Bipolarity, hypersexuality and quality of the relationship: what is their relationship?
Sexual problems in psychiatric patients are not uncommon. As far as bipolar people are concerned, it seems that two aspects of sexual health are peculiar: hypersexuality and the interruption of couple relationships.
Advertising message Sexual problems in psychiatric patients are well documented in the literature, however most studies do not distinguish between diagnostic categories (Bossini et al., 2013; Labbate & Lare, 2001; Rizvi et al., 2011; Swan & Wilson, 1979; Wylie et al., 2002). Many of the difficulties associated with bipolar patients are common to all psychiatric disorders. These can include drug-related sexual dysfunctions, increased risk of sexually transmitted diseases (STDs) and the general neglect of sexual issues in treatment (Magidson et al., 2014; Segraves, 1989; Wright et al., 2007). Two aspects of sexual health are unique in bipolar disorder, namely hypersexuality and the interruption of the couple’s relationships, due to the mood cycle. However,
A research of PsycINFO and PubMed was conducted in order to examine the existing literature and research on mania-induced hypersexuality and on the effects of the mood cycle on couple relationships, so as to summarize the available results and direct subsequent studies. 27 articles were selected for the review, 16 of which deal with the topic of hypersexuality.
The first studies on the relationship between manic-depressive disorder and hypersexuality were conducted in the 1960s and 1970s. Precisely, both in men and women, an increase in libido and sexual activity during the manic phase was found, with a greater increase in the probability of women engaging in provocative sexual activities, such as flirting, allusions to sex and seductive behavior ( Allison & Wilson, 1960; Clayton et al., 1963; Carlson & Goodwin, 1973;). It was also found that patient libido tends to decrease significantly during the depressive phase (Clayton et al., 1963). Finally, in a study by Jamison and colleagues (1980) 40% of patients had perceived the increase in sexual desire and behavior, during the manic or hypomanic phase, as a positive change. Specifically, women showed more positive emotions than men associated with these transformations. Therefore, the presence of correlation between the cyclicity of mood episodes and the fluctuation of the libido of the patients appears evident. Moreover, the alternation of the phases of mania with the depressive phases is associated with disruptive sexual fluctuations that can be very difficult to manage, both by the partner and by the patient himself. More recent studies, such as that of Mazza and colleagues (2011) and Mahadevan and colleagues (2013), not only confirmed the hypotheses previously listed, but also added the absence of significant differences between subjects with bipolar I disorder and patients with bipolar disorder II. Therefore it is possible to conclude that research into increased libido as a symptom of bipolar depression is warranted. However, it should be borne in mind that not a lot of research has been done in recent times that has analyzed this dynamic or attempted to replicate these results.
Advertising message The literature also seems to show that risky sexual behaviors are more frequent in this diagnostic category, precisely during the manic phase, compared to patients belonging to the control group, although they are not prevalent only in bipolar patients. This type of conduct is very often also found in depressed, schizophrenic and schizoaffective patients.
Regarding the aspect of couple relationships, the articles considered revealed that bipolar patients have more strengths useful in managing their relationships than patients with other chronic mental illnesses. Not only do they appear to be more capable of maintaining stable relationships, but they are also more likely to have children than patients with psychotic spectrum disorders. Precisely, in the experiments that made use of healthy control groups, patients with bipolar disorder came closest to the control groups as regards the quality of the relationship, sexual development, sexual satisfaction and marital adaptation. However, partners in this type of patient revealed a decrease in sexual satisfaction, as well as an overall marital dissatisfaction, both during the manic and depressive phase of the disease. Finally, it has become clear that problems of sexual dysfunction in bipolar patients seem to be more common during depressive episodes, further emphasizing the presence of a relationship between depression and hyposexuality.
As far as the limits of the research conducted so far are concerned, not only is there a clear definition of hypersexuality, but also a clarification regarding risky sexual behavior. This denomination can refer to flirting, masturbation, prostitution and unprotected sex. Furthermore, the present review has not found any current study that has examined the etiology, course or prevalence of hypersexuality in manic and hypomanic episodes, just as recent research has not been found that has examined the relationship between bipolar depression and iposessualità.
Learning more about these issues, in relation to bipolar disorder, would certainly have significant implications for the treatment, outcomes and general quality of life of these patients.