Imodeli ekhuthazayo yokuluthwa ucansi - ukuhambisana nempikiswano ngomqondo (2022)

3.1. Izisekelo

Okubalulekile ocwaningweni olukhuthazayo yi imodeli ye-incentive-motivation (U-Ågmo no-Laan, ngo-2022, IBindra, 1978, I-Robinson ne-Berridge, i-1993, Ama-Toate, i-1986, Ama-Toate, i-2009), indlela yokugqugquzela ibangelwa:

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izikhuthazo ezithile ezweni langaphandle, isb ukudla, izidakamizwa, umuntu ongase abe umlingani ocansini naye.

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Izimpawu ezihlobene nezisusa ezinjalo, isb ukuhlotshaniswa okunesimo sakudala phakathi kwekhibhodi ekhompyutheni kanye nokuvela kwezithombe zocansi esikrinini.

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izethulo zangaphakathi zalezi zikhuthazo enkumbulweni.

URobinson noBerridge (1993) ithiyori yesikhuthazo sokusebenzisa izidakamizwa nokuba umlutha inikeza i-akhawunti enethonya elikhulu. Ababhali bayakuvuma ukuhambisana kwayo nalokho okuthiwa imilutha yokuziphatha, njengocansi (IBerridge noRobinson, i-2016) futhi kwakha isisekelo sendatshana yamanje.

3.2. Ukukhetha impendulo

Igama elithi 'cue reactivity' libhekisela ekwenzeni kusebenze iqoqo lezifunda zobuchopho ngokuphendula izinkomba ezifana nokubona izidakamizwa noma lezo ezibikezela ukutholakala kwezidakamizwa. Lo mbono uyasebenza nakuzocansi, okungukuthi ukusabela okuphakeme kakhulu ezimpawu zocansi, njengoba kuboniswa, isibonelo, ngamadoda anenkinga yokusebenzisa izithombe zobulili ezingcolile (I-Kraus et al., I-2016, I-Voon et al., I-2014).

Ukuthambekela kokuthi abantu abayimilutha babonise ukuchema endleleni yokusondela kulokho okuhlosiwe kokulutheka kwabo kuye kwaphenywa kabanzi ezinhlobonhlobo zokulutheka, okuhlobene nezidakamizwa nokungahlobene nezidakamizwa. Ezocansi nezidakamizwa, ukulawula okusekelwe ekuvuseleleni kungasebenza ezingeni lokungazi lutho ngaphambi kokuba ukusabela okuqhubekayo kungene ekuqwashiseni (I-Childress et al., I-2008). Ngenxa yalesi sizathu igama elifuna ukungena Ithebula 1 Ibhokisi A limelwe 'njengokufuna', ukulihlukanisa nokufuna ukwazi. Ubukhulu bendlela yokuchema maqondana nezimpawu ezivusa inkanuko iphezulu kwabesilisa (ISklenarik et al., 2019) nabesifazane (ISklenarik et al., 2020) ngokusetshenziswa kwezithombe zocansi okuyinkinga.

3.3. Ukuthanda nokuthanda

Isici esivezwe umlutha wezidakamizwa ukwehlukana kokufuna (okuhlanganisa zombili izinzwa zegama) kanye nokuthanda (I-Robinson ne-Berridge, i-1993). Ngemva kokusetshenziswa kakhulu, isidakamizwa singase sifuneke kakhulu ngaphandle kokuthandwa okulinganayo lapho sesithathiwe.

Nakuba ukufuna nokuthanda kuyizinqubo ezihlukene, ziyasebenzisana kakhulu. Okusho ukuthi, izikhuthazo zilinganiswa ngokusekelwe emiphumeleni yokuxhumana nazo. Ngempela, bekungaba 'umklamo' oyinqaba ukube izinto bezingenjalo. Ngokuvamile sithanda esikufunayo futhi sifuna esikuthandayo, nakuba lezi zinqubo zingase zingahambi kahle (I-Robinson ne-Berridge, i-1993).

Voon et al. (I-2014) kubika ukuhlukana lapho inani eliphezulu lokufuna kubasebenzisi bezithombe ezingcolile zobulili ezingcolile lingazange lihlotshaniswe nokuthandwa okuphezulu okuhambisanayo. Ukulangazelela ucansi okujulile kungaba khona ngokuthandwa okuncane noma kungabi nhlobo (Timms and Connors, 1992). Okuxakayo ukuthi, umuntu ngezikhathi ezithile ubika injabulo yocansi nozakwethu ovamile kodwa engasuselwe esenzweni sokulutha esingaphezu kwababili (IGolide noHeffner, 1998). Kwesinye isampula, ama-51% abike ukuthi ngokuhamba kwesikhathi umsebenzi wabo wokulutha ucansi waba mnandi kancane noma awuzange ube nenjabulo kuwo (Iwayini, 1997). Iziguli ezimbili eziluthwe ucansi, zibike ukuthi ukujabulela ucansi kwasekuqaleni kwaholela ekunengekeni lapho esekhulile (I-Giugliano, i-2008, ikhasi 146). U-Doidge (2007, p.107) kubike:

Kuyaxaka ukuthi iziguli zesilisa engangisebenza nazo zazivame ukuhahela izithombe ezingcolile kodwa zingakuthandi.

3.4. Izisekelo zebhayoloji

Sescousse et al. (2013) ikhombe inethiwekhi yobuchopho evamile eyenziwa isebenze imivuzo efana nokudla, ucansi kanye nezisusa zemali. Le nethiwekhi ibandakanya i-ventromedial i-prefrontal cortex, i-ventral striatum, amygdala nangaphambili i-insula. Esigabeni esimaphakathi ezingxoxweni zokugqugquzela ukukhuthaza indlela i-dopaminergic ama-neurons avela ku- indawo ye-ventral tegmental (VTA) ku-ventral striatum, ikakhulukazi isifunda esibulalayo esaziwa ngokuthi yi- i-nucleus accumbens (N.Acc.) (I-Robinson ne-Berridge, i-1993).

Umsebenzi kule ndlela uyisisekelo sokufuna kodwa ukungathandi. Kunalokho, ukuthanda kungaphansi kokulawula ezinye izinto, ngokucacile ama-opioid. Ukwenza kusebenze ngokuphindaphindiwe le ndlela kuholela kulokho uRobinson no-Berridge abakubiza ngokuthi 'ukugqugquzela ukugqugquzela', okungukuthi amandla ezidakamizwa ukucupha le ndlela ayazwela. I ukuthamba komuthi kuyanda. Ubufakazi buphakamisa ukuthi ukuvukwa amadlingozi okuphindaphindwayo okubangelwa ucansi kungaba nomthelela ofanayo (ULynch noRyan, ngo-2020, UMahler noBerridge, 2012).

Voon et al. (I-2014) ithole ukuthi amadoda anenkinga yokusetshenziswa kwezithombe zobulili ezingcolile abonise ukusabela okuphakeme kwezimpawu zocansi eqoqweni lezifunda zobuchopho: i-dorsal anterior cingulate cortex, i-ventral striatum ne-amygdala. Lokhu kwakuhlobene namadoda ayekwazi ukubuka ngaphandle kwezinkinga. Ukusebenzisa fMRI, UGola et al. (2017)ithole ukuthi amadoda anenkinga yokusetshenziswa kwezithombe zobulili ezingcolile abonise ukuphinda kusebenze okuphakeme ku-ventral striatum ngokuqondile ukuze kuboniswe ukubikezela kwe izithombe ezivusa inkanuko kodwa hhayi kulezo ezibikezela izithombe zemali (bheka futhi Kowalewska et al., 2018 futhi I-Stark et al., I-2018). Abazange baphendule ngokuhlukile kuzilawuli ekuphenduleni izithombe zangempela. Amadoda abenenkinga yokubuka azwakalise ukulangazelela kakhulu izithombe ezivusa inkanuko kodwa abonakala engazithandi njengoba nje neqembu elilawulayo elingasebenzisi izithombe ezingcolile zobulili ezingcolile. Ngokufanayo, Liberg et al. (2022) kubonise ukuthi labo abasebenzisa inkinga yezithombe zobulili ezingcolile babonise ukusabela okuphakeme ku-ventral striatum kuya ukulindelaizithombe ezivusa inkanuko, impendulo ehambisana nokuthi zibike kangakanani zilangazelela ukubona izithombe ezivusa inkanuko. Amademo et al. (2012) ithole ukuthi ukusabela kwe-nucleus accumbens ezithombeni ezivusa inkanuko kwakuwukubikezela kwesenzo socansi esilandelayo, kuyilapho ukusabela ezinkambisweni zokudla kubikezela ukukhuluphala kwesikhathi esizayo.

