Ukuvama kokucindezeleka okuhlangene nobunzima ukulawula ukugqugquzela ngokobulili, imizwelo, kanye nezinzuzo e-United States (2018)

Novemba 9, 2018

UJanna A. Dickenson, PhD¹; UNeil Gleason, MA¹; U-Eli Coleman, PhD¹; et al UMichael H. Miner, PhD¹

Isihloko Sokwaziswa

I-JAMA Netw Vula. 2018; 1 (7): e184468. i-doi: 10.1001 / jamanetworkopen.2018.4468

Umbuzo  Kuyini ukusabalala phakathi kwamadoda nabesifazane base-US besici esiyinhloko sokucindezela ukuziphatha kocansi, ukucindezeleka nokukhubazeka okuhlobene nokuthola ubunzima bokulawula imizwa yobulili, iziphakamiso, nokuziphatha?

okutholakele  Kulolu cwaningo lokuhlola, sithole ukuthi i-8.6% yesampula emele izwe lonke (i-7.0% yabesifazane namadoda angu-10.3% wamadoda) avunyelwe amazinga okucindezeleka kanye / noma ukukhubazeka okuhambisana nokubunzima ukulawula imizwa yobulili, iziphakamiso, nokuziphatha.

Okusho  Ukukhula okuphezulu kwezimpawu ezinjalo kunempilo enkulu yomphakathi njengenkinga yezenhlalo futhi kubonisa inkinga ebalulekile yomtholampilo okufanele ihlonzwe ochwepheshe bezempilo.

Ukubaluleka  Ukuqiniswa, ukuchazwa kwamagama, nokucabangela kokubheja ngokobulili, ukuziphatha okungahambisani nokuziphatha ngokobulili, ukuziphatha okuphathelene nokuziphatha ngokocansi, nokuziphatha okungacindezeli noma ukuziphatha ngendlela ecindezelayo kuxoxwa kabanzi. Naphezu kokuhluka okunjalo ekucabangeni, wonke amamodeli ahambisana nesici esivelele: ukwehluleka ukulawula imizwa yokuziphatha ngokocansi kanye nokuziphatha ngendlela edala ukucindezeleka okukhulu kanye / noma ukukhubazeka ekusebenzeni. Kodwa-ke, ukusabalala kwenkinga e-United States akungaziwa.

Inhloso  Ukuhlola ukusabalala kokucindezeleka nokukhubazeka okuhambisana nobunzima bokulawula imizwa yobulili, iziphakamiso, nokuziphatha phakathi kwesampula emele izwe e-United States.

Ukuklama, ukubeka, kanye nabahlanganyeli  Lolu cwaningo lokuhlola lusetshenziselwa Ucwaningo lukazwelonke lwezeMpilo yezocansi kanye neDatha yokuziphatha ukuze kuhlolwe ukusabalala kokucindezeleka nokukhubazeka okuhambisana nobunzima bokulawula imizwa yocansi, iziphakamiso, nokuziphatha futhi kunqume ukuthi ukusabalala kwahlukahluka kanjani kuzo zonke izinhlobo zomphakathi. Abahlanganyeli phakathi kweminyaka yobudala ye-18 ne-50 iminyaka babanjwe ngokungahleliwe kuzo zonke i-50 US ngoNovemba 2016.

Imiphumela emikhulu kanye Nezinyathelo  Ukucindezeleka nokukhubazeka okuhlotshaniswa nobunzima bokulawula imizwa yocansi, iziphakamiso, nokuziphatha kwaqalwa ngokusebenzisa i-Compulsive Behavior Inventory-13. Amaphuzu we-35 noma ngaphezulu ngezinga le-0 kuya ku-65 libonise amazinga afanele emiphakathini okucindezeleka kanye / noma ukukhubazeka.

Imiphumela  Kubantu abadala be-2325 (i-1174 [50.5%] ubudala; kusho iminyaka engu- [SD], iminyaka engu-34.0 [9.3], i-201 [8.6%] ihlangabezane nesimo sokusika isikrini se-35 noma ngaphezulu kwi-Compulsive Behavior Inventory. Ukungafani kobulili kwakuncane kunalokho okwashiwo ngaphambili, ne-10.3% yamadoda kanye ne-7.0% yabesifazane abeseka amazinga asemtholampilo ahambisana nokucindezeleka kanye / noma ukukhubazeka okuhambisana nobunzima bokulawula imizwa yocansi, iziphakamiso nokuziphatha.

Iziphetho nokuBheka  Ukuphakama okuphezulu kwalesi sici esivelele esihlotshaniswa nokucindezeleka kokuziphatha ngokocansi kunethonya elibalulekile kubaqeqeshi bezempilo kanye nomphakathi. Ochwepheshe bezempilo kufanele baqaphele inani eliphezulu labantu abacindezelekile ngokuziphatha kwabo ngokobulili, bahlole ngokucophelela uhlobo lwenkinga ngaphakathi kwenkambiso yabo yezenhlalo, futhi bathole ukwelashwa okufanele kokubili amadoda nabesifazane.

