekiselele kwiziganeko zesini, ngoko ke ukuxhasa ukukhuthazwa kweengcamango zokulutha. Izifundo ze-CSB zibonise ukhetho lweemifanekiso zentando yesini kunye nokugqithisa okukhulu ukucinga ngokuqhelekileyo ukufikelela kwimifanekiso yesondo, kunye nesantya sokuhlala kunye nokukhetha okukhethiweyo kwintando yesondo [67]. Ukufikeleleka kwimihla ngemihla yecala yezesondo kunokuthe ngqo ukufumaneka kwe-intanethi yezinto eziveli.
Phakathi kwezifundo zesifo se-Parkinson, ukuxhatshazwa kwezesondo kunokunyusa umnqweno wesini kulabo abane-CSB xa kuthelekiswa nabangenabo [68]; umsebenzi ophuculweyo kwisigxina, i-paralimic, i-temporal, i-occipital, i-somatosensory ne-prefrontal kwimimandla echaphazelekayo kwiinkqubo zengqondo, ezinengqondo, ezizimeleyo, ezibonwayo nezikhuthazayo nazo zaphawulwa. Izigulane ze-CSB zandise umnqweno wesondo ohambelanayo kunye nokwandiswa kwemisebenzi kwi-striatum ye-ventral kunye ne-cortices ye-cortices [ye-68] .Lezi ziphumo zixhomekeke kunye nalabo abasebenzisa izidakamizwa ezibangelwa iziyobisi apho kubandakanywa ukuqhutyelwa kwemimandla enxulumene nomvuzo kuboniswa kwimpendulo ephathelele umlutha othile, ngokuchasene nezimpendulo ezingenangqiqo kumvuzo okanye jikelele weemali [69, 70]. Olunye uphando luye lwabandakanya imimandla ye-prefrontal; kwimfundo encinci yokufunda i-tensor imaging, i-CSB kunye nabangewona ama-CSB abonisa ukuphakama okuphezulu kunokuba kuthetha ukungafani (71].
Ngokwahlukileyo, ezinye iinjongo ezijoliswe kubantu ngabanye ngaphandle kwe-CSB ziye zagxininisa indima yokuhlala. Kwamadoda angewona ama-CSB, imbali edeleyo yokubukela iinthombe zoononophala yayihambelana nempendulo engezantsi ye-leftaminal kwiifoto zoononografi, ezibonisa ukungafuneki kwamandla [72]. Ngokufanayo, kwisifundo esinobudlelwane besiganeko kunye nabesilisa abangenalo i-CSB, abo babika ukusetyenziswa kakubi kweentlophu zoonografi babenokuba nefuthe elingaphantsi kwexesha elifanelekileyo kwiifoto zoononografi ezinxulumene nabangenayo ukusetyenziswa kwengxaki. Ixesha elihle elifanelekileyo eliphezulu liphezulu ngokuqhelekileyo ekuphenduleni iziphumo zamachiza kwizifundo zokuxilisa [73]. Ezi ziphumo zihluke, kodwa azihambelani, ingxelo malunga nomsebenzi ophuculweyo kwizifundo ze-FMRI kwizifundo ze-CSB; izifundo ziyahluke ngohlobo oluthile, uhlobo lwesilinganiselo kunye noluntu oluphantsi kokufunda. Ucwaningo lwe-CSB oluthatywayo luboniswa ngokungaqhelekanga iividiyo zifaniswe neefoto eziphindaphindiweyo; iqondo lokusebenza liye laboniswa ukuba lihluke kwiividiyo ngokubhekiselele kwiifoto kunye nokuhlala kunokuhlala ngokwahlukileyo kuye kuxhomekeke kwi-stimuli. Ukongezelela koko, kulabo baxela ingxaki ngokusetyenziswa kweso sifundo, ubuninzi beeyure zokusetyenziswa bephantsi (ubunzima: 3.8, ukuphambuka okuqhelekileyo (SD) = 1.3 ngokubhekiselele ekulawuleni: 0.6, SD = iiyure eziyi-1.5 / iveki] xa kuthelekiswa Ucwaningo lwe-FBRI lwe-CSB (CSB: 13.21, SD = 9.85 ngokumelene nokulawula: 1.75, SD = iiyure ze-3.36 / iveki). Ngaloo ndlela, ukuhlala kwimeko inokuthi ibhekiselele ekusebenziseni ngokubanzi, ngokusetyenziswa kakubi okunokubambisana ne-cue-reactivity. Izifundo ezongezelelweyo eziphambili zifuneka ukuba zihlolwe ezi ngxaki.
