Isiphithiphithi se-Hypersexual kanye Ne-Internet
UDan J. Stein, MD, Ph.D.,UDonald W. Mnyama, MD,UNathan A. Shapira, MD, Ph.D., kanyeURobert L. Spitzer, MD
Kushicilelwe ku-Inthanethi: 1 Oct 2001 https://doi.org/10.1176/appi.ajp.158.10.1590
Ukuvikela ukungaziwa kwesiguli, icala elivezwe lapha lifaka izici ezivela ezigulini ezimbili ezihlukile, futhi kwenziwa ezinye izinguquko zokuthola imininingwane yokufihla ubunikazi.
I-Case Presentation
UMnu A wayeyindoda eshadile eneminyaka engu-42, isazi sezokuhlalisana kwabantu kwezemfundo, owayebonakala nesikhalazo esikhulu ngesimo sokudangala okuphindaphindekayo, naphezu kokuphathwa okuqhubekayo nomenzeli wokulwa nokucindezela. Uveze ukuthi yize belashwa nge-fluoxetine, i-20 mg / ngosuku, babephumelele ekwelapheni ukudangala okukhulu esikhathini esidlule, ezinyangeni ezedlule, ngokuhambisana nezingcindezi ezintsha empilweni yakhe, isimo sakhe sokudangala sibuyile. Lokhu bekuhambisane nokungahambi kahle, i-anhedonia, ukuncipha kokuxineka, nezinguquko zokulala nokudla.
Lapho eqhubeka nokuhlola, uMnu A uphinde waveza ukuthi ngalesi sikhathi wayandisa ukusetshenziswa kwakhe kwe-Intanethi, echitha amahora amaningi ngosuku efuna ezinye izithombe zocansi. Ubuye waveza ngokusobala ukudana phansi ekulahlekelweni kokulawula le ndlela yokuziphatha ebimelele yena futhi waphawula nokuthi usebenzisa imali eningi ekulandweni kwe-Intanethi kunamandla akhe. Ukuziphatha kwakhe kubuye kwaholela ekuncipheni okuphawuleka kokukhiqizwa kocwaningo, kepha wayedume njengomfundisi omuhle kakhulu, futhi kwakungekho bungozi bokuthi alahlekelwe yisikhundla sakhe. Wezwa sengathi ubudlelwane bakhe bomshado abuthinteki, yize ngenkathi ephulula ubulili ku-orgasm phakathi nosuku wayevame ukungakwazi ukufeza i-orgasm uma yena nomkakhe beya ocansini ngalobo busuku.
Lo mlando uphakamisa izingqinamba eziningana ezahlukahlukene. Ngombono omuhle kakhulu, "ukusetshenziswa okuyinkinga" kwe-Intanethi kusanda kuchazwa ezincwadini zezengqondo (1, 2). Yize lesi kuyisigaba esisha se-psychopathology, ukusetshenziswa kwengqondo kwezinto eziqukethe ezocansi kanye nokushaya indlwabu ngokweqile sekuyisikhathi eside kuchazwa. (3, 4). Umlando wesiguli uphakamisa imibuzo ephathelene nobuhlobo bokusebenzisa kwakhe i-Intanethi ngokweqile ukubuka izithombe ezingcolile nokubuya kwesimo sokucindezelwa. Ngokufanayo, kunombuzo wokuthi iyiphi indlela engcono kakhulu yokuxilonga inkinga yokuziphatha kobulili kwesiguli.
Ngokombono wokubheka kwemithi, kunencwadi encane kodwa ebaluleke kakhulu ngokomtholampilo ekubuyiseleni kwezimpawu ezibucayi ezigulini eziye zaphendula ngempumelelo kudokotela wengcindezelo futhi eziye zaqhubeka nokuhambisana nokwelashwa kwesondlo (5). Izizathu zale nto aziqondakali kahle, kodwa ukuthi kungenzeka ukuthi ukwanda kwabafundi abacindezelayo kudlale indima kunobuntu obucacile bokuthi iqiniso likhona. Ukuphathwa okuphezulu kweziguli ezinjalo nakho akufundiswanga kahle, yize ukwanda komthamo wemithi kunokusekelwa okuthile okuphathelene namandla (5).
Yize kungenzeka ukuthi ukuxilongwa nokuphathwa kwalesi siguli kungacaci ngokushesha, kubonakala sengathi kunesidingo sokungenelela. Ukusetshenziswa ngokweqile kwe-Intanethi emsebenzini ngenxa yezizathu ezingezona ezomsebenzi, ngeshwa, kuhlobene nokukhiqiza okunciphisiwe. Isiguli besisengozini yokuthi abhekane nomthetho ngumqashi wakhe uma isenzo sakhe sivele sabonakala. Usizi abhekana nalo lwalunenhlanhla ngandlela thile, njengoba kwabonakala sengathi kunomthelela esinqumweni sakhe sokufuna ukwelashwa.
Lapho ebuzwa kabanzi, uMnu A waveza ukuthi okokuqala ngqa lapho eba nesiqephu sokudangala esidinga ukwelashwa nge-antidepressant senzeka ngenkathi esengumfundi wasekolishi oneminyaka engu-18, ngokwesimo sokuhlukana kwesikole ubudlelwane. Kwakukhona iziqephu ezifanayo ezalandela zokudangala, futhi wayephuza i-fluoxetine iminyaka ye-3. Ukubuzwa ngokucophelela akuvezi umlando we-hypomanic noma iziqephu ze-manic noma ezinye izimo ze-axis I. Okuqaphelekile, nokho, eziningi zezimpawu zakhe ezicindezelayo zazingezokuphamba; lapho ecindezelekile wayevame ukudla kakhulu futhi alale kakhulu, futhi kwakukhona ubufakazi bokuzwela ukwenqatshwa.
