Ingabe ukuziphatha kocansi okuphoqeleka kungabhekwa njengokulutha umlutha? (I-2016)

IMIBONO: Leli phepha lishicilelwe ngaphansi komkhakha othi "Impikiswano" kumagazini 'Umlutha'. Ubuthakathaka bayo obukhulu ukuthi ihlose ukubhekana nokuziphatha okuphoqelela ngokocansi (CSB), igama lesambulela elihlanganisa yonke into yezocansi. Isibonelo, i- “CSB” ingahlanganisa ubungqingili noma “ukuluthwa ubulili” futhi ingafaka izindlela zokuziphatha ezinjengokungathembeki okulandelanayo noma ukulingisa nezifebe. Noma kunjalo abasebenzisi abaningi be-porn abaphoqelekile abenzi ucansi, futhi bakhawulele ukuziphatha kwabo okuphoqelela ekusebenziseni i-inthanethi kwe-porn. "Ukulutha ngokocansi," kanye nocwaningo olwenziwayo, kudinga ukucatshangelwa ngokuhlukile ekuluthweni kwezocansi kwe-Intanethi. Lesi sakamuva siyisiqeshana se- Internet umlutha. Bona -

Okucasula kakhulu ngaleli phepha ukuthi izigaba "Zesitatimende senkinga" kanye "Nokuchazwa kwe-CSB" zimayelana "nobungqingili," kanti izifundo ezisekela isisekelo se-neurobiological se-CSB cishe zonke zikubasebenzisi be-inthanethi be-porn. Lolu hlobo lokungaqondakali ludala ukudideka okuningi kunokucaca, ngoba kudinga ukuthi ulimi oluqaphele ngokungadingekile maqondana nocwaningo lwabasebenzisi be-inthanethi, okwenza ukubambezeleka kobufakazi obuqinile (nobukhulayo) bube kancane Ukulutha kwe-intanethi ngokungangabazeki kungokoqobo nokuthi ukulutha kwezidakamizwa ze-Internet kuyi-subtype.

UShane W. Kraus1, I-2, *, Valerie Voon3 noMarc N. Potenza2,4

Isihloko sokuqala eshicilelwe ku-intanethi: 18 FEB 2016

Umbhalo: Umlutha

INGXENYE: 10.1111 / engeza.13297

UKUQALA

Izinhloso: Ukuze ubuyekeze ubufakazi bokusekela ukuziphatha okucindezelayo ngokocansi (CSB) njengento engeyona into noma ukuziphatha kabi kokuziphatha.

Izindlela: Idatha evela ezizindeni eziningi (isib. I-epidemiological, phenomenological, clinical, biological) iyabuyekezwa futhi ihlolwe ngokuqondene nedatha esuka ekudleni nokugembula.

Ezenye: Kukhona izici zokuqhaqha phakathi kwe-CSB nokuphazamiseka kokusetshenziswa kwezidakamizwa. Izinqubo ezivamile ze-neurotransmitter zingase zibe negalelo ku-CSB nasezikhungweni zokusetshenziswa kwezidakamizwa, futhi ukuhlolwa kwamuva kwe-neuroimaging ukuveza ukufana okuhlobene nokuthanda nokukhathazeka. Imithi yokwelapha efanayo neye-psychotherapeutic ingase isetshenziswe ku-CSB nokulutha kwezidakamizwa, nakuba izikhala eziningi kolwazi okwamanje zikhona.

Iziphetho: Naphezu kocwaningo olukhulayo oluxhumanisa ukuziphatha okubi ngokocansi (CSB) ekubhebhethekiseni izidakamizwa, izikhala ezibalulekile ekuqondeni ziyaqhubeka nokucindezela ukuhlukaniswa kwe-CSB njengesiyaluyalu.

AMAZWI OKUQALA: Ukulutha umlutha, izidakamizwa zokuziphatha, ukuziphatha kocansi okucindezelayo, ukuxhasana ngokobulili, i-neurobiology, ukugula kwengqondo, ukuziphatha ngokobulili, ukucindezelwa ngokocansi

ISITATIMENDE SOMTHETHO

Ukukhululwa kwe-Manual Diagnostic and Statistical (DSM-5) [1] ukuhlukaniswa kwezidakamizwa. Ngokokuqala ngqa, i-DSM-5 ihlanganisa ukuphazamiseka okungabandakanyi ukusetshenziswa kwezidakamizwa (ukubheja ukubheja) kanye nokuphazamiseka kokusetshenziswa kwezidakamizwa esiteshini esisha esinesihloko esithi: 'Izinto ezihlobene nezidakamizwa kanye nezidakamizwa zokulahla'. Nakuba abacwaningi bebebukeze ngaphambili ukuthi babekwe umlutha [2-4], ukuhlelwa kabusha kuvuselele impikiswano, futhi akucaci ukuthi ukuhlukaniswa okufanayo kuzokwenzeka yini kumagazini we-11th we-International Classification of Diseases (ICD-11 ) [5]. Ngaphandle kokucabangela ukubheja kokugembula njengokwemilutha engahlobene nezidakamizwa, amalungu ekomidi le-DSM-5 acabange ukuthi ezinye izimo ezifana ne-Internet yokudlala ingxabano kufanele zibhekwe njengemilutha yokuziphatha '[6]. Nakuba ingozi yokudlala i-intanethi ayifakiwe ku-DSM-5, yanezelwa ku-Section 3 ukuze ifunde kabanzi. Ezinye iziphazamiso zazicatshangwa, kepha azihlanganisiwe ku-DSM-5. Ngokuqondile, izinqubo ezihlongozwayo zokuhlukunyezwa kwe-hypersexual [7] zazingekho, okwenza imibuzo mayelana nekusasa lokuxilonga lezinkinga zokuziphatha ngokobulili ezinenkinga / ngokweqile. Izizathu eziningi mhlawumbe zanikele kulezi zincumo, ngedatha enganele ezindaweni ezibalulekile okungenzeka zinikele [8].

