Ukubheja Okubhebhetheka Ku-Inthanethi: Okuthi Siyazi Nalokho Esingazikho-Ukubuyekezwa Okuhlelekile (i-2019)

LINKA KUFUNDO ESIFUNDWAYO

Clin. UMedi. 2019, 8(1), 91; doi:10.3390 / jcm8010091

URubén de Alarcón 1 , Javier I. de la Iglesia 1 , Nerea M. Casado 1 futhi Ingelosi L. Montejo 1,2,*

1 Inkonzo Yezengqondo, Isibhedlela Clínico Universitario de Salamanca, Isikhungo Sokucwaninga Kwamakhemikhali eSalamanca (IBSAL), 37007 Salamanca, Spain

2 I-University of Salamanca, EUEF, 37007 Salamanca, Spain

abstract

Eminyakeni embalwa edlule, kuye kwaba negagasi lezindatshana ezihlobene nokuluthwa kokuziphatha; ezinye zazo zigxile ekuluthweni kwezithombe zobulili ezingcolile. Kodwa-ke, ngaphandle kwayo yonke imizamo, asikwazi ukubhala imininingwane yakho uma siziphatha ngale ndlela. Izinkinga ezijwayelekile zifaka: isampula yokuqagela, ukucinga izinsimbi zokuxilonga, ukuqonda okuphikisanayo nodaba, futhi iqiniso lokuthi leli bhizinisi lingafakwa ngaphakathi kwe-pathology enkulu (ie, umlutha wobulili) ongaziveza unophawu olubanzi kakhulu. Imilutha yokuziphatha ngokuziphatha iba ngumkhakha wokufunda ongafakwanga lutho kakhulu, futhi imvamisa ikhombisa imodeli yokusebenzisa inkinga: ukulahleka kokulawula, ukonakala kanye nokusebenzisa okuyingozi. Isifo se-Hypersexual silingana nale modeli futhi singahlanganiswa nezindlela zokuziphatha zocansi eziningana, njengokusebenzisa okuyinkinga kwezithombe zobulili ezingcolile online (POPU). Ukusetshenziswa kwezithombe zobulili ezingcolile ku-inthanethi kuyanda, okunamandla okulutha ngokubheka ithonya le "kathathu A" (ukutholakala, ukufinyeleleka, ukungaziwa). Lokhu kusetshenziswa okuyinkinga kungaba nemiphumela emibi ekuthuthukiseni ezocansi kanye nokusebenza ngocansi, ikakhulukazi kubantu abasha. Sihlose ukuqoqa ulwazi olukhona ekusetshenzisweni kwezithombe zocansi okuyinkinga njengenhlangano. Lapha sizama ukufingqa lokho esikwaziyo ngaleli bhizinisi futhi sibeke ezinye izindawo ezifanele ukucwaninga okuthe xaxa.
Amagama agqamile: izithombe zocansi eziku-inthanethi; umlutha; i-cybersex; i-inthanethi; ukuzibandakanya ocansini okuphoqelekile; hypersexourse

1. Isingeniso

Ngokufakwa kwe- “Ukugembula Ukuphazamiseka” kwisahluko esithi “Ukusetshenziswa Kwezidakamizwa kanye Nezinkinga Zokungezelela” kwe-DSM-5 [1], i-APA ikuvumile esidlangalaleni ukwenzeka komlutha wokuziphatha. Ngaphezu kwalokho, i- “Internet Gaming Disorder” yafakwa Isigaba 3-Izindlela zokuqhubeka nokufunda.
Lokhu kumelela ukuguquka okuguqukayo kwe-paradigm emkhakheni wokulutha okuhlobene nokuziphatha umlutha, futhi kuvula indlela yocwaningo olusha ngokukhanya ngoshintsho lwesiko olubangelwa ubuchwepheshe obusha.
Kukhona i-neurobiological ekhona [2] kanye nemvelo [3] umhlaba phakathi kokuphazamiseka okungafani okuluthayo, kufaka phakathi ukusetshenziswa kabi kwezidakamizwa nokuziphatha okuluthayo; lokhu kungabonakala njengokugubuzelana kwezinhlaka zombili [4].
Ngempenoloologically, abantu abayimilutha yokuziphatha, imvamisa babonisa imodeli yokusebenzisa inkinga: ukulawulwa okukhohlakele (isib. Ukufisa, imizamo engaphumeleli yokunciphisa isimilo), ukulimaza (isib. Ukunciphisa izintshisekelo, ukunganakwa kwezinye izindawo zokuphila), kanye nokusebenzisa okuyingozi (ukuqhubeka kokudla noma ukuqwashisa ngemiphumela eyonakalisayo yengqondo). Ukuthi le mikhuba ihlangabezana nezindlela zomzimba eziphathelene nomlutha (ukubekezelela, ukuhoxisa) kuyaxoxeka kakhulu [4,5,6].
I-Hypersexual disorder kwesinye isikhathi ibhekwa njengenye yalezo zinto eziluthayo ekuziphatheni. Kusetshenziswa njengokwakhiwa kwesambulela okubandakanya izimo zokuziphatha eziyinkinga (ukushaya indlwabu ngokweqile, i-cybersex, ukusetshenziswa kwezithombe zobulili ezingcolile, ukuziphatha ocansini nabantu abadala abavumayo, ukuvakashelwa kwe-strip kilabhu, njll.) [7]. Amanani wokuxhaphaka kwawo asuka ku-3% aye ku-6%, noma kunzima ukuthola ukuthi akukho ncazelo esemthethweni yalokhu kuphazamiseka [8,9].
Ukuntuleka kwedatha yesayensi eqine kwenza ucwaningo lwayo, ukuqonda, kanye nokuhlola kube nzima, okuholela ezinhlotsheni ezahlukahlukene zokuyichaza, kepha kuvame ukuhlotshaniswa nokuxineka okukhulu, imizwa yokujabha nokungasebenzi kwengqondo [8], nezinye izindlela zokulutha [10] futhi kudinga ukuhlolwa okuqondile.
Ngesikhathi esifanayo, ukukhuphuka kobuchwepheshe obusha kubuye kwavula indlela yokuziphatha okuyinkinga yokulutha, ikakhulukazi umlutha we-Intanethi. Lokhu kumlutha kungagxila ohlelweni oluthile ku-inthanethi (imidlalo, ukuthenga, ukubheja, i-cybersex…) [11] onamandla wokuziphatha okufaka engcupheni; kulokhu, kuzosebenza njengesiteshi sokubonakaliswa kokhonkolo kokuziphatha okushiwo [4,12]. Lokhu kusho ukwenyuka okungenakugwenywa, ukuhlinzeka izitolo ezintsha zemilutha emisiwe kanye nabantu abalingayo (ngenxa yobumfihlo obandayo, noma ithuba) ababengeke bahlanganyele kulokhu kuziphatha.
Ukusetshenziswa kwezithombe zobulili ezingcolile kuyi-Internet, okwaziwa nangokuthi ukusetshenziswa kwezithombe zobulili ezingcolile kuyi-Internet noma i-cybersex, kungenzeka kube ngenye yalezo zenzo eziqondene ne-Intanethi ezinobungozi bokulutha. Kuhambelana nokusetshenziswa kwe-Intanethi ukwenza izinto ezahlukahlukene zocansi ezijabulisayo [13], okukhona phakathi kwayo ukusetshenziswa kwezithombe zocansi [13,14] okuwumsebenzi othandwa kakhulu [15,16,17] ngenombolo engapheli yezimo zocansi ezitholakala [13,18,19,20]. Ukusetshenziswa okuqhubekayo ngale ndlela kwesinye isikhathi kutholakala enkingeni yezimali, yezomthetho, yomsebenzi, nobudlelwano [6,21] noma izinkinga zomuntu, ezinemiphumela emibi ehlukahlukene. Umuzwa wokulahlekelwa ukulawula nokuqhubeka kokusebenzisa yize kunemiphumela emibi yakha "ukuvivinya ubulili be-inthanethi"22] noma Inkinga Yokusebenzisa Izithombe Zobulili Ezingcolile ku-inthanethi (i-POPU). Le modeli yokusetshenziswa okuyinkinga iyazuza ezintweni ze- “Triple A” [23].
Ngenxa yalomodeli, ukushaya indlwabu okuhlobene nezithombe zocansi kungenzeka kube kaningi kulezi zinsuku, kepha lokhu akuyona neze inkomba ye-pathology [21]. Siyazi ukuthi ingxenye enkulu yabantu abesilisa abancane abangena kwi-Intanethi yokusetshenziswa kwezithombe zocansi [24,25]; empeleni, ngomunye wemithombo yabo ebalulekile yempilo yezocansi [26]. Abanye bazwakalise ukukhathazeka ngalokhu, bebhekisisa igebe lesikhathi phakathi kokudliwa kwezithombe zobulili ezingcolile okokuqala, kanye nesipiliyoni sokuqala ngokocansi; ngqo, ukuthi okwedlule kungaba kanjani nomthelela ekuthuthukiseni ubulili [27] njengesifiso esiphansi ngokweqile uma udla izithombe zobulili ezingcolile online [28] nokungasebenzi kahle kwe-erectile, okuye kwaphaphama kakhulu phakathi kwezinsizwa eminyakeni embalwa edlule uma kuqhathaniswa nemashumi ambalwa edlule [29,30,31,32,33].
Sabuyekeza ngokuhlelekile izincwadi ezazikhona ngesihloko se-POPU ukuzama nokufingqa inqubekela phambili yakamuva eyenziwe ngokuya nge-epidemiology, ukubonakaliswa komtholampilo, ubufakazi be-neurobiological obuxhasa lo modeli wokusetshenziswa okuyinkinga, ukuqonda kwakhe okuxilongayo maqondana nokuphazamiseka kwe-hypersexual, ukuhlolwa kwayo okuhlongozwayo izinsimbi nezindlela zokwelapha.