Yize uMnu. Azixakekise ngezinto zobulili ezingcolile lapho ecindezelekile, ukusetshenziswa okubalulekile kwezithombe zocansi ze-Intanethi kwakukhona ngisho nalapho ukucindezelwa kwakhe sekuphendulile emithini. Yize ayekujabulela ukufundisa nokucwaninga kwakhe futhi ephumelela emsebenzini wakhe, ngesinye isikhathi lapho umsebenzi wayexineka khona wayebuye enze imisindo engaphezulu. Unkosikazi wakhe akakwazanga ukuba nezingane, futhi akekho nomuzwa wokuthi bafuna ukukhulisa ingane. Kodwa-ke, umsebenzi wakhe wawumfuna ukuba ahambe amasonto ambalwa ngonyaka, futhi ngalezi zikhathi wayezizwa enesizungu ngokwengeziwe, enesikhathi esithe xaxa ezandleni zakhe, futhi futhi wayebuye alulaze futhi. Ngempela, ngesinye isikhathi empilweni yakhe yonke wayethembele ekushayweni indlwabu ukuthola isimo sokuphumula, kwesinye isikhathi ejwayela ukushaya indlwabu ku-orgasm amahlandla amathathu noma ngaphezulu ngosuku. Noma kunjalo, lokhu akuzange kumphazamise emsebenzini wakhe noma emsebenzini wezenhlalo kuze kube yilapho esethole ukutholakala okulungile kwezithombe zocansi ze-Intanethi.
Ukuntuleka kwesiguli kwe-hypomania ne-mania kubalulekile, uma kucatshangelwa ukuthi i-hypersexuality ingaba wuphawu lwalezi zimo. Ukwanda okubonakalayo kokuziphatha okuphathelene ne-hypersexual ngezikhathi zokuxineka kwemizwa kuyathakazelisa ngokuya ngeziphakamiso ezedlule zokuthi ukuziphatha okunjalo empeleni kungaba yizimpawu zokudangala futhi kungahle kuphendule nakwimithi yokulwa nokucindezela (6). Ukulawula ukusetshenziswa kabi kwezidakamizwa nakho kubalulekile, ikakhulukazi uma kunikezwa ukuthi ukusetshenziswa kwe-cocaine kungahle kube nezimpawu zokuqina kwegazi (7). Ekugcineni, iziguli ezinezimpawu ze-hypersexual zingaba nezimo ezahlukahlukene zama-comorbid, kufaka phakathi i-obsessive-activive disorder (OCD) kanye ne-Tourette's disorder (8), ngakho-ke kufanelekile ukukhipha lokhu.
Ngokuya kokungenelela kwe-pharmacotherapeutic, ukuba khona kwezimpawu ezixinzayo ezi-atypical kunemiphumela ebalulekile. Kunobufakazi obunamandla bokuthi i-monoamine oxidase inhibitors engaphenduki (i-MAOIs) isebenza kakhulu kunama-antidepressants ama-tricyclic ekwelashweni kwezimpawu ezinjalo (9). Ngokunikezwa kokuphazamiseka kwezinyathelo zokuphepha zokudla ze-MAOI, i-selejista ekhethiwe ye-serotonin reuptake inhibitors (ama-SSRI) yimithi ewusizo yomugqa wokuqala. Ngokuqinisekile, ukusebenza kwabo okubonakalayo ekwelapheni ukudangala okukhulu kwalesi siguli kuyahambisana nendima ecatshangelwe ye-serotonin ku-hypersomnia kanye ne-hyperphagia kanye nokutholakele kweminye imibiko yangaphambilini ukuthi ama-SSRIs ayasebenza ekwelapheni ukudangala okukhona emzimbeni (10).
Inyuvesi ibinikeze ukufinyelela kwehhovisi kwi-Intanethi kubo bonke ubuhlakani bezungeze iminyaka ye-3 phambilini. Kuqala, uMnu A ubesebenzise kakhulu lokhu ngezinjongo zokucwaninga. Kodwa-ke, kwesinye isikhathi wayechitha isikhathi ezingosini zengevu zokuxoxa ngocansi kuyi-Internet, evame ukusebenzisa i-macho persona, eyaqhathanisa kakhulu neyakhe enenhlonipho futhi ethathe umhlalaphansi.
Ngokuhamba kwesikhathi, nokho, inqwaba yokusebenzisa kwakhe i-Intanethi yayizinikele ekufuneni izinhlobo ezithile zezithombe zocansi; lokhu kuhilela indoda eyayinomuzwa wokuthi i-macho noma igqamile ngandlela thile ukuya ocansini nowesifazane. Ube esesebenzisa lesi sithombe njengesisekelo senganekwane yezocansi lapho ayengowesilisa ohamba phambili wabesilisa abasesithombeni, futhi wayezithoba ngocansi ku-orgasm. Eminyakeni edlule wayevame ukuhambela izitolo zezithombe zobulili ezingcolile ezobheka lezi zinhlobo zezithombe, kepha wayekugwema kakhulu lokhu ngokwesaba ukuthi omunye wabafundi bakhe uzombona.
