Dr. Marianne-Land: An Eating Disorder Recovery Podcast

If you have ADHD and struggle with bulimia or binge eating, it may not be about willpower at all. It may be about dopamine, impulsivity, and a nervous system that has been trying to regulate itself the only way it knows how. In this episode of the podcast, I sit down with psychiatric nurse practitioner Kirsten Book to unpack the often-missed connection between ADHD and eating disorders. We move beyond surface-level explanations and into what is actually happening in the brain, including how dopamine dysregulation, executive functioning challenges, and emotional intensity can drive patterns of bingeing, restricting, and purging. ADHD and Bulimia: The Dopamine Connection Kirsten shares her lived experience of recovering from bulimia and being diagnosed with ADHD later in life. She describes how starting ADHD treatment shifted everything. Instead of feeling constantly out of control, she experienced something many people with ADHD and eating disorders rarely feel, which is a pause. A moment to decide what to do next. That shift in impulsivity and regulation can be a turning point in recovery. We break down how ADHD affects dopamine regulation and why the brain begins to seek out stimulation through food. Binge eating, restriction, and purging can all increase dopamine in the short term, which reinforces these patterns even when they create long-term distress. Why ADHD Gets Missed in Eating Disorders Many people, especially girls and women, are never screened for ADHD. Instead, they are diagnosed with anxiety or depression. This episode explores how untreated ADHD can show up as emotional dysregulation, difficulty focusing, chaotic eating patterns, and a constant sense of being overwhelmed. Kirsten explains why comprehensive screening matters and how identifying ADHD can completely change the direction of treatment. When ADHD is addressed directly, many people experience a reduction in binge eating urges and a greater sense of stability with food. Executive Function, Impulsivity, and Eating Patterns ADHD affects the brain's executive functioning, including planning, organization, and follow-through. This makes consistent eating much harder than it looks from the outside. Skipped meals, irregular eating, and impulsive food choices are not random. They are connected to how the brain manages energy, attention, and motivation. We also talk about interoception and why people with ADHD may feel disconnected from hunger and fullness cues. This disconnection can lead to both undereating and overeating, creating cycles that feel confusing and hard to interrupt. The Role of Dopamine in Binge Eating and Restriction This episode offers a clear explanation of how different eating disorder behaviors interact with dopamine. Binge eating and highly palatable foods can create a surge in dopamine, reinforcing cravings and compulsive eating. Restriction can also increase dopamine in a different way, which helps explain why it can feel rewarding even when it is harmful. Over time, these patterns can change how the brain responds to reward, making it harder to feel regulated without them. Understanding this helps reduce shame and opens the door to more effective, targeted support. ADHD Treatment and Eating Disorder Recovery We talk through how psychiatric medications can support both ADHD and eating disorder recovery. This includes the role of stimulants, SSRIs, and other medications in improving impulse control, emotional regulation, and the ability to follow through with consistent eating. Kirsten also addresses common concerns about medication, especially for parents. She emphasizes the importance of asking questions, understanding risks and benefits, and approaching treatment with openness rather than fear. Medication is not the only tool, but for many people, it creates the stability needed to fully engage in recovery. This Is Not About Willpower If your eating feels chaotic, impulsive, or out of control, there may be more going on beneath the surface. ADHD changes how the brain processes reward, attention, and regulation. When that is not understood, eating disorder behaviors can become a way to cope. You deserve support that looks at the full picture, including your brain, your nervous system, and the ways you have learned to get through the day. Connect With Kirsten Book, PMHNP-BC Kirsten Book is a dual-certified psychiatric mental health nurse practitioner and family nurse practitioner who specializes in working with children, adolescents, and adults navigating eating disorders, ADHD, anxiety, and depression. You can learn more about her work and concierge psychiatric services at her website. She is licensed in California, Illinois, Arizona, and Washington. She is also active on Instagram, Facebook, and LinkedIn. The best way to reach her directly is via email at Apple & Spotify “Stuck” Isn't Lazy: Inertia in ADHD, Autism, & Eating Disorder Recovery With Stacie Fanelli, LCSW on Apple & Spotify. Autism & Eating Challenges: Understanding Sensory Needs, Routines, & Safety on Apple & Spotify. Eating Disorders & ADHD: Neurodivergent-Affirming Recovery With Taylor Ashley, RP @taylorashleytherapy on Apple & Spotify. Work With Dr. Marianne If you are looking for eating disorder support that integrates neurodivergent-affirming care, I offer therapy and coaching for ARFID, binge eating disorder, anorexia, and bulimia. I work with clients across California and Washington, D.C., as well as offer coaching more broadly in the U.S. and worldwide. My approach focuses on sensory needs, nervous system regulation, executive functioning, and building sustainable eating patterns that actually work for your life. You can visit my website drmariannemiller.com to learn more about working with me and explore current offerings, including therapy, coaching, and self-paced programs. Share This Episode on Bulimia and ADHD If this episode resonated with you, share it with someone who needs to hear it and follow the podcast so you do not miss upcoming episodes on ADHD, ARFID, binge eating, and neurodivergent-affirming recovery.

If you feel stuck in constant body checking, repeatedly scanning, measuring, or monitoring your body throughout the day, you are not alone and there is a real reason this pattern is so hard to break. Body checking is not about vanity or lack of willpower. It is a nervous system response shaped by anxiety, eating disorders, sensory processing, and a culture that teaches you to constantly evaluate your body. In this episode, we unpack why body checking becomes compulsive, how it connects to eating disorders, anxiety, and autism, and what actually helps when trying to reduce body monitoring behaviors in a sustainable, neurodivergent-affirming way. If you have ever wondered why you cannot stop checking your body, even when it increases distress, this episode offers a deeper, more compassionate framework for understanding what is really happening. What Is Body Checking? (Eating Disorders & Body Image) Body checking includes behaviors like mirror checking, weighing yourself frequently, comparing your body to others, scanning how your clothes fit, or mentally monitoring body size and shape throughout the day. These patterns are strongly linked to eating disorders such as anorexia, bulimia, binge eating disorder, and ARFID, and they often reinforce body image distress and food-related anxiety. Rather than helping you feel more in control, body checking tends to increase preoccupation with the body over time, creating a cycle that is difficult to interrupt. Why Body Checking Feels So Hard to Stop (Anxiety & Control) Body checking is deeply tied to anxiety and the need for certainty. When the nervous system feels overwhelmed, the brain looks for something to track and control. The body becomes that focus because it is always accessible. Even though body checking may briefly reduce anxiety, it reinforces the cycle long term. The more you check, the more your brain learns that checking is necessary to feel okay. This is why stopping body checking is not about discipline. It is about understanding the anxiety-body checking loop and finding other ways to create safety. Body Checking in Autism & Neurodivergence (Sensory & Interoception) For autistic individuals and other neurodivergent people, body checking can serve additional functions related to sensory processing and interoception. Internal body signals may feel unclear or inconsistent, which can lead to relying on external cues like mirrors, touch, or clothing fit to understand what is happening in the body. At the same time, heightened sensory awareness and pattern recognition can increase focus on subtle body changes. This makes body checking not just about body image, but also about making sense of sensory experiences in a body that may feel unpredictable. The Hidden Cycle of Body Checking & Eating Disorders Body checking creates a reinforcing loop. Anxiety increases the urge to check. Checking temporarily reduces distress. The relief fades. The urge returns stronger. Over time, this cycle strengthens eating disorder behaviors, body image distress, and compulsive monitoring. Understanding this cycle is key to shifting your relationship with body checking. The goal is not immediate elimination, but gradual change that reduces intensity and frequency. What Actually Helps: Neurodivergent-Affirming Strategies Reducing body checking requires a different approach than simply trying to stop. In this episode, we explore harm reduction strategies that support long-term change. We talk about identifying the function of body checking, building alternative ways to regulate anxiety, and using sensory supports that actually work for your nervous system. We also explore how to gently reduce checking behaviors without increasing distress, and how to shift from constant body monitoring toward a more flexible and compassionate relationship with your body. A Liberation-Based Approach to Body Image & Recovery Body checking does not exist in isolation. It is shaped by diet culture, weight stigma, and systemic pressure to monitor and control bodies. Recovery is not about perfect body acceptance or never noticing your body again. It is about moving from surveillance to relationship. This episode offers a neurodivergent-affirming, harm reduction approach to body checking that centers curiosity, flexibility, and sustainability rather than rigid rules. Related Episodes Autism, ADHD, & Eating Disorders: Recovery, Sensory Needs, & Late Diagnosis With Margo White, CPN @margo_wholebodynutrition on Apple & Spotify. “Stuck” Isn't Lazy: Inertia in ADHD, Autism, & Eating Disorder Recovery With Stacie Fanelli, LCSW on Apple & Spotify. Autism & Eating Challenges: Understanding Sensory Needs, Routines, & Safety on Apple & Spotify. Eating Disorders & ADHD: Neurodivergent-Affirming Recovery With Taylor Ashley, RP @taylorashleytherapy on Apple & Spotify. Work With Dr. Marianne If you are struggling with body checking, eating disorders, ARFID, binge eating, or anxiety around food and your body, you do not have to navigate this alone. I offer therapy and coaching with a neurodivergent-affirming, liberation-focused approach. Learn more about working with me at https://www.drmariannemiller.com

What if eating disorder recovery didn't have to be all-or-nothing to be real, valid, and life-changing? If traditional eating disorder recovery models have ever felt too rigid, too fast, or disconnected from your real life, this episode offers a different way forward. In this solo episode, I explore how harm reduction for eating disorders creates space for sustainable, real-world healing, and why lived experience is essential for shaping recovery that actually works. This conversation is especially important for people navigating long-term eating disorders, neurodivergence, chronic stress, and systems that make access to care more complicated. What Is Harm Reduction in Eating Disorder Recovery? Harm reduction in eating disorder recovery shifts the focus away from perfection and toward safety, stability, and sustainability. Instead of asking how to eliminate every behavior immediately, this approach asks how to reduce harm, support the body, and create change that is actually possible in the context of your life. This includes working with capacity, honoring sensory needs, and building consistency in ways that feel accessible rather than overwhelming. Why Lived Experience Matters in Eating Disorder Recovery Lived experience in eating disorder recovery refers to the knowledge that comes from actually living through an eating disorder. This concept has roots in phenomenology and has been shaped by mental health and disability advocacy movements that center the voices of those most impacted. When lived experience is included in recovery spaces, it brings nuance, context, and practical insight that cannot be captured through clinical knowledge alone. How Lived Experience Strengthens Harm Reduction Approaches When lived experience is centered, harm reduction becomes more grounded and responsive. It reflects how people actually navigate food, body, and daily life. It allows for strategies that support executive functioning, sensory preferences, and fluctuating capacity. It also acknowledges the role eating disorder behaviors can play in coping with distress, rather than ignoring their function. Eating Disorders, Intersectionality, and Real-Life Barriers Eating disorder recovery does not happen in a vacuum. Factors like weight stigma, racism, ableism, financial barriers, and access to care all shape what recovery can realistically look like. A harm reduction approach informed by lived experience takes these realities seriously and creates space for recovery that is flexible, inclusive, and grounded in the context of people's lives. Long-Term Eating Disorders and Non-Linear Recovery For many people, eating disorders are long-term and symptoms can shift over time depending on stress, life transitions, and health changes. Harm reduction supports this reality by allowing recovery to evolve, rather than forcing a fixed endpoint. This includes focusing on reducing risk, maintaining stability, and supporting the body across different phases of life. Expanding What Recovery Can Look Like Recovery does not have to be defined by perfection or full symptom elimination to be meaningful. It can include small, sustainable shifts that support your body and your life. Harm reduction creates space for multiple pathways to recovery, especially for those who have felt excluded from traditional models. Related Episodes Harm Reduction for Long-Term Eating Disorders: Peer Support, Healing, & Hope With Johanna Scoglio, M.Ed., M.B.A. on Apple and Spotify. Understanding Harm Reduction: Why "Full Recovery" May Not Be the Goal for Lifelong Eating Disorders on Apple and Spotify. Orthorexia, Quasi-Recovery, & Lifelong Eating Disorder Struggles with Dr. Lara Zibarras @drlarazib on Apple & Spotify. Navigating a Long-Term Eating Disorder on Apple & Spotify. Work With Dr. Marianne If you are looking for eating disorder therapy or coaching that centers lived experience, neurodivergence, and harm reduction, I offer support that is grounded in real-world sustainability. You can learn more about working with me at my website, drmariannemiller.com.

