I have been diagnosed with bipolar illness. I am on medication, however, when a manic phase starts to emerge, unbelievably strong sexual urges are constantly on my mind. I am in a committed relationship with a kind, wonderful man, but at these times I would have sex with anybody, with or without protection. I don’t want to destroy this relationship so I need suggestions about how to manage these urges when the medication doesn’t keep the manic phase under control.
 

Your concerns are very genuine and are real symptoms of your illness as you described so well. Bipolar Disorder tends to have manic and depressive phases. Mania and hypomania (a reduced level of mania) both have symptoms of hyperactivity that could be physical/sexual in nature. During the manic phase of illness, mood is elated, with a heightened sense of pleasurable activities, such as an over indulgence in activities like sex, religion (hypereligiousity) and over spending. These could lead to devastating outcomes. Other symptoms of a manic phase can include grandiosity, expansive thoughts, explosive mood and insomnia. All sub-types of Bipolar disorder affect about 2% to 3% of the population and are frequently misdiagnosed. Ideally, you should not experience manic/hypomanic symptoms. If your symptoms are not in remission, you should discuss this with your doctor. Your medications could be optimized, or more time may be needed to achieve remission. Some of the initial symptoms prior to relapse, before the impulsive behavior starts, could be feelings of restlessness, problems with your regular sleep cycle, reduced concentration, etc.  As soon as you notice these signs, you should get in touch with your doctor. If you are on mood stabilizers and still have some residual symptoms, especially sexual or impulsive behavior, a group of medications like the SSRI’s may be helpful. There is, however, a slight chance that they could precipitate manic symptoms in patients who do not take a mood stabilizer medication.

Azfar Malik, MD, MBA
CenterPointe Hospital
St. Charles, MO  63304
636-441-7300

Strong sexual urges experienced during a manic phase of bipolar are not uncommon. It appears to be more prevalent with those who have experienced a history of long term, severe, sexual abuse (trauma) as children. Victims of this type of abuse have a tendency to “sexualize” crisis situations in their lives due to the lasting effects of this childhood trauma. Acting on these sexual urges is one way to release the obsessive-compulsive energy that develops during the manic phase. With the increasing number of blood-borne and sexually transmitted diseases, this behavior can be particularly risky to one’s self and partner. The infection may lie dormant for a long time, giving the illusion that everything is fine, while continuing to practice unprotected sex.

The following may be helpful to manage these powerful urges.  Educate yourself about the various sexually transmitted diseases and how to protect yourself and your partner. Be able to recognize signs of infection in yourself and a potential partner. If you think you have been exposed, seek immediate medical counsel. Self-help groups such as Sex and Love Addicts Anonymous (314-253-4010) and Sexaholics Anonymous (314-995-2687 local; 615-370-6062 national) offer strong social support and understanding. You can consider redirecting this energy into a safer, positive activity that may even enrich your life. If your relationship is at a stage where you feel that you can trust your partner, perhaps you can open communication to a deeper level to foster understanding. Ongoing psychotherapy can have a significant impact on allaying symptoms as well. Many experience additional relief through a spiritual connection with a Higher Power.

Edward F. Allen, MSW, LCSW
St. Louis, MO
314-780-7410

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