Izindlela zokuzicabangela izinkinga ekucindezelweni kokuziphatha ngokocansi (2018)

abstract

Inhloso yokubuyekeza: Ukubuyekezwa kwamanje kufingqa ukutholakala kwamuva okuphathelene nezinqubo ze-neurobiological zokucindezeleka kokuziphatha ngokocansi (CSBD) futhi inikeza izincomo zocwaningo oluzayo oluthile oluqondene nokuhlukaniswa kwezimo zesimo.

Iziphumo zakamuva: Kuze kube manje, ucwaningi oluningi lokuziphendulela ngokweqile ngokuziphatha okubi ngokocansi luhlinzekele ubufakazi bokusebenzisa izindlela eziqhamuka ezithinta ukuziphatha kobulili nokucindezela okungezona ngokocansi. Ukuziphatha ngokweqile ngokobulili kuhlotshaniswa nokusebenza okushintshiwe ezindaweni ezibuchopho kanye namanethiwekhi okubandakanyeka ekukhuthazeni, ukuhlala, ukuguqulwa kokucindezeleka, nokubuyisela ukucubungula emaphethini afana nokusebenzisa izinto, ukugembula, kanye nokulutha ukubheja. Izizinda zobuchopho ezihlobene nezici ze-CSB zihlanganisa i-cortices yangaphambili neyesikhashana, i-amygdala, ne-striatum, kuhlanganise ne-nucleus accumbens.

Indaba efingqiwe: Naphezu kocwaningo oluningi lwe-neuroscience ukuthola ukufana okuningi phakathi kwe-CSBD kanye nezidakamizwa zokuziphatha nokuziphatha, i-World Health Organization ihlanganisa i-CSBD I-ICD-11 njenge-disorder-control control. Nakuba ucwaningo lwangaphambili luye lwasiza ukugcizelela ezinye izindlela ezisemqoka zalesi simo, uphenyo olwengeziwe luyadingeka ukuze kuqondwe ngalesi simo futhi kuxazululwe izinkinga zokuhlukanisa i-CSBD.

Isingeniso

Ukuziphatha kocansi okuphoqelekile (CSB) yisihloko esixoxwayo esibizwa nangokuthi ukulutha ngokobulili, ukuxhasana ngokobulili, ukuxhaswa ngokocansi, ukufisa ngokobulili, i-nymphomania, noma ukuziphatha okungahambisani nokuziphatha ngokocansi [1-27]. Nakuba amazinga acacile angacaciswanga ngokucwaninga okwenziwe okulinganiselwe we-epidemiological, i-CSB kulinganiselwa ukuthi iyathinta i-3-6% yabantu abadala futhi ivame kakhulu emadodeni kunabesifazane [28-32]. Ngenxa yokucindezeleka nokukhubazeka okuhlotshaniswe ngamadoda nabesifazane abane-CSB [4-6, 30, 33-38], i-World Health Organisation (WHO) inconywe kuhlanganise ne-Compulsive Sexual Behavior Disorder (CSBD) kulo mhlangano ozayo we-11th we- Ukuhlukaniswa Kwezifo Zomhlaba Wonke (6C72) [39]. Lokhu kufakwa kufanele kusize ukwandisa ukufinyelela kokwelashwa kubantu abangekho emphakathini, ukunciphisa ukucwasa nokuhlazeka okuhambisana nokufuna usizo, ukugqugquzela imizamo yokucwaninga ngokubambisana, nokwandisa ukunakekelwa kwamazwe ngamazwe kule nkinga [40, 41] .Sivuma ukuthi eminyakeni engapheli ye-20 kukhona lapho beyizincazelo ezihlukahlukene ezichazwa ukuchaza ukuziphatha okubi ngokobulili ngokuvamile kubonakala ngokubandakanyeka ngokweqile kwimisebenzi yezocansi ezingenasaphila (isb., ubulili obuvamile / obungaziwa, ukusetshenziswa kobucayi kwezithombe zobulili ezingcolile). Ukubuyekezwa kwamanje, sizosebenzisa i-CSB ngokuthi yisikhathi esiphezulu sokuchaza inkinga, ukuziphatha ngokweqile ngokocansi.

I-CSB iye yacatshangwa njengesiyaluyalu esiyinkimbinkimbi-ye-spectrum, i-disorder-control control, noma ukuziphatha komlutha [42, 43]. Izimpawu ze-CSBD zifana nalabo okuhlongozwayo ku-2010fort I-DSM-5 ukuxilongwa kwe-hypersexual disorder [44]. Ukuphazamiseka kwe-hypersexual ekugcineni kwakungabandakanywa yi-American Psychiatric Association I-DSM-5 ngezizathu eziningi; ukuntuleka kwezifundo ze-neurobiological kanye nezakhi zofuzo kwakuphakathi kwezizathu eziveziwe kakhulu [45, 46]. Muva nje, i-CSB ithole ukunakekelwa okukhulu emasikweni nasenhlalakahle ethandwayo, ikakhulukazi kunikezwa ukungalingani kwezempilo okuphazamisa amaqembu angengozini futhi angalondoloziwe. Naphezu kokwanda okukhulu kwezifundo ze-CSB (kufaka phakathi labo abacwaninga "ukulutha ngokobulili," "ukucwasa ngokobulili," "ukucindezela ngokocansi"), ucwaningo oluncane luye lwahlola i-neural underpinnings ye-CSB [4, 36]. Lesi sihloko sibheka izindlela ze-neurobiological ze-CSB futhi sinikeza izincomo zocwaningo lwesikhathi esizayo, ikakhulukazi njengoba zihlobene nokuhlukaniswa kwezigaba ze-CSBD.

