Ukulutha Kokudla ekukhanyeni kwe-DSM-5 (2014)

Ama-Nutrients. 2014 Sep 16;6(9):3653-3671.

Meule A¹, I-Gearhardt AN².

I-PDF ephelele

abstract

Umbono wokuthi uhlobo oluthile lokudla lungahle lube namandla okulutha nokuthi ezinye izinhlobo zokudla ngokweqile kungamelela isimilo sokuziphatha sekuxoxwe ngaso amashumi eminyaka. Eminyakeni yakamuva, intshisekelo yokulutha kokudla iyakhula futhi ucwaningo ngalesi sihloko luholela ezincazelweni eziqonde kakhulu nezindlela zokuhlola. Isibonelo, i-Yale Food Addiction Scale yenzelwe ukulinganisa indlela yokuziphatha njengokudla okuluthayo kususelwa kunqubo yokuxilonga yokuncika kwento ekubuyekezweni kwesine kweDiagnostic and Statistical Manual of Mental Disorders (DSM-IV). Ku-2013, izindlela zokuxilonga zokusetshenziswa kabi kwezidakamizwa kanye nokuncika kuye kwahlanganiswa, ngaleyo ndlela kwanda inani lezimpawu zokuphazamiseka kokusetshenziswa kwezidakamizwa (ama-SUD) ku-DSM-5. Ngaphezu kwalokho, ukuphazamiseka kokugembula manje sekufakiwe kuma-SUD njengokulutha kokuziphatha. Yize kunenqwaba yemibhalo yokubukeza ekhona ekhuluma ngokusebenza kwezinqubo zokuncika kwezidakamizwa ze-DSM-IV ekuziphatheni kokudla, ukudluliswa kwenqubo esanda kufakwa ekudleni akwaziwa. Ngakho-ke, i-athikili yamanje idingida ukuthi ngabe le migomo emisha ingahunyushelwa kanjani ekudleni ngokweqile. Ngaphezu kwalokho, kuhlolwe ukuthi ngabe izindlela ezintsha ze-SUD zingaba nomthelela yini ocwaningweni oluzayo ngokulutha kokudla, ngokwesibonelo, uma "ukuxilonga" ukuluthwa kokudla nakho kungashintshwa ngokubheka zonke izimpawu ezintsha. Ngokunikezwa impendulo ebucayi ekubuyekezweni kwe-DSM-5, siphinde sixoxe ngokuthi indlela yakamuva ye-Research Domain Criteria ingasiza yini ekuhloleni umqondo wokulutha kokudla.

Amagama angukhiye: I-DSM-IV, i-DSM-5, ukuncika kwezidakamizwa, ukuphazamiseka kokusetshenziswa kwezidakamizwa, ukugembula, umlutha wokudla, ukukhuluphala ngokweqile, ukudla ngokuzidla, ukufisa, i-RDoC

1. Isingeniso

Umbono wokuthi uhlobo oluthile lokudla lungaba namandla okulutha nokuthi ukukhuluphala okunjengokuphazamiseka kokudla okuhlobene nokulunywa noma ukukhuluphala kungahle kumele uhlobo lokuziphatha okuluthayo sekuxoxwe amashumi eminyaka. Isikhathi ukulutha kokudla yethulwa okokuqala ezincwadini zesayensi e1956 nguTheron Randolph [1]. Yize ukuqhathanisa phakathi kokulutha nokuziphatha kudla kudonswa kancane kancane kumashumishumi eminyaka alandelayo [2,3,4,5,6,7,8], izindlela zokuhlola ukuhleleka nokuchaza umlutha wokudla azange zilandelwe kuze kube ngama-2000s akuqala. Ikakhulu, ukwanda okukhulu kwenani lokushicilelwa kusetshenziswa leli gama ukulutha kokudla kungabukwa kusukela 2009 [9].

Lokhu kukhula kwesasayensi kulesi sihloko bekuyingxenye yokuqhutshwa kokukhuphuka kwe-neuroimaging kanye nokuthola okulandelayo kokuthi ukukhuluphala kanye nokudla okunethonya kuhlotshaniswa nokushintshana kokusayinwa kwe-dopaminergic kanye ne-cue elicised hyperactivation yezindawo ezihlobene nomvuzo ezihlobene nezinqubo ezibonwe ku abasebenzisi bezidakamizwa [10,11]. Lokho okutholakele kuqhutshekwe kwenziwa ngamamodeli wezilwane okubonisa ukulutha okufana nokuziphatha kanye nezinguquko ze-neuronal kuma-rodents ngemuva kwamasonto athile wokufinyelela ushukela ngezikhathi ezithile [12]. Ku-athikili yamanje, ngeke singene eminye imininingwane mayelana naleyo migqa yocwaningo bese sidlulisela umfundi emisebenzini yakamuva ngalezo zihloko [13,14,15,16,17]. Esikhundleni salokho, sizogxila ekufaneni okukhulu phakathi kokuxhomekeka kwezidakamizwa kanye nezindlela ezithile zokudla ngokweqile kubantu.

