Yini okufanele ifakwe kunqubo yokuphazamiseka kokuziphatha ngokocansi okuyimpoqo? (2020)

Ukuphazamiseka kokuziphatha ngokocansi okuphoqelekile (CSBD) ku-ICD-11

Ukucindezeleka kokuziphatha ngokocansi okuphoqelekile (CSBD) okwamanje kuchazwa ekubuyekezweni kweshumi nanye kwe-International Classification of Diseases (ICD-11; WHO, 2020; UKraus et al., 2018) njengokuphazamiseka kokulawula umfutho futhi "obonakala ngephethini eqhubekayo yokwehluleka ukulawula izifiso ezinamandla, eziphindaphindayo zocansi nokuziphatha" lapho umuntu (1) echitha isikhathi esedlulele emisebenzini yezocansi aze ayekelele impilo, ukunakekelwa komuntu siqu, izintshisekelo, kanye izibopho, (2) okwehliswayo kokulawulwa okuncishisiwe okuboniswa yimizamo eminingi engaphumelelanga yokwehlisa ukusebenza kwezocansi, (3) iyaqhubeka nokwenza ucansi naphezu kwemiphumela emibi, (4) iyaqhubeka nokuzibandakanya ekuziphatheni ngokocansi noma ngabe kutholakala ukwaneliseka okuncane noma akukho, kanye (5) nokuhlangenwe nakho ukucindezeleka okukhulu noma ukukhubazeka kuzizinda zokuphila noma izindawo ezibalulekile zokusebenza. Ukwahlukaniswa kuphinde kwexwayise, "Usizi oluhlobene ngokuphelele nezinqumo zokuziphatha nokungavumi mayelana nezifiso zocansi, ukunxenxa, noma isimilo akwanele ukuhlangabezana nale mfuneko." Ngokwengeziwe, ukuphazamiseka kwe-paraphilic kuyakhishwa. Incazelo ye-ICD-11 yabelana ngokufana nenqubo ehlongozwayo yokuphazamiseka kwe-hypersexual (HD) eyacatshangelwa, kepha ekugcineni yakhishwa kwi-DSM-5 (I-American Psychiatric Association, 2013; IKafka, 2010, 2014), enokuhlukahluka okuphawulekayo okuphathelene (1) nemizwa kanye / noma nezici ezihlobene nokucindezelwa komthetho, (2) ukungaziphathi kahle kokuziphatha okuhlobene nokuziphatha kocansi, (3) izindlela zokuziphatha zocansi eziyinkinga ezihlobene nokusetshenziswa kwezidakamizwa, kanye (4) nokwaneliseka okuncane okuvela imisebenzi yezocansi (Ithebula 1).

Ukwehliswa kwemizwelo nokubhekana nokungahambi kahle

Izimpawu ezihlobene nomzwelo azifakwanga nenqubo ye-CSBD ku-ICD-11 yize idatha ekhombisa ukuthi i-CSB ivame ukuhlotshaniswa nokusebenzisa ucansi ukubhekana nemizwa enzima (isb. Ukudabuka, amahloni, isizungu, isithukuthezi, noma intukuthelo), ingcindezi noma okuhlangenwe nakho okubuhlungu (I-Lew-Starowicz, i-Lewczuk, i-Nowakowska, i-Kraus, ne-Gola, i-2020; Reid, Umbazi, Spackman, & Willes, 2008; Reid, Stein, & Umbazi, 2011). Ekucabangeni kwe-HD ehlongozwe ngu I-Kafka (2010) kwe-DSM-5, izindlela ezimbili kwezinhlanu zibhekana ngqo nokusetshenziswa kwemisebenzi yezocansi ukulawula imizwa noma ukunciphisa ukucindezeleka (i-A2 ne-A3, Ithebula 1).