I-CSB njenge-Addictive Disorder

Izifunda zobuningi ezihilelekile ekusebenzeni imivuzo cishe kubalulekile ekuqondeni umsuka, ukwakheka nokugcinwa kwezimo zokulutha [47]. Izakhiwo ngaphakathi kokuthi okuthiwa 'uhlelo lokuvuza' ziqaliswa ngokufaka amandla okuvuselela, njengokudakwa kwezidakamizwa eziluthayo. I-neurotransmitter eyinhloko ehilelekile ekusetshenzisweni kwemivuzo i-dopamine, ikakhulukazi emgwaqweni we-mesolimbic ohlanganisa indawo ye-ventral tegmental (VTA) kanye nokuxhumana kwayo ne-nucleus accumbens (NAc), kanye ne-amygdala, i-hippocampus, ne-prefrontal cortex [48]. Ama-neurotransmitter engeziwe kanye nezindlela zibandakanyeka ekusebenziseni imivuzo kanye nokuzijabulisa, futhi lezi zifakazo zokucabangela zinikezwa ukuthi i-dopamine iye yahlotshaniswa ngezinga elihlukile ezidakamizwa nezidakamizwa ngabanye kubantu [49-51].

Ngokusho komqondo wokukhuthaza umqondo, izinqubo ezahlukene zobuchopho zithonya isisusa sokuthola umvuzo ('ukufuna') kanye nokuhlangenwe nakho kwangempela kwe-hedonic ('ukuthanda') [52]. Nakuba 'ukufuna' kungase kuhlobene eduze ne-neurotransmission ye-dopaminergic ku-ventral striatum (VStr) ne-orbitofrontal cortex, amanethiwekhi azinikezele ekudaleni izintshisekelo ezifunayo nemizwa ejabulisayo kunzima kakhulu [49, 53, 54].

Ukuphindaphinda okuhlobene nomvuzo kwe-VStr kufundwe ezinkingeni zokulutha ezifana notshwala, i-cocaine, ukuphazamiseka kokusebenzisa i-opioid, kanye nenkinga yokugembula [55-58]. UVolkow nozakwabo bachaza izinto ezine ezibalulekile zokulutha: (1) ukuzwela okubandakanya ukucubungula kabusha kwe-cue kanye nokulangazelela, (2) ukungabi namizwa okubandakanya ukujwayela, (3) ukungazenzisi, kanye (4) nezinhlelo zokucindezeleka ezingasebenzi kahle [59]. Kuze kube manje, ucwaningo lwe-CSB lugxile kakhulu ekusebenzeni kabusha kwe-cue, ukufisa, nokujwayela. Izifundo zokuqala ze-neuroimaging ze-CSB zazigxile ekuhloleni ukufana okungaba khona phakathi kwe-CSB nezidakamizwa, ngokugxila okuthile kumqondo wokukhuthaza osuselwe ekuzweleni kwe-neural sensitization okuhlobene nezinguquko ezinhlelweni zokugqugquzela ezihlobene ne-dopamine [60]. Kulesi simodeli, ukuvezwa okuphindaphindiwe kwezidakamizwa ezingaba umlutha kungashintsha amaseli obuchopho namasekhethi alawula ukunikezwa kwesibindi sokukhuthaza, okuyinqubo engokwengqondo ebandakanyeka ekuziphatheni okukhuthazekile. Ngenxa yalokhu kuvezwa, imijikelezo yobuchopho ingahle ibe ne-hypersensitive (noma ikhuthazwe), ngaleyo ndlela ibe nomthelela ekuthuthukisweni kwamazinga e-pathological of salience okukhuthaza izinto eziqondiwe kanye nezinkomba zazo ezihambisanayo. Isisusa sesikhuthazo se-pathological ('ukufuna') izidakamizwa singahlala iminyaka, noma ngabe ukusetshenziswa kwezidakamizwa kuyekiwe. Kungabandakanya izinqubo ezisobala (zokufuna ukwazi) noma izinqubo ezicacile (zokulangazelela ukwazi). Imodeli yesibindi yokukhuthaza iphakanyisiwe ukuthi ibe nomthelela ekuthuthukiseni nasekugcinweni kwe-CSB [1, 2].

Idatha isekela imodeli yokukhuthaza ukukhuthaza i-CSB. Isibonelo, i-Voon nozakwabo bahlolwe umsebenzi owenziwe ngokukhipha ku-corsulate cteulate cortex (i-DACC) -Vstr -amygdala yenethiwekhi esebenzayo [1] .Men ne-CSB uma kuqhathaniswa nalabo abangaphandle babonise ukwandisa i-VStr, i-DACC, nezimpendulo ze-amygdala kwividiyo yezocansi omfisha. Lokhu okutholakala kumongo wezincwadi ezinkulu kusikisela ukuthi ubulili kanye nokusetshenziswa kwezidakamizwa ekusebenziseni izidakamizwa kuhilela izifunda eziningi kanye nezixhumanisi [61, 62]. Abesilisa abane-CSB uma kuqhathaniswa nalabo abangaphandle ngaphandle kokubikwa nokufunwa okuphezulu (isifiso sokuzicabangela ngokocansi) sezithombe zobulili ezingcolile ezithandayo kanye nokuthanda okunciphisa okuhambisana nethonya lombono wokukhuthaza [1]. Ngokufanayo, amaMechelmans nabalingani bakhe bathola ukuthi amadoda anama-CSB uma kuqhathaniswa namadoda ngaphandle angaboniswa ngcono ukukhathazeka kokuqala okubhekiswe kocansi kodwa hhayi emaceleni okungahambisani necala [2]. Lokhu kutholakala kusikisela ukufanana nokuqhakambisa ukukhathazeka okubheke ekuhloleni ukuhlola izidakamizwa zezidakamizwa ezidakamizwa.

