Front Psychiatry. I-2014 Apr 7; 5: 38. doi: 10.3389 / fpsyt.2014.00038.
Ku-athikili yakamuva (1), UDkt Rippe ugcizelela ukuthi abasebenza ngemithi yezokwelapha kumele bancome izincomo zabo kubufakazi obunengqondo besayensi nokuthi lokhu kuyinkimbinkimbi yokuthi ulwazi lwesayensi luvame ukuhlanekezelwa futhi ukuthinteka kwesinye isikhathi kudidaniswe nobufakazi. Lokhu kufaka, ngokwesibonelo, ukuthi ukuzihlanganisa phakathi kokuhlukahluka okutholakala ezifundweni eziyisisekelo kuvezwa njengobudlelwano be-causal noma ukuthi ukuzihlanganisa phakathi kokuguquguqukayo okutholakala ezifundweni zobhubhane kuvame ukungcoliswa ngokuhlukahluka okubalulekile kwesithathu.
Umbhali uveza izibonelo ezimbalwa zokutholwayo ezivame ukuhunyushwa ngokungachazeki futhi zethulwe njengamaqiniso eqiniso, yize ubufakazi obukhona bufuna ukucutshungulwa ngokuhlolisisa. Lokhu kufaka imibono yokuthi (a) ushukela ubangela ukukhuluphala, (b) ukudla okuthile kuyimilutha, (c) ukudla okuthile kubangela umdlavuza, (d) ukuzivocavoca akusebenzi ekunciphiseni isisindo, nokuthi (e) kukhona ukuxhumana okuholela phakathi ukusetshenziswa koshukela kanye noshukela.
Ngicabanga ukuthi umbhali wenza iphuzu elibalulekile ekuphikiseni ukuthi ubufakazi besayensi buvame ukuhlanekezelwa abacwaningi noma abezindaba nokuthi abacwaningi nabasebenza emkhakheni wezimo zezempilo ngokuqhubekayo badinga ukunakekela ukuhlolisisa okutholakele ocwaningweni. Yize ngivumelana nezitatimende eziningi ezishiwo kuleyo ndatshana, ngicabanga nokuthi ezinye zazo ngomqondo wamanje wokulutha kokudla ziqinisekisa ingxoxo ejulile.
Ukufaneleka Kwamamodeli Yezilwane
Okokuqala, kuthiwa "iningi lokuphikisana okuhlobene nokudla nokulutha kususelwa kwidatha […] yezilwane" nokuthi lawo amamodeli "angaqanjwa kabi kubantu uma kukhulunywa ngokusetshenziswa kokudla." Cishe umbhali ubhekisela kuma-paradigms akhombisa ukusetshenziswa okufana noshukela nokushintshwa kwe-neurobiological ngemuva kwamasonto ambalwa wokufinyelela ushukela ngezikhathi ezithile2). Kulezi zifundo, amagundane, ngokwesibonelo, ukudla ancishiselwe i-12h bese ukwazi ukufinyelela kwi-lab chow noma ushukela we-12h. Lama paradigms kwesinye isikhathi agxekwa ngokuba ngawokwakha futhi, ngenxa yalokho, abe nenani eliphansi lokwenza izingcaphuno mayelana nokuluthwa ushukela okungaba khona kubantu.
Kodwa-ke, ngingasho ukuthi la ma-paradigms ahambelana kahle nezitayela zokudla zabantu abathile. Isibonelo, abantu abane-bulimia amanosa (BN) bayazidla ukudla okuneziqubu, kepha bangadli ukudla okungadingeki (3, 4). Okusho ukuthi, ukudla kungavinjelwa usuku lonke, kulandelwe isiqephu sasemithi (esivame ukufaka i-calorie ephezulu, isib, ushukela omningi, ukudla) kusihlwa. Umbhalo ofanayo wokudla ungabonakala kwabanye abantu abakhathalela isisindo abazama ukukhawulela ukudla kwabo [5)], noma ingakhombisi iziqephu zezihlungo ezigcwele ukushaywa umoya. Ukufingqa, amamodeli ezilwane empeleni ayingxenye ebalulekile yomqondo wokulutha wokudla futhi izifundo zabantu ziyantula ukuxhasa eminye imiphumela etholakala kulezo zifundo. Noma kunjalo, ukufana kokuthola ukudla ngezikhathi ezithile kungahle kufane nokudla i-topography yabantu abathile ngokuziphatha okuvinjelwe noma okuphazamisekile kokudla.
Ubufakazi bokuluthwa kokudla Kususelwa ku-DSM-5
Okwesibili, kuphakama ukuthi "kunobufakazi obuncane kakhulu bokulutha kokudla" ngokususelwa kwinqubo ye-DSM-5 ye-drug use disorder (SUD). Izindatshana eziningi lapho kuxoxiswana khona nomqondo wokulutha kokudla kubhekisele kumbandela wokuthembela kwinto eDSM-IV. Ku-2013, i-DSM-5 yashicilelwa futhi izindlela zokuxilonga zama-SUDs manje zifaka ezinye izimpawu ze-4 [izimpawu ze-11 sezizonke (6)].