Emaphepheni amanje, ukuziphatha okucindezelayo ngokocansi (CSB), okuchazwa njengengqinamba ekulawuleni ukucabanga okungafaneleki noma okwedlulele ngokwezocansi, izikhalo / izifiso noma ukuziphatha okudala ukucindezeleka okuzenzekelayo noma ukukhubazeka emsebenzini wokusebenza kwansuku zonke, kuzocatshangelwa, njengoba kuzokwenza ubudlelwane obukhona nokugembula kanye nezidakamizwa zemithi. Ku-CSB, ukucabanga okucindezelayo okuphindaphindiwe nokuphindaphindiwe ngokobulili, ukuncenga / ukuthanda noma ukuziphatha kungakhula ngokuhamba kwesikhathi futhi kuhlotshaniswe nokukhubazeka kwezempilo, kwengqondo nokuhlukumezeka kwabantu [7,9]. Nakuba izifundo zangaphambili zenze ukufana okukhona phakathi kokulutha ngokocansi, ukuxilongwa kobulili obuyinkimbinkimbi / ukuxilongwa kwe-hypersexual nokucindezelwa ngokocansi, sizosebenzisa i-CSB ngokuthi sichaze isigaba esibanzi semikhuba yobulili enenkinga / ngokweqile ehambisana nayo yonke imigomo engenhla.

Iphepha lamanje lihlolisisa ukuhlukaniswa kwe-CSB ngokubukeza idatha evela ezizindeni eziningi (isib. I-epidemiological, phenomenological, clinical, biological) kanye nokubhekisisa ezinye zezinkinga zokuxilonga nokuhlukanisa ezingahlali zingaphenduliwe. Ngaphakathi, kufanele i-CSB (kufaka phakathi ubulili obukhulu ngokweqile, ukubukwa kwezithombe zobulili ezingcolile kanye / noma ukushaya indlwabu) kubhekwe njengesiyaluyalu sokuxilongwa futhi, uma kunjalo, kufanele ihlukaniswe njengokulutha komzimba? Njengoba sinikezwe izikhala zamanje zocwaningo ekucwaningweni kwe-CSB, siphetha ngezincomo zocwaningo oluzayo kanye nezindlela lapho ucwaningo lungazisa khona ukuhlolwa kokuhlola okungcono nakwezamaphilisi kubantu abathola usizo lwezobuchwepheshe kwi-CSB.

UKUQALA i-CSB

Phakathi neminyaka embalwa edlule, izincwadi ezichaza ukutadisha kwe-CSB zanda (Fig. 1). Naphezu kocwaningo olukhulayo, abacwaningi nabahlengikazi bavumelana kancane mayelana nencazelo kanye nesethulo se-CSB [10]. Abanye babheka ukukhathazeka okunenkinga / okudlulele ekuziphatheni kocansi njengesici se-hypersexual disorder [7], i-CSB engeyona i-parbalic [11], ukuphazamiseka kwemizwelo enjenge-bipolar disorder [12] noma 'ukuziphatha kabi' kwe-behavioral '[13,14]. I-CSB iphindwa futhi njengenhlangano yokuxilonga ngaphakathi kwesigaba sokuphazamiseka kwe-impulsecontrol emsebenzini we-ICD-11 [5].

Phakathi neminyaka eyishumi edlule, abacwaningi nabahlengikazi sebeqalile ukucabanga nge-CSB ngaphakathi kohlaka lokuxilongqiswa kwabantu ngokocansi. Ku-2010, uMartin Kafka uhlongoze isifo esisha sengqondo esibizwa ngokuthi 'ukuxilongwa kwe-hypersexual' ye-DSM-5 ukucubungula [7]. Naphezu kwesilingo sezinsizakalo esisekela ukuthembeka nokuqiniswa kwezinqubo ze-hypersexual disorder [15], i-American Psychiatric Association ayikhipha ukuphazamiseka kwe-hypersexual kusuka ku-DSM-5. Ukukhathazeka kwaphakanyiswa ngokuntuleka kocwaningo kubandakanya ukucabangela kwe-anatomical and functional, i-genetics yama-molecular, i-pathophysiology, i-epidemiology nokuhlolwa kwe-neuropsychological [8]. Abanye babonisa ukukhathazeka ngokuthi ukuphazamiseka kocansi kungabangela ukuhlukumeza ngokweqile noma kuhlinzekwe ukuxilongwa okungamanga, kunikezwe ukungabi khona kokuhlukana okucacile phakathi kwamazinga avamile nobubanzi obuphathelene nezifiso zocansi kanye nokuziphatha [16-18].