I-2. Izindlela

Senze ukubuyekezwa okuhlelekile okulandelayo imihlahlandlela ye-PRISMA (Umfanekiso we-1). Ngokunikeza iqembu elisha lobufakazi maqondana nale ndaba, senze ukubuyekezwa kwethu ngaphandle kokunqunyelwa kwesikhathi esithile. Okubaluleke kakhulu kubekwe ekubuyekezweni kwezincwadi kanye nezindatshana ezishicilelwe ngendlela entsha kunendlela yakudala, ikakhulukazi ngezibuyekezo ezishicilelwe kakade ngalolo daba. I-PubMed neCochrane kwakuyidatha esemqoka esetshenzisiwe, noma kunenqwaba yezindatshana ngokuhlanganiswa kokuphikisana.
I-Jcm 08 00091 g001 550
Umfanekiso we-1. Umdwebo wokugeleza kwe-PRISMA.
Njengoba ukugxila kwethu kwakuyizithombe zocansi eziku-inthanethi kanye nokuziphatha okuthe xaxa kwezocansi, asizifakwanga lezo zihloko ezazinokuhlangana okuphelele kuphela lapho sisesha: lezo ezigxile ekuluzweni kwe-Intanethi okujwayelekile, lezo zigxile ekulinganeni kobulili ezingcolile ngokuhlukahluka kobuhlakani, kanye nalezo yasondela le ndaba ngokubona komphakathi.
Amagama wosesho alandelayo nokuqhamuka kwawo kusetshenziswe ekuhlanganiseni okuningi: i-cybersex, i-porn * (ukuvumela kokubili "izithombe zobulili ezingcolile" kanye "nezocansi"), umlutha * (ukuvumela kokubili "umlutha" kanye "nomlutha"), online, i-inthanethi , ucansi, ucansi oluphoqelelayo, hypersexuality. Ithuluzi lokuphatha ireferensi elithi Zatero lalisetshenziselwa ukwakha i-database yazo zonke izihloko ezibhekwayo.

I-3. Imiphumela

I-3.1. I-Epidemiology

Ukusetshenziswa kwezithombe zobulili ezingcolile kubantu abaningi kufakazela ukuthi kunzima ukukalwa ngokwanele, ikakhulukazi kusukela kukhuphuka kwe-Intanethi nezinto “ezintathu” ezivumele ubumfihlo kanye nokufinyelela kalula. Ucwaningo lukaW Wright ngokusetshenziswa kwezithombe zocansi kubantu besilisa baseMelika besebenzisa i-General Social Survey (GSS) [34], kanye nocwaningo lwe-Price (olunwebeka kumaWallight ngokuhlukanisa phakathi kweminyaka yobudala, yeqembu kanye nemiphumela yesikhathi) [35] akha ezinye ezimbalwa, uma kungezona zodwa, imithombo ekhona ezilandelela ukusetshenziswa kwezithombe zocansi kubantu bonke. Zibonisa ukusetshenziswa okwandayo kwezithombe zobulili ezingcolile ngeminyaka, ikakhulukazi kubantu besilisa ngokuhlukile kwabesifazane. Lokhu kuvame kakhulu kubantu abasha, futhi kuncipha ngokuhamba kweminyaka.
Amanye amaphuzu ajabulisayo ngokuthambekela kokusebenzisa izithombe zobulili ezingcolile ayabonakala. Enye yazo ukuthi i-1963 ne-1972 cohort besilisa bakhombise ukwehla okuncane kakhulu ekusebenziseni kwabo kusukela ngonyaka we-1999 kuqhubeke, bephakamisa ukuthi ukusetshenziswa kwe-porn phakathi kwalawa maqembu kuye kwahlala kuhluka njalo kusukela [35]. Enye futhi ukuthi i-1999 futhi unyaka wokuthambekela kwabesifazane abaneminyaka eyi-18 ukuya kwi-26 yokudla izithombe zobulili ezingcolile kwaba kathathu kungenzeka kunalabo abaneminyaka engu-45 kuya ku-53, esikhundleni sezikhathi ezimbili nje kuphela njengoba bekulokhu kunjalo kuze kube lelo phuzu [35]. Lawa maqiniso amabili angahlobene nokushintsha ukuthambekela kokusebenzisa kabi izithombe zobulili ezingcolile ezishukunyiswa ubuchwepheshe (ukushintshela kokungaxhunyiwe kwi-inthanethi kuya kwimodeli yokusebenzisa i-inthanethi), kepha akunakwenzeka ukuthi wazi ngokweqiniso ngoba idatha yasekuqaleni ayilandeli umehluko kokungaxhunyiwe ku-inthanethi nakulayini ukuhluka lapho kulandelwa ukusetshenziswa kwezithombe zocansi.
Ngokuqondene ne-POPU, akukho datha ecacile nethembekile kuzincwadi ezibuyekeziwe ezinganikeza ukulinganisa okuqinile kokuthandwa kwayo. Ukungezelela kuzisusa esele zishiwo zokuntuleka kwemininingwane yokusetshenziswa kwezithombe zocansi okujwayelekile, ingxenye yayo ingavela esimweni esiqondwayo sendatshana sesihloko esenziwa ngababambiqhaza abangahle, uhla olubanzi lwamathuluzi wokuhlola asetshenziswe ngabacwaningi, kanye nokuntuleka kokuvumelana kulokho empeleni okuwukusebenzisa kokusebenzisa kobuqili kwezithombe zocansi, okuyizo zonke izingqinamba ezibuye zibukezwe kuleli phepha.

Inqwaba yezifundo eziphathelene ne-POPU noma i-hypersexual behaulness isebenzisa amasampula okulula ukuyilinganisa, imvamisa ukuthola, naphezu kokwehluka kwesibalo sabantu, ukuthi bambalwa kakhulu abasebenzisi abayibheka le nkambiso njengemlutha, futhi noma ngabe bayenza nini, bambalwa abakubheka ukuthi lokhu kungaba nomthelela ongemuhle umphumela kubo. Ezinye izibonelo:

(1) Ucwaningo oluhlola umlutha wokuziphatha phakathi kwabasebenzisi bezidakamizwa, lithole ukuthi yi-9.80% kuphela yabangenele be-51 abacabangele ukuthi banokulutha kocansi noma ezocansi [36].

(2) Ucwaningo lwaseSweden oluthole isampula yabahlanganyeli be-1913 ngohlu lwemibuzo lwe-web, i-7.6% ibike inkinga ethile yocansi lwe-Intanethi futhi i-4.5% iveze ukuzizwa 'umlutha' kwi-Intanethi ngezinhloso zothando nezocansi, nokuthi lokhu 'kwakuyinkinga enkulu' [17].

(3) Ucwaningo lweSpain ngesampula yabafundi basekolishi le-1557 lithole ukuthi i-8.6% isengozini engaba khona yokuthuthukisa ukusetshenziswa kwe-inthanethi ye-pornografi, kodwa ukuthi ukwanda komsebenzisi okwenzeka ngokoqobo kwakuyi-0.7% [37].