Kusuka kuTiger Woods kuya eHarvey Weinstein, izihloko zezindaba zithi "ukubheja ocansini" kuyisimo esanda sikhula futhi esingaziwa ngaphambili "esiwumshayabhuqe,"¹ kuyilapho umphakathi wesayensi uphikisana ngokuthi ngabe inkinga enjalo ikhona yini. Nakuba ukuhlolwa kwengqondo kunomlando omude wokuzama ukuveza ubulili obufanayo, abacwaningi nabahlengikazi banemibono engafani ngokuqondene nokuthi imelela yini ukugula kwangempela kwengqondo noma nje kubonisa inkinga enkulu yenhlalo yezenhlalo (ebhalwe ngokuthi ukuziphatha okungahambisani nokuziphatha ngokocansi²). Ngaphezu kwalokho, kube khona ukungavumelani okukhulu mayelana nokucabangela, i-etiology, kanye nomenclature (isib. ukuziphatha kocansi okuphoqelela [CSB],³ukuphazamiseka kwe-hypersexual,⁴ukulutha ngokocansi,⁵ futhi ukuziphatha okungahambisani nokuziphatha ngokocansi²).⁶ Ukuboniswa kwesimpawu kubuyehlukahluka kulo lonke ulwazi, okwenza kube nzima ukulinganisa okucacile kokukhula komphakathi.⁷ Ngenxa yalokho, ikhono lososayensi lokuhlola ngokucophelela ukuqinisekiswa kwesimo samasiko ama pop ukuthi i-CSB "isifo esiyanda"¹ ihlala ingaphelele.

Naphezu kokungavumelani okunjalo ngokuphathelene nokucubungula nokusebenza, yonke imibono ihlanganisa isici esivamile: kunenkinga enkulu yokulawula imizwa yobulili, iziphakamiso, kanye nokuziphatha okubangela amazinga asemtholampilo okucindezeleka kanye / noma ukukhubazeka. Lesi sici esiyinhloko sakha isisekelo sohlelo olusha lokucindezeleka kokuziphatha ngokobulili (CSBD), okwakuqala okokuqala, ukutholwa njengesiyaluyalu esihlelekile Ukuhlukaniswa Kwezifo Zomhlaba Wonke, Ukubuyiselwa Kwayishumi Nanye, ngaphansi kwesigaba sokukhathazeka kokulawula ukucindezeleka.⁷ Ngokukodwa, i-CSBD ibonakala iphethini eliphikisanayo lokuhluleka ukulawula ukucindezela okuphindaphindiwe ngokocansi okuphindaphindiwe, okuholela ekuziphatheni ngokocansi okuphindaphindiwe okubangela ukucindezeleka okuphawulekayo noma ukukhubazeka komphakathi. Ukucindezeleka okunjalo nokukhubazeka kuhlanganisa ukunganaki imisebenzi yezenhlalakahle noma impilo yomuntu siqu, ukuzama ngokuphindaphindiwe ukulawula ukuziphatha ngokocansi kungaphumeleli, nokuqhubeka nokuhlanganyela ekuziphatheni ngokobulili naphezu kwemiphumela emibi noma ngisho nalapho umuntu ethatha injabulo encane emisebenzini yakhe yezocansi.

Njengoba kunikezwa ukuhlelwa kokuhlelwa kwe-CSBD nokungabi khona kwezingcaciso eziqhubekayo, kusenalo ulwazi olwenziwe ngokulandelana kwezifo eziye zaqhutshwa e-United States. Ukulinganiswa okubi kwembono yokuziphatha kobulili okungahambisani nokulawula kutholakale kwamanye amazwe,⁸ futhi ukusabalalisa kwezwe e-United States kuye kulinganiselwa kusekelwe amasampula amancane.^4,7 Ucwaningo olunjalo luye lwabonisa ukuthi bambalwa abantu ababona ukuthi ukuziphatha kwabo ngokocansi kungenakulawulwa futhi bahlangabezana nokucindezeleka kanye / noma ukukhubazeka ngenxa yokuziphatha kwabo ngokobulili. E-United States, ukusabalalisa kulinganiselwa ukuthi kuyahluka kusuka ku-1% kuya ku-6% kubantu abadala, kunesidingo esilindelwe besilisa kuya kwesilinganiso sezinsikazi kusuka ku-2: 1 kuya ku-5: 1.^4,7 Njengoba kunesidingo sezifundo ze-epidemiological ezihleliwe e-United States kanye nezingxabano ezizungeze izincazelo kanye nesethulo esithile sokwempawu, ukuhlola ukusabalala kokucindezeleka nokukhubazeka okuhambisana nobunzima bokulawula imizwa yobulili, iziphakamiso kanye nokuziphatha kuhlinzeka ngokulinganisela okulinganiselwe kwesilinganiso se-CSBD etholakalayo ngalesi sikhathi.

