Humans are inherently social creatures, but if you’ve been feeling disconnected and lonely, this can impact your quality of life significantly. As a depression doctor, I believe it’s important for all of us to understand the impact of loneliness, but also to find ways to combat these feelings of isolation.

Loneliness can be a significant factor in the development of depression. While loneliness itself is a state of feeling disconnected, isolated, or separated from others, it can lead to various mental health issues, including depression. As a psychiatrist for depression, I’ve seen firsthand how loneliness impacts our lives. Here are just a few ways that feelings of loneliness can affect our psyche and lead to depression. ​

• Holiday & Seasonal Depression: For many people, the holidays and the winter season can be a difficult and problematic time, and this is especially true for those suffering from depression. The holidays are meant to be happy occasions, but they often make us feel sad, stressed out and alone.
  
  Additionally,  the lack of daylight during the winter months, and weather that often necessitates staying indoors, also can impact our well-being, leading to feelings of sadness and even full-blown depression. If depression haunts you seasonally, this is known as Seasonal Affective Disorder, and it’s very common. 
• Genetic Predisposition: A family history of depression can increase the risk, suggesting a genetic component to the disorder. 
• Brain Chemistry and Neurotransmitters: Imbalances in the brain's neurotransmitters, such as serotonin, norepinephrine, and dopamine, are believed to play a crucial role in depression. 
• Hormonal Changes: Changes in hormone levels, due to thyroid problems, menopause, childbirth (postpartum depression), or other health conditions, can trigger depression. 
• Life Events: Traumatic or stressful life events, including the loss of a loved one, financial problems, divorce, or significant life changes, can precipitate depression. 
• Chronic Illnesses: Living with chronic pain or a chronic illness, such as diabetes, heart disease, or cancer, can lead to feelings of hopelessness and depression. 
• Substance Abuse: Alcohol or drug abuse can both be a cause and a result of depression. Substance use can exacerbate or trigger depressive episodes. 
• Personality Traits: Individuals with certain personality traits, such as low self-esteem, being overly dependent, self-critical, or pessimistic, are at a higher risk of developing depression. 
• Trauma and Abuse: Experiencing trauma, abuse (whether physical, emotional, or sexual), or neglect, especially in early life, can significantly increase the likelihood of developing depression later in life.
• Social Factors: Poor social support, isolation, and conflict in relationships can contribute to the development of depression.

As a psychiatrist for depression, I work diligently to identify the root causes of a patient’s depression. In some cases, several of these factors can contribute to the development of depression. However, when we can identify the causes, this generally makes treatment more effective. 

If feelings of loneliness and isolation are at the root of your depression, there are some proactive steps you can take to connect with others, engage in meaningful activities and address underlying feelings of isolation. Here are several strategies to help alleviate loneliness:

1. Reach Out to Family and Friends: Make an effort to connect or reconnect with family and friends. Regular phone calls, messages, or video chats can help reduce feelings of isolation. Sometimes family members and friends are unaware of your level of loneliness, which is why you often have to be the person taking that first step. Once you connect, ask if you can schedule a regular phone call or video call or perhaps a weekly lunch or dinner.
2. Join Groups or Clubs: Participate in groups or clubs that align with your interests or hobbies. This can be a great way to meet new people who share similar passions.
3. Volunteer: Volunteering for causes you care about can connect you with others and provide a sense of purpose and community. 
4. Stay Active: Physical activity can boost mood and reduce feelings of loneliness. Joining exercise classes, yoga classes, dance classes or sports clubs can also introduce you to new friends. 
5. Explore New Interests: Taking classes or learning new skills can help you meet people, increase your self-confidence, and reduce feelings of loneliness. 
6. Attend Social Events: Make an effort to attend social gatherings, even if it feels daunting. Each event is an opportunity to connect with others. 
7. Consider a Pet: Pets can offer companionship, unconditional love, and a sense of responsibility. They also can be a way to meet other pet owners. 
8. Online Communities and Support Groups: Joining online forums or support groups related to your interests or experiences can offer a sense of belonging and connection. 
9. Practice Self-Compassion: Be kind to yourself and recognize that feeling lonely is a common human experience. Engage in self-care practices that nurture your well-being. 
10. Make Use of Technology: Use technology wisely to connect with others, but be mindful of screen time. Social media can be a tool for connection, but it's important to seek meaningful interactions. 
11. Create a Routine: Establishing a routine can provide structure and purpose, reducing feelings of aimlessness that can accompany loneliness. 
12. Seek Professional Help: If loneliness is persistent and affecting your mental health, consider talking to a mental health professional. Therapy can provide strategies to cope with loneliness and address any underlying issues.

