title: Hypersexuality and couple relationships in bipolar disorder: A review.
abstract: BACKGROUND
  Although change in sexual behavior is recognized as an integral part of bipolar disorder, most of the relevant literature on sexual issues in patients with this illness concerns medication side effects and does not differentiate bipolar disorder from other serious mental disorders. Surprisingly, little has been published on mania-induced hypersexuality and the effects of mood cycling on couple relationships. In this review, we examine the extant literature on both of these subjects and propose a framework for future research.
  
  
  METHODS
  A search of PsycINFO and PubMed was conducted using keywords pertaining to bipolar disorder, hypersexuality and couple relationships. A total of 27 articles were selected for review.
  
  
  RESULTS
  Despite lack of uniformity in diagnosis of bipolar disorder and no formal definition of hypersexuality, the literature points to an increased incidence of risky sexual behaviors in bipolar patients during manic episodes compared to patients with other psychiatric diagnoses. Further, it appears that bipolar patients are more similar to healthy controls than to other psychiatric patients when it comes to establishing and maintaining couple relationships. Nonetheless, the studies that examined sexuality in couples with one bipolar partner found decreased levels of sexual satisfaction associated with the diagnosis, varying levels of sexual interest across polarities, increased incidence of sexual dysfunction during depressive episodes, and disparate levels of satisfaction in general between patients and their partners.
  
  
  CONCLUSIONS
  Due to changes in diagnostic criteria over time, there is a lack of uniformity in the definition of bipolar disorder across studies. Hypersexuality is not systematically defined and therefore the construct was not consistent across studies. Some of the older articles date back more than 30 years, making them subject to the biases of sexual and gender norms that have since become outdated. Finally, the heterogeneity of the samples, which include patients with comorbid substance use as well as inpatient, outpatient, symptomatic and euthymic patients, may limit the generalizability of results.
  
  
  CONCLUSIONS
  Although bipolar patients experience disease-specific sexual problems of mania-induced hypersexuality and specific effects of mood cycling on couple relationships, the existing literature is mostly outdated and lacks a consistent definition of hypersexuality. Novel research is needed to address sexual symptomatology in bipolar disorder within the context of current sexual, cultural and gender norms.
authors: Mount Sinai Beth Israel Medical Center Department of Psychiatry and Behavioral Sciences 317 East 17th Street, New York, NY 10003 USA. Electronic address: IKopeykina@chpnet.org.
authors: Irina
authors: I
authors: Kopeykina
authors: Mount Sinai Beth Israel Medical Center Department of Psychiatry and Behavioral Sciences 317 East 17th Street, New York, NY 10003 USA. Electronic address: HKim@chpnet.org.
authors: Hae-Joon
authors: HJ
authors: Kim
authors: Mount Sinai Beth Israel Medical Center Department of Psychiatry and Behavioral Sciences 317 East 17th Street, New York, NY 10003 USA. Electronic address: TKhatun@chpnet.org.
authors: Tasnia
authors: T
authors: Khatun
authors: Mount Sinai Beth Israel Medical Center Department of Psychiatry and Behavioral Sciences 317 East 17th Street, New York, NY 10003 USA. Electronic address: Jboland11@fordham.edu.
authors: Jennifer
authors: J
authors: Boland
authors: Mount Sinai Beth Israel Medical Center Department of Psychiatry and Behavioral Sciences 317 East 17th Street, New York, NY 10003 USA. Electronic address: Saphyeh@gmail.com.
authors: Sophia
authors: S
authors: Haeri
authors: Mount Sinai Beth Israel Medical Center Department of Psychiatry and Behavioral Sciences 317 East 17th Street, New York, NY 10003 USA. Electronic address: LCohen@chpnet.org.
authors: Lisa J
authors: LJ
authors: Cohen
authors: Mount Sinai Beth Israel Medical Center Department of Psychiatry and Behavioral Sciences 317 East 17th Street, New York, NY 10003 USA. Electronic address: IGalynke@chpnet.org.
authors: Igor I
authors: II
authors: Galynker
mesh_terms: D001714:Bipolar Disorder / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D012737:Sex Factors; D012725:Sexual Behavior / Q000523:psychology*; D020018:Sexual Dysfunctions, Psychological / Q000523:psychology*; D012747:Sexual Partners / Q000523:psychology*; D012959:Socioeconomic Factors
keywords: Bipolar disorder; Couple relationships; Hypersexuality; Risky sexual behavior; Sexuality