Umlutha Wezithombe Zobulili Ezingcolile: I-Neuroscience Perspective (2011)

CIMISEBENZI: (Bheka izixhumanisi zenkulumo-mpikiswano ku-bottoms wekhasi.) Impikiswano esemqoka lapha iyafana nesayithi lethu: Noma ngabe kungukuziphatha noma amakhemikhali, zonke izidakamizwa zibandakanya izinqubo ezifanayo kanye ne-neurocircuitry. Lokhu kuhlelwa kwe-neurosurgeon kanye nozakwethu kugxile ikakhulu ekuzenziseni, okuvimbela futhi kunciphise usayizi / umsebenzi wama-lobes angaphambili. Kuhlotshaniswa nokulahleka kwekhono lokulawula imizwa evela ohlelweni lobuchopho lobuchopho. Lesi simo (ukungazenzisi) sitholakala ezidakamizweni zezidakamizwa, ukudla, kanye nezocansi. Okunye okuxoxwe ngakho yiDeltaFosB, ikhemikhali edingekayo ekuluthweni kokuziphatha nokwamakhemikhali. Ucwaningo lwakamuva lukhombisa ukuthi iDeltaFosB inyuka ngesipiliyoni socansi, futhi amazinga aphezulu ahlobene nobungqingili.

Umlutha Wezithombe Zobulili Ezingcolile: I-Neuroscience Perspective

UDonald L. Hilton, Clark Watts 

  1. UMnyango weNeurosurgery, i-University of Texas Health Science Center eSan Antonio, San Antonio, TX, USA
  2. UMnyango Neurosurgery, University of Texas School of Law, Austin, TX, USA

Ikheli Lokuxhumana:
Clark Watts
UMnyango Neurosurgery, University of Texas School of Law, Austin, TX, USA

I-DOI:10.4103 / 2152-7806.76977

© 2011 ILilton DL Le yisihloko esivulekile sokufinyelela esisatshalaliswa ngaphansi kwemigomo yelayisensi ye-Creative Commons Attribution, evumela ukusetshenziswa okungavinjelwe, ukusatshalaliswa, nokuphinde kwenziwe kabusha nganoma iyiphi indlela ephakathi nendawo, inqobo nje uma kubhekwa umlobi wokuqala kanye nomthombo.

Ungacaphuna kanjani lesi sihloko: I-Hilton DL, i-Watts C. umlutha wezocansi: Umbono we-neuroscience. I-Surg Neurol Int 21-Feb-2011; 2: 19

Ungasho kanjani le URL: I-Hilton DL, i-Watts C. umlutha wezocansi: Umbono we-neuroscience. I-Surg Neurol Int 21-Feb-2011; 2: 19. Kuyatholakala kusuka: http://surgicalneurologyint.com/surgicalint_articles/pornography-addiction-a-neuroscience-perspective/

Isimo esibalulekile salokhu kuphawula ukuthi yonke imilutha idala, ngaphezu kwezinguquko zamakhemikhali ebuchosheni, ku-anatomical kanye nasezenzakalweni eziholela ekubonakalweni okuhlukahlukene kokungasebenzi kahle kwento ehlanganisiwe enombhalo obizwa ngokuthi yi-hypof Pambal syndromes. Kula ma-syndromes, isici esiyisisekelo, esincishisiwe ekuchazweni kwaso okulula, singumonakalo “ohlelweni oluyisisekelo” lobuchopho. Baziwa kakhulu ngabezokwelapha ngemitholampilo, ikakhulukazi ama-neurologists kanye nama-neurosurgeon, ngoba baphinde babonwe benamaqhubu, imivimbo kanye nomunyu. Ngokweqiniso, ukulahleka kwalezi zinhlelo zokulawulwa kwecala kubonakala kakhulu ngokulandela usizi, kubonakaliswa yi-atrophy ethuthukayo yama-lobes angaphambili abonwa kuma-serial MRI scans ngokuhamba kwesikhathi.