​Combating loneliness is a process, and what works for one person might not work for another. It's important to try various strategies and find what best suits your personality and lifestyle. Remember, seeking connection and community is a fundamental human need, and taking steps to address loneliness is a brave and worthwhile endeavor. It’s not easy to reach out, but it’s also not easy to suffer from loneliness and depression.

Seeking treatment for depression or loneliness is an important step toward improving your mental health and overall well-being. Here are some signs and situations when it's advisable to seek professional help from a local psychiatrist:

​Whether you are dealing with persistent loneliness and/or depression, scheduling an appointment with a psychiatrist for depression is always a good idea. You also can talk with your primary care provider or a therapist.
 
As a psychiatrist for depression, I can provide you with a thorough diagnosis as well as create a treatment plan that addresses all of the issues you are facing. A depression psychiatrist also can provide you with medications, if needed.
 
Many different medications and combinations of medication can treat depression successfully. Talk therapy, dialectical behavior therapy and cognitive behavioral therapy can be helpful, as well. Even with medication, meeting with a depression therapist or psychologist is encouraged as a combination approach tends to yield the best results.
 
If you find that medications and therapy aren’t alleviating your symptoms, there are other options to consider, such as ketamine therapy and eye movement desensitization and reprocessing (EMDR). Other options, such as repetitive transcranial magnetic stimulation (rTMS), electroconvulsive therapy (ECT) or vagus nerve stimulation (VNS), also can be beneficial for those with treatment-resistant depression.
 
If you are struggling with deep feelings of loneliness and despair, it’s best to contact a psychiatrist for depression as quickly as possible. As a depression doctor, I have successfully treated many patients with depression and chronic loneliness, and there is always hope for a brighter future. I also work as a PTSD psychiatrist and anxiety psychiatrist, which often co-occur with depression. I also can treat bipolar disorder, eating disorders, borderline personality disorder or any other co-occurring disorder.
 
I offer both in-person services as a psychiatrist in Thousand Oaks, as well as telepsychiatry, which can be a very convenient option to consider. Don’t wait another day to seek help. Depression and these feelings of loneliness can be tackled, and while it can take time to find a treatment that works, you are worth it and all you have to do is take the first step and give our office a call. 

Bipolar disorder is a complicated mental health condition, and if you are one of the millions of Americans with some form of this disease, you are likely well aware of how difficult it can make life. As a bipolar disorder psychiatrist, however, I have seen many success stories with patients who can manage symptoms with effective treatment options. Let’s take a look at the types of therapy and treatments that may help.

Medication has long been prescribed to individuals with bipolar disorder, and many people successfully navigate life once the correct medications and the correct dosage have been established. This process can take some time, and it’s not always a quick fix, but it can be very beneficial for many patients. Some of the drugs we might use include:

• Mood Stabilizers: Often the first line of treatment (e.g., lithium, valproate).
• Antipsychotics: Used if symptoms persist despite mood stabilizer treatment.
• Antidepressants: Sometimes used in combination with a mood stabilizer to manage depressive episodes.
• Anti-Anxiety Medications: For managing anxiety symptoms, often on a short-term basis.

In general, the best approach always includes some type of therapy. As a bipolar psychiatrist, I can prescribe medication and recommend a course of treatment, but you will want to find a psychologist or therapist who specializes in bipolar disorder for your therapy.

• Cognitive Behavioral Therapy (CBT): Helps identify and change harmful thought patterns and behaviors.
• Dialectical Behavior Therapy (DBT): This type of therapy also can be used to help patients regulate emotions, which can be difficult with bipolar disorder.
• Family-Focused Therapy: Involves family members in the treatment process to improve communication and support.
• Interpersonal and Social Rhythm Therapy (IPSRT): Aims to stabilize daily rhythms such as sleeping, eating, and activity schedules. Sleep disruption is a huge component of bipolar disorder, which I will discuss below, but this is one reason why IPSRT can be beneficial.
• Psychoeducation: Educates the individual and their family about bipolar disorder and its management. This is more important than you might think. It’s so helpful for both patients and friends/family to truly understand the best ways to manage this condition. Education can make a huge difference and boost the success of treatment. 

