Hypersexuality during bipolar mania?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:It is very odd that you can't see the evidence of the illness. Bipolar is typically pretty evident since the diagnosis requires fairly extreme mood states and people's behavior changes as they move between them. You would definitely see evidence of hypo mania and depression. It doesn't sound like he has has mania as you would 100% know if there had been a manic episode. This doesn't really seem to add up to a typical presentation. Memory can definitely her hazy or be remembered through the distorted lens of hypo mania.

OP here. It's all very confusing for the reasons you state here. I thought I was knowledgeable about bipolar disorder before this, and I never would have suspected he had it. His cheating episodes were so wildly outside his normal behavior/personality that when you read about hypersexuality -- the danger, the anonymity, the homosexuality -- it sounds textbook. But, like you said, very little else seems textbook. EXCEPT there are some other things we've read about, particularly "loss of sequencing," that hit home big time. The sample fights and interactions in this book he's been reading about the disorder read like a SCRIPT for the fights we've had the past couple years. But yeah, the tricky part now is every time he's irritated or absent-minded, I think, is he manic right now? Or is this just normal emotion? We no longer know what's his personality and what's the disorder. And that only matters if we have hope that it can be treated successfully.

It is not odd at all, especially with bipolar type II. First of all, hypomania presents as decisions that many people interpret in the realm of "normal but unwise". Overspent? Had sex with the wrong person? Gambled? Staying up late? Drinking a bit more? Overly chatty with people? Can't stay organized/on task? All signs of hypomania. All normal also.

The average time to diagnosis for bipolar is in the range of 5-10 YEARS!!! See, for example, this article https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2796048/

Think about that. If the patient and the doctor doesn't recognize bipolar, how on earth is the partner supposed to? Especially since a big part of hypomania/mania is hidden by the bipolar person.

Bipolar is not "pretty evident' unless your first episode is a florid mania (i.e. a mania that disconnects the person from reality -- like I'm gonna be president or I can fly or Jesus is speaking to me). In that case, you will probably be diagnosed as BP Type I fairly quickly. But, if your florid mania is paranoid you may be misdiagnosed as schizophrenic, particularly if it lasts a long time (like months) and you don't cycle back to mainline or depressive state within a few weeks.

If your first episode of BP is depression, you will likely be diagnosed as having depression only and you may even be prescribed anti-depressants, which for a BP person are terrible -- they can make anxiety worse and flip the person into a manic or hypomanic state. Because the person has been diagnosed as having depression, IME, the hypomania will be missed, and, especially if it is dysphoric, the behavior will be misinterpreted as depression w/ meds that aren't working or depression/asshole behavior.

Also, by definition BP Type II (depression/hypomania) is less extreme mood states than BP I.

Yes BP II is less extreme than BPI but more extreme than normal mood states. Hypomania by definition is not a normal mood state - it is only present when there is an illness present so it isn't something that everyone experiences and so no one is going to see it as anything but a normal mood. If it is was just a normal mood state, it wouldn't be something that gets treated. And I would expect a spouse who lives with the person every day to see a lot more than what a patient might tell a doctor in a short appointment at irregular intervals. It often takes a long time to diagnosis for reasons other than that no one has ever noticed any signs of the illness. For it to be a diagnosable mental illness, it HAS to impact on daily functioning - that is a criteria for diagnosis. A spouse will likely notice some signs of depression, they will notice the shift in mood when someone is hypomanic and making different decisions or personality changes (talking more, sleeping less, impulsive decisions etc). then those go away when the hypomanic state fades. Hypomania and bipolar mood states are not permanent like personality traits where this is just how someone always is. The mood states shift and cycle at various rates so you see changes in how someone presents, acts, reacts, and responds. I have worked in mental health for more than two decades and I don't think I have ever heard the spouse of someone with Bipolar II say they have never seen any signs or symptoms or evidence of the illness, especially once aware of what the symptoms and signs are.

[Anonymous]

I've skimmed this thread. My ex acted out like this, and worse. He was first formally diagnosed as a sex addict, and then NPD, and finally and informally as sociopathic.

Informally, I would add histrionic, bipolar and obviously anti-social. And perhaps bipolar which would explain the mania of the sexual episodes, which included men.

Now, ten years later, it does not matter. You can treat BP with meds, but I'm pretty sure my ex had so many mental illnesses under his perfect veneer that the meds would never have made him a trustworthy and safe and consistently loving partner.