Umsebenzi kule ndlela uzwela kakhulu ezintweni ezintsha kanye nokungaqiniseki komvuzo, into ecwaningwe kabanzi ekugembuleni (URobinson et al., 2015). Lokhu kumele kube yizici ezinamandla kakhulu zalezo zisusa ezivusa inkanuko abantu abazithola sebeyimilutha yazo, isb.

Amandla okuba umlutha wesidakamizwa ancike esivinini esifika ngaso ebuchosheni ngemva kokuwuthatha kanye nezikhawu zokuwusebenzisa (U-Allain et al., 2015). Ngokuqhathanisa, ulwazi mayelana nezisusa ezibonwayo zivame ukufika ebuchosheni ngokushesha okukhulu kulandela ukuchayeka, isb ukuchofoza ikhibhodi nesithombe socansi esivelayo, noma izithombe zingase ziphakame ngisho emcabangweni. Futhi izisusa zocansi zivame ukuhlangana nazo ngezikhathi ezithile nangokungaqiniseki, njengasekusesheni nasekusetshenzisweni kwabadayisa ngomzimba.

Ukwenza kusebenze ukudluliswa kwe-opioidergic okuhambisana nokuthanda kuvame ukukhulisa ukusebenza kwe-dopamine ekuphenduleni isikhuthazo esihlangatshezwana naye kamuva (UMahler noBerridge, 2009).

U-Ley (2012, p.101) uqaphela kahle ukuthi ubuchopho buhlala buguquka njalo ngenxa yokushintsha kwezigigaba zempilo, isib ukufunda ulimi olusha noma ukugibela ibhayisikili. Kusukela kulokhu, uphetha ngokuthi izinguquko zobuchopho ezihlobene nobulili azibalulekile kunalezo ezihlotshaniswa nanoma yimuphi omunye umsebenzi. Lokhu kuyadukisa njengoba ezinye zezinguquko zobuchopho eziwumlutha zingaphakathi kwezindlela ezithile ezikhuthazayo, isb izinhlelo ze-dopaminergic kanye nezindlela ezihlangana kuzo (Isigaba 3.4).

Smith (2018a, p.157) uyabhala:

“…… izinguquko ebuchosheni ezenzeka lapho ukulutheka kukhula ziyafana nezinguquko ezenzekayo njengoba noma yimuphi umkhuba ukhula.”

Izinguquko, isibonelo, ngokufunda ukuxubha amazinyo noma ukugibela ibhayisikili zisezifundeni eziphathelene nokuxhumana kweso nesandla kanye nokulawulwa kwemoto. Ngokungafani nokulutha, le mikhuba ayitholi isifiso sokugqugquzela esikhula njalo ngokuhamba kwesikhathi.

Kunamathuba acebile okuthi isimo sakudala senzeke ekuluthweni kocansi, isb ikhibhodi yekhompyutha ehlotshaniswa nokubuka izithombe zobulili ezingcolile inganikeza injabulo (Amakhadi, i-2001). Ngokunokwenzeka, ngokufanisa nokulutheka kwezidakamizwa, njengesisekelo sebhayoloji lokhu kunesasasa le-dopaminergic neurotransmission ngokushukumisa okunemibandela.

3.5. Ukwakhiwa kwezikhuthazi

Abantu abayimilutha yocansi bavame ukuthola izinjongo ezikhethekile zezifiso (Amakhadi, i-2001), uhlobo lokuphrinta. Ngokwesibonelo, abanye abantu abayimilutha i-cybersexchaza izithombe ezinamandla njengokuthi “zishisiwe” ezingqondweni zabo (Amakhadi, i-2001). Phakathi kwezinye zalezi zithombe, kukhona inqubo yokuguqulwa kwe-polarity kusukela ekuphikisaneni kuya ekulawulweni (McGuire et al., 1964), isb ukuchayeka okuphoqelekile kwezitho zangasese zomfana omncane ebuntwaneni kulandelwa umbukiso wabantu abadala (Lokhu kubonakala kunezici ezifanayo nemodeli yenqubo yokuphikisana USolomoni, 1980). Kubonakala sengathi ukuvuka okukhulu kuyisici esivamile ngenxa yezinguquko ezisuka enyanyeni ziye ekubeni nomdlandla (UDutton no-Aron, ngo-1974).

4.1. Izisekelo

Uhlelo lokulawula ukuziphatha okusanda kuchazwa lwakha ukugxila okuyinhloko kophenyo lokulutheka (Ibhokisi A). Lesi sigaba siphendukela kulawo achazwe emabhokisini BD awo Ithebula 1.

4.2. Isasasa elisekelwe kumgomo

'Ukulawula okusekelwe kumgomo wokuziphatha' (Ibhokisi C of Ithebula 1) ichaza lokho okuhlotshaniswa nokucubungula okuphelele (I-Berridge, i-2001). Esimweni sokulutheka, umgomo usekelwe phezu kwe-hedonic ukumelwa womvuzo osengqondweni (I-Perales et al., 2020). Lokhu kuhlanganisa i-ventromedial i-prefrontal cortex (I-Perales et al., 2020) futhi iyisisekelo sokufuna, ngaphandle kwamakhoma ahlanekezelwe. Ivimbela noma yikuphi ukuthambekela okungahambisani nomgomo (UStuss noBenson, ngo-1984, UNorman noShallice, ngo-1986). Ngaphambi kuka-2001, imininingwane yezinqubo ezimbili yayizotholakala ezincwadini ezihluke ngokuphelele, ngaleyo ndlela iphuthe indaba yokuthi zilawula kanjani ukuziphatha ekusebenzelaneni. I-Berridge (2001) ilethe zombili izinqubo ngaphansi kophahla olulodwa ekubuyekezweni okuhlanganisayo.

5.1. Izisekelo

Kunezinqubo zokuvinjwa okusebenzayo kwesifiso socansi nokuziphatha (U-Janssen no-Bancroft, ngo-2007). Okusho ukuthi, ukulahlekelwa isifiso akubangelwa nje ukulahlekelwa isasasa kodwa futhi nokuvinjelwa okuphikisa ukuvukwa amadlingozi, uhlobo oluthile lokudonselana. Njengesasasa, ukuvimbela kumelelwa izilawuli ezimbili (IBerridge neKringelbach, 2008, UHester et al., 2010, I-LeDoux, i-2000).

Olunye uhlobo lokungqubuzana olungavela lapho umelana nesilingo, ukudonswa kwesikhuthazo (Ibhokisi A) kungqubuzana nomgomo (Ibhokisi D). Ngokuphambene, umuntu ngezinye izikhathi kudingeka anqobe ukungabaza okubangelwa isisusa esiphikisayo, njengokudla ukudla okunambitheka kabi ukuze ajabulise umninikhaya (Ibhokisi C).

5.2. Ukuhambisana kokuvinjelwa ekuluthweni kocansi

U-Janssen no-Bancroft (2007) ichaze izinhlobo ezi-2 zokuthiya ekuziphatheni kocansi: ngenxa yokwesaba (i) ukwehluleka kokusebenza kanye (ii) nemiphumela yokusebenza. Amathoyizi (2009) ifake lokhu emcabangweni wokulawula okukabili, 'nokwesaba ukwehluleka ukusebenza' kuka-Janssen no-Bancroft okuhambisana nokuvinjelwa okuqhutshwa umfutho (isb. umsindo omkhulu, iphunga elibi, umbono wobunzima bokuqhanyelwa) (Ibhokisi B), kanye 'nokwesaba imiphumela yokusebenza. ' okuhambisana nokuvimbela okuqondiswe kumgomo (isb. isifiso sokugcina ukwethembeka) (Ibhokisi D).

Ngokuhambisana nombono obanzi endimeni ye-dopamine ne-serotonin, Briken (2020), I-Kafka (2010) futhi Reid et al. (2015) phakamisa ukuthi lezi ama-neurotransmitters bahileleke ekusaseni nasekuvimbeni ngokulandelana.

6.1. Ukubhekana nesilingo nokuzinikela kuso

Lapho ubhekene nesilingo futhi umelana naso, kucatshangwa ukuthi uhlelo oluqaphela ngokugcwele (Ibhokisi D) luvimbela ukuthambekela kokwenza okuthile. Njengoba isikhuthazo sisondela, namandla esilingo ayanda. Njengomuntu ofanelekela lo mcabango obanzi, kunezikhathi lapho umsebenzi ongaphakathi kwezinhlelo zokulawula ukwazi ungasiza ekunikezeni isilingo, into echazwe Ihholo (2019, p.54) ngokuthi "ukuhlanekezela ukuqonda". Kulapho-ke ephathelene nemiyalezo ethule kuwena yohlobo “lokhu akunandaba” (Kasl, 1989, ikhasi 20; U-Vigorito no-Braun-Harvey, ngo-2018).