Amaphupho wokuya ocansini, kanye namaphupho, sekuyisikhathi eside aqanjwa njengomunye wemigwaqo ebalulekile yokuqonda ongazi lutho. Udokotela kufanele afune ukuqonda ukuthi kungani ukubusa kube neqhaza elibalulekile empilweni yezengqondo yeziguli. Yize izinkanuko ezinolaka mhlawumbe zisesikhathini sonke, ukuqonda umlando wokuphila oyingqayizivele walesi siguli kanye nemiphumela yezingxabano ezingazi ukuthi kungenzeka kube wusizo kanjani ekwakheni uhlelo lokwelashwa. Bekungaba okufanelekile ukubuza mayelana nokuhlangenwe nakho ngokocansi kwasekuqaleni kanye nokuhlukunyezwa ngokocansi kwengane, okungenzeka kuhlotshaniswe nokuziphatha kocansi okwedlulele okulandelayo (2).
Kuyathakazelisa ukuthi izici zesiko-ukuthuthukiswa kwe-Intanethi-zibonakala zibe nomthelela ophambili kwizimpawu zezimpawu zesiguli. Yize i-Intanethi inganikeza odokotela neziguli zabo amathuba abalulekile we-psychoedfundo nokusekelwa (11), futhi kunganikeza ithuba lokugembula kwe-pathological kanye nezinye izinhlobo zokuziphatha okungasebenzi (1, 2).
UMnu A wathi ukuthola uhlobo olufanele lwesithombe kwesinye isikhathi kungathatha amahora. Indoda esesithombeni ibidinga ukubusa, kepha uMnu A akazange avuswe uma kukhona ubufakazi bokuthi lo wesifazane ulimele. Lapho esethole isithombe "esifanele," wayezishaya indlwabu ku-orgasm. Wayenesikhathi eside evuswe yilolu hlobo lwezithombe futhi enenqwaba yezithombe ezifanayo, kepha wayelokhu efuna izinto ezintsha.
Kwezinye izikhathi wayekhumbula izithombe ezamenza lapho yena nonkosikazi wakhe benza uthando, kepha ubukhulu becala baba nobudlelwano bocansi obungajwayelekile futhi obungenasimilo, bobabili obabubona banele. Umlando onemininingwane yezocansi awuzange uveze lutho olujwayelekile. Kwakungekho mlando wokuhlukunyezwa kwezingane.
Kodwa-ke, Mnu A wakuphawula ukuthi ubunzima bokubabaza. Wayethanda, ngokwesibonelo, ukulandela imiyalo yabanye, ngisho noma engavumelani nabo. Ekugcineni, imizwa yentukuthelo yayiqhuma, kwesinye isikhathi ngezindlela ezingafanele. Isibonelo, kunokuba axoxisane nenhloko yomnyango wakhe ngodaba oluthile, uziphathe ngendlela ecasulayo nephazamisayo emihlanganweni yabasebenzi lapho kukhulunywa khona ngendaba ethile. Ekhombeni lemibuzo elincane le-schema lika-Young's (12), isiguli sikhuphuke phezulu ezintweni eziningi ze-schema yokukhwabanisa.
Isisho esithi "kunjalo nje," isiguli sasisebenzisa ukuchaza ukusesha kwakhe izithombe ezingcolile zobuchopho, sisikhumbuza uphawu lwe-OCD. Kodwa-ke, njengoba kuphawuliwe ngaphambili, lesi siguli ngokusobala asikhombisi bufakazi bokuthi sinezinkinga zokuphazamiseka. Ukuntuleka kobudlelwano bokuvuselela abanye ngokocansi ngezinto ezibonakalayo ezihlukumezanayo kukhipha isigqoko sobubi bezocansi. Leli phuzu libalulekile ukugcizelela, inqobo uma kunokudideka okukhulu phakathi kwezimpawu zepharaphilias nezinye (13).
Young (12) liphakamise ukuthi i-schema yokwengeza ingahle ibe khona lapho ukubonakaliswa kwentukuthelo kwengane kudangala, nokuthi abantu abadala abanale schema bayakwazi ukuveza lo mzwelo ngokungaqondile. Ukuqeqeshwa kokuqina kungaba yinto yokungenelela kokuqala ukuze usize iziguli ziqale ukunqoba i-schema yokungena. Ukudluliselwa kokwelashwa kwengqondo okusiza ukuguqula izisekelo zokulimazeka kwangaphambi kwesikhathi nakho kungacatshangelwa. Ubudlelwano obuphakathi kwe-schemas, ama-stressors, izimpawu, kanye nesimo sokushintsha kwemizwa akumane nje kuhilele ukuqondana okukodwa kodwa, kunalokho, kungenzeka kube nzima.
UMnu ekuqaleni wenqabile ukudluliselwa kwe-psychotherapy ngudokotela wakhe wezifo zengqondo, owenze kakhulu umsebenzi we-psychopharmacological, kodwa wavuma ukwanda kwe-fluoxetine ku-40 mg / ngosuku. Emavikini ambalwa alandelayo lokhu kuholele ekuqhubekeni kokuthuthuka kwezimpawu zesimo sokushintsha kwemizwa kepha hhayi ukuthi kwehle i-libido noma olunye ushintsho ekuziphatheni kwakhe kwe-hypersexual. Ezinyangeni ezithile kamuva, uMnu A wavuma ukuxoxa ngezimpawu zakhe nodokotela wezengqondo.