Eating disorders in midlife are increasing, yet they are often missed, misunderstood, or dismissed as “normal” aging concerns. During midlife, many people notice a sudden intensification of food struggles, body dissatisfaction, and eating disorder symptoms such as restriction, binge eating, or food anxiety. This is not random. It is the result of a powerful intersection between ageism, diet culture, and midlife body changes. In this episode, I sit down with Deb Benfield, RDN (@agingbodyliberation), to break down why eating disorders can become more complex during midlife and how pressure to stay thin and young directly fuels disordered eating patterns and recovery challenges. Ageism, Body Image, & Diet Culture in Midlife Ageism and diet culture work together to shape body image and eating behaviors in midlife. During this stage of life, messaging around anti-aging, weight loss, and “fixing” your body becomes louder and more targeted. Cultural narratives reinforce that thinness and youth equal worth, increasing body dissatisfaction and pressure to control food, weight, and appearance. During this conversation, we explore how diet culture does not fade with age. It adapts. Wellness culture, anti-aging industries, and weight-focused health messaging continue to position the body as a problem. This environment can intensify eating disorder symptoms, especially for those with a history of dieting, binge eating, restriction, or ARFID. Midlife Body Changes, Menopause & Eating Disorder Triggers Midlife body changes, including perimenopause and menopause, can act as major triggers for eating disorders. Hormonal shifts, metabolism changes, and body composition changes often occur outside of personal control, which can feel destabilizing and distressing. During midlife, messaging about menopause, weight gain, and “optimal health” often promotes restriction, rigid eating rules, and increased exercise. These approaches can worsen eating disorder symptoms and create more disconnection from hunger, fullness, and body cues. We discuss how these pressures contribute to food anxiety, body monitoring, and difficulty trusting your body during eating disorder recovery. The Pressure to Stay Thin & Young in Midlife The pressure to stay thin and young intensifies during midlife and is reinforced through diet culture, wellness culture, and anti-aging messaging. From weight loss interventions to GLP-1 medications to strict health routines, the message is clear: your body must be controlled to remain acceptable. Deb invites us to ask a critical question: who benefits from your fear of aging and body change? When fear drives behavior, it becomes easier to stay stuck in cycles of restriction, binge eating, or compulsive movement. This section explores how fear-based messaging disrupts body trust and reinforces eating disorder patterns. Body Image, Identity & Eating Disorders in Midlife Body image in midlife is deeply connected to identity, belonging, and perceived social value. During this stage, changes in appearance can feel like a loss of visibility or relevance in a culture that prioritizes youth and thinness. This can lead to increased body monitoring, comparison, and attempts to control weight or shape. We also explore how intersectionality shapes eating disorder experiences. Factors such as race, body size, disability, gender identity, and neurodivergence can amplify pressure and marginalization. Eating disorders in midlife are influenced by these broader systems, which affect access to care, safety, and support. Eating Disorder Recovery in Midlife: Rebuilding Body Trust Eating disorder recovery in midlife is not about returning to a previous version of your body. It is about building a new relationship with your body that is rooted in trust, nourishment, and care. Deb shares how recovery can include untangling internalized ageism, challenging diet culture beliefs, and reconnecting with hunger, fullness, and rest. Creating a sense of safety in the body is essential, especially during a time when cultural messaging promotes undernourishment and overexertion. Recovery in midlife can support greater flexibility, connection, and sustainability in your relationship with food. A More Expansive Approach to Aging, Body Image & Body Diversity During this episode, we explore the limitations of pro-aging and body image spaces that still center thin, white, able-bodied bodies. Expanding the definition of beauty and embracing body diversity across ages is essential for meaningful eating disorder recovery. Midlife can offer an opportunity to reconnect with your values, shift away from body control, and move toward a more expansive understanding of yourself. Aging does not have to be something to fight. It can create space for clarity, autonomy, and deeper connection. Key Takeaway Your body is not the project of your life. Your body is your partner. Eating disorder recovery in midlife can include more trust, flexibility, and freedom. Connect and With Deb Benfield, RDN You can connect with Deb Benfield on Instagram at @agingbodyliberation,  or her website at debrabenfield.com, where she shares insights on ageism, body image, eating disorder recovery, and body liberation in midlife. Her work focuses on helping people reconnect with their bodies, challenge diet culture, and navigate aging with more compassion and autonomy. You can also check out her book, Unapologetic Aging. Related Episodes Restrictive Eating in Midlife: Why Eating Disorders Can Begin After 30, 40, 50 on Apple & Spotify Anorexia & Bulimia After 40: Understanding Midlife Recovery & Change on Apple & Spotify. The Hidden Pain of Midlife Anorexia: Why Coping Breaks Down & What Heals on Apple & Spotify. Why Is Anorexia Showing Up Again in Midlife? You're Not Imagining It on Apple & Spotify. Midlife Bulimia Recovery: Coping With the Internal Chaos on Apple & Spotify. Work With Dr. Marianne If you are navigating eating disorders in midlife, including anorexia, bulimia, binge eating disorder, or ARFID, you do not have to do this alone. I offer eating disorder therapy and coaching in California, Washington, D.C., and globally, with a focus on neurodivergent-affirming and liberation-based care. Learn more about working with me via my website drmariannemiller.com, and explore my ARFID course: https://www.drmariannemiller.com/arfid

When eating feels like a demand, everything changes. For people with a Pervasive Drive for Autonomy (PDA) profile, especially those navigating ARFID (Avoidant/Restrictive Food Intake Disorder), pressure around food can quickly backfire. What may look like refusal or lack of motivation is often a nervous system response to perceived threat. In this episode, Dr. Marianne explores why common advice like “just eat” can make eating more difficult and how shifting toward autonomy-supportive, neurodivergent-affirming approaches can reduce food avoidance and increase access to nourishment. What Is PDA and How Does It Affect Eating Disorders? Pervasive Drive for Autonomy (PDA) is a nervous system profile, often associated with autism, where everyday demands are experienced as threats to autonomy. These demands are not always obvious. They can be subtle, internal, or socially implied, such as expectations around mealtimes or internal pressure to eat “normally.” When PDA intersects with ARFID and other eating disorders, eating becomes tied to autonomy, control, and safety rather than just hunger. This can lead to increased avoidance, shutdown, or distress when food is introduced with pressure or expectation. Why “Just Eat” Backfires in PDA and ARFID For individuals with PDA, “just eat” is not neutral. It is experienced as a demand, and often a high-pressure one. This activates the nervous system's threat response, which can reduce appetite, increase avoidance, and create anxiety or distress around meals. Over time, repeated pressure can make eating feel less accessible rather than more. What is often interpreted as resistance is more accurately understood as a protective response. Recognizing this shift from behavior to nervous system response is essential for supporting meaningful change. SEO keywords: why ARFID gets worse with pressure, food refusal PDA, eating anxiety autism, demand avoidance food, why “just eat” doesn't work PDA, ARFID, and Food Avoidance Across Ages This episode walks through the experience of Drew, who navigates both ARFID and a PDA profile. Whether Drew is an adult or a child, the pattern is similar. Increased reminders, prompting, or pressure around food lead to increased distress and decreased access to eating. When Drew is a child, this often requires a shift in parenting approach. Moving toward a more child-led, autonomy-supportive feeding style can reduce power struggles and support long-term nourishment. This does not mean removing structure, but rather changing how it is offered so that autonomy and safety are prioritized. What Helps: Reducing Food Pressure and Supporting Autonomy Supporting PDA and ARFID requires moving away from demand-based approaches and toward autonomy-supportive ones. This includes softening language around food, reducing pressure, and offering limited, manageable choices that allow for a sense of control. It also involves creating low-lift eating options that are easy to access and sensory-safe, reducing the effort required to eat. Adjusting the environment, timing, and expectations around meals can help lower the intensity of the experience and support nervous system regulation. When autonomy increases and pressure decreases, eating often becomes more possible. Not perfectly or immediately, but in ways that are more sustainable and less distressing. Neurodivergent Eating, Executive Functioning, and Sensory Needs Eating is not just about appetite. For many neurodivergent individuals, it is also shaped by executive functioning capacity, energy levels, and sensory experiences. Food accessibility, predictability, and tolerability all play a role in whether eating feels possible in a given moment. Low-lift eating strategies and honoring sensory preferences are essential supports. These approaches help reduce barriers and create more consistent access to nourishment without increasing demand. A Liberation-Focused Approach to Eating Disorders and PDA A liberation-focused lens challenges rigid expectations around food and bodies. It makes space for different ways of eating and recognizes that autonomy is central to safety. When we reduce pressure and support nervous system regulation, we create conditions where eating can become more accessible over time. This approach shifts the focus from compliance to collaboration, from control to support, and from urgency to sustainability. Related Episodes When PDA Drives ARFID: Understanding Food Refusal, Control, & Safety on Apple & Spotify. ARFID, PDA, and Autonomy: Why Pressure Makes Eating Harder on Apple & Spotify. ARFID Explained: What It Feels Like, Why It's Misunderstood, & What Helps on Apple & Spotify. Why Sensory-Attuned Care Matters More Than Exposure in ARFID Treatment on Apple & Spotify. Complexities of Treating ARFID: How a Neurodivergent-Affirming, Sensory-Attuned Approach Works on Apple & Spotify. Learn More: ARFID Course with Dr. Marianne If this episode resonated with you, Dr. Marianne's self-paced ARFID course offers deeper, practical guidance on how to reduce food-related pressure, support sensory and nervous system needs, and build autonomy into eating. You will learn how to create more sustainable, low-lift eating patterns and better understand the intersection of ARFID, neurodivergence, and autonomy. Explore the course here: https://www.drmariannemiller.com/arfid Listen, Subscribe, and Share If you found this episode helpful, share it with someone who may benefit from a more autonomy-centered approach to eating. Follow the podcast for more conversations on ARFID, neurodivergent eating, harm reduction, and eating disorder recovery.

Not all eating disorders follow a short or linear recovery path. For many people, anorexia and bulimia become long-term, shifting over time rather than disappearing. In this episode, Dr. Marianne explores why eating disorders become chronic, how symptoms can wax and wane across life stages, and what this means for recovery, support, and understanding your nervous system. This episode offers a deeper look at chronic eating disorders, including the roles of nervous system regulation, trauma, neurodivergence, and environmental stressors, while challenging the idea that long-term symptoms reflect failure. Why Do Eating Disorders Become Chronic? Many people search for answers to why anorexia and bulimia become long-term. This episode reframes that question by focusing on function rather than blame. Eating disorders often persist because they provide structure, predictability, and a way to regulate overwhelming internal states. Dr. Marianne explains how anorexia can create a sense of control and stability, while bulimia can help discharge emotional intensity and reduce distress. Over time, these patterns become deeply learned and reinforced, making them more automatic, especially during periods of stress or uncertainty. Chronic Eating Disorders Change Over Time A key theme in this episode is that chronic eating disorders are not static. Symptoms often wax and wane depending on life circumstances, developmental stages, and stress levels. Periods of stability may bring some quieting of symptoms, while transitions, uncertainty, or increased demands can lead to intensification. Dr. Marianne explores how both micro-stressors, such as daily overwhelm, and systemic stressors, such as financial strain or societal pressures, can influence the presence and intensity of eating disorder behaviors. This perspective helps reframe symptom shifts as a nervous system response, rather than a personal setback. The Role of the Nervous System in Long-Term Eating Disorders Chronic anorexia and bulimia are deeply connected to nervous system regulation. Eating disorder behaviors can shift emotional states, reduce overwhelm, and create a sense of safety when other forms of support are not accessible. This episode explains why behavior-focused approaches alone are often not enough. Without alternative ways to support regulation, the body will often return to familiar patterns that have provided relief in the past. Understanding this connection is essential for long-term change. Trauma, Neurodivergence, and Chronic Eating Disorders This episode explores how trauma and neurodivergence intersect with long-term eating disorders. Eating disorder behaviors can help manage trauma-related distress by creating distance from overwhelming emotions or offering a sense of agency. For neurodivergent individuals, including those who are autistic or ADHD, eating patterns may also be shaped by sensory needs, routine, and predictability. What is often labeled as rigidity can be understood as an adaptive response that helps maintain equilibrium in an overstimulating or unpredictable world. Why Eating Disorder Treatment May Not Stick Many people with long-term anorexia or bulimia have engaged in treatment multiple times. When symptoms return, it can lead to frustration or self-blame. This episode offers a different perspective by highlighting how treatment may not always address the underlying functions of eating disorder behaviors. Dr. Marianne discusses how approaches that focus only on symptom change, without addressing nervous system needs, lived experience, and environmental context, may not lead to sustainable shifts. This insight helps explain why eating disorders can persist even when someone is deeply committed to recovery. Rethinking Recovery for Chronic Eating Disorders Recovery from chronic eating disorders does not have to follow a rigid or time-limited model. This episode introduces a more flexible framework that centers on understanding function, increasing support, and expanding options over time. Dr. Marianne explores how recovery can include harm reduction, gradual change, and nonlinear progress, while still being meaningful and valid. This approach allows for a more compassionate and sustainable path forward for individuals living with long-term anorexia or bulimia. Related Episodes Chronic Eating Disorders in 2026: What Hope Can Actually Look Like on Apple and Spotify. Why Some Eating Disorders Don't Resolve: Understanding Chronic Patterns & What Actually Supports Change on Apple and Spotify. When an Eating Disorder Becomes Chronic: Recovery Tools for Persistent Anorexia & Bulimia on Apple and Spotify. Work With Dr. Marianne If this episode resonated and you are looking for support with chronic eating disorders, long-term anorexia, or bulimia, you can work with Dr. Marianne through therapy or coaching. Dr. Marianne offers neurodivergent-affirming, liberation-focused eating disorder support that integrates nervous system regulation, sensory needs, and individualized care. She also uses a harm-reduction approach for those with long-term eating disorders. Services are available for clients in California, Texas, Washington, D.C., and globally through coaching. Learn more about working together: https://www.drmariannemiller.com

What happens when nutrition advice becomes loud, simplified, and everywhere you turn? In this episode, Dr. Marianne welcomes back Kathleen Meehan, RD (@therdnutritionist), an anti-diet, fat-positive dietitian, to unpack the current wave of nutrition myths shaping how people think about food, health, and eating disorder recovery. From protein obsession to processed food panic, this conversation brings nuance back into a space that often lacks it. The Rise of Protein Obsession in Diet Culture Protein is everywhere right now. Social media, food marketing, and even medical guidance are emphasizing high-protein intake as the key to health. Kathleen explains that while protein is important, the current messaging lacks context and balance. This trend often leads to the quiet demonization of carbohydrates and reinforces rigid food rules. It is especially visible in conversations around GLP-1 medications, where protein is framed as a solution for muscle preservation without acknowledging that overall nourishment matters more. Protein cannot compensate for not eating enough. A balanced, consistent pattern of eating is what supports both physical and mental well-being. How Nutrition Messaging Fuels Disordered Eating Many people enter eating disorder recovery already carrying fear and guilt around food. Kathleen highlights how even well-meaning nutrition advice can contribute to disordered eating when it is oversimplified. Messages about avoiding certain foods or “doing it right” can increase anxiety and disconnect people from their internal cues. Over time, this reinforces the belief that food must be controlled, measured, or optimized to be acceptable. Recovery often requires moving away from rigid rules and toward flexibility, trust, and consistency. The Pressure to Optimize Food and Health Wellness culture increasingly encourages people to track and fine-tune every aspect of their health. From wearable devices to food tracking, there is pressure to optimize eating, sleep, and metabolism. This level of monitoring can create stress and a false sense of control. Kathleen emphasizes that focusing on the big picture is often more helpful than micromanaging details. A sustainable relationship with food does not require constant measurement. Zooming out allows for a more realistic and supportive approach to health. Processed Foods and Eating Disorder Recovery Processed foods are often framed as harmful, but this conversation challenges that narrative. Kathleen emphasizes that processed foods are essential for accessibility, convenience, and consistency. For many people, including those with ARFID, processed foods may be the most reliable or tolerable options. Removing them can reduce intake and increase distress. In eating disorder recovery, having access to preferred foods is often more important than striving for an idealized version of eating. Processed foods can support nourishment, especially when life is busy, resources are limited, or sensory needs are present. Food Access, SNAP, and Nutrition Myths Food choices are shaped by access, time, and resources. Kathleen and Dr. Marianne discuss how public conversations about SNAP benefits and food choices often ignore these realities. Shelf-stable and convenient foods can be essential for individuals and families managing work demands, limited access to fresh foods, or financial constraints. Judging food choices without considering these factors oversimplifies complex realities. Nutrition cannot be separated from social context. A broader view of health includes access, stress, and systemic factors. ARFID, Sensory Needs, and Flexible Eating For individuals with ARFID, expanding food options requires safety and flexibility. Kathleen emphasizes that access to preferred foods supports both nourishment and emotional well-being. Pressuring people to eat in a certain way, especially under rigid “clean eating” expectations, can increase distress and reduce intake. Lowering pressure and supporting consistency helps create a more sustainable relationship with food. This approach is especially important for neurodivergent individuals and those navigating sensory sensitivities. A More Nuanced Approach to Nutrition This episode returns to a central theme: nutrition is not meant to be rigid or perfect. Instead of focusing on exact numbers or rules, a more supportive approach asks whether you are eating enough, including a variety of foods, and meeting your needs over time. If nutrition advice feels extreme or overwhelming, it may not be helpful. A flexible, big-picture approach supports eating disorder recovery far more than rigid guidelines. Connect With Kathleen Meehan, RD Follow Kathleen on Instagram at @therdnutritionist or on her website for thoughtful, weight-inclusive perspectives on nutrition, diet culture, and eating disorder recovery. Related Episodes When Children and Teens Struggle With Binge Eating Disorder With Kathleen Meehan, RD @therdnutritionist on Apple & Spotify. Navigating Nutrition in Long-Term Eating Disorders With Jaren Soloff, RD @wholewomennutrition on Apple & Spotify. Chronic Illness, Wellness Culture, & Eating Disorder Recovery: Taking an Anti-Diet Approach With Abbie Attwood, MS, @abbieattwoodwellness on Apple & Spotify. Work With Dr. Marianne Dr. Marianne is a California-based eating disorder therapist specializing in ARFID and other eating disorders. She offers virtual therapy, coaching, and virtual courses to support a more flexible, sustainable relationship with food. Learn more at drmariannemiller.com. Listen & Subscribe If this episode resonated, follow the Dr. Marianne-Land podcast on Apple Podcasts and Spotify, and share it with someone who could benefit from a more nuanced approach to nutrition and eating disorder recovery.