Ngokwazi kwami konke, ngucwaningo olulodwa kuphela oluhlolile inqubo entsha ye-DSM-5 maqondana nokuziphatha okwamanje. Kulolo cwaningo (7), kwenziwa inhlolokhono eyakhiwe kancane, izimpendulo zayo zahlaziywa ngokufanelekile. Imiphumela ikhombisa ukuthi ababambiqhaza abakhuluphele abanenkinga yokudla kokudla (BED), futhi ngezinga elincane nalabo abangenalo iBED, bahlangabezane nenqubo ephelele ye-SUD. Yize abahlanganyeli bebenqabile ukuhlangana nenqubo ezintathu kwezine ezintsha, iningi labo lihlangabezana nenqubomgomo entsha isifiso, noma isifiso esinamandla noma ukunxusa ukusebenzisa into. Kuyavunywa, okutholakele kulolu cwaningo akumele kuchazwe kabanzi njengoba ubuqiniso be-interview eyakhiwe kancane bunokungabaza futhi usayizi wesampula wawumncane. Ngokungangabazeki, izifundo zesikhathi esizayo zidingeka ngokuphuthumayo ukuthi zihlole ukuthi ngabe inqubo entsha ye-DSM-5 SUD ingahunyushwa yini ekuziphatheni kokudla futhi uma lezo zinqubo zihlangatshezwa ngabantu abazibandakanya ekudleni ngokweqile noma ekudleni okuneziqubu [ngengxoxo eningilizayo (bona uMeule noGearhardt , kuhanjisiwe)]. Kodwa-ke, ukulahla ukufaneleka kwenqubo entsha ye-DSM-5 maqondana nokuluthwa kokudla okokuqala akubonakali kungalungile.
Ukutholwa kokulutha kokudla ezigabeni ezihlukene zesisindo
Okwesithathu, umbhali uphakamisa ukuthi "i-Yale Food Addiction Scale [(YFAS) Ref. (8)] izindlela zingahle zingalungeli ukuthola 'umlutha wokudla' 'ngokususelwa ekutheni iningi labantu abakhuluphele abangahlangabezani nalezo zinqubo, kodwa ingxenye enkulu yezifundo ezinesisindo esijwayelekile kanye nezijwayelekile. Impela, izifundo ezisebenzisa lesi silinganiso zithole ukwanda kwezinga lokuluthwa kokudla okungaba yi-5-10% emphakathini noma amasampula abafundi futhi nge-15-25% kumasampula wama-feta (9, 10). Kubantu abakhuluphele ngokweqile noma abantu abane-BED, amanani okubhebhetheka aqala phakathi kwe-30 ne-50% (9, 10).
Kodwa-ke, kungani lokhu okutholakele kuphikisana nokuba semthethweni kwe-YFAS? Ngokubona kwami, kodwa kukhombisa ukuthi isisindo somzimba yisilinganiso esibi lapho ukhuluma ngomlutha wokudla. Ezimweni eziningi, ukukhuluphala kungumphumela wokusetshenziswa ngokweqile kwansuku zonke kokusebenzisa amandla ngaphezulu kwemali esetshenzisiwe (11). Eqinisweni, iphutha kubhalansi yekhalori kubantu abakhuluphele ngokwesilinganiso <0.0017% ngonyaka12). Ukuziphatha kokudla kubantu abanjalo ngokuqinisekile akuqhathaniswa nomlutha kepha kuhambelana nezitayela zokudla ezifana amadlelo or ukudla okungenangqondo. Esikhundleni salokho, umlutha uqhathaniswa kakhulu nokudla okulingene njenge-BED noma i-BN (13, 14) futhi yilokhu kanye okutholakala kusetshenziswa i-YFAS (15, Meule et al., Ihanjisiwe). Ukuphetha, umbono wokuthi umlutha wokudla ungabangela amazinga aphezulu okukhuluphala nokuthi ukukhuluphala ngokwako kumelela isimilo sokudlulelwa yisikhathi (15, 16) futhi i-YFAS ibambe iqhaza kulokhu kubonwa. Esikhundleni salokho, umlutha wokudla uhlobene kakhulu nokuziphatha kokuluma okudla kanye ne-YFAS - yize ingahle ingapheleleli - kubonakala njengethuluzi lokuhlola eliwusizo kulo mongo.
