Compulsive Sexual Behavior, Bipolar Disorder and Borderline Personality Disorder

In our previous blog, The Truth About Sexual Addiction, we talked about sexual compulsion, misconceptions about sex addiction, sex addiction versus sexuality, and Impulse Control Disorder. Briefly, we reviewed some of the causes and treatment of sexual addiction. This blog discusses Compulsive Sexual Behavior Disorder in relation to mental health disorders, some of which are personality-based dysfunctions or related to sexual impulses during mood disturbances.

***For additional help, please consult World of Hope Counseling Center professionals, as only a licensed and qualified clinician should provide any mental health diagnosis.***

If you’re familiar with the question, “Which came first, the chicken or the egg?” then you have an idea of the complexity surrounding sexual behaviors related to mental health and substance abuse. We’ll start with the International Classification of Diseases (11th Revision), or what the World Health Organization uses as the global standard for diagnostic health information for Compulsive Sexual Behavior Disorder diagnosis. Then, we will take a look at some of the most common mental health disorders that overlap with sexual compulsion.

Compulsive sexual behavior disorder (6C72) is characterized by:

• The persistent pattern of failure to control intense, repetitive sexual impulses or urges resulting in repetitive sexual behavior.

Symptoms may include:

1. Repetitive sexual activities becoming a central focus of the person’s life to the point of neglecting health and personal care or other interests, activities, and responsibilities.
2. Numerous unsuccessful efforts to significantly reduce repetitive sexual behavior
3. Continued repetitive sexual behavior despite adverse consequences or deriving little or no satisfaction from it.

• The pattern of failure to control intense, sexual impulses or urges and resulting repetitive sexual behavior is manifested over an extended period of time (e.g., 6 months or more).
• Causes marked distress or significant impairment in personal, family, social, educational, occupational, or other important areas of functioning.

Distress that is entirely related to moral judgments and disapproval about sexual impulses, urges, or behaviors is not sufficient to meet this requirement.

Some people do have compulsive sexual behavior disorder independent of other mental health disorders. However, there may also be some overlap between compulsive sexual behavior disorder, and personality-based mental dysfunction, like borderline personality disorder, or mood disorders, such as bipolar disorder. This is important to understand because a person may exhibit symptoms of sexual compulsive behavior disorder or it may overlap with an underlying mental health condition. A person may not understand how their constant sexual compulsive behavior can affect themselves, their loved ones, and may even victimize others or compromise their own safety. In fact, some people with mental health disorders may assume their day-to-day thinking and activities are normal. World of Hope Counseling Center can help people recognize their mental health needs and help people to control their sexual compulsions in a safe, and empowering environment.

Bipolar Disorder

There are several types of bipolar disorder, but all involve noticeable, distinct mood changes. According to the National Institute of Mental Health, bipolar disorder causes unusual shifts in mood, energy, activity levels, concentration, and the ability to carry out day-to-day tasks. A person with bipolar could have engagement in high-risk sexual activities during manic episodes or depression. Manic episodes refer to periods of higher than usual energy, mood, activity levels, etc. As it relates to sexual compulsion, this may mean talking or thinking excessively about sex, incoherent, sexually explicit speech, daydreaming about sexual fantasies, sexual delusions, etc. with little to no control. Depression, sometimes exhibited by extreme fatigue, memory loss, poor nutrition, could also lead to failed yet cyclical attempts to cope with prolonged sadness and anxiety (also symptoms of depression) with unhealthy sexual behaviors. People with bipolar disorder may become psychotic either when manic or depressed, hearing things that are not there or believing what is not true. Someone with bipolar disorder may believe they have incredible superhuman skills or god-like powers that they do not actually possess. Note: these psychotic episodes occur during mood swings, differentiating it from other disorders, like schizophrenia.