Ukuhlukunyezwa ngokomzwelo kuye kwahlotshaniswa nobungqingili ezimeni zomtholampilo nakumamodeli wokuqonda kanye nethiyori (Amakhadi, i-2001; IKingston & Firestone, 2008; UWry noBillieux, 2017). Imodeli kaGoodman yayinezici eziyinhloko ezintathu: ukungathinteki kokulawulwa komthetho, ukukhubazeka okungavumelekile kokuziphatha, kanye nokuphazamiseka kokusebenza kwezinhlelo zokukhuthaza umvuzo (I-Goodman, i-1997). Ekucabangeni kobungqingili nasekuthuthukiseni i-Hypersexual Behavior Inventory (Reid, Garos, & Umbazi, 2011), UReid noWoolley (2006) kwaqokomisa izingqinamba ezihambisana nokukhubazeka ngokomzwelo (Reid & Woolley, 2006). Lapho kubuyekezwa imiqondo ehlukile ye-etiological ye-CSB, IBancroft neVukadinovic (2004) sathi, “Silibheka iqhaza le-affect njengolibalulekile emacaleni amaningi, uma kungewona wonke, amacala okuziphatha okungalawulwa ngokocansi” (p. 231). Baphakamise imizila emi-3 lapho ukungalawulwa kahle, umthelela omubi ungafaka isandla ku-CSB: ukuvuswa kocansi nokwenza ucansi okufana nokucindezela okungakhombisa imizamo yokuhlangabezana nezinhloso zokulawula ngesikhathi sezimo ezingezinhle ezingokomzwelo; ukugqugquzela ngokocansi okungasetshenziswa njengesiphazamisi ezintweni ezikhuthazayo noma ezimeni ezibanga imizwa engemihle; futhi, ukuvuswa kocansi okungaba yimpendulo enemibandela yokuvusa imizwa emibi kakhulu. Amamodeli wakamuva, ahlukanisekayo, ahlanganisayo agxile emvelweni kanye ne-etiology ye-CSB abuye abalule ukubaluleka kokucwaswa ngokomzwelo (Grubbs, Perry, Wilt, & Reid, 2018; UWalton, uCantor, uBhullar, noLykins, 2017).

Ngokubambisana, lolu cwaningo olungenhla lugcizelela ukubaluleka kwezinhlangano phakathi kokulawulwa kwemizwelo noma ukubizwa kwengcindezi kanye ne-CSB. Indima evelele yokulawulwa ngokomzwelo nayo ichazwe ngokungahambisani nokugembula, isimo esasifakwa phambilini njengesifo sokulawula umfutho futhi manje njengesilutha sokuziphatha. Ngokuqondile, ukulawulwa ngokomzwelo okusebenza njengezisusa zokuqinisa okungekho emthethweni kuchazwe njengeyona ndlela eyinhloko yokuthuthukisa nokugcina ukuphazamiseka kokugembula (IBraszczynski & Nower, 2002). Kuyacaca ukuthi izifundazwe ezingezinhle zingakha zombili izinto ezinciphisa futhi ziqhubekisele phambili ubungozi be-CSB. Kuyathakazelisa ukuthi izindlela ze-DSM-5 zokuphazamiseka kokugembula zifaka umbandela ohlobene nokulawulwa ngokomzwelo kanti inqubo ye-ICD-11 ayifuni. Njengalokhu, umehluko owenziwe ngenhla ungakhombisa ukwehluka okungaguquguquki ngezindlela izindikimba ezilawulayo, i-World Health Organisation kanye ne-American Psychiatric Association, ezibeka imigomo emaphakathi yalezi zinkinga. Amamodeli wokunciphisa ukungezwani noma imishanguzo yokuzelapha iveza ukuthi izindlela zokuziphatha ezingaba umlutha ezakha umuzwa wokuguqula isimo zingasebenza ngezindlela zokuqinisa ezingezinhle ukulungisa izimo ezingezinhle noma ukunciphisa ukucindezeleka (IGola & Potenza, 2016; UKasten, 1999; Khantzian, 1987; IZwiecha et al., 2018), futhi lokhu kufanele kubhekwe ekwethuleni izici zeziguli ezifuna ukwelashwa kwe-CSBD. Ngenkathi le nqubo ingenziwa lula ngokufakwa kwalezi zici ngaphakathi kwenqubo, odokotela sekuyisikhathi eside bahlola izici ezifanele zomtholampilo zokuphazamiseka noma zingafakwanga njengezindlela ezisemqoka (isb. Ukunxusa ukugembula ekuphazamisekeni kokugembula).