Ku-2015, uSeok noSohn bathola ukuthi phakathi kwamadoda ane-CSB uma kuqhathaniswa nalabo abangenalo, umsebenzi omkhulu wabonakala ku-dorsolateral prefrontal cortex (dlPFC), i-caudate, i-gyrus engaphansi kwe-parietal lobe, i-DACC, ne-thalamus ekuphenduleni imibono yobulili [63]. Bathola nokuthi ubukhulu bezimpawu ze-CSB buhambisana nokusebenza okukwenziwa kwe-dlPFC ne-thalamus. Ku-2016, uBrith kanye nozakwethu babone ukusebenza okukhulu kwe-VStr yezinto eziphathekayo zobulili ezingcolile uma kuqhathaniswa nezinto ezingcolile zobulili ezingcolile phakathi kwabantu abane-CSB futhi bathola ukuthi umsebenzi we-VStr wawuhlotshaniswa kahle nezimpawu ezizimele zokusebenzisa umlutha wezocansi ezingcolile ze-intanethi (ehlolwe ngu- Isivivinyo esincane se-Inthanethi se-Addiction shintshiwe nge-inthanethi ye-cyber (s-IATsex) [64, 65].

Ukuqhaqha kanye nabasebenza nabo kusanda kuphawula ukuthi abahlanganyeli abane-CSB baqhathaniswa nabahlanganyeli ngaphandle kokubonisa ukuvuselelwa okukhulu kwe-amygdala ngenkathi kusethulwa izigcawu ezifakiwe (izikwele ezinemibala) ukubikezela izithombe ezingezansi (imivuzo) [66]. Lezi ziphumo zifana nalabo abavela kwezinye izifundo ezihlola ukusebenziselwa kwe-amygdala phakathi kwabantu abanezinkinga zokusebenzisa izidakamizwa namadoda ane-CSB abukela amavidyo kliphu ecacile ngocansi [1, 67] .Usebenzisa i-EEG, uSteele nozakwabo babheka ukuphakama okuphezulu kwe-P300 ezithombeni zocansi (uma kuqhathaniswa izithombe ezingathathi hlangothi) kubantu abathile abazibheka njengezinkinga nge-CSB, ukubonisana nokucwaninga kwangaphambili kokucubungula izici ezibonakalayo ezidakamizwa ekulutha izidakamizwa [68, 69].

Ku-2017, i-Gola kanye nozakwethu bashicilele imiphumela yocwaningo ngokusebenzisa i-imaging yokuvuselela i-magnetic resonance (fMRI) ukuhlola izimpendulo ze-Vstr ekuthathweni kwe-erotic nemali kubantu abafuna ukwelashwa kwe-CSB namadoda ngaphandle kwe-CSB [6]. Abahlanganyeli babenomsebenzi wokubambezeleka wokugqugquzela [54, 70, 71] ngenkathi behlaziya i-fMRI. Ngesikhathi salo msebenzi, bathola imivuzo engavamile noma yemali elandelwa ngaphambili. Amadoda aphethe i-CSB ahluke kulabo abangenazo izimpendulo ze-VStr ukuze baqaphele ukubikezela izithombe ezibucayi, kodwa hhayi ezimpendulo zabo ezithombeni ezingezansi. Ukwengeza, amadoda ane-CSB ngokungafani ne-CSB abonise ukukhishwa okukhulu kwe-VStr ngokuqondile ngamagama okubikezela izithombe ezingezansi futhi hhayi kulabo ababikezela ukuvuza kwemali. Ukuzwela kobudlelwane obuhlobene nokukhuluma (ukubikezela izithombe ezithandanayo nezindleko zemali) kutholakale ukuthi kuhlotshaniswa nesisusa sokuziphatha sokukhula sokubuka izithombe ezingenakuqhathaniswa ('ukufuna'), ubukhulu be-CSB, inani lezithombe zobulili ezingcolile ezisetshenziswe ngesonto, nokuvama kokushaya indlwabu ngesonto. Lokhu kutholakala kusikisela ukufana phakathi kwe-CSB kanye nezidakamizwa, indima ebalulekile yezinkulumo ezifundwayo kwi-CSB, kanye nezindlela zokwelapha okungenzeka, ikakhulukazi ukungenelela kugxile emakhono okufundisa kubantu ngabanye ukubhekana ngokuphumelelayo nezifiso / ukukhuthaza [72]. Ngaphezu kwalokho, ukujwayela kungabonakaliswa ngokunciphisa ubuzwe obunomvuzo okwenzeka ngokujwayelekile futhi kungathinta izimpendulo zomvuzo ezenzweni zobulili kubandakanya ukubuka izithombe zobulili ezingcolile kanye nobulili obuhlukanisiwe [1, 68]. Ukuzijwayeza kuye kwacatshangelwa ekuziphatheni komzimba kanye nokuziphatha ngokweqile [73-79].