6.2. Ukuvusa inkanuko

Ngokuvuka kwemizwa ephezulu, ukuziphatha kuba okusekelwe kakhulu ekuvuseni nasekuthatheni izinto ngamawala, kuyilapho imingcele ekhishwa ekuthathweni kwezinqumo ezinengqondo inesisindo esincane. Lesi simiso sisetshenziswe ekuthatheni ucansi engozini (Bancroft et al., 2003) futhi ichazwa ngegama elithi 'ukushisa-kwesikhathi' (U-Ariely noLoewenstein, ngo-2006). Ubufakazi bukhomba kubantu abayimilutha yocansi ababonisa ukushintsha kwesisindo esinjalo. Reid et al. (p.4) chaza ukuba umlutha wocansi kanje:

“……ukwehluleka ekulawuleni i-cortical “phezulu-phansi” yamasekhethi angaphambili, noma kusukela ekwenzeni kusebenze ngokweqile kokujikeleza kwe-striatal”.

U-Ley (2018, p.441) ithi.

"….ukuhlolwa kwe-neuropsychological kwembula ukuthi imilutha yocansi ayibonisi izinkinga ezilinganisekayo ekulawuleni umfutho kanye nokusebenza okuphezulu."

Lokhu kuyiqiniso ocwaningweni olucashuniwe kodwa lokho kwenziwa esimweni sokwenza Umsebenzi Wokuhlunga Ikhadi le-Wisconsin obanda ngokomzwelo. Reid et al. (2011) beka iphuzu lokuthi imiphumela yabo ingase ingafinyeleli esimweni sesilingo sobulili.

6.3. Okwenziwayo okuphindiwe

Ezinye izingxenye zokulawula ukuziphatha ziba ngokuzenzakalela ngokuhlangenwe nakho okuphindaphindiwe. Ukushintsha okunjalo, ngokusekelwe kukho okwandayo ukukhuthazeka, imele umbandela wencazelo yokuba umlutha (I-Perales et al., 2020). Ekuziphatheni kocansi okungalawuleki, Hunter (1995, p.60) uyabhala:

“Ngesikhathi umuntu eseba yisigqila somqondo esenzweni, ube eseziphilela yedwa. Izenzo zizenzakalela kangangokuthi umlutha uzobika ukuthi "zivele zenzekile" njengokungathi akazange abe nengxenye esenzweni.

Ukuthuthela ku-othomathikhi kuhambisana nesisindo esengeziwe sokulawula esithathwe yi- i-dorsal striatum isihlobo se- i-ventral striatum (U-Everitt & Robbins, 2005; UPierce noVanderschuren, 2010). Nokho, ukulawula akushintshi ngokuphelele kumodi ezenzakalelayo (Isigaba 15.3).

10.1. I-stimuli evamile kanye ne-supernormal stimuli

Indawo esakhula kuyo yayihluke kakhulu endaweni yanamuhla, equkethe insada yezithombe ezingcolile kanye nocansi olutholakala kalula. Igama elithi 'i-supernormal stimuli' (I-Tinbergen, i-1951) sithwebula lesi sici sendawo yethu yocansi yamanje (Adams and Love, 2018).

Ngomqondo ofanayo, ngokusobala amakhasino nokubheja ku-inthanethi kuyizinto ezisungulwe kamuva nje zamasiko ezivaleleka kulezo zindlela ezithuthuke ukuze zikhiqize ukuphikelela lapho kubhekwa izinsizakusebenza eziyindlala. Ngokufanayo, inala yokudla okutholakala kalula okugcwele ushukela okuyisici samasiko acebile bekungeyona ingxenye yokuziphendukela kwemvelo kwethu kwasekuqaleni. Lokhu kubonakala ku ukulutha kokudla nokukhuluphala. Ngamatemu akhuthazayo, izindawo zamanje ziletha izinzuzo ezifinyeleleka kalula ezinamandla kakhulu kunalezo zemvelo yokuzijwayeza kwangaphambi kwesikhathi.

10.2. Umehluko wocansi

Ukuphendula izisusa ezivusa inkanuko, i amygdala futhi ngxenye khombisa ukusabela okunamandla emadodeni kunakwabesifazane (U-Hamann et al., 2004). Ababhali baphakamise ukuthi lokhu kungase kuhambisane nevelu yenkuthazo enkulu yokuvusa inkanuko kwabesilisa.

Abesifazane basemathubeni amaningi okuba imilutha yothando kunokuya ocansini ngomuntu ngamunye, kanti kwabesilisa ukuthambekela kuwumlutha wobulili obumsulwa (Katehakis, 2018). Ukulutheka kwabesifazane kungabonakala ochungechungeni olungapheli lobudlelwano bothando. Ngaphansi kwezimo ezijwayelekile, isifiso socansi kwabesifazane sivame ukuhlelwa ngokwezincazelo (isb. ingabe uyangazisa njengomlingani?), kuyilapho inkanuko yowesilisa iqhutshwa ngamandla izici ezikhangayo ngomzuzwana ngamunye (Ama-Toate, i-2020). Ucansi oluluthayo lubonakala lumelela ihaba lalo mehluko wobulili.

Inkulumo ethi 'Coolidge Effect' ibhekisela enanini elivusa inkanuko yento entsha ekuziphatheni kocansi (I-Dewsbury, 1981). Ngokusobala, lokhu kuwumnyombo wokuluthwa ucansi, kungaba izithombe zocansi noma ucansi lozakwethu. Amadoda akhombisa umphumela onamandla we-Coolidge kunabesifazane (UHughes et al., 2021), okufanelana nenani elikhulu lamadoda ayimilutha yocansi. Ubusha bocansi buyathuthuka i-dopaminergicukudluliselwa kwe-neurotransmission endaweni i-nucleus accumbens (Fiorino et al., 1997).

11.1. Ubunzima bokulawula izifiso

Kunobufakazi obuningi obutholakala ezingxoxweni neziguli zobunzima bazo obukhulu ekulawuleni (Gerevich et al., 2005). Abanye abantu abayimilutha yocansi baze baphoqwe ukuthi bacabange ukuzibulala njengendlela kuphela yokuphuma (UGarcia noT Thibaut, 2010, Schneider, 1991).

11.2. Ukubekezelelana, ubungozi kanye nokwanda

Ukubekezelela, ubungozi kanye nokukhuphuka kufanele kucatshangelwe ndawonye njengoba ingqondo iphakamisa ukuthi kuwukubonakaliswa kwenqubo efanayo. I-Neves (2021, p.6)uchaza umbandela wokubekezelelana ngokuthi.

”… umuntu udinga ukwenza okwengeziwe ukuze azuze umphumela ofanayo”.

Lokhu kusebenza ezidakamizweni, ekwandiseni umthamo ngokuhamba kwesikhathi, kodwa u-Neves uthi akusebenzi ocansini. Kunzima ukuqhathanisa imithamo yezidakamizwa nezocansi. Kodwa-ke, ukwanda okuhambisanayo kwezocansi kungase kube isikhathi esengeziwe esichithwa emsebenzini noma ukwandisa ukuchezuka ekuziphatheni okuvamile (UZillmann noBryant, ngo-1986), isb ukushaqeka njengokubheka izithombe zobulili ezingcolile zezingane (Kasl, 1989, I-Park et al., I-2016).

Abanye abantu abayimilutha yocansi basengozini enkulu yokuphishekela ucansi (Bancroft et al., 2003, UGarner et al., 2020, I-Kafka, i-2010, Umvukuzi no-Coleman, ngo-2013), echazwa ngokuthi icinga “amahits of adrenalin” (Schwartz and Brasted, ngo-1985, ikhasi 103). Inani lesikhathi esichithiwe kanye nezinga lobungozi liyakhula ngokuhamba kwesikhathi (Amakhadi, i-2001, Reid et al., 2012, Sunderwirth et al., 1996). USchneider (1991)ibone ukuqhubeka kokulutheka kwezocansi okubonakala ngokuzama ukuziphatha okusha kanye nezingozi ezikhulayo ukuze uthole 'ukuphakama' okufanayo. Umzingeli (1995)futhi I-Dwulit and Rzymski (2019) wabona ukuqhubekela phambili kokuqukethwe okweqisayo kwezithombe zobulili ezingcolile ngokuhamba kwesikhathi. Kolunye ucwaningo, abahlanganyeli abangu-39 kwabangu-53 babike ukubekezelelana, bedinga ukuchitha isikhathi esiningi emisebenzini yabo yocansi ukuze bathole umphumela ofanayo (Iwayini, 1997).

Esimeni esaziwa ngokuthi yi-bug-jasing, amadoda athandana namanye afuna ucansi olungavikelekile namadoda anegciwane le-HIV (I-Moskowitz no-Roloff, ngo-2007a). Kucatshangwa ukuthi bafuna (p.353):

".ukungaqiniseki kanye nengozi etholakala ebulilini obungavikelekile."