Genetics ye-CSB
Idatha ye-Genetic ephathelene ne-CSB imbalwa. Akukho uphando lwama-genome-wide association of CSB lwenziwe. Ukufundwa kweengxaki ze-88 ezitshatileyo kunye ne-CSB zifumene iziganeko eziphakamileyo zezihlobo zesidanga sokuqala izidakamizwa zokusetyenziswa kweziyobisi (i-40%), ukuphazamiseka kokutya (30%) okanye ukugembula kwe-pathological (7%) [74]. Ukufundwa kweentlobo ezi-2 zaphakamisa ukuxhaswa kwemfuzo ku-77% yeentlukwano ezinxulumene neendlela zokuziphatha ezinengxaki, kanti i-13% yayibangelwa yimibandela engabonakaliyo yendalo (75]. Igalelo elikhulu lomfuzo lisekho kwizinto ezinobungcakaza kunye nokugembula [76, 77]. Ukusebenzisa idatha evulekileyo [i-78], inani elilinganisiweyo lokuhluka kwe-gambling disorder ngenxa yeempembelelo ze-genetic malunga ne-50%, kunye namazinga aphezulu abonwa ngxaki ezininzi. Izinto ezizalwe ziintlobo ezinxulumene nokungafuneki zingabonakalisa ummakishi wokungabikho kokuphuhliswa kweengxaki zokusetyenziswa kweziyobisi [79]; nangona kunjalo, nokuba le miba ikwandisa ingxaki ekuphuhliseni i-CSB ingakhange ihlolwe.
UVAVANYO NOKWENZISWA KWE-CSB
Kwiminyaka elishumi edlulileyo, uphando malunga nokuxilongwa nokunyangwa kwe-CSB lwandise [80]. Abaphandi abahlukahlukeneyo baye bacebisa i-criteria ye-diagnostic [13] kunye nezixhobo zokuhlola eziphuhlisiwe [81] ukunceda abakliniki ekunyangeni kwe-CSB; Nangona kunjalo, ukunyaniseka, ukuqinisekiswa kunye nokusebenza kwezi ezininzi zezi ziko zihlala zingasetyenziswanga. Amanyathelo ambalwa aqinisekisiwe, anqanda ukuveliswa kwawo okwenziwe kwintsholongwane.
Ungenelelo lonyango lwe-CSB lufuna uphando olongezelelekileyo. Zimbalwa izifundo ezivavanye ukusebenza kunye nokunyamezelwa kweyeza elithile [53, 82-86] kunye nonyango lwengqondo [87-91] unyango lwe-CSB. Ubungqina obusekwe kwizifo zengqondo ezinje ngengqondo yokuziphatha ngokuziphatha kunye nokwamkelwa kunye nokuzibophelela kunyango kubonakala kuluncedo kwi-CSB [89,91,92]. Ngokufanayo, i-serotonergic reuptake inhibitors (umz. I-fluoxetine, i-sertraline kunye ne-citalopram) kunye ne-opioid antagonists (umz. Izifundo ezikhoyo zamayeza ziqhele ukuba zizifundo. Isifundo esinye kuphela [i-50] sisebenzise uyilo olubophelelayo, olulawulwa yi-placebo xa kuvavanywa ukusebenza nokunyamezeleka kwesiyobisi (citalopram) kunyango lwe-CSB.
Akukho zilingo ezinkulu ezilawulwa ngandlela-thile ezikhoyo ezikhoyo ezihlolisayo ukuphumelela kweengqondo ze-psychotherapi ekuphatheni i-CSB. Imiba yemigaqo iyancipha ukwanda kwezinto ezikhoyo kwiziphumo zeeklinikhi ezikhoyo, njengoko uphando oluninzi lusebenzisa iindlela ezidityanisiweyo zendlela yokwenza izinto, zihluke kwiinkqubo zokungeniswa / ukungabandakanyi, ukuhluleka ukusebenzisa isabelo esingenanto kwiimeko zonyango kwaye akubandakanyi amaqela okulawula ayimfuneko ukugqiba ukuba unyango lusebenza [80] . Izilingo ezinkulu, ezilawulwa ngandlela-thile zifunekayo ukuvavanya ukuphumelela kunye nokunyamezela kweyeza kunye neengqondo zonyango ekuphatheni i-CSB.