Lapho kulandelwa unyaka we-1, wezwa ukuthi ukwelashwa ngezengqondo bekusebenzele ukusiza ekusizeni ubunzima. Impela, manje wayesenomuzwa wokuthi le ndaba ibe nomthelela ekucindezelekeni azizwa esebenza khona, kanye nomuzwa wokuthi wayesephelelwe amandla okuzibamba ngokuziphatha kwakhe kobulili, nasekucindezelekeni kwakhe kwangaphambili. Kube nokuncipha kokusebenzisa kwakhe i-inthanethi okunenkinga, noma ngesinye isikhathi ngesikhathi sokucindezelwa emsebenzini noma isizungu, wayesathambekele ekusetshenzisweni ngokweqile kwezithombe zocansi nokushaya indlwabu.
Ukwehlukanisa ukwelashwa phakathi kwengqondo nodokotela wengqondo kubandakanya izinkinga eziningi; ngokuqinisekile esimweni sezimpawu isiguli esithola zinamahloni, umcabango wokuveza lokho kumuntu omusha ungandisa izindaba. Ukuphendula kwezimpawu zokucindezelwa edolweni elikhuphukile le-fluoxetine kuyahambisana nobufakazi obuvela embikweni owedlule (5). Yize ama-SSRIs kubikwe ukuthi alusizo ekwehliseni ukushaya indlwabu ngokweqile kanye nezimpawu ezifanayo, imiphumela yazo ayisiqinile njalo (6, 8, 14). Ngaphezu kwalokho, esivivinyweni esilawulwayo se-clomipramine ne-desipramine yezimpawu ezinjalo, ukusebenza kahle akutholakalanga (15). Ukuthi ama-SSRIs anganciphisa usizi lwesizungu kungabikho mkhawulo wokuphazamiseka kwemizwelo kungumbuzo othokozisayo, mayelana nokuthi kukhona imininingwane embalwa.
I-Psychotherapy kuye kwabikwa ukuthi iyindlela elusizo yokwelapha ukushaya indlwabu ngokweqile nezimpawu ezifanayo ngabalobi abaningi (3), futhi yize kunokuntuleka kwezifundo ezilawulwayo kule ndawo ethize, i-psychotherapy ngokuqinisekile icatshangelwa ukuthi isebenza kahle ezinkingeni ezivame ukwenzeka ze-comorbid axis I (ezinjengokudangala), kanye nezinkinga ezithile ze-axis II (ezinjengobunzima bokuzithemba). Ukungenelela kwemibhangqwana kungenzeka futhi kube ukucatshangelwa ukube bekukhona ubufakazi bokungasebenzi komshado. Kungenzeka futhi ukuthi i-pharmacotherapy kanye ne-psychotherapy kuthuthukise enye. Ngaphandle komphumela omuhle ojwayelekile kulesi siguli, kuyaphawuleka ukuthi izimpawu zokuziphatha ngokweqile kobulili kungahle kube nenkambo engapheli (2).
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Isiguli lapha siphinde sabuye sachazwa yincazelo kaKrafft-Ebbing "yobulili obulondekile" eminyakeni engu-100 edlule (16):
Ingena kuyo yonke imicabango nemizwa yakhe, angavumeli ezinye izinhloso empilweni, ngenhlokomo, nangemfashini efana ne-rut-funa ukwaneliseka ngaphandle kokunikeza ithuba lokuthi kube khona kwezethulo zokuziphatha ezilungile nezilungile, futhi nokuzixazulula kube yimpumelelo engaphenduki yobulili ubumnandi.… Lokhu kuziphatha kocansi okuyisidina kuyisisulu esesabekayo koyisisulu saso, ngoba usengozini njalo yokwephula imithetho yombuso neyokuziphatha, yokulahlekelwa wukuhlonishwa kwakhe, inkululeko yakhe ngisho nempilo yakhe.
Vele, imidiya yezokuxhumana yanamuhla inikezela ngezindlela ezihlukile zokubonisa i-psychopathology. I-Intanethi, ikakhulukazi, kungenzeka ibe yindawo ebalulekile yokuveza izimpawu ezahlukahlukene, kufaka phakathi "ubulili be-pathological."
Ucwaningo lwakamuva nje luveze ukuthi "ubulili be-pathological" buyinto engafani neze futhi bungenziwa buhlotshaniswe nokushayeka okukhulu (3, 17). Ukuphazamiseka kubonakala kuvame kakhulu emadodeni, futhi iziguli zingabonakala ngezindlela ezahlukahlukene zokuziphatha, kufaka phakathi ukushaya indlwabu okuphoqayo, ukusetshenziswa ngokweqile kwezithombe zocansi ezinyathelisiwe noma zocingo, kanye nokusebenzisa izinsizakalo kwabasebenza ngocansi. Njengokuphazamiseka kokulawulwa kokuthinteka, noma ngabe izimpawu ziyanelisa, kukhona futhi okukhona emzimbeni we-dy dyicicity. Ukuxilongwa kweComorbid kufaka phakathi ukuphazamiseka kwemizwa, ukuphazamiseka kokukhathazeka, kanye nokuphazamiseka kokusebenzisa izidakamizwa. Izimpawu zingathinta kakhulu umsebenzi womndeni, wezenhlalo, nowokusebenza, futhi imiphumela emibi ifaka leyo yesifo esidluliselwa ngocansi. Kunesidingo esicacile sokuxilongwa okufanele nokwelashwa kweziguli ezinjalo.