Ukuwukuphela kocwaningo olunesampula elimele kuze kube manje luyinto yase-Australia, enesampula yabahlanganyeli be-20,094; I-1.2% yabesifazane abahlolwe yazithatha njengomlutha, kanti kumadoda bekuyi-4.4% [38]. Ukutholwa okufanayo kuyasebenza nasekuziphatheni kwe-hypersexual ngaphandle kwezithombe zocansi [39].
Ababikezeli bezinkinga zokuziphatha okubi kobulili nokusetshenziswa kwezithombe zobulili ezingcolile, yonkana abantu: indoda, iminyaka yobudala, inkolo, ukusetshenziswa kwe-inthanethi okuvamisile, isimo esingesihle sokuthambekela, nokuthambekela ekukhathazekeni kwezocansi, nasekufuneni izinto ezintsha [17,37,40,41]. Ezinye zalezi zinto ezibeka engcupheni zabiwe futhi neziguli zokuziphatha okuphezulu [39,42].

I-3.2. I-Ethopathogenical and Diagnostic Conceptualization

Ukucabanga ngokuziphatha kwe-pathological kuyaqhubeka nokuba yinselele namuhla. Ngenkathi kuye kwenziwa imizamo eminingana maqondana nokuziphatha okuphathelene ne-hypersexual, ukungabikhona kwemininingwane eqine njengamanje kuchaza iqiniso lokuthi akukho ukuvumelana ngalolu daba [9]. I-POPU ineqoqo elithile lezindlela zokuziphatha zocansi ezibandakanya ubuchwepheshe. Ngenxa yokusebenzisa ubuchwepheshe obunenkinga (ikakhulukazi ubuchwepheshe be-inthanethi) bamuva nje, kudingeka siqale sikhulume ngokuziphatha okungahambisani nobuchwepheshe ukuze siqonde indawo yezithombe zocansi eziku-inthanethi ezikulo.
Ukuya ocansini njengokuziphatha kukhulu ngendlela exakile, futhi uhlangothi lwayo olungaba khona lokufunda lufundwe amakhulu eminyaka [43]. Ngakho-ke, kufanekisela inselelo kumamodeli azama ukuchaza kahle, ngoba angafaka izinto ezisukela ekucabangeleni wedwa nodlame lwezocansi [21]. Kunzima futhi ukuchaza ukuthi yini edala ukungasebenzi kahle futhi ulawule ukugwema ukusetshenziswa gwenxa kwaleyo ncazelo ukukhipha inyumbazana nokuxwilisa abantu [44]. Isibonelo, abanye babeka umkhawulo phakathi kokuziphatha okuvamile nangokwezifo zocansi ngezikhathi ezingaphezu kweziyisikhombisa ngeviki [43] (k. 381), kepha le ndlela egxila ngobuningi ingaba yingozi, ngoba lokho okwakha indlela ejwayelekile nokuziphatha kungenzeka kwehluka kakhulu phakathi kwabantu. Lokhu kuntuleka kokufana kanye nokungaguquguquki kokuhlukaniswa kwaso kungaphazamisa ucwaningo lwakusasa lokuphenya ngokuziphatha kwe-hypersexual [45] futhi unganaki izici zekhwalithi ezigxile emizweni emibi ehambisana nayo [46,47]. Kube neziphakamiso zokuhlenga le nkinga kusetshenziswa amathuluzi athile, asevele ethuthukisiwe njengengxenye yesiphakamiso sokuphazamiseka kokuphazamiseka kwe hypersexual asetshenziswe esivivinyweni sensimu ye-DSM-5 [43,47].
Hypersexourse ngokuvamile isebenza njenge-isambulela esakhiwa [7]. Ukuqokwa kwayo kuseseyimpikiswano kuze kube namuhla, futhi kuvame ukuhlangana namagama amaningana abhekisa kumqondo ofanayo: ukuzibandakanya ocansini okuphoqayo, umlutha wobulili, ukuzitika ngocansi, ukuziphatha kwe-hypersexual noma ukuphazamiseka kwe-hypersexual. Abanye ababhali, ngenkathi bebona ukubaluleka kwamagama athi "umlutha" nokuthi "ukuphoqelelwa", bakhetha ukugxila endabeni yokulawula nokulahleka kwayo okungenzeka noma ukuyekethisa njengokukhathazeka okuyinhloko mayelana nalokhu kuziphatha, ngakho-ke bakubiza ngokuthi "kungalawuleki" ukuzibandakanya ocansini ”[45,48,49].
Yize izincazelo zingafani, zivame ukugxila kumvamisa noma ubukhulu bezimpawu [46] kwezinye izifiso nemicabango evamile, lokho kungaholela ekungasebenzi. Lokhu kuyikuhlukanisa ngokuziphatha okuphathelene nobulili okubucayi, yize isidingo sokucaciswa okungcono kokwehluka okungenzeka, ukufana, nokwendelana phakathi kwalezi zinhlobo ezimbili kusaqhubeka [45].
Ngokuvamile kufakwe ekuziphatheni kwe-hypersexual ukumphulula indlwabu ngokweqile nokuziphatha okuhlobene nokuya ocansini, njengokuncika ekuhlanganyeleni okungaziwa ocansini, ukuziphindisela okuphindaphindayo, izithombe zobulili ezingcolile ze-inthanethi, ucansi ocingweni, kanye nokuhambela amakilabhu e-strip [43,44,49,50,51]. IBancroft icabange ikakhulukazi ukuthi, ngokusebenzisa i-Intanethi, ukushaya indlwabu kanye nalezi zinto zocansi kungazihlanganisa, zithi amadoda "ayisebenzisa njengento ekhulayo engenamkhawulo yokuphuma kokulawula indlwabu yokuziphatha".
Ngenkathi kungenzeka ukuthi kutholakale indlela yokuziphatha kwe-hypersexual bekuhlala kutholakala “nge-sex disorder engacaciswanga ngenye indlela” kwi-DSM [1], Kafka [43] izame ukuyiphakamisa njengenhlangano yokuxilonga ye-DSM-5. Uveze iqoqo lezindlela zalo, njengengxenye yezahluko zokuphazamiseka kobulili. Lezi zinhlobo eziphakanyisiwe zifaka phakathi i-hypersexual behaviour njengoba: (1) ikhuthaza ubulili, (2) umlutha wokuziphatha, (3) ingxenye yenkinga yokubona izinto, (4) yengxenye yokuphazamiseka okungabonakali, kanye (5) ne- “ engalawuleki ”yokuziphatha ngokweqile kobulili. Lesi siphakamiso ekugcineni senqatshwa ngenxa yezizathu eziningana; okubalulekile kwathiwa ukungabi bikho kwemininingwane ehlanganisiwe yokwanda kwezifo kanye neuroimaging ephathelene nalokhu kuziphatha [52,53], kodwa futhi namandla ayo okuhlukunyezwa kusengaphambili, isethi ethile enganele yezindlela zokuxilonga, kanye nezombusazwe nezenhlalo ezingaba khona ze-pathologizing indawo ebalulekile yokuziphatha kokuphila komuntu [54]. Kuyajabulisa ukuyiqhathanisa nezinye izindlela ezisetshenzisiwe ezisezincwadini ezibuyekeziwe, lezo kaPatrick Carnes no-Aviel Goodman [9]. Bobathathu babelana ngemibono yokulahleka kokulawula, isikhathi esisetshenzisiwe ekuziphatheni kobulili kanye nemiphumela emibi ekuziqondeni wena / kwabanye, kepha baphambukele kwezinye izinto. Lokhu kukhombisa ngemivimbo ebanzi ukushoda kokuvumelana kokuziphatha ngokweqile kwe-hypersexual kuyo yonke iminyaka. Okwamanje, izinketho eziphambili ziphakamisa ukusebenza kwe-hypersexual noma njengengqondo yokulawula umfutho noma umlutha wokuziphatha [55].
Kusukela ekubonweni kokulawulwa kwesifo sengqondo, ukuziphatha kocansi okubizwa ngokuthi yi-Compulsive Sexual Behavior (CSB). Coleman [56] ungumgqugquzeli wale mbono. Nakuba ehlanganisa ukuziphatha kwe-paraphilic ngaphansi kwalesi gama [57], futhi zingahle zihlangane kwezinye izimo, zihlukanisa ngokucacile kwi-CSB engenaphilisi, yilokho esifuna ukugxila kulokhu kubuyekezwa. Ngokuthakazelisayo, ukuziphatha okungenayo i-nonparaphilic ukuziphatha okungaxubuliswanga ngokuvamile kuyinto evamile, uma kungenjalo, kunezinye i-paraphilias [43,58].