Izinkinga eziningi ze-hypersexual disorder zihlanganyela ngokufanayo nalabo okuphazamiseka kokusetshenziswa kwezidakamizwa (Ithebula 1) [14]. Zomi zombili zibandakanya izindlela eziphathelene nokulawulwa ukukhubazeka (imizamo engaphumeleli yokulinganisa noma yokuyeka) nokusetshenziswa okuyingozi (ie ukusetshenziswa / ukuziphatha kuholela ezimweni ezinobungozi). Imikhawulo ihluke ngokukhubazeka komphakathi phakathi kokushukela ngokobulili nokusetshenziswa kwezidakamizwa. Ukusetshenziswa kwezidakamizwa kusetshenziselwa ukuphazamiseka kwezidakamizwa kufaka phakathi izinto ezimbili ezihlola ukuxhomekeka komzimba (ie ukubekezelelana nokuhoxiswa), kanye nemigomo yokuphazamiseka kwe-hypersexual. Ukuhlukunyezwa okuphathelene ne-hypersexual (ngokuphathelene nokuphazamiseka kwezidakamizwa) kukhona imigomo emibili ephathelene nezimo zesimo sengqondo sokudangala. Lezi zindlela zikhomba ukuthi izifo eziphathelene nokuxilongwa kwe-hypersexuality zingase zibonise amasu okubhekana nokuhlukumeza i-maladaptive, kunendlela yokugwema izimpawu zokuhoxiswa (isib. Ukukhathazeka okuhlobene nokuhoxiswa kwezinto). Kungakhathaliseki ukuthi umuntu uthola ukuhoxiswa noma ukubekezelelana okuhlobene nokuziphatha ngokocansi okuphikisanayo, nakuba kuye kwaphakanyiswa ukuthi izimo zomsindo we-dysphoric zingase zibonise izimpawu zokuhoxiswa ngabanye abane-CSB abasanda kumisa noma bayeka ukuhlanganyela ekuziphatheni kocansi okunenkinga [19]. Umehluko wokugcina phakathi kokugula ngengculazi nokuphazamiseka kokusetshenziswa kwezidakamizwa kuhilela ukuvimbela ukuxilongwa. Ngokucacile, ukuphazamiseka kokusetshenziswa kwezidakamizwa kudinga ukulinganisa okungenani kokubili, kanti ukugula okuphathelene nokuxhumene nocansi kudinga imigomo emine ye-'A 'okufanele ihlangabezane nayo. Njengamanje, ucwaningo olwengeziwe luyadingeka ukuze kunqunywe umkhawulo wokufaneleka we-CSB [20].

Izici zomtholampilo ze-CSB

Kukhona idatha enganele mayelana nokusabalala kwe-CSB. Idatha yomphakathi emikhulu mayelana nokulinganiswa kokusabalalisa i-CSB ayikho, okwenza ukuthi ukusabalala kweqiniso kwe-CSB kungaziwa. Abacwaningi balinganisa amanani avela ku-3 kuya ku-6% [7] nabesilisa abadala abahlanganisa iningi (80% noma ngaphezulu) labantu abathintekayo [15]. Ucwaningo olubanzi lwabafundi baseYunivesithi base-US bathola ukulinganisa kwe-CSB ukuthi kube yi-3% yamadoda ne-1% yabesifazane [21]. Phakathi kwama-veteran ase-US abesilisa bezempi, ukukhula kwalinganiselwa ukuthi kusondele ku-17% [22]. Ukusebenzisa idatha evela ku-US National Epidemiologic Survey nge-Alcohol and Related Conditions (NESARC), izinga lokuphila komdlavuza wesimo sobulili, ubukhulu obukhona be-CSB, litholakala ukuthi luphakeme kubantu (18.9%) kunabesifazane (10.9%) [23]. Nakuba kubalulekile, sigcizelela ukuthi izikhala ezifanayo kolwazi azivimbeli ukufakwa komdlalo wokugembula ku-DSM-III ku-1980 noma ukufakwa kwe-Inthanethi XLUMX ye-Section 3 ye-DSM-5 (bheka ukulinganisa okubanzi okuvela ku-1 kuya ku-50% , kuye ngokuthi ukusetshenziswa kwe-inthanethi okunenkinga kuchazwa kanjani futhi kuvinjelwe [6]).

I-CSB ibonakala kaningi kakhulu phakathi kwamadoda kuqhathaniswa nabesifazane [7]. Amasampuli aseyunivesithi [21, 24] namalungu omphakathi [15, 25, 26] asikisela ukuthi amadoda, uma kuqhathaniswa nabesifazane, angase afune ukwelashwa okwenziwe i-CSB [27]. Phakathi kwabesilisa be-CSB, ukuziphatha okucindezelayo kakhulu okubikwe emitholampilo kuyisimo sokushaya indlwabu, ukusetshenziselwa izithombe zobulili ezingcolile, ubudlelwane obungavamile noma engaziwa nabantu abangabazi, abalingani abaningi bezocansi kanye nobulili obukhokhelwayo [15, 28, 29]. Phakathi kwabesifazane, imvamisa ephezulu yokushaya indlwabu, inani labalingani bocansi kanye nokusetshenziswa kocansi okuhlobene nezithombe zocansi kuhlotshaniswa ne-CSB [30].

Esivivinyweni sezinsizakalo ze-hypersexual disorder, i-54% yeziguli zabika ukuthi zibhekene nezifiso zobulili ezingasetshenziswanga, izikhalazo kanye nokuziphatha ngaphambi kokuba umuntu abe ngumuntu omdala, okuphakamisa ukuqala kokuqala. Amaphesenti angamashumi ayisishiyagalolunye nambili ekhulwini abika ukuthi ubhekene nokuqhubeka kancane kancane kwezinkinga zokugula ngengculazi ngaphezu kwezinyanga noma iminyaka [15]. Ukuqhubeka kwezifiso zobulili ngokuhamba kwesikhathi kuhlotshaniswa nokucindezeleka komuntu kanye nokukhubazeka okusebenzayo kuzo zonke izizinda zokuphila ezibalulekile (isib. Umsebenzi, umndeni, ezenhlalakahle kanye nezomnotho) [31]. Abantu abathandana nabo ngokobulili bangase babe nezinzuzo zokuzizwa benemizwa engaphezu kwemizwa emihle, nokuzilimaza okubalulekile (isb. Amahloni, ukuzonda) kungabangela ukugcinwa kwe-CSB [32]. Izifundo ezilinganiselwe ezinikeziwe nemiphumela ehlanganisiwe, akucaci ukuthi ngabe i-CSB ihlotshaniswa nokulahlekelwa ekusebenzelweni kwezinqumo / ukusebenza okuphezulu okungalungile [33-36].