I-2. Ukufana phakathi Incwadi Yokuhlola Nezibalo Zezinkinga Zengqondo (DSM-IV) Izindlela Zokuncika Kokwethenjiswa Kokusebenzisa Izidakamizwa Nokudlondlobala

Izindlela zokuxilonga zokuncika kwento ekubukezweni kwesine kwe Incwadi Yokuhlola Nezibalo Zezinkinga Zengqondo (DSM-IV) kufakwe ukubekezela (1), kuchazwa njengokudla amanani andayo entengo ukufeza imiphumela efanayo noma ukubhekana nemiphumela enciphile ngokuqhubeka kokusetshenziswa kwamanani afanayo; (2) izimpawu zokuhoxa lapho into ingadli noma usebenzisa into ukugwema izimpawu zokuhoxa; (3) sisebenzisa into ngamanani amakhulu noma isikhathi eside kunalokho obekuhlosiwe; (4) isifiso esiphikelelayo noma imizamo engaphumeleli yokunciphisa ukusetshenziswa kwezidakamizwa; (5) isikhathi esengeziwe sokuzama ukuthola noma ukusebenzisa into noma ukubuyisa imiphumela yaso; (6) ukuncishiswa kwemisebenzi yezenhlalo, yomsebenzi, noma yokuzijabulisa ngenxa yokusebenzisa izidakamizwa; kanye (7) ukusetshenziswa kwento naphezu kwenkinga engapheli yomzimba noma yengqondo ebangelwe noma ekhulayo yento leyo [18]. Ukuncika ezidakamizweni kungaxilongwa lapho kutholakala ukuthi kukhona ukungalapheki okukhulu noma ukuhlupheka futhi okungenani kuhlangane nezimpawu ezintathu ngonyaka owedlule.

Kunezindatshana eziningi lapho kusetshenziswa khona izindatshana eziningi lapho kuxoxwa khona ngokusetshenziswa kwalezo zinqubo zokuthembela ezintweni zeDSM-IV nezinye izici zokuziphatha okuluthayo ku-bulimia amanosa (BN), inkinga yokudla kokudla ngokweqile (BED), ukukhuluphala ngokweqile, noma ukweqisa ngokweqile [19,20,21,22,23,24,25,26,27,28,29,30]. Kodwa-ke, ukuhumusha kwezindlela zokuncika kwezidakamizwa ekuziphatheni kokudla akuqondile futhi, ngenxa yalokho, kunokungavumelani okuthile phakathi kwabaphenyi ngezincazelo eziqondile zezimpawu zokuluthwa kokudla [31,32,33,34,35].

Noma ubufakazi obunamandla bokuthi kusetshenziswe inqubo ethile yokuluthwa kweDSM-IV ekudleni, njengokubekezelelana nokuhoxa, kuncike kakhulu kwizifundo zezilwane [12], zonke lezi zimpawu eziyisikhombisa ngokucabanga zingatholakala kubantu [26]. Ukusekela okuphoqelelayo kwalokhu kwanikezwa ngocwaningo olwenziwe nguCassin noVen Ranson [36], lapho cishe bonke ababambe iqhaza be-BED bethole khona ukuxilongwa kokuxhomekeka kwento lapho ithemu izinto yathathelwa indawo ukudla ukudla engxoxweni yokuxilonga. Ababhali baphawulile, noma kunjalo, ukuthi izimpendulo zabahlanganyeli kungenzeka ukuthi zithonywe izici zokufunwa nokuthi ukuthembeka nokuba semthethweni kokuhlolwa kwabo kwengxoxo bekungathandeki [36].

I-3. Isikali se-Yale Food Addale Scale (YFAS)

Emzameni wokunqoba izincazelo ezixubile zezimpawu zokuluthwa kokudla nokunikeza isilinganiso esilinganayo sokuhlola umlutha wokudla, i-YFAS yasungulwa [37,38]. Leli thuluzi le-25-nto lilinganisa ukuba khona kwezimpawu zokuluthwa kokudla ngokusekelwe kumbandela wokuthembela kokuqukethwe kwe-DSM-IV (ie, izimpawu eziyisikhombisa). Ngaphezu kwalokho, izinto ezimbili zihlola ukulimala okukhulu noma ukuhlupheka ngenxa yokudla kakhulu. Lapho bobabili kunokulimazeka okubalulekile ngokomtholampilo noma ukucindezeleka kuba khona futhi okungenani izimpawu ezintathu kwezingu-7 ziyahlangana, khona-ke ukutholwa kokudla kungatholakala “. Amanani okuvalwa kwalawa okuxilongwa kokudla kokuxilongwa ngokuya ngebanga le-YFAS phakathi kwe-5% –10% cishe kuma-sampuli angewona awemitholampilo [37,39,40,41,42], I-15% –25% kumasampula omileyo [43,44,45,46,47], kanye ne-30% –50% ezigulini ezisezingeni eliphansi zokuziphatha ngokweqile noma abantu abakhuluphele abanenkinga yokudla kokudla [48,49,50,51].

Isibonakaliso esivame kakhulu sokuluthwa kokudla njengoba sihlolwe ne-YFAS a isifiso esiphikelelayo noma imizamo engaphumeleli yokusika noma yokulawula ukudla [42,52]. Phakathi kwabantu abakhuluphele, cishe bonke ababambiqhaza bagcwalisa le nqubo [46,48,49,50,53]. Ezinye izimpawu ezivame ukukhuthazeka yilezi ukuqhubeka nokudla yize kunezinkinga zomzimba noma zengqondo futhi ukubekezelelana, ikakhulukazi kumasampula wokukhuluphala (ibid.). Izimpawu ezisele (ukusetshenziswa kwamanani amakhulu noma isikhathi eside kunokuhlosiwe, ukuchitha isikhathi esiningi ukuthola ukudla noma ukudla noma ukululama emiphumeleni yako, ukuyeka imisebenzi ebalulekile, Futhi izimpawu zokuhoxiswa) azivamile, ikakhulukazi kumasampula okungewona awemitholampilo [42,52], kepha noma kunjalo zivunywa yingxenye enkulu yabantu abakhuluphele [48,49,50,53].