When these symptoms surface during mania, a person with bipolar disorder may be more apt to act on their impulses, taking risks that can lead to irrevocable consequences. These consequences range from hospitalization to prison, financial ruin (as a result of impulsive, excessive purchasing of pornography or sex itself, for example), job loss, divorce, sexually transmitted infections or diseases, and more. Also, one becomes more at risk of developing more mental health disorders and substance abuse.

Borderline Personality Disorder

While bipolar disorder is a mood disorder, borderline personality disorder is characterized by an impairment in the character or the personality of a person as observed in self-views of their:

• Identity
• Self-worth
• Accuracy of oneself
• Self-direction

Understand that people with a personality disorder may also manifest their interpersonal dysfunction through their inability to:

• Develop and maintain close and mutually satisfying relationships
• Ability to understand others’ perspectives
• Manage conflict in relationships

These problems persist for longer than two years.

Although people with borderline personality disorder (BPD) may also experience mood swings, BPD is a personality disorder characterized by fundamental differences in how they see themselves and their role in the world. As a result, their interests and values can change quickly. Someone with borderline personality disorder may pursue risky sexual activities as a behavioral pattern of self-destructive behavior, including:

1. Frantic efforts to avoid abandonment
   A person could engage in sex more often just to make sure that the partner does not leave the relationship. Sex is used to increase connectedness to a partner, or at least the feeling of connectedness.
2. Unstable relationship pattern
3. Identity disturbance
   Someone could compensate for difficulties with self-image by having sex to feel more desired.
4. Impulsivity in at least two areas that are potentially self-damaging
   Excessive spending, unsafe sex, substance abuse, reckless driving, binge eating are impulsive behaviors can lead to dire consequences.
5. Recurrent suicidal behavior
   In fact, risk of suicide is estimated to be between 5% and 6% higher than someone without a psychotic condition.
6. Emotional instability
   With low levels of emotional instability, there could be a probability that a person with bipolar disorder will engage in risky sexual activity. A person who has extreme mood swings may be more likely to act impulsively.
7. A chronic feeling of emptiness
   Sex could be one way to address a chronic feeling of emptiness. By using sex as a way to feel more connected to another person, it could satisfy that feeling of emptiness or even boredom.
8. Inappropriate or intense anger, difficulty to control
   BPD has been associated with increased sexual assertiveness and increased preoccupation with sex and increased dissatisfaction with sexual activity
9. Paranoid ideations or severe dissociation
   Paranoid ideation can cause stress and anxiety due to the continual suspicion that others are out to get you. Frequently zoning out, losing track of time, and disconnecting thoughts, emotions, behaviors, perceptions, memories and identity are signs of dissociation.

Sexual compulsive behavior disorder, bipolar disorder, and borderline personality disorder left untreated can damage relationships and disrupt daily life. All are serious conditions that can have serious repercussions. World of Hope Counseling Center can help with treatment and a care plan. Individuals will also learn better strategies for healthy and appropriate ways to cope with their condition.

It is plausible to associate a behavioral problem with impulse control. Impulsive behavior could relate to being sexually compulsive, as impulsivity may indicate someone does not have time to think through the issues before acting.

In sexual compulsivity or hypersexuality, there will be:

1. Lack of control of sexual behavior.
2. Use of sexual behavior to cope with emotions.
3. Consequences of this type of behavior.

The harmful consequences associated with sexually compulsive behavior could include:

• A risk of sexually transmitted infections which is increased.
• Disruption in people's lives.
• Losing time and energy, like any other addiction.
• Higher probability of being the victim of sexual abuse.

We, together as World of Hope Counselors, work with patients to look at the associations people may have from trauma, and create plans to change reactions to events in a collaborative way. We use therapy that focuses on looking at your feelings, thoughts, and hopes, in order to see how they may be connected to behaviors.

In therapy, we focus on present circumstances rather than prior events, and use your relationship with us to work collaboratively towards resolving issues. World of Hope is here to help you examine both your feelings and the feelings and thoughts of others of specific situations, even as a family member or loved one. World of Hope can help.