Ezinye iindlela
Isiphakamiso sesifo sengqondo sokuxhatshazwa koxhatshazo njengengxaki yesifo sengqondo ayizange ifumaneke ngokufanayo. Ukukhathazeka kuye kwaphakanyiswa ukuba idilesi 'yokuphazamiseka' isenza iimeko eziqhelekileyo zokuziphatha ngokwesondo [93], okanye ukuba ukuziphatha ngokwezesondo / iingxaki zesondo kunokuchazwa kangcono njengokongezwa kweengxaki zempilo yengqondo esele ikhona okanye izicwangciso zokuziphatha ezingekho kakuhle. lawula ukuphazamiseka okuchaphazelayo kunokuba kuchazwe ngxaki yesifo sengqondo [16,18]. Abanye abaphengululi babonisa inkxalabo yokuba abanye abantu ababhala nge-CSB banokuba namazinga aphezulu esinqwenela ngesondo [18], kunye neziphakamiso ezinzima ukulawula izifiso zesondo kunye neendlela eziphezulu zokuziphatha ngokwesini kunye nemiphumo ehambelana nezo ziphatha ezinokuthi zichazwe ngokucacileyo njenge-non- ukuhluka kweentsholongwane zesifiso sezesondo esiphakeme [94].
Kwisampula enkulu yabantu abadala baseCroatia, uhlalutyo lweqoqo lucacise amaqoqo amabini anentsingiselo, enye emele ubunzima besini
kunye nomnye ubonakalisa umnqweno ophezulu wesondo kunye nomsebenzi wesondo rhoqo. Abantu abathile kwingqungquthela enengxaki babika ingqondo ye-psychopathology xa kuthelekiswa nabantu ngabanye abakwiqumrhu eliphambili elifuna / eliqhelekileyo [95]. Oku kuphakamisa ukuba i-CSB inokulungiswa ngokubanzi kunye nokuqhubeka kwexesha lokunyuka kwezesondo kunye nokukhathazeka, apho imeko zeekliniki ziphezulu
kungenzeka ukuba kwenzeke esiphelweni esiphezulu se-continuum okanye ububanzi [96]. Njengoko kunokwenzeka ukuba kukho ukugqithisa okukhulu phakathi kwe-CSB kunye nesifiso esiphakamileyo sezesondo, uphando olongezelelweyo lufunekayo ukuchonga iinkalo ezinxulumene ngokukhethekileyo kunye nokuziphatha okubi ngokwesini.
ISISHWANKATHELO NEMIGQUBO
Ngenxa yokukhululwa kwe-DSM-5, ukukhubazeka ngcakazo kwandiswe kwakhona ngeengxaki zokusetyenziswa kweziyobisi. Olu tshintsho lunzima iinkolelo ukuba ukutshaya umlingo kwenzeka kuphela ngokuphazamiseka kwezixhobo eziguqula ingqondo kwaye kunempembelelo ebalulekileyo kumgaqo-nkqubo, ukukhusela kunye nokwelapha [97]. Iinkcukacha zibonisa ukuba ukubandakanya ngokugqithiseleyo kwezinye izinto zokuziphatha (umz. Umdlalo, isondo, ukuthengwa ngokugqithiseleyo) kunokunokwabelana ngekliniki, izakhi zofuzo, i-neurobiological kunye neemeko ezifanayo kunye nezilingo zomzimba [2,14]. Nangona inani elikhulayo leempapasho kwi-CSB, kukho izikhala ezininzi zolwazi eziza kunceda ukuqonda ngokuthe ngqo ukuba ukubandakanyeka ngokugqithiseleyo kwizenzo zesondo kunokuhle kubekwe ngumlutha. Kuluhlu lwe-2, sibhala iindawo apho uphando olongezelelweyo lufunekayo ukwandisa ukuqonda kwe-CSB. Idatha engonelanelekiyo, ukukhusela kunye nokwenyango. Nangona idatha ye-neuroimaging ibonisa ukufana phakathi kwezilwelo zomzimba kunye ne-CSB, idatha iyanqunyanyiswa ngamanqanaba amancinci amancinci, iisampuli zesini kunye nezicwangciso ze-cross-sectional. Uphando olongezelelweyo lufunekayo ukuze kuqondwe i-CSB kwabasetyhini, amaqela angamahlwempu kunye namahlanga, abantu abathandana nabasetyhini, abantu besini nabasemagqabini, abantu abanokukhubazeka ngokomzimba nangokwengqondo kunye namanye amaqela.
