Danovitch told CBS LA Mornings co-hosts Jamie Yuccas and Sheba Turk that eating disorders such as anorexia and binge eating are marked by inflexible patterns of eating, distress and, often, distortions in body image. Repeated exposure to cultural messages and images contributes to these conditions.

Eating disorders in men have long been underrecognized, he said, though men account for about a third of cases. Rates are now increasing more quickly among men than among women, which Danovitch attributed to cultural pressures around muscularity and appearance.

“We are in an environment where we’re constantly presented with images that are unrealistic of what’s attainable about one’s body,” he said. “We are constantly confronted with platforms, like social media, that cause us to appraise and assess our own appearance and compare it to unrealistic representations.”

Danovitch cautioned against making assumptions about someone’s health based on appearance. When asked how to address concerns about a loved one’s health, he encouraged a direct, caring approach.

“The best thing to do is to directly express your concern: ‘I’m worried about you. I’ve noticed there’s been a change in your behavior,’” he said. He recommended asking questions rather than making judgments because judgments can cause a person to become defensive.

Danovitch added that changing behavior is rarely immediate.

“It’s a marathon,” he told Yuccas and Turk, noting that the most effective approach is to express concern consistently over time and encourage a loved one to see a doctor.

Watch the complete segment from CBS 2.

More than a quarter of U.S. adults say they are estranged from at least one close relative, and “going no-contact” with family members is a phrase heard more often these days. Whether more people are distancing themselves from family—or simply more comfortable talking about it—is unclear.

What is clear, said Itai Danovitch, MD, chair of the Department of Psychiatry and Behavioral Neurosciences at Cedars-Sinai, is that loneliness is a growing health problem, and the holidays can intensify feelings of depression and isolation.

“There are many causes of loneliness, but certainly one of the most significant emerging causes is our physical disconnection and increasing reliance on technology to communicate with each other,” Danovitch said. “We evolved to be a highly social species with the capacity to form personal relationships, families, tribes and communities. Some of the most remarkable distinctions of the human brain are those that help us understand one another, imagine another person’s perspective, and empathically share their feelings.

“But we’ve seen an unraveling of the social structures that have always anchored us, and particularly during times of need, that has left many of us feeling alone and disconnected.”

These dynamics create a host of challenges and difficult emotions that commonly surface during the holidays, when relationships, family and community are front and center.

The Cedars-Sinai Newsroom spoke with Danovitch about ways to cope with loneliness and estrangement during the holiday season, as well as how to build meaningful and healthy connections.

Why do people feel lonelier or depressed during the holidays? 

There are several reasons. Loneliness and isolation are amplified during the holidays if people are already experiencing a sense of separation from their families of origin or the social pain of loneliness. Even people who are not estranged from their families—but who may not live close by or aren’t accustomed to spending time together—can suddenly feel overwhelmed by dynamics that resurface as if no time has passed, although one person is now an adult and another a grandparent. Another contributor to holiday depression or loneliness is expectations. People bring personal ideas about what the holidays should look like, and those expectations often carry emotional weight—and often don’t align with reality.

How can people cope when there is family estrangement or spending time together is difficult?

When it comes to family dynamics, relationships are messy. Families are messy. It’s valuable to be aware of challenging dynamics and to bring patience and grace to any interactions. Take a deep breath and feel compassion and forgiveness if you feel like you're not being your best self. If you suddenly slip back into the 13-year-old version of yourself, give yourself a break. Give your family a break. Also, know that you can't solve everything over one holiday. Developing better or more fulfilling relationships with family takes effort and time. Lean into relationships and approach engagement and connecting in a way that feels appropriate for the situation and the individuals.

For mental wellbeing, is it OK to maintain boundaries with family during the holidays?

There's no right or wrong answer. Boundaries are individualized, and I wouldn’t judge the reason somebody does or doesn't want to spend time with their family—or whether they remain estranged. That's for them to decide. But I think it's helpful to be honest and accepting of our decisions on how to handle the tradeoffs we make. Self-acceptance and self-compassion are an important foundation for everything else.