I-4. Izindlela Zokuncika Kokwethenjiswa Kwezidakamizwa e-DSM-5

Engqulweni esanda kuvuselelwa ye-DSM, izindlela zokuxilonga ukuhlukunyezwa kwezidakamizwa futhi-ukuxhomekeka kwahlanganiswa ngokuthi inqubo yokuphazamiseka kokusetshenziswa kwezidakamizwa (ama-SUDs) manje ihlanganisa (i-1) ukwehluleka ukufeza izibopho ezinkulu zomsebenzi emsebenzini, esikoleni, noma ekhaya njenge umphumela wokusetshenziswa kwezidakamizwa; (2) ukuqhubeka kokusetshenziswa kwezidakamizwa naphezu kwezinkinga zenhlalo noma zomuntu kubangelwa noma kubangelwa ukusetshenziswa kwezidakamizwa; kanye (3) ukusetshenziswa kwezinto ezivamile ezimweni lapho kuyingozi khona ngokomzimba [54]. Ngaphezu kwalokho, inqubo yokuhlukumeza izidakamizwa ye-DSM-IV yehle, kepha kwaba yisibonakaliso esivele sakhiwe ukulangazelela, noma isifiso esinamandla noma ukunxusa ukusebenzisa into kwafakwa (Ithebula 1). Amazinga amathathu obulukhuni manje angacaciswa kusukela ubumnene (ukuba khona kwezimpawu ezimbili kuya kwezintathu) ukuze ngokulinganisela (ukuba khona kwezimpawu ezine kuya kwezihlanu) ukuze kakhulu (ukuba khona kwezimpawu eziyisithupha noma ngaphezulu).

Ukusetshenziswa kokuphazamiseka kokusebenzisa izidakamizwa ngokuya nge Incwadi Yokuhlola Nezibalo Zezinkinga Zengqondo (DSM-5) kanye nenqubo yokulutha yokudla ehambelana nayo.

Ngokuphawuleka, izimpawu ze-SUD nazo ziyahlukahluka kuye ngezinto (Ithebula 1). Isibonelo, noma kunesidakamizwa sokudakwa kanye nokuhoxiswa esichazwe nge-caffeine, ezinye izinkomba azisebenzi nge-caffeine futhi, ngenxa yalokho, akukho nkinga yokusebenzisa i-caffeine. Ngendlela efanayo, yize zonke lezi zimpawu eziyishumi nanye zisebenza ugwayi, akukho ukudakwa okuchaziwe. Ekugcineni, asikho isifo sokuhoxa esichazwa ngama-hallucinogens, ngokwesibonelo i-phencyclidine, kanye nama-inhalants.

I-5. Ukufana phakathi kwe-New DSM-5 Criteria ne-Overeating

I-5.1. Ukunxanela

Ukufisa kusho isifiso esijulile sokudla into kanye nokuhlangenwe nakho okuvame kakhulu kokufisa okuyisici esiyisisekelo sama-SUDs [55]. Kodwa-ke, igama elithi ukunxanela alisho kuphela kokuhlobene nezidakamizwa, kodwa futhi nakwezinye izinto ezinjengokudla noma iziphuzo ezingezona utshwala [56]. Emiphakathini yaseNtshonalanga, abantu bavame ukufisa ukudla okunoshukela omningi noma amanoni (noma womabili) futhi, ngakho-ke, kuyathandeka kakhulu. Ngokuvumelana nalokho, ukudla okufiswa kakhulu yishokolethi, kulandelwa yi-pizza, ukudla okunosawoti, u-ayisikhilimu namanye amaswidi nama-dessert [57] (kepha uqaphele futhi ukuthi kunokwehluka kwesiko ezinhlotsheni zokudla ezifiselekayo [58]). Lezi zinhlobo ezifanayo zokudla zinamathuba amaningi okudliwa ngendlela yokulutha njengokuhlolwa kwe-YFAS [39]. Njengoba kunje, okuhlangenwe nakho kokufisa kuyisibonelo sokuqala sokufana phakathi kokudla nokusebenzisa izidakamizwa. Ngokunjalo, amaphethini wokusebenzisa amandla ezinhlaka ze-neuronal ngaphansi kokulangazelela kokuhlangenwe nakho okuningi kweqa ezintweni ezihlukile, kufaka phakathi nokudla [15,59,60,61]. Ukweqa kuhlotshaniswa nokuhlangenwe nakho okuningi kakhulu nokuvama kokulangazelela kokudla. Isibonelo, inani eliphakeme ngezindlela zokuzibika zokudla ezibikiwe zitholakele ezigulini ezine-BN, BED, noma ukukhuluphala ngokweqile [62,63]. Ngokufanayo, umlutha wokudla njengoba ulinganiswe ne-YFAS ubuye uhlobene nokukhanuka kokudla okubikwa ngokwakho okuphezulu kakhulu [44,45,64]. Ngakho-ke, umbandela wokuhlangabezana nokufisa noma isifiso esinamandla sokusebenzisa into ungahunyushelwa ekudleni futhi umele uphawu olubalulekile ekuluthweni kokudla.

