I-Porn ne-DSM-5: Ingabe Izombangazwe Zomzimba Ezokuzijabulisa? (I-2012)

AMAKHAYA:

  1. Ukulutha kobulili / ucansi? Leli khasi libala Ucwaningo lwe-55 lwe-neuroscience (I-MRI, i-FMRI, i-EEG, i-neuropsychological, i-hormonal). Banikeza ukusekela okuqinile ngesimodeli sokulutha kwezidakamizwa njengoba iziphumo zabo zibuyisa ukutholakala kwezinzwa ezibikiwe ezifundweni zokulutha izidakamizwa.
  2. Imibono yangempela yezobuchwepheshe ekubhekaneni nocansi / ucansi? Lolu hlu luqukethe Ukubuyekezwa kwezincwadi ezingama-30 zakamuva nezincazelo ngezinye zezazi eziphezulu zezinzwa emhlabeni. Bonke basekela imodeli yokulutha.
  3. Izimpawu zokulutha umlutha nokukhula kwezinto ezimbi kakhulu? Izifundo ezingaphezu kwe-55 ezibika okutholakele zihambisana nokukhula kokusetshenziswa kocansi (ukubekezela), ukujwayela izithombe zobulili ezingcolile, ngisho nezimpawu zokuhoxiswa (zonke izimpawu nezimpawu ezihlobene nokulutha).
  4. Ukuxilongwa okusemthethweni? Umbhalo wezokwelapha wezokwelapha osetshenziswa kakhulu emhlabeni, I-International Classification of Diseases (ICD-11), iqukethe ukuxilongwa okusha efanelekile ukulutha izidakamizwa: "Ukucindezeleka Ngokuziphatha Ngokwemvelo. "

I-ARTICLE: Ukunakekelwa ukucabangela izithombe ezingcolile zobulili ze-intanethi / ukulutha kocansi lwe-inthanethi?

Ibhukwana Lamuva Lokuxilonga Nezibalo Le-Psychiatry (I-DSM-5) cishe uzobekwa etsheni. Okwesithathu futhi umjikelezo wokugcina wamazwana kuphela ngoJuni 15, 2012. Kungumsebenzi wawo wonke umuntu ukuthi ayibhekisise le ncwajana. Yize ochwepheshe abaningi bezokunakekelwa bezishaya indiva izincomo ze-DSM lapho behlola futhi belapha amaklayenti abo kanye neziguli, izintatheli kanye nezinkampani zomshuwalense kubheke njengebhayibheli labagula ngengqondo.

Ngokweqile, the I-DSM-5 manje isizisusile zombili lezi zinkinga ezikhuluma ngokulutha kwe-Inthanethi kulesi sithasiselo — okuqanjwa kabusha ngokuthi “Isigaba III” (izinto ezidinga ukucwaningwa okuqhubekayo). Izinkinga ezimbili zikhona Ukusebenzisa i-Internet Disorder futhi I-Hypersexual Disorder (ukuxhumene nocansi nocansi nezithombe ezingcolile zobulili ezingcolile). Lokhu kusho ukuthi lokhu akuyona imibandela esemthethweni ngokuqondene nodokotela be-DSM abakhathazekile.

Yebo, ufunda lokho ngokufanele. I-intanethi ephakanyisiwe ingenye yezenzakalo ezibaluleke kakhulu ezize zishaye ubuchopho bomuntu. Ucwaningo olunzima lwezesayensi olwenziwe eminyakeni embalwa eyedlule lwembula ukuthi ukulutha kwe-intanethi yi-a ngokomzimba umlutha. Kodwa labo abathintekayo abaqondisa abahlengikazi ekutholeni izidakamizwa zokulutha izidakamizwa baye bakhetha ukujula-eziyisithupha zonke izingxenye ezifanele ze-DSM.

Ngokuphazamiseka, lezi ziphazamiso ezimbili azikho ngaphansi kweqembu elifanayo, noma kutholakala esahlukweni esifanayo. Izihloko zombili zibuye zidukise. Ukusebenzisa i-Internet Disorder i-belies igama layo, ngokuzihlanganisa ngokucophelela kwi-intanethi gaming kunokuba kuhlanganise nokulutha kwezithombe zobulili ezingcolile zo-Inthanethi, umlutha wezokuxhumana, njll. Ngaphambi kokuxoshwa, bekusesahlukweni Ukusetshenziswa kwezidakamizwa nokusetshenziswa kwezidakamizwa. I-Hypersexual Disorder, elibala ubulili be-inthanethi nezithombe zobulili ezingcolile, alilokothi likhulume igama elithi “umlutha” nhlobo, lishiya noma yimuphi udokotela noma intatheli incike kwi-DSM entsha ngomqondo wokuthi imilutha yezocansi ye-Inthanethi ayikwazi ukuba khona. Ngaphambilini bekukwi- Dysfunctions ngokocansi isahluko.

Ngamafuphi, iqembu labasebenza ukulutha izidakamizwa le-DSM lizimisele ukucubungula (kepha lihlehlise) ukulutha kwe-Intanethi inqobo nje uma kushiwo “imidlalo” kuphela. Kungani ukulutha kwezemidlalo kwe-Intanethi, nge izifundo eziningi zocwaningo ezikhanyayo ukuchaza, ngendlela efanele yebhuku? Kungani abantu abanezidakamizwa ze-intanethi (i-Facebook, ukuphequlula okucindezelayo) kushiye ngaphandle naphezu kwenani elikhulayo Izifundo zokulutha izidakamizwa ze-Inthanethi ebonisa izinguquko zobuchopho eziphathelene nokulutha?