High achievers are often seen as disciplined, driven, and successful. But behind that external competence, many people are navigating intense internal pressure, perfectionism, and a deep disconnection from their bodies. In this episode, Dr. Marianne explores why high achievers are more vulnerable to eating disorders like anorexia and bulimia, and how these patterns are often hidden in plain sight. You will learn how perfectionism, control, and chronic stress shape eating disorder behaviors, why anorexia and bulimia can feel regulating in the short term, and how high-achieving identities can make recovery more complex. Dr. Marianne also shares from her own lived experience with bulimia, where overexercising functioned as a compensatory behavior, and how her relationship with food and her body shifted over time. High Achievers and Eating Disorders: Why Anorexia and Bulimia Often Go Unnoticed High achievers are less likely to be identified as struggling, even when eating disorder behaviors are present. This section explores how achievement, productivity, and external success can mask anorexia and bulimia, allowing patterns to continue without recognition or support. Perfectionism and Eating Disorders: The Link Between Control, Anorexia, and Bulimia Perfectionism plays a central role in both anorexia and bulimia. Learn how rigid standards, fear of mistakes, and performance-based self-worth contribute to restriction, binge eating cycles, and compensatory behaviors like overexercising. Anorexia vs Bulimia: How Eating Disorders Show Up in High Achievers This episode breaks down how anorexia and bulimia can present differently while serving similar functions. Understand how restriction, rigidity, and control show up in anorexia, and how cycles of eating and compensatory behaviors, including overexercise, show up in bulimia. Chronic Stress, Nervous System Activation, and Eating Disorders High achievers often operate under sustained stress, which can disrupt hunger cues, increase rigidity, and contribute to cycles seen in anorexia and bulimia. Learn how nervous system regulation plays a key role in understanding and healing eating disorders. Neurodivergence, Sensory Needs, and Eating Disorders Many high achievers are also neurodivergent. This section explores how sensory processing, executive functioning differences, and a need for predictability can intersect with anorexia and bulimia, shaping eating patterns and recovery needs. Intersectionality, High Achievement, and Eating Disorder Risk The pressure to achieve is not experienced equally. Dr. Marianne explores how systemic factors, identity, and marginalization can increase vulnerability to eating disorders like anorexia and bulimia. Eating Disorder Recovery for High Achievers: Moving Beyond Control Recovery does not mean losing your drive or ambition. Learn how to build a more flexible, sustainable relationship with food and your body while maintaining your strengths as a high achiever. Related Episodes The Truth About "High-Functioning" People With Lifelong Eating Disorders on Apple & Spotify. Perfectionism, People-Pleasing, & Body Image: Self-Compassion Tools for Long-Term Eating Disorder Recovery With Carrie Pollard, MSW @compassionate_counsellor on Apple & Spotify. Perfectionism, Bulimia, & Recovery: Harnessing Your Strengths to Heal With Dr. Amanda Marie @glitterypoison on Apple & Spotify. Work With Dr. Marianne: Eating Disorder Therapy and Coaching If you are navigating anorexia, bulimia, binge eating, or patterns of overcontrol around food, Dr. Marianne offers therapy and coaching support. Her approach is neurodivergent-affirming, trauma-informed, and grounded in a liberation-focused framework. Learn more about working with Dr. Marianne here: https://www.drmariannemiller.com/

If you have PCOS and feel constantly hungry, deal with strong food cravings, or struggle with binge eating, you are not imagining it. PCOS can directly affect hunger, cravings, and eating patterns through insulin resistance and hormone imbalance. In this episode, Dr. Marianne explains the real link between PCOS and eating disorders so you can understand what is happening in your body without blame. What Is PCOS? PCOS, or polycystic ovary syndrome, is an endocrine and metabolic condition that affects hormones, blood sugar regulation, and appetite. While often labeled as a reproductive issue, PCOS also plays a major role in hunger, food cravings, and disordered eating patterns. PCOS, Insulin Resistance, and Food Cravings Insulin resistance is common in PCOS and can disrupt blood sugar stability. This can lead to increased hunger, intense food cravings, and energy swings throughout the day. These PCOS symptoms are biological and can strongly influence eating behavior, including binge eating. The Link Between PCOS and Eating Disorders The connection between PCOS and eating disorders develops when increased biological hunger meets pressure to restrict food. Restriction can intensify cravings, increase food focus, and contribute to binge eating and disordered eating cycles. This is not a failure of willpower. It is the interaction between hormone imbalance, insulin resistance, and external messaging about food. Neurodivergence, PCOS, and Eating Patterns Neurodivergent individuals may experience additional challenges with eating, including sensory sensitivities, executive functioning differences, and changes in hunger awareness. When combined with PCOS, these factors can make eating feel more complex and require more flexible, individualized support. Why Restriction Can Worsen PCOS and Binge Eating Restricting food can increase hunger and amplify PCOS-related food cravings. This can lead to stronger urges to eat and cycles of binge eating. Supporting consistent nourishment can help stabilize energy, reduce extremes, and support eating disorder recovery. A Non-Restrictive Approach to PCOS and Eating Disorder Recovery Recovery from eating disorders with PCOS requires working with your body, not against it. This includes consistent eating, supporting blood sugar regulation, using low-lift meals, and honoring sensory needs. These approaches can support both hormone balance and a more regulated relationship with food. The Emotional Side of PCOS and Disordered Eating PCOS is often accompanied by body changes and exposure to weight stigma, which can increase distress and drive attempts to control food. Understanding the emotional and social layers of PCOS and eating disorders is an important part of healing. You Are Not Broken If you are living with PCOS, insulin resistance, food cravings, or binge eating, your experience is valid. Your body is responding to real biological processes. Support is possible without restriction, shame, or rigid food rules. Related Episodes Polycystic Ovary Syndrome (PCOS) and Nutrition With Eden Davis, RDN, LDN on Apple & Spotify. Healing Binge Eating Disorder: One Woman's Journey Toward Body Trust & Food Freedom With Dr. Michelle Tubman, M.D. @wayzahealth on Apple & Spotify. Chronic Binge Eating Disorder: Why It Persists & What Real Recovery Looks Like on Apple & Spotify. Work With Dr. Marianne: Binge Eating Recovery Membership If you are struggling with binge eating, disordered eating, or PCOS-related food challenges, Dr. Marianne's binge eating recovery membership offers a non-restrictive, neurodivergent-affirming approach. Learn practical tools to support hunger, reduce food urges, and build a more sustainable relationship with food. Check out more about Dr. Marianne on her website, drmariannemiller.com.

What if what gets labeled as “picky eating” is actually a complex, sensory-based eating disorder shaped by neurodivergence, culture, and access to resources? In this episode, I'm joined by Dr. Panicha McGuire, a licensed therapist and founder of Living Lotus Therapy, who shares her lived experience with ARFID alongside her clinical work with neurodivergent clients. Together, we explore how ARFID shows up in autistic and ADHD individuals, why it is so often misunderstood or missed, and what it actually feels like to navigate eating in a highly sensitive nervous system. This conversation moves beyond surface-level discussions of food and gets into the real, lived reality of sensory overwhelm, executive functioning challenges, and the intersection of identity, culture, and access. What Is ARFID and Why It's Often Missed in Neurodivergent People Avoidant Restrictive Food Intake Disorder (ARFID) is frequently overlooked, especially in autistic and ADHD individuals whose eating patterns are dismissed as personality traits or phases. In this episode, we unpack how ARFID can go unrecognized for years, particularly when someone appears to be functioning well in other areas of life. Dr. Panicha shares how her own experiences were minimized growing up, shaped by assumptions about compliance, academic success, and cultural stereotypes. We talk about how masking, perfectionism, and being labeled easy or well-behaved can hide significant eating struggles beneath the surface. Sensory Survival: What Eating Actually Feels Like For many neurodivergent people, eating is not neutral. It is a full-body sensory experience that can quickly become overwhelming. We explore what sensory sensitivity looks like with ARFID, including texture aversions, taste intensity, smell sensitivity, and how one unexpected bite can shut down appetite. Dr. Panicha describes how her nervous system responds to food and how stress amplifies these responses, making eating even more difficult. This is where the concept of sensory survival comes in. Eating becomes less about preference and more about finding ways to get through the experience with the least amount of distress. That might look like relying on specific textures, repeating the same foods, or needing very particular preparation methods. Autism, ADHD, and Executive Functioning Challenges With Food Eating also involves planning, decision-making, preparation, and energy. We discuss how ADHD and autism intersect with ARFID through executive functioning challenges. Tasks like grocery shopping, meal planning, or deciding what to eat can feel overwhelming, especially after a long day when cognitive and sensory capacity is already low. Dr. Panicha also shares how environmental factors like noise, lighting, and crowded spaces can interfere with eating, highlighting how the experience of food extends far beyond what is on the plate. Culture, Poverty, and Why ARFID Is Not One-Size-Fits-All One of the most important parts of this conversation is the role of intersectionality in ARFID. Dr. Panicha shares her experience growing up as a Thai American child in a low-income household, where food was tied to culture, survival, and respect. Limited access to food choices, combined with cultural expectations, made it difficult for her sensory needs to be understood or supported. We also talk about how many ARFID resources assume access and flexibility, which is not the reality for many individuals and families. This creates additional barriers and highlights the need for more culturally responsive and accessible approaches to care. Safe Foods, Sensory Strategies, and Expanding Options Over Time As an adult, Dr. Panicha has developed tools that support her in navigating ARFID, including identifying sensory preferences like crunchy textures, spicy foods, and umami flavors. We discuss how safe foods evolve, how repetition can be supportive, and how expanding food options often happens through understanding sensory needs rather than forcing change. This includes modifying foods, using strong flavors to support appetite, and planning ahead for meals in unfamiliar environments. Social Experiences, Shame, and Navigating Food With Others ARFID affects more than eating. It shapes relationships, social experiences, and self-esteem. We explore how navigating meals with others can bring up anxiety, shame, or the need to mask. From school lunches to restaurants to travel, eating in social settings often requires significant planning and energy. Dr. Panicha shares how she prepares by researching menus, choosing environments that feel manageable, and communicating her needs with trusted people. We also discuss how lack of accommodation in public spaces can create additional barriers. Does ARFID Get Better Over Time? A common question is whether ARFID improves. Dr. Panicha offers a nuanced answer. ARFID can shift over time. It can ease with increased self-understanding, access to resources, and supportive environments. It can also intensify during periods of stress or life transitions. This conversation emphasizes that progress is not linear and that support must be flexible, individualized, and grounded in compassion. Related Episodes With Dr. Panicha McGuire On our personal neurodivergent stories: Apple & Spotify On neurodiversity, selective eating, & ARFID: Apple & Spotify On colonization, eating, & body image: Apple & Spotify On autism and ADHD in queer individuals: Apple & Spotify. Connect With Dr. Panicha You can learn more from Dr. Panicha McGuire and her work in neuroaffirming care. Follow her on Instagram and TikTok at @drpanichamcguire for insights on ARFID, autism, ADHD, and sensory experiences. You can also visit her website at livinglotustherapy.com and sign up for her newsletter, which offers thoughtful, encouraging, and deeply supportive reflections on neurodivergence and mental health. Work With Dr. Marianne If you are navigating ARFID, binge eating, or eating struggles within the context of neurodivergence, you are not alone. I offer eating disorder therapy and coaching with a neurodivergent-affirming, liberation-focused approach. You can learn more about working with me and explore resources on my website. Check out my awesome self-paced, virtual ARFID course HERE!