I-5.2. Ukwehluleka ukufeza izibopho ezinkulu

Asazi noma yiluphi ucwaningo oluphenya ngokuqondile ukwehluleka ukufeza izibopho ezinkulu zomsebenzi emsebenzini, esikoleni noma ekhaya okuvela ekudleni okufana nomlutha. Yize kungenzeka lokhu kwenzeke esimweni sokukhuluphala ngokweqile ngenxa yokuhamba okuncishisiwe, kuyangabazeka uma lokhu nakho kungaba ngumphumela oqondile wokuziphatha kokudla. Ngokusekelwe kumagama e-DSM-5, izifundo zesikhathi esizayo zingabuza ababambiqhaza uma bezishaya indiva izinto ezinjengomsebenzi, isikole, abangane, umndeni, noma imisebenzi yasendlini ngenxa yendlela abadla ngayo noma uma bengasebenzi kahle esikoleni noma emsebenzini ngenxa indlela abadla ngayo. Kodwa-ke, sisola ukuthi, njengogwayi, lolu phawu kungenzeka lungabi isici esiyisisekelo sokudla okunjengomlutha ngenxa yokuntuleka kwesidakwa sokudakwa.

I-5.3. Izinkinga Zezenhlalo noma Zokuxhumana

Izinkinga zenhlalo nezokuxhumana zingabonakala ngokucacile esimweni sokuziphatha kokudla. Isibonelo, abantu abakhuluphele babika amazinga akhuphukile wokuhlukaniswa nomphakathi ngokuqhathaniswa nabantu abanesisindo esijwayelekile [65]. Ngenkathi lokhu kungumphumela wokuthola isisindo, kutholakale nokuthi izinkinga zabantu njengokukhathazeka kwabantu, ukungavikeleki kwezenhlalo, noma ubutha kuhlobene nokuziphatha kokudla okuzingcayo, okuzimele kwesisindo somzimba [66,67]. Ubudlelwano obuphakathi kokudla kokudla kanye nezinkinga zokuxhumana nabanye kungenzeka bube buthile. Okusho ukuthi, izinkinga eziphakathi kokunye zingaqhakambisa ukuthinteka okungekuhle kanye nokuqala kwangaphambilini kwe-BED, kepha ukudla ngokuzilimaza kungandisa futhi kulondoloze izinkinga zabantu68,69]. Lokhu kubonakala futhi eqinisweni lokuthi bobabili i-Cognitive-Behavioral Therapy (egxile ngqo ekuziphatheni kokudla) kanye ne-Interpersonal Psychotherapy (egxile ebuhlotsheni bobuntu) ibonakala iphumelela ngokufanayo ekwelapheni i-BED [70,71]. Noma kunjalo, izifundo zesikhathi esizayo ziyadingeka kukhombisa ukuthi ukudla okufana nomlutha kubandakanyeka kakhulu ezinkingeni zenhlalo nezabantu. Lokhu kungahlolwa ngemibuzo efana nokuthi "ngigweme izimo zenhlalo ngoba abantu abahambisi indlela engidla ngayo" noma "ngibe nokuxabana nomndeni wami noma nabangane bami ngenxa yendlela engidla ngayo" ezinguqulweni ezizayo ze-YFAS.

I-5.4. Sebenzisa Ezimweni Ezinobungozi Ngokwenyama

Isibonakaliso sokusetshenziswa kwento ejwayelekile ezimweni ezinobungozi obukhulu emzimbeni sisho imiphumela yokuphuza, ngokwesibonelo, ukuthi kuyingozi ukuphatha imishini noma ukushayela imoto ngemuva kokuphuza utshwala. Ukudla ukudla, iqiniso, akubandakanyi ukudakwa. Kodwa-ke, njengoba kuchaziwe ngenhla akukho ukudakwa kukagwayi. Esikhundleni salokho, kukhonjiswa ku-DSM-5 ukuthi, ngokubhema ugwayi, lesi sikhombisi singasho ukubhema embhedeni, okunyusa ubungozi bokuqala umlilo. Ukulandela lo mqondo wokucabanga, kungahle kube nokuphikiswa ukuthi lolu phawu lungavunywa maqondana nokudla lapho kubhekiswa kulo, ngokwesibonelo, ukudla ngenkathi ushayela. Kuyaziwa kabanzi ukuthi ukudla ngenkathi ushayela kuphazamisa ukusebenza kokushayela futhi kwandisa ingozi yokuphahlazeka [72,73,74]. Isidingo esengeziwe sokusetshenziswa kwalolu phawu ekuluthweni kokudla, yiqiniso, ucwaningo olukhombisa ukuthi iziguli ezine-BN, BED, ukukhuluphala ngokweqile, noma abantu abathola i-YFAS diagnostic, empeleni bazibandakanya ekudleni ngenkathi beshayela (noma izimo ezifanayo) njenge qhathanisa nezifundo zokulawula. Ngokwazi kwethu, azikho izifundo ezinjalo ezikhona.

Enye incazelo yalesi sibonakaliso kungenzeka ukuthi kubhekiselwa ekusetshenzisweni kokudla esimweni sesimo sempilo esibi esihambisana nokukhuluphala. Isibonelo, lokhu kungabhekisa ekudleni ushukela omningi yize unesifo sikashukela noma ukudla ngokweqile ekudleni okungalungile ngemuva kokuhlinzwa kwe-bariatric. Njengoba imiphumela eyingozi ingahle ibe ngumphumela wokuthola isisindo kunokuba ube umphumela oqondile wokuziphatha kokudla, singaphikisana nokuthi, njengegwayi, lolu phawu kungenzeka ukuthi alubalulekanga ekuluthweni kokudla ngenxa yokungabikhona kokudakwa.