Ku-2014, Kuhn noGallinat baphawula ukunciphisa i-VStr reactivity ekuphenduleni izithombe ezithandekayo eqenjini labahlanganyeli ukubukela izithombe zobulili ezingcolile njalo, uma kuqhathaniswa nabahlanganyeli ababukela izithombe ezingcolile zobulili ngokuvamile [80] .Ukuhlanganiswa okusebenzayo phakathi kwe-dlPFC ne-VStr kwesokudla kwaphawula futhi. Ukukhubazeka kokujikeleza kwe-fronto-striatal kuye kwahlotshaniswa nokukhetha okungalungile noma okungalungile kokuziphatha kungakhathaliseki ukuthi kungabangela yini imiphumela engalungile kanye nokulawulwa kokukhubazeka kokulutha kwezidakamizwa [81, 82]. Abantu abane-CSBmay baye banciphisa ukulawula okuphezulu lapho bevezwe kwendaba yezocansi [83, 84]. U-Kuhn noGallinat bathola ukuthi umthamo wegrey volume of the striatum efanele (caudate nucleus), okuye kwagxila ekuziphatheni-okunamathiselwe okuhambisana nawo futhi okuhlobene nezimo ezishukumisayo ezihambisana nothando lomlingani, azihambisani kabi nobude bezithombe zobulili ezingcolile ze-intanethi [80, 85, 86]. Lokhu kutholakala kuphakamisa ukuthi kungenzeka ukuthi ukusetshenziswa kaningi kwezithombe zobulili ezingcolile kunganciphisa ukuvuselelwa kobuchopho ekuphenduleni isenzo socansi futhi kwandise ukujwayela izithombe zocansi nakuba kudingeke ukuthi kusetshenziswe isikhathi eside ukuze kukhishwe ezinye izindlela.

Ucwaningo olusebenzisa i-EEG, oluqhutshwa yiPrause kanye nozakwethu, luphakamisa ukuthi abantu abazizwa becindezelekile ngezithombe zabo zobulili ezingcolile, uma kuqhathaniswa neqembu elilawulayo abazizwa bacindezelekile ngokusetshenziswa kwabo kwezithombe zobulili ezingcolile, bangadinga ukugqugquzela okubonakalayo / okukhulu ukuvusa izimpendulo zobuchopho [87]. Abahlanganyeli abangena ocansini-ngabanye 'babhekene nezinkinga ezilawula ukubuka kwabo kwezithombe zocansi' (M= Amahora angu-3.8 ngesonto) -kuboniswe ukusebenza okuncane kwe-neural (kulinganiswa ngamakhono angakapheli esithombeni se-EEG) uma kuvezwe ezithombeni zobulili kunokuba iqembu leqhathaniswa liboniswe emifanekisweni efanayo. Kuncike ekuchazeni isenzo socansi kulolu cwaningo (njengengqikithi noma umvuzo; ngokuningi ubone i-Gola et al. [4]), lokho okutholakele kungase kusekele ezinye iziboniso ezibonisa imiphumela yokuhlala emilonyeni [4] .E2015, Banca kanye nozakwethu babone ukuthi amadoda anama-CSB akhethisa isenzo sobulili noveli futhi abonisa ukutholakala okuphakamisa ukujwayela ku-DACC uma bevezwe ngokuphindaphindiwe emifanekisweni efanayo [88]. Imiphumela yocwaningo olukhulunywe ngenhla lisikisela ukuthi ukusetshenziswa kwezithombe zobulili ezingcolile ngokuvamile kunganciphisa ukuzwela komvuzo, okungenzeka kuholele ekwenzeni ukwandisa nokubekezela, ngaleyo ndlela kukhulise isidingo sokugqugquzela okukhulu ukuvuswa ngokocansi. Kodwa-ke, izifundo zesikhathi eside ziboniswa ukuhlola lokhu kungenzeka. Ukuhlanganiswa ndawonye, ​​ukucwaninga nge-neuroimaging kuze kube yimanje kuye kwahlinzeka ukwesekwa kokuqala ngombono wokuthi ukulingana kwe-CSB kuhambisana nokusetshenziswa kwezidakamizwa, ukugembula, kanye nokulutha ukubheja ngokuphathelene namanethiwekhi okuguqula ubuchopho kanye nezinqubo, kuhlanganise nokuzwela kanye nokujwayela.

I-CSB njenge-Disulse-Control Disorder?

Isigaba esithi "Ukuphazamiseka Kwempikiswano-Okungavunyelwe Kwenye indawo" ku-DSM-IV kwakungokwemvelo futhi kwafaka ukuphazamiseka okuningi okuye kwaphinde kwachazwa njengokuba umlutha (ukugembula kwengozi) noma okuhlobene nokucindezeleka-okuhlobene ne-trichotillomania ku-DSM- 5 [89, 90]. Isigaba samanje ku-DSM-5 sigxile ekuphazamiseni, ukulawula ukucindezela nokuziphatha okungahambisani nokuzibandakanya, ngokubhekelana kakhulu nokugxila ekugxileni ngokufaka i-kleptomania, i-pyromania, i-disruptive disorder disorder, ukuphikisana nokuphazamiseka kwengxabano, ukuphazamiseka kokuziphatha, kanye nokuhlukunyezwa komuntu okungahambisani nabantu [90]. Isigaba sokukhathazeka kokulawula ukucindezeleka ku I-ICD-11kufaka lezi zinkinga ezintathu zokuqala kanye ne-CSBD, ukuphakamisa imibuzo mayelana nokuhlukaniswa okufanele kakhulu. Njengoba kunikezwe lo mongo, ukuthi i-CSBD ihlobene kanjani nokwakhiwa kwe-transdiagnostic yokugunyazwa kokungafuneki ukucutshungulwa okungeziwe kokuhlelwa kwezinhlelo kanye nezinhloso zomtholampilo.