Ku-DSM-5, 'ukunxanela' kwanezelwa njengomgogodla wokuxilonga ngezinkinga zokusebenzisa izidakamizwa [1]. Ngokufanayo, ukufisa kubonakala kuhambisana nokuhlolwa nokwelashwa kwe-CSB. Phakathi kwamadoda amadala asebasha, ukulangazelela izithombe zobulili ezingcolile kuhambisana kahle nemibono yengqondo / yengqondo, ukucindezelwa ngokocansi nokuqina komlutha we-inthanethi ngo-37-41]. Indima ebalulekile yokufuna ukubikezela ukuphindaphinda noma imiphumela yomtholampilo.

Eziguli ezifuna ukwelashwa, abafundi beyunivesithi, kanye namalungu omphakathi, i-CSB ibonakala ivame kakhulu phakathi kwabantu baseYurophu / abamhlophe kuqhathaniswa nabanye (isib. Ama-American American, Latino, ama-Asian Americans] [15, 21]. Idatha encane ibonisa ukuthi abantu abafuna ukwelashwa kwe-CSB kungenzeka ukuthi isimo sesimo sezenhlalakahle nesomnotho kuqhathaniswa nalabo abanezinye izifo zengqondo [15, 42], nakuba lokhu kutholakala kungase kubonise ukutholakala okukhulu kokwelashwa (kufaka phakathi ukwelashwa okukhokhelwayo kwangasese okunikezwayo emshuwalense) kubantu abanemali engenayo ephezulu. futhi kutholakala kubantu abesilisa ocansini namadoda [28, 43, 44], futhi kuhlotshaniswa nezindlela zokuziphatha ezithatha isandulela ngculazi (isib. ubulili obungenalo ikhanda) [i-44, i-45]. I-CSB ihlotshaniswa namazinga aphakeme weengozi zocansi ezithatha bobabili abantu abesilisa nabesifazane abangabesilisa nabesifazane, aboniswa ngamazinga aphezulu we-HIV kanye nezinye izifo zobulili.

I-Psychopathology ne-CSB

I-CSB ivele njalo nezinye izifo zengqondo. Cishe ingxenye yesigceme se-hypersexual ihlangabezana nemigomo okungenani eyodwa ye-DSM-IV, ukukhathazeka, ukusebenzisa izinto, ukulawula umfutho noma ukuphazamiseka komuntu [22,28,29,46]. Emadodeni e-103 afuna ukwelashwa kokusebenzisa izithombe ezingcolile zobulili ezingcolile kanye / noma izenzo zokuziphatha zobulili ezingajwayelekile, i-71% ihlangabezane nemigomo yesifo sengqondo, i-40% yesifo sokukhathazeka, i-41% yesifo sokusetshenziswa kwezidakamizwa kanye ne-24% ye-disorder control control [47] . Amanani alinganiselwe we-CSB kanye nebanga lokungcingo lokugembula kusuka ku-4 kuya ku-20% [25, 26, 47, 48]. Ukungafuni ukuziphatha ngokobulili kuhlotshaniswa nezifo eziningi ezingokwemvelo ezingxenyeni zobulili, ikakhulukazi kwabesifazane. Phakathi kwabesifazane uma kuqhathaniswa namadoda, ukufisa kobulili kwahlanganiswa kakhulu ngokuzibandakanya komphakathi, ukuphuza utshwala nokusetshenziswa kwezidakamizwa, i-schizotypal, insizakalo engezansi, imingcele, i-narcissistic, ukugwema nokucindezeleka komuntu okucindezelayo [23].

IZISEBENZI ZEZIKHATHI ZEZIKHATHI

Ukuqonda ukuthi ngabe i-CSB yabelana kanjani nge-neurobiological ne-(noma ukungafani) nokusetshenziswa kwezinto zokugembula kungasiza ukwazisa imizamo ehlobene ne-ICD-11 kanye nokungenelela kokwelashwa. Izindlela ze-Dopaminergic ne-serotonergic zingabangela ekuthuthukiseni nasekulondolozweni kwe-CSB, nakuba lo cwaningo luphikisana nakancane [49]. Iziphumo ezitholakalayo ze-citalopram endaweni yokuhlola elawulwa yi-placebo eyimpumputhe elawulwa yi-placebo emkhatsini wesampula yamadoda ibonisa ukungasebenzi kahle kwe-serotonergic [50]. I-Naltrexone, ophikisana ne-opioid, ingase isebenze ekunciphiseni kokubili ukukhushulwa nokuziphatha okuhambisana ne-CSB, ehambisana nezindima eziphathelene nezinto zokugembula nokugembula futhi ezihambisana nezinqubo ezihlongozwayo zokumisa ngokuhambisana ne-opioid yomsebenzi we-dopaminergic ezindleleni ze-mesolimbic [51-53].

