Post-traumatic stress disorder secondary to manic episode with hypersexuality in bipolar disorder: a case study of forensic psychotherapy

Post-traumatic stress disorder (PTSD) can arise as a secondary condition to a primary bipolar disorder, an aspect which may be overlooked by clinicians and thus may contribute to the exacerbation of the bipolar disorder itself. The occurrence of manic symptoms can have a traumatic impact on a patient unaware of her/his diagnosis, especially during symptom remission. The present work describes a clinical case of a woman with type-1 bipolar disorder and PTSD secondary to previous manic episodes characterized by hypersexuality. This clinical case is characterized by the fact that the patient had not received an adequate psycho-educational intervention making her aware of bipolar symptoms and helping her to elaborate the trauma of hypersexuality experienced after remission. The psychodiagnostic and psychotherapeutic assessment procedures are described and the forensic psychiatric implications related to the importance of timely and evidence-based intervention on this comorbidity are discussed. Identification of the primary pathology may be complicated by behaviours provoked by the psychiatric symptoms which put these patients at risk of becoming victims of abuse. Therefore, it is necessary to correctly understand these dynamics in order to promptly provide the patient with the correct therapeutic pathways. © Clinical Neuropsychiatry.