Yize izakhi ezibalulekile zama-syofral syndromes — ukushukumisela, ukucindezelwa, imithwalo yemizwa, ukwahlulela okuphethwe kabi — kuchazwa kahle, inqubekelaphambili yenqubo namanje ayikaziwa. Enye into evelayo yalezi zindawo ezinobuhlakani ukufana kwazo nokutholakele kweziguli eziluthayo. Ekhuluma nge-hypofrontality, uFowler et al. kubhaliwe, "Ucwaningo lwemilutha lukhombisa ukuncishiswa kwemisebenzi yeselula ku-orbitof Pambal cortex, indawo yobuchopho [[ithembele]] ukwenza amasu, esikhundleni sokuphoqelela, izinqumo. Iziguli ezinokulimala okulimazekayo kule ndawo yobuchopho zibonisa izinkinga-ulaka, ukwahlulela okungalungile kwemiphumela yesikhathi esizayo, ukungakwazi ukuvimba izimpendulo ezingafanelekile ezifana nalezo ezihlonzwa ngabahlukumezi bezidakamizwa.”[ 8 ] (kugcizelelwa).

Ku-2002, ucwaningo ngokuluthwa kwe-cocaine kukhombise ukwehla kwamandla evolumu ezindaweni eziningana zobuchopho, kufaka phakathi ama-lobes angaphambili. [ 9 ] Le ndlela yokufunda kwakuyi-protocol esekwe kwi-MRI, i-voxel-based morphometry (VBM), lapho ama-1 mm ama-cubes ubuchopho ancishwa futhi aqhathaniswa. Olunye ucwaningo lwe-VBM lushicilelwe kwi-2004 nge-methamphetamine, nokutholakele okufanayo. [ 27 ] Noma zithakazelisa, lokhu okutholakele kungahle kungamangazi nakusosayensi noma kumakhi, ngoba lezi “izidakamizwa zangempela” zisetshenziswe kabi. Noma kunjalo, kwakuphawuleka ukuthi ukulutha kungaletha ushintsho olulinganiselayo, nolunengqondo ebuchosheni.

Okufundisayo okuthe xaxa kakhulu kuyatholakala ngokuhlukunyezwa kokuziphatha okuvamile kokudla, ukudla, okuholela ekuluthweni komlutha kanye nokukhuluphala. Ku-2006, ucwaningo lwe-VBM lushicilelwe lubheka ngqo ukukhuluphala, futhi imiphumela yayifana kakhulu nezifundo ze-cocaine ne-methamphetamine. [ 20 ] Ucwaningo lokukhuluphala lubonise izindawo eziningi zokulahleka kwevolumu, ikakhulukazi ezindaweni ezihlala ngaphambili, izindawo ezihambisana nokwahlulela nokulawula. Lolu cwaningo lubalulekile ekuboniseni ukulimala okubonakalayo kumlutha wemvelo wendabuko, ngokungafani nomlutha wezidakamizwa ongaphandle. Ngaphezu kwalokho, kulula ukwamukela intuitively ngoba imiphumela yokudla ngokweqile ibonakala kumuntu onamafutha.