I-Moskowitz no-Roloff (2007b) phakamisa ukuthi lokhu kufanelana nemodeli yokulutheka kwezocansi, okukhuphukela “ekuphakameni okuphezulu”. Kukhona ukuhlobana phakathi kwamaphuzu omuntu esikalini sokuphoqeleka ngokocansi kanye nokuthambekela kokuzibandakanya emisebenzini yocansi engcuphe kakhulu, njengemijaho yezocansi (UGrov et al., 2010).

11.3. I-Reward Deficiency Syndrome

Ubufakazi be-rewarddeficiency syndrome ngesisekelo semisebenzi yokulutha buba buthaka kancane kancane. Isibonelo, ayikwazi ukuchaza ukudla ngokweqile kwe-pathological, kwesinye isikhathi okukhonjwa njengokulutha kokudla, kuyilapho imodeli yokukhuthaza ingakwenza lokho (UDevoto et al., 2018, I-Stice ne-Yokum, i-2016).

U-Leyton noVezina (2014) kubonakala sengathi kuyixazulule i-conundrum yokuthi umsebenzi we-dopamine omncane kakhulu noma omningi ulele ngesisekelo sokugqugquzelwa. Uma kucatshangelwa indlela umuntu aluthwa ngayo umlutha, kunokungalawuleki endleleni ye-dopamine ekuphenduleni inkomba yokulutha. Ukusabela kuzinkomba zokuziphatha lapho umuntu engaluthekile kukhombisa ukuthi u-hypoactivation. Ubufakazi obengeziwe obuholela esiphethweni sokusebenza ngokweqile kwe-dopamine engaphansi komsebenzi wokulutha buzokwethulwa lapho kuxoxwa ngesifo sikaParkinson (Isigaba 13.5).

11.4. Izimpawu zokuhoxa

Fana no U-Prause et al. (2017), I-Neves (2021, p.7) uphikisa ngokuthi izimpawu zokuhoxa emsebenzini wocansi azikho. Walton et al. (2017) bayagomela ukuthi umbono wokuba umlutha wocansi ungena enkingeni ngenxa yokungabikho ngokomzimba izimpawu zokuhoxa.

Ezinye iziguli eziluthwe ucansi zibika izimpawu zokuhoxa, okuhlanganisa ngezikhathi ezithile ezifana nalezo zezidakamizwa, ngisho ne-cocaine, ukulutheka.U-Antonio et al., 2017, Chaney and Dew, 2003, I-Delmonico ne-Carnes, ngo-1999, UGarcia noT Thibaut, 2010, I-Goodman, i-2008, Griffiths, i-2004, Paz et al., 2021, Schneider, 1991, Schneider, 1994). Izimpawu zihlanganisa izinto ezinjengokushuba, ukukhathazeka, ukucasuka, ukudangala, ukungalali kahle kanye nobunzima bomsebenzi (Gerevich et al., 2005, Hunter, 1995, Kasl, 1989). Ezinye ze I-Carnes (2001) iziguli ezichazwe ebuhlungu izimpawu zokuhoxa. Kwesinye isampula sabantu ababika ukuluthwa ucansi, abangama-52 kwabangama-53 baba nezimpawu zokuhoxa, njengokucindezeleka, ukuqwasha nokukhathala, laba ababili bokugcina nabo bahlotshaniswa nokuhoxa ezinto ezikhuthazayo (Iwayini, 1997).

Ngaphandle uma umuntu ekholelwa ku-dualism, zonke izimo zengqondo zihambisana nezinguquko zomzimba (I-Goodman, i-1998). Umehluko ofanelekile uphakathi kwezimpawu zokuhoxa ezibonakala emzimbeni ngaphandle kobuchopho (isb. ukunyakazisa kwenja emanzi, amaqhubu) kanye nalezo ezingabonwa. Ngalesi simiso, utshwala ne-heroin kuzofaneleka ngokucacile kuyilapho i-cocaine, ukugembula kanye nocansi ngokuvamile ngeke (Ohlakaniphile noBozarth, i-1987). Kodwa ubuhlungu obusekelwe kuphela ebuchosheni/emqondweni ngemva kokuyeka ukusebenzisa abubuhlungu kangako.

11.5. Ukukhuthazwa kwe-Supraphysiological

Ukuba khona kwezidakamizwa noma ukudla okuthathwa okweqile kwezidingo zomzimba kumele izehlakalo emzimbeni ongaphandle kobuchopho. Kodwa-ke, lokho okubizwa ngokuthi umlutha wokuziphatha kuhlotshaniswa nokukhuthazwa kwe-supraphysiological kanye ne-plasticity ngaphakathi kwezifunda zobuchopho ezibonisa le miphumela ekuphenduleni izidakamizwa eziluthayo, (U-Olsen, i-2011), (Isigaba 3.4).

11.6. Amandla amahle athuthukisiwe sekwephuzile

Steele et al. (2013) yahlola inani labantu besilisa nabesifazane ababika ukuthi banezinkinga ngezithombe zobulili ezingcolile ze-inthanethi. Izisusa kwakuyizithombe ezimile futhi amandla e-P300 akalwa. Ababhali bathi i-P300 amplitude iyisilinganiso sesifiso socansi kunokuba umlutha wocansi.

Kunezinkinga ezimbalwa ngalolu cwaningo (Love et al., 2015, U-Wilson, i-2017). Abahlanganyeli abayisikhombisa abazange bahlonze njengabantu abathandana nobulili obuhlukile, ngakho-ke kungenzeka ukuthi abazange bavukwe ucansi ngezithombe ezibonisa abantu bobulili obuhlukile. U-Hilton (2014) waveza ukungabi khona kwanoma yiliphi iqembu lokulawula. Izithombe ezimile, okuhlanganisa ukuphulula nje, kungenzeka zikhiqize impendulo enciphe kakhulu uma iqhathaniswa nezithombe ezihambayo okungenzeka ukuthi zisetshenziswe ngokujwayelekile abahlanganyeli (U-Wilson, i-2017). Steele et al. qaphela ukuthi abantu abaningi abayimilutha bashaya indlwabu ngesikhathi bebuka futhi lapha bavinjelwa ukwenza kanjalo, okungenzeka futhi kube nomthelela emthelela wokungafani. Okunye ukucatshangelwa kumayelana nokuthi izinguquko zamandla zazibonisa ini ngempela: impendulo kusithombe noma ukulindela kwesithombe? Mayelana nezimpendulo ze-ventral striatum, isigaba sokulindela kuphela esihlukanisa phakathi kwabantu abanenkinga nabangenankinga. Kungenzeka ukuthi isimiso esifanayo siyasebenza lapha.

13.1. Izidakamizwa ezihlanganisiwe

Ezinye iziguli zikhombisa inkinga yokusebenzisa ucansi nezidakamizwa/ utshwala, ngezikhathi ezihlukene noma ngokuhlangana kwazo (I-Black et al., I-1997, UBraun-Harvey noVigorito, ngo-2015, Kasl, 1989, U-Långström no-Hanson, ngo-2006, Raymond et al., 2003, Schneider, 1991, Schneider, 1994, Timms and Connors, 1992). Abanye basebenzisa utshwala ukuze baphumule, banqobe izithiyo futhi banikeze isibindi 'sokulingisa' (Kasl, 1989).

Izikhuthazi, ezifana ne-cocaine ne-methamphetamine ('izidakamizwa ezikhishwayo'), zithuthukisa isifiso futhi ukusetshenziswa kwazo okunezinkinga kungavaleleka ekuhlanganeni nokuba umlutha wocansi (U-Antonio et al., 2017, Guss, 2000, I-Moskowitz no-Roloff, ngo-2007a, Sunderwirth et al., 1996). Zihlotshaniswa nokwanda kokuthatha ubungozi kanye nesaphulelo sokubambezeleka (UBerry et al., 2022, Skryabin et al., 2020, I-Volkow et al., I-2007).

Reid et al., (2012, p.2876) waphawula lokho.

“….leyo mibandela yomhlangano ye ukuncika kwe-methamphetamine, babika ukuthi basebenzisa izidakamizwa ukuze benze ubulili.”

Kolunye ucwaningo, cishe amaphesenti angama-70 abantu ababeyizigqila zocansi nabo babeyizigqila ze-cocaine (Washington, ngo-1989)). Ukusetshenziswa kwe ketamine kujwayelekile futhi (UGrov et al., 2010) kanye nokuthuthukisa ukukhululwa kwe-dopamine ku-ventral striatum ingenye yemiphumela yayo (Vollenweider, 2000). I-Gamma-hydroxybutyrate (GHB) ithuthukisa ukukhululwa kwe-dopamine ngemithamo ephansi kodwa hhayi ngemithamo ephezulu (Sewell noPetrakis, ngo-2011futhi yaziwa ngokwenza umphumela we-aphrodisiac (I-Bosch et al., 2017).

