The surgeon had his first visit to a prostitute at 1:30 a.m. He visited another at 3 a.m. But he couldn't get enough, so he visited another at 4 a.m. Then he began an operation at 7 a.m. In his fatigue, he botched the surgery, and his patient died.

The case is a horror story of sex addiction, a disorder not officially recognized by the American Psychiatric Association but one that many psychiatrists are becoming increasingly concerned about. About 8 percent of men in the United States (and 3 percent of women) have the disorder, but few of those affected are getting the help they need.

Dr. John Sealy, a psychiatrist in Torrance, California, who has been treating sex addiction since 1991, defines addiction as "a pathological relationship with a mood-altering experience with associated denial of escalating adverse consequences and/or loss of control."

People are sexually addicted, then, when the need for more and more sex interferes with work or home life, or when it drives them to do dangerous things. The similarities to substance abuse are clear: For a cocaine addict, buying and using drugs can land the patient in jail or a hospital. For the sex addict, affairs and anonymous sex can lead to failed relationships and sexually transmitted diseases, with HIV being a particular concern.

The type or frequency of the sexual behavior does not matter. A sex addict may masturbate 12 times a day or have sex just once a day in an illicit affair; what matters is the negative impact the behavior has on the addict's life. And most addicts use sex to cope with anxiety and life stresses, rather than truly enjoy it.

"It's not between your legs," Dr. Sealy says wryly. "It's between your ears."

Signs of sex addiction

The signs of sex addiction are similar to those of other addictions and compulsive behaviors; not surprisingly, sex addicts are more likely to also be addicted to alcohol, crystal methamphetamine (a form of speed), and cocaine. In fact, reports Dr. Sealy, between 50 and 70 percent of cocaine addicts are also sex addicts. Notably, up to 80 percent of sex addicts were sexually abused as children.

Typically, family and co-workers notice that those with sex addiction miss chunks of time, are explosive or angry, and may use many sexual jokes. A spouse of an addict may note a detachment or lack of interest in sex, coupled with declining frequency of intercourse.

Particularly troubling are the rapidly expanding opportunities for sex and pornography afforded by the Internet. "The Internet is to sex addicts what crack cocaine is to substance abusers," Dr. Sealy explains. He describes one patient who was found facedown on his computer keyboard, two fifths of vodka gone, after masturbating compulsively for 48 hours. A recent article in the journal Sexual Addiction and Compulsivity estimated that at least 200,000 people in the United States have become sex addicts, and described cases in which cybersex had led to divorce.

Can you stop?

Profound shame keeps many from seeking help, and a high relapse rate means that sufferers must be faithful to treatment for long periods of time. However, there is help available both with therapy and medication.

Because many with the disorder also suffer from conditions such as obsessive-compulsive disorder and major depression, antidepressants are sometimes helpful. One problem, however, is that a side effect of many newer antidepressants such as fluoxetine (Prozac) and sertraline (Zoloft) is delayed ejaculation, and therefore the drugs may simply extend the amount of time addicts engage in sex. Drugs such as medroxyprogesterone (Depo-Provera) have been used to lower sex drive, but these often have limited effects. The most successful treatments are 12-step programs based on Alcoholics Anonymous, which are usually most effective when combined with individual psychotherapy.

For many sex addicts, particularly ones who were abused or neglected as children, sex becomes a replacement for other things, something to turn to in times of need, a way to escape boredom, or an attempt to calm themselves in times of anxiety. Some even use sex in order to sleep at night. If you have this disorder, or the signs are there in someone you love, there are places to get help listed below. Of course, your primary care physician is a good place to start for advice and guidance.

Related links:

Outside link for the addict: Sexaholics Anonymous

Outside link for the addict: Sexual Compulsives Anonymous

Outside link for the partner or family member: S-Anon International Family Groups

Outside link for the partner or family member: Codependents of Sex Addicts