Noma kunjalo, izincazelo zamuva zakwa-CSB zivame ukubhekisela ekuziphatheni eziningi zocansi ezingase ziphoqeleke: ukubhekwa ngokweqile ngokuvamile, kulandelwa ukusetshenziswa kocansi kwezithombe zobulili ezingcolile, ukuziphatha okubi, ukuhamba ngokucindezela, kanye nobuhlobo obuningi (22-76%) [9,59,60].
Ngenkathi kunezinhlawulo eziqakathekileko phakathi kokusondelana ngokobulili nemibandela efana ne-obsessive-compulsive disorder (OCD) nokunye ukuphazamiseka kokulawula umthamo [61], kunezinye izimo eziphawulekayo ezivelele: isibonelo, ukuziphatha kwe-OCD akubandakanyi umvuzo, ngokungafani nokuziphatha kocansi. Ngaphezu kwalokho, ngenkathi ukuphoqelelwa kungaholela ekusizeni iziguli ze-OCD okwesikhashana [62], ukuziphatha kocansi ocansini ngokuvamile kuhlotshaniswa yecala futhi kuzisola ngemuva kokwenza isenzo [63]. Futhi, ukungaziphathi kahle okungase kuqondise ukuziphatha kwesiguli akuhambisani nokuhlela ngokucophelela okudingekayo ngezinye izikhathi ku-CSB (isibonelo, ngokuphathelene nokuhlangana kocansi) [64]. UGoodman ucabanga ukuthi ukuphazamiseka kwezidakamizwa kuphazamisa ukucindezeleka kokucindezela (okubandakanya ukunciphisa ukukhathazeka) kanye nokuphazamiseka okuphazamisayo (okubandakanya ukuzithokozisa), kanye nezimpawu ezixhaswa yizinqubo ze-neurobiological (izinhlelo ze-serotoninergic, dopaminergic, noradrenergic, ne-opioid) [65]. UStein uvumelana nesibonelo esihlanganisa izindlela eziningana zokuziphatha kanye nokuphakamisa imodeli ye-ABC (ukuhlukunyezwa kwe-affective, ukulutha kokuziphatha nokuhlukunyezwa kwengqondo) ukutadisha le nhlangano [61].
Kusukela ekuziphatheni komlutha, ukuziphatha kobulili obucansi kuxhomeke ekuhlanganyeleni izici eziyinhloko zokulutha. Lezi zici, ngokwe-DSM-5 [1], ubheke imodeli yokusebenzisa inkinga ekhonjiwe esetshenziselwa ukuziphatha okuphathelene ne-hypersexual, kokubili ungaxhunyiwe ku-intanethi futhi ku-inthanethi [6,66,67]. Ubufakazi bokubekezelelana nokuzihoxisa kulezi ziguli kungenzeka ukuthi kubalulekile ekuhlukaniseni lesi sigaba njengengxabano yomlutha [45]. Ukusetshenziswa okunzima kwe-cycling yobulili nakho kuvame ukucatshangelwa njengokweqile ukuziphatha [13,68].
Igama elithi "umlutha" elisebenza kuleli bhizinisi lisengxoxweni enkulu. UZitzman ubheka ukuthi ukumelana nokusebenzisa leli gama umlutha “kukhombisa inkululeko yenkululeko yokuya ocansini nokuvumela kunoma yikuphi ukuntuleka kokuxhumana okubonakalayo nezinye izindlela zokulutha” [69]. Kodwa-ke, leli gama lidinga ukusetshenziswa ngokuqapha, ngoba lingahunyushwa njengokucacisa kosesho olungenangqondo lokuzanelisa kanye nenjabulo ye-hedonist, futhi basola imiphumela ephazamisayo kuyo.
Kudala kwaba nempikiswano phakathi kukaPatrick Carnes no-Eli Coleman ngokuxilongwa kwe-hypersexual behaviour. UColeman uye wabheka i-hypersexourse ukuthi iqhutshwe yisidingo sokunciphisa uhlobo oluthile lokukhathazeka, hhayi ngesifiso sobulili [56] eseyihlukanise ngama-subtypes ayisikhombisa (enye yawo isetshenziswa kwezithombe zobulili ezingcolile) [57], ngenkathi uCarnes (ochaze umlutha ngokuthi "ubudlelwane be-pathological kanye nesipiliyoni sokushintsha imizwa") uthola izifaniso zokunye ukuluthwa kokuziphatha njengokugembula, wagxila ekulahlekelweni kokulawula nasekuqhubekeni kokuziphatha yize kube nemiphumela emibi [70].
Ukubuyekezwa okuphelele kwezincwadi nguKraus [71], baphetha ngokuthi ngaphandle kwalezi zilinganiso, izikhala ezibalulekile ekuqondeni komqondo zenza ukuhlukaniswa kwabo kube umlutha. Okukhathazayo okuyinhloko kuhloselwe enanini lokuqhamuka kwesilinganiso esikhulu sokwanda, idatha emide kanye nemitholampilo (ichaza izimpawu eziyinhloko kanye nemikhawulo yokuxilonga), esekelwa yi-neuropsychological, neurobiological, kanye nedatha yofuzo, kanye neminye imininingwane mayelana nokuhlonza ukwelashwa nokuvimbela, kanye likhomba kubuchwepheshe bedijithali ekuziphatheni kwe hypersexual njengephuzu eliyisihluthulelo locwaningo lwakusasa.
Ukukhuphuka kwe-Intanethi kukhulisa amathuba wokuxhumana ngokocansi, hhayi nje ezocansi eziku-inthanethi (ama-webcamming, amawebhusayithi ezothando ocansi). Noma ngabe ukusetshenziswa kwe-Intanethi kumelela umgudu wezinye izinhlobo zokuziphatha okuphindaphindayo (isib., Ezocansi noma ukugembula) noma kwakha ibhizinisi elehlukile ngokwalo kusapikiswana ngakho [72]. Noma kunjalo, uma icala lingelokuqala, ubufakazi bangaphambili nokucatshangwayo kungasebenza kahle kozakwabo ose-inthanethi.
Njengamanje kunesidingo sezindlela ezisuselwe emandleni ezinaka izinto ezihlukile eziqukethwe ku-inthanethi (ngokungaxhunyiwe ku-inthanethi) zokuziphatha zocansi, ngoba iningi lazo alunayo inguqulo engaxhunyiwe ku-inthanethi engaqhathaniswa ne- [73]. Kuze kube manje, kuye kwakhulunywa ngezinto ezintsha lapho sisebenzelana nokuziphatha kobulili okuku-inthanethi, njengokukhona kokuhlukaniswa online [74], okudala "ukuthikamezeka ngokomqondo nangokomzwelo lapho uganisene, nesikhathi esincishisiwe nokuzenzisa". Lokhu kuzihlukanisa sekuchaziwe kakade maqondana neminye imisebenzi eku-inthanethi [75], esekela umbono wokuthi ukusetshenziswa kwe-cybersex okuyinkinga kungahle kuhlobane nakho kokubili i-inthanethi nokulutha ngobulili [76].
Okokugcina, kufanele sisho ukuthi inhlangano yokuxilonga okubizwa ngokuthi "ukuphazamiseka kokuziphatha kobulili okuphoqelekile" ifakiwe kuhlu oluzayo lwe-ICD-11, esahlukweni esithi "impulse control matatizo"77]. Ukuchazwa kungabonakala lapha https://icd.who.int/dev11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f1630268048.
Ukufakwa kwalesi sigaba ku-ICD-11 kungaba impendulo ekulweni kwalolu daba futhi kufakazela ukusetshenziswa kwalo kliniki, kanti idatha ekhulayo kodwa nokho engafani nayo ivimbela thina ekuhlukaniseni kahle njengokuphazamiseka kwempilo yengqondo [72]. Kukholakala ukuthi kunikezela ngethuluzi elingcono (nokho elisenqubo yokucwilisa) ukubhekana nezidingo zokwelashwa ezifuna iziguli kanye necala elinokwenzeka elihambisana [78], futhi futhi ingabonisa izimpikiswano eziqhubekayo eziphathelene nokuhlukaniswa okufanele kwe-CSB kanye nenani ledatha yakhe yemininingwane kwezinye izindawo [55,71] (Ithebula 1). Lokhu kufakwa kungaba isinyathelo sokuqala ekuqapheleni le nkinga futhi sandise kuso, iphuzu elilodwa elingangabazeki ngokungangabazeki liyi-subtype yayo engcolile ye-inthanethi.
Ithebula 1. Izindlela ze-DSM-5 ne-ICD-11 zokuhlukanisa indlela yokuziphatha kwe-hypersexual.
Ithebula