Njengamanje, akucaci ngokuphelele ukuthi kungani izindlela ezihlobene nomthethonqubo ohlobene nomzwelo noma zokucindezelwa zazingafakwanga kunqubo ye-ICD-11 ye-CSBD. Sikhuthaza futhi sisekela ingxoxo evulekile ngale ndaba njengesihluthulelo sendlela izinto ezingumgogodla ze-CSBD ezicatshangwayo ngayo nokuthi imizamo ephathelene ne-CSBD isondela kanjani ocwaningweni nasezilungiselweni zomtholampilo. Lapho kuchazwa inqubo ye-CSBD, kungabaluleka ukuthi ucabangele ukuthi izimpawu eziwumgogodla zingahlukaniswa kanjani nezinqubo ezingokwengqondo, njengoba kusanda kuchazwa ngenkinga yokudlala nezinye izindlela zokulutha (Brand, Rumpf, King, Potenza, & Wegmann, 2020).

Ukunciphisa injabulo

Ingxoxo eyengeziwe maqondana nokufana nokwehluka phakathi kwezinqubo ze-HD ne-CSBD iyafuneka. Uma kuqhathaniswa ne-HD, izindlela ze-CSBD ziyehluka ngoba zibandakanya ngokusobala ukuqhubeka kokuziphatha kocansi lapho uthola injabulo encane noma cha (I-WHO, 2020). Lokhu kubonakala kukhombisa izisekelo ezihlongozwayo "zokuphoqelela" zesifo esiphakamisa ukuthi ukuziphatha kocansi phakathi kwabantu abatholakele kungaqhutshwa yizinto ezingahlobene nenjabulo; lezo zinto zingafaka ucansi njengokuziphatha okujwayelekile noma okunemibandela noma imizamo yokunciphisa imicabango engalawuleki kanye / noma umthelela omubi ohlotshaniswa nayo (IBarth & Kinder, 1987; UStein, 2008; UWalton et al., 2017). Injabulo encishisiwe etholakala ekuziphatheni ngokocansi ingakhombisa nokubekezelelana okuhlobene nokuphindaphindwa nokuvezwa ngokweqile kuzisusa zocansi, ezifakiwe kumamodeli wokulutha we-CSBD (IKraus, Voon, & Potenza, 2016) futhi kusekelwa okutholwe yi-neuroscientific (IGola & Draps, 2018). Indima ebalulekile yokubekezelelana maqondana nokusetshenziswa kwezithombe zobulili ezingcolile eziyinkinga iphakanyisiwe nasemasampulini omphakathi nakwezingaphansi (Chen et al., 2021). Ukucatshangelwa okuqhubekayo kwalezi zimo njengoba zihlobana nenqubo ye-CSBD kungasiza ukuhlukanisa phakathi kwabantu abanezimpawu ze-CSBD nalabo abenza imvamisa ephezulu ezenzweni zocansi ngenxa yezifiso eziphakeme zocansi noma ukushayela (UCarvalho, Štulhofer, Vieira, noJurin, 2015), okwakuyiphuzu langaphambilini lokugxekwa kwesayensi kwe-HD ne-CSBD (Ukudumisa, i-2017).

