Paraphilia and Hypersexuality in Bipolar I Disorder and Histrionic Personality Disorder: A Case Report

Paraphilias are rare and often overlooked psychiatric conditions characterized by intense, atypical, and recurrent sexual urges or behaviors. This case report describes a 33-year-old woman with comorbid bipolar I disorder and histrionic personality disorder, presenting with hypersexuality and risky sexual practices, suggestive of quantitative paraphilia. The patient's behavior included group sexual encounters, unprotected intercourse, and impulsive dissemination of explicit images via social media, culminating in a Trichomonas vaginalis infection. Management required an interdisciplinary approach, combining pharmacotherapy (lithium carbonate and quetiapine), cognitive-behavioral therapy (CBT) targeting impulsivity and emotional regulation, and psychoeducational interventions emphasizing safe sexual practices and impulse control. The report highlights the interconnected nature of severe psychiatric disorders and sexual behavior dysregulation, emphasizing the need for integrated therapeutic strategies to achieve clinical stabilization and minimize risks. This case also underscores gaps in specific guidelines for managing paraphilic behaviors in psychiatric populations, particularly in contemporary sociocultural contexts with evolving sexual dynamics. Future studies are warranted to develop structured, evidence-based approaches to address this complex interplay of psychiatric comorbidities and paraphilias.