​IED is a mental health disorder characterized by repeated episodes of anger or aggression that are disproportionate to the situation. Let’s look at a possible example of how IED manifests.  
 
For instance, a child spills a glass of milk onto the kitchen floor. A person without IED might feel irritated or even speak sharply to the child, but they typically recognize that this is just an accident and calm down quickly with no lasting damage or emotional harm.
 
A person with IED, on the other hand, might experience a quick and intense surge of anger in response to this simple accident. They may yell loudly, slam doors, throw objects, etc, with seemingly no ability to control the anger or the aggressive behavior.
 
While the latter situation can be very traumatic, it is important to understand that the person who has the outburst typically will feel deep remorse or shame about the incident and also not understand why they had such an extreme response to a small issue. This is not simply an anger issue; this is a disorder with impaired impulse control.
 
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is published by the American Psychiatric Association, lists specific criteria that we use to diagnose all mental health conditions, including IED.  The following criteria describe the key features used to identify and diagnose IED.

​In general, there is usually no single reason why IED will develop in a person. Typically, there is a combination of biological, psychological, and even environmental factors that affect impulse control and emotional regulation in general.
 
Some studies suggest that people with IED may have differences in areas of the brain that control emotional regulation, particularly areas that control threat response and inhibition. In some cases, serotonin imbalances are linked to impulsivity and aggression.
 
It’s possible that there is a genetic component, and people with a family history of mood disorders, substance use disorders, and impulse control disorders seem to have a higher risk of developing IED.
 
Additionally, people with IED often have experienced early life trauma, such as abuse or neglect, or exposure to chronic conflict within their household. These experiences can increase the likelihood of aggressive and impulsive outbursts in later life.  In many cases, all of these factors will contribute to the development of IED as well as many other mental health conditions. 

Bipolar disorder and IED certainly can co-occur, but as a bipolar psychiatrist, I find that it’s crucial to distinguish between the types of aggression common to both disorders. For instance, with IED, outbursts are short-lived and not tied to sustained mood changes.
With bipolar disorder, irritability or aggression occurs during manic or hypomanic episodes and is accompanied by other symptoms such as decreased need for sleep, increased energy, grandiosity, or risky behavior.​

Aggression is quite common with Attention Deficit Hyperactivity Disorder, or ADHD. Generally, with IED, we see that the aggression is severe, emotionally driven, and episodic. With ADHD, aggression is usually less extreme and is more consistent with a person’s distractibility or frustration tolerance.
 
With IED, a person has an immediate, disproportionate response to a stressor. With ADHD, you likely will notice a person becoming more and more frustrated, while a person with IED might seem to explode out of nowhere. As an ADHD psychiatrist, I have seen patients with both IED and ADHD, and we need to provide treatment that addresses aggression stemming from both disorders. ​

​First and foremost, it is important to understand that people with IED experience a loss of control during these issues. These are not issues relating to defiance or antisocial behavior. While they can cause great distress to others as well as the individual with IED, these outbursts are not intentional or driven by a desire to harm others.
 
As a psychiatrist in Westlake Village, I know that the best way to begin is with a thorough, thoughtful diagnosis, and it’s important to find a psychiatrist who treats IED for several reasons.
 
First, we are medical doctors, so we not only treat mental health, but we also understand how medical conditions can contribute to mental health. In some cases, we may find that, in addition to treating IED, we also need to treat other types of physical disorders. For instance, a person could suffer from hormonal or metabolic imbalances that exacerbate anger responses. We need to treat this physical issue as well as treat the IED.
 
Second, a psychiatrist is the only mental health professional who can prescribe medication. There are no approved medications specifically for IED; however, we sometimes use medications that help reduce impulsivity and emotional regulation, such as selective serotonin reuptake inhibitors (SSRIs) or mood stabilizers. These need to be monitored carefully, which is why it is crucial that you find a local psychiatrist to help with any type of medication management.
 
Lastly, we can develop a comprehensive treatment plan that addresses all of the issues you are facing. Many people with IED have co-occurring disorders, and I not only treat IED, but I also work as a psychiatrist for anxiety, a psychiatrist for depression, as well as for conditions such as PTSD, bipolar disorder, ADHD, OCD, and borderline personality disorder.
 
With this level of experience, as well as a thorough knowledge of pharmacology and different treatment options, I can help develop a treatment plan that ensures the best possible outcome and reduction of symptoms for all of the conditions that a patient might have. 