I-6. Ukuphazamiseka Kwezokugembula kanye Nokuzonda ngokweqile

Ngaphandle kwezindlela ezibukeziwe ze-SUD, inkinga yokugembula manje isingeziwe njengengozi ehlobene ne-non-drug [54]. Izindlela zokuxilonga zibandakanya (1) isidingo sokugembula ngamanani akhulayo wemali ukuze kufezekiswe injabulo oyifunayo; (2) ukungabinakunyakaziswa noma ukucasulwa lapho izama ukusika noma ukuyeka ukugembula; (3) iphindaphinde imizamo engaphumelelanga yokulawula, yokunciphisa, noma yokuyeka ukugembula (4) ukuzibandakanya kakhulu nokugembula; (5) ukugembula lapho uzizwa ekhathazekile; (6) ngemuva kokulahlekelwa yimali yokugembula, ukubuya nolunye usuku ukuthola; (7) ukuqamba amanga ukufihla ubukhulu bokuzibandakanya nokugembula; (8) engcupheni noma elahlekelwe ubudlelwano obalulekile, imisebenzi, noma amathuba emfundo noma omsebenzi ngenxa yokugembula; futhi (9) bathembele kwabanye ukuthi bahlinzeke ngemali yokunciphisa izimo ezibucayi zezezimali ezidalwa ukugembula (Ithebula 2). Ukuphazamiseka kokugembula kungatholakala nokuthi ubumnene (kuhlangatshezwe izindlela ezine kuya kwezinhlanu), ngokulinganisela (kuhlangatshezwe izindlela eziyisithupha kuya kweziyisikhombisa), noma kakhulu (izindlela eziyisishiyagalombili kuya kweziyisishiyagalolunye zahlangana), lapho izimpawu zazikhona ngonyaka owedlule.

Izindlela zokugembula zokugembula ngokuya nge-DSM-5 kanye nenqubo yokulutha yokudla ehambisanayo.

Ezinye izindlela zokuphazamiseka kokugembula zingasebenza ngendlela efanelekile ekuziphatheni kokudla. Isibonelo, imizamo ephindaphindwayo engaphumelelanga yokulawula, yokunciphisa emuva, noma yokumisa ukusebenza iyisici esiyisisekelo seBN, BED, nokulutha kokudla njengoba kulinganiswa ne-YFAS (bheka ngenhla). Ngaphezu kwalokho, ucwaningo olusebenzisa i-YFAS lubonisa ngokungaguquki ukuthi umlutha wokudla uhlotshaniswa kakhulu nokugxila kokudla nokudla nangokudla ngokweqile lapho uzizwa ukhathazekile [37,39,48,49,64,75]. Njengasifo sokuhoxa kuma-SUDs, ukungakwazi ukuhoxa noma ukucasuka lapho uzama ukunciphisa noma ukuyeka ukudla ngokweqile kubonakala kunengqondo. Isebenzisa i-YFAS, cishe i-30% yabantu abakhuluphele kuze kufike kuma-50% wabantu abakhuluphele abane-BED babika okuhlangenwe nakho okujwayelekile kwezimpawu ezinjalo zokususa lapho behlisa ukudla okuthile [48,49,50]. Kodwa-ke, le mibiko esetshenziswayo inokuphikisana njengoba kungenzeka kube nzima ngabaphenduli ukuhlukanisa phakathi kwezimpawu ezivelayo kusuka ekusweleni kwamandla okuvamile (ie, ukungadli kilojoule eyanele) nalezo ezihambisana nokugwema ukudla okuthile.

Umkhombandlela wesidingo sokugembula ngamanani akhulayo wemali ukuze uzuze injabulo oyifunayo ungahunyushelwa kwisidingo sokudla amanani andayo okudla ukuze uzuze ukwaneliseka okufisayo. Le ncazelo izoba, ke, ilingane nenqubo yokubekezelela yama-SUDs, ekhonjiswe ukuthi ivunyelwe yingxenye enkulu (cishe i-50% -60%) yabantu abakhuluphele ezifundweni ezisebenzisa i-YFAS [48,49,50]. Kodwa-ke, le nqubo ingahle ingasebenzi ekudleni lapho kugcinwa ireferensi umuzwa wenjabulo lapho uziphatha.

Ezinye izinkomba zibonakala njengengaqhathaniswa lapho kufakwa endaweni yethemu ukugembula nge ukudla ngokudla (Ithebula 2). Abantu abane-BN noma i-BED bavame ukuba nemizwa emakwe amahloni futhi, ngenxa yalokho, ukufihla ukudla kwabo okulingene futhi lokhu kuvame ukukhohlisa abanye mayelana nokuzibandakanya kokudla ngokweqile [76]. Ukunciphisa noma ukulahleka kobudlelwano obalulekile, umsebenzi, noma ithuba lemfundo noma lomsebenzi kungenzeka kwenzeke ngenxa yokuthola isisindo. Isibonelo, kunobufakazi bokuhlola obukhombisa ukuthi izisebenzi zabasebenzi zibukela phansi ukugcotshwa kwabantu abakhuluphele futhi ngeke zibancishe [77]. Ngokuphathelene nenqubo yezimo zezimali ezinesifiso esibangelwa ukugembula, imali esetshenziswe kokudla okunefufayo ibuye ikhombe ikhwalithi yempilo kubantu abane-BN neBED, eyokugcina ehlushwa yizinkinga zezezimali [78,79]. Yize ukudla ukuzidla kubandakanya ukufaka imali enkulu, empeleni ukungena esikweletini noma ukuboleka imali kwabanye abantu ukuze uxhase ngokweqile kungenzeka kwenzeka ezimweni ezingavamile. Ekugcineni, uphawu lokubuya ngolunye usuku ukuzothola ngisho nangemva kokulahlekelwa yimali yokugembula akubonakali kungadluliselwa ekuziphatheni kokudla noma kuma-SUD.