Ubufakazi obunamandla kakhulu phakathi kwe-dopamine ne-CSB buhlobene nesifo sikaParkinson. Imithi yokwelapha ye-Dopamine (isib. I-levodopa kanye ne-dopamine agonists njenge-pramipexole, i-ropinirole) ihlotshaniswa nokuziphatha okucindezelayo ukuziphatha / ukuphazamiseka (kufaka phakathi i-CSB) phakathi kwabantu abane-Parkinson's disease [54-57]. Phakathi kweziguli zesifo se-3090 Parkinson, ukusetshenziswa kwe-dopamine agonist kwakuhlotshaniswa nokunyuka kwe-2.6 kwenkinga yokuba ne-CSB [57]. I-CSB phakathi kweziguli zesifo sikaParkinson nayo ibike ukuthi iyakhipha uma imithi ishiyiwe [54]. I-Levodopa nayo ihlotshaniswe ne-CSB nezinye izifo zokulawula ukucindezeleka esifweni sikaParkinson, njengoba kunezinye izici eziningi (isib. Indawo, isimo somshado) [57].

I-pathophysiology ye-CSB, okwamanje ayiqondakali kahle, iphindelwa ngentshiseko. Umsebenzi we-hypothalamic-pituitary-adrenal axis umsebenzi uye waxhunyaniswa nezidakamizwa futhi wathathwa kamuva ku-CSB. Amadoda e-CSB ayengaphezu kwamadoda angewona ama-CSB ukuba abe yi-dexamethasone yokucindezela-ukuhlola okungewona abathintekayo futhi abe namazinga aphezulu e-horrenocorticotrophic hormone. I-hyperactive hypothalamic-pituitary-adrenal axis emadodeni e-CSB angase anciphise izifiso zokuzikhandla kanye ne-CSB ezihlobene nokulwa nokucindezeleka ngokomzwelo wezwe [58].

Ucwaningo olukhona lwe-neuroimaging lugxile ngokuyinhloko ekusebenzeni kabusha kwe-cue-induced. Ukwehla kwe-cue-reactivity kuhambisana nemithi yokwelashwa kwezidakamizwa, okufaka isandla ekuthandeni, kukhuthaza futhi kubuyisela kabusha i- [59]. Ukuhlaziywa kwe-meta yakamuva kubike ukuxubana phakathi kogwayi, i-cocaine ne-alcohol-caculate in-ventral striatum, i-anterior cingulate cortex (AC) kanye ne-amygdala ehlobene nokuzizwa kwezidakamizwa nokuzikhandla okubikiwe, okuphakamisa ukuthi lezi zifunda zengqondo zingaba yingqikithi isifunda sokufuna izidakamizwa kuzo zonke izidakamizwa [60]. I-incentive theory of the addictions iveza ukuthi ukulimala kuhlobene nokukhuthazwa okukhuthazayo okukhuthazayo okubangelwa ukuthunjwa okukhulu, ukubhekana nokuziphatha, ukulindela kanye nesisusa (noma 'sifuna') izidakamizwa. [61, 62]. Le mbono iphinde isetshenziswe ku-CSB [63].

Kubafundi besifazane ekolishi [i-64], ukuhlukana komuntu ngamunye okuhlobene nomvuzo okuhlobene nomvuzo ku-nucleus accumbens ekuphenduleni kokudla nezithombe zocansi ezihlobene ngokuqondile kuya ekuzuzeni isisindo nokusebenza ngokobulili izinyanga ze-6 kamuva. Ukuphakanyiswa kwemivuzo ebuchosheni ebuchosheni ekudleni noma kwezocansi kuhlotshaniswa nokudla ngokweqile nokwandisa umsebenzi wobulili, okuphakamisa indlela ejwayelekile ye-neural ehambisana nokuziphatha okuphazamisayo. Ngesikhathi sokucabanga kwama-magnetic resonance (fMRI), ukuvezwa kwezingqikithi zevidiyo ezingcolile uma kuqhathaniswa namavidiyo angathandeki ngokocansi kuma-CSB amadoda ahlobene namadoda angewona ama-CSB ahlanganiswe nokusebenza okukhulu ekuhambeni kwe-anterior cingulate, i-ventral striatum kanye ne-amygdala, izifunda ezibandakanya izidakamizwa -sindisa izifundo zokuvuselela izidakamizwa [63]. Ukuxhumeka okusebenzayo kwalezi zifunda kwakuhlotshaniswa nesifiso sobulili esizithobayo, kodwa hhayi ukuthanda, phakathi kwabantu abane-CSB. Lapha, isifiso sithathwe njengenhlahlandlela yokufuna 'uma kuqhathaniswa' nokuthanda '. Amadoda ane-CSB ngokumelene nalabo abangenawo abuye abike isifiso sobulili ekhulisiwe futhi abonise ukukhishwa okukhulu kokuqala kwe-cingulate nokuhlaselwa ekuphenduleni izithombe zobulili ezingcolile [65].

Amadoda we-CSB aqhathaniswa nalabo abangaphandle ngaphandle kokubonisa ukukhathazeka okukhulu kakhulu ekukhulumeni kobulili, okuphakamisa indima ekuphenduleni kokuqala kokuqondisa okubhekiswe kumazwi e-pornography [66]. Amadoda we-CSB akhombisa nokukhetha okukhethwa kukho okukhethwa kukho okukhulunywa ngakho kokubili kobulili nezindleko zemali uma kuqhathaniswa namadoda ngaphandle kwe-CSB [67]. Ukukhathazeka okukhulu kokuqala kokuzibandakanya kwezocansi kwakuhlobene nokuziphatha okuthe xaxa okubhekiswe kwezocansi ezifakiwe, ngaleyo ndlela kusiza ukugqugquzela izinkolelo zokulutha umlutha. Izihloko ze-CSB zibuye zibonise okuthandwayo kwezithombe zobulili zendabuko kanye nokuhlehlisa okukhulu ukujwayela ukuzithokozisa kwezithombe zocansi, ngezinga lokujwayele ukuhambisana nokuthandwa okuthuthukisiwe kobuciko bobulili [67]. Ukufinyeleleka kwenzalo yezocansi kwendabuko kungase kube ngqo ekutholakaleni kwe-intanethi yezinto zokwazisa.