Ukungafisi kungase kuchazwe ngokuthi, "ukulungiswa kokuqondisa okusheshayo, okungakahlelwa okubangelwa ngaphakathi kwangaphakathi noma kwangaphandle ngokunciphisa imiphumela emibi kumuntu oyedwa noma abanye" [91]. Ukungaziphathi kahle kuye kwahlotshaniswa nocansi [92]. Ukungafani komzimba kuyakhiwa okuningi ngezinhlobo ezahlukene (isb., Ukukhetha, impendulo) okungenzeka ibe nemfanelo nezici zesimo [93-97]. Izinhlobo ezingafani zokungafisi kungabuyekezwa nge-self-report noma ngemisebenzi. Kungase kuhlangane ngokubuthakathaka noma cha, ngisho nangendlela efanayo yokungafuni; okubalulekile, bangase bahambisane ngokuhlukile nezici zomtholampilo nemiphumela [98]. Ukuziphendulela komqondo okungenzeka kungalinganiswa nokusebenza emisebenzini yokulawula engavimbeleki, njengezimpawu zokumisa noma i-Go / No-Go imisebenzi, kanti ukukhetha okungalingani kungase kuhlolwe ngokubambezeleka kokukhipha imisebenzi [94, 95, 99].

Idatha ibonisa ukungafani phakathi kwabantu abangenawo ngaphandle kwe-CSB ekuziphenduleleni komuntu siqu nakwezinyathelo ezisekelwe emisebenzini yokungabi nesifiso [100-103]. Ngaphezu kwalokho, ukungahambi kahle nokulangazelela kubonakala sengathi kuhlotshaniswa nobuqili bezimpawu zokusetshenziswa kobulili ezingcolile, njengokulahlekelwa kokulawula [64, 104]. Isibonelo, isifundo esisodwa sithole imiphumela ehlangene yamazinga okungafisi okulinganiselwe yi-self-umbiko kanye nemisebenzi yokuziphatha ngokuphathelene nemithonya eqoqayo ekuqinekeni kwezimpawu ze-CSB [104].

Phakathi kwamasampula okufuna ukwelashwa, i-48% kuya ku-55% yabantu bangabonisa amazinga aphezulu wokungafuni ukukhiqiza ku-Barratt Impulsiveness Scale [105-107]. Ngokuphambene nalokho, olunye ulwazi lubonisa ukuthi ezinye iziguli ezifuna ukwelashwa kwe-CSB azikho ezinye izimo zokuzikhukhumeza noma izidakamizwa ezingenakuqhathaniswa ngaphandle kokubhekana nezinkinga zokuziphatha ngokobulili ezihambisana nokuthola okuvela ekuhloleni okukhulu kwe-inthanethi kwamadoda nabesifazane okuphakamisa ubudlelwane obuthakathaka obuphakathi kokungabi namfutho nabanye izici ze-CSB (ukusetshenziswa kwezithombe ezingcolile zobulili ezingcolile) kanye nobuhlobo obunamandla nabanye (ubulili obufanayo) [108, 109]. Ngokufanayo, ocwaningweni esebenzisa izinyathelo ezahlukene zabantu abanezithombe zobulili ezingcolile eziyinkimbinkimbi zisebenzisa (isikhathi esithinta izithombe zobulili ezingcolile samasonto onke sisebenzisa = amaminithi we-287.87) nalabo abangenawo (isikhathi esithinta izithombe zobulili ezingcolile samasonto onke = amaminithi we-50.77) awafani nalokho okubikiwe (UPPS-P Isikali) noma izinyathelo ezisekelwe emsebenzini (Stop Signal Task) zokungaziphathi kahle [110] .Ngaphezu kwalokho, u-Reid nozakwabo abazange babone umehluko phakathi kwabantu abane-CSB nokulawula okunempilo ekuvivinyeni kwe-neuropsychological yokusebenza okuphezulu (okungukuthi, ukuvimbela impendulo, isivinini sezimoto, ukukhetha ukunakwa, ukuphaphama, ukuguquguquka kwengqondo, ukubunjwa kwemqondo, ukusetha ukushintsha), ngisho nangemva kokulungiswa kwekhono lokuqonda ukuhlaziya [103]. Ngokubodwa, ukufundwa kusikisela ukuthi ukungafisi kungathinta kakhulu ukuxhumene kocansi kodwa hhayi emafomu athile e-CSB njengokusetshenziswa kocansi okuyizinkinga. Iphakamisa imibuzo mayelana nokuhlukaniswa kwe-CSBD njengengxabano yokulawula impulse I-ICD-11 futhi kugcizelela isidingo sokuhlolwa okuqondile kwezinhlobo ezahlukene ze-CSB. Lokhu kubalulekile ikakhulukazi ngoba ucwaningo oluthile lukhombisa ukuthi ukungaziphathi kahle kanye nezizinda ezingaphansi kwe-disorder-control control (i-disorder-control control disorder) ziyahlukahluka ezingeni lomqondo kanye ne-pathophysiological [93, 98, 111].