For severe episodes or when medication and psychotherapy do not work, ECT can be effective, particularly for depressive episodes and, in some cases, mania. ECT was formerly called shock therapy and it has a rather dubious reputation throughout the psychiatric community. However, multiple studies illustrate its success with major depression, severe bipolar disorder and schizophrenia.
 
Another option to consider might be Transcranial Magnetic Stimulation or TMS. This option is less invasive and, for lack of a better word, a bit less scary. The FDA has allowed its use as a treatment for bipolar depression as well as for treating major depressive disorder, OCD and even issues such as migraine headaches. As a side note, migraines are extremely common in patients with bipolar disorder, and TMS might be an option to treat both your depression and migraines.

Psilocybin, or magic mushrooms, as they are sometimes called, are gaining interest as a treatment option for some psychiatric disorders. However, because this substance has long been illegal federally, there have been few studies undertaken to gauge its safety or efficacy. It’s also worth noting that psilocybin is illegal in all but two states – Colorado and Oregon.
 
Having said that, there are a few studies that suggest psilocybin might be a good treatment for depression as well as PTSD. As a psychiatrist, I am intrigued by the idea of using psilocybin as part of therapy and look forward to more studies and research as I believe it may yield positive results.
 
However, it is important to understand that even in the states where it is decriminalized, it is being used at licensed facilities and not simply sold over the counter as you might purchase cannabis. People with bipolar disorder often self-medicate to alleviate symptoms, but I don’t recommend trying psilocybin on your own.
 
With bipolar disorder, there also is some anecdotal evidence to suggest that psilocybin might activate a manic phase, which is not a good outcome. Again, more research needs to be conducted, specifically with bipolar patients before I would feel comfortable recommending this as a treatment option although I truly feel it has great promise to help those with treatment-resistant depression and PTSD.

As a psychiatrist specializing in bipolar disorder, I recommend trying a multi-treatment approach to this disease. A combination of medication and different therapies tends to elicit the best results. However, the following tips have been shown to be helpful for patients with bipolar disorder as part of a combination approach.

Changing your lifestyle can make more of a difference than you might think. For instance, regular exercise can help improve your mood and reduce depressive symptoms. A healthy diet that includes omega-3 fatty acids also has been shown to help. It is recommended that you avoid red meat and foods high in saturated fat and trans fat, such as “junk” food.
 
Creating a healthy sleep schedule is crucial, as sleep disruption can trigger both manic and depressive episodes. This is hugely important, and one step you can take is to create a sleep journal. Write down what you ate and when, and what you drank and when, as well as when you took medications, went to sleep, woke up, etc. This can help identify triggers that lead to poor sleep. I also recommend creating a sleep ritual that includes turning off electronic devices and perhaps winding down with some meditation, a warm bath and some relaxing music.

These days, meditation is easier than ever before. For instance, many phone meditation apps can help you clear the mind and relax and de-stress, as well as classes in meditation and mindfulness. Deep breathing exercises also can be helpful and reduce stress and regulate your mood.

Many people with bipolar disorder struggle with feelings of isolation and feelings that no one truly understands what they are going through. Finding a support group can be a great way to feel less alone and isolated.

If you’ve been searching for a bipolar psychiatrist near me but have yet to find someone who is a good match for you, feel free to contact our office at any time. While I work as a psychiatrist in Thousand Oaks and serve the greater Los Angeles area, I also offer telepsychiatry and this can be a good option to consider if you can’t find a good fit in your immediate area.
 
I have extensive experience working with patients with bipolar disorder as well as co-occurring disorders. I can create a diagnosis and treatment plan that addresses all of the issues you face and help lead you on a journey to a brighter, happier future. If you need a bipolar disorder psychiatrist, please don’t wait another day to seek treatment. Help is available, and bipolar disorder can be managed successfully and long-term.

While feelings of anxiety affect all of us at certain points in our lives, if you are living with an anxiety disorder, this issue isn’t just an occasional problem, it’s a chronic condition that impacts every aspect of your life. Finding a qualified anxiety psychiatrist can be the first step toward taking control of your anxiety and starting the journey to a happier life.
 