Ukucabangela imibandela yokufaka

Ngaphezu kwalokho, ngqo ukuthi ungayibheka kanjani inqubo ngayinye ye-CSBD ekwenzeni ukuxilongwa akuchazwa ngokucacile. Njengamanje, kunencazelo yezimpawu ezingahle zixhumane nokuxilongwa, kanye nokuholwa okuncane okuqondile mayelana nokuthi yiziphi futhi zingaki izindlela ezidingekayo uma kuqhathaniswa nokuzikhethela kokwenza ukuxilongwa (I-WHO, 2020). Ukuxilongwa kwe-HD kudinga umbandela womhlangano B kanye no-3 koku-5 kwe-A-type criteria (bheka Ithebula 1). Njengamanje, imininingwane ehambisanayo ayinikezwa i-CSBD. Lesi sihloko sidinga ukuhlolwa okwengeziwe ocwaningweni oluzayo nasekuzameni kwemitholampilo nokucaciswa okuqhubekayo ku-ICD-11.

Ukungaziphathi kahle kokuziphatha

Incazelo yamanje ye-CSBD ifaka nesitatimende sokuthi ukuxilongwa kwe-CSBD akufanele kwenziwe uma ukucindezeleka kuhlobene ngokuphelele nokungavunyelwa noma ukwahlulelwa kokuziphatha. Lesi sitatimende sikhombisa uphenyo lwakamuva mayelana nemithelela engaba khona yezinkolelo ezingokwenkolo nezokuziphatha ekufuneni ukwelashwa kwe-CSB (IGrubbs et al., 2018; Grubbs, Kraus, Perry, Lewczuk, & Gola, 2020; I-Lewczuk, Szmyd, Skorko, & Gola, 2017; ILecczuk, iGlica, iNowakowska, iGola, neGrubbs, 2020), idatha ebingatholakali ngenkathi kuhlongozwa i-HD ye-DSM-5. Kodwa-ke, imizwa yokungaziphathi kahle kokuziphatha akufanele ikhubaze umuntu ngaphandle kokuthola ukuxilongwa kwe-CSBD. Isibonelo, ukubuka izinto ezibeka obala ezocansi ezingahambisani nezinkolelo zakho zokuziphatha (isibonelo, izithombe zocansi ezibandakanya udlame olubhekiswe kwabesifazane nokuphikiswa (I-Bridges et al., I-2010), ubuhlanga (UFritz, uMalic, uPaul, noZhou, 2020), izingqikithi zokudlwengulwa nezihlobo zocansi (UBőthe et al., 2021; URothman, uKaczmarsky, uBurke, uJansen, noBaughman, 2015) kungabikwa njengokungaziphathi kahle kokuziphatha, futhi ukubukwa ngokweqile kokuqukethwe okunjalo kungaholela nasekuthikamezekeni kuzizinda eziningi (isb., ezomthetho, ezomsebenzi, ezomuntu nezomndeni). Futhi, umuntu angazizwa engaziphathi kahle ngokuziphatha kwezinye izindlela zokuziphatha (isb., Ukugembula ekuphazamisekeni kokugembula noma ukusetshenziswa kwezidakamizwa ekuphazamisekeni kokusetshenziswa kwezidakamizwa), kepha ukungaziphathi kahle kokuziphatha akubhekwa kuzimo zezimo ezihlobene nalezi zindlela zokuziphatha, noma kungahle kudinge ukucatshangelwa ngesikhathi sokwelashwa (ILewczuk, iNowakowska, iLandandowska, iPotenza, neGola, i-2020). Kungase kube khona nokwehluka okubalulekile okuhambisana namasiko okuphathelene nenkolo okungaba nomthelela ekuziphatheni okungathandeki kokuziphatha (Lewczuk et al., 2020). Ngaphezu kwalokho, abacwaningi baphakamise imibuzo mayelana nokuthi ngabe izinhlobo ze-CSB ezibandakanya ukuba khona noma ukungabikho kokuziphatha okungaziphathi kahle zihlukile njengoba kuhlongoziwe (Umkhiqizo, ama-Antons, Wegmann, & Potenza, 2019). Ngakho-ke, yize ukungaziphathi kahle kokuziphatha kungabaluleka emtholampilo kulokho okugqugquzela abantu ukuthi bafune ukwelashwa kwe-CSB (IKraus & Sweeney, 2019), Indima yayo ku-etiology kanye nencazelo ye-CSBD ivumela ukuqonda okwengeziwe.