I-3.3. Ukubonakaliswa Kwemitholampilo

Ukubonakaliswa kwemitholampilo kwe-POPU kungafingqwa ngamaphuzu amathathu abalulekile:

  • Ukungasebenzi kahle kwe-Erectile: ngenkathi ezinye izifundo zithole ubufakazi obuncane bokuhlangana phakathi kokusetshenziswa kwezithombe zobulili ezingcolile kanye nokungasebenzi kahle kwezocansi [33], abanye baphakamisa ukuthi ukwanda kokusetshenziswa kwezithombe zobulili ezingcolile kungaba yinto esemqoka echaza ukukhuphuka okubukhali kokungasebenzi kahle kwe-erectile phakathi kwabantu abasha [80]. Kokunye ukuhlola, i-60% yeziguli ezathola ukungasebenzi kahle kwezocansi nomlingani wangempela, ngokwesimilo azizange zibe nale nkinga ngezithombe zocansi [8]. Abanye bathi ukuvela phakathi kokusetshenziswa kwezithombe zobulili ezingcolile kanye nokuphazamiseka kwezemacansini kunzima ukusungula, ngoba izilawuli zangempela ezingafakwanga ezithombeni zobulili ezingcolile azivamile ukutholwa [81] futhi ngiphakamise ukwakhiwa kocwaningo okungenziwa kulokhu.
  • Ukwaneliseka ngokwezengqondo: Ukusetshenziswa kwezithombe zobulili ezingcolile kuhlobene nokunganeliseki ngokocansi kanye nokungasebenzi kahle kwezocansi, kwabesilisa nabesifazane [82], ngokuba ngugxeka kakhulu umzimba womuntu noma womlingani wakhe, inyusa ingcindezi yokusebenza kanye nobucansi bangempela [83], ukuba nabalingani abaningi bezocansi kanye nokuzibandakanya ekuziphatheni okubi ngokobulili [34]. Lo mphumela ubonakala kakhulu ebudlelwaneni uma buhlangane [84], ngendlela efanayo kakhulu nokusetshenziswa kwensangu, ukwaba izinto ezibalulekile njengokufihla okuphezulu [85]. Lezi zifundo zincike ekusetshenzisweni kwezithombe zocansi okungezona eze-pathology, kepha izithombe zocansi eziku-inthanethi kungenzeka zingabi nemiphumela elimazayo ngokwazo, kuphela uma sekungumlutha [24]. Lokhu kungachaza ubudlelwane phakathi kokusetshenziswa kwezithombe zocansi zabantu besifazane kanye nemiphumela emihle kwabesifazane [86].
  • Ama-Comorbidities: Ukuziphatha kwe-hypersexual kuhlotshaniswe nokukhathazeka kokukhathazeka, kulandelwa ukuphazamiseka kwemizwa, ukuphazamiseka kokusebenzisa izidakamizwa kanye nokungasebenzi kahle kwezocansi [87]. Lokhu okutholakele kuyasebenza naku-POPU [88], futhi ukuhlotshaniswa nokubhema, ukuphuza utshwala noma ikhofi, ukusetshenziswa kabi kwezidakamizwa [41] nokusetshenziswa okuyinkinga komdlalo wevidiyo [89,90].
Ukuba nezintshisakalo zokuqukethwe ezocansi okucacile kuhlobene nokukhula kwezinkinga ezibikiwe [17]. Kuke kwaxoxwa ngakho uma lezi zinhlelo zemitholampilo zingumphumela wokuhlukunyezwa okuqondile kwe-cybersex noma ngenxa yezihloko zizibona zingumlutha [91].

I-3.4. Ubufakazi be-Neurobiological Supporting Addiction

Ukuqoqa ubufakazi nge-POPU kuyinqubo enzima; idatha esemqoka kule ndaba isakhawulelwe ngosayizi omncane wesampula, amasampula wobungqingili besilisa kuphela kanye nemiklamo eyingqayizivele [71], ngaphandle kwezifundo ezanele ze-neuroimaging kanye ne-neuropsychological [4], mhlawumbe kubangelwa izithiyo ezibonakalayo, zezezimali nezokuhlelela. Ngaphezu kwalokho, ngenkathi umlutha wezidakamizwa ungabukwa futhi ualinganiswe ezilwaneni zokuhlola, ngeke sikwazi ukukwenza lokhu ngomlutha wokuziphatha okhethwayo; lokhu kungakhawulela ukufundwa kwethu kokungaphezulu kwe-neurobiological [72]. Izikhala zolwazi lwamanje mayelana nocwaningo lokuziphatha okuphathelene ne-hypersexual, kanye nezindlela zokuthola ukubhekana nazo, zimbozwe ngobuciko futhi zafushaniswa embhalweni kaKraus [71]. Iningi locwaningo olutholakala ocwaningweni lwethu lumayelana nokuziphatha okuphathelene ne-hypersexual, kanti izithombe zobulili ezingcolile ziyisici esisodwa sazo ezibaliwe.
Lobu bufakazi bususelwa ekuqondeni okuvelayo kwenqubo ye-neural phakathi kwezinguquko ezihlobene nokulutha kwe-neuroplasticity. Amazinga e-Dopamine adlala indima ebalulekile kulokhu kushukunyiswa komvuzo wokuya ocansini, njengoba kubonwa kakade ekuwohlokeni komqondo wangaphambi kwezidakamizwa (i-frontotemporal dementia) kanye nemithi ye-pro-dopaminergic kwisifo sikaParkinson esixhunyaniswa nokuziphatha kocansi [92,93].
Inqubo yokulutha ngezithombe zocansi eziku-inthanethi ingahle ikhuliswe ngobunono obusheshisiwe kanye “nesisusa somfutho” (igama eliqanjwa ngumnqobi womklomelo kaNobel, uNikolaas Tinbergen) owenza izithombe zocansi ze-Intanethi [94]. Lo mkhuba kungenzeka wenze isisusa sokufakelwa (kulokhu, izithombe zobulili ezingcolile ngendlela esivame ukusetshenziswa ngayo namuhla, uhlobo lwaso online) ziphendule impendulo yezakhi zofuzo ezivele ngokuziphendukela kwemvelo. Umbono uthi kungenzeka ukuthi benze kusebenze uhlelo lwethu lwemivuzo yemvelo ngamazinga aphezulu kunalokho okhokho ababehlangana nakho njengoba ubuchopho bethu bavela, okwenza kwaba nesibopho sokushintshela kwimodi yokulutha [2]. Uma sicabangela i-inthanethi eyi-porn kusuka kulo mbono, singaqala ukubona ukufana kwezidakamizwa ezivamile.

Izinguquko ezinkulu zobuchopho ezibonwe kulo lonke umlutha wezidakamizwa zibeka isisekelo socwaningo lwakusasa lokuziphatha okuluthayo [95], kufaka phakathi:

  • Ukuzwela [96]
  • Ukwehlisa amandla [97]
  • Amasekhethi angaphambili angasebenzi kahle (hypofrontality) [98]
  • Isistimu yokusebenza kwengcindezi engasebenzi [99]
Lezi zinguquko zobuchopho ezibonwe kumlutha zixhunyaniswe neziguli ezinokuziphatha okuphathelene ne-hypersexual noma abasebenzisi bezithombe zocansi ngokusebenzisa ucwaningo olucishe lwenziwe lwe-40 lwezinhlobo ezahlukahlukene: i-magnetic resonance imaging, i-electroencephalography (i-EEG), i-neuroendocrine, ne-neuropsychological.
Isibonelo, kunokwehluka okucacile kokusebenza kobuchopho phakathi kweziguli ezinokuziphatha okucansini kokulawula nokulawula, okubonisa lokho okwabamele imilutha yezidakamizwa. Uma kudalulwa izithombe zobulili, izihloko ezi-hypersexual zikhombisile umehluko phakathi kokuthanda (ngokuhambisana nokulawula) kanye nokufuna (isifiso sobulili), esasinkudlwana [8,100]. Ngamanye amagama, kulezi zifundo kunesifiso esengeziwe kuphela sentambo ethile yocansi, kepha hhayi inkanuko yezocansi eyejwayelekile. Lokhu kusikhomba kunkomba yocansi uqobo etholwa njengomvuzo [46].
Ubufakazi balesi sigameko se-neural esibonakalisa isifiso ikakhulukazi kuvelele kwi-correx ye-prefrontal [101] kanye ne-amygdala [102,103], njengobufakazi bokukhuthaza. Ukusebenza kulezi zifunda zobuchopho kukhumbuza umvuzo wezezimali [104] futhi ingase ithwale umthelela ofanayo. Ngaphezu kwalokho, kunezifundo eziphakeme ze-EEG kulaba basebenzisi, kanye nesifiso esinciphile sokulala nomlingani, kodwa hhayi ngokushaya indlwabu ezithombeni ezingcolile [105], into eveza futhi umehluko ekukhwalweni kwekhwalithi [8]. Lokhu kungabhekwa njengesibonakaliso sokungabi namthetho. Kodwa-ke, ukutadisha kukaSteele kuqukethe amaphutha amaningana okucatshangelwayo (ngokubhekwa kwesifo se-heterogeneity, ukuntuleka kokuhlola izifo zengqondo noma ukulutha, ukungabikho kweqembu lokulawula, nokusetshenziswa kwamaphepha angagunyaziwe ukusetshenziswa kwezithombe ezingcolile) [106]. Ucwaningo olwenziwa nguPrause [107], ngalesi sikhathi neqembu lokulawula, liphinde laphindaphinda lezi zithole. Indima yokuqamba kabusha kanye nokulangazelela ekuthuthukiseni ukubheja kocansi nge-inthanethi kuye kwaqiniswa ngokulingana ngokobulili obuhlukile [108] namasampuli wesilisa ongqingili [109].
Lokhu kukhetha ukunaka izinkambo zocansi kuyinto ebaluleke kakhulu kubantu bokuqala be-hypersexual [110], kepha ukuzivezela okuphindaphindayo kubo kukhombisa ukwehluleka [111,112]. Lokhu kusho ukwehliselwa phansi kwezinhlelo zemivuzo, okungenzeka zilinganiswe yi-dorsal cingrate enkulu kakhulu [107,113,114]. Njengoba i-dorsal cingulate ibandakanyeka ekulindeleni imivuzo futhi iphendula imicimbi emisha, ukwehla komsebenzi wayo ngemuva kokuvezwa okuphindaphindiwe kusikhombisa ekuthuthukisweni kokuhlala kusikhuthazo esedlule. Lokhu kuphumela ekuthandeni okungekuhle okuthuthukile kokungenangqondo ngokocansi [115], okungabonakala njengemizamo yokunqoba indawo yokuhlala eshiwo kanye nokuphelelwa yithemba ngokwesesha okuningi (okusha) njengezindlela zokwanelisa ngokocansi, ukukhetha le ndlela esikhundleni sobulili bangempela [20].
Le mizamo yokufuna okunyanyayo ingahle iqondiswe ngokusebenza kabusha kwe-ventral striatal [116] kanye ne-amygdala [117]. Kuyaziwa ukuthi ukubukwa kwezithombe zocansi kubasebenzisi abajwayelekile kuhlobene nomsebenzi omkhulu we-neural [99], ikakhulukazi ku-ventral striatum [116,118] edlala indima enkulu ekulindeleni imivuzo [119].
Noma kunjalo, ukuxhumana phakathi kwe-ventral striatum kanye ne-cortex yangaphambili kuncishisiwe [103,113]; ukwehla kokuxhumana phakathi kwe-cortex yangaphambili ne-amygdala nakho kuye kwaqashelwa [117]. Ngaphezu kwalokho, izifundo ze-hypersexual zikhombise ukuncishiswa kokuxhumana okusebenzayo phakathi kwe-caudate ne-temport cortex lobes, kanye nokushoda kwendaba kulezi zindawo [120]. Zonke lezi zinguquko zingachaza ukungakwazi ukulawula ukuthambekela kocansi.
Ngaphezu kwalokho, izifundo ze-hypersexual zikhombise ivolumu ekhuphukayo ye-amygdala [117], ngokungafani nalokhu okuchayeka okungapheli kwento, okukhombisa ivolumu ye-amygdala enciphile [121]; lo mehluko ungachazwa umphumela ongaba khona wento ye-neurotoxic. Ezifundweni eziyizidlakudla, umsebenzi nevolumu kungakhombisa ukugqagqana nezinqubo zokulutha (ikakhulukazi ukusekela imibono yenkuthazo yokusekela) noma kungaba wumphumela wezindlela zokuxineka zenhlalo ezingapheli, njengokulutha kokuziphatha ngokwakho [122].
Labo basebenzisi baphinde bakhombisa impendulo yokuxineka engasebenzi kahle, ikakhulukazi eqondiswa nge-hypothalamus-pituitary-adrenal axis [122] ngendlela ekhombisa lezo zinguquko ezibonwe kumilutha yezidakamizwa. Lezi zinguquko zingaba wumphumela woshintsho lwe-epigenetic kubahlaziyi bezokushayela be-classic abasebenza ngokulutha, njenge-corticotropin-releasing-factor (CRF) [123]. Le hypothesis ye-epigenetic regulation icubungula imiphumela yokuziphatha kwe-hedonic ne-anhedonic okungenani ithinteka kancane ngofuzo lwe-dopaminergic, futhi mhlawumbe nezinye izinhlobo ezihlobene ne-neurotransmitter gene polymorphisms [124]. Kukhona futhi ubufakazi bokuthi i-tumor necrosis factor (TNF) ephezulu iyimilutha yezocansi, nokuhlangana okuqinile phakathi kwamazinga we-TNF nezikolo eziphakeme kwizilinganiso zokulinganisa ze-hypersexuality [125].

I-3.5. Ubufakazi be-Neuropsychological

Mayelana nokubonakala kwalezi zinguquko ekuziphatheni kobulili, izifundo eziningi ze-neuropsychological zibonisa uhlobo oluthile lomphumela oqondile noma oqondile ekusebenzeni okuphezulu [126,127], mhlawumbe njengomphumela wezinguquko zangaphambi kwecortex [128]. Uma isetshenziswa kuzithombe zocansi eziku-inthanethi, inesandla ekuthuthukisweni nasekugcinweni kwayo [129,130].
Ukucaciswa kwalokhu kusebenza kwesigungu esimpofu kufaka phakathi: ukuqhutshwa [131,132], ukuqina kokuqonda okuthikameza izinqubo zokufunda noma amandla okuhambisa ukunaka [120,133,134], ukwahlulela okungalungile nokwenza izinqumo [130,135], ukuphazamiseka kokusebenza kwenkumbulo yokusebenza [130], ukusilela emthethweni wokulawula imizwelo, kanye nokuzibandakanya ngokweqile ngocansi [136]. Lokhu okutholakele kusikhumbuza okunye ukuluthwa kokuziphatha (njengokugembula kwendlela) kanye nokuziphatha kokuncika kwezinto137]. Ezinye izifundo ziphikisana ngqo nalokhu okutholakele [58], kepha kungahle kube nokukhawulelwa kwendlela yokusebenza (ngokwesibonelo, usayizi omncane wesampula).
Ukusondela ezintweni ezibamba iqhaza ekuthuthukisweni kokuziphatha kwe-hypersexual ne-cybersex, kunenqwaba yazo. Singacabanga ngokusebenza kabusha kwe-cue, ukuqiniswa okuhle nokufunda okuhambisana [104,109,136,138,139] njengezindlela eziyinhloko zokuthuthuka kwemilutha yezocansi. Noma kunjalo, kungahle kube nezici zokubekeka engcupheni [140], njengo: (1) iqhaza lokwanelisa ngokocansi kanye nokukhubazeka okungasebenzi kubantu abathile abachazwe ngaphambilini [40,141,142,143] noma kungumphumela wokucindezelwa kwesici [144,145] noma ukuphoqelelwa kwesimo [146], kanye (2) izindlela zokuthambekela / zokugwema [147,148,149].

I-3.6. Ukuqunjelwa

Iningi lezifundo liboniswe lisebenzisa izifundo ngokukhombisa isikhathi eside ezithombeni zocansi eziku-inthanethi [34,81,113,114], ngakho-ke ukubonakaliswa kwayo kwemitholampilo kubonakala kungumphumela oqondile futhi olinganiselayo wokuzibandakanya kulokhu kuziphatha okungalungile. Sishilo kobunzima ekutholeni izilawuli zokuqalwa kokuqamba, kepha eminye imibiko yamacala iphakamisa ukuthi ukunciphisa noma ukuyeka lokhu kuziphatha kungadala ukuthuthuka kokungaziphathi kahle ngokobulili kanye nokungagculiseki ngokobulili [79,80] nokululama okugcwele; lokhu kungasho ukuthi ukuguqulwa kobuchopho obekushiwo ngaphambili kuyaphindeka.