Understanding Anxiety Disorders
Anxiety disorders encompass a range of mental health conditions characterized by excessive fear and anxiety. Here's a brief description of the different types:
 
Generalized Anxiety Disorder (GAD): People with GAD experience persistent and excessive worry about various aspects of daily life, such as work, health, or finances, often disproportionate to the actual source of worry.
 
Panic Disorder: Involves recurrent panic attacks—intense periods of fear or discomfort accompanied by physical symptoms like heart palpitations, chest pain, and dizziness.
 
Social Anxiety Disorder (Social Phobia): Features an intense fear of social situations and being judged or negatively evaluated by others, leading to avoidance of social interactions.
 
Specific Phobias: Involve an irrational fear of a specific object or situation, such as heights, flying, or spiders, that leads to avoidance behavior.
 
Agoraphobia: The fear of being in situations where escape might be difficult or help might not be available, often resulting in avoidance of places like malls, public transportation, or even open spaces.
 
Separation Anxiety Disorder: While commonly thought of as affecting only children, this disorder also can affect adults, causing distress when separated from home or from individuals to whom there is a strong emotional attachment.
 
Selective Mutism: A complex childhood anxiety disorder characterized by a child's inability to speak in certain social situations, such as at school or in the community, despite speaking in other settings.
 
Medication-Induced Anxiety Disorder: Anxiety or panic that is directly caused by taking or withdrawing from certain drugs or medications.
 
Each of these disorders can impact daily functioning significantly, but with proper diagnosis and treatment, individuals can manage symptoms and lead fulfilling lives. Keep in mind, that many people with an anxiety disorder also have a co-occurring disorder such as depression, ADHD, bipolar disorder, autism spectrum disorder, etc.
 
The Role Of An Anxiety Psychiatrist
My first goal as an anxiety psychiatrist is to spend time with a patient to determine a thorough diagnosis. As a psychiatrist, I am both a mental health professional as well as a medical doctor, and this unique perspective allows me to look at all of the facets of a patient’s life to determine what disorders and health conditions are reducing the quality of life.
 
As stated above, in many cases, a patient will have multiple diagnoses, and potentially even physical health conditions that are contributing to a decline in mental health. We must address all of these issues to truly improve a person’s life. Once we’ve completed a thorough evaluation and determined the correct diagnosis, we can begin to plan treatment.
 
Treatment Options
There are many different treatment options for those suffering from anxiety disorders. There are medications available as well as different types of therapy that can help patients manage their anxiety. While medications can be very beneficial, I typically recommend a combination approach that includes some type of talk therapy in addition to medication. Let’s take a look at some of the options.
 
Medication Management
Several different types of medications might be prescribed to a patient with an anxiety disorder. These include:
 

• Selective Serotonin Reuptake Inhibitors (SSRIs): Often the first-line treatment for anxiety disorders. Examples include fluoxetine (Prozac), sertraline (Zoloft), and escitalopram (Lexapro).

• Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs): Another class of antidepressants that can treat anxiety. Examples include venlafaxine (Effexor XR) and duloxetine (Cymbalta)
• Benzodiazepines: Used for short-term relief of acute anxiety symptoms. Examples include alprazolam (Xanax), lorazepam (Ativan), and diazepam (Valium).
• Tricyclic Antidepressants: An older class of medications that, while primarily used to treat depression, can be effective for anxiety as well. Examples include imipramine (Tofranil) and clomipramine (Anafranil).
• Buspirone: An anxiolytic that can be used for chronic anxiety. It's less sedating than benzodiazepines and doesn't cause dependence.
• Beta-Blockers: Primarily used for cardiovascular issues, beta-blockers like propranolol (Inderal) can help control physical symptoms of anxiety, such as trembling and rapid heartbeat.
• Antipsychotics: At low doses, some antipsychotic drugs like quetiapine (Seroquel) can be used to augment the treatment of anxiety disorders.
• Hydroxyzine: An antihistamine that can be used for short-term management of anxiety.
• Pregabalin (Lyrica) and Gabapentin (Neurontin): Originally developed to treat epilepsy, they also help to relieve anxiety in some people.
• Monoamine Oxidase Inhibitors (MAOIs): These include options such as phenelzine (Nardil), but MAOIs are less commonly used due to significant dietary restrictions and potential side effects but can be effective for some anxiety disorders.

 
Keep in mind that there is not a one-size-fits-all medication solution and, if a patient has co-occurring disorders, some of these medications might not be the best match. Additionally, many of these medications take time to work and with some medications, you cannot simply quit taking the medication at any given time but will need to taper on and off the medicine.
 