Eminyakeni edlule, kusetshenziswe amagama ahlukahlukene ukubhekisa kulezi ziguli, kufaka phakathi i- “Don Juanism” kanye ne “nymphomania” (18, DSM-III). Yize isigaba se-DSM-III-R esikhuluma ngezinkinga zocansi ezingacaciswanga ngenye indlela sifaka igama elithi “ukulutha okungelona ipharadesi,” leli gama lehle ku-DSM-IV. Umqondo "wokuvuselelwa ocansini" (19, 20) kusekelwe emcabangweni wokuthi kukhona ukugqama okukhulu kanye nokwengqondo kwengqondo phakathi kwaleli bhizinisi ne-OCD. Ngokuphikisana nalokhu, abanye basebenzise igama elithi “ukuzitika ngocansi” futhi bagcizelela ukugqagqana kokuphazamiseka kokulawula okungathandeki (21, 22). Umbono wokuluthwa ngokocansi nawo ubuye uhlongoziwe, usususelwa ekulweni okufana nalokhu nokuphazamiseka okuluthayo (3, 23). I-"paraphilia-related disorder" iye yaphakanyiswa uma kubhekwa ukufana okuphezulu kakhulu, kanye nokufana okufana ne, paraphilias (13).
Ukuntuleka kwegama okuvunyelwene ngalo kube nomthelela ekuthini kucabangele ukucubungula okukhona kule ndawo. Elinye lamagama ahlukene ngokuphikisana linazo izinzuzo nobubi bobunye. Impela, baphakamisa izindlela ezahlukahlukene zemibono yokucwaninga esikhathini esizayo kule ndawo. Kodwa-ke, noma ngabe yikuphi amandla nokulinganiselwa kwalezi zindlela, siyagcizelela ukuthi kunezincwadi ezinomkhawulo kule ndawo, okwenza kube nzima ukuvumela noma imuphi umfuziselo owodwa wethiyori (17, 24). Ngokuhambisana nokugcizelelwa kweDSM kwi-phenomenology echazayo esikhundleni somqondo ongasekelwa, igama elithi "hypersexual disorder" mhlawumbe lifaneleka impela.
I- “Hypersexual disorder” mhlawumbe ithola ukwesekelwa ubufakazi bokuthi inani lokukhipha ubulili, elichazwa njengenani lokuziphatha kobulili evikini eliphela ku-orgasm, liphezulu kuleli qembu leziguli (13), yize izinga lapho izimpawu zibandakanya i-orgasm yomzimba (kunokuba, isib, imicabango nezocansi) ziyahlukahluka kwisiguli kuya kwesinye. Okuxakayo nokho ukuthi leli gama ligxila kuzimo ezibonakalayo futhi lisuka kunoma yiluphi uhlaka lwethiyori olunganele. Enye indlela endala ye- “pathological hypersexourse” izwakala inengqondo endlebeni yesimanje.
Kungenzeka yini ukuthi wakhe izindlela zokuxilonga ezihlukanisa ukuphazamiseka kwe-hypersexual nokuziphatha okuwuphawu lwenye inkinga (njengokudangala), kanye nokuziphatha okujwayelekile kobulili? Kudingeka kusungulwe, ngokwesibonelo, ukuthi kunokucabanga ngokweqile ngemicabango evusa inkanuko yobulili, izinkanuko, noma isimilo ngokweqile ngobude obude besikhathi (isib, izinyanga ze-6). Ngaphezu kwalokho, kufanele kunqunywe ukuthi izimpawu azibalwa kangcono ngenye i-axis I disorder (isib, isiqephu se-manic noma i-delusional disorder, i-erotomanic subtype) futhi izimpawu azikho ngenxa yemiphumela eqondile yomzimba wento ethile (isib. isidakamizwa sokuhlukumeza noma somuthi) noma isimo sempilo esivamile. Okokugcina, isahlulelo sokuthi imicabango yokuya ocansini, ukunxusa, noma isimilo ngokweqile (okusho, simele i-psychopathology) kufanele sinake ukuguquguquka okujwayelekile njengomsebenzi wobudala (isb., Kwintsha, izinga eliphakeme lokugxila emcabangweni wezocansi kungaba yinto evamile) futhi amanani asenkambisweni (isib., ezigulini ezazisa ukungashadi, ukuba khona kwezifiso ezithile zocansi nokucindezelwa okuhambisana nakho kungaba yinto evamile), kanye nezinga lapho izimpawu zingumthombo wokuhlupheka noma ukuphazamisa izindawo ezibalulekile ekusebenzeni kwazo.
Lokhu kucatshangelwa kanye negama elisetshenziswe lapha kuyahambisana neziphakamiso ezincwadini (17, 24). Ngakho-ke, ukuthola ukuthi izimpawu zingamaphupho ocansi, ukunxenxa, nokuziphatha okungaqhathaniswa nalokhu okulandelayo kusuka encazelweni ye-DSM-IV yokuphambanisa; le yimibono evamile, evusa inkanuko yocansi, izinkanuko zocansi, noma isimilo esivame ukubandakanya izinto ezingezona ezomuntu, ukuhlupheka noma ukuthotshiswa nguwe noma umlingani womuntu, noma izingane noma abanye abantu abangavumanga. Eqinisweni, umqondo lapha uthi ekuphazamisekeni kwe-hypersexual, izimpawu yilezo ezibonwa emaphethini ajwayelekileko we-arousal.