Futhi kungani, lapho lezo zifundo zokulutha nge-Intanethi ngokuvamile zifaka ukusetshenziswa kocansi, ingabe iqembu labasebenzi bezocansi kanye nobulili libheka igama elithi "umlutha?" Kungenzeka yini ukuthi iqembu lomsebenzi lifuna izinga eliphakeme lobufakazi bokulutha kwezidakamizwa ze-inthanethi kunalokho obekudingeka ukuze kuqinisekiswe ukuphazamiseka okuningi osekuvele the I-DSM-5 Dysfunctions ngokocansi isahluko?

Hambisa i-em — ungalahli i-em

Kuthiwani ngalomqondo esikhundleni salokho? Hambisa konke okuhlobene nokulutha kwe-intanethi (imidlalo, i-inthanethi ye-cyber, imithombo yezenhlalo nezithombe ezingcolile) kuya Ukusetshenziswa kwezidakamizwa nokusetshenziswa kwezidakamizwa bese uyibeke ngaphansi kwesigungu seqembu elithile labachwepheshe bokulutha ukulutha, abaqonda ukuthi ukulutha ngokweqile kuyisimo esisodwa. Eqinisweni, mhlawumbe ezinye odokotela abavela kuzo I-American Society of Addiction Medicine kungasiza ngomsebenzi.

Kakade, ukubheja ukugembula kuye kwahambela Ukusetshenziswa kwezidakamizwa nokusetshenziswa kwezidakamizwa. Ngokufanele, zonke izilingo zokuziphatha zizoshintshwa kulesi sahluko futhi zizohlolwa ngokufanele. Kodwa okungenani, zonke izidakamizwa ze-intanethi kumele zihlanganiswe, zisuswe futhi zihlengwe kusukela ku-Section III.

Nakuba ukubuka kuqala i-Internet ye-intanethi kanye nokulutha kwe-inthanethi e-cycling kungase kubonakale sengathi kunezidakamizwa zobulili, ngaphezu kwakho konke, Internet izidakamizwa zabaningi abagulayo. Bavela ku- innovation njalo enikezwa yi-phenomenon eyingqayizivele ye-intanethi ephezulu, okuholela ekugqibeleni, okuholela ekushintsheni kobuchopho obuhlobene nokulutha. Kungakhathaliseki ukuthi umdlalo we-Inthanethi wokulutha, uxoxe, udlulise amehlo, noma ubheke ngokweqile, umlutha wabo ngokuyinhloko kuveli amaphikseli, noma ngabe iqiniswe ngomvuthwandaba.

Ukulutha ngokweqile kwe-Intanethi kulimaza ababukeli abasha

Uma esidlule kungumhlahlandlela, eminyaka elandelayo ye-15-20 umphakathi wethu uzobe uboshwe ngawo I-DSM-5, kanye nezintatheli kanye nezinkampani zomshuwalense zizithembela ngokungekho emthethweni. Okwamanje, i I-DSM-5Ukungaziboni izingcuphe zokusetshenziswa kwezithombe zocansi kwi-Intanethi kudala indawo enkulu engabonakali kothisha, abanakekeli, abasebenzisi nezintatheli. Ngaphandle kokuqondiswa okuzwakalayo, abafana bacabanga ukuthi ngoba ukushaya indlwabu kunempilo ayikho inani lokusetshenziswa kocansi lwe-inthanethi okungenampilo. Abaningi abaqapheli ukuthi izimpawu zabo zihlotshaniswa neminyaka yokusebenzisa i-highspeed porn eqhubekayo kuze kube sekupheleni.

Iqiniso lokuthi ubuchopho bentsha okungaphezu komuthi wokulutha Kunokuba ubuchopho bomdala buvume ukulutha kwe-intanethi ku- I-DSM-5 kubaluleke kakhulu. Iningi labasebenzisi be-porn abasha banamuhla abakwazi ukulinda kuze kube yilapho i-DSM elandelayo izobhekana nezinkinga zabo ezihlobene nokulutha. Kwabanye, isimo sibi.

Isibonelo, ngesonto eledlule nje izindatshana ezilandelayo ziphume zazixwayisa ngokungasebenzi kahle kocansi ezinsizeni ezinsizwa. (Cishe kubangelwa ukungabi namdlandla kwemijikelezo yomvuzo wobuchopho, ushintsho oluhlobene nokulutha.) Zonke lezi zingcezu zenziwa ngochwepheshe noma zibika ukubonwa kochwepheshe:

Iphuzu eliyinhloko: Akukhathaleli ukukhipha i-DSM entsha ngaphandle indlela ehlongozwayo yokuxilongwa yezilutha ze-intanethi. Ucwaningo seluvele seluthola amanani okulutha kwe-inthanethi kusuka ku-3% kuya phezulu njengo-25% (kumadayunivesithi).

Izombusazwe zobulili kanye nephutha lomlando

I-Hypersexual Disorder yi-brainchild yama-sexologist ku-groupgroup ye-Sexual and Gender Identity Disorders. Abacansi be-sexologists mhlawumbe babhekwa njengabachwepheshe ekusetshenzisweni kocansi ngoba kungabandakanya ukushaya indlwabu, nokho abaningi bezocansi bakholelwa ngokuqinile ukuthi “Imilutha yezocansi” ayikho-Ngaphandle kwalabo abanezifo zengqondo zangaphambili. Futhi abavumi ukuthi ukulethwa kocansi lwe-Intanethi nemikhuba yabasebenzisi bayo (isb. Ukubuka eminyakeni yobudala) kuyenza ihluke kakhulu kwezocansi zangaphambilini ngokwemiphumela engaba khona ebuchosheni.

