Ukuziphatha ngokobulili ku-autism: ukuziphatha kocansi kanye nokuziphatha kwe-paraphilic kwabesifazane namadoda ane-autism spectrum disorder esebenza kahle (i-2017)

I-Dialogues Clin Neurosci. I-2017 Dec; I-19 (4): 381-393.

I-PMCID: PMC5789215

UDaniel Schöttle, MD^*

UDaniel Schöttle, uMnyango Wezengqondo Nezempilo Yengqondo, Isikhungo Sezokwelapha saseHamburg-Eppendorf, eHamburg, Germany;

I-peer Briken, MD

I-Peer Briken, Isikhungo Sokucwaninga Ngocansi kanye ne-Forensic Psychiatry, i-University Medical Center Hamburg-Eppendorf, Hamburg, Germany;

U-Oliver Tüscher, MD

U-Oliver Tüscher, uMnyango Wezengqondo Nezengqondo, i-University Medical Center Mainz, Mainz, Germany;

UDaniel Turner, MD, PhD

UDaniel Turner, Isikhungo Sokucwaninga Ngocansi kanye ne-Forensic Psychiatry, i-University Medical Center Hamburg-Eppendorf, Hamburg, Germany; UMnyango Wezengqondo Nezengqondo, i-University Medical Center Mainz, Mainz, Germany;

abstract

Njengabantu abadala abangaboni, abantu abane-Autism spectrum disorder (ASDs) bakhombisa lonke uhla lokuziphatha kocansi. Kodwa-ke, ngenxa yezimpawu eziyinhloko zesibonakaliso sokuphazamiseka, kufaka phakathi ukusilela kwamakhono ezenhlalo, ama-sensor hypo- kanye nama-hypersensitivities, nokuziphatha okuphindaphindayo, abanye abantu be-ASD bangathuthukisa ngobuningi bezindlela zokuziphatha ezingaphezulu kwesilinganiso kanye nokuziphatha okungathandeki. Ngemuva kokubukeza izincwadi ezithintekayo eziphathelene nezocansi kubantu abasebenza kakhulu be-ASD, sethula okutholakele kumanovelokuvama kokuziphatha okuvamile kobulili nalabo mayelana nokuhlolwa kwemicabango nokuziphatha okuphathelene nabazimele kubantu be-ASD esifundweni sethu. Abantu abane-ASD babonakala banemibono nokuziphatha okuthe xaxa kokuziphatha kunesimilo kunokuphakamisa izifundo ezijwayelekile zabantu. Kodwa-ke, lokhu kungahambisani kuqhutshwa ikakhulu ukubonwa kwabahlanganyeli besilisa abane-ASD. Lokhu kungenxa yokuthi abesifazane abane-ASD bavame ukuzivumelanisa nezenhlalo futhi bakhombise uphawu lwe-ASD oluncane. Izimpawu ezenzeka ekuziphatheni kobulili ezigulini ze-ASD kufanele zibhekwe zombili ngemfundo yezocansi nangezindlela zokwelapha.

Amagama angukhiye: I-Asperger syndrome, autism, ukuxilongwa kwe-hypersexual, ubulili obufanayo, paraphilia, ukuphazamiseka kwengqondo, ubulili

Isingeniso

Izinkinga zokuphazamiseka kwe-Autism spectrum (ASD) ukuphazamiseka kwe-neurodevelopment okuhlanganisa iqembu lezimo ezinamandla, ezibonakaliswa ukuphazamiseka ekuxhumaneni nomphakathi nasekuxhumaneni, kanye nezintshisekelo nokuziphatha okuphindaphindayo.¹ Amanani okubikwa kokukhuphuka akhuphukile kakhulu emashumini eminyaka amuva (kufinyelela ku-1% isikhathi sokuphila), lapho abantu abadala nabaningi bethola i-ASD.² Kucatshangwa ukuthi isilinganiso samadoda kuya kwabesifazane siphakathi kwe-3 ne-4 kuya ku-1,³ futhi kukhona umehluko othile wobulili kwi-ASD.⁴ Yize abacishe babe yingxenye yabantu abane-ASD abangakhubazekile ngokwengqondo futhi banamakhono ajwayelekile okuqonda nawolimi (njengabantu abanokusebenza okuphezulu kwe-autism noma i-Asperger syndrome), ukuhlangana komphakathi kanye nokusilela kokuxhumana nobunzima ekuboneni umbono wabanye nokuqonda okungazwisisi kahle izinkambo zenhlalo zakha izithiyo ezifihliwe ekwakheni ubudlelwano bezothando nezothando.^5,6 Izinkinga ezihlobene nezocansi zingavela, ikakhulukazi ekuqaleni kokuthomba, isikhathi lapho ukuthuthukiswa kwamakhono okuxhumana nabantu e-ASD kungeke kuhambisane nezidingo zenhlalo ezikhulayo, nezinselelo zokwakha ubudlelwane bezothando nezocansi zibonakala kakhulu.⁷

Izifundo eziphathelene nezocansi kubantu abane-ASD

Cishe iminyaka eyi-10 ngemuva kokufakwa okusemthethweni kwe-autism kuhlobo lwesithathu lwe I-Diagnostic kanye ne-Statistical Manual of Mental Disrupt (DSM-III) e-1980, izifundo zokuqala ezilandelanayo eziphathelene nezocansi kweziguli ezine-ASD zashicilelwa.^8-11 Isimo samanje sokucwaninga ngamava wezocansi, ukuziphatha kobulili, izimo zengqondo zocansi, noma ulwazi lwezocansi lwabantu abathile be-ASD kuhlanganiswa, ezinye izifundo zithola umehluko kulawulo olunempilo (ama-HCs) kanti abanye abanalo. Kodwa-ke, ngenxa yemvelo ephakeme ye-spectrum yokuphazamiseka kanye nendlela ehlukahlukene yesayensi yezifundo, akumangazi. Ucwaningo lwangaphambilini lube: (i) lufaka iziguli zabesifazane kanye / noma zesilisa kuzilungiselelo zokuhlala ezinokulimazeka okuthe xaxa kanye namathuba amancane okuhlangenwe nakho kwezocansi; (ii) kugxilwe kubantu abakhubazeke ngokomqondo noma abanye abakhubazekile bokuthuthuka komqondo, ngaleyo ndlela kuholele emiphumeleni emangazayo (iii) basebenzise ucwaningo oluse-inthanethi lapho kuphela abantu abasebenza okuphezulu ababambe iqhaza; (iv) bathembele embikweni wamalungu omndeni nabanakekeli noma ezigulini ngokwazo; futhi (v) kuhlolwe abantu abane-ASD emazingeni ahlukene wobudala.