Ngokufanayo, kubalulekile impela ukunquma lapho izimpawu ze-hypersexual zichazwa kangcono ezinye izimo zengqondo noma izimo zezokwelapha ezijwayelekile kunokuxilongwa okuthile kwe-hypersexual disorder. Njengoba kuphawuliwe ngaphambili, ngokwesibonelo, iziguli ezisebenzisa i-mania noma i-cocaine zingakhombisa ukuziphatha kwe-hypersexual. Ngaphezu kwalokho, ukusebenza kwe-hypersexual kungabonakala ezimweni eziningi zemizwa ezahlukahlukene (7). Esimweni esivezwe lapha, abukho ubufakazi bokuthi izimpawu zingabalwa kuphela ngesimo sokuphazamiseka kwemizwa noma okunye ukuphazamiseka, yize imizwa (futhi mhlawumbe nokuntula ukuzithemba) kungezelela kakhulu lezo zimpawu zocansi bese kuthi zona zande kakhulu ngazo.
Ekugcineni, kunomsebenzi onzima we-conceptually wokuchaza ukuhluka okujwayelekile kusuka ku-psychopathology (25). Amagama asetshenziswe ngenhla agcizelela ukuthi izahlulelo zomtholampilo mayelana ne-psychopathology kufanele zibheke ukuhlukahluka okujwayelekile kanye nokulimala okubangelwa yizimpawu. Ngakho-ke, ngokwesibonelo, imicabango emibi yezocansi ebusheni noma ekucindezelekeni okubangelwa isifiso sobulili kubantu abalwela ukuba yizinyoni ngokujwayelekile ayisiyo ingqondo yengqondo.
Kukhona, empeleni, izincwadi ezicebile zefilosofi ezizama ukuchaza ukuphazamiseka kwezokwelapha nezengqondo nemingcele yazo ngokujwayelekile (26-28); Inkinga yokucacisa ukwehluka okujwayelekile kusuka ku-psychopathology inzima ikakhulukazi lapho, esimweni sokuphazamiseka kwe-hypersexual, indlela ye-phenomenology (ngencazelo) evamile. Amagama asetshenziswe lapha ahambisana nemibono yabalobi abaningi abathi ukuxilongwa kwezifo zokwelashwa kubandakanya ukubukwa kwezimpawu eziphathelene namasiko (27, 28).
Yize kungenzeka kube ngokomqondo ukuthi kufakwe "i-hypersexual disorder" engxenyeni ye-DSM ezikhathini zokulawulwa kokuthinteka kokulawula, kubonakala sengathi ingxenye enkulu yezingqinamba eziphathelene nocansi. Lokhu kuyahambisana nokuhlukaniswa kwezinto ezinama-analogous njenge-bulimia (enezimpawu zokuphoqelela kepha zihlukaniswe njengengxaki yokudla).
Ukuvela kwakamuva kwezindlela ezahlukahlukene zokuziphatha ngaphansi kwe-rubric "inkinga yokusebenzisa i-inthanethi" kuphakamisa umbuzo wokuthi ngabe lokhu futhi, kufanele kube yisifo sokuxilongwa kwengqondo (29, 30). Izifundo ezimbili (1, 2) uveze ukuthi imiphumela yokusebenzisa okunjalo ingafinyelela kude impela, ngezifundo eziningi zingalali, isikhathi sekwephuzile emsebenzini, ukungazinaki izibopho zomndeni, kanye nokuhlupheka imiphumela yezimali neyomthetho. Isifundo esijwayelekile kulezi zifundo sasisezingeni eliphansi kakhulu kuye maphakathi-30s, okungenani wayenemfundo ethile yasekolishi, echitha cishe amahora we-30 ngesonto ekusebenziseni i-Intanethi "okungabalulekile", futhi wayenemizwa, ukukhathazeka, ukusetshenziswa kwezidakamizwa, noma ubuntu ukuphazamiseka. Njengoba kunikezwe ukuthi i-Intanethi ivumela ukufinyelela okusheshayo kwezinto eziphathelene nocansi kanye nabalingani bezocansi (31), Ukuziphatha kocansi kulo mongo kufanelekile ikakhulukazi (32). Kubonakala kunengqondo ukuphakamisa ukuthi umlando wokuziphatha kwe-Intanethi ufakwe njengengxenye yenhlolokhono ejwayelekile yezengqondo. Noma kunjalo, uma sazi ukuthi lezo zimpawu zivame ukuqondakala ngokuxilongwa okukhona (kufaka phakathi i-hypersexual disorder), kunesizathu sokuqapha ngokumane nje sitholakale ngokuxilongwa kokusetshenziswa kwe-inthanethi okuyinkinga. Ukuvumelana kwegama lokuxilonga kanye nenqubo yokuziphatha kwe-hypersexual kuzokhuthaza ucwaningo olwengeziwe olungasisiza ukuba siziqonde kangcono lezi ziguli, futhi ngethemba ukuthi sizonikeza ukunakekelwa okungcono. Yize uhla lwama-hypotheses abekwe phambili mayelana ne-etiology ye-hypersexual disorder (3, 17), mincane imininingwane yedatha yokusekela noma imuphi umbono. Imithi eminingana iye yaphakanyiswa ukuthi ilusizo, ngokugxila okuningi kuma-SSRI, kepha kunodaba lokuvivinywa okulawulwayo. Ngokufanayo, ukwelashwa ngezengqondo kukhuthaza njalo ngaphandle kokuxhaswa okulinganiselwe. Noma kunjalo, odokotela abasebenza ngokusebenza ne-hypersexual disorder banethemba lokuthi iziguli eziningi zingasizwa ngokunakekelwa okufanele komtholampilo. (33).