Ucwaningo lwamanje luhlola ukusabalalisa kwalesi sici esiyinhloko e-United States ngokulawula i-Compulsive Behavior Inventory-13 (CSBI-13) kwisampula emele izwe.Figure). I-CSBI-13 yenzelwe njengesixhobo sokuhlola ukuhlola ubunzima bokuziphendulela nokuziphatha kocansi ngokuphoqelela.^9,10 Izinto ezikhona ze-13 zihambisana nezindlela ezihlongozwayo ze-CSBD futhi zihlola ubunzima bokubona kunzima ukulawula imizwa yobulili, iziphakamiso, nokuziphatha kanye nesilinganiso sokucindezeleka (ukuzizwa unamahloni ngokuziphatha ngokobulili, ukuziphatha ngendlela yokuziphatha ngokocansi njengendlela yokulawula umzwelo) futhi ukukhubazeka kwengqondo (ezempilo, ezenzweni zabantu, nemiphumela yomsebenzi) ezihambisana nokuziphatha okunjalo.¹¹ Njengamanje, i-CSBI-13 yiyona kuphela yesikhombisi sokuhlola esikhona esinephuzu elinqunywe lomtholampilo ukuze kutholakale ngokunembile labo abahlangabezana futhi abangahlangabezani nezimo ze-CSB syndrome cishe 72% ne-79% yesikhathi, ngokulandelana.¹¹ Ngokusekelwe kokulinganiselwa kwangaphambili kwe-US kwe-CSBD, sithembele ukuthi i-1% kuya ku-6% yabantu bayohlangana nomqondo wokusika we-CSBI-13 no-20% kuya ku-30% walabo abahlangabezana nephuzu lokunqunywa emitholampilo kungaba abesifazane.

Idatha yaqoqwa njengengxenye yoSwaningo lweZwelonke lwezeMpilo yezocansi nokuziphatha (NSSHB) elandela i-American Association for Public Opinion Research (I-AAPOR) isiqondiso sokubika sokuhlola kocwaningo. Ucwaningo lwe-NSSHB lwaklanyelwe ukuhlola okuhlangenwe nakho kobulili phakathi kwabantu base-US phakathi kweminyaka engu-18 ne-50 iminyaka (iminyaka engu-[SD] ethatha inxaxheba, iminyaka engu-34.0 [9.3] futhi ihlanganisa nabantu bazo zonke izifunda ze-50 ne-District of Columbia. Abahlanganyeli baboshwa basebenzisa i-KnowledgePanel (GfK Research) ngezikhathi zamaviki angu-2 ngoNovemba 2016 kusukela kubantu abaningi abadala abaqedile i-1 yamagagasi wangaphambili wezifundo ze-NSSHB kanye nesampula entsha yabantu abaningi abadala e-United States. Ababambiqhaza kusukela kokubili amaqembu ahlosiwe baqashelwa ngokungahleliwe ngokusebenzisa isampuli esisekelwe ematheni, futhi izindlu zanikezwa ukufinyelela kwi-inthanethi ne-hardware uma kudingeka.¹² Le ndlela yasetshenziselwa isampula esikhulu sampula kazwelonke esivela kuwo lapho amasampula amele ngokugcwele angakhiwa ukuze akhiqize izinkomba ezithinta izibalo kubantu abafunda. Kulabo abathintekayo kulolu cwaningo, i-51% (i-2594) iqhubekele isithakazelo esifundweni ngokuvakashela iwebhusayithi lapho bangafunda khona ngesifundo. Kulaba bantu ngabanye, i-94% (2432) inikeze imvume enolwazi, futhi i-95.6% (2324) yalabo abanikeza imvume enolwazi baqedile i-CSBI-13. I-NSSHB ivunyiwe yibhodi lokubuyekeza lezikole lase-Indiana University.

I-CSBI-13 iyithuluzi lokuhlola elihlola isici esiyisisekelo se-CSBD: ukukhubazeka okusebenzayo kanye / noma ukucindezeleka okuhambisana nobunzima bokulawula imizwa yobulili, iziphakamiso, nokuziphatha.¹⁰ I-CSBI-13 ikhonjisiwe ukuthi inokwethenjelwa okwanele, ukuqinisekiswa kwemigomo ethembekile, nokufaneleka okubandlulula nokuguquguquka.¹¹ Izinguqulo zangaphambilini ze-CSBI zihlolwe ezinhlobonhlobo ezihlukahlukene zamadoda nabesifazane abadala ase-United States^13-17 nakwamanye amazwe.^17,18 Ababambiqhaza banquma zonke izinto ze-13 (Figure) esikalini se-5-kusuka ku-1 (angakaze) kuya ku-5 (kakhulu kakhulu). Isibalo esiphelele sesilinganiso sibalwa ngokuhlanganisa phakathi kwezinto. Amaphuzu we-35 noma ngaphezulu kuye kwaboniswa ukuthi iyindawo ecacile futhi eqondile yokuhlukanisa abantu abahlangabezana nezilinganiso ze-CSB yesifo somzimba esibucayi, esivumelana nendlela yokuhlonza ehlongozwayo ye-CSBD.¹¹ Ngenxa yokuthi i-CSBI-13 iyithuluzi lokuhlola lokuzihlola elizimele ngaphambi kokufakwa kwesigaba esisha se-CSBD, amaphuzu we-35 noma ngaphezulu aveza amathuba aphezulu okuhlola ukuhlolwa komsebenzi futhi aqinisekise ukuhlolwa okwengeziwe ukuze kuqinisekiswe ukuthi i-CSBD ihlolwe yini.