Ngenxa yalokho, okwamanje I-DSM-5 imilutha yemilutha. Ake sithi uphilile ngokwengqondo futhi umane ungumlutha wezithombe zocansi ze-Intanethi. Udluliselwa kudokotela wezocansi onamathela ku- I-DSM-5. Ubhekene nokukhethwa nguHobson maqondana nokuxilongwa / ukuhlolwa: Kuphakathi kokuthi “awunankinga” futhi kufanele uqhubeke nokulandela izincomo zohlelo lobuchopho bakho obudinwe ngokweqile kuze kube yilapho babe isifo, noma unesifo sengqondo, okudinga izidakamizwa ze-psychotropic kanye nokweluleka. Kungakhathaliseki ukuthi, umhlinzeki wakho wokunakekelwa kwezempilo akabheki ukuhlupheka kwakho kwangempela: ukulutha kwe-intanethi. Ngokuphambene, uma unomlutha wezokugembula, uzotholakala ukuthi ungumlutha ngaphansi kwe I-DSM-5 futhi wanikeza amasu okubuyisela.

Ngokusobala, umthwalo oyinhloko wesigceme sokusebenzisana ngokobulili nokuhlukunyezwa kwezobulili ukukhiqiza imihlahlandlela yokwelapha izindaba ezinjengalezi i-pedophilia kanye nezinhlobonhlobo zezigqila ezinemibala, ukuphuza ukuphuza, futhi izingane zizama ukuthola yimuphi ubulili. Ukubuka okusheshayo odokotela abakhonza kule Ukuphazamiseka ngokobulili kanye nobulili i-groupgroup ibonisa ukujula okumangalisayo ekutadisheni abenzi bokuhlukumeza ngokocansi, i-orgasm yezinsikazi, izindaba zobulili ezingcolile, nokunye okunye, kodwa akukho dokotela oyedwa obonakala sengathi unesizinda esinamandla ku-neuroscience of addiction.

Laba odokotela bangakwazi ukubona izifo zengqondo, kodwa Umlutha awukho ku-radar yabo. Le ndawo eyimpumputhe ibuya emuva okungenani iminyaka engu-20-uma i iphutha lenziwe emkhakheni wezokwelapha. Ngenkathi i-American Medical Association ivume ukukhethekile kwemithi yokulutha umlutha, iveza ngokucacile ukuziphatha kobulili ngaphandle kohlu lwezinyosi ezingase zibe khona.

Ubulili abukhishwe ngezizathu zezombangazwe, naphezu kobufakazi bokuthi bekufanele bufakwe, futhi ukungabikho kwesisombululo sesayensi sokukuyeka. (Okufanayo izifunda ubuchopho bulawula kokubili ubulili nezidakamizwa. Zonke izidakamizwa, ukuziphatha kanye namakhemikhali, dysregulate lesi sigaba-Kufaka hlangana ubulili bekungabikho no-brainer.)

Ngaleso sikhathi, noma kunjalo, izithombe zocansi ze-Intanethi nocansi lwe-inthanethi lwalusekusasa lesintu, futhi imilutha yangempela yezocansi yayimbalwa, ngakho-ke ukuyekethisa kwabonakala kunengqondo. Maye, ngokubuka komlutha-wesayensi, sekucacile ngokusobala ukuthi lokhu kuxegiselwa bekuyiphutha. Ngokufika kwe-Intanethi enejubane eliphezulu, iphutha libuyile luma isizukulwane sonke… Kanzima.

Manje, sibhekene nesimo esingabekezeleleki: The I-DSM-5Ochwepheshe bezocansi bathola umsebenzi wokuphenya ngezinkinga zocansi oluku-inthanethi nocansi lwe-Inthanethi, kepha babonakala benenkolelo-ethembele ekubukeni komlando — ukuthi ukuziphatha ngokocansi Ayikwazi ube yimilutha (ngaphandle uma isiguli sinesifo esivele sikhona sengqondo). Noma imbandezelo yabo yokugula ngengqondo ingabamba ama-frotteurs nababukisi, asikho isizathu sokucabanga ukuthi iphethe imilutha yentsha yanamuhla ye-Intanethi.

Ngabe iqembu lomsebenzi libeke umugqa wokufakazela ukuthi ubukhona bezidakamizwa ze-inthanethi eziphakeme kakhulu? Buyini ubufakazi obudingekayo ukuqinisekisa ukuthi uyi-voyeur (isifo in ibhukwana)? Ukwehluleka ukuyeka ukuhlasela ubumfihlo babanye naphezu kwemiphumela emibi, akunjalo? Kodwa-ke lapho umlutha we-porn we-Intanethi engakwazi ukuyeka naphezu kwemiphumela emibi, futhi amashumi eminyaka wokuhlolwa kobuchopho nokuhlolwa kokuxilongwa kuhlangana ukuchaza ukuthi kungani, isimo sakhe sihlehliselwe esigabeni sokwenza ucwaningo ngokuqhubekayo.

Ingabe ukucela abacansi bezocansi ukuthi baphenye imiphumela engaba yingozi ye-eerotic e-intanethi ngokufanayo nokucela abacwaningi bekampani begwayi ukuba baphenye ukulutha ukubhema ugwayi?

“Kungani kufanele ufunde ama-unicorn?”

Kungenzeka iqembu labasebenzi lezehlakalo zokuhlukunyezwa ngokobulili nangokobulili lisacabanga ukuthi ubufakazi bokuthi ungumlutha, ngokwesayensi nokunye, abubalulekile. “Kungani kufanele ufunde ama-unicorn?” kubuza isazi sezocansi lapho ukunakwa kwakhe kubhekiswe ku izimpawu ezinamandla futhi izibonakaliso zemithi yokulutha ukuthi imilutha yentsha yanamuhla iyabika.

Ilungu lezisebenzi uMartin P. Kafka, MD linikezela ngaphasi kwekhasi ekubhekeleni kwe-addiction neuroscience ekubuyekezweni kwakhe okubanzi kwe-2009 I-Hypersexual Disorder: Ukuxilongwa Okuhlongozwayo kwe-DSM-V. Ekuvikeleni kukaKafka, ucwaningo olusha olucacisa iqhaza lomjikelezo womvuzo kwezobulili kanye nokulutha komuntu seluphumile kusukela ekubuyekezweni kwakhe — kanye nasezifundweni eziningi zemilutha ye-Intanethi yezinhlobo ezahlukahlukene. Ngokujabulisayo, i-DSM-5 isenonyaka wokuvuka ukuze isheshise kulolu cwaningo olubalulekile ngaphambi kokukhipha ibhukwana elisha.

