Hypersexuality: It’s all in the head

Slut, ratchet, freak. These are just some of the names that 33-year-old Gladys* has been branded over the past decade. At a glance, her detractors do not seem very far off the mark.

Gladys, a graphic web designer, can best be described as sexually reckless. She can’t count the number of one-night stands she has had on her fingers, and she has even had sexual relations with unavailable men and on occasion, strangers.

If it looks like a duck, quacks like a duck, swims like a duck then it probably is a duck, right? Well, not in this case. Gladys does not deserve these labels because her sexual choices have nothing to do with her morals.

After years of struggling with anxiety and bouts of depression, Gladys was diagnosed with bipolar disorder six years ago. Her bipolar is characterised by extreme mood swings. She experiences lows of depression and highs of mania.

A low phase can have her locked up in her house for days. During her mania phases, she talks fast, experiences bouts of high energy, racing thoughts and insomnia. The mania also puts her sex drive into overdrive and raises her desire to indulge in sex to dangerous levels.

WHAT IT LOOKS LIKE

Her sexual urges during these periods are uncontrollable. As a result, she has continually put herself at risk for STIs.

She had no idea that her high sex drive and her mental illness were related until about a year and a half ago. She didn’t even learn of it from her doctor but from the internet.

“I thought that I had a primary sexual condition. When I raised the issue with a close friend, he just told me to be careful. Sex isn’t something that people freely talk about so I went to the internet to silently search for answers. I learnt that hypersexuality is sometimes a symptom of another medical condition. My doctor confirmed that it was indeed a highly likely symptom of my bipolar,” she says.

“Putting a name to the hypersexuality, knowing that there was an explanation for my feelings was a huge relief,” she says.

Merriam Webster Dictionary defines hypersexuality as unusual or excessive concern with or indulgence in sexual activity. While it can be a condition by itself, hypersexuality often is a symptom of a number of mental and neurological disorders. According to a study by Dr. Kay Redfield who was one of the earliest bipolar experts, up to between 25 and 80 per cent of all patients with mania experience hypersexuality.

According to a 2011 WHO report, an estimated 5.7 per cent of patients in Kenya have neuropsychiatric disorders. This means that that there is a chance that the woman you put a label on because of her sexual habits could be struggling with a mental illness.

Women, apparently, are more likely to fall victim than men. During the manic phases, the activity level in a patient’s brain makes it almost impossible to control their impulses.

Inhibitions are usually lowered resulting in recklessness and poor decision making.

“There is a heightened need for physical contact and excitement,” Gladys says.

ALCOHOLISM

For June, a 25-year-old alcoholic, “Sex is a painkiller.” June had her first drink when she was just 13. By 21, she had acknowledged that she had  an alcohol problem. Intoxication elevates her sex drive. She experiences very high levels of sexual energy and a constant need for attention from the opposite sex. This need has seen her dress provocatively and even go to entertain in strip clubs.

“I use it as a response to stress, pain or even boredom. The alcohol isn’t enough to dull the pain and the feeling of emptiness anymore, so I have sex,” she says.

These two women have little control of their feelings and subsequent actions during particular phases of their lives. Just because they are not at fault does not mean that they are spared the consequences or the society’s judgmental attitude.

Gladys shares that while she is a bit relieved at understanding hypersexuality, it is still the most difficult and destructive part of her bipolar.

“There is still a lot of stigma towards mental illness. Sex on the other hand is something that we just never talk about. I was surprised that my doctor was well aware that hypersexuality was one of the symptoms of my illness and yet had never discussed it with me,” she says.

The after effects of acting on her urges are usually guilt, remorse and loneliness. Her disorder has ruined friendships and gotten her hurt several times after she tried to create relationships out of casual sex.

For June, in addition to the barely existent relationship with her parents and siblings, she has had to suffer embarrassment after doing things that were out of character. Once or twice, she has spent the night in police cells for stripping naked in public. She has just gotten into a treatment programme to manage her alcoholism. She is however not very hopeful that she will be able to mend all those relationships that have been broken along the way.

A reading of Electroboy, a book by Andy Behrman who is bipolar, shows that hypersexuality also risks a patient losing interest in all things that are not sexual, which will ultimately erode the quality of their life.

Dr. Fredrick Owiti, a psychiatrist with a private practice on Koinange Street in Nairobi, says that hypersexuality has also been associated with borderline personality disorder and some forms of dementia.

Some patients with borderline personality disorder experience an elevated sex drive which they use as an outlet when they are overwhelmed. Between two and 17 per cent of patients with dementia  also experience hypersexuality which manifests in the form of sexually inappropriate behaviour, exposure, masturbation and using obscene sex language.

TREAT THE DISEASE

Hypersexuality is listed as one of the primary symptoms of bipolar disorder but there is still limited research on the same. According to sexologist Dr Joachim Osur, the most unfortunate thing about hypersexuality issues is that there isn’t a clear definition of hypersexuality. A patient with a higher sex drive than their partner might assume that they are hypersexual thus creating a problem where there isn’t one. He advises a medical diagnosis before taking action.

“When it is a result of a mental illness, then it isn’t a sexual disorder but a mood disorder. You treat the disease, not the symptom. Bipolar

patients have abnormalities in their brain structure. This can’t be altered but it can be managed. Once the mental illness is under control, so will the hypersexuality,” he says.

Hypersexuality should be addressed in the context of the mental illness. Once the mental illness is under control, you will have gotten rid of the sexual behaviour.

According to Martin Kunga the addictions counselor at the Nairobi Place Addictions Treatment & Specialized Medical Centre in Karen, in addition to antidepressants and mood stabilizers, cognitive behaviour therapy is also very effective in treating the symptom of hypersexuality in mental illness. It helps a patient recognise the distorted thought processes, one becomes aware of their behaviour changes and can prepare for them better.

“It has been effective, I now understand and can look out for the onset of my mania phases and I have learnt to substitute my sexual behaviour and thoughts with other behaviours and thoughts. I joined dance classes; when I start feeling like that, I dance,” says Gladys, who is has been undergoing cognitive behaviour therapy alongside her mood stabilisers for the past year and a half.

According to Martin, group therapy also often works as patients get to see that their problem isn’t alien and you get to learn from others what works and what doesn’t.

***

Do you have hypersexual disorder?

1. Do you periodically experience an insatiable need to have sex?

2. Do you have major swings in sex drive that are dependent on your mood?

3. Have you made attempts in the past to correct your problematic sexual behaviour?

4. Have you made and broken promises to yourself or others regarding your sexual behaviour change?

5. Have your sexual decisions resulted in negative life consequences, affected your physical or emotional health or significantly affected your career or resulted in legal problems?

6. Have you repeatedly engaged in sexual behaviour while disregarding the negative effects either to you or to others?

7. Do you hide aspects of you social behaviour from your partner?

8. Do you feel that your sexual behaviour is abnormal?

9. Do you have sex in response to stressful life situations?

Scoring guide

0- 3 points – Hypersexuality is unlikely

4-6 points – Hypersexuality is possible

7 and above points – Hypersexuality is highly likely

* This test should not be used as the basis of a conclusive diagnosis. Please see a doctor for guidance.