Davranışsal Bağımlılıklar
Özet
Hazza veya anksiyete azaltmaya yönelik davranışların kontrolünün kaybedilerek kompulsif şekilde tekrarlanmasıyla karakterize olan ve madde bağımlılığı ile benzer dopaminerjik, serotonerjik ve ödül mekanizmalarını paylaşan davranışsal bağımlılıklar, bireysel ve toplumsal sorunlara yol açmaktadır. İncelenen temel türler arasında, erkek ergenlerde sık görülen ve DSM-5 tanı kriterlerinde yer alan dijital oyun bağımlılığı; sosyal izolasyon ve prefrontal korteks aktiviteleriyle ilişkili internet bağımlılığı; cinsel eylemler üzerinde kontrol güçlüğüyle beliren seks bağımlılığı; kadınlarda ve kentsel alanlarda daha yaygın olan kompulsif alışveriş bağımlılığı; tolerans, yoksunluk ve yüksek intihar riski barındırıp DSM-5'te "Madde ile İlişkili Olmayan Bozukluk" olarak sınıflandırılan kumar oynama bozukluğu (KOB) yer almaktadır. Ayrıca yeme, egzersiz ve akıllı telefon bağımlılıkları da diğer önemli türler olarak sunulmuştur. Tedavi yaklaşımlarında, tüm bağımlılık türlerinde depresyon, anksiyete ve zaman yönetimini iyileştiren Bilişsel Davranışçı Terapi (BDT) ön plana çıkmaktadır. Farmakolojik açıdan ise oyun bağımlılığında bupropion ve metilfenidat; internet bağımlılığına eşlik eden durumlarda atomoksetin; seks ve alışveriş bağımlılığında SSRI ile naltrekson tercih edilirken; KOB için onaylı bir ajan olmamakla birlikte klomipramin, fluoksetin ve paroksetin gibi antidepresanların plaseboya üstünlük sağladığı bildirilmiştir.
Behavioral addictions, characterized by the loss of control and compulsive repetition of behaviors aimed at pleasure or anxiety reduction, share similar dopaminergic, serotonergic, and reward mechanisms with substance addictions, leading to individual and social problems. The main types investigated include digital gaming addiction, which is common among male adolescents and included in DSM-5 diagnostic criteria; internet addiction associated with social isolation and prefrontal cortex activities; sex addiction manifested by difficulty controlling sexual acts; and compulsive shopping addiction, which is more prevalent in women and urban areas. Additionally, gambling disorder (GD), classified under "Non-Substance-Related Disorders" in the DSM-5, involves tolerance, withdrawal, and a high suicide risk. Food, exercise, and smartphone addictions are also presented as other significant types. Regarding treatment approaches, Cognitive Behavioral Therapy (CBT) stands out by improving depression, anxiety, and time management across all addiction types. Pharmacologically, bupropion and methylphenidate are utilized for gaming addiction; atomoxetine for comorbidities in internet addiction; SSRIs and naltrexone for sex and shopping addictions; and although no agent is approved for GD, antidepressants such as clomipramine, fluoxetine, and paroxetine have shown superiority over placebo.
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