Ukudla, vele, kubalulekile ekusindeni komuntu ngamunye, okudingekayo ekusindeni kwezinhlobo. Omunye umsebenzi odingekayo ekusindeni kwezinhlobo ezocansi, umbono okuholela ochungechungeni lwemibuzo enengqondo etholakala emsebenzini wokukhuluphala. Ngabe ukutholwa okubonwe ekudakwiseni umlutha bekungabonakala ekuziphatheni okubi kakhulu ngokobulili? Ngabe ubulili bungaba umlutha ngomqondo we-neurological? Uma kunjalo, ingabe kukhona okuhambisana nezinguquko zomlutha womqondo ebuchosheni obonwa kanye nezinye izidakamizwa? Ucwaningo lwakamuva lusekela ubufakazi obukhulayo bokuthi ubulili obuphoqayo bungaba umlutha ngempela. Ku-2007, ucwaningo lwe-VBM oluphume eJalimane lwalubheka ngqo i-pedophilia, futhi lwakhombisa cishe ukutholakala okufanayo ocwaningweni lwe-cocaine, methamphetamine, kanye nokukhuluphala. [ 25 ] Kuphetha okokuqala ukuthi ukuphoqelelwa ngokocansi kungadala ushintsho lomzimba, lwe-anatomic ebuchosheni, uphawu oluyimilutha yobuchopho. Ucwaningo lokuqala lubonise ukungasebenzi kahle kwangaphakathi ezigulini ezingakwazi ukulawula indlela yokuziphatha kwezocansi. [ 16 ] Lolu cwaningo lusebenzise i-MRI ye-infusion ukuvivinya umsebenzi wokudluliselwa kwengqondo ngendaba emhlophe. Kubonise ukungahambi kahle esifundeni esiphambili sangaphambili, indawo ehlotshaniswa nokuphoqelelwa.

Eminyakeni eyishumi edlule uDkt Howard Shaffer eHarvard wabhala, "Ngaba nobunzima obukhulu nabalingani bami uqobo lapho ngiphakamisa ukuthi umlutha omningi ungumphumela wesipiliyoni… ukuphindaphinda, imizwa ephakeme, isipiliyoni esivame kakhulu. Kepha kuyacaca ukuthi i-neuroadaptation — okuwukuthi, izinguquko zokujikeleza kwe-neural ezisiza ukuqhubekisela phambili ukuziphatha — zenzeka yize kungekho izidakamizwa. ”[ 13 ] Muva nje ubhale ukuthi, “Yize kungenzeka ukuthi kube nenkulumo mpikiswano yokuthi kufanele sifake izinto noma umlutha wokulutha embusweni wokulutha, ngokweqiniso akukho ukukhetha okuncane. Njengoba ukusetshenziswa kwezinto ezingaphandle kudala ukuqothula ama-mocule we-impostor alwela amasayithi we-receptor ngaphakathi kobuchopho, imisebenzi yabantu ivusa ama-neurotransmitters ngokwemvelo. Umsebenzi walezi zinto ezinengqondo ezenzeka ngokwemvelo kungenzeka unqunywe njengabalamleli ababalulekile bemilutha eminingi yenqubo. ”[ 24 ]

Ku-2005, uDkt Eric Nestler wabhala iphepha eliyisisekelo elichaza konke ukulutha njengokuphazamiseka kwezindawo zemivuzo ye-mesolimbic. Umlutha wenzeka lapho izindlela zenjabulo / zomvuzo zigqitshwa izidakamizwa zangaphandle ezinjenge-cocaine noma ama-opioid, noma izinqubo zemvelo ezibalulekile futhi ezihambisana nokusinda njengokudla nobulili. Izinhlelo ezifanayo ze-dopaminergic zifaka indawo ye-ventral tegmental nendawo yayo yokuqagela kuma-nucleus accumbens nakwezinye izikhungo ze-striatal salience. Ubhale, "Ubufakazi obukhulayo bukhombisa ukuthi indlela ye-VTA-NAc kanye nezinye izifunda ezinamandla okukhulunywe ngazo ngenhla ngokufana, okungenani, ngokwengxenye, yimiphumela emnandi yemiphumela yemivuzo yemvelo, njengokudla, ucansi kanye nokuhlangana komphakathi. Lezi zifunda nazo ziye zaba nomthelela kulokhu okubizwa ngokuthi 'imilutha yemvelo' (okungukuthi, ukusetshenziswa okuphoqelelayo kwemivuzo yemvelo) njengokudla ngokweqile, ukugembula okubangelwa ukugula, nokulutha kwezemacansini. Ukutholwa kokuqala kusikisela ukuthi izindlela ezihlanganyelwe zingabandakanyeka: (ngokwesibonelo) ukuzwela okwenzeka phakathi kwemivuzo yemvelo nezidakamizwa zokuhlukumeza. [ 18 ]

Lokhu kunakwa kwenqubo (noma yemvelo) yokulutha kudinga ukugxila ekungasebenzi kahle kwe-metabolic ezindleleni ze-mesolimbic salience. Njengoba nje izidakamizwa ezilawulwa ngokweqile zibangela ukwehliswa kwama-dopamine receptors kuma-nucleus accumuls ngomlutha, ubufakazi buxhasa ukusekela ama-neurotransmitters asebenza ngokweqiniso abangela i-pathology efanayo.

