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Dual Diagnosis: Understanding Sex Addiction With Bipolar Disorder

Bipolar disorder manifests itself in one college student’s “need” to sexually expose himself on campus. Marty was diagnosed with bipolar 1 disorder in the spring of his junior year in college. The symptoms had emerged during adolescence, but it wasn’t until a particularly startling manic episode that Marty’s doctor knew his depression was more than unipolar (i.e., clinical depression by itself). The gifted art student had painted his naked body in elaborate geometric patterns and shown up at the fountain in front of his university’s grand administrative building during the middle of a sunny afternoon. He proceeded to dramatically quote Michel Foucault’s Madness and Civilization, even as he was carried away by campus security. The combination of SSRIs and mood stabilizers prescribed to Marty for the treatment of bipolar disorder did help, at least for the symptoms of mania. But the depression continued to plague him like a 10-ton fog, relentless and oppressing. And an obsession with exhibitionism held sway. Marty’s doctors explained that this kind of hypersexual behavior was a symptom of his bipolar disorder, and as long as he adhered to his treatment protocol, he would learn to manage it; he would be safe. But Marty did not find this to be true. He didn’t know exactly where his desire—no, his need—to sexually expose himself came from, whether it sprang from this “brain disease” called bipolar illness, or whether it was some other manifestation that merely overlapped. All he knew was that his weekly talk therapy sessions and the small pile of pills he consumed daily were not enough to quash it. It was only a matter of time before he’d find himself arrested again, before his hopes of a successful life would seem dashed by the impulsive and ultimately unsatisfying behavior that controlled him.

Hypersexuality as a Symptom of Bipolar Disorder

During bipolar mania, a tendency toward poor decision-making occurs along with an increase in impulsivity. Sex drive also increases. These symptoms combined often lead individuals with bipolar disorder toward their own sexual extremes, at least during manic episodes. Hypersexuality involves “excessive interest” in sexual subject matter and activities. Hypersexual behavior may express itself in a variety of ways, such as:

  • An increased desire for sex with one’s partner
  • Participation in sex outside of one’s relationship (i.e., affairs)
  • An increased interest in Internet and other pornography or erotic material
  • Paying for prostitutes, regardless of cost
  • Sexually risk-seeking behaviors or sexual activity regardless of risk

It can be hard to distinctly describe or define hypersexuality, because the behaviors tend to vary in content and degree, but a person with bipolar disorder finds his or her usual sexual interests to be greatly heightened during this period.

Hypersexuality vs. Sex Addiction for Bipolar Patients

Part of that last sentence bears repeating: when the symptom of hypersexuality is present, individuals with bipolar disorder find their usual sexual interests to be greatly heightened. So how is this distinct from sexual addiction, a condition in which sexual interest and activity becomes compulsive and persists despite negative consequences? One might say it is a matter of consistency. People with bipolar disorder experience hypersexuality only as often as they experience the kind of mania that induces it—which, for most, is relatively infrequent. But people who experience sexual addiction cannot be said to catch a break from their hypersexual tendencies; they live with them day and night. And in the case of someone who has bipolar disorder and also experiences sexual addiction, the combination can be quite intolerable. Recurring manic episodes can spur on addictive tendencies, urging extremes in behaviors at a faster rate. When this is the case, the treatments for bipolar disorder alone will likely not suffice in helping to manage sexual acting out behaviors. A sex addiction recovery treatment or program of some kind will be required in conjunction with bipolar disorder therapy, and it is best when these treatments are made integrative—when they cross over and interact, just as the symptoms do. There are many professional clinicians, group therapy settings and 12-step programs that work to do just that, so for individuals struggling with manic hypersexuality and sex addiction symptoms, there is hope.

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