Ubudala, ubuhlanga / ubuhlanga, imfundo kanye nemali engenayo yasendlini kwaqoqwa ngesikhathi senqubo yokuqashwa kweGfK. Imali ibike ngokulandelana ukusuka kokungaphansi kwe $ 5000 kuya ku-$ 250 000 noma ngaphezulu. Njengoba kunikezwe inani lezigaba ezigciniwe, imali engenayo ihlelwe kulezi zigaba ezilandelayo: ngaphansi kuka-$ 25 000, i-25 000 ku-$ 49 999, i-50 000 ku-$ 74 999, i-75 000 ku-$ 99 999, i-100 000 kuya ku-$ I-150 000, futhi ngaphezulu kuka $ 150 000. Ngokufanayo, izinga lemfundo laqoqwa ngokweqile futhi lahlehliswa ngezigaba ezilandelayo: ngaphansi kwezemfundo ephakeme esikoleni, idiploma yesikole esiphakeme noma ilingana, i-degree yasekolishi noma i-associate, i-bachelor degree, ne-degree degree noma ngaphezulu. Abaphenduli bakhetha ubuhlanga babo / ubuhlanga kusukela kulokhu okulandelayo: abamhlophe, abangewona amaSpanishi; abamnyama, abangewona iSpanishi; izinhlanga eziningi, ezingezona iSpanishi; ne-Hispanic. Ngesikhathi sokuhlola, abahlanganyeli babike ubulili babo njengendoda, owesifazane, i-transman, noma i-transwoman. Ngenxa yokuthi abantu abangu-4 kuphela abathintekayo njenge-transgender, abantu be-transgender babenqunywe ngokusho kobulili babo. Ababambiqhaza nabo babhala ngokuziphatha kwabo ngokocansi njengabesilisa ocansini, abesilisa nabesilisa nabesilisa nabesilisa, abesilisa nabesifazane, abesilisa nabesilisa abashadile, abakwa-asexual, noma okunye okunye. Labo abathintekayo njenge-asexual noma enye into bahlanganisiwe, kunikezwa imvamisa ephansi yalezilebula.

Ukusabalalisa kwabantu abaye bavumela amazinga asemtholampilo ahambisana nokucindezeleka nokukhubazeka okuhlotshaniswa nokuthola ubunzima bokulawula imizwa yocansi, iziphakamiso, nokuziphatha kwahlolwa ngokulinganisa inani le-95% yokuzimela kwabantu abathola i-35 noma ngaphezulu kwi-CSBI-13 ngokusebenzisa okuchazayo izibalo ku-version ye-software yesofthiwe ye-SPSS i-22.0 (IBM). Izici phakathi kwabantu abahlangane futhi abangazange bahlangabezane nephuzu lokunqunywa emitholampilo ye-CSBI-13 banikezwe njengamaphesenti (iziguquguquko zesigaba) noma izindlela (izinguquguquko eziqhubekayo). Ukuphenya ukungezwani kwenani labantu abahlangabezane nendawo yokunqunywa emitholampilo ye-CSBI-13 ngezici ezihlukahlukene zomphakathi (isb. Ubulili, ubuhlanga / ubuhlanga, kanye nobuhlobo bobulili), χ² izibalo zabalwa. Ukuthola okubalulekile (i-2-side P <.05) babuye bahlolwa kusetshenziswa ukuhlehla kanambambili ngomsebenzi we-log-link ukulinganisa umehluko kuma-rate ratios kuzo zonke izinto eziguquguqukayo zenhlalo yabantu.

Ukuze ulungise imithombo yesampuli kanye nephutha elingathandwayo, isampula yokutadisha isilungiswe ngokulungiswa kwe-poststratification besebenzisa ukunikezwa kwezindawo ezivela ku-Recent Population Survey kusukela ku-US Census Bureau.¹⁹ Lezi zinguquko zenze isisindo se-panel panel esasetshenziswa ngamathuba okulinganisa nendlela yokukhetha usayizi yokusungula isampula sokwenza isifundo samanje.¹² Yonke idatha ethulwe kulolu cwaningo isebenzisa lezi zindwangu.

Abahlanganyeli (N = 2325) babephakathi kweminyaka yobudala be-18 ne-50 (iminyaka eyi-[SD] yobudala, iminyaka engu-34 [9.26], enezinombolo ezilinganayo ezilinganayo zabantu abesilisa nabesifazane (1174 [50.5%] wesifazane) (Ithebula). Idatha echazayo yemfundo ibonise ukuthi i-10.8% (abahlanganyeli be-251) abaqedanga esikoleni esiphakeme, i-26.8% (622% igcwaliswe esikoleni esiphakeme), i-30.7% (713) igcwaliswe ekolishi, i-19.4% (i-450) ithole i-bachelor degree, ne-12.4% ( I-289) ithole isitifiketi sobuchwepheshe. Mayelana neholo, i-19.7% (i-458) ithole ngaphansi kwe-$ 25 000 futhi i-41.0% (953) ithole imali engaphezulu kwe $ 75 000. Ngokuphathelene nobuhlanga nobuzwe, i-19.8% (i-455) ikhonjiswe njengeSpanishi; I-58.4% (i-1358) njengemhlophe, engeyona iSpanishi; I-12.7% (i-296) njengomnyama, engeyona iSpanishi; I-1.6% (i-36) njengemihlanga eminingi, engeyona iSpanishi; futhi i-7.7% (i-179) njengenye, engeyona iSpanishi. Ingqikithi ye-91.6% yabahlanganyeli (i-2128) ichaze ngokwayo njengobungqingili, 4.4% (101) njengobulili obufanayo, i-2.6% (60) njenge-gay noma i-lesbian, ne-1.4% (33) njengenye into. I Ithebula ichaza ukusatshalaliswa kwezici ze-sociodemographic kubantu abakhombise futhi abangabonisi amazinga asebenzayo okucindezeleka ahambisana nezifiso zabo zobulili nokuziphatha, kanye nokungafani kwamazinga okukhula ezihlukahlukene eziguquguqukayo zezenhlalakahle.

