Despite such findings, personal sexuality is a subject often avoided on the psychiatrist’s couch. Indeed, patients complain that their doctors rarely want to hear about it. Whatever insights they’ve arrived at have come by way of friends and fellow patients, they say. Consider Jane (not her real name), a 20-something woman from the New York metropolitan area, who was diagnosed for several years with bipolar disorder before recognizing that her risky sexual behavior had a name and an explanation. The person who educated her on that score was neither her psychiatrist nor her therapist. Rather, it was one of her sexual partners, a man who himself happened to be diagnosed with bipolar. “It’s your bipolar disorder that’s making you do it,” he told her. This insight left Jane with a huge feeling of relief. “You don’t want to be a slut,” she says. “I was stigmatizing myself with that ‘slut’ label for a long time. It was time to let it go.”

Experts agree. “Manic people are not embarrassed talking about sex,” says Barbara Geller, MD, professor of psychiatry at the Washington University in St. Louis. “It’s the doctors who are embarrassed—especially in child psychiatry: I’ve had colleagues who’ve said they don’t want to ask that question.” Geller, on the other hand, has been asking it a lot. The author of a groundbreaking study about hypersexuality behavior in children with bipolar, she has helped overturn widespread assumptions through her research. Before her study was published in the December 2000 issue of theJournal of the American Academy of Child & Adolescent Psychiatry , experts widely assumed that overt sexuality in young children was almost always a sign of sexual abuse.Geller’s research disproved that assumption; it found that flirtatious, sexual behavior was a common symptom in 30 percent of young, prepubescent children with mania and in 60 percent of the adolescents.

After ruling out the possibility of sexual abuse, Geller found that these behaviors weren’t confined to excessive masturbation and other forms of sexual self-stimulation. She described the case of an openly flirtatious 10-year-old boy who told a 50-year-old visiting nurse that he’d like to put on some dance music, because “I dig older women.” She told about parents of children with bipolar who reported that their little boys often tried to rub up against or touch the chests of older women, or reach up to pat a strange woman’s behind at the supermarket. Children can carry this behavior into school with them, making overt sexual comments to classmates or teachers, or touching themselves or others inappropriately.

For parents, this can be a double whammy. It is not uncommon for teachers and social workers to suspect parents of causing the inappropriate hypersexual behavior they see in schools, according to Susan Resko, executive director of Child & Adolescent Bipolar Foundation (bpkids.org), a childhood bipolar support organization.

“When parents come into school for a conference, they, or someone else in the household, are often suspected of sexual child abuse, responsible for the child’s hypersexual behavior,” says Resko, who feels that there is a very low general understanding of how bipolar disorder affects children.

“Families want all the help they can get,” says Geller. “They’re not embarrassed by discussing it. And patients aren’t embarrassed by it. It’s the psychiatrists who are embarrassed. “Even highly respected colleagues who do research in the area have to be prompted to ask questions,” Geller continues. “I tell psychiatrists, ‘you must ask these questions because it’s terrifically important to find out. You want to know if a hypersexual child might be making up romantic fantasies about a teacher. You want to protect them until we can get them stabilized. You want to keep them safe from committing suicide, safe fromgetting AIDS.’”

Joseph R. Calabrese, MD, professor of psychiatry and director of the Mood Disorders Program at Case Western Reserve University, agrees with the importance of introducing the topic with patients. “All psychiatrists should first ask, ‘has your physical energy increased? Has your sexual energy increased?’ This should be followed by a question about impulsive new relationships and impulsive sex during the mood swings.” Calabrese points out, however, that masturbation is less relevant when discussing hypersexuality with patients. “Impulsive new relationships and impulsive sex frequently involve risk-taking behavior to both the self and others,” he says, “but masturbation normally does not.”