I-Royal Society yaseLondon ehlonishwayo, eyasungulwa kuma-1660s, inyathelisa iphephabhuku lesayensi elide kunazo zonke emhlabeni. Kumagazini wakamuva we Ukuhwebelana kwezefilosofi zeRoyal Society, isimo samanje sokuqonda umlutha sabikwa njengoba bekuxoxwa nabanye ososayensi abaphambili bomlutha emhlabeni emhlanganweni weNhlangano. Isihloko sokukhishwa kukamagazini okubike umhlangano sithi "I-neurobiology yokulutha - i-vistas entsha." Kuyathakazelisa ukuthi, ezihlokweni ze17, ezimbili zazikhathazekile ngobufakazi bokuluthwa kwemvelo: ukugembula kwe-pathologic [ 23 ] nokudla ngokweqile. [ 28 ] Iphepha lesithathu, likhuluma ngezinhlobo zezilwane zezidakamizwa nezomlutha wemvelo, ezihlobene ne-DeltaFosB. [ 19 ] I-DeltaFosB yiprotheni efundwe nguNestler ebonakala ekhonjiswa ngokweqile kuma-neurons wezifundo eziluthayo. Kutholakala okokuqala kuma-neurons ezilwane ezazifundwe umlutha wezidakamizwa [ 17 ] kepha manje sekutholakele kuma-nucleus accumbens ahlobene nokusetshenziswa ngokweqile kwemivuzo yemvelo. [ 18 ] Iphepha lakamuva eliphenya ngeDeltaFosB nendima yalo ekusebenziseni ngokweqile imivuzo emibili yemvelo, ukudla, kanye nezocansi, liyaphetha:… umsebenzi owethulwe lapha unikeza ubufakazi bokuthi, ngaphezu kwezidakamizwa zokuhlukunyezwa, imivuzo yemvelo yenza amazinga ∆FosB e-Nac … Imiphumela yethu iphakamisa ukuthi i-∆FosB yokungeniswa kwi-NAc ingahle ihlanganyele kuphela izici ezibalulekile zokuluthwa yizidakamizwa, kodwa futhi nezici zokulutha okungokwemvelo okubandakanya ukusetshenziswa okucindezelayo kwemivuzo yemvelo. [ 29 ]

 

Okuhlobene kakhulu namaphepha asanda kushicilelwa kwi-2010 echaza umphumela wobulili obuyi-neuroplasticity. Kokunye ukuhlola, isipiliyoni sobulili sikhonjiswe ukuthi sinikeze ushintsho kuma-spiny neurons aphakathi nendawo kuma-nucleus anqwabelene afana nalawo abonwa ngezidakamizwa zokuhlukumeza. [ 21 ] Olunye ucwaningo luthole ukuthi ubulili bukhulisa ngokukhethekile i-DeltaFosB ku-nucleus accumbens, futhi isebenza njengendlamli kwimemori yemivuzo yemvelo. Lolu cwaningo luphinde lwathola ukuthi i-overexpression ye-DeltaFosB idonsa i-hypersexual syndrome. [ 22 ] Njengoba uDkt Nestler asho, iDeltaFosB ingahle ibe "yi-biomarker yokuhlola isimo sokwenza umsebenzi womuntu ngamunye, kanye nezinga umuntu 'elimlutha ngalo', zombili ngesikhathi sokuthuthukisa umlutha ukuwa ngesikhathi sokuhoxa noma ukwelashwa okweluliwe. ”[ 22 ]