Lezi zifundo ziphakamisa ukuthi abantu abaningi abane-ASD bafuna ubudlelwano bocansi nobothando obufanayo nesibalo se-non-ASD^12,13 futhi ube nakho konke okuhlangenwe nakho kocansi nokuziphatha.^12-18 Kodwa-ke, zisekhona izinkolelo-mbumbulu eziningi nezinkolelo zenhlalo yabantu ngabantu abane-ASD, zibhekise kubo njengabangenandaba nobudlelwano bezenhlalo nezothando futhi njengabantu abasebenzayo.^10,19,20 Ithebula I wethula umbono ophelele wezifundo ezihlola izici ezahlukahlukene zocansi kubantu abasha nabadala abane-Autism esebenza ngokusebenza okuphezulu, ngesisekelo semibuzo yemibiko yokuzibika.^{11,12,15,21-33} Sigxile kakhulu ekubuyekezweni kwezincwadi kulezi zifundo ngoba indlela yazo ihambelana nendlela yocwaningo esetshenziswe ocwaningweni olwethulwe lapha. Izifundo ezethulwe Ithebula I qinisekisa ukuthi ucansi lubalulekile kubantu abathile be-ASD, futhi kuyacaca ukuthi konke ukwedlula yonke okuhlangenwe nakho kwezocansi kanye nokuziphatha kumelelwa kuleli qembu.^{11-13,15,20-31}

Ukubuka konke ngezincwadi. Qaphela: Kusetshenziswe la magama alandelayo kusesho lwezincwadi oluhlelekile: "ucansi," "ubulili," "ukuziphatha kobulili," "ukuphazamiseka kobulili," "ubudlelwano bocansi," ...

Luningi ucwaningo olukhona kuze kube manje olugxile kwabesilisa, futhi zimbalwa izifundo eziye zabhekana nezinkinga eziqondene nobulili maqondana nezizinda zenhlalo, zomzwelo nezengqondo, futhi bambalwa kakhulu izifundo ezikhona ezihlola ubulili ngokuzimela emadodeni nakwabesifazane abane-ASD.^12,13,20,32 Ukuqashelwa okumbalwa kwemitholampilo³² kanye nesethi encane yezifundo ezihlelekile zibonisa ukuthi abesifazane abane-ASD bangase babonise ukusilela okungaxhunyiwe kwezenhlalo nakwezokuxhumana futhi babe nezintshisakalo ezikhethekile ezihambisana kakhulu nezintshisekelo zamaqembu abo wontanga.^33-36 Ngaphezu kwalokho, abesifazane abane-ASD babonakala besebenzisa amasu okubhekana nawo, njengokulingisa amakhono wezenhlalo kontanga yabo engeyona i-ASD, ngenxa yalokho bangathandeki emphakathini.³⁴ Ngokuphathelene nezinkinga eziphathelene nezocansi, abesifazane abane-ASD babonakala benamazinga ampofu wokusebenza okuphelele kocansi, bazizwa bengcono kakhulu ebudlelwaneni bezocansi kunamadoda ane-ASD, futhi basengozini enkulu yokuba yisisulu sokuhlukunyezwa ngokocansi noma ukuhlukunyezwa.³⁷ Kutholakale abesilisa abane-ASD bezibandakanyeka kakhulu ezenzweni zocansi zodwa,^11-14,18,37 kanye nokuba nesifiso esikhulu sobudlelwano bezocansi nezothando²⁰; noma kunjalo, kukhona ubufakazi bokuthi abesifazane abane-ASD, yize benesifiso sobulili esiphansi, bavame ukuzibandakanya kobudlelwano be-dyadic.¹³

Yize abantu abane-ASD befuna ubudlelwano bezocansi nobudlelwano, ukuthuthukiswa kanye nokugcinwa kobudlelwano bezothando nezocansi kuthinteka kakhulu ukusilela kwamakhono ezenhlalo nezokuxhumana kanye nobunzima ekuqondeni izindlela zokuxhumana ezingenamlomo noma ezicashile nangokusebenzisa ingqondo (okusho ukukwazi ukuqonda okwakho nezinye izimo zengqondo zabanye, isb. imizwelo, izifiso, ukuqonda okwenzeka kubantu abanjalo.⁶ Ngaphezu kwalokho, abantu abaningi abane-ASD abayitholi imfundo yezocansi ebhekisisa izici zabo zokuziphatha, futhi mancane amathuba okuthi bathole ulwazi ngocansi emithonjeni yenhlalo.^5,22,38

Elinye iphuzu okufanele licatshangelwe izintshisekelo ezivinjelwe futhi eziphindaphindekayo, ezingase zibe ezinganeni ebuntwaneni kodwa ezingaguqula zibe ngumphumela wokuziphatha kocansi nomuntu okhulile. Ngaphezu kwalokho, imizwa yokuzwa evame ukubikwa ingaholela ekwenyuseni ngokweqile noma ekulinganiseni kokuthonya kwemizwa kumongo wesipiliyoni sobulili.³⁹ Kubantu abane-hypersensitive, ukuthinta okuthambile komzimba kungabonakala njengokubi; ngakolunye uhlangothi, abantu abane-hyposensitive bangaba nezinkinga ekuvukeni nasekufinyeleleni i-orgasm ngokuziphatha kocansi.²⁰ Kuhlanganiswe, izinkomba eziyinhloko ze-ASD ezihlanganiswe nolwazi olulinganiselwe lwezocansi nendawo encane kakhulu yokuba nokuhlangenwe nakho kothando nezothando lwezocansi kungabeka engcupheni abanye abantu abane-ASD ukuba babe nokuziphatha okuyinselele noma okuyinkinga kwezempilo,^22,38 ezinjengokuziphatha okukhohlisayo kanye ne-paraphilic, ngisho nokona ngokobulili.