Ukuzibandakanya kokukodwa umlutha wokuziphatha kungabangela ukuphindeka kokunye, okuchazwe ngu-Schneider njengokuthi "ukubuyela emuva okuphindaphindiwe". Ezinye iziguli eziluthwe ngokocansi zibika ukuthi, lapho kunciphisa ukuziphatha kocansi, omunye umsebenzi omluthayo, njengokugembula, ukusebenzisa izidakamizwa noma ukudla ngokweqile, uyakhula. Kolunye ucwaningo, nakuba kusampula encane yabantu abanokuziphatha okuyinkinga kocansi, eminye imisebenzi eyeqisayo evame kakhulu pyromania, ukugembula, kleptomania kanye nokuthenga (I-Black et al., I-1997).

Abaphenyi bachaza izinhlobo ezahlukene 'zephezulu' (Sunderwirth et al., 1996, Nakken, 1996). Okuphezulu okutholwe ocansini nokugembula, kanye nezikhuthazi ezifana ne-cocaine kanye amphetamine, ibizwa ngokuthi 'ukuphakama okuvusa inkanuko'. Ngokuphambene, 'ukusuthiswa okuphezulu' kuhlotshaniswa ne-heroin nokudla ngokweqile. I-Heroin ayisona isidakamizwa esivusa amadlingozi.

13.2. I-Attention Deficit Hyperactivity Disorder (ADHD)

I-Comorbidity phakathi kwe-ADHD kanye ne-hypersexuality kwenzeka (I-Blankenship ne-Laaser, ngo-2004, Korchia et al., 2022). Ukwelapha i-ADHD kungadambisa ukuluthwa kocansi okuhambisanayo. Kunesivumelwano esibanzi sokuthi i-ADHD ibonakala njengokungajwayelekile ekucubunguleni imivuzo. I-Blankenship ne-Laaser (2004) phawula ukufana okuthile phakathi kokuba umlutha wocansi kanye ne-ADHD: ukuthambekela kokuba osinde ekuhlukumezekeni kwangaphambi kwesikhathi, ukungabekezeleli isithukuthezi, ukufuna ugqozi kanye nokuheha ekuziphatheni okuyingozi kakhulu. I-ADHD iphinde ibonakale ngokwehluleka ukuthatha imiphumela ekucatshangelweni lapho wenza, okuthile okwabelwana nge-borderline personality disorder (UMathies noPhilipsen, ngo-2014) (Isigaba 13.3).

Bonke bayavuma ukuthi ukuphazamiseka kwe-dopamine neurotransmission kubaluleke kakhulu ku-ADHD (U-Van der Oord no-Tripp, ngo-2020). Nokho, inkimbinkimbi yokuthi kuyini ngempela okungavamile kungaphezu kobubanzi bokubuyekezwa kwamanje.

13.3. I-Borderline Personality Disorder (BPD)

I-Borderline Personality Disorder (BPD) ibonakala ikhulisa ubungozi bokulutha ucansi (Jardin et al., 2017). Kuvame ukuba ne-comorbidity phakathi kokulutha ngokocansi kanye ne-BPD (I-Ballester-Arnal et al., 2020, UBriken, 2020). I-BPD ivame ukuhlotshaniswa nobunzima bokulawulwa ngokomzwelo, ukucinga ukuzanelisa ngokushesha, ukwanda kwemvamisa yokuba umlutha wezidakamizwa (okuthandwayo wukuqhekeka noma inhlanganisela ye-cocaine ne-heroin), ukulutheka kokufuna imizwa kanye nokuziphatha.Bandelow et al., 2010). Kwezinye izimo, kuncishisiwe ukuvinjelwa ekuziphatheni kocansi, okuvezwa njengokuziphatha kocansi okuyingozi kanye nenani elikhulu labalingani.

Uma kucatshangelwa izisekelo zebhayoloji ze-BPD, kukhona ukusikisela mayelana nemvelaphi efanayo engaba khona ne-SA. Ubufakazi bukhomba ukuntuleka kwe-serotonin, kuyilapho ukusebenza kahle kwengxenye antipsychotic ama-ejenti asikisela ukungasebenzi kahle kwe-dopamine (Bandelow et al., 2010 I-Ripoll, 2011). Bandelow et al. (2010) ubufakazi be-marshal bokuthi isisekelo ku-BPD ukungasebenzi kahle kwesistimu ye-opioid engapheli, isb.

13.4. I-Bipolar disorder

Ku-bipolar disorder, izigaba ze-manic ne-hypomanic zingabukeka into efana ne-SA (Okumnyama, i-1998). Kukhona ukuhlangana okuthile phakathi kwe-bipolar disorder kanye nokulutha kokuziphatha, umphumela onamandla nge ukugembula ukubheja kunokuluthwa ucansi (UDi Nicola et al., 2010, U-Varo et al., 2019). Isigaba se-manic/hypomanic sihlotshaniswa namazinga aphezulu e-dopamine (UBerk et al., 2007).

13.5. Isifo sikaParkinson (PD)

Inani leziguli elashwe nge i-dopamine agonists futhi L-I-Dopa ikhombisa "i-pathological hypersexuality", ekhathaza bona noma imindeni yabo noma bobabili. Lokhu kuziphatha kuphambene ngokuphelele, isb isifiso se-paedophilic, umbukiso noma ucansi oluphoqelelwe. Lokhu kuphakamisa ukuthi ukukhuphuka kwamazinga e-dopamine kubangela ukuseshwa kwentsha yezocansi (Klos et al., 2005, Nakum and Cavanna, 2016, USola et al., 2015).

Ezinye iziguli ze-PD zikhombisa ukugembula okunenkinga, ngokwazo noma ngokuhlangana nobulili obuyinkinga. Ukuphela komuthi kulandelwa ukulahlekelwa noma okungenani ukulungiswa kokuziphatha okweqile. Uma ukuziphatha bekuvele kulungise umthelela omubi, akucaci ukuthi kungani kufanele kuphele ngokuyekwa kwemithi eqondise ku-dopamine.

Iziguli zikaParkinson ezinobungqingili obuningi kanye nezithombe zocansi ezibonisiwe zembula impendulo eyandayo ku-ventral striatum lapho emithini yazo uma kuqhathaniswa nesikhathi sokuphumula (I-Politis et al., I-2013). Ziphinde ziveze ukuzwela kwesistimu (O'Sullivan, et al., 2011). Le miphumela iyenzeka nasekuluthweni kwezidakamizwa nezocansi (Isigaba 3.4). Njengemilutha, kukhona ukuhlukana phakathi kokufuna nokuthanda: Iziguli ze-PD azilinganisi izisusa ezivusa inkanuko kakhulu ngokuthanda.

Iqiniso lokuthi i-hypersexuality ivela lapho amazinga e-dopamine ekhona kuthuthukisiwe ayihambisani nemodeli yokuntuleka kwe-dopamine. Kunalokho, ithanda imodeli yokukhuthaza, esekelwe ekuphakameni kwe-dopamine (IBerridge noRobinson, i-2016).

13.6. ukucindezeleka

Ukucindezeleka okukhulu kudlala indima ebalulekile ekuqhakambiseni ukuziphatha okumlutha ngokocansi (IBancroft neVukadinovic, 2004, Amakhadi, i-2001, I-Kafka, i-2010). Ukucindezeleka kunciphisa ukuvinjelwa okwenziwa ukulawula okusekelwe kumgomo (U-Bechara et al., 2019). Ngasikhathi sinye, kwandisa ukuzwela kwendlela ye-dopaminergic ejabulisayo (I-Peciña et al., 2006). Ngaleyo ndlela, kunciphisa amandla okuzibamba futhi kwandisa ukuzwela eziphawulweni zocansi.

13.7. Ukudana

Abanye besilisa abayimilutha yocansi bathola isifiso sabo sokuba phezulu ngezikhathi zokucindezeleka (IBancroft neVukadinovic, 2004). Ubufakazi buphakamisa ukuthi umsebenzi we-dopamine uphansi ngezikhathi ezinjalo (Shirayama and Chaki, 2006). Lokhu kungase kubonakale kungahambisani nezimiso zokugqugquzela nokuthanda ithiyori yokuntuleka komvuzo. Kodwa-ke, kungenzeka ukuthi isifiso sayo yonke imisebenzi sinciphile kodwa ukuthi ukuya ocansini kusaphuma phambili (I-Perales et al., 2020). Okunye okungenzeka, okungahambisani nalokhu, ukuthi amadoda anenkumbulo yokuhlangana okudlule okwaphakamisa umoya wawo. Lokhu kufana nokuthi umuntu angase abe nenkumbulo yokuthatha i-aspirin ngenxa yekhanda elibuhlungu.