Yamukelwe ngoJulayi 24, 2000; izibuyekezo zithole uJan. 19, Ephreli 13, noMeyi 22, 2001; yamukelwe ngoMeyi 23, 2001. Kuvela eMnyangweni Wezengqondo, Inyuvesi yaseStellenbosch; uMnyango Wezengqondo, i-University of Iowa, Iowa City; uMnyango Wezengqondo, iYunivesithi yaseFlorida, eGainesville; kanye neNew York State Psychiatric Institute, uMnyango Wezengqondo, eColumbia University, eNew York. Faka izicelo zokuphindwaphindwa kuDkt Stein, ophikweni olubhekene nokukhathazeka ngokuxhamazela, uMkhandlu Wezokucwaninga Ngezokwelapha, uMnyango Wezengqondo, Inyuvesi yaseStellenbosch, I-PO Box 19063, iTygerberg 7505, eKapa; [i-imeyili ivikelwe] (i-imeyili) .Dr. UStein usekelwa nguMkhandlu Wokucwaninga Ngezokwelapha waseNingizimu Afrika.
Okubhekwayo
I-1. IShapira NA, iGoldsmith TD, i-Keck PE Jr, i-Khosla UM, iMcElroy SL: Izici zengqondo zabantu abanenkinga yokusebenzisa i-inthanethi okuyinkinga. I-Affect Disord I-2000; I-57: 267-272I-Crossref, I-Medline, -Google Scholar
I-2. I-Black DW, i-Belsare G, iSchlosser S: Izici zokwelashwa, ukuqina kwengqondo, kanye nezinga lempilo elihlobene nempilo kubantu ababika ukusebenza kwekhompyutha okuphoqelekile. J Clin Psychiatry I-1999; I-60: 839-844I-Crossref, I-Medline, -Google Scholar
I-3. UGoodman A: Umlutha Wezocansi: Indlela Ehlanganisiwe. I-Madison, i-Conn, Amanyuvesi Wezizwe Cindezela, i-1998-Google Scholar
I-4. UFreud S: Izindatshana ezintathu emcabangweni wezocansi (i-1905), ku-Full Psychological Works, i-ed ejwayelekile, i-vol 7. ILondon, iHogarth Press, i-1953, i-X XUMUM-125-Google Scholar
I-5. I-Fava M, iRosenbaum JF, iMcGrath PJ, iStewart JW, i-Amsterdam JD, i-Quitkin FM: ukwengezwa kwe-Lithium kanye ne-triceclic yezokwelapha nge-fluoxetine yokulwa nokudangala okukhulu: isifundo esiphindwe kabili esingaboni. Am J Psychiatry I-1994; I-151: 1372-1374isixhumanisi, -Google Scholar
I-6. ILungu leKafka: Ukwelashwa okuphumelelayo kokuthintela ukunqotshwa kwemizwa yokuluthwa okungaxutshwe nalutho kubantu abesilisa. J Clin Psychiatry I-1991; I-52: 60-65I-Medline, -Google Scholar
I-7. UStein DJ, Hugo F, Oosthuizen P, Hawkridge S, van Heerden B: Neuropsychiatry of hypersexuality: amacala amathathu nengxoxo. I-CNS Spectrum I-2000; I-5: 36-48I-Medline, -Google Scholar
I-8. UStein DJ, uHollander E, u-Anthony D, uSchneier FR, uFallon BA, uLiebowitz MR, uKlein DF: Imithi yaseSerotonergic yokuthola inkanuko yezocansi, umlutha wobulili, kanye neparaphilias. J Clin Psychiatry I-1992; I-53: 267-271I-Medline, -Google Scholar
I-9. ILiebowitz MR, Quitkin FM, Stewart JW, McGrath PJ, Harrison WM, Markowitz JS, Rabkin JG, Tricamo E, Goetz DM, Klein DF: Ukucaciswa kwe-Antidepressant ekucindezelekeni kwe-atypical. I-Arch Gen Psychiatry I-1988; I-45: 129-137I-Crossref, I-Medline, -Google Scholar
I-10. I-Lonngvist J, Sihvo S, Syvalahti E, Kiviruusu O: I-Moclobemide ne-fluoxetine ekucindezelekeni kwe-atypical: isivivinyo esiphindwe kabili. I-Affect Disord I-1994; I-32: 169-177I-Crossref, I-Medline, -Google Scholar
I-11. UStein DJ: Psychiatry ku-Intanethi: inhlolovo yohlu lwamakheli lwe-OCD. Psychiatr Bull I-1997; I-21: 95-98I-Crossref, -Google Scholar
I-12. I-JE Encane: Ukwelapha Okuqondayo Kwezinkinga Zobuntu: Indlela Egxilwe Kwisosha. ISarasota, i-Fla, i-Professional Resource Exchange, i-1990-Google Scholar
I-13. Ilunga leKafka, i-Prentky RA: Ukuqashelwa kokuqala kwe-DSM-III-R axis I comorbidity emadodeni anezinkinga zokuhlaselwa yisifo sokusha kanye ne-paraphilia. J Clin Psychiatry I-1994; I-55: 481-487I-Medline, -Google Scholar