Kusetshenziswe amagama ahlukene ukuchaza ubukhulu bokuziphatha okuphezulu ngokwesilinganiso kufaka phakathi umlutha wezocansi, ukuvivinya umzimba ngokocansi, ukuzikhathaza ngokobulili, kanye ne-hypersexourse. Kulesi sihloko, sizosebenzisa amagama athi ukuziphatha kwe-hypersexual noma i-hypersexourse ebhekise emcabangweni ocabanga njalo ocansini, isifiso sobulili, kanye nokuziphatha.^40,41 Kodwa-ke, umuntu kufanele aqaphele ukuthi ubukhona nje bezindlela zokuziphatha zocansi ezingaphezulu kwesilinganiso alunakufanelekela ukwabelwa isifo sokuxilongwa kwengqondo (njenge-hypersexual disc noma i-activational sexual behavery). UKafka uphakamise ukuthi kufakwe nenqubo yokuxilonga yokuxilongwa kwe-hypersexual diagnostic I-DSM-5. ⁴⁰ Lezi zindlela zichaza ukuphazamiseka kwe-hypersexual njengamaphupho aphathelene nobulili obujwayelekile, izifiso, noma isimilo sobuntu esikhathini esingangezinyanga okungenani ze-6, okubangela usizi olukhulu emtholampilo, futhi lokho akubangelwa ezinye izinto noma izimo zezokwelapha; futhi, umuntu ngamunye kufanele okungenani abe neminyaka eyi-18.^40,42 Yize uReid nozakwabo bekhombisile ukuthi ukuphazamiseka kwe-hypersexual kungahle kube ngokuhlolisisa nangokuthembekile ngokusebenzisa lezi zinqubo zokuxilonga, i-American Psychiatric Association nokho yenqabile ukusetshenziswa okunjalo ngenxa yesimo sokucwaninga esingasenele, ebiza izifundo ezengeziwe mayelana nokuhlola okwenziwa ngamasiko ukungahambi kahle, izifundo ezibamele izifo ezihlaselayo, kanye nezifundo nge-etiology kanye nezici ezihlobene nomzimba.⁴³

Okweshumi nane nanye ehlongozwayo Ukuhlukaniswa Kwezifo Kwamazwe Ngamazwe (ICD-11), le ncazelo elandelayo yokuxilongwa kokukhubazeka kokuziphatha kobulili okucindezelayo⁴¹ kuyabhekwa:

Ukuphazamiseka kokuziphatha ngokocansi okuphoqelekile kuboniswa yizifiso zocansi eziphikelelayo neziphindaphindwayo noma izifiso ezitholwa njengokungenakuphikiswa noma okungalawuleki, okuholela ekuziphatheni okuphindaphindayo kwezocansi, kanye nezinkomba ezingeziwe ezifana nemisebenzi yezocansi eba yinto ephambili yokuphila komuntu kuze kube seqophelweni lokungayinaki impilo nokunakekelwa komuntu siqu noma eminye imisebenzi, imizamo engaphumelelanga yokulawula noma yokwehlisa isimilo, noma ukuqhubeka nokuziphatha okuphindaphindayo kwezocansi ngaphandle kwemiphumela emibi (isb. ukuphazamiseka kobudlelwano, imiphumela yomsebenzi, umthelela ongemuhle empilweni). Okuhlangenwe nakho komuntu ngamunye kukhuphule ukungezwani noma ukuvusa okusebenzayo ngaphambi nje kokwenza ucansi, nokukhululeka noma ukuncipha kokungezwani ngemuva kwalokho. Iphethini yezinkanuko zocansi nokuziphatha kubangela ukucindezeleka okuphawulwe noma ukukhubazeka okubalulekile komuntu siqu, umndeni, ezenhlalo, ezemfundo, ezomsebenzi, noma ezinye izindawo ezibalulekile zokusebenza.

Ngokuqondene paraphilias, the I-DSM-5 manje kwehlukanisa phakathi kokuphazamiseka kwezimpawu zokuphamba futhi, ngaleyo ndlela kuhloswe ngaso ukucwaswa kwezintshisekelo zokuziphatha ezingezona ezezifiso zokuziphatha kanye nokungaziphathi kahle okungazibangeli usizi noma ukulimaza umuntu lowo noma ukulimaza abanye.⁴² In the DSM-5, amapharaphaza achazwa ngokuthi "noma yiziphi izintshisekelo zocansi ezixakile futhi eziphikelelayo ngaphandle kokuthakazelela ezocansi ekuvuseleleni ubulili noma ukuthinta ngokuzilolonga ngezinto ezijwayelekile, ezivuthiwe ngokomzimba, ezivumayo zabalingani bomuntu" (bona Ibhokisi 1 ukuthola uhlu lokuphazamiseka kwengqondo okufakiwe DSM-5). ⁴⁴ Yize inqubo ehlongozwayo yokuphazamiseka kwe-paraphilic ku I-ICD-11 fana nalabo DSM-5, umehluko owodwa omkhulu phakathi kwale mibhalo emibili yokuxilonga ukususwa kwezifo ezithinta ipharamitha ezitholakala ngokuyinhloko ngesisekelo sokuziphatha okungahambisani nakho futhi okuhlobene nokubandezeleka noma ukungasebenzi kahle kokusebenza. Lokhu kwaholela I-ICD-11 ukungafakwa kwe-fetishistic, masochism yezocansi, kanye nokuphazamiseka kwe-transvestic,^41,45 Ukuziphatha okubikwe kumuntu ngamunye we-ASD.

Ibhokisi 1. Sibutsetelo bokuphazamiseka kwengqondo okufakiwe kumamanyuwali wokuxilonga yamanje.

Ukuphazamiseka kwemibukiso

• Ukuvusa ucansi ngokuveza izitho zakho zobulili noma izitho zocansi kumuntu ongavumi.

Isifo se-Fetishistic *

• Ukuvuselela ucansi ngokudlala ngezinto ezingaphili.

