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Sexual problems and couple disharmony in bipolar patients - a case series

Trovão, N1; Rodrigues, C2; Ribeiro, R3; Marques, A1; Ward, S4

1: Centro Hospitalar Vila Nova de Gaia/Espinho, Portugal; 2: USCP São Neutel, Portugal; 3: Hospital de Braga, Portugal; 4: Sint Jan Kliniek, Belgium

Objectives: Sexual dysfunctions and problems are common across several psychiatric diseases, but hypersexual behaviour arising from manic episodes is unique to bipolar disorder. Despite carrying considerable burden to the couple, in-depth study of this subject is scant and evidence based interventions are lacking. Our aim is hence to address sexual and marital problems in bipolar patients as well as their correlates and prognostic predictors.

Material and Methods: We described qualitative clinical parameters concerning sexual functioning and marital relationship in a case series of three male patients with bipolar I disorder.

Results: All three patients were similar in respect to age (6th decade), marriage length (30 to 34 years), education (middle school), religious system (catholic) and occupational status (retired due to illness, but with amateur occupations). All have had bipolar disorder diagnosed for more than 30 years and one psychiatric hospital admission in the last 4 years. Two of them experienced mild hypomanic symptoms in the last 12 months, while the other experienced mild anxiety only. All were currently medicated with sodium valproate combined with second-generation antipsychotic. As part of the manic episode symptoms, none had history of substance misuse other than alcohol; all reported increased sexual desire and two of them did engage in extramarital risky sexual contacts while the other reported increased flirtation only. All reported marital disharmony and sexual avoidance by the spouse at the manic phase, two of them maintaining those complaints at present, euthymic state. Interestingly, the patient achieving sexual and relational satisfaction was the only one whose wife asked permission into the consultation and adhered to couple counselling, even after the previous extra-marital affairs. This wife had shown progressive knowledge about the illness and symptom attribution, while the spouses not adhering to couple therapy after invitation blamed the patient for his behaviour during active illness phases.

Conclusions: Inviting the spouse to the consultation, addressing her sexual satisfaction and providing couple counselling showed a better outcome than working with the patient alone. The severity of hypersexual behaviour consequences during manic episodes may have a lesser impact on the outcome of couple relationship restoration. Larger samples are needed in future research to support these correlates.


Work supported by industry: no.

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