What does it mean when your safe foods suddenly stop working? If you live with ARFID (Avoidant Restrictive Food Intake Disorder), this experience can feel confusing, scary, and isolating. A food that felt reliable can suddenly feel impossible, leaving you wondering if your eating challenges are getting worse or if you are doing something wrong. In this episode of Dr. Marianne-Land, Dr. Marianne explores why this happens and offers a compassionate, neurodivergent-affirming framework for understanding ARFID plateaus, safe food loss, and burnout. Rather than framing this as a setback, this conversation reframes it as a shift in nervous system capacity, where stress, sensory load, and life context all influence how food feels from day to day. Through a relatable case example, you will hear how safe foods can change during periods of increased demand and how support, not pressure, can help restore flexibility over time. What Is ARFID and Why Safe Foods Matter Avoidant Restrictive Food Intake Disorder (ARFID) is an eating disorder characterized by limited food intake linked to sensory sensitivities, fear of aversive consequences, or low interest in eating. Safe foods often become essential because they provide predictability and reduce sensory overwhelm. In this episode, Dr. Marianne explains how safe foods function as a form of nervous system support rather than simply preference, and why relying on them is both adaptive and necessary for many people. ARFID Burnout: Why Safe Foods Suddenly Stop Working Many people with ARFID experience periods where even their most reliable foods become harder to eat. This episode introduces the concept of ARFID burnout, where the cumulative effort of eating, decision making, and sensory processing leads to exhaustion. When the nervous system is overwhelmed, tolerance for even familiar foods can decrease. Dr. Marianne explores how stress, illness, fatigue, and life transitions can all narrow capacity and make eating feel more difficult, even when nothing about the food itself has changed. ARFID and Decision Fatigue Around Food Eating with ARFID often requires ongoing problem solving, which can create significant mental load. This episode highlights how decision fatigue plays a role in eating challenges, especially when every meal requires evaluating options, anticipating sensory experiences, and managing uncertainty. Reducing the number of decisions required around food can help create more stability and make eating feel more accessible. When Safe Foods Stop Working: What Helps If your safe foods are not working the way they used to, this episode offers practical and compassionate ways to respond without increasing pressure. Dr. Marianne discusses how supporting the nervous system, rather than forcing food, can help rebuild capacity over time. The episode explores ways to create a more flexible structure around eating, including expanding the range of low-effort meals, reducing cognitive load, and adjusting expectations so that eating feels more doable in the moment. The focus is on creating sustainability rather than perfection. ARFID Recovery Is Not Linear In this episode, Dr. Marianne emphasizes that ARFID recovery is not linear. Shifts in food tolerance are not signs of failure, but reflections of changing capacity. Learning how to respond with flexibility, curiosity, and support can help create a more sustainable relationship with food over time, especially during periods when things feel harder. Related Episodes ARFID Explained: What It Feels Like, Why It's Misunderstood, & What Helps on Apple & Spotify. Why Sensory-Attuned Care Matters More Than Exposure in ARFID Treatment on Apple & Spotify. Complexities of Treating ARFID: How a Neurodivergent-Affirming, Sensory-Attuned Approach Works on Apple & Spotify. Work With Dr. Marianne If you are looking for deeper support, Dr. Marianne offers a virtual, self-paced ARFID and selective eating course designed to help you better understand your eating patterns through a neurodivergent-affirming and trauma-informed lens. The course includes practical tools to support sensory needs, reduce overwhelm, and build a more sustainable approach to eating. Learn more at drmariannemiller.com

If eating feels stressful, overwhelming, or even scary, you are not alone. Fear of food is incredibly common, especially for people navigating eating disorder recovery or trying to unlearn years of diet culture messaging. What often gets labeled as “lack of willpower” is actually something much deeper. It is learned fear. In this episode, Dr. Marianne explores how fear of food develops, why it feels so real in the body, and how diet culture conditions people to distrust their own eating instincts. This conversation moves beyond surface-level advice and gets into the psychological and nervous system layers of food anxiety. How Diet Culture Creates Food Anxiety and Food Rules Diet culture teaches people to categorize food into rigid binaries such as “good” and “bad,” while also tying eating behaviors to morality and self-worth. Over time, this creates internalized food rules that can feel impossible to break. These rules often lead to anxiety, restriction, and a growing sense that eating must be controlled at all times. Dr. Marianne explains how these patterns develop gradually and why they are often reinforced by praise, healthcare messaging, and social norms. What begins as an attempt to feel in control can slowly turn into fear of specific foods, fear of eating freely, and fear of losing control. Fear of Food in Eating Disorder Recovery Fear of food is a central experience in many eating disorders, including anorexia, bulimia, binge eating disorder, and ARFID. Even when someone intellectually understands that food is not dangerous, their nervous system may still react with anxiety. This episode breaks down why that happens and how long-term restriction strengthens food fear over time. Dr. Marianne shares how the brain begins to associate certain foods with danger and why reintroducing those foods can feel so overwhelming. Neurodivergence, Sensory Needs, and Food Anxiety For neurodivergent individuals, including those with ADHD and autism, food anxiety can be layered with sensory sensitivities, executive functioning challenges, and differences in hunger awareness. Diet culture often ignores these realities, which can make eating feel even more complicated. Dr. Marianne discusses why a neurodivergent-affirming approach to eating disorder recovery is essential and how honoring sensory needs and autonomy can reduce fear and increase safety around food. Rebuilding Trust With Food After Diet Culture Healing fear of food is not about forcing yourself to “just eat” or pushing through anxiety. It is about gradually helping the nervous system learn that eating is safe again. Dr. Marianne introduces the concept of microdosing uncertainty as a way to take small, manageable steps toward flexibility with food. She also explores how questioning food rules, creating supportive eating environments, and working with the nervous system can help reduce food anxiety over time. Recovery is not about perfect eating. It is about building a relationship with food that is less governed by fear and more grounded in trust. You Are Not Broken If you feel afraid of food, it does not mean you are failing. It means you have learned to associate eating with danger in a culture that constantly reinforces those fears. This episode offers a compassionate and practical framework for understanding food anxiety and beginning the process of healing. Related Episodes SkinnyTok & Anorexia: How Harmful Trends Thrive Despite TikTok's Ban with Jen Tomei @askjenup on Apple and Spotify. ARFID, PDA, and Autonomy: Why Pressure Makes Eating Harder on Apple & Spotify. When PDA Drives ARFID: Understanding Food Refusal, Control, & Safety on Apple & Spotify. Work With Dr. Marianne If you are struggling with fear of food, eating disorder recovery, or food anxiety, you can work with Dr. Marianne through therapy or coaching. Services are available in California, Texas, Washington, D.C., and globally. You can also explore Dr. Marianne's self-paced course on ARFID and selective eating, which includes neurodivergent-affirming, sensory-supportive approaches to rebuilding trust with food. Learn more at drmariannemiller.com

What if the eating challenges you have struggled with were never just about food? In this deeply validating and expansive conversation, Dr. Marianne sits down with Margo White, CPN, to explore the intersection of autism, ADHD, and eating disorders through a neurodivergent-affirming lens. Margo shares her lived experience of being late-identified as autistic and ADHD, and how years of unmet needs, sensory overwhelm, and trauma shaped her relationship with food, her body, and herself. This episode gently reframes eating disorders not as isolated problems, but as meaningful adaptations that develop in response to a nervous system trying to survive. Autism, ADHD, and Eating Disorders: Understanding the Overlap Autism and ADHD are closely connected with eating disorders, yet this relationship is often misunderstood or overlooked in traditional treatment models. Margo shares how her neurodivergent brain shaped her early experiences, including sensory sensitivities, difficulty feeling connected, and a persistent sense of not fitting in. Without the language or support to understand these experiences, food became a place of predictability, comfort, and regulation. This conversation expands the narrative around anorexia and other eating disorders by exploring how they can emerge from unmet needs, overwhelm, and the need for safety, rather than solely from body image concerns. Late Diagnosis of Autism and ADHD: A Turning Point in Recovery Receiving a late diagnosis of autism and ADHD can be a profound shift. Margo describes this as a “lightbulb moment,” where years of confusion and self-blame suddenly made sense. Patterns that once felt like personal failures became understandable responses to a neurodivergent brain navigating a world that was not built for it. This reframe is often a critical piece of healing. When people understand their brain, they can begin to meet their needs more directly, which can significantly change their relationship with food and reduce reliance on eating disorder behaviors. Sensory Needs, Food Preferences, and ARFID A core part of this conversation focuses on sensory needs and how they shape eating. Many autistic and ADHD individuals experience strong preferences around texture, temperature, predictability, and even the utensils they use. Margo and Dr. Marianne explore how these preferences are often mislabeled as disordered when they are actually reflections of a neurodivergent nervous system. They discuss how something as simple as using a specific spoon or eating foods in a certain order can be rooted in sensory comfort rather than pathology. The conversation also highlights the overlap between ARFID and neurodivergence, and how nervous system regulation can expand flexibility with food over time. Rather than forcing exposure or compliance, a neurodivergent-affirming approach centers safety, choice, and collaboration. Anorexia, Trauma, and the Search for Safety Margo shares openly about her experience with anorexia and how it developed within the context of bullying, low self-worth, and unmet emotional needs. Food and restriction became ways to create structure and a sense of control when everything else felt overwhelming and unpredictable. This part of the episode reframes eating disorders as protective strategies. While harmful, they often emerge to help someone cope with distress, regulate emotions, or navigate an environment that feels unsafe. Understanding this function can shift how we approach recovery, moving away from blame and toward compassion. Neurodivergent-Affirming Eating Disorder Recovery Recovery, especially for neurodivergent people, is not about forcing oneself into rigid food rules or expectations. Margo shares how her healing involved learning about her brain, honoring her sensory needs, and creating environments that felt safe enough for her nervous system to relax. Instead of trying to eliminate comfort eating or achieve perfection with food, she learned to build flexibility and trust. Recovery became less about control and more about responsiveness, allowing her to eat in ways that supported her body while respecting her sensory experiences. This approach offers a powerful alternative to traditional models that can unintentionally increase shame or overwhelm. Body Changes, Weight Gain, and Healing from Weight Stigma A deeply important part of recovery is navigating body changes. Margo speaks candidly about gaining weight in recovery and how this brought up past trauma from being bullied in a larger body. These experiences did not disappear simply because her behaviors changed. Instead, they required ongoing processing and support. This section explores how weight stigma shapes both eating disorders and recovery, and how individuals can begin to build safety and acceptance in their bodies over time. Margo also speaks about reclaiming the word “fat” as neutral, separating it from the harm that society has attached to it. ARFID in Autism and ADHD: Supporting Families Margo also shares about her upcoming parent course designed to support families navigating ARFID in children and teens. Grounded in a neurodivergent-affirming and trauma-informed approach, the course focuses on reducing pressure, increasing safety, and rebuilding connection around food. The course addresses how ARFID intersects with other experiences such as PDA, OCD, trauma, and burnout, and offers practical ways for caregivers to create predictable, supportive environments. Rather than focusing on compliance, the emphasis is on collaboration, understanding, and meeting the child where they are. From Survival to Flexibility: What Recovery Can Look Like One of the most powerful themes in this episode is the shift from survival to flexibility. Margo reflects on how her relationship with food has changed, including moments where she can now eat in environments that once felt overwhelming or unsafe. These shifts are not about forcing change, but about building enough safety and support that new possibilities become accessible. Recovery does not mean thoughts never return. It means having the awareness and tools to respond differently, with more compassion and less fear. Connect With Margo White, CPN You can connect with Margo on Instagram at @margo_wholebodynutrition and learn more about her work at wholebodynutrition.com.au, where she shares resources and support for neurodivergent individuals and families navigating eating challenges. Related Episodes “Stuck” Isn't Lazy: Inertia in ADHD, Autism, & Eating Disorder Recovery With Stacie Fanelli, LCSW on Apple & Spotify. Autism & Eating Challenges: Understanding Sensory Needs, Routines, & Safety on Apple & Spotify. Eating Disorders & ADHD: Neurodivergent-Affirming Recovery With Taylor Ashley, RP @taylorashleytherapy on Apple & Spotify. Work With Dr. Marianne Dr. Marianne offers eating disorder therapy, coaching, and consultation for individuals navigating binge eating disorder, ARFID, anorexia, and bulimia. Her work is neurodivergent-affirming, trauma-informed, and rooted in autonomy and collaboration. Services are available in California, Texas, Washington, D.C., and globally. To learn more or get started, visit drmariannemiller.com.

Most people still believe eating disorders only begin in adolescence or early adulthood. But restrictive eating can develop later in life, and midlife can be a particularly vulnerable time. Changes in the body, new health conditions, medications, major life transitions, and cultural pressure around aging can all shape someone's relationship with food. In this episode of Dr. Marianne-Land, Dr. Marianne explores why restrictive eating in midlife is more common than many people realize and why it often goes unnoticed. She discusses how bodies change as we mature, how medications and medical diagnoses can alter appetite and body composition, and why restrictive eating may be socially accepted or even praised in older adults. This conversation also looks at the emotional and cultural factors that can make midlife a turning point in someone's relationship with food. If eating has become more rigid, stressful, or rule-driven later in life, you are not alone. Eating disorders after 40 are real, and recovery is possible. Restrictive Eating in Midlife Restrictive eating in midlife often develops gradually. Someone may begin skipping meals, cutting out food groups, or eating less in response to body changes, stress, or health concerns. What begins as small adjustments can slowly become more rigid and anxiety-driven. Dr. Marianne explains how restrictive eating patterns in midlife can sometimes be mistaken for healthy lifestyle changes. Because restriction is often praised in adults, it can be difficult for people to recognize when eating has become disordered. Eating Disorders After 40 and Late-Onset Eating Disorders Eating disorders after 40 are more common than many people realize. Research and clinical experience show that late-onset eating disorders can develop during midlife due to life transitions, hormonal changes, chronic stress, or new medical conditions. In this episode, Dr. Marianne discusses why people who develop eating disorders later in life often feel confused or isolated. Because eating disorders are so frequently associated with youth, many adults struggle to understand what they are experiencing. Body Changes in Midlife and Restrictive Eating Bodies naturally change as we age. Hormones shift, metabolism evolves, and body composition often changes during midlife. Perimenopause, menopause, sleep changes, stress, and shifting activity levels can all influence appetite and energy levels. Dr. Marianne explores how body changes in midlife can create distress or uncertainty for many people, especially in a culture that pressures individuals to maintain the same body size throughout adulthood. These experiences can lead some people to try to manage body changes through restrictive eating. Health Conditions, Medications, and Changes in Eating Patterns Midlife is also a time when many people begin navigating new health diagnoses or medications. Certain medications can change appetite, digestion, metabolism, or body composition. Medical conversations about weight or health markers can also increase attention on food and eating behaviors. Dr. Marianne discusses how health conditions and medications can unintentionally contribute to restrictive eating patterns when people feel pressure to control body changes or manage symptoms through food restriction. Why Restrictive Eating Can Be Socially Accepted in Midlife Restrictive eating in older adults often goes unnoticed because it may be socially encouraged. Eating less, avoiding certain foods, or losing weight is frequently framed as discipline or commitment to health. Dr. Marianne explains how diet culture and weight stigma can reinforce restrictive eating behaviors, making it harder for people to recognize when their relationship with food has become rigid or distressing. Eating Disorder Recovery in Midlife Recovery from restrictive eating is possible at any stage of life. Midlife can even bring strengths to the recovery process, including deeper self-awareness, life experience, and a clearer sense of personal values. In this episode, Dr. Marianne discusses how recovery can include building a more compassionate relationship with the body, recognizing that bodies naturally change over time, and challenging cultural messages that equate worth with body size or control over food. Related Episodes Anorexia & Bulimia After 40: Understanding Midlife Recovery & Change on Apple & Spotify. The Hidden Pain of Midlife Anorexia: Why Coping Breaks Down & What Heals on Apple & Spotify. Why Is Anorexia Showing Up Again in Midlife? You're Not Imagining It on Apple & Spotify. Midlife Bulimia Recovery: Coping With the Internal Chaos on Apple & Spotify. Welcome to the Jungle: Eating Disorders in Midlife & Our Personal Recovery Stories with Amy Ornelas, RD on Apple & Spotify. Work With Dr. Marianne Dr. Marianne Miller is a licensed marriage and family therapist specializing in eating disorder recovery. She supports people navigating restrictive eating, binge eating disorder, ARFID, and complex relationships with food. Dr. Marianne provides therapy services in California, Texas, and Washington, D.C., and offers coaching and educational resources available globally. She also offers self-paced virtual courses, including her course on ARFID and selective eating, which explores neurodivergent-affirming approaches to supporting a sustainable relationship with food. You can learn more about working with Dr. Marianne through her website, drmariannemiller.com.