It doesn't matter anymore. I'm free from him. OP, you can walk away from this craziness. I am VERY skeptical of men who have sex with other men, from experience and from hearing from other women in the same boat.

Get out now. I'm sorry.

[Anonymous]

Anonymous wrote:

Anonymous wrote:It is very odd that you can't see the evidence of the illness. Bipolar is typically pretty evident since the diagnosis requires fairly extreme mood states and people's behavior changes as they move between them. You would definitely see evidence of hypo mania and depression. It doesn't sound like he has has mania as you would 100% know if there had been a manic episode. This doesn't really seem to add up to a typical presentation. Memory can definitely her hazy or be remembered through the distorted lens of hypo mania.

OP here. It's all very confusing for the reasons you state here. I thought I was knowledgeable about bipolar disorder before this, and I never would have suspected he had it. His cheating episodes were so wildly outside his normal behavior/personality that when you read about hypersexuality -- the danger, the anonymity, the homosexuality -- it sounds textbook. But, like you said, very little else seems textbook. EXCEPT there are some other things we've read about, particularly "loss of sequencing," that hit home big time. The sample fights and interactions in this book he's been reading about the disorder read like a SCRIPT for the fights we've had the past couple years. But yeah, the tricky part now is every time he's irritated or absent-minded, I think, is he manic right now? Or is this just normal emotion? We no longer know what's his personality and what's the disorder. And that only matters if we have hope that it can be treated successfully.

Why are you putting up with this?

[Anonymous]

Anonymous wrote:OP here.

22:13, thank you for that correction. I've been using the wrong acronym.

22:01, thank you for all your info. If you are the one who made several posts on this topic in 2017, I want to thank you. I searched the forum for hypersexuality and your posts made me feel less alone.

DH was the most risk-averse guy I've ever known, and I had no inkling he'd ever be with a man. He still swears he has zero desire for men, that they were just easily accessible on Craigslist (he has zero game), and that he was able to mentally detach. In fact, his emotional detachment has been an issue our entire 20-year relationship, and I suspect he's on the autism spectrum, which is something else he'll be exploring with his doctor soon.

Maybe the only glimmer of hope I can draw from your post is that his mania presents negatively. Dysphoric instead of euphoric. He never exhibits any of the classic signs of mania -- he's never chipper, optimistic, energetic, gung ho. His presents as agitation, anger, impatience, irritability, and extreme anxiety. (OH AND GAY SEX. Surprise! Like what the f*ck.) So I don't think he'd have any reason to resist taking his meds. I just wonder how effective they are. He's been on lamotrigine, but the psych just added lithium for mania.

What about the memory loss? I've read that can be experienced during manic periods, but it also seems really freaking convenient that he can't recall any details about his actions. This behavior is so shocking, so risky, so nervewracking -- how does it not stick with you?? My trust is obviously gone now, so I don't know what to believe about what's bipolar-related and what's just old-fashioned cheating.

I think the bold is one of the hardest aspects of living with someone with mental illness -- it becomes difficult to sort out from the outside which behaviors are triggered by the illness and which are "choice" and what degree of control the ill person has. I spent a long time (years) learning about bipolar, journalling my DH's behavior, trying to understand the what and the why of his behavior, and waiting to see if the meds would help. To some extent this can be "anosognosia" -- which is the idea that someone who is mentally ill may be unaware of aspects of their illness. There is a very good book on this - "I'm not Sick; I don't Need Help."

In one way, I took the idea of in sickness and in health very seriously and thought that I had a duty to figure this out and help, just like if DH had a heart attack. I am glad I did this to some extent, because when I finally did permanently end things, I was able to do so without a shred of doubt or what-ifs. That was very helpful to me as I started my new life with our kids.

I think I finally came to a point where I realized that even if his behavior (especially the cheating) was entirely driven by illness, I still had a right to decide how I wanted to live my life. Early in our dating, I made it very clear that I was only interested in a monogamous relationship/sex. It's my body, and I have every right to set the parameters under which I consent to sex. My ex violated those boundaries. In the end, it doesn't really matter why, or if he wished he couldn't. I just wasn't willing to change my parameters of consent for a sexual relationship, and I wasn't willing to live in a sexless marriage or to do an open marriage. Maybe someone else would feel differently, but I didn't and I don't need to apologize for that.