I-7. Imithelela Yenqubo Yokucwaninga Kwesizinda Sokucwaninga Kokudla

Muva nje, i Izindlela Zokucwaninga Zesizinda (I-RDoC) yethulwe njengendlela entsha yokuhlukanisa izifo zengqondo, kepha kubalulekile ukuqaphela ukuthi i-RDoC yakhelwe njengohlaka lokucwaninga kunolunye uhlaka lokuxilonga [80,81,82]. Indlela ye-RDoC yenzelwe ukugxila kuzizinda ezibonisa ubuhlakani bezinzwa, bokuphila, bokuzala kanye nokuziphatha. Izizinda zamanje zigxila ekuphakameni okuhle, ubuwena obungenangqondo, ukusebenza kwengqondo, izinqubo zenhlalo, kanye nokuvuswa komthetho [80]. Abagxeki be-DSM basikisela ukuthi ukugxila ekuhlolweni kwe- “theory free” kukhawulele ukufakwa kwenqubekela phambili yesayensi kuhlaka lokuxilonga [82]. Ngakho-ke, ngesimo sayo samanje, i-DSM kungenzeka ingakhombisi ngokwanele ulwazi olutholwe ezindaweni zokucwaninga ngofuzo, ngokomzimba nangokomzimba. Yize uhlelo lwe-RDoC lungakhelwanga ukuthi lusetshenziswe njengendlela yokuxilonga kuzilungiselelo zomtholampilo, kungenzeka lube yinto enkulu eqondisayo ekuhlolweni kwesayensi kwe-psychopathology futhi ngethemba lokuthi luzothuthukisa ukusebenza kahle kokwelashwa [80].

Indlela ye-RDoC yokuxilonga izobuye iqondise ocwaningweni lokuthi inqubo efakwayo inomthelela ezinhlotsheni ezithile zokudla ngokweqile. Isifo sokudlengwa kwengqondo sidla ngokuhlobene nezinqubo eziningi ezifakwe ekuphazamisekeni okuluthayo, kufaka phakathi isisusa esiphakeme sokufuna ukudla okungathandeki, ukusebenza ngokukhululeka kwe-neural ekujikelezeni okuhlobene nomvuzo kuya emikhondweni yokudla enekhalori ephezulu, kanye nemikhawulo yokulawula kwengqondo [23,83]. Kodwa-ke, abantu abane-BED diagnostion abayona eyokungazi, ngesibalo esivezwa amazinga aphezulu wokuvinjwa kokudla nokunye okufihliwe okubonisa umthelela omkhulu ongemuhle, ukufakwa, kanye ne-pathology ephelele [84,85]. Lawa ma-subtypes amabili we-BED angahle aqhutshwe izindlela ezihlukile ngenqubo yokulutha okungenzeka ibe nomthelela kulokho okulandelayo (kodwa hhayi okwangaphambili). Ngakho-ke, abanye (kepha hhayi bonke abantu) abaxilongwa nge-BED bangathola impendulo yokulutha kokudla okuthile.

Ekugcineni, enye yezindlela ezinkulu eziphakanyisiwe zomlutha oyikhono yento yomlutha / yokuziphatha umlutha wokuguqula izinhlelo ezingaphansi kwendlela eqhuba ukuziphatha okuyinkinga [86]. Ngamanye amagama, izici zobungozi zomuntu ngamunye (isib. Impulsivity, sensitivity sensitivity, negativethelela) zixhumana namandla okulutha ento / yokuziphatha ukuze kuholele ku-pathology. Njengoba indlela ye-RDoC igcizelela ukubaluleka kokuhlonza izindlela, ukubheka ukuthi ukudla okuthile noma izithako ekudleni ziyakwazi yini ukuguqula uhlelo ngendlela ehambelana nezinto / izimilo eziwumlutha kuzoba umugqa obalulekile ocwaningweni. Kube nenqubekela phambili enkulu kule ndawo kusetshenziswa izinhlobo zezilwane zokudla [87,88,89], kepha ucwaningo kubantu lukhawulelwe. Ukubhekana nalolu igebe ezincwadini kubaluleke kakhulu ekuhloleni ubuqiniso bomqondo wokulutha kokudla. Sekukonke, uhlelo lwe-RDoC luzobaluleka ekuhlolweni komqondo wokulutha kokudla njengoba luqokomisa ukuhambisa ngaphezu kwezimpawu nezimpawu okwabiwe ngalo futhi esikhundleni salokho kugxile ekuhloleni ukuthi ngabe i-etiology kanye nokuqina kokulutha kuyasiza yini ekusetshenzisweni kokudla okuphoqelekile.

I-8. Imithelela Yenqubo Ebuyekeziwe Yocwaningo Lokuluthwa Kwokudla

I-8.1. Ingabe umlutha wokudla uyi-SUD noma umlutha wokuziphatha okuhle?