How can people cope if they don’t have family to spend the holidays with?

Foster connections within the community and the people around you—friends, neighbors, or groups who share an interest that’s important to you. Think about participating in a food kitchen or a beach cleanup, or volunteer with an animal shelter or in supportive services for kids. Spend time outdoors or reach out to your neighbors. Consider what interests you, what moves you, and how you can find others who share those interests. These connections are crucial for mental health. 

What are healthy ways to manage holiday stress—say, social anxiety or discomfort during holiday gatherings?

Social anxiety is one of the most common types of anxiety, and meeting new people is one of the most stressful things people do. Part of what makes us anxious is the feeling that we're being judged, so we're prone to worrying about coming across the right way. When you're in a group and somebody is new, be gracious and include them. It goes a long way. For people worried about falling into old habits with their family, consider intentional activities. Some families come together and talk, and then conversation drifts toward points of conflict—like politics or religion. Redirect with a board game, a movie or a group hike. It’s time together that matters.

Read more on the Cedars-Sinai Blog: Social Anxiety—How to Navigate the Holiday Season

The multi-institutional study was published in the peer-reviewed journal JAMA Internal Medicine.

The addiction consultation service, called the Substance Use Treatment and Recovery Team (START), pairs experts in addiction treatment: a physician with a social worker or case manager. The team provides each patient with diagnostic assessments, recommendations for treatments, psychosocial support, connections to post-hospital medical care and follow-up telephone calls for one month.

“Our program addresses a major challenge across hospitals,” said Itai Danovitch, MD, chair of the Department of Psychiatry and Behavioral Neurosciences at Cedars-Sinai and senior author of the study. “Even though effective medications exist for opioid use disorders, only a small percentage of hospitalized patients begin treatment during their stay or connect with services after discharge.”

Danovitch, START lead principal investigator, said the service offers a supportive, patient-centered intervention that reduces stigma, promotes engagement and increases access to both treatment and follow-up services.

The co-led study was done in collaboration with RAND and conducted from 2021 through 2023 at three geographically distinct U.S. hospitals: Cedars-Sinai in Los Angeles; University of New Mexico Hospital in Albuquerque, New Mexico; and Baystate Medical Center in Springfield, Massachusetts.

The study included 325 hospitalized patients 18 or older who had a probable diagnosis of opioid use disorder. Of the patients enrolled,164 were randomly assigned to the START program while 161 received the usual hospital care.

The data shows that 57.3% of the START patients began medication treatment for opioid use disorder while in the hospital compared with 26.7% of the patients in the usual care group. Additionally, the study showed that 72% of the START patients accessed follow-up care within 30 days after discharge from the hospital compared with 48.1% of the control group.

Prior studies have shown that addiction consultation services are associated with improvements in care and outcomes, but this new study was the first multisite, randomized, controlled trial to compare the effects of such services to usual care, Danovitch said.

Opioid use disorder is a persistent problem. Nearly 80,000 people died from opioid overdoses in the U.S. in 2023, according to the U.S. Centers for Disease Control and Prevention. Between 2002 and 2018, hospital admissions for opioid use disorder rose significantly—from nearly 302,000 to nearly 942,000.

“Hospitalization provides a crucial window to involve patients in addiction treatment when they might be most open to it, particularly after experiencing health-related consequences of their substance use,” said Jeffrey A. Golden, MD,  director of the Burns and Allen Research Institute and executive vice dean for Research and Education at Cedars-Sinai. “These important findings show how the medical community can significantly boost this engagement and help find solutions for the national opioid epidemic.”

Other Cedars-Sinai authors include: Mia W. Mazer, BSc; Teryl Nuckols, MD, MSHS; and Waguih William IsHak, MD.

Other authors include: Allison J. Ober, PhD; Cristina Murray-Krezan, PhD; Kimberly Page, PhD; Peter D. Friedmann, MD, MPH; Jess Anderson, MS; Karen Chan Osilla, PhD; Stephen Ryzewicz, MD; Sergio Huerta, MD: Randall A. Hoskinson, MA; Richard Garvey, MA; Alexandra Peltz, BA; Katherine E. Watkins, MD, MSHS; and Louis T. Mariano, PhD.