It is also crucial that you let your doctor know about any other medications and supplements you take, including any recreational drugs that may or may not be legal. Your doctor truly needs to understand all of the substances you use to find the best possible options for your needs. Keep in mind, if you are struggling with substance abuse, your anxiety psychiatrist often can provide you with the services of an addiction psychiatrist, as well, if that is an issue.
 
Psychotherapy Techniques
A psychiatrist for anxiety can provide you with a diagnosis and provide you with prescriptions for medication management, but these professionals usually don’t also provide you with psychotherapy or talk therapy. A therapist or psychologist is the professional you will need to contact for these services. Here are just a few types of therapy that could be beneficial to treat anxiety disorders as well as many other mental health issues.
 
Cognitive-Behavioral Therapy (CBT): CBT is highly effective for anxiety disorders and focuses on identifying, understanding, and changing thinking and behavior patterns. Techniques often include exposure therapy to gradually face feared situations in a controlled manner.
 
Exposure Therapy: A subset of CBT, this involves systematic exposure to the source of fear in a safe and controlled environment, which can help reduce the anxious response over time.
 
Dialectical Behavior Therapy (DBT): Initially developed for borderline personality disorder, DBT has been adapted for other conditions including anxiety, focusing on skills like mindfulness, distress tolerance, and emotion regulation.
 
Acceptance and Commitment Therapy (ACT): ACT helps patients accept their thoughts and feelings rather than fighting or feeling guilty for them. It encourages commitment to actions that enrich one’s life.
 
Alternative Treatment Options
While the aforementioned medications and therapy options have been utilized for many years, there are also some alternative treatment options to consider. In many cases, you might mix one of these treatments with talk therapy and/or medication to provide you with the best possible outcome.
 
Eye Movement Desensitization and Reprocessing (EMDR): This originally was designed to treat PTSD, but EMDR has been found to help with anxiety by changing the way negative memories are stored in the brain. 
 
Esketatmine: Ketamine is a drug that, for many years, served primarily as an anesthetic. However, in the last few years, this drug has been used to help those with treatment-resistant depression. Ketamine is not FDA-approved for the treatment of depression, although it is still utilized as an alternative treatment. It is imperative that ketamine be used only in a medical setting by trained medical professionals.
 
Esketamine, is a form of ketamine that is administered as a nasal spray. This option is FDA-approved for those with treatment-resistant depression. However, there is some evidence to suggest that this drug can be used to treat anxiety, OCD and other mental health conditions.
 
Exercise & Yoga: Exercise can be beneficial for anyone with a mental health condition. Regular physical activity has been shown to improve mood and reduce symptoms of anxiety due to the release of endorphins. Yoga, because it combines breathing exercises and medication, can be particularly beneficial.
 
Mindfulness & Meditation: These practices focus on present-moment awareness and have been shown to reduce symptoms of anxiety and stress. In addition to anxiety, meditation can be beneficial for many other mental health disorders including depression and ADHD.
 
Biofeedback: This therapy method teaches control over certain bodily functions, such as heart rate and breathing as well as promoting relaxation.
 
Again, a combination approach is typically the best course of action, and it can take time to find the best treatments and the best doctors and therapists to suit your individual needs.
 
Contact Dr. Jesalva Today!
If you need an anxiety psychiatrist, this is one of my areas of specialization. As a local psychiatrist, I provide in-person care as a psychiatrist in Westlake Village, Thousand Oaks and the surrounding areas. However, if you live outside that area or simply prefer to use an online psychiatrist, I also provide telepsychiatry services. In addition to treating anxiety, I also treat bipolar disorder, depression, ADHD, eating disorders, PTSD and more, and I can provide you with a diagnosis and treatment plan that drastically improves the quality of your life.

It is estimated that as much as 9% of the U.S. population suffers from some form of eating disorder and sadly more than 10,000 people die each year from these disorders. While these statistics are alarming, the good news is that with proper treatment, one can recover from an eating disorder. It’s not easy, but with the help of a qualified eating disorder doctor, there is hope for a brighter, healthier future. 
 
Finding an eating disorder psychiatrist or therapist can be tricky, but before we provide some tips to help you find the best doctor for your needs let’s discuss some facts and myths about eating disorders in general.
 
