Straight Talk about Hypersexuality in Children with Bipolar

A very common symptom of bipolar disorder— hypersexuality — is one that particularly affects and disturbs the families of children who have the illness, and yet is rarely talked about.

Hypersexuality in children is rarely openly discussed for two reasons: one is that sexuality in children (bipolar or not) is simply not spoken about in public; and the other, sadly, is that parents of hypersexual children are afraid to mention the subject. They are petrified that child protective service agencies will find out and wrongly assume that a hypersexual child is an over stimulated child, and that overstimulation stems from sexual abuse in the home. Few people—even the professionals at child protective service agencies— realize that hypersexuality is very common during the manic or hypomanic stages of bipolar disorder in adults and in children.

What is the definition of hypersexuality?

Webster’s New Collegiate Dictionary describes “hypersexual” as “unusually or excessively interested in or concerned with sexual activity.” It is an accepted fact that hypersexuality is a symptom of hypomania or mania in an adult who has bipolar disorder.

In children, the symptom may manifest as a fascination with private parts and an increase in self-stimulatory behaviors, a precocious interest in things of a sexual nature, and language laced with highly sexual words or phrases.

Children who have bipolar disorder have problems reining in sexual impulses that may overtake them and cause them to overreach the boundaries of what is appropriate in a social context—particularly in hypomanic or manic states when all systems rev up. They seem on a different time clock than other children, as though behavioral programs primed to unfold in the adolescent years are unleashed well before their natural time. Yet doctors, nurses, and social workers in this country are taught routinely that any sign of increased sexual behavior in children is a result of overstimulation in the home environment.

… hypersexuality is a common clinical symptom of bipolar disorder …

But is this so? When Barbara Geller, MD, professor of psychiatry, and her colleagues at Washington University in St. Louis, Missouri, studied a group of 93 children and adolescents diagnosed with bipolar disorder as a part of an ongoing National Institute of Mental Health—supported phenomenology study, they found that 43 percent of this group who were manic were also hypersexual. Less than one percent of these hypersexual bipolar children had evidence of overstimulation or sexual abuse in the home. The 43 percent rate of hypersexuality in the prepubertal and early adolescent subjects strongly supports hypersexuality as a symptom of mania.

Indeed, author Danielle Steel describes her son Nick’s intense interest in women at the age of two in the memoir of her son who had bipolar, His Bright Light: The Story of Nick Traina (Delacorte Press, 1998). She wrote: “He was absolutely enamored of women. And just as I had thought early on, he often seemed to me like a grown man in a toddler’s body. … He groped, he hugged, he caressed, and who would expect a two-year old of anything other than being cuddly? I did. I knew him better. Even at two, Nick was a Don Juan in the making.”

She continued: “He used to sneak up behind my housekeeper, creep under her skirt and pat her bottom, and then laugh outrageously. When I took him to our neighborhood ice cream store for an ice cream cone, he would invariably stand in line with a look of innocence, and reach up to a comfortable height for him and pat some woman’s bottom … And when we went to a beach house we still rented then, he would cheerfully suggest we go down to the beach and ‘hug the ladies.’”

Many mothers of children who display this tendency describe some variation of the child’s hugging or kissing in an extremely sensual way, such as: “He loves to smash his face into my breasts when he hugs me and he constantly begs to ‘squish my big, fat tummy.’ He usually has his hands on me before I can pry him off.”

How can a parent effectively deal with hypersexuality?

Hypersexual symptoms disappear with proper stabilization, but until that day arrives, a parent whose child is hypersexual is going to have to contend with the child’s conversations and behaviors and, embarrassed or not, teach appropriate social behaviors for the child— without making the child feel ashamed.

Because it is extremely difficult to think through appropriate responses to language and actions that happen almost out of the blue and that leave a parent gasping with shock and embarrassment, the following “fall-back lines” could help other parents address these behaviors and utterances simply and cogently.

Scenario A: The child is running naked around the house. One mother described it and dealt with it this way: “He loves his body, loves how it feels, and doesn’t have any impulse control. At eight and a half, he still runs around the house naked, dancing to a rock song. I calmly say: ‘Come on sweetie, put some clothes on.’ I don’t ever discuss it or give it too much attention, but he is definitely Naked King of the Moment.’ It goes along with everything about them—they’re just out there and I understand that.”

In response to her son’s nakedness she said to him: “Your penis and testicles and butt are very special and will be throughout your life. But you notice that even in the pool, this is the one area people cover up and still keep private. Why? Because it is so special.”

Scenario B: The child is trying to kiss a parent on the mouth in a sensuous manner. His mother replied: “Honey, this is a special kiss; something a Mommy and a Daddy do, and you will do it as an adult when you feel very close to someone. But it’s not a Mommy-son kiss. We have a special kiss.”

In response, she demonstrated kissing him on both cheeks and then giving him a big hug.

Hypersexuality in the dreaded teenage years

Since over 60 percent of American teenagers below the age of 16 have some form of sexual encounter, adolescence becomes a minefield for parents of a teenager who has bipolar disorder who may be unstable at times and exhibit periods of hypersexuality.

Many parents have described watching with horror as their daughters get “dressed” in the skimpiest of outfits and attempt to go out flaunting their bodies to cadres of boys in the neighborhood and school, or placing highly sexual photos of themselves on self fashioned Web sites. Boys, on the other hand, may make a beeline for pornography sites or place phone calls to 1-900 numbers when parents are out of earshot.

The first thing parents of such a teenager should do is to call the treating psychiatrist and have the teen’s blood levels checked. Hypersexuality may be a sign that the levels have dropped or the teen is being noncompliant with his or her medications. (Note: In an adolescent with no history of the disorder, hypersexuality may be a symptom of the impending onset of illness, not an indication that the teen is amoral.) During these periods, perhaps the teen should be kept home from school for a few days, have computer privileges suspended, or, at the very least, be very closely monitored while the medications are adjusted to keep him or her out of trouble.

Most parents who confront these issues are especially surprised by their children’s precocious knowledge.

It may be that children who have bipolar disorder are so exquisitely attuned to things that they hear snatches of lyrics in a parking lot as they walk to a store with a parent, or see a television commercial at a friend’s or relative’s house, or overhear something at school and it simply makes a bigger impression on them. We can’t say for sure.

What we do know is that hypersexuality is a common clinical symptom of bipolar disorder. It is poorly understood, often goes undisclosed, and yet can cause enormous stress within the family. Understanding and learning to deal with this significant symptom of the disorder is an important aspect of treatment. Parents should be made to feel comfortable, without the fear of recrimination or reprisal, in discussing the symptoms of hypersexuality and their impact with clinicians who treat their child.