Many people in eating disorder recovery eventually wonder how their early environment may have shaped their relationship with food. Questions about family dynamics and eating disorders often come up in therapy, especially when someone is trying to understand why certain patterns around food, body image, and control feel so deeply ingrained. Eating disorders such as anorexia, bulimia, binge eating disorder, and ARFID do not develop from a single cause. Research shows that eating disorders emerge through a complex combination of biological vulnerability, personality traits, neurodivergence, trauma, life stress, and cultural pressures. Family dynamics are only one piece of this puzzle, but they can strongly influence how children learn to relate to food, bodies, emotions, and control. In this episode of the Dr. Marianne-Land Podcast, Dr. Marianne Miller, eating disorder therapist, explores how family relationships, childhood experiences, and early emotional environments can shape patterns of disordered eating that continue into adulthood. How Family Dynamics Can Shape Disordered Eating Children learn about food and bodies long before they are able to critically question the messages around them. Family dynamics often influence beliefs about body size, self-worth, and emotional expression. In some families, diet culture and body criticism are normalized through comments about weight, food choices, or appearance. In others, emotions may be discouraged or minimized, leaving children to cope with distress on their own. These experiences can contribute to the development of disordered eating behaviors such as restriction, binge eating, or cycles of control around food. Family environments can also shape how children understand achievement, perfectionism, and control. When approval is linked to discipline or performance, some individuals learn to use food and body control as a way to gain safety, validation, or stability. These patterns do not mean families intentionally create eating disorders. Often caregivers are doing their best while navigating the same cultural pressures around weight, food, and health that affect all of us. A Case Example of Family Dynamics and Eating Disorders In the episode, Dr. Marianne shares a clinical case example illustrating how family dynamics can influence eating disorder development over time. A client grew up in a household where discipline, achievement, and self-control were highly valued. Food was discussed frequently in terms of “good” and “bad,” and comments about body size were common among relatives. As the client entered adolescence and experienced normal body changes, these messages began to feel increasingly intense. Restricting food initially created a sense of control and calm during a time of pressure and uncertainty. Over time, those behaviors gradually developed into an eating disorder. This example highlights an important truth. Eating disorders often develop as coping strategies, particularly when someone is trying to manage overwhelming emotions, social pressure, or a sense of instability. Diet Culture, Anti-Fat Bias, and Family Messages About Bodies Family dynamics do not exist in isolation. They are shaped by larger cultural forces such as diet culture, anti-fat bias, racism, and ableism. These systems influence how bodies are discussed, how health is interpreted, and how children learn to evaluate themselves. For example, children in larger bodies may receive more scrutiny around food. Neurodivergent children may experience pressure to control eating behaviors or mask sensory needs. Cultural messages about worth, discipline, and appearance often filter directly into family conversations about food and bodies. Understanding these intersections can help people recognize that their relationship with food developed within a much larger social context. Healing Family Patterns in Eating Disorder Recovery Exploring family dynamics in eating disorder recovery is not about blame. Instead, it offers insight into how early experiences shaped coping strategies. Many people discover that their eating disorder once served a function. It may have helped them regulate emotions, manage uncertainty, or create a sense of control in difficult situations. Recognizing that function can help people develop new coping tools that support long-term eating disorder recovery. Healing often includes building more compassionate relationships with food, learning new emotional regulation skills, and establishing boundaries around conversations about weight, dieting, and body criticism when necessary. Recovery is possible, even when eating patterns feel deeply rooted in early experiences. Related Episodes How Childhood Trauma Shapes Eating Disorders & Body Shame (Content Caution) on Apple & Spotify. Childhood Trauma & Eating Disorders on Apple & Spotify. The Connection Between Unresolved Trauma & Long-Lasting Eating Disorders (Content Caution) on Apple & Spotify. Work With Dr. Marianne Dr. Marianne Miller is a Licensed Marriage and Family Therapist specializing in eating disorder therapy, including treatment for anorexia, bulimia, binge eating disorder, and ARFID. Her work integrates neurodivergent-affirming care, trauma-informed therapy, and liberation-focused approaches to support sustainable recovery. Therapy, consultation, and coaching services are available for individuals in California, Texas, Washington, D.C., and globally. Learn more at drmariannemiller.com. If this episode resonated with you, consider subscribing to the Dr. Marianne-Land Podcast on Apple Podcasts or Spotify and sharing this episode with someone who may benefit from learning more about family dynamics and eating disorders.

What happens when traditional recovery messaging does not fit someone's lived reality? For many people living with long-term eating disorders, the expectation of full recovery can feel overwhelming, unrealistic, or even invalidating. In these situations, harm reduction for eating disorders offers another path forward, one that centers dignity, autonomy, safety, and compassion. In this episode of the Dr. Marianne-Land Podcast, Dr. Marianne speaks with Johanna Scoglio, M.Ed., M.B.A., founder of Dragonfly's Dream, a nonprofit rooted in lived experience and dedicated to supporting people with long-term eating disorders through harm reduction, peer support, and mind-body healing. Johanna brings both professional expertise and personal insight to this conversation. Together, she and Dr. Marianne explore how harm reduction approaches can support individuals who have been living with eating disorders for many years and may feel overlooked by traditional treatment models. This episode offers a thoughtful and compassionate discussion about chronic eating disorders, community care, and new ways of thinking about healing. Understanding Harm Reduction for Long-Term Eating Disorders Harm reduction is an approach that focuses on reducing suffering and increasing safety, rather than insisting on a single definition of recovery. In the context of long-term eating disorders or chronic eating disorders, harm reduction acknowledges that healing is complex and that people deserve support even if their symptoms do not disappear entirely. Johanna explains that harm reduction is not about giving up on healing. Instead, it is about meeting people where they are and supporting meaningful improvements in quality of life. For many individuals living with persistent eating disorders, this may mean reducing medical risk, building sustainable coping strategies, improving emotional well-being, and creating environments where eating and nourishment feel safer. Rather than framing recovery as all-or-nothing, harm reduction allows space for nuance, flexibility, and compassion. The Role of Peer Support in Eating Disorder Healing A key focus of Johanna's work is peer support for eating disorders. Many people living with long-term eating disorders report feeling isolated or misunderstood, especially when their experiences fall outside standard recovery narratives. Peer support can create powerful spaces where individuals feel seen, understood, and less alone. Johanna shares how peer-led communities offer validation and connection. When people speak openly with others who have lived through similar experiences, shame often begins to soften. Peer support can also provide practical strategies, encouragement, and hope that healing is still possible, even when the journey looks different than expected. For many individuals, peer support becomes a vital complement to therapy, medical care, or other forms of treatment. It reminds people that they are not alone and that their experiences matter. Expanding the Conversation About Eating Disorder Recovery This episode also explores how the eating disorder field can broaden its understanding of recovery. Traditional treatment models often emphasize full symptom elimination as the only successful outcome. While full recovery is possible for many people, others may experience a more complicated path. Johanna and Dr. Marianne discuss how harm reduction frameworks allow clinicians, families, and communities to support individuals without judgment. Instead of labeling someone as failing recovery, harm reduction acknowledges the realities of persistent eating disorders and prioritizes safety, dignity, and compassionate care. By shifting the focus toward quality of life, connection, and incremental change, harm reduction can help people build more sustainable relationships with food, their bodies, and their communities. About Johanna Scoglio Johanna Scoglio, M.Ed., M.B.A., is the founder of Dragonfly's Dream, a nonprofit organization dedicated to supporting individuals living with long-term eating disorders. Her work centers on harm reduction, peer support, and mind-body healing, with the goal of creating spaces where people can access compassionate and realistic support. Through advocacy, education, and community building, Johanna is helping expand the conversation around chronic eating disorders, recovery pathways, and inclusive care. Johanna recently published a book: When the Water Still Holds Me: Letters Through the Tides of a Long-Term Eating Disorder You can learn more about it and purchase it HERE. Here is her website: https://shimmeringseaglass.com/ Related Episodes Understanding Harm Reduction: Why "Full Recovery" May Not Be the Goal for Lifelong Eating Disorders on Apple and Spotify. Why Eating Still Breaks Down for Neurodivergent People With Long-Term Eating Disorders on Apple and Spotify. Orthorexia, Quasi-Recovery, & Lifelong Eating Disorder Struggles with Dr. Lara Zibarras @drlarazib on Apple & Spotify. Navigating a Long-Term Eating Disorder on Apple & Spotify. Listen to the Episode If you or someone you care about is navigating a long-term eating disorder, this episode offers an important reminder that healing does not have to follow a single path. Harm reduction, peer support, and compassionate care can create meaningful change and help people build lives that feel more supported and hopeful. Work With Dr. Marianne If you are looking for support with eating disorders such as ARFID, binge eating disorder, anorexia, or bulimia, Dr. Marianne Miller offers compassionate, neurodivergent-affirming care that recognizes how sensory needs, trauma, and complex life experiences can shape relationships with food. Dr. Marianne is a licensed eating disorder therapist who provides therapy for clients in California, Texas, and Washington, D.C., as well as coaching for people around the world. She specializes in working with adults navigating ARFID, binge eating disorder, and long-term eating disorders. To learn more about therapy, coaching, or Dr. Marianne's self-paced ARFID and selective eating course, visit drmariannemiller.com.

Eating disorder recovery can feel frightening for reasons that go far deeper than food, weight, or body image. One of the most powerful drivers of eating disorder behaviors is fear of uncertainty. When recovery removes rigid rules and predictable routines, the nervous system can interpret that loss of certainty as danger. In this episode, Dr. Marianne explores how fear of uncertainty operates underneath many eating disorder behaviors and why letting go of control can feel destabilizing. She explains the psychology of intolerance of uncertainty and how eating disorders such as anorexia, bulimia, binge eating disorder, and ARFID can develop as attempts to create predictability in an overwhelming world. Intolerance of Uncertainty and Eating Disorders Many people with eating disorders experience what psychologists call intolerance of uncertainty. This means the brain interprets ambiguity and unpredictability as unsafe. Instead of thinking “I don't know what will happen but I can cope,” the nervous system may assume that something bad will happen if there is not a clear plan or outcome. Eating disorder behaviors can temporarily reduce this distress. Restrictive eating, binge eating, purging, body checking, and rigid food rules can create the illusion of certainty. These patterns often lower anxiety in the short term, which reinforces the cycle and makes recovery feel more intimidating. Dr. Marianne explains how this dynamic shows up in eating disorder recovery and why the loss of rigid control can trigger powerful anxiety responses. Why Uncertainty Feels Especially Hard for Neurodivergent People For many listeners, fear of uncertainty is intensified by neurodivergence, trauma history, or systemic stress. Changes in routine, fluctuating internal cues, sensory differences, and executive functioning challenges can all make unpredictability feel overwhelming. Dr. Marianne discusses how autism, ADHD, and other neurodivergent experiences can interact with eating disorders and recovery. She also highlights how weight stigma, ableism, racism, and other systemic pressures can make uncertainty in eating disorder recovery feel even riskier. Understanding these contexts helps shift the conversation from shame to compassion. Microdosing Uncertainty in Eating Disorder Recovery A key concept introduced in this episode is microdosing uncertainty. Instead of forcing dramatic change, recovery can involve practicing small, manageable exposures to unpredictability. Dr. Marianne explains how gradually introducing small shifts in eating patterns, routines, or body-related behaviors can help retrain the nervous system. These repeated experiences allow the brain to learn that uncertainty does not automatically lead to catastrophe. Microdosing uncertainty can help expand the window of tolerance and make eating disorder recovery feel more sustainable. Five Practical Skills for Managing Fear of Uncertainty This episode also explores five practical skills that can help people tolerate uncertainty in eating disorder recovery. Dr. Marianne discusses the importance of practicing small exposures to uncertainty, accurately naming nervous system reactions, creating compassionate structure that reduces overwhelm, regulating anxiety through body-based techniques, and cultivating contextual self-compassion. These skills help widen emotional capacity so recovery does not feel like stepping into chaos. Instead, listeners can gradually build confidence in their ability to navigate unpredictability. Related Episodes An Open Letter to the Body: Listening to the Part That Fears Getting Better on Apple and Spotify. Eating Disorders as Safety Systems: Why Letting Go Can Trigger Fear on Apple and Spotify. If Recovery Feels Unsafe Right Now: A Guided Moment for Eating Disorder Recovery Fear on Apple and Spotify. Expanding Freedom Beyond Eating Disorder Rules Eating disorders often promise certainty, but they narrow life in the process. Recovery may introduce unpredictability, yet it also expands possibilities for nourishment, flexibility, connection, and autonomy. Dr. Marianne emphasizes that recovery is not about eliminating uncertainty. The goal is to build the capacity to live meaningfully alongside it. Therapy and Self-Paced Eating Disorder Recovery Courses If this episode resonates with you and you are looking for additional support, you can visit Dr. Marianne's website to learn more about therapy and self-paced recovery courses. Dr. Marianne is a Licensed Marriage and Family Therapist specializing in eating disorders, including ARFID, binge eating disorder, anorexia, and bulimia. She offers therapy services in California, Texas, and Washington DC and provides virtual courses for people seeking flexible recovery resources. You can learn more about therapy and courses at drmariannemiller.com.