Ukuluthwa kokudla kanye nokulingiswa kobuchopho
Okwesine, enye impikiswano ukuthi "izifundo zokucabanga kobuchopho […] azixhasi imodeli yokuluthwa." Lokhu kusekelwe ekubuyekezweni okubucayi okwenziwe nguZiauddeen nozakwabo (16), yona, kwaxoxwa ngayo ngombango (17-19). Ngokuqondile, abalobi bathola ukuthi izifundo zokucabanga kobuchopho ezibandakanya ukwethulwa kwezindlela zokudla kubantu abakhuluphele abane-noma abangenalo iBED azihambelani. Yize ukwenza kusebenze kobuchopho ezifundweni ezinjalo kuvame ukuhlobana nezindawo zangaphambili, ze-limbic noma ze-paralimbic, ukubandakanyeka kwezindawo ezithile kuyehluka ocwaningweni. Ngaphezu kwalokho, yize kukhona ukufana ngezimpendulo zobuchopho ekudleni nasezidakamizweni, umehluko omkhulu ubonakalisiwe (20).
Noma kunjalo, izingxenyana ezijwayelekile zikhonjwe ekuhlaziyweni kwe-meta (21). Ukungahambelani kwezifundo zokucabanga kobuchopho kuqhutshwa yingxenye ye-heterogeneity yamasampula afundwayo. Ngokuncomekayo, izifundo zesikhathi esizayo eziphenya ngemodeli yokuluthwa kokudla kufanele zifake abantu abathola empeleni ukutholwa kokulutha kokudla (isib. Ukusebenzisa i-YFAS) neqembu lokulawula labantu abangakutholi ukuxilongwa kokuluthwa kokudla. Ngakho-ke, kungahle kungabi nesizathu sokuphetha ngokuthi izifundo ze-neuroimaging azixhasi imodeli yokuluthwa kokudla, ngoba izifundo eziningi ezikhona bezingafakwanga ngokuqondile ukuphenya lokhu.
Isidingo Nokubekelwa Phansi Kwe-Model Adiction Model
Ekugcineni, umbhali uphetha ngokuthi "iningi lemithi ehlobene nokudla ebonwa emtholampilo ingachazwa futhi iphathwe ngaphandle kokuheha, futhi kwezinye izikhathi ukusebenzisa umlutha kungaholela ekuqhubekeni kwento ehlobene nokudla." kufaka nengozi yokudala ihlazo elisha (22, 23) noma ukuhambisa ukunakekela kude nesibopho somuntu ngamunye kumthethonqubo wesisindo njengokuzibandakanya komzimba (24, 25). Ngaphezu kwalokho, izindlela zamanje zokwelapha ze-BED ziphumelela impela (26) futhi, ngakho-ke, kungahle kungadingi ukuthi kushintshwe ngokuya ngemodeli yokuluthwa kokudla.
Kodwa-ke, kuphinde kwatholakala ukuthi umqondo wokuluthwa kokudla unombono omuhle womphakathi uma uqhathaniswa notshwala noma ugwayi nokuthi ilebula lomlutha wokudla lingaba sengozini yokubandlululwa esidlangalaleni kunakwezinye izinto eziluthayo (22, 23, 27). Ngaphezu kwalokho, imibiko yamacala ikhona, ekhombisa ukuthi ukuhlinzeka ngohlaka lokulutha kungasiza kwabanye abantu, ngokwesibonelo, labo abahlangabezana nokwehluleka ngokweqile nokudla (28, 29) noma ngezinkinga zokudla njenge-BN (30). Ngakho-ke, imodeli yokulutha kokudla ingahle ibe yinzuzo kwezinye izimo futhi ingahle ingadingeki noma inokwehla kokuthile kwabanye. Kodwa-ke, ukudonsela iziphetho eziqondile akunakwenzeka okwamanje.
Isiphetho
Umbono wokuthi ezinye izindlela zokudla ngokweqile zingamelela isenzo sokulutha nokuthi ukudla okuthile kungenzeka kube namandla okulutha kuxoxwe ngakho ezincwadini zesayensi amashumi eminyaka (31). Kuma-2000s, inzalo yesayensi yokulutha kokudla ikhule ngamandla ekukhanyisweni kobhubhane lokukhuluphala kanye nokukhuphuka kwezifundo ze-neuroimaging (32). Ngeshwa, "le ngxabano ihlangana kakhulu nabezindaba kanye nomphakathi futhi yathuthukiswa ngokungakhethi" (1) (k. 5). Ngivumelana ngokungananazi nomlobi ukuthi (a) imibiko yabezindaba ayingeni kahle umbono ophikisanayo wokuluthwa kokudla, (b) imiphumela eminingi evela ezifundweni zezilwane ayikaphindwa ezifundweni zabantu, (c) ukukhuluphala akumeleli umlutha ngokwawo , (d) izifundo zokucabanga kobuchopho azihambelani, nokuthi (e) isidingo noma ukubhekelwa phansi komqondo wokuluthwa kokudla ekwelashweni noma ezindabeni zezempilo zomphakathi akukacaci. Kodwa-ke, lezo yizinkinga ezingabhekelelwa kakhulu ezifundweni ezizayo. Ngakho-ke, bekungaba nesizathu sokuchitha umqondo wokuthi umlutha wokudla ususelwe kwidatha ekhawulelwe (18).
Okubhekwayo