自我刺激

自我刺激行為(也稱為stimming、[1] stims、[2] 自我刺激、[3] 刻板動作(stereotypy),以及刻板性動作疾患(stereotypic movement disorder))是指身體重複做出某一動作、重複發出某一聲音、重複講出某個詞語、總是要來回移動某個物體或重複做出其他動作。自我刺激行為是一種受限且重複的行為(restricted and repetitive behavior, RRB)。[4] 這類行為在所有人身上多少都會出現,但在發展性障礙(developmental disability)、注意力不足過動症(ADHD)、感覺處理障礙(sensory processing disorder)[5]或自閉症人士身上尤其強烈且頻繁。[3]
自我刺激行為可被解釋為對感官過載的保護性反應,透過阻斷不可預測的環境刺激(這些刺激會被高敏感的感官處理靈敏度放大),使人得以平靜下來。[3][5] 自我刺激行為也可能是緩解焦慮及其他負面或強烈情緒的一種方式。[6]
雖然部分自我刺激行為通常被認為是健康且有益的,因為它們有助於調節強烈的感覺經驗、緩解如焦慮等強烈情緒、可能促進與其他自閉症人士的理解與社交互動、促進愉快情緒並建立安全感[7][8][9][10][11] 但自我刺激行為常被社會污名化。許多神經多元人士常覺得必須隱藏或減少這些重複行為,因為它們看似不被社會接受,並可能引來不理解者的負面反應。即使減少具破壞性或有害的重複行為可能有益,[12][13][14] 但抑制或掩飾(masking)一些無害或具有適應性的自我刺激行為也可能危害心理健康與福祉。[8][15][11][10][16][17][9]
自我刺激行為可能涉及觸覺、視覺、聽覺、發聲、本體感覺(與肢體感知相關)、嗅覺及前庭系統(與平衡有關)的刺激。一些常見的自我刺激範例包括揮動雙手、拍手、搖晃、眨眼、踱步、撞頭、重複聲音或詞語、彈手指、腳尖走路及旋轉物體。[18][19] 在某些情況下,自我刺激行為可能是危險且對身體有害的,例如有人可能會因用力將身體撞擊牆壁而造成傷害。[20] 另外,重複行為在某些情境下可能會干擾部分自閉症人士的學習與社交溝通。[21][22]
自閉症
[编辑]
自我刺激行為幾乎總是出現在自閉症人士身上,但僅憑這一點並不一定能作為診斷依據。[10][23] 自閉症人士與非自閉症人士之間最大的差別在於自我刺激的種類與頻率。[23] 在美國精神醫學學會出版的《精神疾病診斷與統計手冊第五版》(DSM-5)中,自我刺激行為被描述為「刻板或重複的動作方式」,並列為自閉症譜系障礙的五項核心診斷標準之一。[24]
不同觀點認為,自我刺激同時涉及感官與動作功能。當這些感官或動作功能發展不足時,個人可能會以自我刺激作為一種可控的反應。一項訪問三十二位自閉症成年人的研究發現,無法預測且過度刺激的環境會引發自我刺激。[15]
自我刺激有時可能導致自我傷害,例如撞頭、咬手、過度摩擦或抓傷皮膚。[25]
由於自我刺激主要具有自我調節的功能,且大多是在無意識下發生,因此很難壓抑。[26] 調整感官與情緒環境,同時增加日常運動量,可以讓人更舒適,進而減少對自我刺激的需求。[27] 有意識或無意識地抑制自我刺激是一種自閉症掩飾(masking)的形式,以期表現得更接近神經典型人士。[28][29] 這通常需要極大的努力,並可能對心理健康與整體幸福感造成負面影響。[28][29][30]
注意力不足過動症(ADHD)
[编辑]一些,但不是所有患有ADHD的人會從事自我刺激行為。[31] 雖然其成因尚未被徹底理解,但專家認為自我刺激行為很可能與ADHD人士腦中出現的多巴胺失衡效應有關。[32] ADHD人士可能自我刺激的原因包括:幫助專注、處理並面對情緒、應對無聊、表達興奮、在被環境壓力淹沒時自我調節,以及在對某個主題或工作缺乏興趣時幫助集中注意力。[33]
與ADHD相關的自我刺激行為通常具有重複性,並且可能是有意識或無意識下的。[33] 許多神經典型(neurotypical)人士也會出現類似的行為,被稱為「坐立不安」(fidgeting)。然而,對ADHD人士來說,這些行為更為嚴重、更常發生,並且會影響其日常生活。[32] 一些可能較負面或有害的行為包括磨牙、咬指甲和嘴唇、摳皮膚和結痂、過度飲食、衝動行為,以及咬臉頰內側。[33]
對ADHD人士而言,自我刺激行為可能會隨時間改變。有些行為可能會減少或消失,而其他行為則可能因壓力源而出現。[31] ADHD症狀可能因特定環境、情境和情緒而加劇,進而觸發自我刺激行為。這些觸發因素包括:涉及衝突或被拒絕的情緒情境、電視和手機造成的分心、混亂或繁忙的環境、強烈或干擾性的氣味,以及刺眼的照明。[33]
研究
[编辑]其他情況下可能自我刺激行為
[编辑]揮手動作
[编辑]雙手(通常同時)揮動是最常見的自閉症特徵之一,但也出現在天使人症候群和皮特-霍普金斯症候群(Pitt–Hopkins syndrome),而這些情況並不被認為與自閉症有關。這些症候群中的揮手動作是否符合更廣義的自我刺激行為是屬於術語上的問題;例如,在關於天使人症候群的文獻中常使用刻板動作(stereotypy)一詞。揮手動作同樣可見於X染色體易裂症者;雖然X染色體易裂症與自閉症有高度相關性,但即使是不符合自閉症診斷條件的患者,也可能出現揮手動作。[34]
玩具
[编辑]一些被稱為自我刺激玩具(stim toys)或感官玩具(sensory toys)的小物件可以用來滿足一個人的自我刺激行為。某些刺激玩具可能是專為特定的自我刺激行為行為設計,例如指尖陀螺。也可能是任何只要能被人操控以達到預期的自我刺激行為的普通物品。許多流行的自我刺激玩具是手持的;它們也可能提供口腔刺激,例如咀嚼飾品(chewelry)。[35]
参考文献
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