I-3.7. Amathuluzi Okuhlola

Kunezinsizakusebenza zokuhlola i-CSB ne-POPU. Bonke bathembela ekuthembekeni nasekuthembekeni komphenduli; mhlawumbe okungaphezulu kakhulu kokuhlolwa kokuhlolwa kwengqondo okujwayelekile, ngoba izindlela zokuziphatha zocansi ezithobeka kakhulu ngenxa yemvelo yazo yangasese.
Ngokwe-hypersexeness, kukhona ngaphezulu kwe-20 ukuhlolwa kwamaphepha emibuzo nezingxoxo zekliniki. Okunye okuphawuleka kakhulu kufaka phakathi i-Sex Addiction Screening Test (SAST) ehlongozwe yiCarnes [150], nenguqulo yayo ebukezwe kamuva engu-SAST-R [151], Inventory yezocansi yokuzibandakanya ocansini (CSBI) [152,153] kanye ne-Hypersexual Disorder Screening Inventory (HDSI) [154]. I-HDSI ekuqaleni yayisetshenziselwa ukuhlolwa kwemitholampilo kwe-DSM-5 isiphakamiso sensimu ye-hypersexual disorder. Ngenkathi kubuye kuhlolwe eminye imithelela yamandla maqondana nenqubo nokucaciswa kwamaphuzu we-cutoff, okwamanje ibamba ukwesekwa okuqinile kwengqondo futhi iyithuluzi elivumelekile lokulinganisa ukuphazamiseka kwe-hypersexual [151].
Ngokuqondene nezithombe zocansi eziku-inthanethi, ithuluzi elisetshenziswa kakhulu ukuhlolwa i-Intanethi (i-ISST) [155]. Ihlola ubukhulu obuhlanu (ukuphoqelelwa kwezocansi online, ukuzibandakanya kobulili online, ezokuziphatha zocansi online, ukusetshenziswa kwezimali ngokocansi online kanye nentshisekelo ekuziphatheni kobulili online) ngemibuzo ye-25 dichotomic (yebo / no). Kodwa-ke, izakhiwo zalo ze-psychometric ziye zahlaziywa kuphela ngobumnene, ngokuqinisekiswa okuqinile kweSpanish [156] okusebenze njengokubhaliwe kwencwadi yezifundo zangemva [157].
Ezinye izinsimbi eziphawuleka yisilinganiso esiyinkinga senkinga yokusebenzisa izithombe zocansi (PPUS) [158] elinganisa izingxenye ezine ze-POPU (kufaka phakathi: izinkinga zokucabanga nezinkinga zokusebenza, ukusetshenziswa ngokweqile, ukulawula ubunzima nokusetshenziswa kokuphunyuka / ukugwema imizwa engemihle), ukuhlolwa okulutha kokulutha okufushane kwe-inthanethi kuhambisane nemisebenzi yezocansi eku-inthanethi (s-IAT-sex) [159], iphepha lemibuzo le-12-nto elilinganisa izilinganiso ezimbili ze-POPU, kanye ne-cyber-porn use yokusungula (CPUI-9) [160].
I-CPUI-9 ihlaziya ubukhulu abathathu: (1) imizamo yokufinyelela, (2) ibone ukucindezelwa, kanye (3) ukucindezeleka okungokomzwelo. Kuqala kubhekwe ukuthi inezindawo ezakhayo zengqondo [9], lolu luhlu olusanda kukhombisa ukuthi alunakwethenjwa: ukufakwa kwamazinga wekheli “lokudangala komoya” amahloni necala, okungekhona okulinganiswa kokulutha futhi ngaleyo ndlela kushaye izikolo phezulu [161]. Ukufaka i-inventri ngaphandle kwalokhu ubukhulu kubonakala kukhombisa ngokunembile ukusetshenziswa okuthile kwezithombe zobulili ezingcolile.
Enye yezinto ezisanda kwenzeka isikali senkinga yokusebenzisa ubucansi (PPCS) [162], ngokususelwa kumodeli yokuluthwa eyinhlanganisela yezingxenye eziyisithupha [163], noma ilinganiselwa umlutha, ukusetshenziswa okuyinkinga kuphela kwezithombe zocansi ezinezakhiwo eziqinile zengqondo.
Ezinye izindlela ze-POPU ezingadalelwanga ukukala ukusetshenziswa kwezithombe zocansi okuku-inthanethi kodwa eziqinisekisiwe ngokusebenzisa abasebenzisi bezocansi abasebenza online [9], faka I-Inthanethi Yezingcolile Zobunqunu (i-PCI) [164,165], Isikali Sokucobeka Kwezithombe Zobulili Ezingcolile (CPCS) [166] kanye nohlu lwemibuzo lwe-pornogravel Craving (PCQ) [167] ezingakwazi ukuhlola izingqinamba zesimo phakathi kwezinhlobo ezihlukile zomsebenzisi wezithombe zocansi.
Kukhona futhi amathuluzi wokuhlola ukulungela kwabasebenzisi bezithombe zocansi ukulahla le ndlela ngamasu okuzisungula [168] nokuhlolwa kwemiphumela yokwelashwa ngokwenza [169], ichaza izisusa ezintathu ezingase ziphinde zibuyele ekuthini: (a) ukuvusa inkanuko yobulili / isithukuthezi / ithuba, (b) ukudakwa / izindawo / ukufinyelela okulula, kanye (c) nemizwelo engemihle.

I-3.8. Ukwelashwa

Uma kunemibuzo eminingi esasele mayelana nokuqonda, ukucabanga, kanye nezimbangela zokuziphatha kwe-hypersexual kanye ne-POPU, kunemizamo embalwa yokucwaninga ngezinketho zokwelashwa ezinokwenzeka. Ezifundweni ezishicilelwe, osayizi beesampula bavame ukuba bancanyana futhi bangenawo amandla amaningi, izilawuli zemitholampilo ziyashoda, futhi izindlela zokucwaninga ziyahlakazeka, azithembeki, futhi aziphindeki [170].
Imvamisa, ukuhlanganisa izindlela zokomqondo, zokuqonda, zokuziphatha, zengqondo nezokwelapha zithathwa njengezisebenza kakhulu ekwelapheni umlutha wezocansi, kepha le ndlela engacacisanga ikhombisa ukungabi nalwazi mayelana nale ndaba [9].

I-3.8.1. Izindlela Zasemithi

Izifundo zigxile paroxetine ne-naltrexone kuze kube manje. Uchungechunge olulodwa lwamacala olubandakanya i-paroxetine ku-POPU lisize ukwehlisa amazinga okukhathazeka, kepha bagcina behlulekile wanciphisa isimilo yodwa [171]. Ngaphezu kwalokho, ukusebenzisa ama-SSRIs ukudala ukungasebenzi kwezemacansini ngemiphumela yawo engemihle ngokusobala akusebenzi, futhi ngokusho kokuhlangenwe nakho komtholampilo kuyasiza ezigulini ezine-comorbid psychiatric [172].
Kuchazwe imibiko emine ebandakanya i-naltrexone yokwelapha i-POPU. Ukutholwa kwangaphambilini kuphakamise ukuthi i-naltrexone ingaba yindlela yokwelapha yokuluthwa kokuziphatha kanye nokuphazamiseka kwe-hypersexual [173,174], kunciphisa izinkanuko nezifiso ngokuvimba i-euphoria ehambisana nokuziphatha. Ngenkathi kungakabi nesivivinyo esilawulwa ngokungahleliwe ne-naltrexone kulezi zifundo, kunemibiko yamacala amane. Imiphumela etholwe ekunciphiseni ukusetshenziswa kwezithombe zocansi ihlukile kokuhle [175,176,177] ukumaphakathi [178]; okungenani koyedwa wabo isiguli sibuye sathola i-sertraline, ngakho-ke akucaci ukuthi kungakanani okungathiwa yi-naltrexone [176].