Izinga lamanje leqembu lomsebenzi wolwazi lokulutha libonakala engxoxweni engenamsebenzi ebilokhu iqhuba mayelana nokuthi yini engakha "i-hypersexual."

Kubukeka kunokukhathazeka okujulile ukuthi noma yikuphi ukusikisela kokuthi isimilo esisiza kuvuthondaba lwezocansi kungaholela ekuluthekeni kuzoholela ekuhlolweni okungadingekile nasekubhaleni imikhuba yezocansi yalabo abaziphethe kabi. Ukwesaba okunjalo kungaba okungafanele. Igama elithi “umlutha” alisho ukuthi umuntu unokwehluleka kokuziphatha or ukugula kwengqondo. Kusho ukuthi umuntu udinga usizo ekushintsheni ukuziphatha kwakhe akusekho okufunayo ukuze aguqule ezinye izinguquko zobuchopho epulasitiki obubuhlungu.

Lezi yizinguquko zobuchopho okufanele zenziwe umsebenzisi wanamuhla we-Intanethi funda ukubona isikhathi eside ngaphambi kokuba babe amakhowe abe umlutha ogcwele. Ukube lezi zimpawu beziwulwazi lomphakathi, iningi labasebenzisi abasebancane be-Intanethi belingahlehlisa ngaphandle kokudinga ukwelashwa. Kungani kungenjalo I-DSM-5 ukukhuthaza lo mzamo obalulekile wemfundo? Kungani kungabhekisiswa ukuthi isizwa kanjani imilutha ye-Intanethi ukuthi iguqule indlela yokuziphatha ebacindezela futhi kuthinte kabi ukusebenza kwabo ngokocansi?

Kungenzeka yini ukuthi i-DSM-5 ngokungazi iqhubekisela phambili i-ajenda yezombusazwe egunyaza ukugcinwa kwesimo esikhona? Impela, asikho isizathu sokuthi "ukuqhubeka nokufunda" kuqhubeke kuchazwe "ubungqingili." Ngemuva kwakho konke, ubungqingili imvamisa abuyona eyokugula; umlutha njalo. Isinqumo sokususa izihloko zocansi lwe-inthanethi nezithombe zobulili ezingcolile ngaphandle kwebhukwana ziye kusihlomelo sangaphambili (Isigaba III) sigcina ngempumelelo lonke udaba limbo, futhi ukugxila kude nendlela ethembisayo yokuhlaziya: ukuluthwa.

Lokhu kuhamba kunzima kakhulu ukuvikela uma kunikezwe ukuthi iphutha lomlando eliyisisekelo (eliqoshwe "ucansi" ngokukhethekile kokulutha) manje selilungisiwe odokotela be-3000 I-American Society of Addiction Medicine (ASAM). Ku-2011, i-ASAM yamemezela ukulimala a okuyisisekelo ukugula (akukho ukugula kwengqondo okwakukhona ngaphambili okudingekayo), futhi washo ngokuqondile ukuthi ukuziphatha ngokocansi nokulutha kokudla kungokoqobo, futhi kuchazwa izinguquko zobuchopho, hhayi isimilo. Isitatimende sayo somphakathi sisuselwa emashumini eminyaka ocwaningo lwe-neuroscience.

Amalungu eqembu le-DSM's Sexual and Gender Identity Disorders group group abazinakile izingcweti zomlutha we-ASAM. Ngenxa yalokho, izwi elisemthethweni le-AMA (the I-DSM-5) ayibonisi isayensi yokulutha yamanje. Kuyindida ukuthi imilutha ye-Intanethi ayiyona imilutha yezocansi, njengoba kuchaziwe ngenhla. Izithombe zobulili ezingcolile ze-intanethi nokulutha kocansi lwe-inthanethi kuyimilutha yesikrini. Susa isikrini nokuziphatha akusekho, okufana nemidlalo yevidiyo.

Isiyaluyalu ingenye yezinkinga ezixilongwa kakhulu

Ukukhathazeka okuphelele kokuvala zonke izici zokulutha kwe-inthanethi emgodini wokufundwa okudinga izidingo (Isigaba III), yilokho Inhloso ye-DSM yasekuqaleni bekuwukuthuthukisa ukuthembeka kokuhlola, ngakho-ke ochwepheshe bezempilo yengqondo bangakhipha imiphumela engaguquguquki, ephindaphindekayo, evumelekile ngokwesayensi. Imvamisa emlandweni wezokwelapha izifo zengqondo kune-etiology ye- iyiphi ukuhlupheka kuye kwaqondwa kahle njengokulutha. Njengokwethenjelwa kokuxilongwa yiyona I-DSM-5Umsebenzi, kufanele wamukele ukuhambisa zonke izidakamizwa ze-Intanethi ku Ukusetshenziswa kwezidakamizwa nokusetshenziswa kwezidakamizwa njengendaba yesayensi.

Uma ufundile kuze kube manje, ungahle uthokozele ukuphindwaphindwa okufushane kokutholwa kwezidakamizwa kwe-neuroscience kwakamuva: Sekuyiminyaka, abacwaningi bakwazi ukwengeza umlutha ezinhlotsheni zezilwane ngokuthanda futhi bafunda ubuchopho babo ngokujulile. Omaka abaningi baqondakala kahle futhi abanye sebevele babonwa futhi balinganiswa kubantu.