Phakathi kwezifo zesifo sikaParkinson, ukuvezwa kwezifiso zobulili kwandula isifiso socansi kulabo abane-CSB uma kuqhathaniswa nalabo abangenawo i- [68]; umsebenzi othuthukisiwe ezindaweni ezihamba phambili, paralimic, temporal, occipital, somatosensory and prefrontal ezibandakanyeka ezinkampanini ezingokomzwelo, ezinokuqonda, ezizimele, ezibukwayo nezishukumisayo nazo zaphawula. Iziguli ze-CSB 'zanda isifiso socansi ezihambisana nokusebenza okuqhubekayo emgodini we-ventral kanye ne-cortices ye - cingulate ne - orbitofrontal [68] .Lokhu okutholakele kubonisana nalabo abasemayelana nokulutha kwezidakamizwa lapho kuqhutshelwa khona ukukhushulwa kwezifunda ezihlobene nomvuzo kubonakala ekuphenduleni izici ezihlobene ukulutha ngokweqile, ngokuphambene nezimpendulo ezingenayo ukubuyekezwa okujwayelekile noma kwezimali [69, 70]. Ezinye izifundo ziphinde zithinte izifunda ze-prefrontal; ekutadisheni okucatshangelwa kwe-imaging encane ye-diffusion, i-CSB ngokumelene namadoda angewona ama-CSB abonise ukuphakama okuphezulu okuphezulu kusho ukungafani [71].

Ngokuphambene nalokho, ezinye izifundo ezigxila kubantu abangenawo i-CSB ziye zagcizelela indima yokuhlala. Kumadoda angewona ama-CSB, umlando omude wezokubuka izithombe zobulili ezingcolile uhambelaniswe nezimpendulo ezisezantsi ezenziwe ngezithombe ezingcolile, okuphakamisa ukungahlehlisi okungahle kwenzeke [72]. Ngokufanayo, ekuhlolisweni okuhlobene nomcimbi okuhlobene nomcimbi namadoda futhi ngaphandle kwe-CSB, labo ababika ukukhathazeka kwezithombe zobulili ezingcolile babenezindlela ezincane ezisezingeni eliphansi ezithombeni zezithombe zobulili ezingcolile ezihlobene nalabo abangabika ukusetshenziswa kwezinkinga. I-potential potential late is aphakanyiswe ngokujwayelekile ekuphenduleni izikhangiso ezidakamizwa ekufundiseni izidakamizwa [73]. Lezi zitholakele zihluke, kodwa azihambisani, umbiko wezenzo ezithuthukisiwe ezifundweni ze-FMRI ezifundweni ze-CSB; lezi zifundo ziyahlukahluka kohlobo olushukumisayo, indlela yokulinganisa nesilinganiso esivela ngaphansi kwesifundo. Ukucwaninga kwe-CSB kusetshenziswe kaningi ngamavidiyo kuqhathaniswa nezithombe eziphindaphindiwe; izinga lokusebenza liye laboniswa ukuthi lihluke kumavidiyo ngokuhambisana nezithombe kanye nokujwayela kungase kuhluke kuye ngokuthi yi-stimuli. Ngaphezu kwalokho, kulabo ababika ukukhathazeka ngokucwaninga ekuhloliseni okuhlobene nomcimbi, inani lamahora okusetshenziswa laliphansi [inkinga: i-3.8, ukuphambuka okujwayelekile (i-SD) = i-1.3 ngokumelene nokulawula: i-0.6, SD = amahora we-1.5 / isonto] uma kuqhathaniswa ne-13.21 Ucwaningo lwe-CSB lwe-FMRI (CSB: 9.85, SD = 1.75 ngokuya nokulawula: 3.36, SD = Amahora we-XNUMX / isonto). Ngakho-ke, ukujwayela kungase kuhlobanise nokusetshenziswa okujwayelekile, ngokusetshenziswa okunamandla okungase kuhlotshaniswe nokucubungula-ukubuyiswa komsebenzi. Izifundo eziqhubekayo ezengeziwe zidingeke ukuba zihlolwe la mahluko.

I-Genetics ye-CSB

Idatha ye-Genetic ehlobene ne-CSB ayifushane. Ayikho isifundo sohlobo lwe-genome-wide ye-CSB esenziwe. Ukuhlolisisa imibhangqwana eshadile ye-88 ne-CSB itholakale izihlobo eziphezulu zezihlobo zokuqala zezidakamizwa eziphathelene nokusetshenziswa kwezidakamizwa (40%), ukukhathazeka kokudla (30%) noma ukugembula okufuywayo (7%) [74]. Ucwaningo lwezinhlangothi ezimbili luphakamisa ukunikezwa kwezakhi zofuzo okwenziwe i-77% yokuhlukahluka okuphathelene nemikhuba yezinkinga eziyinkimbinkimbi, kuyilapho i-13% ibangelwe izici ezingezona ezabelwana ngazo [75]. Iminikelo emikhulu yezakhi zofuzo ikhona nakwezinto zokugembula nokugembula [76, 77]. Ukusebenzisa idatha emibili [78], isilinganiso esilinganiselwe sokuhluka komthwalo wokugembula ngengculazi ngenxa yemithonya yezofuzo cishe nge-50%, ngezinga eliphakeme elibonwe ngezinkinga ezinkulu. Izici ezithathwayo ezihlobene nokungabi nesisindo zingase zimele umaka wokungcupheni ekuthuthukiseni izidakamizwa zokusetshenziswa kwezidakamizwa [79]; Kodwa-ke, ngabe lezi zici zandisa izinkinga zokuthuthukisa i-CSB ingakafiki.

