The Facts About Bipolar Disorder

Bipolar disorder is a sometimes misunderstood and stigmatized condition that affects more than 2 million Americans and results in sharp changes in moods that alternate between "manic" and "depressive."

These mood swings can last for days or weeks at a time and are generally characterized as such:

• Manic episodes cause an affected individual to feel energized and perhaps overly confident and reckless.
• Depressive episodes cause sadness; irritability; issues with concentration, sleep and appetite; reduced self-esteem; and possibly suicidal thoughts.

These episodes have also been shown to influence sexual desire, activity and relationships, alternating between periods of hypersexuality (excessive preoccupation with sex) and hyposexuality (lack of desire for sex).

Given its prevalence in America, it's likely someone you know is affected by bipolar disorder. It's important to have an understanding of this complex condition so you can identify potential symptoms in yourself, help others with the condition, and minimize potential misconceptions or stigmas regarding the disorder.

The precise causes of bipolar disorder aren't entirely clear. Like many mood disorders, the specific reasons bipolar disorder appears in some people and not in others is unique to the individuals.

Certain genetic factors have been proved to increase the chances a person may develop bipolar disorder, but beyond this, experts believe the development could be linked to changes in the brain's neurotransmitters and other psychological or environmental elements.

Stress, drug and alcohol abuse, and a family history of the disease are also common risk factors.

Factors that trigger bipolar disorder vary from person to person, but the best way to identify those triggers is to work with a mental health professional. In many instances, tracking your mood on a daily basis and making a note of especially high highs and low lows can help determine the cause(s) of episodes.

Some common triggers include a lack of sleep, a change in routine or a change in a relationship. As a general note, bipolar episodes can typically be predicted when behavior becomes extreme, such as extreme energy or extreme fatigue.

Understanding when these manic or depressive episodes set in is the first step in identifying what's causing them.

There are numerous risks associated with bipolar disorder, many of which are symptoms of manic and depressive mood swings.

Due to the "high" of manic episodes, it is common for individuals with bipolar disorder to engage in riskier behaviors in all aspects of life, particularly in sexual activities. This tendency often surfaces as hypersexuality, an increased desire for sex that, in extreme cases, can fall into the category of sex addiction.

On the other end of the spectrum, depressive episodes can lead to feelings of lethargy and even suicidal thoughts, with a substantial decrease in sexual desire known as hyposexuality.

Depressive episodes have been linked to drug and alcohol abuse, which can act as a coping mechanism or form of self-medication.

Mood disorders, such as bipolar disorder, anxiety and depression, have been connected to fibromyalgia, a chronic disorder characterized by widespread pain, fatigue, muscle stiffness, insomnia and brain fog.

Fibromyalgia can have a severe impact on mood, and as a result, physicians have recently begun to classify it as a neurological condition, one that could lead to other mental disturbances, including bipolar disorder.

Diagnosing and testing for bipolar disorder is typically performed by a mental health professional and involves a series of physical and mental exams. Psychiatrists often ask patients to track their moods over a period of time, making special note of extreme highs or lows.

Prominent periods of high energy contrasted by periods of low energy and depression are indicators of bipolar disorder. Doctors may order laboratory tests to rule out other causes of mood fluctuation. Paired with a physical exam and an analysis of family history, doctors are usually able to determine a treatment plan for individuals with bipolar disorder.

Like other mental health issues, bipolar disorder is primarily treated through a dual treatment plan of therapy and medication.

Therapy for bipolar disorder typically involves working on methods of managing and navigating the fluctuations between mania and depression, thus, creating a stable routine for daily activities, as well as identifying triggers for the episodes.

Medications prescribed to patients with bipolar disorder consist of mood stabilizers, antianxiety medications and neuroleptics, each meant to help minimize symptoms and allow people to live with bipolar disorder.

In fact, research has shown that 9 in 10 people taking medication are satisfied with the results and say their outlook on life has improved.

Some medications used in the treatment of bipolar disorder have side effects that can impact both quality of life and sexual health. These include antidepressants and other drugs that can potentially cause erectile dysfunction (ED) or lower sexual desire.

The sexual side effects of bipolar disorder are likely to vary depending on the individuals involved as well as the degree to which someone is experiencing their manic and depressive episodes.

But there are commonalities among the experiences of individuals with bipolar disorder, depending on which type of episode they are experiencing.

Manic episodes and sexual health

Manic episodes can often lead to intense periods of sexual arousal, resulting in sudden and frequent spikes in libido and the desire to engage in reckless or risky sexual behavior.