Isiphithiphithi se-Frotteuristic

• Ukuvusa ucansi ngokuhlikihla izitho zakho zocansi kumuntu ongavumi.

Isifo sokuzibona ngocansi *

• Ukuvuselela inkanuko ngokocansi ngokuboshwa, ukushaywa, noma ngenye indlela okwenziwa ngayo ukuba ube nobuhlungu emzimbeni noma ukuthotshiswa.

Isiphithiphithi sokudabukisa ngokocansi

• Ukuvuswa kocansi ngokuhlukumeza ngokwengqondo noma ngokomzimba noma ngobuhlungu kumlingani wezocansi.

Isifo se-Transvestic *

• Ukuvuselela abanye ngokocansi ngokugqoka nangokuziphatha isitayela noma ngendlela ehambisana nobulili obuhlukile.

Ukuphazamiseka kwe-Voyeuristic

• Ukuvuselela abanye ngokocansi ukubuka abanye lapho behamba ze noma behlanganyela ocansini.

Isifo se-Pedophilic

• Ukuheha okuyisisekelo noma okukhethekile kokuya ocansini ezinganeni ezi-preubescent.

* Ukubonisa izimo ezisuselwa ekuziphatheni okuvumayo futhi okuvame ukungabandakanyi abanye futhi kungahambisani nabo uqobo nokubandakanyeka kokuncipha kokusebenza. Iqembu elisebenzayo ngokuhlukaniswa kwezinkinga zocansi kanye nezempilo zocansi lihlongoze ukuthi kususwe lezi zimo ICD-11.

Kuze kube manje, bambalwa kuphela abacwaningi abahlolile ekuziphatheni kwe-hypersexual noma paraphilic kubantu abane-ASD, futhi iningi labo yimibiko yesimo ebika ngabantu be-ASD ababonisa ukushaya indlwabu ngokweqile,^46-50 izimilo zokubonisa,⁵¹ imicabango / izimilo zokuzenzisa,^52,53 imicabango / izimilo zokuziphatha ezingejwayelekile,^54,55 sadomasochism,⁵⁰ noma ezinye izindlela zokuphamba.⁵⁶ Kodwa-ke, olwazini lwethu, zonke izifundo zangaphambilini zokuziphatha okuphathelene ne-hypersexual ne-paraphilic zenziwe emadodeni kanti ezimweni eziningi zinabantu abalimele ngokwengqondo be-ASD.

Ngemuva kokubukeza izincwadi, sihlose ukuphenya ngokuziphatha kwe-hypersexual kanye nemicabango nokuziphatha okuyisisekelo kusampula enkulu yeziguli ze-ASD zowesilisa nabesifazane kuqhathaniswa nama-HCs afaniswe ngokobulili, iminyaka, kanye nezinga lemfundo.

izindlela

Abahlanganyeli

Ukuthola imininingwane eqondile evela kubantu abane-ASD nokufunda isampula elingcono kakhulu, sifake kuphela abantu abadala abane-ASD ngaphandle kokulimazeka kwengqondo. Isizathu sokubandakanya kuphela abantu abane-Autism esebenza kakhulu noma i-Asperger syndrome kwakuwukunciphisa imiphumela edidayo yokukhubazeka kwengqondo futhi ngaleyo ndlela bakwazi ukufunda ngqo umthelela we-ASD kwezocansi. Ngokwesisekelo se-selfreport, zonke iziguli zitholwe ngudokotela wezengqondo noma ngudokotela wezengqondo (n= 90, Asperger syndrome; n = 6, atypical autism); iminyaka yobudala lapho iziguli zithole khona ukuxilongwa kwazo kwe-ASD kwakuyiminyaka ye-35.7 (ukuphambuka okujwayelekile [SD] = iminyaka ye-9.1; ububanzi = 17 kuya eminyakeni ye-55). Iqembu lesiguli le-ASD (lisho amaphuzu [M] = 26.7; SD = 4.9) lalinezikolo eziphakeme kakhulu kune-HCs (M = 6.4; SD = 3.3) kuhlobo lwesiJalimane lwe-Autism Spectrum Quotient iDemo (AQ-SF; P⁵⁷ Zonke iziguli ze-ASD futhi akukho neyodwa yama-HC atholakale ngenhla kwenani lokunqunywa elinqunyelwe lamaphuzu we-17.⁵⁷ Ababambe iqhaza kuwo womabili amaqembu babefaniswa ubulili, iminyaka. kanye neminyaka yemfundo (Ithebula II).

Izici zababambiqhaza. I-ASD, i-autism spectrum disorder; Ama-HC, izilawuli ezinempilo; n, inombolo; I-SD, ukuphambuka okumile

Inqubo

Ibhodi lokubuyekezwa kokuziphatha koMkhandlu Wezempilo waseHamburg livume inqubo yokufunda. Ukuze kuqashwe abantu abatholakala be-ASD, amaqembu okuzisiza kulo lonke elaseJalimane athintwa futhi acelwa ukuthi asakaze incwajana yokufunda phakathi kwabahlanganyeli babo. Abanye ababambiqhaza babuye baqashwa esikhungweni sezempilo esikhungweni sezempilo e-University Medical Center Hamburg-Eppendorf, Germany. Ama-HC aqashwa kabusha ngokukhangiswa e-University Medical Center Hamburg-Eppendorf nase-University Medical Center Mainz eJalimane, ezinxanxatheleni zezitolo zendawo, nangokuxhumana komuntu siqu kwabaphenyi.