Okulandelayo, abacwaningi bakhishwa ukuziphatha ukuluthwa ezilwaneni, ukusebenzisa amasondo-ukugijima nokulutha kokudla. (Siyaxolisa abasebenzisi be-porn, ososayensi abakwazi ukwenza amagundane ukuthi ayitholele amaphikseli, kepha angasebenzisa amagundane ukuqonda ukuxhumana phakathi kocansi nokulutha. Bheka ngezansi.)

Muva nje, abacwaningi bafunde ukuthi izidakamizwa zokuziphatha (ukulutha kokudla, ukugembula okungokwemvelo, ukudlala ividiyo futhi Ukulutha kwe-intanethi) kanye nezidakamizwa zemithi zonke zibandakanya izindlela ezifanayo eziyisisekelo, bese uholela kufayela le- iqoqo lezinguquko ezabiwe ku-anatomy yobuchopho nakumakhemikhali. (Hlala wazi ukuthi izidakamizwa eziluthayo zibanga ukulutha ngoba zikhulisa noma zivimbela izindlela kakade endaweni yokuthola umvuzo wemvelo njengokuvusa ucansi.)

I-master switch ebangela eziningi zalezi zinguquko ezihlobene nokulutha yiprotheni DeltaFosB. Ukuqhubeka kokusetshenziswa ngokweqile kwe- imivuzo yemvelo (sex, ushukela, amafutha amaningi, ukuvivinya umzimba) noma ukuphathwa okungapheli cishe noma yikuphi ukuphathwa kabi kwezidakamizwa kubangele ukuthi i-DeltaFosB iqoqe emjikelezweni wokuvuza. Eqinisweni, njengoba kucatshangwe ngenhla, abacwaningi baye babonisa ukuthi ukwenza ucansi kubangela ukunqwabelana kweDeltaFosB, kuthuthukisa "ukusebenza kahle kwezocansi" kwamagundane.

Yikuphi okunye ukuphazamiseka kwe-DSM okungakhiqizwa kabusha kumamodeli wezilwane, noma kutholwe ngokuthembeka okukhulu njengokulutha kokuziphatha? Ngokuqinisekile akuzona izinkinga eziningi zokubeletha iqembu leqembu lezocansi kanye nobulili elicabanga ukuthi lingaqinisekiswa ku-DSM-5: i-frotteurism, i-sadomasochism, i-exhibitionism, i-transvestism, njalonjalo. Kunesayensi elukhuni ngokwengeziwe ekuluthweni kokuziphatha nasekuhloleni kwabo (kufaka phakathi ukulutha kwe-Intanethi), nokuzibona okuningi kwezidakamizwa ezingcolile zobulili ezikhononda imiphumela embi.

Asikho isidingo sokulinda ucwaningo oluqhubekayo

Okwamanje I-DSM-5 ibeka isigwebo esinzima kulabo abasha abayimilutha ye-Intanethi banesifo sengqondo kodwa abadinga usizo. Isayensi iqinile ukuthi imilutha yokuziphatha iyisimo esiyisisekelo futhi esisodwa. Ukulutha ukugembula sekuvele ku-DSM-5; Umlutha we-Intanethi ungowakhona futhi. Akunasizathu esikholisayo sokulinda ucwaningo olwengeziwe mayelana nokulutha kwe-Intanethi.

Ngokubhala I-Hypersexual Disorder futhi Ukusebenzisa i-Internet Disorder ukungaqapheli, okwamanje I-DSM-5 ngu:

  • Ukunganaki ubufakazi bokutholwa kwe-clinical, anecdotal, nokuhlola okukhomba ukulutha kwe-intanethi njengomlutha wangempela.
  • Ukungahoxisi izifundo eziningi zobuchopho ku-inthanethi ye-addiction disorder, okuhlanganisa ukusetshenziswa kocansi.
  • Ukukhuthaza inganekwane yokuthi izimpawu, izimpawu kanye nokuziphatha okufana nokulutha umlutha okubikwa yimilutha yezocansi ze-Intanethi kanye nabanakekeli babo kumele kuvele kwezinye izindlela ezingaziwa ngaphandle kwezinguquko zobuchopho ezihlobene nokulutha (isb., “Ukugula ngengqondo”).
  • Ukuqeda ukuhlaziywa-ukucwaninga-ukucwaninga ochwepheshe bezokwelapha (ASAM).
  • Ukwenqaba ukuvuma ukuthi i-eerotic e-inthanethi ayifani ne-eerotica yangesikhathi esidlule ngokuhambisana nokulethwa nendlela esetshenziswa ngayo.

Uma unomzuzwana, sicela ukhuthaze i-DSM-5 ukubeka zonke izidakamizwa ze-intanethi ku Ukusetshenziswa kwezidakamizwa nokusetshenziswa kwezidakamizwa: [i-imeyili ivikelwe]

I-ADDENDUM

I-DSM ithola umlutha ngakwesokudla, ngo-Juni 6, i-2012

06/07/2012

I-DSM Ithola Umlutha Ngakwesokudla - NY Times

Ngu-HOWARD MARKEL

U-Ann Arbor, uMikh.

Uma sithi umuntu "ungumlutha" ekuziphatheni okunjengokuthi ukugembula noma ukudla noma ukudlala imidlalo yevidiyo, kusho ukuthini lokho? Ingabe ukuphoqeleka okunjalo kuyavumelana nezindinganiso ezifana nokulutha kwezidakamizwa nokuphuza utshwala - noma lokho kungukukhuluma okuxekethile?