​As stated above, medication may be used to help with mood stabilization, impulse control, and serotonin levels, but that is just one component of treatment. Cognitive Behavioral Therapy (CBT) can help people with IED recognize triggers and learn to better handle stressful situations. CBT can be an extremely effective treatment for IED, as well as many other mental health conditions.
 
Anger management therapy and emotion regulation skills training are two other types of psychotherapy that can be highly beneficial, in addition to CBT. A therapist or psychologist can provide the services, as well as talk therapy and other types of psychotherapy for co-occurring disorders.
 
Meeting with a psychiatrist as well as a therapist or psychologist is crucial, but there are also some helpful lifestyle changes you can make that can help reduce aggression and control mood. For instance, consistently getting a good night’s sleep can be highly beneficial, as well as learning stress management techniques. Daily exercise and meditation also can help with stress reduction and mood control. 

​The aggressive outbursts and violence associated with IED can be very damaging to families, friendships, and work environments. It’s important to keep in mind that a person with IED truly does not mean to be inflicting harm and generally feels tremendous shame after an episode has passed.
 
While in no way do we want to simply excuse the behavior, the ultimate goal is to find a path toward treatment. To that end, an empathetic response is usually the best way to help a person seek treatment.
 
During an outburst, stay calm and use calm, reassuring tones. However, if you feel that you or anyone in your family is in danger, leave the room or home, as your safety should be a priority.
 
Once the “storm” is over, it can help to acknowledge the person’s feelings while also expressing that the aggression is not acceptable. “I see how angry and overwhelmed this situation made you feel, but the outburst was not ok.”
 
From there, you might discuss how these outbursts seem like symptoms of IED and encourage your loved one or friend to seek help, normalizing treatment as simply a way to build skills to help them manage anger and aggression.
 
Of course, those with IED often damage relationships, and those will need to be rebuilt. Therapy, such as family or couples therapy, can help. If you are a loved one dealing with a person with IED, your safety and mental health are crucial. It is perfectly fine to create boundaries to ensure your mental and physical safety.
 
With any mental health condition, patience and empathy are key, as many people with mental illnesses feel shame about their condition and see it as a sign of failure. However, mental illness is not a weakness; it’s simply a biological disease that is often treatable. Seeking help for IED or any mental illness is no different than seeking treatment for diabetes or high blood pressure.
 
If you or a loved one is struggling with IED, please give me a call and let’s find a treatment plan that helps you reduce symptoms and live a happier life. In addition to working as a psychiatrist in Westlake Village, I also serve as a psychiatrist in Thousand Oaks, a psychiatrist in Simi Valley, and the surrounding areas. 

Psilocybin, often known as “magic mushrooms,” is a naturally occurring psychedelic compound found in some types of mushroom species. It is classified as a hallucinogen and has been used for centuries in spiritual and therapeutic practices.
When consumed, psilocybin is metabolized into psilocin in the body, which then binds to serotonin receptors in the brain. This interaction results in changes to perception, mood, and consciousness, often leading to visual and auditory hallucinations.​

A study at Washington University in St. Louis tracked changes in the brain before and after the use of psilocybin. The researchers found that a microdose of psilocybin had a profound effect on what is known as functional connectivity. This refers to how different regions in our brains communicate and work together to perform tasks or process information.
Essentially, it is postulated that small doses of psilocybin, given in controlled circumstances, might act as a sort of “reset” for our brains. Research suggests that psilocybin may boost our brain’s ability to reorganize and form new and healthier patterns of thought and behavior. It may help patients improve emotional processing as well as emotional regulation.

It’s estimated that as many as five million Americans have borderline personality disorder, although that number could be higher, as many people with this condition go undiagnosed and untreated. As a borderline personality disorder doctor, I know that this mental health condition is often misunderstood and I also know that this disorder can be treated successfully, despite myths to the contrary. Let’s take a look at this mental health condition and some of the current treatment options.

In the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is produced by the American Psychiatric Association, borderline personality disorder is listed among 10 distinct personality disorders.
 