Izindlela

I-Autism Spectrum Quotient IFomu Elifushane, inguqulo yaseJalimane

Uhlobo lwaseJalimane lwe-Autism Spectrum Quotient Amafomu amafushane (AQ-SF) lwemibuzo⁵⁷ yayisetshenziselwa ukuhlolwa kwezimpawu ze-autistic kubo bonke ababambe iqhaza. Isikolo esinqunyiwe se-17 sikhonjwe njengenani elihle le-cutoff ngezinjongo zokuhlola futhi sathola ukuzwela kwe-88.9% kanye nokucaciswa kwe-91.6% ngendawo engaphansi kwekhola ye-receiver performance curve ye-0.92 kusampula yokuqinisekiswa kweJalimane.⁵⁸

I-Hypersexual Behavior Inventory (HBI-19)

I-Hypersexual Behavior Inventory (HBI-19)^58,59 iqukethe izinto ze-19 futhi ihlola indlela yokuziphatha eyi-hypersexual. Zonke izinto kufanele ziphendulwe esikalini se-5-point Likert esikalini futhi zichazwe ngokobulili ngokungathathi hlangothi. Abahlanganyeli abanesikolo ngenhla kwe-49 bavame ukuhlukaniswa njenge-hypersexual. Uhlobo lwesiJalimane lwemibuzo luveza ukuvumelana okuhle kwangaphakathi kwe-α = 0.90 yenani eliphelele.⁶⁰

Uhlu lwemibuzo ngamava ocansi kanye ne-Behaviors (QSEB)

Uhlu lwemibuzo ngamava ocansi kanye nokuziphatha (i-QSEB)⁶¹ iqukethe izinto ze-120 futhi ihlola ulwazi oluphathelene nesizinda somndeni, inhlalo yokuzibandakanya kwezocansi, indlela yokuziphatha ocansini, nezindlela ezihlukile zocansi. Ngaphezu kwalokho, uhlu lwemibuzo luhlola ulwazi mayelana nemicabango nokuziphatha okuya ocansini (kufaka phakathi imicabango nemikhuba yokuziphatha ocansini). Izinto eziningi zibhekisela esikhathini sokubukwa kwezinyanga ze-12; ezintweni ezihambelana nomtholampilo, uhlu lwemibuzo lucela ababambiqhaza ukuba basho isikhathi lapho uphawu lomtholampilo selukhona. Ocwaningweni olukhona manje, kuhlaziywe kuphela izinto eziphathelene nobuningi bokushaya indlwabu nokuzibandakanya ezenzweni zocansi, kanye nemicabango nokuziphatha okuhle.

Ukuhlaziya kwesitatimende

Ukwahluka kweqembu kwahlaziywa kusetshenziswa Χ ² izivivinyo ngokuguquguquka kwesigaba, futhi t-Izivivinyo zamasampula azimele eziguquguqukayo eziqhubekayo. Ngoba izivivinyo eziningi zezibalo zenziwa kusethi efanayo yedatha, sasilawula izinga lokubaluleka kokuqongelela iphutha lehlobo-I ngokusebenzisa isilinganiso sokutholwa okungamanga (i-FDR) ngokususelwa kunqubo eyenziwe nguBenjamini! kanye ne-llochberg.⁶² Ukulawula ukuhlolwa okuningi kuholela ekunciphiseni kwe PUmkhawulo wesahluko. Esifundweni samanje, kulungisiwe PUmbundu wobuhle be-0.0158, okusho ukuthi kuphela P-Imigomo engezansi kwale cutoff kufanele ibhekwe njengebalulekile. Ngaleyo ndlela, i-FDR ayilondolozi kangako kunokulungiswa ngokwesiko kweBonferroni; noma kunjalo, muva nje, kuphakanyisiwe ukuthi i-FDR kumele ithande ukuthandwa ngaphezulu kwendlela yeBonferroni, ikakhulukazi ezifundweni zezempilo nezokwelapha.⁶³

Imiphumela

Isimo sobudlelwane

Kubantu abane-ASD, kakhulu abesifazane (n = 18; 46.2%) kunamadoda (n = 9; 16.1%) njengamanje abebudlelwaneni (P<0.01). Akukho mehluko obalulekile otholakele enanini labesifazane (n = ll; 27.5%) nabesilisa (n = 8; 14.3%) ne-ASD ababike ukuthi banezabo izingane. Ngokuqhathanisa abantu be-ASD nama-HCs, sabona ukuthi iningi labesifazane be-HC (n= 31; I-79.5%; P> 0.01) nangaphezulu kwabesilisa be-HC (n= 47; I-82.4%; (P> 0.01) kunabantu abane-ASD bebesebudlelwaneni njengamanje. Akukho mehluko obonwe kwinani labahlanganyeli abanezingane zabo (HCs: n= 7; I-7.3%).

Izindlela zokuziphatha zocansi ezihlala zodwa nezi-dyadic

Abesifazane

Njengoba kubonisiwe IThebula III, akukho mehluko owatholakala phakathi kwabahlanganyeli besifazane imvamisa yokushaya indlwabu (P> 0.05). Kodwa-ke, ama-HC abesifazane akhombisa ukuya ocansini kaningi kuneziguli zesifazane ze-ASD (P<0.05). Iphethini efanayo itholakele maqondana nombuzo othi “ufisa kangakanani ukuya ocansini,” okukhombisa ukuthi abesifazane be-HC babenesifiso esikhulu sokuya ocansini kunabalingani babo be-ASD (P

Abesilisa

Mayelana nemvamisa yokushaya indlwabu emadodeni, abahlanganyeli be-ASD besilisa babike ukushaya indlwabu njalo kunama-HC amaduna (P<0.01). Uma kuqhathaniswa nobuningi bobulili, kwatholakala iphethini ehlukile, ngama-HC abika imvamisa ephezulu yezocansi kunabantu be-ASD. Abesilisa be-ASD babike isifiso esikhulu socansi kunabalingani babo be-HC (P<0.05, IThebula III).