Ukusetshenziswa kwezidakamizwa kanye ne-bipolar symptomatology

Izindlela ze-CSBD azizibheki ngokusobala ezinye izinto ezingaba ezifanele ukuxilongwa kubandakanya ukusetshenziswa kwezidakamizwa (Kafka, 2010; Reid & Meyer, 2016). Ukuziphatha okwenzeka ngokubambisana okuthile (isb., I-CSB enqunyelwe ezikhathini zokusetshenziswa kwe-cocaine ekuphazamisweni kokusetshenziswa kwe-cocaine noma izindlela zokwelashwa ze-dopamine kwisifo sikaParkinson's) zihlobene kanjani neziqinisekiso ze-CSBD zokucatshangelwa okwengeziwe. Ngokufanayo, i-CSB enqunyelwe eziqephu ze-manic kufanele icatshangelwe, njengoba kunjalo manje ngokugembula okuhlobene nemania maqondana nenkinga yokugembula.

Ukwahlukanisa

Ukuhlukaniswa kwe-CSBD njengesifo sokulawula umfutho nakho kudinga ukucatshangelwa. I-HD ibithathwa yiqembu le-DSM-5 le-Sexual and Gender Identity Disorders Workgroup (I-Kafka, i-2014), Futhi idatha iphakamisa ukufana phakathi kwe-CSBD nokuphazamiseka kokulutha (IGola & Draps, 2018; IKraus, Martino, & Potenza, 2016; I-Stark, i-Klucken, i-Potenza, i-Brand, ne-Strahler, i-2018). Ucwaningo olwengeziwe lungasiza ekucazululeni ukuhlukaniswa okufanele kakhulu kwe-CSBD njengoba kwenzekile ngenkinga yokugembula, kwahlukaniswa kabusha kusukela esigabeni sokuphazamiseka kokulawula umfutho kuya ekuluthweni okungezona okwezidakamizwa noma kokuziphatha ku-DSM-5 naku-ICD-11. Ngokuhambisana nalo mqondo, olunye ucwaningo luthole ukungafisi njengento ehambisanayo ezingaphansi kwesigamu seziguli ezifuna usizo lwe-CSB (Reid, Cyders, Moghaddam, & Fong, 2014) nokuthi ukungafisi kungenzeka kunganikeli ngokuqinile ekusetshenzisweni kwezithombe zocansi eziyinkinga njengoba abanye bephakamisile (I-Bőthe et al., 2019).

Izinhlobo zokuziphatha ngokocansi

Izimpawu zokuziphatha ezifana nalezo eziwela ngaphansi kwe-CSBD ziye zafundwa futhi ngaphakathi kohlaka oluncane lokusetshenziswa kwezithombe zocansi eziyinkinga (de Alarcón, de la Iglesia, Casado, & Montejo, 2019). Ukunikezwa kokubuka izithombe zobulili ezingcolile okunenkinga nokucindezela ukushaya indlwabu kuvame ukubonakaliswa kokuziphatha okuvelele kwe-CSBD (UGola, uKowalewska et al., 2018; Reid et al., 2011), Umuntu angasho ukuthi ukusetshenziswa kwezithombe zobulili ezingcolile okunenkinga kufanele kubhekwe njengohlobo oluthile lwe-CSBD, yize kuchazwe okunye ukucatshangelwa (I-Brand et al., I-2020). Indlela ehlongozwayo ye-HD (I-Kafka, i-2010) kufaka phakathi izikhombisi zokuziphatha eziyisikhombisa (okungukuthi, ukushaya indlwabu, izithombe zobulili ezingcolile, ukuziphatha ngokocansi nabantu abadala abavumayo, i-Cybersex, i-Telephone Sex, ama-Strip Clubs, nezinye) ezazenzelwe ukusiza ukuhlukanisa phakathi kwezethulo ezahlukahlukene zalesi sifo. Ku-ICD-11, awekho ama-subtypes we-CSBD okwamanje achaziwe, okungaba ngumsebenzi wocwaningo lwesikhathi esizayo. Ukusekelwa kwedatha izindlela ezingafani kakhulu nezethulo zokuziphatha okuyinkinga kwezocansi (UCarvalho et al., 2015; UKnight & Graham, 2017; IKingston, 2018a, 2018b), okungaphenywa ngokuqhubekayo nenqubo ye-CSBD engqondweni. Ngokuphathelene nocwaningo lwesayensi, ukuqashelwa kwe-CSBD ku-ICD-11 kungasiza ekuhlanganiseni imigqa yocwaningo ehlobene kodwa kwesinye isikhathi (ukusetshenziswa kwezinkinga eziyizithombe zocansi eziyinkinga, izithombe zobulili ezingcolile kanye nokulutha ngokocansi, ucansi oluyinkinga lwe-inthanethi, ubungqingili), okungadala ukucaca okukhulu kwesayensi futhi kusheshiswe ucwaningo nentuthuko emitholampilo.