If eating disorder recovery has made your stomach feel worse instead of better, you are not alone. Many people experience bloating, constipation, reflux, stomach pain, and fullness during recovery. These symptoms can feel frightening and discouraging, especially when they show up after you start nourishing your body more consistently. In this solo episode, Dr. Marianne Miller, LMFT, explains why gastrointestinal symptoms are common during eating disorder recovery and why they do not mean recovery is failing. You will learn how restriction affects the digestive system, why symptoms sometimes intensify during early recovery, and what helps the gut heal over time. Dr. Miller also shares practical strategies for coping with GI discomfort while continuing recovery. This episode offers compassionate guidance for navigating one of the most misunderstood parts of eating disorder healing. Why GI Issues Are Common in Eating Disorder Recovery Many people are surprised when digestive symptoms worsen after they begin eating more consistently. Bloating, constipation, reflux, nausea, and stomach pain can make recovery feel confusing or even frightening. In this episode, Dr. Marianne Miller explains how restrictive eating, purging, inconsistent nourishment, and limited food variety affect the gastrointestinal system. When the body does not receive enough energy, digestion slows in order to conserve resources. Motility decreases, stomach emptying may become delayed, and the muscles of the digestive tract lose strength over time. When nourishment increases during recovery, the digestive system must relearn how to function. This recalibration process can temporarily intensify symptoms. While uncomfortable, these changes are often part of the gut rebuilding normal digestive rhythms. Common Digestive Symptoms During Eating Disorder Recovery People in eating disorder recovery frequently report symptoms such as bloating, constipation, reflux, abdominal discomfort, nausea, and early fullness. These symptoms may appear during early refeeding or after increasing meal consistency. Dr. Miller discusses how slowed gastrointestinal motility, microbiome changes, and nervous system activation contribute to these experiences. She also explains why bloating can feel especially distressing in a culture that places intense pressure on stomach appearance and body size. Understanding the physiology behind these symptoms can help reduce fear and prevent the eating disorder from using GI discomfort as justification for returning to restriction. The Gut Is Adaptable and Healing Is Possible One of the most important messages of this episode is that the digestive system is highly adaptable. With consistent nourishment, hydration, and medical support when needed, the gastrointestinal tract can recover significant function. Over time, stomach emptying can improve, bowel patterns can normalize, and abdominal discomfort can decrease. The gut lining regenerates, digestive enzymes adjust, and the microbiome can become more balanced. Recovery does not always follow a straight line, but healing is possible when the body receives consistent energy and care. Practical Ways to Cope With GI Symptoms in Recovery This episode also explores practical ways to cope with digestive discomfort while continuing eating disorder recovery. Dr. Miller discusses the role of mechanical eating in helping retrain digestive rhythms and why regular meals often support gastrointestinal healing. Sensory supports can also help regulate the nervous system, including wearing loose clothing, using a heating pad on the abdomen after meals, and creating calming eating environments. Hydration can support bowel function, and gentle abdominal massage may help stimulate motility. For some individuals, medical providers may recommend medications or short term treatments to reduce symptoms such as constipation, reflux, or delayed gastric emptying. Dr. Miller emphasizes that any movement during eating disorder recovery must be cleared by a medical provider first. If a physician has determined that movement is safe, gentle activities such as short walks or stretching may sometimes support digestion. Medical clearance is essential before incorporating movement into recovery. The Role of Medical Support in GI Healing Because digestive symptoms can overlap with other medical conditions, collaboration with an eating disorder informed medical provider is important. Physicians can help assess symptoms, rule out other causes, and recommend appropriate treatments when needed. Medications or medical supports may be helpful for constipation, reflux, nausea, or delayed gastric emptying. Seeking medical care for GI symptoms does not mean recovery is failing. It means symptoms are being treated compassionately and responsibly. Intersectionality and GI Symptoms Dr. Miller also highlights how systemic bias can affect how digestive symptoms are treated. People in larger bodies may have GI concerns dismissed as weight related rather than recognized as recovery related. People of color may experience undertreatment of pain. Neurodivergent individuals may experience sensory distress that is misunderstood or minimized. Acknowledging these realities helps contextualize why some people struggle to receive appropriate care and why compassionate, informed providers are so important. A Message of Hope for Eating Disorder Recovery GI distress during eating disorder recovery can feel discouraging, especially when symptoms appear after you begin nourishing your body more consistently. But digestive discomfort does not mean recovery is harming you. In many cases, it means the digestive system is relearning how to function. With time, consistent nourishment, appropriate medical support, and nervous system regulation, many people see meaningful improvement in digestive symptoms. Your body is not failing you. It is adjusting and healing. Work With Dr. Marianne Miller Dr. Marianne Miller, LMFT, is a fat eating disorder therapist who specializes in binge eating disorder, ARFID, and complex eating disorder recovery. She works with clients in California, Texas, Washington DC, and internationally through virtual therapy and coaching. If you are looking for eating disorder therapy that integrates physiology, neurodivergent affirming care, and liberation informed approaches, you can learn more about working with Dr. Miller at her website drmariannemiller.com. She also offers self-paced courses and resources designed to support sustainable eating disorder recovery.

Have you ever had the experience of suddenly feeling huge in your body, even though nothing about your body has actually changed? That moment of intense body distress is incredibly common in eating disorder recovery. But what if that feeling is not really about body size at all? In this episode of Dr. Marianne-Land, Dr. Marianne Miller is joined by Amy Ornelas, RDN, an eating disorder dietitian, yoga teacher, and somatic therapy practitioner, to explore what body distress may actually be signaling underneath the surface. Together, they unpack how thoughts like “I feel huge” can often reflect emotional activation, overwhelm, grief, shame, anger, or stress rather than a literal change in body size. Amy explains how eating disorder behaviors such as restriction, binge eating, and purging can alter brain chemistry and disconnect people from their internal emotional world. When those behaviors begin to shift in recovery, many people suddenly find themselves face to face with emotions that may have been numbed or pushed aside for years. This can feel confusing, intense, and sometimes even frightening. Dr. Marianne and Amy talk about how eating disorders can function as powerful survival strategies that help people manage overwhelming emotional states. Rather than demonizing these behaviors, they explore how they often develop as adaptive coping mechanisms in environments where emotional expression was discouraged, dismissed, or unsafe. The conversation also highlights how family dynamics, culture, trauma, and neurodivergence can shape the way people learn to relate to their emotions. Many individuals grow up hearing messages that they are too sensitive, too emotional, or should simply get over what they feel. Over time, these messages can make emotional awareness feel dangerous or overwhelming. Amy introduces the role of somatic therapy in eating disorder recovery and explains how body-based approaches can help people reconnect with their internal sensations in a gradual and supportive way. Instead of forcing emotional processing, somatic work focuses on building safety in the nervous system and slowly increasing the capacity to notice and tolerate emotional states. Dr. Marianne and Amy also discuss how body image distress can function as a powerful distraction. It can feel easier to focus anger, fear, or grief on the body than to confront deeper sources of pain, such as relational conflict, social stress, or systemic injustice. Learning to translate body distress into emotional language can help people understand what their internal system is truly trying to communicate. This episode also addresses an important reality in eating disorder recovery: sometimes people appear more emotionally dysregulated as they begin healing. That increase in emotional expression can actually be a sign that someone is reconnecting with their inner world after years of emotional numbing. Amy shares several practical tools that can help people begin reconnecting with their emotions, including brief emotional check-ins throughout the day, asking simple questions about what feelings may be present when eating disorder urges arise, and using movement to help emotional energy move through the body. Dr. Marianne also brings in a neurodivergent-affirming lens, discussing how stimming, rocking, sensory soothing, and other nervous system supports can help people stay connected to themselves during emotionally intense moments. Together, they emphasize that emotions are not problems to eliminate. They are information from our internal systems that help guide us toward safety, boundaries, authenticity, and healing. In this episode, we discuss How eating disorder behaviors can numb or redirect difficult emotions. Why recovery often brings a surge of feelings to the surface, What somatic therapy is and how it can support eating disorder recovery. Why the thought “I feel huge” often reflects emotional distress rather than body change. How trauma, family systems, and culture shape emotional expression. Why body image distress can act as a distraction from deeper pain. The difference between compartmentalizing emotions and avoiding them. Why increased emotional intensity can be a sign of progress in recovery. Practical ways to begin noticing and naming emotions during recovery. How neurodivergent people may benefit from stimming and sensory supports. About the guest Amy Ornelas, RDN, is a registered dietitian nutritionist, eating disorder specialist, yoga teacher, and somatic therapy practitioner based in California. She works with individuals, families, and groups and integrates nutrition care with somatic and nervous system–informed approaches to eating disorder recovery. Connect with Amy Ornelas Instagram: @amyornelasRD Website: i-heart-nutrition.com Listen if you are Experiencing intense body image distress during eating disorder recovery. Trying to understand why recovery can bring more emotion, not less. Curious about somatic therapy and body-based approaches to healing. Looking for tools to help manage urges to restrict, binge, or purge. Interested in understanding the emotional layers beneath body distress. Related episodes On Eating Disorders as a Coping Strategy for Deeper Pain via Apple or Spotify. On Eating Disorders in Midlife & Our Personal Recovery Stories via Apple or Spotify. On Atypical Anorexia via Apple or Spotify On Eating Disorder Recovery, Higher Level of Care, & Renourishment via Apple or Spotify On Reconnecting With Your Body in Eating Disorder Recovery via Apple or Spotify On Trauma, Eating Disorders, & Levels of Care via Apple or Spotify. Final note Body distress can feel incredibly convincing in the moment. But sometimes the feeling that your body is the problem is actually your emotional system trying to communicate something deeper. Learning to listen to those signals can be a powerful part of eating disorder recovery. Contact Dr. Marianne Check out Dr. Marianne's self-paced, virtual courses on ARFID and binge eating, as well as her therapy services in California, Texas, and Washington D.C., at her website drmariannemiller.com.

Weight stigma affects far more than body size. It shapes healthcare, mental health treatment, and eating disorder recovery for people across all bodies. In this solo episode, eating disorder therapist Dr. Marianne Miller, LMFT, examines how anti-fat bias operates inside medical systems, mental health care, and everyday cultural messages about bodies. Weight stigma does not only harm people in larger bodies. It distorts how clinicians diagnose illness, how providers respond to symptoms, and how individuals relate to food, movement, and self-worth. People in larger bodies often face delayed diagnosis, dismissal of medical concerns, and barriers to eating disorder treatment. At the same time, people in smaller bodies frequently receive praise for behaviors that signal medical or psychological danger, which can hide eating disorders and delay care. In this episode, Dr. Marianne explores how weight stigma disrupts physical health, fuels disordered eating, and complicates recovery. Anti-fat bias increases stress, discourages people from seeking medical care, and encourages shame-based approaches to health. These pressures influence people across body sizes. They can lead individuals to distrust hunger cues, suppress bodily needs, and feel that their worth depends on body size. This conversation also explores how weight stigma interacts with other systems of oppression. Racism, ableism, gender bias, and class inequality can amplify weight-based discrimination in healthcare and mental health settings. When these systems overlap, people often experience greater barriers to accurate diagnosis, compassionate treatment, and sustainable eating disorder recovery. Dr. Marianne also discusses how a liberation-centered approach to treatment can support healing. Recovery becomes more possible when clinicians prioritize autonomy, body respect, and nervous system safety rather than weight control. Challenging anti-fat bias allows providers to offer more accurate care and helps clients rebuild trust with their bodies. If you have ever wondered why eating disorder recovery can feel harder in a culture obsessed with body size, this episode offers an important perspective. Addressing weight stigma creates space for more compassionate healthcare, more effective mental health treatment, and more accessible eating disorder recovery for people in every body.   Here are some related episodes: Anti-Fat Bias in Healthcare & Chronic Illness: Healing Body Image in a Marginalized Body With Ivy Felicia @iamivyfelicia on Apple and Spotify. Medical Weight Stigma & Eating Disorders on Apple & Spotify. Having Anorexia in a Larger Body: Navigating Medical Anti-Fat Bias & Lack of Care with Sharon Maxwell @heysharonmaxwell on Apple & Spotify.   Dr. Marianne Miller is a licensed marriage and family therapist specializing in eating disorder recovery, including ARFID, binge eating disorder, anorexia, and bulimia. Her work centers neurodivergent-affirming care, body liberation, sensory attunement, and trauma-informed treatment that supports long-term healing. You can learn more about therapy with Dr. Marianne Miller or explore her self-paced courses on eating disorder recovery via her website at drmariannemiller.com.

Many people believe restrictive eating is easy to recognize. They picture dramatic weight loss, visible food refusal, or a body that clearly signals medical danger. In reality, restrictive eating often develops quietly and exists on a wide spectrum that includes subtle undereating, ARFID, atypical anorexia, and chronic long-term restriction. In this solo episode, Dr. Marianne Miller explores the restrictive eating spectrum and explains why restriction does not always look the way people expect. Restrictive eating can appear in socially normalized patterns like skipping meals, chronic undereating, rigid food rules, sensory-based food avoidance, or medicalized dieting. Many people living with restriction never receive proper screening or support because their bodies or eating patterns do not match stereotypes about eating disorders. This episode also explores how neurodivergence, sensory sensitivities, trauma, and interoceptive differences can shape restrictive eating patterns, particularly in people with ARFID (Avoidant Restrictive Food Intake Disorder). Even when body image concerns are not present, the body can still experience significant restriction that affects mood, digestion, metabolism, and cognitive functioning. Dr. Marianne also examines so-called "atypical anorexia" and restrictive eating in higher-weight bodies, highlighting how weight stigma and anti-fat bias in healthcare can delay diagnosis and treatment. Many individuals experience serious medical complications from restriction while being told they are healthy or encouraged to continue dieting. The episode also addresses chronic restrictive eating, which can persist for years or decades and reshape hunger cues, nervous system regulation, and energy levels. Dr. Marianne explains how long-term restriction affects the body and why recovery requires more than simply “trying harder” to eat. Finally, this conversation explores what meaningful recovery looks like across the restrictive eating spectrum. Healing requires adequate nourishment, autonomy, compassionate support, and liberation from shame-based food culture. Recovery is not about perfection or rigid rules. It is about helping the body move toward safety, nourishment, and greater freedom over time. If you have ever wondered whether restrictive eating always fits inside a single diagnosis, or if your own relationship with food feels difficult to explain, this episode offers a broader and more compassionate framework for understanding what restriction can look like and how recovery can begin. Related Episodes Anorexia in Higher-Weight Bodies: Rethinking “Atypical Anorexia” & the Restrictive Eating Spectrum With Dr. Jennifer Gaudiani, MD @gaudianiclinic on Apple and Spotify. Anorexia & Night Eating Syndrome: Why Restriction Fuels Night Eating & What Helps on Apple and Spotify. The Quiet Places Where Anorexia Meets Identity & Expression on Apple and Spotify. Topics Discussed in This Episode Restrictive eating spectrum and why restriction is often invisible Subtle undereating and socially normalized food restriction ARFID and sensory-based restrictive eating patterns Being neurodivergent, experiencing interoception, and having eating issues. Atypical anorexia and restrictive eating in higher-weight bodies Weight stigma and diagnostic gaps in eating disorder care Chronic restrictive eating and long-term nervous system changes What real eating disorder recovery requires across the restrictive eating spectrum Resources Mentioned Dr. Marianne Miller's ARFID and Selective Eating Course teaches neurodivergent-affirming and sensory-attuned approaches to expanding nourishment safely and compassionately. The course provides structured guidance for individuals navigating ARFID, restrictive eating patterns, and complex relationships with food. You can learn more about the course and other recovery resources at drmariannemiller.com. Listen and Support the Podcast If this episode resonated with you, consider following the podcast, leaving a review, or sharing the episode with someone who may benefit from hearing it. These small actions help more people find compassionate, evidence-informed conversations about eating disorder recovery.

