Driven sexual behavior in bipolar spectrum patients: psychodynamic issues

Recent psychiatric attention to the bipolar spectrum conditions (Bipolar I, Bipolar II, and Bipolar NOS Disorders in the DSM-IV-TR) has revealed that many more individuals are affected by bipolar disorder (BD) than was earlier appreciated. Increased sexual thoughts, impulses, and risk-taking sexual behavior are recognized symptoms of the bipolar conditions when individuals are manic or hypomanic. There is little scientific information on the prevalence of symptoms of driven sexuality in individuals with the less severe forms of BD as well as those individuals with severer forms of the disorder who are recovering or have recovered from an episode of mania or hypomania. This article discusses the use of developmentally oriented psychotherapy for an individual with a bipolar spectrum condition whose symptoms were well controlled on medications except for her driven sexuality. Current concepts in psychodynamic psychotherapy offer a way to understand and treat sexual symptoms in many individuals with less severe or partially treated BD.