UKUHLOLA NOKUSEBENZISWA KWE-CSB

Phakathi neminyaka eyishumi edlule, ucwaningi mayelana nokuxilongwa nokuphathwa kwe-CSB landa [80]. Abacwaningi abahlukahlukene baye bakhetha izindlela zokuhlola (13] namathuluzi okuhlola athuthukile [81] ukusiza odokotela ekunakekeleni i-CSB; Kodwa-ke, ukwethembeka, ukuqinisekiswa nokusebenza kwamaningi alazi zilinganiso kuhlale kungakaqashiwe. Kunezinyathelo ezimbalwa eziqinisekisiwe, ezivimbela ukukhiqiza kwazo okujwayelekile ukuze kwenziwe umtholampilo.

Ukungenelela kokwelashwa kwe-CSB kudinga ucwaningo olwengeziwe. Zimbalwa izifundo ezihlolisise ukusebenza nokubekezelelana kwemithi ethile yezemithi [53, 82-86] kanye ne-psychotherapeutic [87-91] yezokwelapha ze-CSB. Ama-psychotherapies asekelwe ebufakazini njengokwelashwa kwengqondo-nokuziphatha nokwelashwa kokwamukela nokuzibophezela kubonakala kuwusizo ku-CSB [89,91,92]. Ngokufanayo, i-serotonergic reuptake inhibitors (isb. I-fluoxetine, i-sertraline ne-citalopram) kanye nabaphikisi be-opioid (isb. Izifundo zemithi ezikhona ngokujwayelekile beziyizifundo eziyizibonelo. Ucwaningo olulodwa kuphela [50] olusebenzise ukwakheka okulawulwa kabili, okulawulwa yi-placebo lapho kuhlolwa ukusebenza nokubekezeleleka komuthi (i-citalopram) ekwelapheni i-CSB.

Ayikho ukuhlolwa okukhulu okulawulwa ngokungahleliwe okukhona okukhona okukhona okukhona okuhlola ukuphumelela kwengqondo ye-psychotherapies ekwelapheni i-CSB. Izinkinga zemiqondo zinciphisa ukutholakala kwemiphumela yezibalo ezikhona emitholampilo, njengoba ucwaningo oluningi lusebenzisa imiklamo yezinhlelo ezibuthakathaka, zihluke kwizinqubo zokungeniswa / ukungavunyelwa, ukuhluleka ukusebenzisa isabelo okungahleliwe kwezimo zokwelashwa futhi azibandakanyi amaqembu okulawula okudingekayo ukuphetha ngokuthi ukwelashwa kusebenza [80] . Ukuhlolwa okukhululekile, okungahleliwe okuhleliwe kuyadingeka ukuze kuhlolwe ukuphumelela kanye nokubekezela kwemithi kanye nezingqondo zokwelashwa ekuphatheni i-CSB.

Ezinye izindlela

Isiphakamiso sokuphazamiseka kwe-hypersexual njengesiyaluyalu sengqondo asizange samukele ngokufanayo. Ukukhathazeka kuye kwaphakanyiswa ukuthi ilebula elithi 'ukuphazamiseka' libonisa ukuhlukahluka okuvamile kokuziphatha kocansi okunempilo [93], noma ukuthi ukuziphatha ngokweqile ngokweqile ngokocansi kungase kuchazwe kangcono njengesandiso se-disorder health disorder noma amasu amancane okubhekana nokuziphatha okusetshenziselwa ukulawula ukuphazamiseka okungathandeki kusho kunokuba kube nokukhubazeka okuhlukile kwengqondo [16,18]. Abanye abacwaningi babonisa ukukhathazeka ukuthi abanye abantu abhalwe nge-CSB bangase babe namazinga aphezulu wesifiso socansi [18], ngeziphakamiso ukuthi kunzima ukulawula izifiso zobulili kanye nokuziphatha okuphezulu kokuziphatha ngokocansi kanye nemiphumela ehambisana nalezo zokuziphatha kungachazwa ngokucacile njengendlela engeyona i- ukuhluka kwesifo socansi oluphezulu [94].

Esikhathini sampula enkulu yabantu abadala baseCroatia, ukuhlaziywa kwamaqoqo kubonakala amaqoqo amabili anenjongo, eyodwa emele ubulili obuyinkimbinkimbi
futhi omunye ubonisa isifiso sobulili obuphezulu kanye nomsebenzi ocansini ovamile. Abantu abasechungechungeni eliyinkimbinkimbi babike ukuthi kune-psychopathology engaphezulu uma kuqhathaniswa nabantu ngabanye abasesikhungweni esiphakeme sokuzikhandla / njalo [95]. Lokhu kusikisela ukuthi i-CSB ingahle ihlelwe ngokuqhubekayo kokuqhubeka kwezimvamisa zobulili nokwandisa, lapho amacala omtholampilo angaphezulu
kungenzeka ukuthi kwenzeke ekupheleni kokugcina kokuqhubeka noma ubukhulu [96]. Njengoba kunikezwa ukuthi kune-overlap enkulu phakathi kwe-CSB nesifiso esiphakeme sezocansi, ucwaningo olwengeziwe luyadingeka ukuze kutholakale izici ezihlobene ikakhulukazi nokuziphatha okucindezelayo ngokobulili.