In general, a person with a “personality disorder” will experience different patterns of thought than most people. This includes how they perceive themselves as well as others, and how they respond and relate to other people. These disorders also affect behavior and emotional response. Most importantly, these disorders often cause distress and problems with daily life and relationships.
​ 
Borderline Personality Disorder (BPD) is characterized by a pattern of unstable relationships, self-image, and emotions. People with BPD often have difficulties regulating their emotions and thoughts, suffer from severe mood swings and they may exhibit impulsive and reckless behavior. Here are the primary symptoms of borderline personality disorder:

• Fear of Abandonment: People with BPD often fear being abandoned or left alone. Even something as innocuous as a loved one arriving home late can trigger intense fear. This can result in frantic efforts to keep the other person close.
  
• Unstable Relationships: Individuals with BPD tend to have relationships that are intense and short-lived. They may fall in love quickly, but their idealization of others can quickly shift to devaluation.
• Unclear or Shifting Self-Image: People with BPD might frequently change their self-image, goals, values, or even their career plans. They may view themselves as evil or bad, and sometimes they may feel as if they don't exist at all.
• Impulsive Behaviors: Engaging in potentially harmful activities such as substance abuse, binge eating, reckless driving, or spending sprees can be common among those with BPD.
• Self-Harming Behavior: Suicidal behavior or threats and self-harm, like cutting, are potential symptoms. These distressing actions often result from feelings of emptiness and boredom, or as a way to cope with intense emotions.
• Extreme Emotional Swings: Unstable emotions and moods are common in people with BPD. While they can be joyful and loving one moment, they can become irritable or anxious the next, often lasting a few hours to a few days.
• Chronic Feelings of Emptiness: Individuals with BPD often express feeling empty which can be distressing.
• Explosive Anger: They may struggle with intense anger, often finding it challenging to control. This can result in shouting, throwing things, or becoming completely consumed by rage.
• Feeling Suspicious or Out of Touch with Reality: Periods of paranoia related to stress or feeling disconnected from oneself or reality, known as dissociation, can occur.

As a psychiatrist in Westlake Village who often treats patients with BPD, I find that It's important to note that BPD is a complex disorder, and not everyone with BPD will exhibit all these symptoms. The severity and manifestation of symptoms can vary widely among individuals. If someone suspects they or someone they know may have BPD, it's essential to seek a professional diagnosis and appropriate treatment from a borderline personality disorder doctor, such as a psychiatrist or psychologist (or ideally, both). 

Borderline personality disorder (BPD) is a complex mental health condition that is often misunderstood. Several myths and misconceptions surround BPD, which can contribute to stigma and make it harder for those with the disorder to seek help and support.
 
Myth: People with BPD are just seeking attention.
Fact: BPD is a legitimate mental health disorder with specific symptoms. It's not about seeking attention but rather a struggle with emotional regulation, self-image, and interpersonal relationships.

​Myth: BPD isn't a real psychiatric disorder.
Fact: As stated above, BPD is recognized by major medical institutions and diagnostic manuals, such as the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The Americans With Disability (ADA) Act also recognizes BPD as a disability.
 
Myth: Only women have BPD.
Fact: While BPD is diagnosed more frequently in women, men can and do suffer from it as well. The presentation of symptoms might differ between genders, leading to potential underdiagnosis in men.
 
Myth: People with BPD are manipulative.
Fact: While individuals with BPD might exhibit behaviors that seem manipulative, it's essential to understand these actions often stem from an intense fear of abandonment or rejection rather than a desire to manipulate others.
 
Myth: BPD is a result of bad parenting.
Fact: While childhood trauma or neglect can be risk factors, BPD's exact cause is unknown. It's believed to result from a combination of genetic, environmental, and neurological factors.
 
Myth: BPD and bipolar disorder are the same.
Fact: While both disorders involve mood disturbances, they are distinct conditions. BPD primarily affects interpersonal relationships and self-image, while bipolar disorder affects mood in terms of mania and depression.
 
Myth: People with BPD are violent and dangerous.
Fact: While some individuals with BPD might have aggressive outbursts, it doesn't mean they are inherently violent. Often, the anger is directed inward, leading to self-harm rather than outward violence. Self-harm, such as cutting, and suicidal thoughts and suicidal attempts are extremely common with BPD.
 
Myth: Individuals with BPD can't have healthy relationships.
Fact: While interpersonal relationships can be challenging for those with BPD, with therapy and support, many can and do have fulfilling, healthy relationships.
 