Assessment

Ukuthuthukela enhlosweni yocwaningo oluhlanganisiwe, izinyathelo zokuhlola izimpawu ze-CSBD ezibonisa ngokwanele inqubo ngayinye ye-CSBD nokubaluleka kwayo okuhlobene kufanele kuthuthukiswe futhi kuqinisekiswe. Lo msebenzi, yize ububalulekile, ubukhombise ukuthi ubunzima ekuqaleni kwe-HD, njengoba izindlela zokuhlola i-HD zazigxekwa ngokuthola kakhulu ababambiqhaza benani labantu, okungenani kwamanye amasampula (isib. Walton et al., 2017). Imizamo yokuqala ifake ukwakhiwa kwesikali sezinto eziyi-19 esiqinisekiswe ngezilimi ezintathu (I-Bőthe et al., 2020). Ucwaningo olwengeziwe luyadingeka ukuhlola ukusebenza kwalo kanye nokwethembeka kwezinye iziphathimandla ezingaba nemibono ehlukene yamasiko ngocansi (phakathi kokunye umehluko) nokuphenya ucwaningo lwayo kanye nezinsiza zomtholampilo.

Imiphumela Yomtholampilo

Ngaphandle kwesidingo sokucaciswa okwengeziwe njengoba kuxoxwe kuleli phepha, kufaka phakathi i-CSBD ku-ICD-11 kufanele kube wusizo kubantu abafuna ukwelashwa kanye nabahlinzeki bezokunakekelwa kwempilo. Cishe indoda eyodwa kwabayisikhombisa ebuka izithombe zobulili ezingcolile ibike intshisekelo yokufuna ukwelashwa ngokusetshenziswa kwazo kwezithombe zobulili ezingcolile, futhi labo abanentshisekelo yokwelashwa babenamathuba amaningi okuhlangana nomngcele womtholampilo wobungqingili (IKraus, Martino, & Potenza, 2016). Kanjalo, ukufakwa kwe-CSBD ku-ICD-11 ukwengeza okwamukelwe okufanele kube nomthelela omkhulu emtholampilo. Abaphenyi kufanele bakwazi ukwakha phezu kwesisekelo semigomo ye-CSBD ukuhlinzeka ngemibono eyengeziwe nemibono mayelana nalesi sifo kanye nezici ezihambisana naso futhi basize ukukhuthaza ukuthuthuka komtholampilo.

Imithombo yokuxhasa ngezimali

Lo msebenzi ubungasekelwa yimali.

Umnikelo wabalobi

I-MG, i-KL, ne-RCR yathuthukisa umbono wokuqala wokusalungiswa kombhalo wesandla, i-MNP, i-JBG, i-DAK, ne-RS inikeze ukuguqulwa okuphawulekayo nemibono eyengeziwe yezinguqulo ezalandela. Bonke ababhali baxoxe ngokuqukethwe okwethulwayo futhi bavumelana ngohlobo lokugcina.

Ukungqubuzana kwesithakazelo

Ababhali babika ukuthi akukho kungqubuzana kwezintshisekelo.

Ukubonisa

Akukho.