I say that because I feel like you are spending a lot of time thinking about the why of the cheating. Perhaps you think that if you understand why, you can more accurately gauge your risk in staying. IME, that's a fool's errand. You have no way of knowing whether he is telling you the truth about what he did and why. You only know the facts -- that you got an STD and the only way you could have gotten it is from him. So, you know that he cheated on you in some way. You also have no way of predicting whether he will stay on meds or be receptive in the future to medical help. People with bipolar don't need a "reason" to stop taking meds. It's an aspect of illness.

Your decision is pretty simple -- do you want to live in a relationship where you know that is always a possibility? If so, on what terms will you proceed -- finances, legalities, open/closed marriage, sex/sexless, etc. If not, then OK, the answer is divorce. The one caveat for you, I think, is to be absolutely sure that your choice is truly consensual and not colored by any disempowerment you may feel as a result of your disability and your perception that you need a caretaker. You might want to work with a therapist to address that and have a neutral person who can help reality test and problem solve aspects of disability.

[Anonymous]

Anonymous wrote:OP here.

Yes, that was me above about the STIs. He gave me trich. He's negative for everything else, and we've both been treated. That said, I don't see how I could ever have sex with him again.

Thankfully (I guess) we don't have children, but there are complicating factors, the primary one being I have a chronic, degenerative health problem and need help with daily chores and long-term medical care. Bummer.

I appreciate all the helpful PPs. I feared mostly rude comments, but you've given me a lot to consider. Too much. Take it back. I want my simple life back damn it.

I can support myself, our house is in both our names (though we just finished an expensive renovation, putting more money in than we could sell it for because it was supposed to be the forever house), and I do have a separate bank account. As a PP predicted, my knee-jerk response is to say his mania doesn't present this way (irresponsibility with money), but he keeps surprising me, so sure, why the hell not.

Truly, he seems to be fine at work (though he is easily stressed, and I do think he takes coworkers' comments too personally -- slight paranoia). He doesn't spend money. He doesn't do anything spontaneous...except three occasions of oral sex, each spread about 10 months apart, the last one being in 2018. PP makes a good point that he could be lying or might not remember even more egregious behavior. But the fact that there are no other obvious symptoms makes the whole thing hard to wrap my head around.

Can anyone explain more about the memory loss aspect? I am unable to distinguish when DH is manic or not. There are basically no signs. Depression and anxiety (his version of mania) often present the same way. So I don't know how long his manic periods last. Days, weeks, months, I have no idea. Is he aware of his actions during the mania but then gets amnesia when he's out of the mania? Does he only forget certain, specific, particularly egregious/traumatic events? Is it possible, as PP suggested, that he could have done things he doesn't remember (as opposed to just not remembering the details of his actions)? Would this memory loss, say, make him forget to take his medication? Basically, how does it manifest?

I just have so many questions, and I'm struggling to get through each day, going to work, dealing with my chronic pain and those appointments. Therapy for myself is something I know I need to do, but I'm overwhelmed by where to start. And how on earth will 50 minutes once a week even scratch the surface?

Thank you again for all your helpful replies. Keep them coming if you have the energy.

FWIW, when confronted with evidence of his cheating, my ex made up a story about the person with whom he cheated. I think he thought the story of cheating he told me would be more palatable than what really happened. In therapy, he told me the "truth", but it was clear he was also still lying to me about things. How did I know he was lying? First of all, he never authentically answered any questions. Everything had to be dragged out of him, and he was very careful to only say something when I gave him a small crumb of what I already knew. And, I put a key logger on my computer (which he used) and began to watch joint credit cards, phone bill and car mileage. It became very evident that he was continuing to lie to me.

We have kids together, so I have to be in contact with him. Over many years, I have come to the conclusion that he just is not able to tell the truth when it is not in his interests. I don't know if this is bipolar or personality, and frankly, it doesn't matter.

[Anonymous]

Anonymous wrote:

Anonymous wrote:OP - I’m interested in how you figured out about the BP and the infidelity. I understand that you got an STI - is that what triggered it - that you got tested for some reason and then came home and confronted him and he confessed? or did you have to drag it out of him?