I-CSB njenge-Obsessive-Compulsive-Spectrum Disorder?

Isimo esisodwa (i-trichotillomania) esichazwa njengesiyaluyalu sokulawula ukucindezeleka ku-DSM-IV senziwe kabusha nge-dispersive-compulsive disorder (OCD) njengesiyaluyalu esicindezelayo futhi esihlobene no-DSM-5 [90]. Ezinye izidakamizwa ze-DSM-IV ezifana nokugembula kwengculazi kubonisa ukungezwani okukhulu okuvela ku-OCD, okusekela ukuhlukaniswa kwabo ngezigaba ezihlukene [112]. Ukuphoqeleka kuyisakhiwo sokudlulisa amehlo okubandakanya, "ukusebenza okuphindaphindiwe nokusebenza kanzima ngokweqile noma kokuziphatha ngaphandle kokusebenza okuguquguqukayo, okwenziwe ngendlela eqondile noma ejwayelekile, ngokusho kwemithetho eqinile noma njengendlela yokugwema imiphumela emibi" [93]. I-OCD ibonisa amazinga aphezulu okuphoqeleka; Nokho, ngakho-ke kukhona izidakamizwa nezidakamizwa zokuziphatha ezifana nokugembula kwesifo [98]. Ngokwesiko, ukuphazamiseka okuphoqelekile nokucindezela kwakubhekwa njengokulala phansi ekugcineni kwe-spectrum; Kodwa-ke, idatha idlulisa ukuthi ukwakheka kuyindlela yokwehlukana kwezinkinga eziningi ezibeka phambili ezilinganisweni zombili kokungahambi kahle nokucindezela [93, 113]. Ngokuphathelene ne-CSB, ukuhlukunyezwa ngokobulili kuye kwachazwa njengokuchitha isikhathi futhi kuphazamiseka futhi kungase kubhekane ngokweqile ku-OCD noma kuzici ezihlobene ne-OCD [114].

Izifundo zakamuva ezihlola izici eziphoqelekayo ezisebenzisayo usebenzisa i-Obsessive-Compulsive Inventory -Izibuyekezo (OCI-R) azizange zibonise ukuphakama phakathi kwabantu abane-CSB [6, 37, 115]. Ngokufanayo, ukuhlola okukhulu kwe-intanethi kutholakale izici zokucindezela kuphela ezihlobene nobuthakathaka obunzima bokusebenzisa izithombe zobulili ezingcolile zisebenzisa i- [109]. Ngokubambisana, lezi zithole azibonisi ukusekela okuqinile kokucubungula i-CSB njengengxabano ehlobene nokucindezeleka. Izici ze-Neural ezisekelwe ekuziphatheni okucindezelayo ziye zachazwa futhi zihlangana phakathi kwezifo eziningi [93]. Izifundo ezengeziwe zisebenzisa izindlela eziqinisekisiwe zengqondo kanye nezindlela zokwenza izinto ezibucayi ekwelapheni okukhulu kokwelashwa okufunwa amasampula kuyadingeka ukuze uhlole ukuthi i-CSBD ingahle ibhekane kanjani nokuphoqeleka kanye ne-OCD.

Izinguquko zesakhiwo se-Neural phakathi kwama-CSB ngabanye

Kuze kube manje, izifundo eziningi ze-neuroimaging zigxile ekushintsheni komsebenzi kubantu abane-CSB, futhi imiphumela ibonisa ukuthi izimpawu ze-CSB zixhunyaniswa nezinqubo ezithile ze-neural [1, 63, 80]. Nakuba izifundo ezisekelwe emsebenzini zithuthukise ulwazi lwethu mayelana nokusebenza kwesifunda nokuxhumana okusebenzayo, izindlela ezengeziwe kufanele zisetshenziswe.

Izinyathelo ezimhlophe noma ezimpunga zihlolwe ku-CSB [102, 116]. Ku-2009, i-Miner nozakwabo bathole ukuthi abantu abane-CSB uma kuqhathaniswa nalabo abangaboniswa isifunda esiphezulu esiphezulu esiphezulu kusho ukungafani futhi babonise ukulawulwa okungenakuphikisana okuncane. Ekucwaningweni kwamadoda angaphandle kwe-CSB kusuka ku-2016, ivolumu engaphezulu kwesokunxele i-amygdala ivaliwe eqenjini le-CSB nokuhlanganiswa okusebenzayo okunciphisa ukuphumula kombuso kubonwe phakathi kwe-amygdala ne-dlPFC [116]. Ukunciphisa imiqondo yobuchopho ku-lobe yangokwemvelo, i-lobe yangaphambili, i-hippocampus, ne-amygdala zitholakala zihlobene nezibonakaliso zobungqingili ezicansini ezinezifo ezibangelwa ukugula komzimba noma isifo se-Parkinson [117, 118]. Lezi zindlela ezibonakala ziphikisanayo ze-amygdala ivolumu ephathelene ne-CSB ziqokomisa ukubaluleka kokucabangela ukungezwani kwe-neuropsychiatric ekuqondeni i-neurobiology ye-CSB.

