Bipolar Hypersexuality: Why It Happens — and What You Can Do

From impulsive sex to lasting shame, hypersexuality can be deeply disruptive. Here’s what people with bipolar disorder want you to know.

While reading an article about bipolar disorder and hypersexuality, a woman from Vancouver, British Columbia, was surprised to discover that it had been 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 bipolar symptoms.

“I wrote to him and said, ‘This is me,’” the woman recalls. “‘You never told me about this part.’”

A Hidden and Understudied Symptom

Hypersexuality may be the last frontier in bipolar disorder. Even now, despite everything that has been learned about the condition, it’s still hard to pinpoint the true extent of the issue. 

The research is limited also. Only a handful of studies have been published on the subject and their findings are varied. According to these studies, hypersexuality occurs in 25 to 80 percent of all those with mania. 

Drawing from available research, Kay Redfield Jamison, PhD, a leading clinical psychologist and one of the most well-known voices with lived experience of bipolar — and the late Frederick K. Goodwin, MD, a renowned expert in mood disorders and suicide prevention, estimated that hypersexuality occurs in about 57 percent of people with mania. They reported this figure in their influential textbook, Manic-Depressive Illness: Bipolar Disorders and Recurrent Depression.

The Elephant in the Exam Room

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.

In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), hypersexuality is listed as a symptom of bipolar, yet many psychiatrists refer to it almost as an afterthought — if at all — when forming a diagnosis:

“Like, what do you mean?” says 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.”

Understanding Hypersexuality and Its Impact on Your Life

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, and 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. “He was a good man and we would have had a good retirement together.”

RELATED: 5 Tips to Manage Manic Hypersexuality in Bipolar

Bev was diagnosed with bipolar in 2006, following years of unrelenting depression and anxiety. She had a strong family history of mental health conditions: Her mother died by suicide and her daughter is clinically depressed. 

But it wasn’t until Bev reached her early forties 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,” Bev recalls. “He finally asked me and I said, ‘No.’ The second time he asked me, I couldn’t lie.”

Gender Differences in Sexual Impulses and Mania

An earlier study led by Dr. Jamison found that hypersexuality may play a more prominent role in women’s experience than men’s. It 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.

However, a more recent study found that compulsive sexual behavior disorder (CSBD) is more common in men.  

Hypersexuality Is Often Not Discussed as a Symptom of Bipolar 

Despite such findings, personal sexuality is a subject often avoided on the psychiatrist’s couch. Indeed, people complain that their doctors rarely want to hear about it. Whatever insights they’ve arrived at have come by way of friends and others with bipolar, they say.

Consider Jane (not her real name), a 20-something woman from the New York metropolitan area. She’d been 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.”

Recognizing Hypersexuality as a Symptom of Bipolar Disorder

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. “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.”

Dr. Calabrese points out, however, that masturbation is less relevant when discussing hypersexuality. “Impulsive new relationships and impulsive sex frequently involve risk-taking behavior to both the self and others,” he says, “but masturbation normally does not.”

When Clinicians Don’t Know What to Say

Those conversations did not take place for Jane of New York. 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 porn or searching for partners. It’s the excess that gets him into trouble.

A Private Struggle With Very Real Risks

For Behrman, hypersexuality is not just the primary symptom of his bipolar; it’s also the most challenging one. His book, Electroboy, is filled with raw depictions of sexual obsession, hustling, and having sex in exchange for cocaine.

“When you’re hypersexual, you’ll be six hours late because you’re busy,” says Behrman. “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.”

When he became a father, Behrman started to recognize the responsibilities parenthood brought on. “I’m extremely conscious about boundaries,” he says. “My private life is private.” He says he spends most of his time being protective of them, which means protecting them from any symptoms of his bipolar. “I’m hyper-vigilant about my symptoms,” he adds.

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.”

Realizing That Compulsive Sexual Behavior Is Actually Hypersexuality

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 an unsolicited 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.” 

Torn Between Empowerment and Pain

One minute, Andrea is boasting about her sexual prowess; the next minute, she rues the havoc it wreaked on her self-esteem, physical health, and marriage, saying, “I was never faithful.”

The first therapist she saw was coldly judgmental, telling her, “You really shouldn’t be doing this.” Andrea left her office flooded with feelings of shame and worthlessness. “I know it’s something I should control myself,” she says. “But it almost physically hurts, because I want to engage in sexual activity so badly.”

Andrea has been treated for multiple sexually transmitted diseases. 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.”

Why Bipolar Disorder Increases Risk for Hypersexuality

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.

Dr. Cozolino attributes their vulnerability to a “disinhibition” of social restraints during manic periods. In other words, they are unable to act with an eye toward future consequences of their behavior.

“It’s like the CEO in their brain goes off to Bermuda,” says Cozolino, author of the book The Neuroscience of Human Relationships: Attachment and the Developing Social Brain.

How Brain Chemistry Plays a Role

Cozolino defines the brain’s attachment circuitry as the area that helps soothe emotions and tamp down fear. An important part of that is due to the amygdala, an almond-shaped structure deep inside the cerebral hemisphere that regulates fear and panic, and controls the endorphin receptors related to a feeling of well-being.

Numerous MRI studies have confirmed that people with bipolar have significantly greater cerebral blood flow to the left amygdala, suggesting that abnormalities in this brain structure may be implicated in the mental health condition.