Izinga lokusakazeka lokuvumela amazinga asemtholampilo afanelekayo okucindezeleka kanye / noma ukukhubazeka okuhambisana nobunzima bokulawula imizwa yobulili, iziphakamiso, nokuziphatha (uphawu lwe-CSBI-13 ≥35) yi-8.6% (95% CI, 7.5% -9.8%) (abahlanganyeli abangu-201 ). Phakathi kwamadoda, ama-10.3% (119) avunyelwe amazinga okucindezeleka kanye / noma ukukhubazeka okuhambisana nokubunzima ukulawula imizwa yocansi, iziphakamiso, nokuziphatha, uma kuqhathaniswa ne-7.0% yabesifazane (abahlanganyeli be-82). Nakuba amadoda ayengu-1.54 (95% CI, izikhathi ezingu-1.15-2.06) amathuba amaningi okuvumela amazinga amakhulu okucindezeleka ahambisana nobunzima bokulawula imizwa yocansi, iziphakamiso, nokuziphatha (χ² = 8.32, P = .004), abesifazane babalwa cishe isigamu (40.8%) sabantu abahlangabezana nephuzu lokusika lomtholampilo.

Ukungafani okuphawulekayo ekukhulekeleni ukucindezeleka okuhambisana nobunzima bokulawula imizwa yocansi, iziphakamiso, nokuziphathelanisa kuzo zonke izici zezenhlalakahle zahlolwa ngokuqhubekayo nokuguqulwa kwemigomo. Ngokuphathelene nemali engenayo, sithole ukuthi abantu abanezinzuzo ezingaphansi kwe-$ 25 000 banenkinga ephezulu yokuvumela ukucindezeleka nokukhubazeka okuhambisana nobunzima bokulawula imizwa yocansi, iziphakamiso, nokuziphatha ngokuqhathaniswa nalabo abanenzuzo ye $ 25 000 kuya ku-$ 49 999 isilinganiso esingu- [OR], 3.38; 95% CI, 2.06-5.55), $ 50 000 kuya ku-$ 74 999 (OR, 4.01; 95% CI, 2.37-6.81), $ 75 000 kuya ku-$ 99 999 (OR, 1.80; 95 % CI, 1.15-2.82), $ 100 000 kuya ku-$ 150 000 (OR, 4.08; 95% CI, 2.41-6.93), nangaphezulu kwe $ 150 000 (OR, 1.67; 95% CI, 1.08-2.59). Ukwengeza, labo abanemali phakathi kwe-$ 75 000 ne-$ 100 000 babenenkinga enkulu yokuvumela ukucindezeleka nokukhubazeka okuhambisana nobunzima bokulawula imizwa yocansi, iziphakamiso, nokuziphatha ngokuqhathaniswa nalabo abanenzuzo phakathi kwe-$ 25 000 ne-$ 50 000 (OR, 1.88; 95% CI, 1.12-3.16), $ 50 000 kuya ku-$ 75 000 (OR, 2.23; 95% CI, 1.29-3.88), no-$ 100 000 kuya ku-$ 150 000 (OR, 2.27; 95% CI, 1.31-3.95 ). Ngokufanayo, labo abanenzuzo engenayo kunezigidi ze-150 000 babenenkinga ephakeme uma kuqhathaniswa nalabo abanenzuzo phakathi kwe $ 25 000 no-$ 50 000 (OR, 2.02; 95% CI, 1.22-3.36), $ 50 000 kuya ku-$ 75 000 (OR, 2.40; 95% CI, 1.40-4.13), ne-$ 100 000 kuya ku-$ 150 000 (OR, 2.44; 95% CI, 1.42-4.20). Mayelana nezemfundo, labo abanezemfundo ephakeme (OR, 0.48; 95% CI, 0.30-0.76), ezinye zekholeji (OR, 0.65; 95% CI, 0.42-0.99), i-bachelor degree (OR, 0.45; 95% CI, 0.27 -0.74), noma i-degree degree (OR, i-0.47; i-95% CI, i-0.26-0.83) yayinezinkinga eziphansi zokuvumela amazinga asemtholampilo ahluphekile nokukhubazeka okuhambisana nobunzima bokulawula imizwa yobulili, iziphakamiso, nokuziphatha kunabanye abangaphansi kwesikole esiphakeme imfundo.