Lo mbuzo uvele kamuva ngemuva kokuba ikomidi ibhale uhlelo lwakamuva lwe-Diagnostic and Statistical Manual of Mental Disorders (DSM), incwadi ejwayelekile yokubhekisela kwezifo zengqondo, yamemezela izincazelo ezibuyekeziwe ekusebenziseni kabi izidakamizwa notshwala kanye nokulutha umlutha, kufaka phakathi isigaba esisha se "izidakamizwa zokuziphatha." Njengamanje, ukuphela kwesifo esikulesi sigaba esisha kungukugembula kwezemvelo, kodwa ukusikisela ukuthi ezinye izifo zokuziphatha zizofakwa ngesikhathi esifanele. Ukulutha kwe-intanethi, isibonelo, ekuqaleni kwakucatshangelwa ukuthi kufakwe kodwa kwafakwa kwisihlomelo (njengoba kwakungumlutha wezocansi) kulindele ucwaningo olwengeziwe.

Abazongabazwa bakhathazeka ngokuthi izindlela ezinjalo zokulutha izidakamizwa zizobamba iqhaza ekuziphatheni okujwayelekile (uma zimbi) futhi ziholele ekutheni i-overnoagnosis ne-overtreatment. U-Allen J. Frances, uprofesa we i-psychiatry kanye nesayensi yokuziphatha eDuke University esebenze ku-DSM, uthe izincazelo ezintsha ziba "ukukhishwa kwemithi yansuku zonke" futhi zizodala "izifo eziwumshayabhuqe." Umshwalanse we mpilo izinkampani ziyakhathaza ukuthi indlela entsha yokuxilonga ingadala uhlelo lokunakekelwa kwempilo amakhulu ezinkulungwane zamaRandi ngonyaka, njengoba ukuhlunga izidakamizwa kwanda.

Kukhona njalo okusemandleni okusebenzisa kabi uma izinqubo zokuxilonga zanda. Kodwa ngombono oyinhloko wesayensi, abagxeki be-DSM bangalungile. Njengoba noma ubani ojwayele umlando wokuxilongwa kokulutha umuthi angakutshela, izinguquko ze-DSM zibonisa ngokucacile ukuqonda kwethu okuqhubekayo kokuthi kusho ukuthini ukuba umlutha.

Umqondo wokulutha umlutha ubelokhu ushintsha futhi ukwandisa amakhulu eminyaka. Ekuqaleni, kwakungeyona ngisho nomqondo wezokwelapha. ERoma lasendulo, "ukulutha umlutha" okubhekiswe ekuxhomekeni komthetho: isibopho sobugqila ababolekisa ababolekisi. Kusukela ekhulwini lesibini leminyaka AD kuze kube yi-1800, "ukulutha umlutha" kuchaza isimo sengqondo kunoma iyiphi inamba yokuziphatha okulahlayo, njengokufunda ngokweqile nokubhala noma ukuzibophezela ngokugqilaza ekuzijabuliseni. Leli gama lalivame ukubonisa ubuthakathaka bomlingiswa noma ukuhluleka kokuziphatha.

"Isiyaluyalu" sangena isichazamazwi sezokwelapha kuphela ngasekupheleni kwekhulu le-19th, ngenxa yomuthi opium we-opium ne-morphine odokotela. Lapha, umqondo wokulutha umlutha wawuhlanganisa nomqondo wezinto ezidonswa emzimbeni. Kusukela ekuqaleni kwekhulu le-20th, esinye isici esiyinhloko ekutholeni ukulutha umlutha kwakukhona ukubonakala kwezimpawu zokukhishwa ngokomzimba lapho ushiya into ekhonjisiwe.

Le ncazelo yokulutha yayingasetshenzisiwe ngokucophelela (kuthatha iminyaka yokuphuza utshwala futhi i-nicotine ukuze kubekwe umlutha, naphezu kokwenza kwabo umthethosivivinywa), futhi akuzange kube yinto enembile. Cabanga insangu: Ngama-1980, lapho ngangiqeqesha ukuba ngudokotela, imbongi yayibhekwa ukuthi ayinalo umlutha ngoba umbhemisi wayengavamile ukuba nezimpawu zomzimba lapho eyeka. Manje sisazi ukuthi kwabanye abasebenzisa inambuzane bangaba umlutha omkhulu, kodwa ngenxa yokuthi imvume yesidakamizwa evela emaqenjini amafutha omzimba kuthatha amasonto (kunokuba amahora noma izinsuku), ukuhoxiswa ngokomzimba kungabonakali kwenzeka, nakuba ukuhoxiswa kwengqondo ngokuqinisekile kungakwazi.

Ngako-ke, odokotela abaningi baye bathola izinguquko ekuchazeni umlutha, kodwa abaningi basalokhu begcina ukuthi labo kuphela abantu abaqeda ukugcoba izinto ezivame ukubizwa ngokuthi izidakamizwa. Nokho, phakathi namashumi eminyaka adlule, umzimba obuthakathaka wobuchwepheshe besayensi uye wabonisa ukuthi izinto ezibonakalayo azibalulekile kakhulu ekubhekaneni nokulutha kunomkhuba wesifo okubangelwa yizifo ezivela ebuchosheni - inqubo ephazamisa isakhiwo se-anatomical yobuchopho, isimiso somyalezo wamakhemikhali kanye nezinye izindlela ezibhekene nokulawula imicabango nezenzo.

Isibonelo, kusukela kuma-1990 okuqala, izazi zezinzwa ze-Kent C. Berridge noTerry E. Robinson eYunivesithi yaseMichigan ziye zafunda i-neurotransmitter i-dopamine, okwenza kube nemizwa yokulangazelela. Baye bathola ukuthi uma uthabatha ngokuphindaphindiwe into efana ne-cocaine, uhlelo lwakho lwe-dopamine luyaba ne-responsive, okwenza ukuthi lo muthi ube nzima kakhulu ebuchosheni obunomlutha ukungayinaki. Ngisho noma izidakamizwa ngokwazo zidlala indima ebalulekile ekuqaleni le nqubo, izinguquko ebuchosheni ziqhubeka isikhathi eside ngemuva kokuba umlutha uhoxiswe: izici zokusebenzisa izidakamizwa kanye nezinkumbulo ziyaqhubeka nokwenza izifiso ngisho nasezigqila eziye zaphela iminyaka.

