Deb's Mental Health And Wellness Guide
~ Sexuality & Mania~
This is an EXTREMELY important symptom of mania and a topic that needs to be discussed more openly. It has affected me and MANY other's greatly and has caused immeasurable harm. For some of us...we are lucky to still be alive to share our stories. Many men and women have suffered from serious Sexually Transmitted Diseases, Rape, Violence and Death.
An open discussion about this topic could save many lives.
An Article From Bipolar Magazine (bphope.com)
September 2012 Issue
Written by Sara Solovitch, Freelance Writer (Santa Cruz, CA)
A few years ago, a middle-aged woman from Vancouver, British Columbia, happened to read an article about bipolar disorder and hypersexuality, written by her very own psychiatrist. In all the years she’d been going to see him, she was shocked to realize, this doctor had never once asked if hypersexuality was one of her symptoms. “I wrote to him and said, ‘This is me,’” the woman recalls. “ ‘You never told me about this part.’”
Hypersexuality may be the last frontier in bipolar disorder. Even now, despite everything that has been learned about the illness, it’s hard to put a finger on how big a problem it really is. The research is limited. Only seven studies have ever been published on the subject and their findings diverge: According to these studies, hypersexuality occurs in 25 to 80 percent of all patients with mania. After reviewing the literature, Manic-Depressive Illness (the 2007 text by Frederick K. Goodwin, MD, and Kay Redfield Jamison, PhD) settled on an average of 57 percent. And that hardly tells the story. For, despite its primal role in human behavior, sexuality remains one of the hardest, most sensitive subjects to dredge up in any but the most cursory details. Which explains why, while hypersexuality is listed as one of the primary symptoms of bipolar in the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition), many psychiatrists refer to it almost as an afterthought—if at all—when forming a diagnosis:
Racing thoughts? Check.
Wild mood swings? Check.
Unrestrained spending sprees? Check.
“Like, what do you mean?” demands Andy Behrman, who became a poster boy for bipolar disorder with the 2003 publication of his edgy, sexually frank, and popular book,Electroboy: A Memoir of Mania . “Am I having sex with strangers? Yes. Constantly masturbating? Yes. Can I get myself to a place where I’m fully satisfied sexually? No. As much as I want to shop, buy, and make money, that’s as much as I want to have sex.
”Though hypersexuality may present itself as just one aspect in a constellation of problems, it is often the most destructive and challenging part of bipolar disorder—troubling families of young children suffering from juvenile hypersexuality, ruining marriages, generating life-threatening health problems. “The one thing I regret is what I did to my husband,” says Bev, a middle-aged woman from rural Quebec who was diagnosed with bipolar a few years ago. “He was a good man and we would have had a good retirement together.”
Bev was diagnosed with bipolar in 2006, following years of unrelenting depression and anxiety. She had a strong family history of mental illness: Her mother died by suicide; her daughter is clinically depressed. But it wasn’t until Bev reached her early 40s that her sexual impulses underwent a sudden change. She began “doing things I had never done before. ”It began with extramarital affairs, mostly with younger men: “It was as if my husband couldn’t see what was going on. He finally asked me and I said ‘no.’ The second time he asked me I couldn’t lie,” Bev recalls.
At least one study found that hypersexuality appears to play a larger role in women’s lives than in men’s. The 1980 study, led by Kay Redfield Jamison, PhD, a clinical psychologist generally regarded as one of the foremost experts on bipolar disorder—and one of its most well-known sufferers—reported that women with bipolar tend to be far more sexually provocative and seductive than their male counterparts. Further, Jamison found that twice as many women as men reported sexual intensity as “very much increased” during hypomania. The women in her study also rated sexual intensity as the most important and enjoyable part of mania.
Despite such findings, personal sexuality is a subject often avoided on the psychiatrist’s couch. Indeed, patients complain that their doctors rarely want to hear about it. Whatever insights they’ve arrived at have come by way of friends and fellow patients, they say. Consider Jane (not her real name), a 20-something woman from the New York metropolitan area, who was diagnosed for several years with bipolar disorder before recognizing that her risky sexual behavior had a name and an explanation. The person who educated her on that score was neither her psychiatrist nor her therapist. Rather, it was one of her sexual partners, a man who himself happened to be diagnosed with bipolar. “It’s your bipolar disorder that’s making you do it,” he told her. This insight left Jane with a huge feeling of relief. “You don’t want to be a slut,” she says. “I was stigmatizing myself with that ‘slut’ label for a long time. It was time to let it go.”
Experts agree. “Manic people are not embarrassed talking about sex,” says Barbara Geller, MD, professor of psychiatry at the Washington University in St. Louis. “It’s the doctors who are embarrassed—especially in child psychiatry: I’ve had colleagues who’ve said they don’t want to ask that question.” Geller, on the other hand, has been asking it a lot. The author of a groundbreaking study about hypersexuality behavior in children with bipolar, she has helped overturn widespread assumptions through her research. Before her study was published in the December 2000 issue of theJournal of the American Academy of Child & Adolescent Psychiatry , experts widely assumed that overt sexuality in young children was almost always a sign of sexual abuse.Geller’s research disproved that assumption; it found that flirtatious, sexual behavior was a common symptom in 30 percent of young, prepubescent children with mania and in 60 percent of the adolescents.