Similarly - how did he get diagnosed? By primary care doc? By psychiatrist? By therapist (LCSW? PhD? other therapist)? Is he taking meds currently? If so, what kind - mood stabilizer? Anti-depressant? Is he taking them willingly? regularly? transparently? Do you attend psych appointments for at least part of the appointment? Does he also see a therapist regularly?

Answers to these also point to likely future outcomes.

Yes, I had symptoms, got tested, got diagnosed, confronted him, and he confessed to the Craigslist encounters, which he said ended in 2018. (I believe him for various reasons.) Frustratingly, he never had symptoms and he tested negative. Which apparently can happen. There's nowhere else I could've gotten it. But it still adds yet another layer of confusion to the whole ordeal.

He had been diagnosed with Bipolar II about 6 months ago by a psychiatrist. His primary care doc had been prescribing meds for anxiety (Lexapro), but his anxiety was only getting worse, so she sent him to a psychiatrist, who immediately suspected Bipolar II and put him on lamotrigine.

DH never told the psychiatrist about the hypersexual episodes because he feared I'd find out somehow and because he downplayed in his own mind their significance. I was actually the first one who tied the cheating to the bipolar diagnosis because I have a relative with bipolar disorder and am familiar with the hypersexuality component to mania. I just didn't think DH had mania that extreme. Like I said, I can't even discern when he's manic.

He has since told his psychiatrist about the sex, and the psych added mania to his diagnosis and prescribed lithium. That was 2 weeks ago. Yes, he takes his meds willingly, but I don't watch over him. He has his first therapy appointment next week, which he's going to alone. We both agree I should be included in the appointments eventually, but it's early days -- I have no idea how often these appointments will be. So far, it's been very hard to get mental healthcare. But he does agree that he can't self-report his own symptoms.

Your DH's prescription history really jumped out at me. It is similar to my now exDH. The primary care doc misdiagnosed him and put him on Lexapro, which is an SSRI. SSRIs are known to trigger mania or make it worse. This also happened to my DH (being misdiagnosed and prescribed an SSRI). It definitely made his mood swings worse -- higher and more dysphoric and more sexual. The first doc was entirely unaware that the medication was making things worse because the doc didn't incorporate me into treatment and because my DH was probably lying about the sexual aspects and thought the hypomania meant he was getting better.

The first psychiatrist your DH saw prescribed Lamotrigine, which is know as a "mood-elevating" mood stabilizer. It's usually prescribed to bipolar patients or those who have had repeated episodes of depression or who haven't responded to SSRI trials (usually more than one). If your DH was still hiding the hyper sexuality/hypomania, then that was a reasonable choice, I suppose. But, it could be that the Lexapro accentuated the hyper sexuality because of its mood-elevating properties.

The lithium is the oldest medication (historically), but that also means that it has tons of research backing it's mood stabilizing properties. At this point, I assume he is off the Lexapro and the lamotrigine and is only taking Lithium? I think that is the right move. If he is still manic or hypomanic on Lithium then he made need to have an anti-psychotic med like Seroquel to complete end the mania. If he's only been on the Lithium for a few weeks, it might be a reasonable decision to put off making any long term decisions about the relationship while you both see how he responds to the medication and whether he seems committed to taking it independently and transparently. It takes a while for the Lithium to build up to an effective level in the blood, and a patient has to take it consistently to maintain that effective blood level. At the same time, you can be addressing your financial, legal and other vulnerabilities.

Your description is actually a really good example of why doctors who treat patients with bipolar should invite close family members into the treatment process. Many psychiatrists believe they can't due to federal privacy regulations and in order to build a successful relationship with the patient. But, TBH, incorporating caretakers into treatment is a "best practice" in APA treatment algorithms and good psychiatrists have ways of doing this, both in terms of getting patient consent and in terms of setting up the actual meetings.

My ex DH and my kids all have some kind of MI. The drill has always been that I go to psychiatrist appointments as well and am invited in for the first 5 minutes to give my perspective my family member's mood and behavior. Then the family member talks privately with the psychiatrist for the rest of the appointment, and I am invited back in for the last 5 minutes, when the doctor shares with me the treatment plan agreed upon by patient and doctor and answers any questions.

Of course, now that I am not married anymore, I don't go to ex's appointments. As my kids grow older and more independent, I have less input to their sessions, but I still know that if I am concerned I can call their psychiatrist or therapist. And, my kids understand that it is to their benefit to have a close family member who is not judgmental but supportive know about their mental health issues in case they decompensate.