Ngokuqondene nobuhlanga / ubuhlanga, abantu abathile ababa ngabomnyama, abanye, namaSpanishi babe yi-2.50 (95% CI, 1.69-3.70), i-2.02 (95% CI, i-1.22-3.33), ne-1.84 (95% CI, i-1.27-2.65 ) izikhathi eziningana, ngokulandelana, kunabantu abamhlophe ukuvumela amazinga asemtholampilo ahluphekile nokukhubazeka okuhambisana nobunzima bokulawula imizwa yocansi, iziphakamiso kanye nokuziphatha. Okokugcina, abantu abesilisa nabesilisa abesilisa nabesifazane abathandanayo nabo babenenkinga encane yokuvumela amazinga asemtholampilo ahambisana nokucindezeleka nokukhubazeka okuhambisana nobunzima bokulawula imizwa yobulili, iziphakamiso, nokuziphatha kunokuthi labo abathintekayo njengabalingani bobulili, abesilisa nabesifazane, noma abanye. Ngokuphathelene nabantu abathandana nabobulili obufanayo, abantu abathandana nabo besilisa noma abesilisa abathandana nabo babengama-2.92 (95% CI, 1.51-5.66) amathuba amaningi, abantu abesilisa nabesifazane bobulili bangama-3.02 (95% CI, 1.80-5.04) amathuba amaningi, futhi abantu abathile babethiwa yi-4.33 ( I-95% CI, i-1.95-9.61) izikhathi eziningi zokuvumela ukucindezeleka ezihambisana nobunzima bokulawula imizwa yocansi, iziphakamiso, nokuziphatha. Ayikho enye umehluko obalulekile otholiwe (P > .05 yabo bonke).

Ingabe isiko sama-pop sinembile sicabanga ukuthi i-CSB iyisifo? Imiphumela ibonisa ukuthi inani elikhulu labantu (10.3% lamadoda kanye ne-7.0% yabesifazane) bayazibona ukuthi banenkinga yokulawula imizwa yabo yocansi, iziphakamiso, nokuziphatha ngendlela edala ukucindezeleka kanye / noma ukukhubazeka ekusebenzeni kwabo kwengqondo. Incazelo ecacile kakhulu yukuthi abantu abahlangabezane nephuzu lokunqunywa emitholampilo ye-CSBI-13 babamba lonke uhla lwe-CSB, kusukela ekuziphatheni okwezinkinga kodwa ezingekho ngaphansi kocansi okungaqondakali ukuhlolwa kwe-CSBD. Lokhu kuphakamisa ukuthi amazinga asemtholampilo ahambisana nokucindezeleka nokukhubazeka okuhambisana nobunzima bokulawula imizwa yobulili, iziphakamiso kanye nokuziphatha kungabhekisela kokubili inkinga ye-sociocultural kanye nesifo somtholampilo (okungukuthi, ukubonakaliswa kwezingxabano zomphakathi nezenhlalo eziphathelene nezindinganiso zobulili ngokuxilongwa komtholampilo we-CSBD). Ngakho-ke, ochwepheshe bezempilo kufanele baqaphele inani eliphezulu labantu abacindezelekile ngokuntuleka kokulawula ukuziphatha kwabo ngokobulili nokuhlola ngokucophelela uhlobo lwenkinga, cabangela ukuthi kungenzeka yini ukuthi i-etiology iyatholakala, futhi uthole ukwelashwa okufanele kokubili amadoda nabesifazane.

Ukuthola kwethu kubonisa ukuthi ukuhlukana kobulili ekukhuthazeni amazinga asebenzayo okucindezeleka nokukhubazeka okuhambisana nokubunzima ukulawula imizwa yobulili, iziphakamiso, kanye nokuziphatha kwakuncane kunalokho okwakucatshangwa ngaphambili.^20,21 Amadoda avela kuphela okungenani okungenani kwe-54 (OR, 1.54; 95% CI, 1.15-2.06) yokuhlangana iphuzu lokunqunywa komtholampilo kunabesifazane, ababeka i-41% yesampula ehlangene nendawo yokusika isikrini. Izincazelo ezibonisa ukuthi i-CSBD ingaba yinto evamile kakhulu kunabesifazane kunabesifazane abangazange baqonde, nakuba abanye abacwaningi bakhombise ukungezwani kobulili besilisa ngokuphathelene nesisusa socansi ngaphakathi, ukukhululeka kokuvusa, kanye nokucabanga okuningi okuphathelene nokulala ngokocansi.⁴ Izincazelo ezinjalo zithinta isiko lobuhlobo bobulili ngokobulili oluhambisana nokucabangela imibono yabantu (okungukuthi, ubulili besilisa "njengento engafaneleki"²²) futhi siphakamisa ukuthi uma amadoda ethola ukufinyelela okwengeziwe kuzikhangiso "zocansi,"²² bangase bathambekele ekuthuthukiseni ukuziphatha kocansi okuphoqeleka. Lokhu kuqhathaniswa nemibono yabesifazane ekhomba abesifazane ngokuthi "abagcini bocansi,"²² ngubani kulindeleke ukuthi agcine izifiso zocansi esheke futhi, ngaleyo ndlela, ngeke kube lula ukuhlakulela ukuziphatha kocansi.

