The manic hypersexuality often characteristic of bipolar disorder and the possibility of bipolar disorder in those diagnosed with sex addiction are sometimes difficult to untangle.
According to a handful of studies reported in the National Alliance for Mental Illness (NAMI) article “Opening the Door on Hypersexuality,” the prevalence of hypersexuality among people with bipolar disorder is anywhere from 25 to 80% with an average estimate of 57%. NAMI states:
“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.”
Manic hypersexuality is generally described as involving a significantly heightened sex drive resulting in things like constantly thinking about sex, a preoccupation with pornography, an abundance of one-night stands, engaging in sex with multiple partners, having random and often unprotected sex, seeking out prostitutes or having multiple affairs even when in a committed relationship.
A Healthline article on sexuality during mania gives a laundry list of out-of-control sexual behaviors that sound like those of sex addicts.
And the heightened sexuality in mania is sometimes described as driven by other characteristics of mania like the heightened physical and sensory state, the disregard of consequences, feelings of being indestructible, impulsivity and amorality.
Bipolar disorder and addiction generally
An article in Daily Rx refers to “the nearly inextricable link between bipolar disorder and the use of alcohol and drugs.” According to that article “Research suggests up to 60 percent of bipolar sufferers experience a substance abuse problem at some point in their lives.”
Since all addictions are now thought to have a great deal in common in terms of their origins and their neurobiology, it stands to reason that there would be a high incidence of sex addiction as well among those diagnosed with bipolar disorder. So that although drug and alcohol use has been seen as being largely an attempt to self medicate bipolar disorder, it may be that the addictions and the bipolar diagnosis have some common roots.
Is there an overlap with sex addiction?
The incidence of child sexual abuse is reportedly high among those with bipolar disorder. This is seen as likely due to the fact that bipolar disorder is heritable and therefore that a parent with mania or hypomania may have been sexually inappropriate with or around a child.
And the possibility of disruptions or dysfunction in parenting with a parent with bipolar disorder would also be a risk factor for sex addiction and other addictions as well.
The incidence of child sexual abuse among sex addicts is as high as 83% according to the work of Patrick Carnes. Thus a high proportion of those diagnosed with bipolar disorder might also have sex addiction due to the prevalence of child sexual abuse in both populations.
This all suggest to me that there may be a drift over time toward an increasing overlap of sex addiction and bipolar spectrum disorders due to the way nature and nurture support the same processes.
Diagnosis and treatment
First let it be said that bipolar disorder is not the only DSM diagnosis with hypersexual behavior as a symptom. Others include PTSD, Dissociative disorder, dementia, impulse disorders and paraphilias, to name a few. But bipolar disorder is a distinct diagnosis and is treated very differently from these other disorders and very differently from the addictions.
There are distinct diagnostic criteria for bipolar disorder. And bipolar hypersexuality responds to treatment and will diminish when the symptoms of mania are brought under control. This would not be the case with a person diagnosed with only sexual addiction.
Many sex addicts initially have reason to want to deny their addiction; they would prefer to think that their sexual behavior is only due to a mood disorder. This is because they think the latter is more understandable, more socially acceptable, less stigmatized, and easier to treat. On the other hand people with manic sexual behaviors may not see themselves as having a “mental disorder” but rather feel that they simply have a “high sex drive.”
In my experience, the two diagnoses are often fellow travelers and both can be difficult to treat because they share one more common feature. Both are very difficult to see and to accept in oneself. Find Dr. Hatch on Facebook at Sex Addictions Counseling or Twitter @SAResource