Ukufakwa kwenkinga yokugembula njengokuluthwa kokuziphatha kanye nama-SUDs e-DSM-5 kudinga ingxoxo uma umlutha wokudla uvumelana kakhulu nezindlela ezisetshenziselwa ama-SUDs noma nalezo ezisetshenziselwa ukugembula ukuphazamiseka. Igama elithi umlutha wokudla u-pelaori lisho ukuthi ukusetshenziswa kwento ethile (noma kulokhu, izinto eziningana ezihlangana njengokudla) kubalulekile kulolu hlobo lomlutha. Ucwaningo lokuthi yikuphi ukudla (noma izithako ekudleni okuthile) okungaba umlutha kukho ezisezigabeni zalo zesibeletho. Kungenzeka ukuthi ezinye izinkomba zokulutha zingavelela ngezinhlobo ezithile zokudla. Isibonelo, amamodeli ezilwane aphakamisa ukuthi ushukela ungahlotshaniswa kakhulu nezimpawu zokuhoxiswa kunamafutha [87]. Kungenzeka futhi ukuthi kube nezimpawu ezihlukile ekuphenduleni-kokuphendula kokudla okwenziwe kakhulu okuhlobene nezidakamizwa zokuhlukumeza, kepha ucwaningo lwesikhathi esizayo luyadingeka. Ngaphandle kokuhambisana okungenzeka kwezinhlobo ezithile zokudla / izithako, noma kunjalo, ucwaningo luye lwaqokomisa ukuthi amaphethini athile wokudla (noma Ukudla i-topography) kungahle kudingekile ukuze ukudla kuthuthukise izakhiwo zalo zomlutha. Ngokukhethekile, kutholakele ukuthi izimpawu zokulutha kokudla zingabukwa ikakhulukazi lapho ukudla okune-calorie ephezulu kudliwa ngokushintshana kwezikhathi zokuvinjelwa kanye nokuzidla [12,22].

Ngokufanayo, umlutha wokudla ukhombisa ukufana kwe-SUDs kanye nokuphazamiseka kokugembula. Kodwa-ke, singasho ukuthi izindlela ze-SUD zingahunyushwa ngokungenangqondo zibe ukudla nokudla. Isibonelo, ukuphazamiseka kokugembula kufaka phakathi izimpawu ezikhomba ngqo imali elahlekile ngesikhathi sokugembula (i-1, i-6, ne-9), engasetshenziswa nakancane ekudleni. Ngakho-ke, yize umlutha wokudla ungamelela ingxube ye-SUD futhi umlutha wokuziphatha, siphethe ngokuthi inqubo ye-DSM-5 SUD kunaleyo yokuphazamiseka kokugembula kufanele iqondise ucwaningo lwesikhathi esizayo ngokulutha kokudla.

I-8.2. Ngabe ukusebenzisa izindlela ezintsha ze-SUD kuzokhuphula noma kunciphise ukuvinjezelwa komlutha wokudla?

Ku-DSM-IV, ukuncika kwezinto kungatholakala lapho okungenani kwethulwe izimpawu ezintathu. Lo mngcele ungene esikhundleni samazinga ehlukene obukhulu futhi i-SUD ngobunzima obukhulu manje isiyabonakala lapho okungenani kunezimpawu ezimbili. Lokhu kungenzeka ukuthi kwandise ukwanda kokuluthwa kokudla. Isibonelo, ucwaningo lwakamuva olwenziwe nguCurtis noDavis [90] basebenzise inhlolokhono ehleliwe phakathi kwabantu abakhuluphele ngaphandle futhi ngaphandle kwe-BED bagxile kulwazi lwabo lokudla kokuzidla noma ukudla ngokweqile, ngokulandelana. Bathole ukuthi bonke ababambiqhaza nge-BED (n = 12) kanye ne-42% (5 ngaphandle kwe-12) lalabo abangenayo i-BED bahlangabezane nemikhawulo yobunzima be-SUD, edlula ukulinganiselwa kobukhona bokulutha kokudla ngokususelwa ku-YFAS [91,92]. Ngokuphawulekile, abahlanganyeli bekungajwayelekile ukuthi bathethe ezintathu kwezindlela ezine ezintsha ngokuthi yizinkinga eziyinhloko ezihambisana nokudla kwabo [90]. Ngokuhambisana nokutholakele kwezifundo kusetshenziswa i-YFAS, ezimbili zezimpawu ezibikwa kakhulu bekuyizo kuthathwe inani elikhulu lokudla futhi imizamo engaphumelelanga yokusika phansi, kungakhathalekile ukuthi umuntu ngamunye wayeneBED noma cha. Ngaphezu kwalokho, abantu abakhuluphele abane-BED bavame ukufeza izindlela Ukuqhubeka kokusebenzisa naphezu kwezinkinga kanye nakho okwenzeka njalo kwe ukulangazelela [90].

Ngakho-ke, ukusebenzisa umkhondo wobunzima obukhulu kunganda kakhulu kokuthikameza kokudla, njengabantu abaningi abanokukhuluphala, kepha nabantu abaningi abangamanoni abanenkinga yokudla, ukudla ngokweqile kanye nokukhuluphala ngokweqile kungavumela okungenani izimpawu ezimbili. Ngaphezu kwalokho, abantu abadla ukudla okulingene emtholampilo kungenzeka bathola ukuxilongwa okungenani ukwehla okulinganiselayo (izimpawu ezine kuya kweziyisihlanu), okuyingxenye ngenxa yokufakwa kwenqubo entsha yokufisa. I-DSM-5 ikhombisa ukuthi ukuphazamiseka kwengqondo, okufana nomlutha, kuholela ekulimaleni noma ekucindezelekeni okukhulu ngokomtholampilo [54]. Ngaphezu kwezimpawu, i-YFAS ibuye ihlole ukuthi ngabe amazinga wobunzima obufanele abakhona yini [37]. Kungabaluleka ukucabanga kobunzima bemitholampilo maqondana nokusetshenziswa kwe-DSM-5 ekudleni okunomlutha njengendawo yokuhlonza.