Why do some people with autism, ADHD, or AuDHD rely on the same safe foods every day, while certain textures or smells make eating feel impossible? In this episode, therapist and AuDHD advocate Patrick Casale shares how food sensory issues, texture aversion, and safe foods shape eating patterns for many neurodivergent adults. In this conversation, Dr. Marianne Miller speaks with Patrick about his experience of late-diagnosed autism and ADHD and how sensory sensitivities affect food choices, routines, and daily life. Patrick describes intense texture aversions, smell sensitivity, and the role safe foods play in creating nervous system stability. They also explore the internal tension many people with AuDHD experience between routine and novelty. Eating the same foods repeatedly can feel regulating and predictable, yet the ADHD side of the brain may crave variety and change. Patrick shares how this push and pull can make food decisions unexpectedly stressful. The discussion also touches on body dysmorphia in men, the pressure of toxic masculinity around appearance and strength, and why many men struggling with body image or eating concerns remain invisible in eating disorder conversations. Patrick also reflects on unmasking and self-advocacy, including honoring sensory needs, choosing comfortable clothing, and setting boundaries around overwhelming social expectations. About Patrick Casale Patrick Casale is an AuDHD TEDx speaker, therapist, podcaster, and consultant. He is the founder of All Things Private Practice and Resilient Mind Counseling. Patrick hosts the All Things Private Practice podcast and co-hosts Divergent Conversations with Dr. Megan Neff of Neurodivergent Insights. He also writes about late-discovered autism and ADHD on Substack in his newsletter The Grief Relief Paradox. Connect with Patrick on Instagram: @patrick.casale Related Episodes “Stuck” Isn't Lazy: Inertia in ADHD, Autism, & Eating Disorder Recovery With Stacie Fanelli, LCSW on Apple & Spotify. Autism & Eating Challenges: Understanding Sensory Needs, Routines, & Safety on Apple & Spotify. Work With Dr. Marianne Miller Dr. Marianne Miller is a licensed marriage and family therapist who specializes in eating disorders, ARFID, binge eating disorder, and neurodivergent experiences with food. Check out her website at drmariannemiller.com. To learn more about therapy with Dr. Marianne Miller or explore her self-paced virtual courses on eating disorder recovery, visit her website. Topics discussed: AuDHD, autism and ADHD, food sensory issues, texture aversion, safe foods, body dysmorphia in men, neurodivergent eating.

Chronic binge eating disorder is not a failure of willpower. It is a nervous system pattern shaped by restriction, shame, trauma, and unmet needs. In this solo episode, Dr. Marianne Miller explores why binge eating becomes chronic, how dieting and food scarcity fuel the cycle, and what real recovery actually looks like for adults living with long-term binge eating disorder. If you feel stuck in the binge cycle, this conversation offers clarity, compassion, and a realistic path forward. Chronic Binge Eating Disorder Is Not About Weakness Many people living with chronic binge eating disorder believe that if they were more disciplined, more motivated, or more in control, the behavior would stop. This episode challenges that harmful narrative. Chronic binge eating disorder persists because powerful biological and psychological systems are involved. Restriction increases hunger hormones and food preoccupation. Stress activates survival responses. Shame reinforces secrecy and isolation. Dr. Marianne explains why binge eating makes sense in context and why understanding the function of the behavior is essential for sustainable binge eating recovery. Why Binge Eating Becomes Chronic Long-term binge eating disorder rarely develops in a vacuum. Dieting, weight stigma, trauma, sensory overload, executive functioning strain, and chronic stress all contribute to the cycle. When the body experiences restriction or perceived scarcity, it responds with urgency. When the nervous system feels overwhelmed, binge eating can temporarily regulate distress. This episode explores how biological drives, nervous system regulation, and shame interact to keep binge eating disorder chronic, even when someone desperately wants change. Neurodivergence, Sensory Needs, and Binge Eating Disorder For many adults, chronic binge eating disorder intersects with ADHD, autism, and other forms of neurodivergence. Food may provide stimulation, grounding, predictability, or relief from decision fatigue. Traditional binge eating treatment models often overlook these factors. Dr. Marianne discusses how a neurodivergent-affirming approach to binge eating recovery can reduce shame and increase effectiveness by supporting sensory needs and executive functioning rather than ignoring them. What Real Recovery From Chronic Binge Eating Disorder Looks Like Mainstream recovery messaging often centers perfection and dramatic transformation. Real recovery from chronic binge eating disorder is usually quieter and more gradual. It begins with safety rather than control. It focuses on consistent nourishment, nervous system regulation, and shame reduction. This episode outlines how sustainable binge eating recovery involves stabilizing food intake, reducing restriction, expanding coping strategies, and building self-compassion. Progress is measured not by perfection, but by increased flexibility, dignity, and safety in the body. Related Episodes Healing Binge Eating Disorder: One Woman's Journey Toward Body Trust & Food Freedom With Dr. Michelle Tubman, M.D. @wayzahealth on Apple & Spotify. Lived Experience of Having Both Bulimia & Binge Eating Disorder With Milda Zolubaite @nutrition.path on Apple & Spotify. ADHD & Binge Eating Disorder With Toni Rudd @the.binge.dietitian on Apple & Spotify. Join the Binge Eating Recovery Membership If you are navigating chronic binge eating disorder and want ongoing, compassionate support, Dr. Marianne's Binge Eating Recovery Membership offers structured guidance rooted in neurodivergent-affirming, trauma-informed, and weight-inclusive care. Inside the membership, you will learn practical tools for nervous system regulation, reduce shame around binge eating, and build sustainable recovery strategies in community. Learn more at: drmariannemiller.com Key Topics in This Episode Chronic binge eating disorder Long-term binge eating patterns Binge eating recovery for adults Restriction and binge cycle Nervous system regulation and food Neurodivergence and binge eating Shame and eating disorders Weight-inclusive eating disorder treatment

Mechanical eating refers to eating on a consistent schedule, usually every three to four hours, regardless of hunger cues. It is commonly introduced in early eating disorder treatment to stabilize nourishment and interrupt restriction or binge cycles. In this episode, Dr. Marianne explains how mechanical eating creates physiological rhythm in a body that has experienced disruption. Eating disorders affect digestion, blood sugar, hormones, and nervous system regulation. Mechanical eating restores predictability and reduces biological chaos. Lifelong recovery invites a deeper question. Is structure still serving you years into recovery, or has it become rigid? How Mechanical Eating Supports Your GI System, Blood Sugar, and Mood Mechanical eating is not just about timing. It directly supports digestive health, metabolic stability, and emotional regulation. Regular nourishment helps the gastrointestinal system relearn movement and tolerance after restriction. It can reduce bloating, reflux, constipation, nausea, and abdominal pain that often occur when eating patterns have been irregular. Mechanical eating also stabilizes blood sugar levels. Long gaps without food can lead to shakiness, irritability, brain fog, dizziness, and intense urgency to eat. Consistent intake smooths those fluctuations and supports steady energy throughout the day. Because the brain depends on adequate fuel, mechanical eating also improves mood regulation. Anxiety, irritability, and low mood often intensify when nourishment is inconsistent. Stabilizing blood sugar reduces these physiological stress responses and creates a more regulated emotional baseline. For many people, these benefits make mechanical eating a powerful and supportive tool. When Mechanical Eating May Stop Fitting Lifelong eating disorder recovery requires flexibility. A strategy that was essential in early recovery may need to evolve over time. Mechanical eating can become rigid if the clock replaces internal cues entirely. Some people experience anxiety if eating times shift. Others notice that hunger cues remain muted even after years of structure. For neurodivergent individuals, strict schedules may conflict with executive functioning variability, sensory sensitivities, or fluctuating energy. This episode explores how to recognize when mechanical eating is supportive and when it may need to be adapted. Recovery is not about perfect adherence. It is about building a sustainable, compassionate relationship with food and body over time. Who Mechanical Eating Helps Most in Long-Term Recovery Mechanical eating often benefits people who need predictable physiological regulation, reduced decision fatigue, and steady nourishment despite unreliable hunger signals. It can be especially helpful during stress, illness, life transitions, or periods of emotional overwhelm. Rather than seeing mechanical eating as a permanent rule, Dr. Marianne reframes it as a flexible tool that can be used when needed and modified when necessary. Lifelong recovery allows room for adaptation. ARFID, Selective Eating, and Mechanical Eating For individuals with ARFID or selective eating, mechanical eating alone is often not enough. Sensory sensitivity, fear of aversive consequences, and low appetite require neurodivergent-affirming and sensory-attuned approaches. Dr. Marianne's ARFID and Selective Eating Course provides structured, trauma-informed, and liberation-centered support for people who need more than traditional eating disorder recovery tools. In the course, she addresses nervous system regulation, sensory safety, and realistic long-term change. Learn more about the ARFID course and therapy options at drmariannemiller.com. Related Episodes Intuitive vs. Mechanical Eating: Can They Coexist? on Apple & Spotify. Orthorexia, Quasi-Recovery, & Lifelong Eating Disorder Struggles with Dr. Lara Zibarras @drlarazib on Apple & Spotify. The Truth About "High-Functioning" People With Lifelong Eating Disorders on Apple & Spotify. Understanding Harm Reduction: Why "Full Recovery" May Not Be the Goal for Lifelong Eating Disorders on Apple & Spotify. Key Topics Covered in This Episode Mechanical eating in lifelong eating disorder recovery Chronic eating disorders and long-term recovery GI system healing and digestive regulation Blood sugar stabilization and binge-restrict cycles Mood regulation and nervous system safety Neurodivergent-affirming eating disorder treatment ARFID and selective eating support If this episode resonated with you, consider sharing it with someone navigating long-term eating disorder recovery. And if you are looking for therapy or structured support grounded in liberation, sensory attunement, and autonomy, visit drmariannemiller.com to learn more about working with Dr. Marianne Miller. Take gentle care of yourself.

Confidence is not about loving how you look. It is about resilience, safety, and agency in eating disorder recovery. In this thoughtful and grounded conversation, Dr. Marianne Miller sits down with therapist, educator, and podcast host Rachelle Heinemann, LMHC, LPC @raquelleheinemann, to explore the deeper emotional and relational layers beneath body image distress and disordered eating. Rather than focusing only on surface-level body image strategies, this episode examines how confidence develops through resilience, meaningful connection, personal agency, and small intentional steps taken over time. Together, they discuss why traditional approaches to body image may feel incomplete, how unsafe environments can intensify negative body thoughts, and what it truly means to cultivate confidence in the context of eating disorder recovery. This conversation offers compassionate, clinically informed insight for anyone navigating body image struggles, low self-esteem, chronic disordered eating patterns, or the long path of healing. What We Explore in This Episode The relationship between body image, confidence, and disordered eating. Why confidence is better understood as resilience rather than appearance or personality. How safety, stress, and environmental context influence body image distress. The role of agency, assertiveness, and small achievable steps in recovery. Why meaningful, supportive relationships are foundational to confidence building. How deeper emotional needs often drive body image pain more than physical appearance. Practical ways to begin cultivating resilience in eating disorder recovery. A Different Way to Understand Confidence Many conversations about confidence center on visibility, charisma, or loving one's body at all times. In this episode, Raquelle offers a more compassionate and realistic framework: confidence as an internal, flexible resilience that can grow even when fear, uncertainty, or body image distress are still present. Through clinical stories and lived therapeutic insight, this discussion reframes confidence as something that develops through curiosity, connection, and repeated small acts of courage, rather than perfection or performance. About Rachelle Heinemann, LMHC, LPC Rachelle Heinemann is a licensed mental health counselor in New York and a licensed professional counselor in New Jersey. She specializes in working with individuals experiencing disordered eating, eating disorders, anxiety, depression, and relationship challenges. She teaches courses on eating disorders and body image, provides continuing education for clinicians, and hosts the podcast Understanding Disordered Eating. Raquelle also contributes leadership within the International Association of Eating Disorder Professionals New York. Her confidence and resilience workbook, discussed in this episode, guides readers through curiosity, connection, and small actionable steps toward meaningful and sustainable change. Resources and Links Rachelle's Confidence & Resilience Workbook: (Use code PODCAST to download for free.) Understanding Disordered Eating Podcast Bergen Mental Health Group Follow Rachelle on Instagram: @rachelleheinemann Related Episodes DIVING DEEP to Help Folks Recover From Eating Disorders, With Rachelle Heinemann, LMHC, CEDS, @rachelleheinemann on Apple and Spotify. When Exercise Becomes Punishment: Body Image, Shame, & Disordered Eating With Dr. Lisa Folden @healthyphit on Apple and Spotify. Work With Dr. Marianne Miller Dr. Marianne Miller is a licensed marriage and family therapist specializing in: Eating disorder recovery ARFID and selective eating Binge eating disorder Neurodivergent-affirming care Body liberation and weight-inclusive healing Therapy and coaching are available in California, Texas, Washington, DC, and worldwide. You can also explore: The ARFID & Selective Eating Course The Binge Eating Recovery Membership More episodes of the Dr. Marianne-Land Podcast on body image, neurodivergence, and long-term recovery Listen, Follow, and Share If this episode resonated with you, consider following the podcast, leaving a review, or sharing it with someone who may need compassionate, evidence-informed support for body image and eating disorder recovery. Your support helps more people find liberation-oriented, neurodivergent-affirming care.

