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One of the signature symptoms of the manic side of bipolar disorder is hypersexuality.

1-What does this actually mean; typical behaviours?

Hypersexuality in BPD can be a symptom of the disease. It is when there is a greater focus by individual on sexual activity than they would normally exhibit in a stable state. It can mean that they have a desire that can be overwhelming to indulge in sexual activity, porn; one night stands or they may think about sex constantly. It can be high risk and reckless at times, the best guage is when there is a change in their baseline libido- otherwise when they are stable.

2-What is the basis for increased sexual drive in people in the throes of a manic episode? The hyper or hyposexuality is a symptom of the disease. The high risk taking behaviour occurs in the unstable state. For example in a manic state an individual may become obsessed with sex, overspending, grandiose ideas of self. Alternatively when in a depressed or low state they may have no libido, little interest in activity and struggle with dark thoughts.

3-How does present in/impact relationships? What is the ‘problem’ with which you are presented? Infidelity/betrayal? Increased demands on partner? When in a committed relationship the hypo or hypersexuality becomes an issue at the partner may go from sexual interactions daily to months of abstinence and no desire at all. Learning to understand that the change is a symptom of BPD is difficult as the often mismatched libidos become an issue. The high risk sexual behavior is also a problem. One night stands, unprotected sex all cause distress to partners.

4-Are there any hypothetical or real but anonymous anecdotes of more extreme cases? When couples present in therapy and want to be able to manage the disease and still sustain a committed relationship they are encouraged to become very observant of behaviours. In particular when their partner is in a stable mood see what the environment is like at home, work, within the relationship and look for triggers that change that. Journal their baseline behaviours sexually and look for changes. Enforcing meds it also another vital tool in creating a stable environment. Partners are encouraged to be actively involved and be an enforcer of meds. Understanding the changes in a partner’s behavior can be difficult and hurtful particularly when hypersexuality is involved and they discover infidelity. Having a good support network can be helpful, along with relationship counseling where an open dialogue in encouraged and boundaries are set.

5-How do you work with couples dealing with this, in terms of minimising harm to the relationship? I’m guessing much of the ‘work’ needs to be done outside of crises?Often couples can post an episode and therapy allows them to reflect openly with their partner and can allow the partner to gain an insight into the manic behavior. A good therapist can help instill contingency plans going forward to support both partners.

6-What other effects does bipolar disorder tend to have on relationships? (Other symptoms with implications…e.g. excessive spending/financial sabotage through spending or pouring money into grandiose schemes?)

When in a manic state often overspending, inflated ideas of ones ability and grandiose thoughts that can be completely impractical occur. I have a client who racked up a credit debt of hundreds of dollars in a brothel and then became paranoid that he had a sexually transmitted disease that had never been heard of before. He thought it was his role to be the guinea pig for research and had visions and ideas that he wanted to contact the media to break the news. He was married and it was very distressing to not only discover the infidelity but he was also missing for two days.

7-Are there any ways in which such an illness can draw a couple closer together and under what circumstances? 

Living with someone with BPD can be difficult and many couples struggle. Even with a greater understanding of the disease and realizing that the behaviour is a symptom of it can be incredibly challenging. However with pharmaceutical stability and good communication, support and commitment hurdles can be overcome. It is strongly encouraged that the couple seek therapy together and learn strategies to handle the unstable episodes. Regularly seeing a relationship counselor also can keep a check on the mood state of the BPD sufferer.

8-What is the biggest misconception about bipolar disorder, in your view, if applicable? 

A big misconception of BPD is that the manic state causes more damage to others, however a low and dark mood state causes withdrawal from relationships and disconnection. No desire to hold hands, kiss, talk or engage with a partner can be very isolating. The unpredictability of it is also challenging. I have one client who has apprehension each time he calls his partner, as he is not sure of he will get Doris Day or Cruella DeVille on the line!