UDkt Nora Volkow, iNhloko yeNational Institute on Drug Abuse (NIDA), kanye nesinye isayensi eshicilelwe futhi ehlonishwayo emkhakheni wokulutha, ukuqaphela ushintsho ekuqondeni umlutha wemvelo, okhuthaza ukuguqulwa kwegama i-NIDA eNational Institute on Diseases of Addiction, njengoba kucashunwe kuleyo magazini Isayensi"UMqondisi weNIDA uNora Volkow uzwe nokuthi igama lesikhungo sakhe kumele libandakanye izidakamizwa ezifana nezithombe zobulili ezingcolile, ukugembula, nokudla, kusho umeluleki weNIDA uGlen Hanson. 'Ungathanda ukuthumela umyalezo wokuthi [kufanele] sibheke yonke insimu.' ” 7 ] (kugcizelelwa).

Ngobufakazi obukhulayo bokuthi ukudla ngokweqile kungaba umlutha wangempela njengoba kuchazwa izinguquko ezilinganisekayo, ezifakazisekayo ezikhungweni ze-saliic salience, ukunaka kwethu le nkinga kuyanda ngokufanelekile. Kepha ubulili, kanye nezibopho zayo zokuziphatha, busingathwa ngokungagxili empikiswaneni yesayensi. Lokhu kubonakale ngemuva kocwaningo lweHogg olushicilelwe e1997, olukhombisa ukwehla kweminyaka engu-20 yesikhathi sokuphila kwabantu abathandana nabesilisa abesilisa abathandana nabesilisa. [ 12 ] Ababhali, ngokusobala bezizwa benengcindezi yomphakathi, bakhiphe ukucacelwa ukuthi bangavunyelwa ukuthi bakubize ngokuthi yini ngokuthi “ukubizwa ngokungekuhle.” [ 11 ] Ukuthi iphephabhuku lesayensi lingashicilela ukuxolisa okunjalo kwezinhlobo kubalulekile futhi. Siyakholelwa, nokho, ngesisekelo esandulele sekuyisikhathi sokuqala izingxoxo ezibucayi zokuluthwa ngokocansi kanye nezinto zalo ezifana nezithombe zocansi.

I-DSM-5 ehlongozwayo, okuthiwa izoshicilelwa ngoMeyi we-2014, iqukethe kulokhu kuhlanganiswa okusha kwe-Hypersexual Disorder, okubandakanya ukusetshenziswa kwezithombe zocansi okuyinkinga, okuphoqayo. [ 1 ] UBostwick noBucci, embikweni wabo ophuma eMayo Clinic ekwelapheni umlutha wezocansi nge-inthanethi nge-naltrexone, babhale ukuthi “… ukuvumelana ngamaselula emgomeni (wezocansi) ongumlutha we-PFC kuphumela ekuvuselelekeni kwesikhuthazo esihlotshaniswa nezidakamizwa, kunciphe ukuzwela kokungezona izidakamizwa ezingekho emthethweni , futhi yehlise intshisekelo yokulandela imisebenzi eqondiswe kunhloso eyinhloko ekusindeni. ”[ 3 ]