Ku-2018, u-Seok no-Sohn basebenzisa i-voxel-based morphometry (VBM) nokuhlaziya ukuxhumeka kombuso ukuze bahlole izinyathelo zokuphumula nezimo zokuphumula ku-CSB [119]. Amadoda ane-CSB abonise ukunciphisa okubalulekile kwe-gray gyrus. Ivolumu ye-Left superior temporal gyrus (STG) ayihambisani kakhulu nobukhulu be-CSB (okungukuthi, Ukuvivinya kocansi kwe-Sexual Testing-Revised [SAST] ne-Hypersexual Behavior Inventory [izikolo ze-HBI]) [120, 121]. Ukwengeza, ukuguqulwa kwesokunxele kwesigxathu se-STG-kwesokunxele kanye nesobunxele be-STG-right caudate connectivities kwabonakala. Okokugcina, imiphumela yembula ukungafani okuphawulekayo phakathi kokukodwa kwe-CSB nokuhlanganiswa okusebenzayo kwe-STG kwesokunxele kuya ku-nucleus kwesokudla se-caudate.

Yize ucwaningo lwe-CSB luye lwakhanyisa, kuncane okusaziwa ngezinguquko ezakhiweni zobuchopho nokuhlanganiswa komsebenzi phakathi kwabantu abathile be-CSB, ikakhulukazi ezifundweni zokwelashwa noma ezinye iziklamo zesikhathi eside. Ukuhlanganiswa kokuthola okuvela kwezinye izizinda (isb., Izakhi zofuzo kanye ne-epigenetic) kuzoba kubalulekile ukucubungula ngezifundo ezizayo. Ukwengeza, ukutholakala okuqondile ngokuqhathanisa ukuphazamiseka okuqondile nokufaka izinyathelo zokudlulisa amehlo kuzokuvumela ukuqoqwa kolwazi olubalulekile olungazisa imizamo yokuthuthukiswa kokungenelela nokungenelela okwamanje.

Iziphetho kanye nezincomo

Lesi sihloko sibukeza ulwazi lwesayensi mayelana nezinqubo ze-neural ze-CSB kusuka emibono emithathu: umlutha, ukulawula umfutho, nokucindezela-okuphoqelekile. Ucwaningo oluthile lubonisa ubudlelwane phakathi kwe-CSB nokukhuphula ukuzwela kwemiklomelo yesimo esibucayi noma izinkomba zokubikezela le mivuzo, kanti abanye basikisela ukuthi i-CSB ihlobene nokwenyuka kwesimo se-cue for stimuli oshukumisayo [1, 6, 36, 64, 66]. Ucwaningo lubonisa ukuthi izimpawu ze-CSB zihlobene nokukhathazeka okuphakeme [34, 37,122]. Nakuba kunezikhala ezikhona ekuqondeni kwethu kwe-CSB, izindawo eziningi zobuchopho (kufaka phakathi i-coral, yangaphambili, i-amygdala, ne-striatum), ixhunywe ne-CSB nezici ezihlobene.

I-CSBD ifakwe phakathi kwenguqulo yamanje yamanjeI-ICD-11 njenge-disorder-control control disorder [39]. Njengoba kuchaziwe yi-WHO, 'Ukuphazamiseka kokulawula umfutho kubonakala ngokuhluleka okuphindaphindiwe ukumelana nomfutho, ukushayela noma ukukhuthaza ukwenza isenzo esivuzayo kumuntu, okungenani ngesikhathi esifushane, naphezu kwemiphumela efana nesikhathi eside -kulimaza umuntu noma abanye, ukucindezeleka okuphawulekayo ngephethini yokuziphatha, noma ukukhubazeka okukhulu emndenini, emndenini, ezenhlalakahle, ezemfundo, emsebenzini, noma kwezinye izindawo ezibalulekile zokusebenza '[39]. Izibalo zamuva ziphakamisa imibuzo ebalulekile mayelana nokuhlelwa kwe-CSBD. Iziphazamiso eziningi ezibhekene nokungaziphathi kahle-zilawulwa kwezinye izindawo I-ICD-11 (isibonelo, ukugembula, ukugembula, nokuphazamiseka kokusebenzisa izidakamizwa kubhekwa njengenkinga yokulutha) [123].

Njengamanje, i-CSBD yakha isifo esiyingqayizivele, futhi ukulungiswa okuqhubekayo kwe-CSBD kufanele kuhlukanise phakathi kwe-subtypes ehlukene, okunye okungase kuhlobanise nokuhlukunyezwa kwezinkinga zokuziphatha ngokobulili kubantu abathile [33, 108, 124]. I-Heterogeneity ku-CSBD ingase ibe yingxenye ichaza ukubonakala kokungafani okubonakalayo kuzo zonke izifundo. Nakuba izifundo ze-neuroimaging zithola ukufana okungafani phakathi kwe-CSB kanye nezidakamizwa zokuziphatha nokuziphatha, ucwaningo olwengeziwe luyadingeka ukuze uqonde ukuthi indlela yokuthola i-neurocognition ihlobene kanjani nemikhakha yempilo ye-CSB, ikakhulukazi ngokuphathelene nezenzo zokuziphatha ngokocansi. Ucwaningo oluningi luye lwagxila ekusetshenzisweni okubucayi kwezithombe zobulili ezingcolile ezingahle zikhawulele kwezinye izici zobulili. Ngaphezu kwalokho, izinyathelo zokufaka / ukungeniswa kwezingxenye zabacwaningi be-CSB ziye zahlukahluka kuzo zonke izifundo, futhi ziphakamisa imibuzo ngokuphathelene nokukhiqiza okujwayelekile nokuqhathanisa kuzo zonke izifundo.