I-14. I-Kafka M: Ukwelashwa kwe-Psychopharmacological kokuziphatha okungahambisani nobulili. I-CNS Spectrum I-2000; I-5: 49-59I-Medline, -Google Scholar
I-15. IKruesi MJP, Fine S, Valladares L, Phillips RA Jr, Rapoport JL: Paraphilias: Ukuqhathanisa okungaboni okubili okungafani nokuqhathanisa ne-clomipramine dhidi ye-desipramine. I-Arch Sex Behav I-1992; I-21: 587-593I-Crossref, I-Medline, -Google Scholar
I-16. UKrafft-Ebbing R: Psychopathia Sexis: Ucwaningo lweMedico-Forensic (1886). INew York, Amadodana kaGP Putnam's, 1965-Google Scholar
I-17. I-Black DW: Ukuziphatha kobulili okuphoqelekile: isibuyekezo. J Ezisebenzayo Izeluleko Zengqondo Nezempilo I-1998; I-4: 219-229-Google Scholar
I-18. I-Fenichel O: I-Psychoanalytic Theory of Neuroses. New York, WW Norton, 1945-Google Scholar
I-19. I-Quadland M: Ukuziphatha okucansini okuphoqayo: Incazelo yenkinga nendlela yokwelashwa. I-Sex Sex Ther I-1985; I-11: 121-132I-Crossref, I-Medline, -Google Scholar
I-20. I-Coleman E: Imodeli ecasulayo-yokuphoqelela yokuchaza ngokuziphatha kocansi okuphoqelelayo. I-Am J Preventive Psychiatry Neurol I-1990; I-2: 9-14-Google Scholar
I-21. I-Barth RJ, i-Kinder BN: Ukufakwa ngendlela engafanele kwezipho zokuya ocansini. I-Sex Sex Ther I-1987; I-1: 15-23I-Crossref, -Google Scholar
I-22. UStein DJ, Hollander E: Imikhawulo yokuxilonga “umlutha”: Impendulo kaDkt Stein noDkt Hollander (incwadi). J Clin Psychiatry I-1993; I-54: 237-238I-Medline, -Google Scholar
I-23. I-Orford J: I-Hypersexuality: imiphumela yemfundiso yokuncika. Br J Addict I-1978; I-73: 299-310I-Crossref, -Google Scholar
I-24. UStein DJ, uBlack DW, uPienaar W: Izinkinga zocansi ezingacaciswanga ngenye indlela: kuyaphoqa, kuyaphoqeleka noma kuyimilutha? I-CNS Spectrum I-2000; I-5: 60-64I-Medline, -Google Scholar
I-25. I-Spitzer RL, Wakefield JC: Inqubo yokuxilonga ye-DSM-IV ngokubaluleka komtholampilo: kuyasiza yini ukuxazulula inkinga yamanga yokuthola imiphumela? Am J Psychiatry I-1999; I-156: 1856-1864abstract, -Google Scholar
I-26. I-Boorse C: Umahluko phakathi kwezifo nokugula. Ifilosofi kanye Nezindaba Zomphakathi I-1975; I-5: 49-68-Google Scholar
I-27. I-Wakefield JC: Umqondo wokuphazamiseka kwengqondo: emngceleni phakathi kwamaqiniso emvelo namagugu ezenhlalo. I-Psychol I-1992; I-47: 373-388I-Crossref, I-Medline, -Google Scholar
I-28. UReznek L: Ukuvikelwa Kwefilosofi Yengqondo. I-New York, i-Routledge, i-1991-Google Scholar
I-29. I-Brenner V: I-Psychology yokusetshenziswa kwamakhompiyutha, i-XLVII: imingcele yokusebenzisa i-Inthanethi, ukuhlukunyezwa nokulutha: izinsuku zokuqala ze-90 ze-Internet Ukusetshenziswa Kwe-Intanethi. I-Psychol Rep I-1997; I-80: 879-882I-Crossref, I-Medline, -Google Scholar
30. I-KS Encane: Ibanjwe kuNet. ENew York, John Wiley & Sons, 1998-Google Scholar
I-31. UMcFarlane M, Bull SS, Rietmeijer CA: I-Intanethi njengendawo esanda kuvela yobungozi yezifo ezidluliselwa ngocansi. I-JAMA I-2000; I-384: 443-446I-Crossref, -Google Scholar
I-32. I-Cooper A, i-Scherer CR, i-Boies SC, i-Gordon BL: Ukuya ocansini kwi-Intanethi: kusuka ekuhloleni ngobulili kuya ekubonisweni kwe-pathological. I-Professional Psychology: Ucwaningo Nokuzilolonga I-1999; I-30: 154-164I-Crossref, -Google Scholar
I-33. I-Carnes P: Ngaphandle Kwemithunzi: Ukuqonda Ukulutha Kwezocansi. IMinneapolis, iMinn, iCompcare, i-1983-Google Scholar
;