I-14.1. Isikhathi

Ukuthambekela kokuthi umsebenzi ube umlutha uncike ekutheni wenziwa nini okokuqala, ubusha kanye nokuba umuntu omdala omele isikhathi esisengozini kakhulu kuzo zombili izidakamizwa (UBickel et al., 2018) nezocansi (I-Black et al., I-1997, IHholo, i-2019, I-Kafka, i-1997) ukulutheka. Voon et al. (I-2014) ithole ukuthi isampula lezinsizwa ezaba nezinkinga zokusebenzisa izithombe ezingcolile zobulili ezingcolile zaqala ukubuka lapho zineminyaka engu-14 isilinganiso, kuyilapho izilawuli ezinokubuka okungenazinkinga zaqala eminyakeni engu-17. Iphesenti elikhulu labesilisa abayimilutha yocansi baqala ukubuka izithombe zobulili ezingcolile ngisho nangaphambi kweminyaka engu-12 (Weiss, 2018).

14.2. Ithiyori yokunamathisela

Umcabango ogcwele ezincwadini ukuthi ukulutheka ngokuvamile kuwumphumela wokwehluleka kokunamathiselwe kwezingane kusenesikhathi (Adams and Love, 2018, Beveridge, 2018, McPherson et al., 2013). Okusho ukuthi, kukhona ukwehluleka ukuthola okunamathiselwe okuvikelekile. Lokhu kubangela ukuseshwa kwesinxephezelo, okungenzeka kube yizidakamizwa, noma, njengasesimeni samanje, ucansi. Isixazululo esitholakele sinikeza umthombo wokuzithobisa. Ikhambi litholakala kanjani? Kungaba, ukuthi, ukuthinta ngephutha izitho zangasese okuholela ekushayeni indlwabu noma ukumodela ukuziphatha kocansi kontanga.

14.3. Ukuthuthukiswa kobuchopho

Izindlela zobuchopho ezithakaselwayo lapha zibonisa iphethini yentuthuko ehlukile: izifunda ezingaphansi kwe-subcortical ezihilelekile ekukhuthazeni isisusa zikhula ngokushesha kunezifunda zangaphambili ezivimbelayo ngenxa yezinzuzo zemiphumela yesikhathi eside (UGladwin et al., 2011, UWahlstrom et al., 2010). Lokhu kuphumela ekubeni ubusha kube yisikhathi lapho kunokungalungi kahle okukhulu futhi yingakho ukubusa kwe-sub-cortical appetitive system (ISteinberg, 2007). Ukuzibandakanya emisebenzini kulesi sigaba kwandisa amathuba okuthi bazolutheka. Ubufakazi obuningi buvela ekuluthweni kwezidakamizwa kodwa kubonakala kunengqondo ukudlulela ebulilini obuyinkinga. Ukuhlukumeza kubonakala kukhulisa ukungalingani futhi kwenze ukulutheka kube nokwenzeka kakhulu.

14.4. Imiphumela yokuhlukumeza kusenesikhathi

Amathuba okukhombisa noma yiziphi izinto eziningi eziluthayo kubantu abadala, okubandakanya ukusetshenziswa kwezidakamizwa, ucansi kanye nokudla okunezinkinga ayanda ngokuhlukunyezwa kwezingane (UCarnes noDelmonico, ngo-1996, USmith et al., 2014, Timms and Connors, 1992). Kunezinkomba zokuhlobana phakathi kobunzima bokuhlukunyezwa kwezingane (ikakhulukazi ukuhlukunyezwa ngokocansi) kanye nenani lezenzo eziluthayo (kuhlanganise nocansi oluyizinkinga) uma umuntu esekhulile (UCarnes noDelmonico, ngo-1996; Cf. U-Långström no-Hanson, ngo-2006). Abanye abantu abayimilutha yocansi baphinda uhlobo lokunukubezwa ngokocansi abaluthola beseyizingane, noma bephinda indima yokuba isisulu kodwa manje ngokuzithandela noma sebedlala indima yomhlukumezi (Firoozikhojastehfar et al., 2021, Kasl, 1989, Schwartz et al., 1995b).

14.5. Ukuchaza imiphumela yokuhlukunyezwa

Ukucatshangelwa kokuziphendukela kwemvelo kunganikeza ukuqonda okungenzeka kokuthi ukuthambekela ekubeni umlutha kuvela kanjani. Belsky et al. (1991) basikisela ukuthi ingane esakhulayo yenze ukuhlola engazi lutho ngendawo yayo kanye nezinga lokuzinza elikunikezayo. Lapho kuningi ukungaqiniseki okuhilelekile, isib. umndeni ophukile, abazali abashintshayo kanye/noma ukuhamba njalo ekhaya, inqubo yokuvuthwa kocansi kwengane iyashesha. Ingane-ke iba nokuthambekela kokukhiqiza inzalo enokutshalwa kwezimali okuncane kunoma iyiphi yazo. Umqondo wokuziphendukela kwemvelo wukuthi amathuba okukhwelana ayabanjwa uma ekhona. Ngokuphambene, indawo yomkhaya ezinzile ihlotshaniswa nokukhula kwengane sekwephuzile ngokobulili. Ukukhwelana kubambezelekile futhi kuhlotshaniswa nokutshalwa kwezimali okuphezulu kunoma iyiphi inzalo.

I-Alley and Diamond (2021) chaza ubunzima bempilo yakuqala (ELA), okusho ukuhlukunyezwa ngokomzimba, ngokwengqondo noma ngokocansi nanoma iyiphi inhlanganisela yalokhu. Kuvezwa ubufakazi bokuthi abantu abaphethwe i-ELA banokuthambekela okuphezulu kokubonisa ukuthatha ingozi ekuziphatheni kwabo kocansi. Lokhu kubonakala ezintweni ezifana nokuqala kocansi kusenesikhathi, ukukhulelwa kusenesikhathi, ukubanjwa kwezifo ezithathelwana ngocansi kanye nenani eliphakeme kakhulu labalingani bocansi.

Yiziphi izindlela i-ELA enalo mphumela ngazo? U-Alley no-Diamond babuyekeza ubufakazi obuphathelene nezinto ezifana nethonya lontanga kanye nokuba umzali onenkinga. Bese bebuza ukuthi lezi zici ziyilamula kanjani indima yazo ekuziphatheni kocansi mayelana nokuthatha izinqumo zomuntu omusha bese bephendula: “ukuzwela okukhulayo emvuzweni yocansi”. Ubunzima ekuqaleni kwempilo nangesikhathi sokuthomba bubeka ibhalansi phakathi kokuthatha ingozi nokuphepha, okunikeza umphumela ochemile ekujabuleleni ucansi ngokushesha kanye nokufuna ukuzwa ('isu elisheshayo') futhi kude nokubambezeleka ukuzanelisa.

Njengoba kuphawuliwe nje, ubusha ngokuvamile buyisikhathi sokuthatha ingozi enkulu. Nokho, I-Alley and Diamond (2021) buyekeza ubufakazi bokuthi izingane kanye nabantu abadala abake babhekana nobunzima bangaphambi kwesikhathi bavame ukubonisa ukuthatha ubungozi okuvamile kwentsha.

15.1. Ubulili obuningi noma isifiso esiphezulu kakhulu: hypersexuality

I-Hypersexuality ichazwa ku-DSM-5 ngokuthi “isifiso esinamandla kunokuvamile sokwenza ucansi” (okucashunwe ngu Schaefer and Ahlers, 2018, i-p.22). UCarvalho et al. (2015) ukuhlukanisa phakathi kwabantu abanobulili obudlulele nalabo abanobulili obunezinkinga. Yilokhu kokugcina kuphela okungahlanganisa 'umlutha', owokuqala uchazwa nje ngokuba nothando (I-Perales et al., 2020).

Incazelo 'yobulili obudlulele' kunokuthi 'umlutha' ingafanelana nesampula yabesifazane efundwe ngabo Blumberg (2003). Babika izifiso ezijulile zocansi, abazenza, ngokwenqaba ukuziphatha kwabo emphakathini. Nokho, babike ukuthi bajabule ngesimo sabo futhi abazange bafune usizo lokusilungisa. UBlumberg unqabe ilebula ethi 'umlutha' ukuze azichaze. Ngempela, indinganiso eyisisekelo yokulutheka akuyona eyodwa yobuningi bobulili kodwa enye yezingxabano, ukuhlupheka kanye nesifiso sokushintsha.

15.2. I-Obsessive-compulsive disorder (OCD)

Igama elithi 'impoqo' lithatha isici sempilo yengqondo yabantu abayimilutha yocansi, okungukuthi umuzwa wokuphoqeleka ukwenza okuthile, ngokuvamile ngokumelene nokwahlulela kwabo okungcono (I-Perales et al., 2020). Ngakho-ke, ingabe ukulutha kwezocansi kungahlukaniswa njengohlobo lwe-OCD?

