Seks Bağımlılığı
Özet
Seks bağımlılığı, ciddi kişilerarası ve psikolojik sorunlara yol açmasına rağmen uzun yıllar göz ardı edilmiş, ancak hiperseksüel bozukluk olarak tanımlanmasıyla klinik literatür hızlanmıştır. Tarisel süreçte Krafft-Ebbing’in artmış cinsel arzuyu tanımlamasından sonra 1970'lerde Orford, bu durumu alkol bağımlılığı ile karşılaştırarak kontrol bozukluğu üzerinden ele almıştır. Bozukluk, hazzı hedefleyen impulsif bir kısım ile döngünün devamlılığını sağlayan kompulsif bir spektrum üzerinde tanımlanır. DSM-5'e dahil edilmese de genel popülasyondaki tahmini yaygınlığı %3 ile %6 arasında değişmekte olup erkeklerde kadınlara kıyasla (3:1 ile 5:1 oranında) daha sık görülmektedir. Klinik görünümde obsesif düşünceler, erken yaşta cinsel deneyim, çocukluk dönemi ebeveyn ayrılığı ve istismar öyküsü risk faktörleridir. Semptomlar yeni partner arayışı, kompulsif mastürbasyon ve pornografi gibi davranışsal belirtiler ile suçluluk, utanç ve düşük özgüven gibi bilişsel-duygusal belirtilerden oluşur. Tedavide farmakolojik ve psikoterapötik yaklaşımların kombinasyonu esastır; sitalopram, fluoksetin, topiramat, naltrekson gibi ilaçların yanı sıra bilişsel davranışçı terapi ve Adsız Seks Bağımlıları gibi kendine yardım grupları etkilidir. Seks bağımlılığı henüz resmi sınıflamalarda yer almasa da dürtüsellik-zorlantı çerçevesinde incelenerek klinik olarak zenginleşmektedir.
Although sexual addiction causes serious interpersonal and psychological problems, it has been ignored for many years, but the clinical literature has accelerated after it was defined as hypersexual disorder. Historically, after Krafft-Ebbing defined increased sexual desire, Orford addressed this condition through control impairment by comparing it with alcohol addiction in the 1970s. The disorder is defined on a spectrum with an impulsive part targeting pleasure and a compulsive part contributing to the continuation of the cycle. Although not included in the DSM-5, its estimated prevalence in the general population varies between 3% and 6% and is observed more frequently in men compared to women (at a ratio of 3:1 to 5:1). In the clinical presentation, obsessive thoughts, early onset of sexual behavior, childhood parental separation, and history of abuse are risk factors. Symptoms consist of behavioral signs such as seeking new partners, compulsive masturbation, and pornography, as well as cognitive-emotional signs like guilt, shame, and low self-esteem. In treatment, a combination of pharmacological and psychotherapeutic approaches is essential; medications such as citalopram, fluoxetine, topiramate, and naltrexone, as well as cognitive behavioral therapy and self-help groups like Sex Addicts Anonymous, are effective. Although sexual addiction is not yet included in official classifications, it is clinically enriched by being examined within the framework of impulsivity-compulsivity.
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