Types Of Eating Disorders
The American Psychiatric Association recognizes several different eating disorders in its Diagnostic and Statistical Manual of Mental Disorders (DSM-5). With all of these disorders, the patient is afflicted by distressing thoughts regarding food and body image and, of course, eating behaviors also are affected severely. Here’s a quick summary of each type of eating disorder recognized in the DSM-5.
 
Anorexia Nervosa
Anorexia nervosa is a serious and potentially life-threatening eating disorder characterized by self-starvation, an intense fear of gaining weight, and a distorted body image. This disorder is characterized by the following:
 

1. Restriction of Food Intake: Persistent restriction of energy intake leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. The individual's weight is markedly below the minimum expected or, for children and adolescents, minimally expected for their age and height.
   
2. Intense Fear of Gaining Weight: Intense fear of gaining weight or becoming fat, even though underweight. This fear may persist, and the individual will continue to restrict food despite significant weight loss. 
3. Distorted Body Image: Disturbance in the way one's body weight or shape is experienced, undue influence of body shape and weight on self-worth, or persistent lack of recognition of the seriousness of the current low body weight. The individual may perceive themselves as overweight even if they are underweight.

 
Anorexia Nervosa Subtypes

• Restricting Type: Weight loss is achieved primarily through dieting, fasting, or excessive exercise. Individuals with this subtype do not engage in regular binge-eating or purging behavior.

 

• Binge-Eating/Purging Type: The individual engages in regular binge-eating or purging behaviors (i.e., self-induced vomiting or misuse of laxatives, diuretics, or enemas).

 
Physical & Psychological Complications of Anorexia:

• Cardiovascular complications, including bradycardia, hypotension, and arrhythmias.
• Osteoporosis or bone density loss.
• Gastrointestinal issues, such as constipation or gastroparesis.
• Endocrine disruptions, including amenorrhea (absence of menstruation) in females.
• Electrolyte imbalances, which can lead to severe complications, including cardiac arrest.
• Psychological issues, such as depression, anxiety, obsessive-compulsive behaviors, and social withdrawal.

 
Bulimia Nervosa
Bulimia nervosa is an eating disorder characterized by recurrent episodes of binge eating followed by inappropriate compensatory behaviors to prevent weight gain. This disorder is characterized by the following:
 

1. Recurrent Episodes of Binge Eating: An episode of binge eating is characterized by both of the following:​

• Eating, in a discrete period (e.g., within any 2 hours), an amount of food that is larger than most people would eat in a similar period under similar circumstances.
• A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).  
  

   2. Inappropriate Compensatory Behaviors: Recurrent inappropriate compensatory behaviors to prevent weight  gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise.
    3. Frequency: The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for three months.
   4. Self-Evaluation Influenced by Body Shape & Weight: Self-worth is excessively influenced by body shape and weight.
   5. Distinction from Anorexia Nervosa: The disturbance does not occur exclusively during episodes of anorexia nervosa.

Physical and Psychological Complications:

• Electrolyte imbalances – These can lead to cardiac arrhythmias and even cardiac arrest.
• Physical damage from vomiting, including tooth erosion, gum disease, and swelling of the salivary glands.
• Gastrointestinal issues, such as acid reflux or constipation.
• Psychological issues, including feelings of guilt, shame, anxiety, and depression.
• Risk of self-harm or suicidal ideation.

 
Binge Eating Disorder
While Binge Eating Disorder (BED) may seem similar to Bulimia Nervosa (BN) in that people with either disorder will engage in binge eating. However, with Binge Eating Disorder, the individual, while concerned with weight gain, does not engage in actions to restrict this weight gain, such as vomiting or using laxatives. This disorder is more common than BN and is characterized by:
 

1. Binge Eating Episodes: Just like BN, individuals with BED have recurrent episodes of binge eating where they consume a large amount of food and feel a lack of control.
   
2. No Regular Compensatory Behaviors: Unlike BN, individuals with BED do not regularly engage in inappropriate compensatory behaviors after binge eating. This is a key distinguishing feature.
3. Frequency: Binge eating episodes occur, on average, at least once a week for three months.
4. Associated Features: Binge-eating episodes are associated with at least three of the following:
   

• Eating much more rapidly than normal
• Eating until feeling uncomfortably full
• Eating large amounts when not feeling physically hungry
• Eating alone due to embarrassment
• Feeling disgusted, depressed, or guilty afterward

     5. Physical Consequences: Individuals with BED are at increased risk for obesity and related medical conditions,  such as heart disease and type 2 diabetes. 