When Sex Becomes a Soothing Substitute

“We know that in bipolar, the homeostatic regulation between the amygdala and other areas of the brain, are out of balance,” Cozolino explains. He adds that, during sexual arousal and orgasm, biochemicals are activated that generate a feeling of safety and calm.

“It doesn’t last long, it’s not the real thing, but it’s a really pleasant substitute,” says Cozolino. “So think of hypersexuality as an addiction. As an addict, you never get enough of a drug. With bipolar disorder, you have people who are more vulnerable to using sex as an addiction because they use it for soothing.” 

Increased Sexual Activity, Hypersexuality, And Guilt 

Most people who struggle with hypersexuality recognize the truth of Cozolino’s statement. “The very thing you think you want — intimacy — is the thing you’re afraid of,” says Karen of Long Island, New York. “You masturbate five or six times a day, you have phone sex, and at some point, the sex feels really good and you get addicted to it. It’s a painkiller.”

Raised in a middle-class family, Karen later established a strong spiritual connection and completed a 12-step treatment program focused on sexual behavior, which helped her begin deeper emotional healing. 

When Hypersexuality Is Rooted in Trauma

“When I was younger, the sex was more about getting attention,” Karen says. “I had no boundaries. There was a lot of sexual abuse that happened to me. Although I was not molested, I always felt like a sexually abused person.” She adds that, in some way, she felt that because she was compromised emotionally, she could not protect herself. “Or else my impulse control was so off,” she says.

Treatment for Hypersexuality in Bipolar Disorder

While doctors sometimes prescribe medications developed for obsessive-compulsive disorder (OCD) for people with hypersexuality, many people are dismissive of their effectiveness. Behrman, for example, says he’s never found a medication that targets hypersexuality directly — despite trying dozens of options.

It is well-established that the selective serotonin reuptake inhibitors (SSRIs) are associated with a lowered sex drive. Yet SSRIs are rarely used for those with bipolar since they may trigger manic episodes. 

Lithium, however, is well-known for its dampening effect on sexuality and has long been used for its stabilizing effect on the marriages of people with bipolar, according to Manic-Depressive Illness. 

Medication Can Help — But Not in the Way You Might Expect

“The issue with SSRIs is that they can increase libido, and actually cause hypersexuality for people with mania,” explains S. Nassir Ghaemi, MD, director of the Mood Disorders Program at Tufts Medical Center. However, he says, those same SSRIs can reduce libido for people who do not have bipolar, noting the subtle distinctions of the use of the same drugs for different people.

“The mood stabilizers do not cause sexual dysfunction directly or reduce libido directly,” Dr. Ghaemi adds. “By reducing the mania, the hypersexuality is also reduced.”

Stabilization Comes First

In any case, medication adherence is strongly recommended, along with regular sleep and meals — both are important first steps in getting a person with bipolar stabilized.

“No one can grow and become healthy while struggling with that kind of biochemical disregulation,” says Cozolino. “It takes all their energy just to survive the biological storms.”

RELATED: How to Deal With Hypersexuality in Bipolar Disorder

It is only after someone has been medically stabilized that therapy can be effectively introduced. “From a psychodynamic point of view, you’re trying to develop close and trusting relationships, to ‘reparent’ the brain and build the circuitry that’s absent,” Cozolino explains. “And the fact that the brain remains plastic throughout life makes that possible.”

Therapy Builds the Foundation for Long-Term Healing

Therapy takes advantage of this plasticity and uses it to develop a new parental relationship between the therapist and the person with bipolar, in effect recreating the missing mother-child bond. That theory borrows from a growing body of research that places primary importance on the mother-child relationship. 

Recreating this maternal warmth — if possible — may take years. But Cozolino, who is in private practice in Los Angeles, says he has had some success with those with borderline personality disorder who share a similar psychological makeup with those with bipolar. In fact, this is just one way of addressing the symptoms via therapy.

The Correlation Between Maternal Warmth and Hypersexuality 

The significance of maternal warmth is something that resonates with people like Karen, who recalls the adolescent girl she once was — the one for whom boys would line up outside the bathroom door, waiting to have sex with her — and sees “an outcast, an untreated bipolar person who’d do anything to get attention.”

Years later, Karen recognizes that her parents always tried to do the right thing, even if that included enrolling her as a five-year-old child in a Weight Watchers class. “They couldn’t stand that I was overweight,” she says. “The message all my life was, ‘You’re not good the way you are.’”

Finding Belonging — and Limits — in Recovery

Even today, food is Karen’s drug of choice. But a careful regimen of medication has helped regulate her rapid cycling and mood swings, while her religious community has given her a sense of belonging. Karen says she is in full recovery. This doesn’t mean she has become a “good girl,” however.

“You don’t forget what happened to you when you were in that manic phase,” she says, referring to the hypersexuality. “I can’t make it go away now that I’ve found God. I can say no to giving people money, I can say no to sex, and I can say no sex until I’m married. But even if I get married to someone tomorrow, am I able to be a demure little housewife? No, I don’t think so.”

Editorial Sources and Fact-Checking

• Sher L. Manic-Depressive Illness: Bipolar Disorders and Recurrent Depression, Second Edition. The American Journal of Psychiatry. April 2008. 
• Jamison KR et al. Sexual and Other Factors Predicting the Presence of a Depressive Episode in Bipolar Patients. Archives of General Psychiatry. 1980.
• Kürbitz LI et al. Is Compulsive Sexual Behavior Different in Women Compared to Men? Journal of Clinical Medicine. July 21, 2021.

UPDATED: Printed as “Opening the Door on Hypersexuality,” Spring 2009