Ukuzibandakanya kwezocansi okujwayelekile noku-dyadic ezigulini ezisebenza kakhulu nge-autism kuqhathaniswa nezilawuli ezinempilo. I-ASD, i-autism spectrum disorder; Ama-HC, izilawuli ezinempilo; ns, akubalulekile

Zokuziphatha Hypersexual

Kwi-HBI, iziguli ze-ASD (HBI_isamba= 35.1; I-SD = 13.7) yayinesibalo esiphakeme kakhulu kunama-HCs (HBI)_isamba= 29.1; SD = 8.7; P<0.001), futhi abantu abaningi ngokwengeziwe be-ASD babenamaphuzu angaphezu kwenani le-cutoff elihlongozwayo lamaphoyinti angama-49 futhi ngenxa yalokho bangahlukaniswa njenge-hypersexual (P<0.01). Njengoba kukhonjisiwe ku- Ithebula IV, amadoda anokuxilongwa kwe-ASD abike ezinye zokuziphatha kwe-hypersexual, kanti bekungekho mehluko onjalo phakathi kweziguli zabesifazane ezine-ASD ne-HCs zabesifazane. Ngaphezu kwalokho, ngenkathi abantu besilisa be-17 bethola amaphuzu aphezulu e-49 futhi ngenxa yalokho kungachazwa njenge-hypersexual, ama-HCs amabili kuphela abesilisa abathole amaphuzu ngaphezu kwe-cutoff ehlongozwayo (P<0.001). Akukho mehluko owatholakala phakathi kweziguli zabesifazane be-ASD nama-HC ngesilinganiso sobulili obufanayo.

Izinkomba ze-hypersexuality kanye neparaphilias kwiziguli ezisebenza kakhulu ze-Autism uma kuqhathaniswa nezilawuli ezinempilo. I-ASD, i-autism spectrum disorder; Ama-HC, izilawuli ezinempilo; I-HBI = I-Hypersexual Behavior Inventory; max, esiphezulu; n / A, ayisebenzi. *P-amagama namanje ...

Imibono nemikhuba ephikisayo

Sekukonke, imicabango nemikhuba yokuziphatha yocansi eyisimangaliso kubikwa kaningi kakhulu ezigulini zabesilisa ezine-ASD kunakwabesilisa abangama-HCs. Ngemuva kokulungiswa kokuhlolwa okuningi, umehluko omkhulu ubesekhona enanini labantu ababika imibono engaqondile, imicabango edabukisayo, imicabango nemikhuba yokuziphatha engathandeki, imicabango nemikhuba yokuziphatha, kanye nemicabango yokuziphatha kwezingane, kanye nemicabango yokuziphatha kwezingane zabesifazane (bona Ithebula IV). Iziguli zabesifazane ezine-ASD azikhombisanga umehluko ekujuleni kwemicabango noma ekuziphatheni okufana nokuqhathanisa nabalingani babo be-HC, ngaphandle kokuvama kwezindlela zokuziphatha, lapho ama-HCs amaningi abesifazane ekhombisa ukuziphatha kwe-eyechistic kuneziguli ze-ASD zabesifazane.

Ingxoxo

Ngokolwazi lwethu, lolu cwaningo lokuqala lokuhlola izici eziqondene nobulili zemicabango nokuziphatha okuyisigcawu eqenjini labantu abasebenza kakhulu abane-ASD ngokuqhathaniswa neqembu lokulawula elihambisanayo. Ukuthola kwethu okuyinhloko ukuthi abantu abane-ASD babonisa imicabango nokuziphatha okuhle kwe-paralilic kanye nokuziphatha kune-HCs.

Ucwaningo lwangaphambilini luphakamise ukuthi kubantu abane-ASD, yize bebhekwe njengabobodwa,¹⁸ kwakukhona amanani aphakeme (afinyelela ku-15% kuya ku-35%) wokuthanda ubungqingili noma ukubhekisisa kunesibalo esingesabantu be-ASD.^14,64 Ocwaningweni lwamanje futhi, bambalwa abantu abane-ASD ababike ukuthi banobungqingili kunama-HCs; kodwa-ke, kufanele kuphawulwe ukuthi onke ama-HC ayengabathandana abanye futhi ngenxa yalokho awafani nokuqhathaniswa nesibalo sabantu bonke. Ocwaningweni olungezansi lwezocansi olukhona emhlabeni jikelele, inani eliphelele le-10% lababambe iqhaza likhombisa ukuthi bangongqingili.⁶⁵ Ukucatshangelwa okuhlukile kwenziwe mayelana nobubanzi obubanzi bokuthanda ukuya ocansini kubantu be-ASD. Mhlawumbe ubulili abubalulekile lapho ukhetha umlingani, ngenxa yokufinyelela okulinganiselwe ebudlelwaneni bezothando noma bocansi kanye nesipiliyoni esilinganiselwe nokushintshana kobungqingili nontanga yabo. Ngokuhambisana nolwazi oluncane lokuya ocansini, lokhu kungaholela ekuqondeni okuvinjelwe kokuthanda kocansi noma ukuthanda.^33,35,37 Ngaphezu kwalokho, kunobufakazi bokuthi abantu be-ASD kungenzeka babekezelele kakhulu ebudlelwaneni bobulili obufanayo,¹⁵ futhi kungenzeka ukuthi abantu be-ASD bakhethe izifiso zabo zobulili ngokuzimela ngokwengeziwe okwamukelwa noma okufunwayo emphakathini, mhlawumbe ngenxa yokuzwela okuphansi kwezindlela zenhlalo noma izindima zobulili.¹⁵

Ama-HCs aphakeme kakhulu kunabantu abane-ASD kubikwa ukuthi abebudlelwaneni nokuhlukahluka okuphathelene nabesilisa. Abesifazane abaningi kunabesilisa abane-ASD babesebudlelwaneni. Imiphumela yolunye ucwaningo oluhlola umehluko wobulili esimweni sobudlelwano ayifane yodwa, kepha kukhona ubufakazi bokuthi yize abesilisa befisa ubudlelwano be-dyadic ukwedlula abesifazane, abesifazane be-ASD bavame kakhulu ebudlelwaneni bezothando nezocansi.^11,31 Lokhu kungabangelwa yikhono labesifazane le-ASD lokucela amasu okuthuthuka okubhekana nesimo (isib.^33-36 Ngokuphathelene nokuvama kokuziphatha kobulili, abesifazane abane-ASD babike kakhulu ngasese kunokuziphatha komuntu othambekele ekuya ocansini futhi banesifiso esincane sokuya ocansini nomuntu abathandana naye kunabalingani babo besifazane abanga-ASD. Iphethini efanayo yatholakala emadodeni e-ASD, ahambelana nezinye izifundo.^12,23,24,33