After ruling out the possibility of sexual abuse, Geller found that these behaviors weren’t confined to excessive masturbation and other forms of sexual self-stimulation. She described the case of an openly flirtatious 10-year-old boy who told a 50-year-old visiting nurse that he’d like to put on some dance music, because “I dig older women.” She told about parents of children with bipolar who reported that their little boys often tried to rub up against or touch the chests of older women, or reach up to pat a strange woman’s behind at the supermarket. Children can carry this behavior into school with them, making overt sexual comments to classmates or teachers, or touching themselves or others inappropriately.
For parents, this can be a double whammy. It is not uncommon for teachers and social workers to suspect parents of causing the inappropriate hypersexual behavior they see in schools, according to Susan Resko, executive director of Child & Adolescent Bipolar Foundation (bpkids.org), a childhood bipolar support organization.
“When parents come into school for a conference, they, or someone else in the household, are often suspected of sexual child abuse, responsible for the child’s hypersexual behavior,” says Resko, who feels that there is a very low general understanding of how bipolar disorder affects children.
“Families want all the help they can get,” says Geller. “They’re not embarrassed by discussing it. And patients aren’t embarrassed by it. It’s the psychiatrists who are embarrassed. “Even highly respected colleagues who do research in the area have to be prompted to ask questions,” Geller continues. “I tell psychiatrists, ‘you must ask these questions because it’s terrifically important to find out. You want to know if a hypersexual child might be making up romantic fantasies about a teacher. You want to protect them until we can get them stabilized. You want to keep them safe from committing suicide, safe fromgetting AIDS.’”
Joseph R. Calabrese, MD, professor of psychiatry and director of the Mood Disorders Program at Case Western Reserve University, agrees with the importance of introducing the topic with patients. “All psychiatrists should first ask, ‘has your physical energy increased? Has your sexual energy increased?’ This should be followed by a question about impulsive new relationships and impulsive sex during the mood swings.” Calabrese points out, however, that masturbation is less relevant when discussing hypersexuality with patients. “Impulsive new relationships and impulsive sex frequently involve risk-taking behavior to both the self and others,” he says, “but masturbation normally does not.”
Those conversations did not take place for Jane, the New York woman. When she finally told her therapist about her hypersexuality—including the details of her own personal wake-up call with a stranger who refused to wear a condom—the therapist appeared uncomfortable and merely urged her to “be careful.”Being “careful,” of course, is precisely what some people with bipolar struggle to achieve. Just as someone coping with mania might not stop at $50 when his credit card allows him to spend $5,000, he may also devote hours each day staring at Internet porn or searching for partners. It’s the excess that gets him into trouble.
For Behrman, hypersexuality is not just the primary symptom of his illness; it is also the most challenging one. His book, Electroboy, is filled with raw depictions of sexual obsession, hustling, having sex in exchange for cocaine. “When you’re hypersexual, you’ll be six hours late because you’re busy,” says Behrman, who’s currently working on anothermemoir, this one tentatively calledSex Junkie. “It becomes your secret little world. Your door’s closed, you escape to this world of sexual fantasy, your mind is racing, and this is the direction your mind is racing to.”These days, as the father of two young children, Behrman recognizes the responsibilities parenthood has brought. “I’m extremely conscious about boundaries,” he says. “My private life is private. I have a 2-year-old and a 4-year-old and I spend most of my time being protective of them—which means protecting them from any symptoms of my illness. Now, I’m hyper-vigilant about my symptoms.”
He knows his old behaviors led to a lot of poor judgment calls in the past. “Bad things, scary things have happened to me,” he admits. “You put yourself in a lot of danger when you’re naked and stripping in a club. ”The club scene has been a regular, weekend haunt of Andrea, a well-spoken, 36-year-old Denver professional who was diagnosed with bipolar disorder in 2000. Like several other women interviewed for this article, she originally sought help after a friend expressed concern about her risky sexual behavior. “I did a lot of bad things, made a lot of bad choices, and suffered a lot of bad consequences,” she says, sounding a lot like Behrman.
Andrea frankly identifies herself as a predator in the longstanding male tradition of the Don Juan. Proud of her looks, she offers up, unsolicited, a description of herself as a “very attractive woman, six feet tall with a lot of legs going on,” possessing an aura of sexual energy that draws men like bees to honey.“I’m a woman who pursues men and once the pursuit is done, I’m done,” she says. “There’s a man in the club whom I didn’t particularly care about,” she goes on. “But once someone told me his girlfriend was there I pursued him; I went after him quite vigorously. Now I’m done with him—the chase was too easy. He’s gone and he doesn’t even know it.”
One minute Andrea is boasting about her sexual prowess, the next minute she rues the havoc it has wreaked on her marriage (“I was never faithful”), her self-esteem, and her physical health. The first therapist she saw was coldly judgmental (“You really shouldn’t be doing this,” she scolded). Andrea left her office flooded with feelings of shame and worthlessness. “I know it’s something I should control myself. But it almost physically hurts, because I want to engage in sexual activity so bad.”
Andrea has been variously treated for gonorrhea, chlamydia, syphilis, herpes, and genital warts. Yet one of the things that troubles her most, she says, is the thought that, deep down, she’s unable to love: “Because with me it’s always physical.” Of course, not everyone who has extramarital affairs or indulges in pornography has bipolar disorder. But people with bipolar are at special risk of hypersexuality or—what’s more or less the same thing—sexual addiction, according to Louis J. Cozolino, PhD, a professor of psychology at Pepperdine University in southern California.