Avoidant Restrictive Food Intake Disorder
Avoidant Restrictive Food Intake Disorder (ARFID), previously known as Selective Eating Disorder, is a relatively new diagnosis that was introduced in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). It's characterized by restrictive eating patterns that are not associated with concerns about body shape or weight. Here are some characteristics of this disorder:

     1. Restrictive Food Intake: An eating or feeding disturbance manifested by persistent failure to meet appropriate nutritional and/or energy needs, leading to one or more of the following:​

• Significant weight loss or failure to achieve expected weight gain in children.
• Significant nutritional deficiency.
• Dependence on enteral feeding or oral nutritional supplements.
• Marked interference with psychosocial functioning.

     2. Lack of Interest or Avoidance: The disturbance is not due to a lack of available food or cultural practices. It may be associated with:

• Lack of interest in eating or food
• Avoidance based on sensory characteristics of food
• Concerns about the consequences of eating (fear of choking, etc.

     3. Absence of Body Image Disturbance: The eating disturbance is not due to concerns about body weight or  shape, and the individual does not exhibit any behaviors or symptoms consistent with anorexia nervosa or bulimia nervosa.
    4. Not Attributable to Another Medical Condition: The eating disturbance cannot be better explained by another medical condition or mental disorder. 

Associated Features:
Individuals with ARFID might have a limited range of preferred foods and may be highly sensitive to the texture, smell, or taste of certain foods. The disorder can lead to social isolation, as individuals might avoid social situations involving food or may experience anxiety around meal times. Unlike other eating disorders, individuals with ARFID do not have a distorted body image and do not engage in behaviors to lose weight.
 
Rumination Disorder
Rumination Disorder is a feeding and eating disorder characterized by the repeated regurgitation of food, which may be re-chewed, re-swallowed, or spit out. This regurgitation is not due to a medical condition but is rather a repeated behavior that can be voluntary or involuntary. Here are some characteristics of this disorder:
 

1. Repeated Regurgitation: Repeated regurgitation of food for at least one month. Regurgitated food may be re-chewed, re-swallowed, or spit out.
2. Not Attributable to a Medical Condition: The behavior is not due to an associated gastrointestinal or other medical condition (e.g., gastroesophageal reflux). 
3. Not Exclusive to Anorexia, Bulimia, BED, or ARFID: The behavior does not occur exclusively during the course of anorexia nervosa, bulimia nervosa, binge-eating disorder, or avoidant/restrictive food intake disorder.
   
4. Developmentally Inappropriate: If the symptoms occur in the context of another mental disorder (e.g., autism spectrum disorder, intellectual disability, another neurodevelopmental disorder) or during a neurodevelopmental period, they must be severe enough to warrant clinical attention. 

What Causes Eating Disorders?
Eating disorders are complex and there’s no single reason why a person might develop an eating disorder. In some cases, it might be genetic, and if there is a family history of an eating disorder, one may be more likely to develop an eating disorder. For others, low self-esteem or dissatisfaction with their body might be the initial trigger and social and cultural pressures can have a huge impact on the development of eating disorders.
 
Others develop eating disorders as a result of a traumatic event, abuse or bullying. Sometimes a person in a dysfunctional relationship or a dysfunctional family can develop an eating disorder. There is no single reason why these disorders develop, and for each person, determining the root cause can be beneficial for recovery.
 
Signs A Loved One Has An Eating Disorder
While we typically think of eating disorders as afflicting young women, any person can develop an eating disorder at any age and from any walk of life. As with just about any mental or physical issue, early intervention is key, but what are some signs that loved ones should watch for? Here are a few signs that a person may have some type of eating disorder:
 
Behavioral and Emotional Signs:

• Preoccupation with Food: Constantly talking about food, dieting, counting calories, or reading about nutrition.
• Change in Eating Habits: Skipping meals, avoiding social events where food is involved, or adopting strict or unusual food rituals.
• Frequent Dieting: Especially without weight loss or with continued expressions of feeling "fat."
• Fear of Gaining Weight: Even if they are underweight.
• Frequent Checking: Constantly checking their body in the mirror, weighing themselves often, or measuring body parts.
• Mood Swings: Irritability, depression, or anxiety, especially around meal times.
• Withdrawal: Avoiding friends, family, and social events, often to hide their eating habits.