15.3. I-impulse control disorder

Isici sokuthatheka singachazwa njengokuthanda imivuzo esheshayo kunemivuzo yesikhathi eside (UGrant noChamberlain, 2014). Ngalesi simiso abantu abayimilutha yocansi bakhombisa ukuthatheka. Ngocansi olungalawuleki, UBarth noKinder (1987) siphakamisa ukuthi sisebenzise igama elithi 'atypical impulse control disorder'. Kodwa-ke, cishe i-50% yeziguli ezifuna usizo lobulili obunenkinga ekhombisa ubufakazi bokuthatheka okujwayelekile okungaphakamisa ukulawulwa okujwayelekile kokuya phansi okwanele (UMulhauser et al., 2014).

Izincwadi zichaza izinhlobo ezimbili zokuthatheka: isizinda-jikelele, okubonakala ngokunganaki umsebenzi, kanye nesizinda esithile, lapho izinga lokungasukumi lincike kumongo.I-Perales et al., 2020, UMahoney nommeli, 2018). Mulhauser et al. phakamisa ithuba lokuthi, ebulilini obuyinkinga, ukuthatheka kungase kuboniswe kuphela phambi kwezimpawu zocansi.

Abantu abayimilutha yocansi bavame ukubonisa isigaba eside sokuhlela, isb ukuskena izingosi ze-inthanethi ukuze uthole othintana nabo abathembisayo, ukuxhaphaza izinsiza zokuqonda ezigcwele (IHholo, i-2019), okungukuthi inqubo yeBhokisi C (Ithebula 1). Baphinde bakhombise ikhono elimangalisayo lokuqamba amanga nokukhohlisa mayelana nezinhloso nezenzo zabo, isb kwabashade nabo (Amakhadi, i-2001). Ukuqamba amanga okuphumelelayo kudinga ukucutshungulwa okuphambene nalokho kuthatheka okucashile, okungukuthi ukusebenza kokuziphatha okuqondiswe kumgomo osizwa ukuvimbela lokuvezwa kweqiniso. Lokhu kusikisela ukuthi, nakuba kungaba nesici sokuthatheka kulokhu kuziphatha, ukuluthwa ucansi akufanele kuthathwe nje njengokuphazamiseka kokulawula umfutho.

15.4. Ezinye izinhlobo zokuphazamiseka kwengqondo

15.5. Ukushayela okuphezulu

Kunokuba 'umlutha wocansi', abanye baphikisa ngokuthi kungaba ngcono ukusebenzisa igama elithi 'ukuthanda ucansi oluphezulu'. Nokho, njengoba U-Kürbitz no-Briken (2021) phikisana, 'ukushayela okuphezulu' akufanele kusetshenziselwe ukuchaza ukuba umlutha wocansi njengoba 'ukushayela okuphezulu' akusho ukuhlupheka. Igama elithi 'shayela' alizange lisetshenziswe ocwaningweni lokugqugquzela emashumini ambalwa eminyaka edlule, nakuba ngezinye izikhathi livela ezincwadini eziphathelene nobulili obunezinkinga (UBraun-Harvey noVigorito, ngo-2015, Hunter, 1995). Walton et al. (2017) bhekisa 'ku-biological drive'. Uma idrayivu isho noma yini (njengoba isetshenziswa ngu UFreud, 1955 futhi ILorenz, 1950), bese kusho ukuthi ukuziphatha kuphushwa kusuka ngaphakathi ukunqwabelana kwengcindezi engakhululekile edinga ukukhishwa (isifaniso se-pressure-cooker).

Abantu abayimilutha yocansi ababonisi ukuphushana okungagxilile kunoma iyiphi indawo yocansi. Kunalokho bangakhetha kakhulu kulokho abakuphishekelayo (I-Goodman, i-1998, I-Kafka, i-2010, Schwartz and Brasted, ngo-1985). Schwartz et al. (1995a) qaphela ukuba khona kwesenzo sika (p.11).

“Ukuba nezindaba ezingapheli nabantu ongabazi, kuhlanganiswe nokuvinjwa kocansi nomyeni noma unkosikazi wakho”.

Abanye baziba umlingani ozimisele ngokocansi futhi okhangayo ukuthi abukele amafilimu ocansi noma ashaye indlwabu ukuze acabange ngabesifazane (Okumnyama, i-1998) noma zivulwa kuphela ngokusebenzisa abathengisa ngomzimba (URosenberg et al., 2014). Ngesampula yakhe yezitabane nabesilisa abathandana nabobulili obubili, I-Quadland (1985) bathole ukuthi labo ababonisa ukuziphatha okuphoqelelayo ocansini babefisa inani eliphansi kakhulu labalingani kunabo empeleni ababenabo. Nokho, ngaphandle kokwelashwa abakwazanga ukuzuza le nombolo. Ubone lokhu njengobufakazi obuphikisana nokuba “nogqozi oluphakeme locansi”. Ngamanye amazwi, 'ukufuna' kwabo kwakungqubuzana nokufuna kwabo (Ithebula 1).

Konke lokhu kuzwakala njengokuthatha isisusa esinamandla angaphezu kwavamile kunokuphuthuma okubangelwa idrayivu evamile engakhululekile. Ngamanye amazwi, ithiyori ye-incentive motivation ishada kahle nokuluthwa ucansi kanye nokuphishekela eyodwa noma ngaphezulu Ikakhulu izikhuthazo.

Ukuvuswa kokugqugquzelwa yizisusa, kunokuba kube khona noma yikuphi ukuphakama okungavamile kwedrayivu evamile, kungamela imvelo ye-idiosyncratic yezinye izinhlobo zokulutheka ngokocansi. Isibonelo, amanye amadoda ayimilutha yocansi aveza isici se-fetishist ekuvukeni kwawo (I-Black et al., I-1997, I-Kafka, i-2010), isb ukugqokisana noma ukubuka izithombe zocansi ezikhombisa abesifazane bechama (Amakhadi, i-2001) noma usemisebenzini eyingozi ngokwemvelo njengocansi olungaphephile, umbukiso noma i-voyeurism (Schwartz and Brasted, ngo-1985).

16.1. Izisekelo

Ngaphandle kokucaphuna ubufakazi, U-Ley (2012, p.140) uthi.

"Okokuqala, ezenzweni eziningi zocansi, ubulili budlala ingxenye encane kuphela esenzweni".

Lo mcabango owake wathuthukiswa ngabalandeli besifazane uye waphikiswa kaningi (Kasl, 1989, Palmer, 1988), incazelo yesimanje ukuthi a Inhlanganiselaisifiso socansi kanye nokubusa kusesisekelo esishukumisayo sokunukubezwa ngokocansi (U-Ellis, i-1991). Abahlukumezi bocansi bavame ukukhombisa ukunganaki kahle, okuthile okuhlotshaniswa nokulutheka (Smith, 2018b). Nokho, akuzona zonke abenza ucansi khombisa ingemuva elinjalo izici ezicatshangelwayo. Isibonelo, labo ababuka izithombe zocansi zezingane bangaqala ngezithombe zocansi ezisemthethweni futhi bathuthukele kokungekho emthethweni, bathwetshulwe amandla ezithombe (Smith, 2018b).

I-Carnes (2001), UHerman (1988), Smith (2018b) futhi Toates et al. (2017) baphikisa ngokuthi okunye ukuhlukumeza ngokocansi kungaqondwa kangcono ngemodeli yokuluthwa ucansi. Njengezinye izidakamizwa, abahlukumezi bocansi abajwayele ukuqala ukucasula lapho bekhula. Ukukhuphuka kuvame ukwenzeka kusuka ezinhlotsheni ezincane kuye kwezimbi kakhulu (Amakhadi, i-2001). Abadlwenguli abathanda izisulu zabafana bakhombisa ukuthambekela okuqinile kokuthi bahlukunyezwe beseyizingane, okuphakamisa uhlobo lwenqubo yokuphrinta (UBeard et al., 2013). Icala lingase lihlelwe isikhathi eside ngaphambi kokubulawa kwalo, eliphikisa ukona nje kuwumphumela wokwehluleka ukulawula okungalindelekile (I-Goodman, i-1998).

Isigwebo sikaHarvey Weinstein ejele savusa ukuqagela okuningi mayelana nokuba khona noma okunye kokuluthwa ucansi kanye nokuhambisana kwako necala lakhe. U-Weinstein waya emtholampilo obizayo ozinikele ekwelapheni ukuluthwa ucansi futhi lesi senzo bekuyinhloso eyintandokazi yalabo abawuchithayo umbono wokuba umlutha wocansi.

Ukuthi umlutha wocansi ukhona umbuzo owodwa. Ukuthi u-Weinstein uyawamaka yini amabhokisi okuba umlutha umbuzo ohluke kakhulu futhi kokubili akufanele kuhlanganiswe. Kungani, okungenani ngokomthetho, umuntu engeke abe kokubili umlutha wocansi kanye nomoni? Lezi yizilinganiso ezimbili ezihluke kakhulu ze-orthogonal.