Kodwa-ke, ukungazinaki isiko lesenhlalo kanye namakhono okuhlala akhawulelwe ezitholakala emphakathini kanye nama-sensory hyposensitivities noma ama-hypersensitivities kungakhulisa nengozi yokuzibandakanya ekuziphatheni okubi ngokobulili noma ngokwesilinganiso esingaphezulu kwesilinganiso.^22,38 Ukunciphisa lokhu kucabanga, sithole ukuthi ukuziphatha kwe-hypersexual kwabikwa kaningi kakhulu kubantu abodwa be-ASD kune-HCs; kodwa-ke, lo mehluko uqhutshwa ikakhulukazi yiziguli zesilisa ze-ASD, futhi akukho mehluko phakathi kwamaqembu abesifazane owabhekwa. Ngokwesisekelo sokusebenza okuqondile kokuziphatha okuphathelene ne-hypersexual, izifundo zangaphambilini zithole ukulinganiselwa kokusukela ku-3% kuya ku-12% ngezifundo zesilisa ezinempilo.^66-68 Ocwaningweni oluku-inthanethi cishe lwamadoda aseJalimane acishe abe yi-9000, uKlein nozakwabo bathole ukwanda kwezimpawu zokuziphatha kwe-hypersexual (kuchazwa njengama-orgasms angaphezu kwesikhombisa ngesonto esikhathini esingangenyanga ye-1) ye-12%.⁶⁹ Ngokusobala, lokhu kukhombisa ukuthi izifundo eziningi zabesilisa ze-ASD ekuziphatheni kwethu kweze-hypersexual kunalezi zilinganiso ezenzelwe abantu. Kuze kube manje, ngabakwaFernandes nozakwethu kuphela abahlola indlela yokuziphatha kwe-hypersexual kubantu abathile be-ASD futhi bathola amanani aphansi kunathi.⁷⁰ Kuma-55 abantu besilisa abasebenza ngokweqile abahloliwe, i-7% ibike ngokuziphatha okuyi-hypersexual, kuchazwa njengezenzo zocansi ezingaphezu kwesikhombisa ngeviki, futhi i-4% ibandakanyeka ezenzweni zocansi isikhathi esingaphezu kwehora le-1 ngosuku, okucacile ukuthi lingezansi kwezinombolo. etholakala esifundweni samanje. Kodwa-ke, uFernandes et al akazange asho ukuthi bayichaza kanjani imisebenzi yezocansi, futhi kungenzeka ukuthi abahlanganyeli ocwaningweni lwabo balinganise kuphela imisebenzi yokuziphatha kwezocansi, echaza inani eliphansi lokuziphatha okuyi-hypersexual.⁷⁰ Izimbangela ezingenzeka zamanani aphezulu we-hypersexeness emadodeni e-ASD ahlala kungacaci, kepha kungafakwa ukuthi iyingxenye yezindlela zokuziphatha eziphindaphindayo noma ezithonywe yimizwa yengqondo. Ngenxa yokuthi asizange sahlukanise phakathi kokuziphatha komuntu ocansini nomuntu oziqondayo, izinga eliphakeme lokuziphatha okweqile kumadoda e-ASD lingaba futhi isisho sokushaya indlwabu ngokweqile, okutholakele kwezinye izifundo nemibiko yamacala. Kwaphakanyiswa ukuthi ukuziphatha kwe-masturbatory ngokweqile kungabonisa isifiso sokuya ocansini yize kungakwazi ukukufeza lokhu ngenxa yezinkinga ezibandakanya ubudlelwano bocansi be-dyadic ngenxa yamakhono omphakathi alinganiselwe.^14,46-48,52 Mayelana nabesifazane, kucwaningwe okumbalwa kakhulu okwenziwe mayelana nemvamisa yokuziphatha kwe-hypersexual, futhi ngenxa yosayizi omncane wesampula, ukulinganiselwa kokuhlunga kusukela ku-4% kuya ku-40% kubantu jikelele.⁶⁰ Ocwaningweni lokuqinisekiswa lwaseJalimane lwe-HBI, i-4.5% yabesifazane abacishe babe yi-1000 ifakiwe amaphuzu ngaphezulu kwe-hypersexuality cutoff ehlongozwayo.⁵⁹ Njengengxenye ye I-DSM-5 izivivinyo zasemkhakheni wokuphazamiseka kwe-hypersexual disorder, kutholakale ukuthi i-5.3% yazo zonke iziguli ezifuna usizo esikhungweni sokunakekelwa okukhethekile kwabafazi zingabesifazane,⁴³ okukhombisa ukuthi izinga lokuziphatha okuphathelene ne-hypersexual lingase liphansi kakhulu kwabesifazane kunakulabesilisa. Njengoba iziguli ze-ASD zabesifazane zibonakala zingcono ukuzivumelanisa nezenhlalo futhi zivame ukukhombisa uphawu lwe-ASD olungabizi kangako (isib. Izindlela eziphindaphindayo eziphindaphindekayo), akumangalisi ukuthi izimilo ze-hypersexual kulolu cwaningo lwamanje nazo zitholwe zingajwayelekile kakhulu kowesifazane kunakubantu besilisa be-ASD.