 
Physical Signs:

• Rapid Weight Loss or Gain: Fluctuations in weight without a clear medical cause.
• Stomach Complaints: Consistent complaints about constipation, stomachaches, or feeling cold.
• Menstrual Irregularities: Missed periods or irregular menstrual cycles.
• Dizziness or Fainting: Due to malnutrition or dehydration.
• Signs of Vomiting: Swollen cheeks, calluses on knuckles, or discolored teeth from frequent vomiting.

 
Other Signs To Watch For:

• Wearing Baggy Clothes: To hide weight loss or body shape.
• Secretive Behavior: Hiding food, eating in secret, or frequent trips to the bathroom after meals.
• Excessive Exercise: Engaging in intense, prolonged exercise, especially outside of regular training sessions or despite adverse weather conditions or injuries.
• Sleep Problems: Insomnia or changes in sleep patterns.
• Use of Laxatives or Diet Pills: Especially in secret or in large amounts.

 
Psychological, Emotional & Social Indicators:

• Increased Sensitivity: To comments or criticism about eating, weight, or body shape.
• Low Self-Esteem: Particularly if they base their self-worth on their body shape or weight.
• Feelings of Worthlessness: Or feelings of hopelessness, often accompanied by other signs of depression.
• Perfectionism: Setting high standards and being very critical of perceived mistakes.
• Avoiding Social Situations: Especially those involving food.
• Isolation: Withdrawing from friends, family, or activities they once enjoyed.

 
Choosing An Eating Disorder Doctor
If you suffer from any of these eating disorders, finding an eating disorder psychiatrist can be a good place to start. A psychiatrist is both a medical doctor and a mental health professional, which means that this type of doctor can diagnose both your eating disorder as well as any physical conditions that might be contributing to the disorder or caused by the eating disorder.
 
Many people with eating disorders also suffer from co-occurring disorders such as anxiety or depression, and a psychiatrist can provide you with expert care and a complete diagnosis that includes all of your physical and mental health conditions. An eating disorder psychiatrist also can create a treatment plan, that may or may not include medications, but will address all of the issues you are facing, including co-occurring disorders.
 
Typically, the treatment for eating disorders is intense psychotherapy. This might include cognitive-behavioral therapy and nutritional rehabilitation. Sometimes medications such as antidepressants also can be an effective tool for patients, and an eating disorder psychiatrist is the only mental health professional who can provide you with a prescription for these medications.
 
The best approach is to find both an eating disorder psychiatrist and a psychologist or therapist who provides care for those with eating disorders. The therapist or psychologist can provide you with talk therapy and other types of therapy to help aid in your recovery.
 
Talking with a nutritionist also can be an excellent idea, especially one that specializes in the treatment of eating disorders. Sometimes joining a support group also can be beneficial. In severe cases, it can be wise to seek long-term care in an inpatient or intensive outpatient eating disorder program.
 
In some cases, patients will be limited to finding eating disorder doctors that are covered by their insurance. If this is not an issue or you can submit an out-of-network doctor bill to your insurance provider, you have a bit more flexibility. This allows you to meet with multiple doctors and find a provider that truly seems to fit your needs and comfort level.
 
If you find that a provider makes you feel uncomfortable, I highly recommend searching for a new doctor. It can take time to find the best fit, but when you have an excellent support team, your journey toward recovery will be more successful.
 
As an experienced eating disorder psychiatrist, I offer both in-person treatment and treatment via telepsychiatry. Using a virtual psychiatrist can be a great option to consider because it expands your options beyond your local area and allows you to find the best possible match.
 
An online psychiatrist or therapist also can meet with you from anywhere you have an internet connection, which means you don’t necessarily have to skip appointments if you are out of town or perhaps not feeling well enough to attend in-person meetings. I can meet with patients either virtually or in person, or a combination of the two, depending on their needs.
 
Contact Our Office Today
Eating disorders take a huge toll on your mental and physical health, but there is hope and treatment can be successful. Millions of people have courageously and successfully recovered from eating disorders and live happier, healthier lives. The path might not always be easy, but your journey to wellness can be successful. If you need an eating disorder psychiatrist, please don’t hesitate to give us a call and set up an initial consultation.

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.
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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!