16.2. Amaphupho nokuziphatha

Kubantu abanobulili obunezinkinga nalapho iphupho livusa inkanuko yocansi futhi libukeka kahle, kukhona ukuthambekela kokuziphatha ngokuziphatha okuqukethwe kwenganekwane (Rossegger et al., 2021). Bobabili abesilisa nabesifazane banandisa imicabango ephoqelelayo kodwa amadoda kaningi kunabesifazane (U-Engel et al., 2019). Akumangalisi ukuthi amadoda maningi amathuba okuthi enze iphupho elinobudlova eqinisweni.

16.3. Ukubulala inkanuko

Ezinye izici zokubulala okulandelanayo ngokocansi ziphakamisa ukulutheka okucashile. I-borderline personality disorder imelelwa kakhulu phakathi kwababulali abanjalo (U-Chan no-Heide, ngo-2009). Abanye ababulali babika ukungaboni ngaso linye ekuziphatheni kwabo, kuyilapho ukwenyuka besuka ekuziphatheni okungathí sina kakhulu (isb. i-voyeurism, i-exhibitionism), ngokudlwengula, ukuya ekubulaleni inkanuko kuvamile phakathi kwabo (I-Toates ne-Coschug-Toates, 2022).

Inani lababulali benkanuko babika imininingwane yomuntu siqu ehambisana nokulutheka. U-Arthur Shawcross uchaze inguquko esuka enyanyeni iye ekubulaleni iye ekuheheni (Fezzani, 2015). UMichael Ross ubike ukuthi uhlaselwe izithombe ezingathandeki futhi ukuqina kwazo kuncishiswa ukwelashwa kwe-anti-androgen, into ayishicilele kujenali. Ukuphuza ngokweqile nokucindezela (Ross, 1997).

19.1. Ifilosofi engumhlahlandlela

Njengomthetho ojwayelekile, kubonakala sengathi umuntu oyisigqila socansi unesisindo eseqile sokuthakasela okuhlobene nokuzithiba (UBriken, 2020). Izindlela zokwelapha zibandakanya ngokusobala ukukhulisa isisindo esihlobene sokuvinjelwa. Incwadi enesihloko Ukwelapha Ukulawula Ukuziphatha Ngokwecansi: Ukunciphisa ukubheja ngokwecansiakavumi ilebula yokuluthwa ucansi (UBraun-Harvey noVigorito, ngo-2015). Ngokuxakayo, ababhali bachaza ngokuvunywa komqondo wokuncintisana ebuchosheni phakathi kwezinhlobo ezahlukene zokulawula ezisetshenziswe ngempumelelo ekuluthweni kwezidakamizwa (U-Bechara et al., 2019). U-Braun-Harvey no-Vigorito bachaza indima enamandla (i) yento entsha kanye neyokuhlala ngokuphambene kanye (ii) nokuba seduze kwento emkhathini kanye nesikhathi, zonke izici eziyinhloko zokugqugquzela. Empeleni, ukwelapha kwabo abakuthandayo kuhilela ukuzama ukulinganisa kabusha isisindo esihlobene sokususelwe kusivuseleli kanye nesisekelwe kumgomo ukuze sivune lokhu kwakamuva.

19.2. Ukungenelela kwezinto eziphilayo

Iqiniso lokuthi i-serotonin reuptake inhibitors ekhethiwe ngezinye izikhathi zisebenza ngempumelelo njengokwelashwa kocansi oluyinkinga, akuniki umehluko ongenziwa OCD njengoba nazo zimiselwe lokhu. Kodwa-ke, kucatshangwa ukuthi kunciphisa ukuvinjelwa futhi ngakho-ke kungenzeka ukuthi ukusebenza kwazo kusebenza lapho (UBriken, 2020).

Impumelelo yomphikisi we-opioid naltrexone ekwelapheni ukuluthwa ucansi, okubuye kusetshenziselwe ukwelapha ukuluthwa yizidakamizwa, (UGrant noKim, 2001, I-Kraus et al., I-2015, USultana noDin, 2022) ihambisana nemodeli yokulutheka yokuziphatha ngokocansi. Ukusetshenziswa ngempumelelo kwe testosterone blockers ezimweni ezimbi kakhulu (UBriken, 2020) futhi ikhomba isimo esiluthayo sobulili obungalawuleki.

Ngaphezu kokusetshenziswa kwezidakamizwa, ukugqugquzelwa kukagesi okungeyona invasive ye-prefrontal cortex, okuhloswe ngayo. i-dorsolateral prefrontal cortex, ingase iqashwe, njengokwelapha ukuluthwa izidakamizwa (U-Bechara et al., 2019).

19.3. Izindlela ze-Psychotherapeutic

Njengokujwayelekile okubanzi, ukungenelela okuningana kwe-psychotherapeutic kuhilela ukusetha imigomo (isb ukufeza ubulili obungewona umlutha) futhi ngaleyo ndlela kuvinjwe ukuthambekela kokuziphatha okungqubuzana nomgomo wezinga eliphezulu wokulungisa isimo sokulutha. Indlela yokucabanga yesikhathi esizayo ye-episodic izama ukuqinisa amandla okuqonda okuhlobene nekusasa futhi isetshenziswe ekwelapheni ukuluthwa izidakamizwa (U-Bechara et al., 2019).

Ukusebenzisa ukwelashwa kokwamukela nokuzibophezela (ACT), U-Crosby no-Twohig (2016)belaphe iziguli ngenxa yokulutheka kwezithombe zobulili ezingcolile ngokukhuphula imvamisa ye-(p.360) "imisebenzi yempilo ephezulu." Ukwelashwa okusekelwe engqondweni kuhilela "inhloso kanye nokuzikhethela", ngenhloso eyinhloko "yokuhlakulela umuzwa wokuzikhethela nokulawula komuntu siqu (UBerry noLam, ngo-2018). U-Berry and Lam (2018, p.231) Qaphela ukuthi.

".iziguli eziningi zisebenzisa ukuziphatha okuluthayo ukuze zizisize zibhekane nemizwa enzima kodwa aziwazi lo msebenzi."

19.4. Ukungenelela kokuziphatha

Ezinye izindlela zokulutha zingakhuthazwa futhi ziqiniswe (I-Perales et al., 2020). Ukumelana nesilingo, iziguli zingakhuthazwa ukuba ziphathe isithombe sothandekayo, zihlolwe ngezikhathi zokulingwa (Smith, 2018b). Lokhu kungahunyushwa njengokuletha ukucatshangelwa okukude esikhathini samanje kanye nokulawulwa kokuziphatha ekuqondaneni nezinhloso ezingaluthisi.

Lapho usesimweni esibandayo kungaba nzima kakhulu ukubikezela ukuziphatha okungavela esimweni esishisayo. Ngakho-ke izinhlelo zingasungulwa esimweni esibandayo, njengokuthi 'ukugwema ukuba seduze kwezikole namachibi okubhukuda' ngethemba lokuthi isiguli ngeke singene esimweni esishisayo. Ihholo (2019, p.54) ibhekisela “ezinqumweni ezibonakala zingabalulekile”. Uyisibonelo salokhu ngendoda 'esanda kuba se-Soho²' futhi lapho ewela esilingweni. Nokho, wayehlele umhlangano wakhe webhizinisi owawuzoba seLondon futhi wakhipha imali ebhange emasontweni ambalwa ngaphambi kwalokhu. Kusesigabeni esipholile sokuhlela lapho ukungenelela kokuziphatha kungase kube yimpumelelo kakhulu. Ukubheka nje i-Soho ngenxa yesikhathi esidala kungase kubonakale kuyinhlekelele.

19.5. Okunye ukucabangisisa okungaba usizo

U-Vigorito no-Braun-Harvey (2018) basikisela ukuthi umuntu angase amthande ngobuqotho umlingani wakhe kodwa aqhubeke enqotshwa isilingo. Ukweqiwa akufanele kucatshangwe ukuthi kungasebenzi umgomo wokuzama ukulondoloza ukwethembeka. Babhala (p.422):

“……ukwenza indlela yokuziphatha engaphandle kokulawula ngaphakathi kwemodeli yenqubo embaxambili iveza indlela yokuziphatha engqubuzanayo njengomuntu wangempela, obonakala enqubweni efanayo yokungapheleli neguquguqukayo echaza okuningi kokuziphatha komuntu nezinkinga zakho.”

Ihholo (2013) kuchaza isiguli esabikela unkosikazi waso ukuthi sisebenzisa abadayisa ngomzimba nezithombe zobulili ezingcolile kodwa asisakujabuleli lokho. Unkosikazi wabuza umelaphi ukuthi kungenzeka yini umehluko onjalo futhi watshelwa ukuthi kunjalo. Waphendula ngokuthi angamxolela njengoba engasazijabuleli lezi zinto.