Omnye ummandla ofuna uphando olungakumbi uquka ukuba utshintsho lwezobuchwepheshe lunokuchaphazela njani ukuziphatha kwabantu ngokwesondo. Njengoko idatha ibonisa ukuba ukuziphatha ngokwesini kuncediswa kwi-intanethi kunye ne-smartphone izicelo [98-100], uphando olongezelelweyo kufuneka luqwalasele indlela ubuchwepheshe bedijithali obuhambelana ngayo ne-CSB (umz. Ukunyanzelisa i-masturbation kwi-intanethi okanye kwiindawo zokuxoxa ngezocansi) kunye nokubandakanyeka ekuziphatheni okubi ngokwesondo (umz ngokwesini, amaqabane amaninzi ezesondo ngexesha elinye). Ngokomzekelo, ingaba ukunyuka okufikelela kwi-intanethi ye-intanethi kunye nokusetyenziswa kwewebhusayithi kunye nezicelo ze-smartphone (umz. Grindr, FindFred, Scruff, Tinder, Pure, njl.) Eyenzelwe ukuququzelela ukulala ngokwesondo phakathi kwabantu abadala badibene nemibiko eyongeziweyo yokuziphatha okuxhatshaxayo kulindelekile kuphando. Njengoko idatha eqokelelwayo, ulwazi olufunyenweyo kufuneka luguqulelwe kumgaqo-nkqubo ophuculweyo, ukukhusela kunye nokonyango
Imibulelo
Olu pho nonongo lwaxhaswa ngemali evela kwiSebe leMagqirha, ii-VISN 1 zeMpilo yokuPhando kwezeMpilo kunye neZiko lezonyango, iZiko likaZwelonke lokuGembula eliXanduva kunye neCASAColumbia. Umxholo wale ngqangi ayibonakali nembono yee-arhente zenkxaso-mali kwaye ibonakalisa imbono yabalobi. Ababhali babika ukuba abanakho ukuxabana kwezemali malunga nomxholo wale ngqangi.
Isibhengezo somdla
Ababhali babika ukuba abanakho ukuxabana kwezemali malunga nomxholo wale ngqangi. I-MNP ifumane inkxaso okanye yembuyekezo malunga nale ilandelayo: idibeneyo kwaye icebise uLundbeck, Ironwood, Shire, INSYS kunye neMountainMend Health; ufumene inkxaso yocwaningo (ukuya kwiYale) kwiiNational Institutes of Health, uMegangan Casino, iZiko likaZwelonke leGementi elijongene nokuGega kunye nePfizer imithi; uye wathatha inxaxheba kwiiphando, i-mailings okanye umnxibelelwano ngefowuni ezinxulumene nokuxhatshazwa kweziyobisi, iziphazamiso zokulawulwa kweengxaki okanye ezinye izihloko zempilo; ucebise ukugembula kunye nemibutho esemthethweni kwimibandela enxulumene nokulawulwa kwefuthe; unikezela ngononophelo kwikliniki kwiSebe leMpilo yeNgqondo kunye neNkqubo yeNgcaliso yeNkonzo yeCandelo loNgcakazo; uye wenza ukuphononongwa kwezibonelelo zeZizwe zeZiko lezeMpilo kunye nezinye i-arhente; liye lahlelwa okanye lidibene neendwendwe okanye amajelo amaphephancwadi; unikeze iintetho zemfundo ngokubanzi, ii-CME kunye nezinye iiklinikhi okanye izenzululwazi; kwaye ivelise iincwadi okanye izahluko zeencwadi kubavakalisi bempilo yengqondo.
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