Myth: People with BPD are just being dramatic.
Fact: The emotions and reactions of someone with BPD are very real to them. Labeling them as "dramatic" invalidates their experiences and struggles.
Understanding and dispelling these myths is crucial for reducing stigma and providing appropriate support and care to those with BPD.
 
Myth: BPD is untreatable.
Fact: BPD is treatable, and many individuals with the disorder experience symptom relief and improved quality of life with appropriate therapy, such as Dialectical Behavior Therapy (DBT).

​Psychotherapy is the most common treatment option for people with BPD. There are several different types of psychotherapy that a borderline personality disorder doctor might suggest including dialectical behavior therapy (DBT), mentalization-based therapy (MBT), schema-focused therapy and other types of talk therapy.
 
While there are no FDA-approved medications available specifically to treat BPD, a borderline personality disorder doctor (a psychiatrist) can prescribe medications to treat some issues related to this disorder, such as antidepressants, mood stabilizers or antipsychotic drugs. There is also some evidence to suggest that ketamine might be a treatment option to consider.
 
Ketamine’s original purpose was as an anesthetic, but eventually, it was found to have a positive effect on reducing suicidal ideation as well as in patients with treatment-resistant depression. Ketamine must be administered in a doctor’s office; it cannot be used at home like other types of psychiatric drugs. However, for many patients, only a few treatments might be necessary to achieve a significant lessening of symptoms.
 
In general, the best approach with any mental health disorder is a combination approach that includes talk therapy and, possibly, medication. A therapist or psychologist can help with talk therapy, and a psychiatrist can help with both diagnosis and medication management. As a psychiatrist also is a medical doctor, they also can consider whether any physical issues might be contributing to your mental health issues.
 
In many cases, a person with BPD also will have a co-occurring disorder, such as anxiety, depression, an eating disorder, addiction or another type of mental illness. Your care team must address all of the issues you are facing for the treatment to be successful.
 
I find that many of my patients suffer from multiple mental health disorders and it’s crucial to dive deep and find a diagnosis and treatment plan that accounts for all of these issues. I recommend finding mental health professionals who specialize in personality and mood disorders to ensure that all of your needs are being met.
 
Borderline personality disorder can be overwhelming for patients, as well as friends and family. I highly recommend friends and family members learn all that they can about this disorder and how to help a loved one with this condition. Talk therapy also can be a helpful outlet for loved ones. This helps you discuss worries, hopes, and frustrations in a safe place and find strategies to help your loved one.
 
For patients, maintaining consistent therapy sessions is crucial. Opting for doctors who provide teletherapy or telepsychiatry is an excellent option. This allows you to keep a consistent therapy regimen even if you are away from home or unable to drive to an appointment, etc. A virtual psychiatrist or psychologist treat borderline personality disorder from anywhere you have an internet connection.
 
For some patients, skipping the occasional therapy session isn’t always a problem. However, for people with borderline personality disorder, consistency is crucial and helpful, so an online psychiatrist or therapist can be a good option.
 
I also recommend keeping life as simple as possible, maintaining a daily schedule that includes exercise, a healthy diet, a good sleep schedule and some mindfulness exercises, along with techniques you learn in therapy. Keeping a mood diary also can help you understand what types of events trigger emotional responses and help you to see these situations in a more detached way.
 
For instance, you might look through your mood journal and notice that certain situations consistently trigger feelings of fear, rejection or abandonment. You can discuss these situations with your therapist and come up with strategies that help you work through these issues. 
 
BDT is a complex mental health condition, but it is absolutely not untreatable. I firmly believe that with consistent treatment people with BDT can enjoy happier, more successful lives and see a significant reduction in symptoms. The key is to seek treatment and stay consistent with therapy and medications.
 
Despite what you may believe about yourself – you are a worthy human being, and you deserve to have a better life. Not one of us humans is perfect, and we all must work to become the best versions of ourselves. With BPD, it can be tough because you are struggling with a mental health disorder and that’s not your fault, but it’s not impossible to treat and help is out there.
 
If you are searching for a psychiatrist in Westlake Village, I treat patients in person from all over the Los Angeles area. If you live outside of this area or prefer telepsychiatry, I can provide diagnosis and treatment plans via telepsychiatry. In addition to BPD, I also work as an ADHD psychiatrist, addiction psychiatrist, and bipolar psychiatrist and treat anxiety, depression, eating disorders and many other mental health conditions. Give me a call today and let’s get you on a path toward wellness and a better life!