Funding: Support for the study was provided by the National Center for Advancing Translational Sciences and National Institute on Drug Abuse, both parts of the National Institutes of Health, under grant award number U01TR002756-01A1. This content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Cedars-Sinai Health Sciences University is advancing groundbreaking research and educating future leaders in medicine, biomedical sciences and allied health sciences. Learn more about the university.

Heart failure affects nearly 6 million adults in the United States, and approximately 50% of heart failure patients experience symptoms of depression along with their condition. Past studies show patients with heart failure and depression have lower cardiac function, more emergency department visits and hospital admissions, higher caregiver burden, and poorer quality of life compared with patients with heart failure who are not depressed.

“The most important finding here is that patients experiencing depression have a choice in terms of their treatment between therapy or medications,” said Waguih W. IsHak, MD, vice chair of Education and Research in the Department of Psychiatry and Behavioral Neurosciences at Cedars-Sinai and first author of the study. “Patients who prefer not to be on medication can do behavioral activation therapy with similar results.”

The study, which was published in the peer-reviewed journal JAMA Network Open, followed more than 400 patients over the course of a year. Half of the study participants received antidepressant medication management to treat depression symptoms while the other half participated in behavioral activation psychotherapy, an evidence-based treatment for depression that promotes engagement in activities a patient finds enjoyable. 

The research was done in close collaboration with the Smidt Heart Institute at Cedars-Sinai, and its heart failure program led by Michele Hamilton, MD, vice chair of the Department of Cardiology in the Smidt Heart Institute and co-author of the study.

Investigators say there was no statistically significant difference between the effectiveness of the two methods, with each patient group experiencing a more than 50% reduction in the severity of depressive symptoms.

Study participants randomized to receive behavioral activation therapy worked with a therapist to develop a personalized list of activities that bring them joy and fulfillment, including having lunch with a friend, taking a walk, volunteering, listening to their favorite music—among other options—on a regularly scheduled basis. The treatment focused on increasing the level of enjoyable and rewarding activities the patient was doing every week for 12 weeks, and then incorporating them into their regular activity schedule.

Patients who received psychotherapy intervention showed a slight improvement in their physical and mental health-related quality of life, a secondary outcome monitored by the study. They also had fewer emergency department visits and spent fewer days hospitalized during the course of the study compared with the patients who were randomized to receive antidepressant medications.

“This study, which was conducted in a real-world setting, demonstrates that it is entirely feasible to incorporate psychiatric treatment into specialty medical care. Integrating psychiatric treatment into medical care is an effective way to reduce stigma, increase access and improve outcomes for people who struggle with mental health problems alongside their chronic medical conditions,” said Itai Danovitch, MD, MBA, chair of the Department of Psychiatry and Behavioral Neurosciences and a study co-author. “Most people who suffer from depression do not receive effective treatment. It is critical that we increase screening for psychiatric conditions and ensure that patients have access to high-quality and effective mental health care.”

Other Cedars-Sinai authors involved in the study are Michele A. Hamilton, MD; Samuel Korouri, BA; Marcio A. Diniz, PhD; James Mirocha, MS; Rebecca Hedrick, MD; Robert Chernoff, PhD; Jeanne T. Black, PhD; Harriet Aronow, PhD; Brigitte Vanle, MD, PhD; Jonathan Dang, MD; Gabriel Edwards, MD; Tarneem Darwish, MD; Gabrielle Messineo, LCSW; Stacy Collier, RN; Mia Pasini, RN; John G. Harold, MD; and Brennan Spiegel, MD, MSHS. Additional authors include Kaleab K. Tessema, MD, PhD; Michael K. Ong, MD; and Kenneth Wells, MD.

Funding: The study by was funded by the Patient-Centered Outcome Research Institute (PCORI) (award No.: 2017C2-7716; paid to Cedars-Sinai Medical Center).

Read more from the Cedars-Sinai Blog: Living With Heart Failure