Njengoba kunikezwe ukushicilelwa kwamasiko okwakamuva ukuze kube nokuvumela ukukhulumisana ngokobulili kanye nokusabalala kokufinyeleleka emfanekisweni wezocansi kanye nobulili obungavamile ngokusebenzisa i-intanethi, izinhlelo zokusebenza zesofthiwe, kanye nemithombo yezokuxhumana, enye incazelo ebonakalayo yokwahlukana okuncane kobulili okutholakala esifundweni sethu ukuthi ukusabalala kunzima ukulawula ukuziphatha ngokobulili phakathi kwabesifazane kungase kwande. Incazelo enjalo iqinisekisa ukuthi ukuhlolwa okusemthethweni kuyaphumelela, kunikezwe ukulinganiselwa kokulinganiselwa kwangaphambili kwe-epidemiological. Ngaphandle kwalokho, kunikezwa ukudliwa kwedatha kwi-CSBD phakathi kwabesifazane, enye kungenzeka ukuthi ukuhlukana kobulili kuncane kakhulu kunezingcingo. Abacwaningi nabahlengikazi bangenakuzivikela emphakathini ngokuphathelene nobulili kanye nemibono yezocansi²³ ngakho-ke kungaba amathuba okungawunaki i-CSBD yowesifazane noma ukuyiqagela njengento yokubonakalisa enye inkinga yomtholampilo (isib. ukuhlukunyezwa, ukukhubazeka kwe-bipolar, noma i-borderline personality disorder).²⁴ Ucwaningo lwesikhathi esizayo kufanele luhlolisise imibuzo eningi ephakanyiswe yilokho okutholayo ngokuhlola idatha yesikhathi eside, imibono yobulili nokunamathela emithethweni yobulili, kanye nokuphathwa kwengqondo kwengqondo.

Ngokuqondene nezici zabantu, sathola ukuthi abantu abanezemfundo ephansi, labo abanomholo ophansi kakhulu noma ophansi kakhulu, abancinci bezinhlanga / ubuhlanga, kanye nabancane abancane ngokocansi babengase bafinyelele iphuzu lokunqunywa emitholampilo kunabantu abathi babenemfundo ephakeme, babe nomthelela imali engenayo, futhi imhlophe futhi isandulela ngculazi. Lokhu okutholakele kusikisela ukubaluleka kokuqonda isimo senkambiso yenhlalo lapho ukucindezeleka okuzungezile kunzima ukulawula ukuziphatha kocansi kwenzeka. Kodwa-ke, siyazi izifundo ezimbalwa kuze kube manje eziye zahlola isimo se-sociocultural CSBD, ngaphandle kokuzibandakanya kwezocansi.^13,25 Abacwaningi baye bathi abesilisa abancane bezocansi bangase babe engozini yokuthuthukisa ukucindezelwa ngokocansi, banikezwe izinombolo zabo eziphezulu zocansi, ukuvunywa okukhulu kobulili obungavamile, nokufinyelela ezinhlobonhlobo zezitolo zocansi.²⁵ Nokho, maduzane, ucwaningo luye lwathola ukuthi ukucindezeleka okuncane kunandisa ingozi yokucindezela ngokocansi,²⁶ kanye nezinkinga ezihambisana nezifo (isib. ukucindezeleka, ukukhathazeka, ukuxhashazwa ngokocansi kwezingane, ukusetshenziswa kabi kwezidakamizwa, ubudlova obusondelene nabo, kanye nokuziphatha kocansi) kwandisa ingozi enjalo kubantu abancane abesilisa ocansini ngendlela exhomeke emzimbeni.²⁷ Imiphumela yethu iqinisekisa ukuthi ukucindezeleka kwezincane kuyandisa ingozi ye-CSBD futhi kuphakamisa ukungalingani kwezempilo okungenzeka okungenzeka ku-CSBD. Ngakho-ke, i-CSBD akumele ihlolwe ngaphandle komongo wayo wezenhlalo, futhi indlela yezempilo yomphakathi ingagunyazwa ukubhekana ne-CSB.

Ukutadisha kwamanje kwakunqunyelwe uhlobo lwenhlolovo kanye nezindlela zalo. Okokuqala, i-CSBI-13 iyithuluzi lokuhlola futhi liye labonakala iphutha lokulinganisa ngokunemba kwalo ukuhlukanisa isifo se-CSB esiyinkinga yomtholampilo. Ngisho noma sibheka iphutha lesilinganiso esikalwa (ngokusekelwe ku-79% ngokunemba kwe-CSBI-13), ukulinganisa (8.6%) kuhlala kunaphezulu kunalokho okucatshangwa ngaphambilini futhi kuphakeme kunezinye izinkinga zempilo yengqondo (isib. Ukusabalalisa kwanoma yisiphi isifo sokucindezeleka i-5.7%²⁸). Ukwengeza, i-NHSSB ayizange ihlole izimbangela ezengeziwe zokucindezeleka mayelana nokuziphatha kocansi kwabahlanganyeli ngaphandle kokuntuleka kokulawula, okwenza ukuba sikwazi ukuhumusha incazelo yezinga eliphezulu lokusakazeka. Izingxabano ezithinta uhlangothi ezihlobene nemigomo yezenhlalo mayelana nobulili kanye nobulili, izingxabano zobulili, nezinkinga ezithile ezingokwengqondo (isib. Ukuphazamiseka kwe-bipolar, izinkinga zokusebenzisa izidakamizwa, ukucindezeleka okucindezelayo) okuye kwahlotshaniswa nokucindezelwa ngokocansi kungachaza ukuba khona kwe-CSBD. Lokhu kubonisa indlela ebalulekile yokucwaninga esikhathini esizayo. Okokugcina, lolu cwaningo alukwazi ukulawula ukuthi ngabe ukungafani komphakathi kungenxa yezinselelo ezilinganiselwe. Kodwa-ke, kungenzeka ukuthi ukukhishwa kwesilinganiso kunciphisa izinguqulo eziningi ze-CSBI eziye zahunyushwa, zaqinisekiswa futhi zafundwa kubantu abahlukahlukene ngaphakathi nangaphandle kwe-United States.