Ngaphezu kwalokho, iqembu labososayensi abaholwa nguNora Volkow eNational Institute on Drug Abuse baye basebenzisa i-positron emission tomography (PET) ukuhlola ukuthi ngisho nalapho umlutha we-cocaine ubheka kuphela amavidiyo abantu abasebenzisa i-cocaine, amazinga e-dopamine akhula ngengxenye yobuchopho bawo ehambisana nomkhuba nokufunda. Iqembu likaDkt Volkow kanye nabanye ososayensi baye basebenzisa izilinganiso ze-PET nokusebenza imaging resonance magnetic ukukhombisa ukufana kwe-dopamine receptor derangements ebuchosheni bemilutha yezidakamizwa, abagijimi begembula nabadla ukudla okudla okudla kakhulu.

Isiphetho sokudweba lapha ukuthi yize izinto ezinjenge-cocaine zisebenza kahle ekubangela izinguquko ebuchosheni obuholela ekuziphatheni komlutha nokukhuthaza, akuzona kuphela okubangela ukuthi kwenzeke: cishe noma yimuphi umsebenzi ojabulisayo - ubulili, ukudla, ukusetshenziswa kwe-inthanethi - unamandla okuba umlutha nokulimaza.

Izincazelo zezifo ziyashintsha ngokuhamba kwesikhathi ngenxa yobufakazi obusha besayensi. Yilokho okwenzekile ngokulutha umlutha. Kufanele samukele imigomo entsha ye-DSM futhi sihlasele zonke izinto nezinto zokuziphatha ezikhuthaza ukulutha nokulwela ngemithi yokwelapha esebenzayo.

Howard Markel, udokotela kanye noprofesa womlando wezokwelapha eYunivesithi yaseMichigan, ungumbhali we-An Anticomy of Addiction: uSigmund Freud, uWilliam Halsted, noMangaliso weDrug Cocaine.

Intuthuko ethokozisayo engagcina ishubile i-DSM nezombusazwe zayo, ngenkathi inikeza ukunakekelwa okungcono kweziguli - futhi ngaphezu kwakho konke ukuqonda okungcono komzimba wezinkinga zengqondo… mhlawumbe kufaka phakathi ukulutha kokuziphatha.

05/05/2013

UThomas Insel, umqondisi we-NIMH, usanda kukhishwa lesi sitatimende esiphathelene ne-DSM5: http://www.nimh.nih.gov/about/director/2013/transforming-diagnosis.shtml.

Nansi umbhalo:

Ukuguqula Ukuxilongwa

By Thomas Insel ngo-Ephreli 29, i-2013

Emasontweni ambalwa, i-American Psychiatric Association izokhipha uhlelo lwayo olusha lwe-Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Leli volumu lizokwehlukanisa izigaba eziningana zokuthola izifo zamanje, kusuka ku-autism spectrum ekuphazamiseni ukukhathazeka kwemizwa. Ngenkathi eziningi zalezi zinguquko ziye zaphikisana, umkhiqizo wokugcina uhilela ukuguqulwa okuzenzekelayo kokushicilela kwangaphambilini, ngokusekelwe embonweni omusha avela ocwaningweni kusukela ku-1990 lapho i-DSM-IV ishicilelwe. Ngezinye izikhathi lolu cwaningo lunconywa imikhakha emisha (isb., Ukucindezeleka kwemizwa yomsindo) noma ukuthi izigaba zangaphambilini zingahle zishiywe (isb., I-Asperger's syndrome).1

Umgomo wale ncwajana entsha, njengakuzo zonke izinhlelo zangaphambilini, ukuhlinzeka ngolimi oluvamile ukuchaza ngengqondo ye-psychopathology. Ngenkathi i-DSM ibichazwe ngokuthi "iBhayibheli" ensimini, kungcono, isichazamazwi, ukudala iqoqo lamalebula nokuchaza ngayinye. Amandla e-editions ngayinye ye-DSM abe "ukuthembeka" - uhlelo ngalunye luqinisekisile ukuthi odokotela basebenzisa amagama afanayo ngezindlela ezifanayo. Ubuthakathaka ukungabi khona kweqiniso. Ngokungafani nezincazelo zethu ze-ischemic isifo senhliziyo, i-lymphoma, noma i-AIDS, ukuxilongwa kwe-DSM kuncike ekuvumelaneni ngezigaba zempawu zomtholampilo, hhayi noma yiliphi isilinganiso se-laboratory esinjongo. Kuzo zonke ezinye izidakamizwa, lokhu kuzolingana nokudala izinhlelo zokuxilonga ezisekelwe ebuhlungu besifuba noma izinga lomkhuhlane. Ngempela, ukuxilongwa okusekelwe esibonelweni, okuye kwavame kwezinye izindawo zezokwelapha, sekuye kwafakwa esikhundleni sekhulu leminyaka edlule njengoba sesiye saqonda ukuthi izimpawu zodwa azikhombisi ukwelashwa okungcono kakhulu.

Iziguli ezinenkinga yengqondo zifanelwe kangcono. I Blinguenues Izinkomba Zomkhakha Wokucwaninga (RDoC) iphrojekthi yokuguqula ukuxilongwa ngokufaka i-genetics, imaging, isayensi yokuqonda, namanye amazinga yolwazi ukubeka isisekelo sesistimu entsha yokuhlukaniswa. Ngokuchungechunge lwamasifundisane ezinyangeni ze-18 ezedlulile, sizame ukuchaza izigaba eziningana eziyinhloko ze-nosology entsha (bheka ngezansi). Le ndlela yaqala ngezizathu eziningana:

  • Indlela yokuxilonga esekelwe ku-biology kanye nezimpawu akumele zivinjelwe ngezigaba zamanje ze-DSM,
  • Ukuphazamiseka kwengqondo kukhona ukuphazamiseka kwezinto eziphilayo ezibandakanya izijikelezo zobuchopho ezithinta izizinda ezithile zokuqonda, imizwelo, noma ukuziphatha,
  • Izinga ngalinye lokuhlaziya kudingeka liqondwe kunoma yikuphi umsebenzi,
  • Ukubala imephu yokuqonda, isifunda, kanye nezakhi zofuzo zokuphazamiseka kwengqondo kuzoletha amathekisthi amasha futhi angcono ekwelapheni.

