Double The Stigma: Hypersexuality In Bipolar Illness And How To Manage It

Imagine the following scenario. A petite woman with dark hair and a wounded expression in her eyes suddenly buries her face in her hands and starts to cry.

"What's wrong?" her friend asks.

"Eric cheated on me. I found him in bed with my friend's younger sister. He told me two days ago that he loved me and would never do anything to hurt me. He went on and on about how beautiful I was. He stayed up all night writing me poems about his undying love for me. Wrote me 12 sonnets. Told me how he worshipped the ground I stood on."

"He's crazy that boyfriend of yours. Isn't he the one with bipolar?"

While this is of course a fictional account, the likelihood of it actually happening does exist in the realm of possibility. (I've included statistics of infidelity later in this article.) But chances are you are only observing the outward behaviors and not delving into the larger, overall picture. What is the real story behind the story I've created for this article? And is hypersexuality just another way to stigmatize those with a mental health condition?

"Hypersexuality" is a common (and frequently misunderstood) symptom of bipolar illness. This symptom can present a significant challenge in committed relationships and can oftentimes lead to a break-up or divorce. Huge differences in sexual desire between partners, STDs, and infidelity are just some of the distressing issues that can arise.

However, with some insight and knowledge of the beast, we're dealing with, perhaps some alternate outcomes are possible. Let's dive in and see!

Dr. Tracey Marks explains why this happens in bipolar disorder in her clear and informative youtube video, which I've included here.

Bipolar disorder is a mood disorder in which intense mood swings take over a person’s day-to-day experience. Previously known as manic-depressive illness, “bi-polar” refers to the two poles, or opposing mood states, mania and depression.

When a person is manic (or hypomanic, mania’s less severe cousin), their mood may be elevated (or irritable), their self-esteem is significantly higher than usual, they may be sleeping very little, or engaging in out-of-control spending sprees. They may be talking at a fast rate and much more than usual. Some may experience delusions or psychosis as well.

Hypersexuality is "a dysfunctional preoccupation with sexual fantasies, urges, or behaviors that are difficult to control," according to Diana Rodriguez's article in Everyday Health. Her article is called "Hypersexuality and Bipolar Disorder."

There is very little data on the exact number of manic-depressive people who experience hypersexuality during a manic episode. However, the 2007 text Manic-Depressive Illness by Frederick Goodwin, MD, and Kay Redfield Jamison, Ph.D. averaged it to be about 57%, with more women affected than men. Other research estimates that it's even higher, somewhere between 25-80%. That's certainly not an insignificant amount. 

Now all by itself, hypersexuality need not be a bad thing. What could be wrong with wild, intense, inhibition-free sex? The problem is, when hypersexuality is part of the overall picture that includes other symptoms of bipolar illness, this can lead to a heap load of trouble.

The elevated mood, increase in self-esteem, and "involvement in pleasurable activities that have a high potential for painful consequences" (Diagnostic and Statistical Manual of Mental Disorders, 4th edition) can lead to dire outcomes.

Oftentimes, there is a false sense of invincibility, a feeling that we can face a firing squad, be pumped full of bullets, and still get up and carry on, like the Roadrunner or Wily Coyote does in the cartoons. Peter Forster, MD, a clinical professor of psychiatry at the University of California-San Francisco explains it this way: “When you become manic the part of the brain that assesses risk shuts down.”   

What are some real-life consequences of hypersexuality?

From the Sound Off section in bp magazine's Spring 2009 edition (a bit dated but still highly relevant) "Confronting Mania's Secret Symptom," comes the candid responses of those affected by hypersexuality as part of their manic symptoms.

One man from Amherst, NH said "...I had thoughts that I was truly a reincarnated Adonis sent to please women. I walked away from that battle wounded with an STD (sexually transmitted disease)."

A woman from Bremerton, WA said that she had been fired from two jobs for reasons directly related to her hypersexual symptoms. She said that while she is in that particular state, that "nothing else matters. Family, work, food, sleep--all are ignored so that I can feed my [sexual] appetite."

A. L., from Vancouver, BC said that the euphoria of manic episodes heightened his sexuality to a level he "would never have imagined." He went on to say "I would feel bad after each encounter. But when the energy came back, I wanted more. I have hurt a lot of people in the process and also hurt the one I love--my wife." 

What does it feel like to be hypersexual?

From the Sound Off section in bp's June 2021 edition comes the sentiments of those who have experienced the ramped-up sex drive when manic:  

"I've only had a few episodes of hypersexuality, but that was more than enough to let me know what it’s like. I remember realizing that I had no control over it—it was like an enormous wave, crushing me into the sand, forcing me... For me, hypersexuality is incredibly frightening. It makes me feel immoral, sinful. I remember praying that this would end. When I finally felt like myself again, I was so incredibly grateful." - Name Withheld from Seneca Rocks, WV

"When my hypersexuality symptoms strike, it’s like someone completely different has suddenly inhabited my brain. Someone who can’t stop thinking about what it would be like to sleep with a certain co-worker or acquaintance right at that very moment..."  - J. H. from Pensacola, FL

How do you treat hypersexuality?

If you or a partner experiences symptoms of hypersexuality during a bipolar manic phase, it's best to start with treating the bipolar illness first. A psychiatrist may prescribe mood stabilizers or antipsychotics to stabilize a patient. Couples counseling, in addition to effective medication for the person with bipolar, can be very restorative for both.

As mental health improves, sexual urges and behaviors decrease. Before medication has kicked in, try strenuous exercise, masturbation, and/or mindfulness therapies to take off the sexual edge.