Lolu cwaningo luyilokuqala esikwaziyo ukuloba ukusabalalisa kwezwe lase-US lokucindezeleka okuhambisana nobunzima bokulawula imicabango, imizwa, kanye nokuziphatha komuntu siqu-isici esiyinhloko se-CSBD. Ukukhula okuphezulu kwalesi sigameko sezocansi kunenkinga enkulu yezempilo emphakathini njengenkinga yenhlalo futhi kubonisa inkinga ebalulekile yomtholampilo efuna ukunakekelwa kwabachwepheshe bezempilo. Ngaphezu kwalokho, ubulili, ukulingana ngokobulili, ubuhlanga / ubuhlanga, nokungafani kwemali kukhombisa ukungafani kwezempilo, ukukhomba ukuthi isimo se-sociocultural senkinga ye-CSBD, futhi ukuphikisana nendlela yokwelapha eyenza impilo encane, imibono yobulili, kanye nemigomo nemigomo yezenhlalo ezizungezile ubulili kanye nobulili. Abanakekeli bezempilo kufanele baqaphele inani eliphezulu labantu abacindezelekile ngokuziphatha kwabo ngokobulili, bahlole ngokucophelela uhlobo lwenkinga, futhi bathole ukwelashwa okufanelekile kokubili amadoda nabesifazane.

Kuvunyelwe Ukushicilelwa: Septhemba 13, 2018.

Kushicilelwe: Novemba 9, 2018. doi:10.1001 / jamanetworkopen.2018.4468

Ukufinyelela okuvulekile: Leli gama lokufinyelela elivulekile elishicilelwe ngaphansi kwemigomo ye- I-CC-BY License. © 2018 Dickenson JA et al. I-JAMA Network ivuliwe.

Umbhali ohambelanayo: I-Janna A. Dickenson, i-PhD, Uhlelo lokuHlala koBuntu, uMnyango Wezokwelapha Komndeni kanye Nempilo Yomphakathi, i-University of Minnesota, i-1300 S 2nd St, iSte 180, iMinneapolis, MN 55454 ([i-imeyili ivikelwe]).

Iminikelo Yomlobi: UDkt. Coleman ube nokufinyelela okugcwele kuyo yonke idatha ekucwaningweni futhi uthatha umthwalo wokuthembeka kwedatha kanye nokunemba kokuhlaziywa kwedatha.

Umqondo nomklamo: Dickenson, Coleman, Miner.

Ukuthola, ukuhlaziywa, noma ukuhumusha kwedatha: Bonke abalobi.

Ukuhlelwa kombhalo wesandla: Dickenson, Coleman.

Ukubuyekezwa okubalulekile kombhalo wesibalo sokuqukethwe okubalulekile kwengqondo: Bonke abalobi.

Ukuhlaziywa kwesitatimende: Dickenson, Gleason.

Ukusekela kokuphatha, ezobuchwepheshe, noma izinto ezibonakalayo: Bonke abalobi.

Ukuqapha: Coleman.

Ukuphikisana kwezintshisekelo: UDkt Coleman uyingxenye yomkhandlu wokweluleka iChurch & Dwight Co, Inc, neRoman, Inc, futhi ubike nezimali zomuntu siqu ezivela eChurch & Dwight Co, Inc, naseRoman, Inc, ngaphandle komsebenzi ohanjisiwe. Akukho okunye ukudalulwa okubikiwe.

Imali / Ukusekelwa: Ucwaningo Lukazwelonke Lwezempilo Nokuziphatha Kwezocansi luxhaswe yisibonelelo esivela kwaChurch & Dwight Co, Inc. Ucwaningo lwamanje beluyisengezo esingakhokhelwa kulolu cwaningo.

Indima yoMxhasi / Umxhasi: Umcwaningi we-National Survey of Health and Behavior akazange abe nendima ekwakheni nasekuqhubeni isifundo samanje; ukuqoqwa, ukuphathwa, ukuhlaziywa, nokuchazwa kwedatha; ukulungiselela, ukubuyekezwa, noma ukuvunywa kombhalo wesandla; futhi isinqumo sokuhambisa lo mbhalo ukuze ushicilelwe.

Iminikelo eyengeziwe: UDebra Herbenick, PhD, uMqondisi weSikhungo Sokukhuthazwa Kwezempilo Kwezocansi e-Indiana University, ubambisene nokwengeza i-Compulsive Sexual Behavior Inventory – 13 kuNhlolovo Kazwelonke Yezempilo Yezocansi nokuziphatha. Wanxeshezelwa yisibonelelo esivela kuChurch & Dwight Co, Inc, esasisekela lolu cwaningo.