Often associated with hypersexuality, some common examples of this risky sexual behavior include:

• Compulsive sex, sometimes with strangers
• Excessive masturbation
• Habitual exhibitionism and/or voyeurism
• Inappropriate sexual touching
• Increased consumption of pornographic content
• Numerous affairs outside of a monogamous relationship

Depression and sexual health

As a juxtaposition to the increased sex drive found in people experiencing a manic episode, individuals in the midst of depressive episodes may experience lower self-confidence, feel unattractive or ignore their personal hygiene.

Furthermore, feelings of inadequacy can interfere with sexual relationships or lead to hyposexuality. This condition can reveal itself as a lack of interest in sex, feeling undesirable, frustration or confusion, feelings of extreme vulnerability and worthlessness, fatigue and difficulty concentrating during sex.

Therapy and medication appropriately prescribed by a licensed mental health practitioner can help with bipolar disorder and its sexual side effects. But there are several ways affected individuals can help manage their sexual health while living with bipolar disorder.

Mindfulness practices and sexual boundaries are crucial to maintaining a positive sexual relationship with yourself and a partner.

In some instances, sex toys can help appease some urges brought on by hypersexuality, as can watching certain types of pornography to fit the mood.

It's important to have open conversations with your partner about your wants, desires and needs.

If your libido fluctuates with your mood, expressing to a partner that your interests in bed may also change can help both of you identify solutions. These solutions could include initiating certain types of foreplay or simply letting your partner know that being adverse to sex during some periods has nothing to do with them.

Being single and experiencing the highs and lows of sexual desire can be frustrating for anyone, but when dealing with bipolar disorder, those highs and lows can reach even more extremes.

Keep in mind that frequently engaging in risky sexual behavior makes you more likely to experience the negative consequences of those risky behaviors.

Creative masturbation can help ease some of the sexual frustration during manic episodes, and if an increased amount of casual sex is involved, be sure to use protection and take a moment to think things over beforehand.

Given that energy levels tend to fluctuate greatly in people with bipolar disorder, managing them can be tricky.

During heightened periods, physical activity can help to exhaust some of the high-energy levels associated with mania. This activity can include exercise or, in the case of sexual activity, creative masturbation or explorative sex.

Likewise, physical activity can help to ease symptoms of depression and improve mood. Beyond that, identifying triggers and learning to navigate the highs and lows of bipolar disorder with a licensed professional can help the two of you develop a specialized plan to fit your needs as an individual.

Bipolar disorder can be a difficult condition to live with, in part, because of the stigma surrounding it and because the illness is inherently frustrating and debilitating. However, there are resources available to offer support and guidance:

• The National Alliance on Mental Illness (NAMI)
• The Depression and Bipolar Support Alliance (DBSA)
• The Substance Abuse and Mental Health Services Administration (SAMHSA)

What are the signs of bipolar disorder?

Symptoms of bipolar disorder often manifest during late adolescence and early adulthood. Here are some common signs of bipolar disorder:

Having just one of these signs does not mean you have bipolar disorder. However, if they all seem familiar, it might be time to reach out to your healthcare provider.

What are the four types of bipolar disorder?

According to the National Alliance on Mental Illness, the four types of bipolar disorder include:

How is bipolar disorder triggered?

The following stressful situations can trigger the symptoms of bipolar disorder:

• Aggressive and impulsive behavior while using poor judgment
• Cycling between near-euphoria and depression
• Feeling guilty or worthless without a reason
• Having consistent feelings of hopelessness or sadness
• Rapid speech, racing thoughts and getting easily distracted
• Engaging in risky behavior, such as sexual promiscuity and substance use
• Difficulty staying awake during the day or falling asleep at night
• Difficulty maintaining social relationships, family relationships and work life

1. Bipolar I. The most common type, involving one or more manic episodes with or without depressive episodes. Hospitalization is required for this type to be diagnosed, and the condition lasts for at least one week.
2. Bipolar II. This type is recognized by the shifting between less severe hypomanic and depressive episodes.
3. Cyclothymia. This type involves mood shifts between hypomanic and depressive for a period of more than two years. Periods of normalcy may occur, but only for periods of eight weeks or less.
4. Unspecified bipolar disorder. This type is used to describe a bipolar disorder that does not easily fit the symptoms of the other three but still involves manic mood swings.

• A breakdown of a close relationship
• A death of a close relative or friend
• Emotional, physical or sexual abuse
• Problems in daily-life circumstances
• Physical illness
• Sleep disorders