I-3.8.2. Izindlela Zokusebenza Kwezengqondo

Ngokungangabazeki, i-psychotherapy ingaba yithuluzi elibalulekile ekuqondeni ngokuphelele nasekuguquleni indlela yokuziphatha. Ngenkathi i-cognitive-behaal therapy (i-CBT) ibhekwa ngabodokotela abaningi ukuthi ilusizo ekwelapheni i-hypersexual disorder [179], ucwaningo olwalubandakanya abasebenzisi bezinkinga zocansi abayinkinga be-inthanethi behlulekile ukufeza ukwehliswa kwalokhu kuziphatha [180], noma ubucayi bezimpawu ze-comorbid ezicindezelayo nezinga lempilo elijwayelekile luthuthukisiwe. Lokhu kuletha umbono wenzalo wokuthi ukunciphisa nje ukusetshenziswa kwezithombe zocansi kungenzeka kungameleli inhloso yokwelashwa ebaluleke kakhulu [170]. Ezinye izindlela ezisebenzisa i-CBT ukwelapha i-POPU zenziwe, kepha ukwenziwa kabusha kwezinkinga zendlela kule ndawo kusivimbela ekuthathweni iziphetho ezithembekile [181,182].
I-Psychodynamic psychotherapy kanye nezinye ezifana nokwelashwa komndeni, ukwelashwa kwemibhangqwana, nokwelashwa kwengqondo okwenziwa ngemuva kwezinyathelo zezinyathelo ze-12 kungahle kubonakale kubalulekile lapho kukhulunywa ngezindikimba zehlazo nokuzizwa unecala nokubuyisela ukwethembana phakathi kobudlelwano obusondele kakhulu babasebenzisi [170,172]. Ukuphela kwesivivinyo esilawulwa ngokungahleliwe esikhona esinenkinga yabasebenzisi bezithombe zocansi ezi-inthanethiogxila kugxila ku-Ukwemukelwa kanye neZibopho zokwelapha (ACT) [183], ukuthuthuka kusuka kuchungechunge lwamacala wabo we-2010 [184], obekuyisifundo sokuqala sokuhlola ukubhekisisa i-POPU. Ucwaningo lukhombise imiphumela esebenzayo kepha kunzima ukukhipha ngoba isampula lalibuye lincane kakhulu futhi ligxile kubantu abathize kakhulu.
Impumelelo ebikiwe nge-CBT, i-conjoint therapy ne-ACT ingahle ithembele eqinisweni elisuselwa ezinhlakeni zokucabanga nokwamukela; ngokuya ngomongo, ukwanda kokusebenzisa izithombe zobulili ezingcolile kunganda ngokulingana noma kubaluleke kakhulu kunokunciphisa ukusetshenziswa [170].

I-4. Ingxoxo

Kubukeka sengathi i-POPU akuyona eyodwa kuphela yokuphazamiseka kwe-hypersexual disorder, kepha njengamanje yiyona evame kakhulu ngoba ibuye ibuye futhi ihilela ukushaya indlwabu. Noma lokhu kunzima ukunquma ngokunembile ukuthi kungani kungaziwa futhi kufinyeleleka izici ezenza ukusetshenziswa kwezithombe zocansi kube namuhla, sinokuqinisekisa okungenani ukuthi umvikeli wokusebenzisa izithombe zobulili ezingcolile useshintshe cishe iminyaka eyishumi edlule. Bekungeke kube okungenangqondo ukucabanga ukuthi ukuhlukahluka kwe-intanethi kube nomthelela omkhulu kubathengi bayo, nokuthi izici ezintathu zithuthukisa ubungozi obungahle bube khona nge-POPU nezinye izindlela zokuziphatha zocansi.
Njengoba sesishilo, ukungaziwa kuyinto esemqoka engcupheni yokuthi le ndlela yokuziphatha yezocansi ibe yinkinga. Kudingeka sikhumbule ukuthi izibalo eziphathelene nale nkinga ngokusobala zilinganiselwe kubantu abaneminyaka yobudala esemthethweni ukuba bazibandakanye kwezocansi, online noma ngenye indlela; kodwa akusiphunyukeli ukuthi umsebenzi wobulili awuvami ukuba uqale ngemuva kwalokhu, futhi kungenzeka nethuba lokuthi izingane eziqhubeka nohlelo lwe-neurodevelopment ziyisakhamuzi esisengozini ethile. Iqiniso ngukuthi ukuvumelana okuqinile kokuthi iyiphi indlela yokuziphatha yokuziphatha kocansi, okungaxhunyiwe ku-inthanethi naku-inthanethi, kuyadingeka ukukala ngokwanele ngendlela emele futhi iqinisekise ukuthi yimalini yenkinga emphakathini wanamuhla.
Njengoba sisazi, iziningi zezifundo zamuva zisekela le nhlangano njengesiyaluyalu nemibonakaliso ebalulekile yomtholampilo njengokungasebenzi kocansi nokunganeliseki ngokobulili. Iningi lomsebenzi okhona usekelwe ocwaningweni olufanayo olwenziwe ngezidakamizwa ezingokwemvelo, ngokusekelwe ekucabangeni kwezithombe zobulili ezingcolile kuyi-intanethi njenge-'promorormal stimulus 'ngokuhambisana nomuthi wangempela, ozosetshenziswa ngokuqhubekayo, ongabangela ukukhubazeka komlutha. Kodwa-ke, imiqondo efana nokubekezelelana nokuziyeka ingakabonakali ngokucacile ukuze ikwazi ukubhaliswa kokulutha, futhi ngaleyo ndlela ibe yingxenye ebalulekile yocwaningo oluzayo. Okwamanje, inhlangano yokuxilonga ehlanganisa ukuziphatha kobulili ihlanganisiwe ku-ICD-11 ngenxa yokusebenza kwayo kwemitholampilo yamanje, futhi ngokuqinisekile iyoba usizo ukubhekana neziguli ezinalezi zimpawu ezicela usizo lwabahlengikazi.
Amathuluzi ahlukahlukene wokuhlola akhona ukusiza odokotela abajwayelekile ngokuthola izindlela zokuxilonga, kepha ukunqamula lokho okuyindlela yokwelapha hhayi ngendlela enembile namanje kuyinkinga eqhubekayo. Kuze kube manje, ingxenye ebalulekile yamasethi amathathu ebekiwe ehlungwe yiCarnes, uGoodman, neKafka kufaka phakathi imiqondo eyisisekelo yokulahleka kokulawula, isikhathi esiningi esisetshenzisiwe ekuziphatheni kobulili nemiphumela emibi kuye nakwabanye. Ngandlela thile noma ngenye indlela, akhona eningi lamathuluzi wokuhlola abukeziwe.
Zingahle zibe yisakhiwo esifanelekile ukwakha kuzo. Ezinye izinto, ezibukwa ngamazinga ahlukahlukene okubaluleka, kungenzeka zisigunyaze ukuthi sibheke izici ngazinye. Ukuqamba ithuluzi lokuhlola eligcina lizinga elithile lokuguquguquka ngenkathi futhi libalulekile ekunqumeni okuyinkinga kunenye yezingqinamba zamanje esibhekene nazo, futhi cishe kuzohambisana nokucwaninga okwengeziwe kwe-neurobiological okusisiza ukuba siqonde kangcono lapho ubukhulu obuthile impilo yomuntu ejwayelekile isuka ekuziphatheni okujwayelekile iye ekungazingeni.
Ngokuqondene namasu okuthola ukwelashwa, inhloso esemqoka njengamanje igxile ekunciphiseni ukusetshenziswa kwezithombe zobulili ezingcolile noma ukukuyeka ngokuphelele, ngoba ukubonakaliswa komtholampilo kubonakala kuphindeka kushintshe. Indlela yokufeza lokhu iyahlukahluka ngokuya ngesiguli futhi ingadinga ukuguquguquka okuthile kumasu asetshenzisiwe, ngokuqonda ngokwengqondo nokwamukelwa okusekelwe ngokwengqondo njengokulingana noma okubaluleke kakhulu kunendlela ye-pharmacological kwezinye izimo.

Izimali

Lolu cwaningo alutholanga imali yangaphandle.

Izingxabano Zesithakazelo

URubén de Alarcón, Javier I. de la Iglesia, noNerea M. Casado bathi akukho kungqubuzana kwezintshisekelo. U-AL Montejo uthole imali yokubonisana noma izibonelelo ze-honaria / zokucwaninga eminyakeni emihlanu edlule evela kwaBoehringer Ingelheim, eForse Pharmaceuticals, eRovi, eServier, eLundbeck, Otsuka, Janssen Cilag, Pfizer, Roche, Instituto de Salud Carlos III, noJunta de Castilla y León .

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