Sex and Bipolar: A New Conversation

Patient Expert

In previous posts, we discussed the various slings and arrows of bipolar loving relationships. Let's complete that conversation and open up a new one by talking about sex.

The only DSM reference to sexual behavior in bipolar concerns our propensity to engage in risky activity when manic or hypomanic. There is no mention of hypersexuality or any form of enhanced (or for that matter blunted) sexuality. A PubMed search involving various combinations of "bipolar", "mania", "sex", and "hypersexuality" comes up empty.

Literally, no one has researched the topic. By contrast, a quick search here on BipolarConnect turns up a trove of personal experience from the real experts - you, patients and loved ones. This from MarriedToMania:

The sex life of a bipolar marriage: It's awesome when she's hypomanic (wish there was a pill that could keep both of us in that stage) ...

And from Mel:

My girl is a sex addict and she is bipolar. It's hard to please her sexually.

From Whatever:

There are times I'm driving and I get so wound up I'll call my husband and tell him to meet me 'cause I need to have sex.

We all know it, even if the experts are afraid to talk about it: Enhanced sexuality is linked to our manias and hypomanias. There are obvious benefits to possessing this kind of superpower, but Whatever is clearly frightened over her lack of control. What will happen when her husband isn't around to satisfy that urge? Clearly, she doesn't want to find herself in the same situation as** Lost**, who writes:

I am currently growing through a divorce due to I am unable to have sexual relations with my husband anymore. But I counted on my hand today -I am currently talking to 8 guys and having sex with 5 of them.

We don't get Lost's husband's perspective, but we hear plenty from those whose hearts have been broken and trust violated. The lies, the cheating, the perversions ...

Then there is the depression side to the equation, when the sex just stops, though it's not as simple as that. A 2006 NIH-funded study of a large teen population found that those who were depressed were far more likely to engage in risky behaviors such as drug use and sex. Like drugs, some people use sex as a means to self-medicate.

Last but not least is the issue of meds. Most of the conversation centers around being pharmaceutically turned into eunuchs or their equivalents. But others find a toned-down sex drive - closer to "normal" - comforting and easier to live with.

Now throw into the mix the very natural hormonal and neurotransmitter fluctuations that are part of the process of attracting and keeping a mate. Different brain systems are at work in different phases over the weeks and months and years. We need our emotional surges to help us decide, but what if those surges are turbo-charged (or blunted) by our illness?

What if we read our feelings wrong? What if we fall in love when we shouldn't be falling in love? Or, the other way around? Or- what happens when we grow tired of our partner when we should be transitioning to a longer-term bond?

Meanwhile, our "normal" loved ones may also be misreading vital signals. They - not us - may be the ones who mistake intense sex for something else. They - not us - may be the ones who grow tired.

And when the music stops - are we stuck with the wrong partner? Or do we find ourselves left out in the cold?

Questions, questions ...

This is the first in what I am hoping will be a long and fruitful conversation on sex and bipolar. There has been a lot written about sex and a lot written on bipolar, but virtually nothing on the two together. You - patients and loved ones - are the only ones with insight into that link. We need to hear from you.

You are in a safe place here, but please don't feel you have to disclose your private life. I am certainly not about to. But our experiences have made us much wiser, so please share that wisdom with us.

Literally, together, we can write the book. Comments below ...