I-8.3. Ingabe Ukubukezwa Kwe-YFAS Kuyadingeka?

Njengoba kunikezwe ukugcwala okukhulu phakathi kwenqubo endala ne-SUD yakudala, singasho ukuthi i-YFAS isazosiza ezivivinyweni zesikhathi esizayo zokulutha kokudla. Kodwa-ke, inguqulo entsha kungenzeka ukuthi idingwe ukuhlola imibuzo ephakanyiswe ngenhla futhi, ngenxa yalokho, okwamanje isakhiwa. Isici esibalulekile lapha ukubaluleka kokuhlola imibundu, ikakhulukazi inqubomgomo yokufisa. Yize izinkanuko zokudla ezivama kakhulu nezihlangene zihambisana nokudla kokuzidla noma izikolo ze-YFAS [44,45,64,90], isifiso sokudla ngese ngalinye kungokuhlangenwe nakho okujwayelekile kubantu okungahambisani nokudla okukhohlisiwe noma ukucindezeleka okukhulu kubantu abaningi [93]. Ngakho-ke, ukubuza nje abahlanganyeli ukuthi ngabe kwesinye isikhathi bathola ukudla kunxanela noma cha kungaholela ekuzweleni okuphezulu, kepha ukucaciswa okuphansi kokuthola umlutha wokudla.

I-9. Iziphetho

Ucwaningo lwe-DSM-IV yokuxilonga izindlela zokuncika kwezinto lukhombisa ukuthi zingahunyushwa ekuziphatheni kokudla nokuthi abantu abaningi abanokukhuluphala kanye / noma BED bafeze lezo zindlela ngokuya ngezindlela zokuzibika ezifana ne-YFAS. Ngokuphathelene nenqubo esanda kufakwa ku-DSM-5, ucwaningo olulodwa lukhombisa ukuthi izimpawu ezintathu kwezine zingahle zingasebenzi kumongo wokudla nokudla [90]. Kodwa-ke, lokhu bekuwucwaningo lokulingana olusezingeni elincane olususelwa kuzindikimba ababambiqhaza abazisho ngokungazenzisi ngesikhathi se-interview eyakhiwe kancane. Njengoba sesichazile ngenhla, zonke lezi zimpawu ezintsha zingafakwa ngokufanelekile ekudleni. Ngakho-ke, izifundo zesikhathi esizayo zisebenzisa izindlela ezijwayelekile ezifana ne-YFAS ebuyekeziwe ziyadingeka ukuze kuhlolwe ngokufanelekile imibandela entsha ye-SUD yokulutha kokudla.

Noma ngabe kuvela ukuthi izimpawu ezintsha, ngaphandle kokufisa, zingaveli kumongo wokudla nokudla, kusenokungabazwa ukuthi ngabe lokhu kuyaphikisana yini nokuba khona komlutha wokudla. Njengoba kungabonakala ngaphakathi Ithebula 1, izinqubo zokuxilonga njengoba zichaziwe ku-DSM-5 azisebenzi kwinto ngayinye ngezinga elifanayo. Ngokukhethekile, kukhona ama-SUD angahlanganisi uhla oluphelele lwezimpawu (i-caffeine, i-hallucinogens, inhalants) noma engafaki ukudakwa (ugwayi). Ngaphezu kwalokhu, izindlela ze-DSM ngokuvamile ziye zagxekwa ngokungafanele ukubhema.94]. Futhi, iDSM igxekwa ngokungahambeki kwayo ezinqubekweni ezingaphansi, okuyingxenye esemqoka yohlelo olusanda kuhlaziywa lweRooC. Ngakho-ke, isivivinyo esikhulu se-hypothesis yokulutha kokudla ngeke size sigxile kakhulu kwizimpawu nezimpawu ezixhumanisa umlutha nokuziphatha okuyinkinga, kepha futhi sihlole ukufana nokwehluka kokuzithoba kwalezi zimo.

Ukuphetha, sicabanga ukuthi inqubo ye-DSM-5 ingahle ibaluleke ocwaningweni lokuluthwa kokudla, noma ngabe ezinye zalezo zimpawu zingavunyelwe ukuvumela ababambiqhaza bebonisa ukudla okufana nokudla. Ngakolunye uhlangothi, ukusebenzisa lezo zindlela zokuthola umlutha wokudla kufaka ubungozi obedlula ngokwenzeka umlutha wokudla. Ngakho-ke, uphenyo lwesikhathi esizayo ludinga ukuqikelela ukuthi izindlela ezintsha ze-SUD zihunyushwe ngokufanele ekudleni nasekudleni nokuthi kusetshenziswe imigoqo efanelekile yokuxilonga lapho kutholwa umlutha wokudla. Ekugcineni, sigcizelela isidingo sokucabanga kakhudlwana ekuhloleni umlutha wokudla ngokuhlola umnikelo wemibuthano yemvelo, yengqondo neyokuziphatha efakwe umlutha wokuziphatha okuyinkinga.

Iminikelo Yomlobi

Bobabili lababhali babhala futhi babukeza lo mbhalo wesandla ngokubambisana.

Izingxabano Zesithakazelo

Abalobi bathi akukho mpikiswano yenzuzo.

Okubhekwayo

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