Iziqondiso Future

Kumelwe kuphawulwe ukulinganiselwa okuncane ngokuqondene nokuhlolwa kwamanje kwe-neuroimaging futhi kucatshangelwe uma uhlela uphenyo oluzayo (bheka ithebula 1). Imikhakha eyinhloko ihlanganisa amasayizi amancane esampula amhlophe, abesilisa nabesilisa nabesifazane. Ucwaningo olwengeziwe luyadingeka ukuze kutholakale amasampula amakhulu, ahlukene ngamadoda abesilisa nabesifazane abane-CSB nabantu ngabanye bobulili obuhlukile nobujamo. Isibonelo, akukho izifundo zesayensi ezihleliwe eziye zaphenya izinqubo ze-CSB ezithinta abesifazane. Ucwaningo olwenziwe luyadingeka lunikezwe idatha ehlanganisa ukuxilonga ngokocansi ekucindezelaneni kwengqondo kwabesifazane ngokuqhathaniswa namadoda kanye neminye imininingwane ekhombisa ukungezwani kobulili emiphakathini ye-clinic ne-CSB [25, 30]. Njengoba abesifazane nabesilisa abanezidakamizwa bangabonisa ukugqugquzela okuhlukile (isib., Okuhlobene nokungaqiniseki okungalungile nokuziqinisa) ngokuhlanganyela ekuziphatheni okuluthayo nokubonisa umehluko ekucindezelweni nasekubhekaneni nezidakamizwa, izifundo ze-neurobiology ezizayo kufanele zibheke izinhlelo zokucindezeleka nezinqubo ezihlobene nokuphathelene nobulili uphenyo lwe-CSBD lunikezwe ukufakwa kwamanje kulo I-ICD-11 njenge-disorder disorder disorder [125, 126].

Ngokufanayo, kunesidingo sokuqhuba ucwaningo oluhlelekile olugxile ezintweni ezingezansi zobulili nezinhlanga ukuze kucaciswe ukuqonda kwethu kwe-CSB phakathi kwala maqembu. Izinsimbi zokucubungula ze-CSB zivame ukuhlolwa futhi ziqinisekiswe kumadoda amhlophe aseYurophu. Ngaphezu kwalokho, izifundo zamanje zigxile ikakhulukazi kubantu abesilisa nabesifazane. Ucwaningo oluthe xaxa oluhlola izici zemitholampilo ze-CSB phakathi kwamadoda nabesifazane besilisa nabesifazane abesilisa nabesifazane kuyadingeka. Ucwaningo lwe-neurobiological ngamaqembu ethize (i-transgender, i-polyamorous, i-kink, enye) nemisebenzi (ukubuka izithombe zobulili ezingcolile, ukushaya indlwabu ngokucindezelayo, ubulili obungavamile, nezinye) kuyadingeka. Njengoba kunikezwe ukulinganiselwa okunjalo, imiphumela ekhona kufanele iqondwe ngokucophelela.

Ukuqhathaniswa okuqondile kwe-CSBD nezinye izinkinga (isib. Ukusetshenziswa kwempahla, ukugembula, umdlalo, nezinye izinkinga) kuyadingeka, njengoba kufakwe ezinye izindlela ezingafani (isib., Izakhi zofuzo, epigenetic) nokusetshenziswa kwezinye izindlela zokucabanga. Amasu afana ne-positron emission tomography nawo anganikeza ukuqonda okubalulekile kwi-neurochemical underpinnings ye-CSBD.

Ukungahloniphi kwe-CSB kungabuye kucaciswe ngokuhlola ngokucophelela izici zomtholampilo ezingatholakala engxenyeni evela kumcwaningomqondo ofaneleko njengezindlela zokuhlola zokuhlola zomphakathi [37]. Ucwaningo olunjalo lungabuye lunikeze ukuqonda ngemibuzo yesikhathi eside njengokuthi izithombe ezingcolile zobulili ezingcolile zingaholela ekusebenziseni ubulili, futhi ukuhlanganisa ukuhlola okungenayo i-neurocognitive kulezo zifundo kungenza kube nokuqonda ngezinqubo ze-neurobiological. Ngaphezu kwalokho, njengoba ukungenelela kokuziphatha nokusebenza kwamakhemikhali kuvivinywa ngendlela efanele ekusebenziseni i-CSBD, ukuhlanganiswa kwezinhlolovo ezingenakulinganiswa kungasiza ekutholeni izindlela zokwelashwa okuphumelelayo kwe-CSBD kanye nama-biomarker. Leli phuzu lokugcina lingabaluleka ikakhulu ngoba ukufakwa kwe-CSBD ku I-ICD-11 cishe izokwandisa inani labantu abafuna ukwelashwa kwe-CSBD. Ngokuqondile, ukufakwa kwe-CSBD ku I-ICD-11 kufanele baqwashise ngeziguli, abahlinzeki, nabanye futhi bangase basuse ezinye izithiyo (isib. ukubuyisela imali evela kubahlinzeki bomshuwalense) okungenzeka kube khona manje kwi-CSBD.