Ku-2006 imali yezithombe zocansi emhlabeni ibingama-97 dollar ayizigidi eziyinkulungwane, okungaphezulu kwe-Microsoft, Google, Amazon, eBay, Yahoo, Apple, neNetflix kuhlanganisiwe. [ 14 ] Lokhu akuyona into engasho lutho, engabalulekile, kepha kunesifiso sokunciphisa imiphumela engemihle yezenhlalo nezobulili ezingcolile. Umkhakha wezocansi ubonise ngempumelelo noma yikuphi ukuphikisana nezithombe zocansi njengokuvela ngokombono wenkolo / ngokokuziphatha; zona-ke zichitha lezi ziphikiso njengokuphulwa kokuqala kokuchitshiyelwa. Uma umlutha wobulili ezingcolile ubukwa kahle, ubufakazi bukhombisa ukuthi empeleni buyalimaza abantu maqondana nokuzibopha ngababili. [ 2 ] Ukuxhunyaniswa (i-85%) phakathi kokubuka izithombe zocansi zezingane nokubamba iqhaza ebudlelwaneni boqobo bezocansi nezingane kuboniswe nguBourke noHernandez. [ 4 ] Ubunzima bokuxoxwa kontanga okuhlosiwe Injongo yalesi sihloko kukhonjiswa ngokuzama ukucindezela le datha ngezizathu zenhlalo. [ 15 ] Ukuhlaziywa kwe-meta yakamuva ngu-Hald et al. isekela ngokuqinile futhi icacise idatha yangaphambilini ekhombisa ukulungiswa ngokuphathelene nezithombe zobulili ezingcolile ezisusa isimo sengqondo sokuhlukunyezwa ngokumelene nabesifazane. [ 10 ] Ngedatha enjalo eqondana ne-correlative, akunandaba nokubhekana nokuthi kungenzeka ukuthi kungenzeka yini ukuthi kungabangela ukuthi kutholakale. Ukubuyekeza le datha kumongo wamaphethini wokusetshenziswa kwamanje ikakhulukazi ngokuphathelene; U-87% wamadoda asekolishi ubudala abuka izithombe zobulili ezingcolile, i-50% masonto onke kanye ne-20 nsuku zonke noma enye imihla, kanye ne-31% yabesifazane ababuka futhi. [ 5 ] Umphumela wokubikezela wezithombe zobulili ezingcolile ekuziphatheni ngokobulili kwabaselula uye waboniswa. [ 6 ]

Ngokuqinisekile indima yethu njengabaphulukisi ibonisa ukuthi singenza okungaphezulu ukuphenya nokuphatha izifo zabantu ezihlobene nalesi sigaba esisha senqubo noma ukulutha kwemvelo, ikakhulukazi kunikezwa isisindo esivimbayo sobufakazi obusekela isisekelo se-neural yazo zonke izinqubo zokulutha. Njengoba nje sibheka ukulutha kokudla njengokwesisekelo se-biologic, kungabi namagama okugqoka noma i-term-laden terminology, yisikhathi sibheka izithombe zobulili ezingcolile nezinye izinhlobo zokulutha ngokocansi ngenjongo efanayo. Njengamanje, ukucindezelwa kwezenhlalakahle kubangela ukuphathwa kwezithombe zobulili ezingcolile ngokuyinhloko ezenzweni zomphakathi noma ezinkundleni zobugebengu. [ 26 ] Lokhu kuhlaziywa akusona isicelo sokushintsha lezo zindlela noma nini ngokushesha. Isitatimende esifuna ukugqugquzela ukuhlolwa ngemithi ngokujwayelekile kanye nezici zokwelapha nge-neuroscience ikakhulukazi yendima yokwelashwa ekulawuleni ukulutha komzimba wezithombe zobulili ezingcolile.

Ekuphetheni lo mbono, iphrofayela yePublic Health yezithombe zobulili ezingcolile ingaba usizo. Noma iyiphi iphrofayli enjalo ngemvelo yayo iyoba yinto encane kakhulu ngenxa yesimo samanje sokwazi umlutha kanye nemvelo lapho kwenzeka khona. Ithebula 1 umzamo wokunikeza iphrofayili enjalo yecala lezithombe zobulili ezingcolile, besebenzisa njengesibonelo ukuphenywa kokuqhekeka kwekholera eLondon ku-1854, lapho ukuqonda kweMpilo yoMphakathi kubangelwa ukwelashwa ngokwemithi mhlawumbe njengokungathi kuyimfihlo njengalezo zobulili ezingcolile namuhla. Ngenkathi sibona umnikelo omkhulu wembonini yezinto ezingcolile zobulili ezingcolile ezizodinga ukubhekana nazo ngokusebenzisa izinsiza ezingekho kwemithi, kuphakamisa futhi indawo yemithi ekulawuleni umlutha.

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