Kuze kube manje, cishe azikho izifundo ezilandelanayo eziphathelene nama-paraphilias kubantu be-ASD^64,70; imininingwane eminingi ivela ezifundweni zamacala. Ngaphezu kwalokho, cishe zonke izifundo zocwaningo beziqondise ekuziphatheni okufana nalokhu kubantu besilisa be-ASD abanohlobo oluthile lokulimala kwengqondo; ngakho-ke, ukuqhathanisa nokutholakele ocwaningweni lwamanje kukhawulelwe. Ocwaningweni lukaFernandes nozakwabo (kulwazi lwethu okuwukuphela kocwaningo lwangaphambilini olwalubhekisisa izithasiselo emadodeni ase-ASD asebenza kakhulu), amaphheraphitha atholakala kakhulu kwakuvame ukuba yi-voyeurism kanye ne-fetishism.⁷⁰ Imibono nokuziphatha kwe-Voyeuristic nakho kungenye yezimpawu ezitholakala kakhulu zabesilisa nabesifazane be-ASD esifundweni samanje. Ngaphezu kwalokho, amapharaphaza ayebikwa njalo ayengamaphupho angawobuwula nawokuziphatha kabi. Futhi, lokhu kungaba wukubonakaliswa kwe-hyposensitivity ebekiwe kubantu be-ASD, okukhombisa ukuthi abantu abanjalo badinga ukuvuselelwa okuthe xaxa ukuze bavuswe ngokocansi. Ngaphezu kwalokho, u-Fernandes et al uthole ukuthi ukwenzeka kwepharare kuhlotshaniswa nezimpawu ezengeziwe ze-ASD, amazinga aphansi wekhono lokuqonda, kanye namazinga aphansi okusebenza okusebenzayo, eveza ukuthi amakhono aphansi okuqonda abonakala njengento ebalulekile ku-etiology of fantaphilic fantasies nokuziphatha ku-ASD.⁷⁰ Kungashiwo ukuthi ukuqwashisa ngezindlela zenhlalo kanye nokuzithiba kokuziphatha kuphansi ngisho nakubantu be-ASD abanokulimala kwengqondo, kuchazwa izinga eliphakeme lokuziphatha okuyisiphazamiso. Yize abantu abaningi be-ASD ocwaningweni lwamanje babenemibono eyingqayizivele, abantu abambalwa kakhulu empeleni bakhombisa ukuzibandakanya okuthe xaxa kokusekelwa, beseka isiphakamiso sokuthi abantu abasebenza kakhulu be-ASD bangaba namakhono wokuzithiba okuphakeme kuneziguli ze-ASD ezinokukhubazeka kwengqondo. Imininingwane ngokudotshwa kwezithombe kubantu abaningi nayo iyindlala, iningi lezifundo ezibandakanya abesilisa, ikakhulukazi abaqeqeshiwe emitholampilo noma kwisehlo sasemuva.⁷¹ Ngokwesibalo sabantu bonke, isilinganiso sokuhlasela kwanoma ikuphi paraphilia kucatshangwa ukuthi siphakathi kwe-0.4% ne-7.7%. ^72-75 Futhi, usebenzisa i-QSEB, u-Ahlers et al uthole isilinganiso se-59% yanoma yikuphi ukubuka okuyisisekelo nesilinganiso se-44% nganoma yikuphi ukuziphatha okuyisiphazamiso kusampula labo elivamile labantu besilisa baseJalimane i-367 %), fetishistic (35%), and sadistic (30%) fantasies.⁶¹ Ocwaningweni olukhona manje, ikakhulukazi kubantu besilisa be-ASD, amanani wokuqagela nokuziphatha okuphakeme bekuphakeme kakhulu kunokuqagelwa kokutholakala okutholakale iningi lezifundo zabantu bonke. Futhi, sithole ukwehlukahluka kobulili ekuvamisaneni kwemicabango nokuziphatha okuyisimangaliso kubantu bethu be-ASD. Ukuchazwa kwalokhu mehluko kungaba ukuthi i-sex drive eqinile emadodeni e-ASD ingakwazi ukulamula ubukhona bezinto ezinjengamaphazili ngamandla afinyeziwayo ekufezeni izifiso zabo zocansi noma ukuthi labo abanocansi oluphezulu basebenzise imisebenzi ethize kalula, bayiholele. ukulwela imisebenzi yenoveli.^71,76,77 Ngaphezu kwalokho, i-hypersexuality kungahle futhi kuholele ekunyanyisweni okuyisisekelo kocansi noma ekuthambekeleni imicabango eqondile noma ekuziphatheni okucacisa ukuxhumana phakathi kwezinga eliphakeme le-hypersexual, kanye ne-paraphilic, yokuziphatha.⁷⁷

Imiphumela yocwaningo lwethu ilinganiselwe ngoba isuselwe kuphela ekuzibikeni ngokwakho, futhi umuntu akanakuba nesiqiniseko sokuthi bonke ababambiqhaza batholwe udokotela wezengqondo noma oqeqeshiwe wezifo zengqondo. Kodwa-ke, bonke ababambiqhaza be-ASD bathole amaphuzu angenhla kwenguqulo yaseJalimane ye-AQ, baqinisekisa ukuthi babonisa uphawu lwe-ASD. Ngaphezu kwalokho, bonke ababambiqhaza baqashwa ngamaqembu okuzisiza we-ASD noma izikhungo zokunakekela izingane eziphuma ngaphandle ze-ASD, okukhombisa ukuthi ukuxhumana kwabo nohlelo lwezokwelapha kungenxa yezimpawu zabo. Imiphumela yethu yokufunda ibuye ikhawulelwe yikhono lokuthi abantu abanentshisekelo ephezulu ezindabeni ezihlobene nezocansi, futhi mhlawumbe futhi banezinkinga eziningi zocansi, kungenzeka bavolontiye ukubamba iqhaza, ngaleyo ndlela kuthinta inani labantu abafundwayo. Lokhu kungahle kuholele ekuphakameni ngokweqile kwesilinganiso sangempela semicabango nokuziphatha okuhle kwe-paradilic eqenjini le-ASD. Noma kunjalo, uma kuyiqiniso, lokhu kufanele futhi kwenzeke eqenjini le-HC.

Ucwaningo olukhona kungolokuqala ukuhlola imicabango nokuziphatha okuyisimo esibonelweni esikhulu sabantu abasebenza kahle be-ASD besilisa nabesifazane uma kuqhathaniswa neqembu lokulawula elifanisiwe, okubonisa ukuthi yize abantu be-ASD benentshisekelo enkulu ekuziphatheni kobulili, ngenxa ukuphazamiseka kwabo okuthe ngqo ekusebenzeni kwezenhlalo nezothando, eziningi zazo zibika nokulimazeka okuthile ocansini.

Ukuvuma

Sifuna ukubonga uStefanie Schmidt owenza umsebenzi omuhle ekusekeleni ukuqashwa kwabahlanganyeli. Ngaphezu kwalokho, sifuna ukubonga wonke amaqembu azisizayo azimisele ukuhambisa isimemo sethu sokufunda phakathi kwabahlanganyeli bawo. Akukho mali yangaphandle etholakele yocwaningo.

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