Kwacaca ngokushesha ukuthi asikwazi ukuklama isistimu esekelwe kuma-biomarker noma ukusebenza komqondo ngoba asikho idatha. Ngalo mqondo, i-RDoC iyisimo sokuqoqa idatha edingekayo ukuze kube nososayensi entsha. Kodwa kubalulekile ukuqaphela ukuthi asikwazi ukuphumelela uma sisebenzisa izigaba ze-DSM njenge "standard standard".2 Uhlelo lokuxilonga kufanele lusekelwe kwidatha yokucwaninga evelayo, hhayi ngezigaba zamanje ezisuselwa kumpawu. Cabanga ukuthi unquma ukuthi i-EKGs ayilusizo ngoba iziguli eziningi ezinezinhlungu zesifuba azizange zinezinguquko ze-EKG. Yilokho esikwenzile amashumi eminyaka uma sinqabe i-biomarker ngoba ayitholi isigaba se-DSM. Kudingeka siqale ukuqoqa i-genetic, imaging, physiologic, kanye nedatha yokuqonda ukuze sibone ukuthi yonke idatha - hhayi nje izimpawu - iqoqo nokuthi lezi ziqoqo zihlobene kanjani nempendulo yokwelashwa.

Yingakho i-NIMH izophinde iphinde iqondise ucwaningo lwayo kude nezigaba ze-DSM. Ukuqhubekela phambili, sizobe sisekela amaphrojekthi okucwaninga abheka ngezigaba zamanje - noma ahlukanise izigaba zamanje - ukuqala ukuthuthukisa uhlelo olungcono. Lokhu kusho ukuthini abafakizicelo? Ukuhlolwa kwemitholampilo kungacwaninga zonke iziguli emtholampilo wemoya kunokuba labo abahlangabezana nezinkinga ezinkulu ezicindezelayo zokucindezeleka. Ucwaningo lwezinto ezibonakalayo "zokucindezeleka" lungase luqale ngokubheka izinkinga eziningi nge-anhedonia noma ukuhlaziywa ngokomzwelo ngokomzwelo noma ukuphuza kwengqondo ukuze uqonde izizinda ezisekelwe kulezi zimpawu. Lokhu kusho ukuthini iziguli? Sizibophezele ekwelapheni okusha nezinhle, kepha sizizwa ukuthi lokhu kuzokwenzeka kuphela ngokuthuthukisa uhlelo oluthile lokuxilonga. Isizathu esihle sokuthuthukisa i-RDoC ukufuna imiphumela engcono.

I-RDoC, okwamanje, uhlaka lokucwaninga, hhayi ithuluzi lomtholampilo. Le yiphrojekthi ethathe iminyaka eyishumi esaqala nje. Abaphenyi abaningi be-NIMH, asebevele becindezelwe ukuncishiswa kwesabelomali kanye nomncintiswano onzima wokuxhaswa ngezimali kocwaningo, ngeke balwamukele lolu shintsho. Abanye bazobona i-RDoC njengesifundo esihlukaniswe nemikhuba yokwelashwa. Kodwa iziguli nemindeni kufanele balwamukele lolu shintsho njengesinyathelo sokuqala esiya “imithi eqondile, "Ukunyakaza okuye kwashintsha ukuxilongwa komdlavuza nokwelashwa. I-RDoC ayiyona into engaphansi kwesiguquko sokuguqula umkhuba wokwelashwa ngokuletha isizukulwane socwaningo olusha ukuze sazise indlela esizihlolisisa ngayo nokuphatha ukuphazamiseka kwengqondo. Njengoba izakhi ezimbili zezokwelapha zesifo sengqondo seziphelile, "Ekupheleni kwekhulu le-19th, kwakungengqondo ukusebenzisa indlela elula yokuxilonga eyanikeza ukuqinisekiswa okucacile kokubikezelwa. Ekuqaleni kwekhulu le-21st, kufanele senze izinto zethu ziphakeme. "3

Izizinda ezinkulu zokucwaninga kwe-RDoC:

Ama-Negative Valence Systems
Amasistimu e-Valence ayenayo
Izinhlelo Zokuqonda
Izinqubo zezinqubo zomphakathi
Izinhlelo ze-Arousal / Modulatory

Okubhekwayo

1Impilo yengqondo: Embukisweni. Adam D. Nature. 2013 Apr 25; 496 (7446): 416-8. i-doi: 10.1038 / 496416a. Ayikho i-abstract etholakalayo. I-PMID: 23619674

2Kungani sekuthathe isikhathi eside ukuhlolwa kwengqondo ukuze kuthuthukiswe izivivinyo zokwelashwa nokuthi yini okufanele uyenze ngakho? Kapur S, Phillips AG, Insel TR. I-Mol Psychiatry. I-2012 Dec; 17 (12): 1174-9. i-doi: 10.1038 / mp.2012.105. I-Epub 2012 Aug 7.PMID: 22869033

3I-Kraepelinian dichotomy - iyahamba, iya… kepha ayikakahambi. Craddock N, Owen MJ. Br J Psychiatry. 2010 Feb; 196 (2): 92-5. i-doi: 10.1192 / bjp.bp.109.073429. I-PMID: 20118450