SUMMARY AND CONCLUSIONS

Ngokukhululwa kwe-DSM-5, ukungazitholi ukugembula kwahlelwa kabusha ngezinkinga zokusebenzisa izidakamizwa. Lolu shintsho lunezinselele izinkolelo ukuthi ukulutha umlutha kwenzeka kuphela ngokufaka izinto ezishintsha ingqondo futhi kunezimpikiswano ezibalulekile kumasu, izinqubo zokuvimbela kanye nokwelashwa [97]. Idatha ibonisa ukuthi ukubandakanya ngokweqile kwezinye izimo zokuziphatha (isb. Ukudlala, ubulili, ukuthengwa ngokweqile) kungabelana ngemitholampilo, izakhi zofuzo, izinzwa ze-neurobiological kanye ne-phenomenological nezidakamizwa ezidakamizwa [2,14]. Naphezu kwenani elikhulayo lezincwadi kwi-CSB, kunezikhala eziningi zolwazi ezikhona ezingasiza ekunqumeni ngokucacile ukuthi ukubandakanya ngokweqile ekuziphatheni ngokocansi kungase kubekwe ukuthi kuyisidakamizwa. KuThebula 2, sibhala izindawo lapho kudingeka khona ucwaningo olwengeziwe ukwandisa ukuqonda kwe-CSB. Idatha enganele ngokwenza kube nzima ukwenza imizamo, ukuvimbela nokwelapha. Ngenkathi idatha ye-neuroimaging ibonisa ukufana phakathi kwezidakamizwa ezidakamizwa kanye ne-CSB, idatha ilinganiselwe ngamasayizi amancane wesampula, amasampula kuphela abesilisa abesilisa abesilisa nabesifazane kanye neziklamo ezihamba phambili. Ucwaningo olwengeziwe luyadingeka ukuze siqonde ama-CSB kubantu besifazane, amaqembu amancane, abesilisa abesilisa abesilisa nabesilisa abesilisa nabesilisa abesilisa nabesilisa, abanesibalo sokukhubazeka ngokomzimba nangokwengqondo kanye namanye amaqembu.

Esinye indawo esidinga ukucwaninga okwengeziwe kuhilela ukuthi ushintsho lwezobuchwepheshe lungathonya kanjani ukuziphatha kwabantu ngokocansi. Njengoba kunikezwa ukuthi idatha idinga ukuthi ukuziphatha ngokocansi kunconywa nge-intanethi kanye ne-smartphone zokusebenza [98-100], ucwaningo olwengeziwe kufanele lucabangele ukuthi ubuchwepheshe be-digital buhlobene kanjani ne-CSB (isib. Ukushaya indlwabu ngokucindezela izithombe ezingcolile zobulili kwi-intanethi noma izingxoxo zokuxoxa ngocansi) nokubandakanyeka ekuziphatheni kobulili okuyingozi (isib. ubulili, abalingani abaningi bezocansi ngesinye isikhathi). Isibonelo, kungakhathaliseki ukufinyeleleka kokufinyeleleka kwezithombe zobulili ezingcolile ze-intanethi kanye nokusetshenziswa kwamawebhusayithi kanye nezinhlelo zokusebenza ze-smartphone (isb. Grindr, FindFred, Scruff, Tinder, Pure, njll.) Eyenzelwe ukusiza ubulili obuvamile phakathi kwabantu abadala abahlotshaniswayo kuhlotshaniswa nemibiko eyanda kakhulu yokuziphatha okuxilisayo okulindile ucwaningo lwesikhathi esizayo. Njengoba idatha eqoqwe, ulwazi olutholakala kufanele luhunyushwe kumasu apolisi, ukuvimbela nokwelapha

Ukubonga

Lolu cwaningo lwaluxhaswe ngemali evela eMnyangweni Wezilwane Zomphakathi, i-VISN 1 Education Illness Research Education kanye neSikhungo Sezokwelapha, Isikhungo Sikazwelonke Sokudlala Gaming, kanye neCASAColumbia. Okuqukethwe kulo mbhalo wesandla akubonakali ukubukwa kwezinhlaka zezimali futhi kubonisa imibono yabalobi. Abalobi babika ukuthi abanakho izingxabano zezimali ezithakazelisayo ngokuphathelene nokuqukethwe kwalesi script.

Isimemezelo sezintshisekelo

Abalobi babika ukuthi abanakho izingxabano zezimali ezithakazelisayo ngokuphathelene nokuqukethwe kwalesi script. UMNP uthole ukwesekwa kwezezimali noma isinxephezelo salokhu okulandelayo: uxoxisane futhi weluleka uLundbeck, Ironwood, Shire, INSYS kanye noMfula weMfula; uye wathola ukwesekwa kocwaningo (kuya ku-Yale) kusuka ku-National Institutes of Health, i-Mohegan Sun Casino, Isikhungo Sikazwelonke Sokudlala Amageyimu kanye nePfizer imithi; uye wabamba iqhaza ekuhloleni, ekuthumelelweni kweposi noma ekubonisaneni ngocingo okuhlobene nokulutha izidakamizwa, ukuphazamiseka kokucindezeleka noma ezinye izihloko zezempilo; uye wabonisana nokugembula kanye nezinhlangano ezingokomthetho ezindabeni ezihlobene nokulawula ukucindezela; inikeza ukunakekelwa kwemitholampilo eMnyangweni wezeMpilo weNgqondo waseConnecticut kanye noHlelo Lwezinsizakalo Zokugembula Zenkinga Yezinsizakalo; uye wenza ukubuyekezwa kwesibonelelo seNational Institutes of Health nezinye izinhlaka; lihlelwe noma lihlelwe izivakashi noma izingxenye zamaphephandaba; unikeze izinkulumo zemfundo ngezikhathi ezinkulu, izenzakalo ze-CME kanye nezinye izindawo zempilo noma zesayensi; futhi uye wakhiqiza izincwadi noma izahluko zencwadi yabamemezeli bemibhalo yengqondo yengqondo.