Regarding the use of medications, certain ones can help, while certain ones can make the problem worse. According to a May 2020 study, people who took Lithium alone or with benzodiazepines (such as Valium or Klonopin) had decreased sexual desire. In contrast, those bipolar patients who took Bupropion found that in some cases it made hypersexuality worse. 

With this in mind, I'd like to add a word of caution here in the use of Lithium, which you may want to bring up with your doctor. Long-term use can significantly damage your kidneys. I found this out the hard way so I'm hoping this little tip may help you or your partner in the long run. Likewise, natural or holistic supplements can trigger episodes, as they are not approved by the FDA, so beware.

What can be done to manage hypersexual symptoms while waiting for the meds to kick in?

According to bp's January 2021 article, "7 Ways to Outsmart Bipolar Hypersexuality," Olympic runner Suzy Favor Hamilton depends on lots of physical activity to help curb her bipolar urges. She participates in hiking, biking, yoga, and intense cross-training.

Parker Wilson, PsyD, a psychologist and clinical director of a private therapy practice in Colorado, suggests that mindfulness-based therapies may be specifically useful in dealing with hypersexuality. He says, “If you learn how to observe your libido rather than identifying with your libido, it can automatically give you some sense of pause, and then you can decide if you want to identify with it or not.” 

Robin Flanigan's June 2021 article (also in bp magazine), "Help for Hypersexuality" quotes clinical psychologist Suzanne A. Black, PsyD, from UCSF School of Medicine. Black says, "Increasingly insatiable sexual urges send a message that there’s a mood episode on the horizon..." She suggests documenting “regular” sexual urges and behaviors as part of your mood tracking routine. In this way, you can establish a baseline to know when it’s changing.

Couples therapy can be extremely valuable as well. From Zawn Villines' October 2018 post "Keeping a Healthy Marriage When One of You Has Bipolar Hypersexuality" on the Good Therapy blog, therapy can help to:

• Address infidelity and support couples in dealing with it
• Educate about symptoms of hypersexuality
• Open the channels of communication between partners to talk about differences in sexual desire and other sensitive topics
• Offer coping skills to help each partner manage anxiety, guilt, or shame
• Deepen intimacy and connection between partners

Likewise, sex therapy can be helpful. Flanigan's article introduces Daniel Rosen, LCSW, a sex therapist in Rochester, New York. Rosen emphasizes the need for discussing sexual matters frankly and openly and notes that it is a matter of respect for your partner, to not pressure the other person.

“People will have conversations about how much they’ll spend at the grocery store, but they won’t have conversations about how often they’ll have sex together,” he says. “Establishing consent for sexual behavior, especially when judgment is going to be reduced, is imperative. Talking about sexuality … before the next [manic] episode will make addressing it during a manic episode easier,” he says.  

What are some "safe" sex practices when the urge strikes?

From Sound off, June 2021 bp magazine J.J. from Asheville, NC--... I do admit to looking at porn online and I masturbate a lot. Masturbation is loving yourself and satisfying your own needs. You are not hurting anyone and actually increasing endorphins. This is how I keep my libido under control..." 

This self-pleasuring strategy removes the dangerous risks of having multiple partners, possibly getting or transmitting STDs, breaking up marriages, or spending thousands of dollars on phone sex or prostitution. It's a way to satisfy the urges without causing harm to ourselves or our loved ones.

Bipolar hypersexuality and infidelity:

What are the statistics on infidelity among bipolar spouses?

There is not a lot of information on exact statistics of infidelity in which one partner has bipolar disorder. According to the previously mentioned Good Therapy blog post, there is little evidence to suggest that being bipolar, or even having bipolar hypersexuality, is a significant risk factor for infidelity. Instead, other factors, like age or gender seem to play a much larger role.

However, in one (antiquated) 1975 study, it was found that 29% of people with bipolar disorder had cheated on their spouse 10 times or more. (Of course, that also means that 71% did not cheat. I prefer to think of the glass as 71% full, rather than 29% empty.)  I haven't found a more recent study on these statistics. As you can see, the evidence is not conclusive at this point.

How can you tell if your bipolar partner is "cheating" due to hypersexuality symptoms?

According to Julie A. Fast in her March 2021 article "My Partner With Bipolar Cheated on Me When Manic & Hypersexual," there are three signs that make it likely that infidelity is because of mania:

1. Sexual behavior is out of character.

The person who “cheated” is most likely very confused by what happened and often is very ashamed or even mortified. Hypersexuality can be intensely embarrassing for those of us with bipolar disorder and we will mention this most likely when the episode is over.

2. Your partner has asked for and accepts help.

This signifies that the sexual behavior was during an episode and it stopped once the episode was over. Your partner can tell he or she was hypersexual and this has led to their wanting help so that it doesn’t recur.

3. There is an open discussion about mania prevention.

We know that mania causes hypersexuality. The most effective way to stop sexual behavior due to bipolar is to stop the manic symptoms by treating the disorder.

How can you tell that the sexual indiscretions were in fact cheating?

According to Julie Fast's article, your partner acts as if infidelity wasn't a big deal and it happens continually. 

In the case of "cheating" due to hypersexuality, though the betrayal still stings, acknowledging and accepting the fact that it was illness speaking and not your partner's intentional choice, could very well be the first step in starting to heal. 

I hope that you, dear reader, have come away with more strategies to manage the distressing symptoms of hypersexuality if that is what you are seeking. If you're reading this article to educate yourself about the condition because you think your partner might have bipolar and/or hypersexuality, I hope you have acquired more insight into the actual experience of what it's like to be "in the skin" of someone with hypersexuality. Don't just look at the overt behavior. Dig deeper. You might even unlodge some remnants of the person you once loved.