Many people enter eating disorder recovery believing that effort guarantees progress. Follow the meal plan. Use the coping skills. Stay consistent. When recovery still feels stuck, shame often follows. This episode explores a different truth. Recovery can stall even when you are doing everything right, and stalled progress usually reflects misalignment rather than failure. Dr. Marianne examines the hidden reasons eating disorder recovery plateaus, including nervous system overload, limited capacity, chronic stress, trauma history, neurodivergence, and lack of structural support. She explains why compliance without regulation rarely leads to sustainable healing and why recovery models that ignore real-world context can unintentionally increase distress. This conversation also centers intersectionality. Systems of oppression such as racism, anti-fat bias, ableism, homophobia, transphobia, and medical discrimination shape both eating disorder development and recovery access. When treatment ignores these realities, people may feel blamed for struggles that are deeply structural. Understanding this context can transform how stalled recovery is interpreted and supported. Listeners will gain a more compassionate and clinically grounded framework for understanding recovery plateaus, along with language that reduces shame and opens space for more humane, sustainable healing paths. In This Episode Dr. Marianne explores why motivation does not equal capacity and why nervous system regulation must accompany behavior change. She discusses how grief, identity shifts, and emotional exposure often emerge during recovery and can be mistaken for failure. She also explains why neurodivergent people frequently experience recovery mismatch due to sensory, executive functioning, and interoceptive differences that traditional treatment overlooks. The episode highlights the emotional toll of constant self-monitoring, the importance of therapeutic fit, and the role of intersectional stress in shaping recovery progress. Most importantly, it reframes stalled recovery as meaningful clinical information rather than personal weakness. Who This Episode Is For This episode is for people who feel stuck in eating disorder recovery despite working hard. It is also for clinicians, loved ones, and advocates seeking a more intersectional, nervous-system-informed understanding of recovery plateaus. Related Episodes “Slips” in Eating Disorder Recovery in 2026: Why Setbacks Are Part of Progress, Not Failure (With Mallary Tenore Tarpley, MFA) on Apple and Spotify. The Middle Place in Eating Disorder Recovery: How Slips Can Be Stepping Stones With Mallary Tenore Tarpley, MFA @mallarytenoretarpley on Apple and Spotify. Slips, Setbacks, & Relapses in Eating Disorder Recovery on Apple and Spotify. Work With Dr. Marianne Miller If recovery feels confusing, stalled, or misaligned, you do not have to navigate it alone. Dr. Marianne Miller is a Licensed Marriage and Family Therapist who specializes in eating disorder recovery through a neurodivergent-affirming, trauma-informed, and liberation-oriented lens. Learn more about therapy, coaching, virtual courses, and recovery support at her website drmariannemiller.com.

In this solo episode, Dr. Marianne Miller explores how the Emmy-winning and Golden Globe–winning medical drama The Pitt portrays eating disorders, emergency medicine, and bias in ways that feel both culturally meaningful and clinically relevant. She reflects on how the show separates two critical themes across seasons: the medical system's tendency to miss eating disorders in Black women, and the role of weight bias in emergency department diagnosis and care. Drawing from years of clinical experience, Dr. Miller discusses how many clients first encounter medical crisis in emergency rooms, often because of dangerously low heart rates, dizziness, fainting, or other complications linked to disordered eating. She explains how ER responses vary widely, and how bias, time pressure, and assumptions about body size or race can shape whether clinicians recognize eating disorder symptoms. The episode highlights a season two storyline in which a Black woman presents to the ER without classic eating disorder signs, making diagnosis more complex. Dr. Marianne examines why missing textbook symptoms often leads clinicians to overlook bulimia and other eating disorders, especially in populations that medicine historically underdiagnoses. She also reflects on how the show names this reality directly and why that representation matters for visibility, validation, and future care. Dr. Marianne then turns to season one's depiction of a physician challenging a resident's assumption that body weight predicts health. She explores how medical weight bias affects diagnosis, delays treatment, and reinforces stigma in emergency medicine. She also shares the change she wishes the episode had made, noting that many people with bulimia live in bodies that are not thin, and that anti-fat bias and racial bias together create additional barriers for Black women seeking care. Throughout the episode, Dr. Marianne centers a liberation-informed lens that honors intersectionality, context, nervous system safety, and autonomy in eating disorder recovery. She invites listeners to consider how accurate media representation can shift clinical awareness and expand who medicine recognizes as deserving care. You can watch The Pitt on HBO and HBO Max. Topics Covered in This Episode Eating disorders in Black women Missed diagnosis in emergency medicine Low heart rate and medical risk in eating disorders Bulimia without classic symptoms Medical weight bias in ER care Race, stigma, and underdiagnosis Media representation and clinical awareness Liberation-informed eating disorder therapy Related Episodes Boundaries, Therapy While Black, & Eating Disorders with Kaela Farrise, LMFT on Apple and Spotify. Avoidance, Body Image Standards, & the Notion of the Strong, Black Woman with Jasmine Jacquess, MA, PLPC on Apple and Spotify. Recommended Books -Not All Black Girls Know How to Eat: A Story of Bulimia, by Stephanie Covington-Armstrong -The Body Is Not An Apology, 2nd ed., by Sonya Renee Taylor -Fearing the Black Body: The Racial Origins of Fat Phobia, by Dr. Sabrina Strings Resources and Support If you are looking for eating disorder therapy that centers intersectionality, lived context, and liberation-informed care, you can learn more about working with Dr. Marianne Miller through therapy or consultation on her website, drmariannemiller.com. Her approach honors autonomy, neurodivergence, trauma history, body diversity, and systemic realities that shape recovery. You deserve care that sees the full picture of your life, not just symptoms on a chart.

ADHD, autism, and eating disorders through the lens of inertia. What if feeling stuck is not laziness, resistance, or lack of motivation? In this conversation, Dr. Marianne Miller speaks with ADHD and neurodivergent-affirming therapist Stacie Fanelli, LCSW, @edadhd_therapist, about how autistic inertia, ADHD hyperfocus, and executive functioning differences shape restriction, bingeing, and symptom cycling. They explore why recovery approaches built on willpower and choice can deepen shame for neurodivergent people and how capacity-aware care offers a different path. Inertia outside of the ED can be a trigger for EDs existentially because of the sense of “stuckness” it creates; then, the ED swoops in and offers a sense of control.  This episode reframes stuckness as a nervous system experience rather than a character flaw and introduces compassionate, liberation-centered recovery grounded in harm reduction, radical acceptance, and real support for neurodivergent healing. Contact Stacie https://www.autonomousmindstherapy.com Related Episodes Recovering Again: Navigating Eating Disorders After a Late Neurodivergent Diagnosis (Part 1) With Stacie Fanelli, LCSW @edadhd_therapist on Apple and Spotify. Recovering Again: Navigating Eating Disorders After a Late Neurodivergent Diagnosis (Part 2) With Stacie Fanelli, LCSW @edadhd_therapist on Apple and Spotify. Minding the Gap: The Intersection Between AuDHD & Eating Disorders With Stacie Fanelli, LCSW on Apple and Spotify.  

Why does eating still feel impossible for neurodivergent people with long-term eating disorders, even after insight, treatment, and real effort? In this episode, Dr. Marianne Miller explores the hidden sensory, executive functioning, and nervous system friction that causes eating to keep breaking down in daily life. This conversation moves beyond motivation, fear foods, and traditional recovery advice to name the invisible moments when hunger arrives too late, meals require overwhelming cognitive energy, sensory overload interrupts eating, masking replaces body awareness, or a nervous system crash follows nourishment. You'll learn why neurodivergent eating disorder recovery often stalls inside standard treatment models, how chronic eating disorders can reflect adaptation rather than failure, and what actually supports sustainable nourishment for people living with ARFID, anorexia, bulimia, binge eating disorder, and long-term restrictive or chaotic eating patterns. This episode offers a neurodivergent-affirming, trauma-informed, and weight-inclusive framework for understanding why eating still feels so hard—and how recovery can begin by reducing friction instead of increasing pressure. If you're searching for realistic eating disorder recovery, support for ARFID in adults, or compassionate care that centers sensory needs and autonomy, this conversation is for you. You can also check out my self-paced, virtual ARFID course or other resources on my website, drmariannemiller.com. Related Episodes Unmasking, Embodiment, & Trust: A Neurodivergent Approach to Eating Disorder Recovery With Dr. Emma Offord @divergentlives via Apple & Spotify. Unmasking in Eating Disorder Recovery: What Neurodivergent People Need to Know About Safety & Healing via Apple & Spotify. Autism & Anorexia: When Masking Looks Like Restriction, & Recovery Feels Unsafe via Apple & Spotify. Recovering Again: Navigating Eating Disorders After a Late Neurodivergent Diagnosis (Part 1) With Stacie Fanelli, LCSW @edadhd_therapist via Apple & Spotify.

Night eating can feel confusing, distressing, and isolating for people living with anorexia, especially when restriction shapes daytime eating. Many adults limit food during the day and then experience intense hunger, urgency to eat, or automatic eating at night. This pattern often creates shame and the belief that recovery is failing. In this episode, Dr. Marianne Miller explains why anorexia and night eating syndrome frequently overlap and how daytime restriction drives nighttime eating through biological survival responses and nervous system stress. She reframes night eating as adaptation rather than loss of control and challenges treatment messages that rely on shame or rigid control. This conversation centers trauma-informed, neurodivergent-affirming eating disorder recovery and introduces non-punitive tools that support regulation, safety, and sustainable change. Why Anorexia and Night Eating Syndrome Often Occur Together Many clinical frameworks treat anorexia and night eating syndrome as separate or opposing diagnoses. In practice, restriction, energy deficit, and nervous system activation during the day often lead the body to seek nourishment at night when threat levels feel lower. Night eating in anorexia does not reflect a failure of discipline. It reflects a biological and neurological survival response to deprivation, chronic stress, and unmet energy needs. Understanding this connection reduces shame and opens the door to more effective, compassionate eating disorder treatment. How Daytime Restriction Fuels Nighttime Eating Restriction includes more than eating small amounts of food. It can involve delaying meals, limiting food variety, suppressing hunger signals, or following rigid food rules that keep the body in a constant state of vigilance. When restriction continues across the day, the body tracks energy debt, stress hormones rise, and hunger intensifies. Nighttime may become the first moment when eating feels possible or safe. This cycle explains why night eating in anorexia can persist even when someone feels committed to recovery. Why Shame and Control Do Not Resolve Night Eating Common advice such as eating more during the day often overlooks nervous system safety, trauma history, and neurodivergent sensory needs. Increasing pressure or tightening rules usually strengthens the restriction and night eating cycle rather than resolving it. Reducing shame and supporting regulation creates conditions where change can occur without punishment or fear. Supportive Approaches That Address Root Causes Recovery-supportive care focuses on safety, predictability, and nervous system regulation rather than control. Daytime nourishment becomes more sustainable when eating feels safe enough and emotionally tolerable. Removing moral judgment from night eating reduces the restriction-shame cycle that keeps symptoms active. Gentle structure can support regulation without imposing rigid rules, and trauma-informed, neurodivergent-affirming treatment allows the body to receive nourishment without overwhelming threat. When these conditions develop, night eating often softens naturally over time. Who This Episode Is For This episode speaks to adults living with anorexia and night eating syndrome, people who restrict during the day and eat at night, and individuals navigating chronic eating disorders or recovery that feels stalled despite effort. It also supports neurodivergent adults managing sensory needs around food and anyone seeking weight-inclusive, trauma-informed eating disorder therapy that honors autonomy and lived experience. Related Episodes Night Eating Syndrome on Apple & Spotify (my 2nd most popular podcast episode of all time!) Understanding Night Eating Syndrome: Executive-Function Tools for Real Recovery on Apple & Spotify. Why Am I Eating at Night? Understanding Night Eating Syndrome in Your 30s, 40s, & 50s on Apple & Spotify. Work With Dr. Marianne Miller If you are looking for eating disorder therapy in California or support for anorexia, night eating syndrome, ARFID, or binge eating disorder, Dr. Marianne Miller offers neurodivergent-affirming, liberation-centered care for adults. You can learn more about therapy services, recovery resources, and ways to work together by visiting her website, drmariannemiller.com. You deserve support that works with your body, respects your nervous system, and honors your autonomy in recovery.

What if anorexia is being missed simply because of body size? In this powerful and deeply validating conversation, I sit down with eating disorder physician Dr. Jennifer Gaudiani, MD @gaudianiclinic to explore why the term “atypical anorexia” can obscure real medical risk, delay diagnosis, and reinforce weight stigma across healthcare systems. We discuss what has changed since the first edition of Sick Enough, why weight stigma remains foundational to eating disorder harm, and how current research is reshaping clinical understanding of restrictive eating, ARFID in adults, digestive illness, neurodivergence, chronic medical conditions, and long-term eating disorder recovery. At the center of this episode is an urgent truth for 2026: severe eating disorder suffering does not require being underweight. What We Discuss in This Episode Throughout this conversation, we examine why most people with anorexia are not underweight and how weight stigma continues to shape who gets believed, diagnosed, and treated. Dr. Gaudiani shares what is new and expanded in the second edition of Sick Enough, including updated medical research on binge eating disorder, ARFID across the lifespan, atypical anorexia, and the broader restrictive eating spectrum. We also explore the critical role of gastrointestinal pain, mast cell activation syndrome (MCAS), postural orthostatic tachycardia syndrome (POTS), and complex chronic illness in both driving and worsening restrictive eating patterns. This discussion highlights why many adults with ARFID remain misdiagnosed for years, how neurodivergence such as autism and ADHD intersects with eating disorders, and why neurodivergent-affirming, weight-inclusive, trauma-informed care is essential for meaningful recovery. Key Themes for Eating Disorder Recovery in 2026 We further discuss harm reduction, autonomy, and realistic pathways for people living with long-term or chronic eating disorders, including how rebuilding trust after medical trauma can reopen the possibility of healing. Rather than framing recovery as “full recovery or nothing,” this episode explores how supporting quality of life, medical stability, and patient-directed goals can actually improve outcomes. These themes reflect major shifts happening in eating disorder treatment in 2026, including movement toward weight-inclusive medicine, trauma-informed care, recognition of ARFID in adults, support for chronic eating disorders, and clinical models that affirm neurodivergent lived experience. About the Guest Dr. Jennifer Gaudiani, MD @gaudianiclinic is a board-certified internal medicine physician and one of the leading medical experts in eating disorder care. She is the founder and medical director of the Gaudiani Clinic, a weight-inclusive outpatient medical practice providing specialized treatment for eating disorders, undernourishment related to complex medical conditions, and trauma-informed primary care across the United States via telemedicine. Dr. Gaudiani previously served as medical director at the ACUTE Center for Eating Disorders and is the author of Sick Enough: A Guide to the Medical Complications of Eating Disorders, a widely respected clinical and patient resource now released in a fully updated second edition. Her work centers compassion, autonomy, and dignity for people in all body sizes seeking eating disorder recovery. Resources Mentioned Resources referenced in this episode include Sick Enough: A Guide to the Medical Complications of Eating Disorders (Second Edition) and the Gaudiani Clinic, which offers weight-inclusive outpatient medical care for eating disorders throughout the United States. Content Caution This episode includes discussion of eating disorders, restrictive eating, ARFID, medical complications, gastrointestinal illness, weight stigma, and medical trauma. Please listen in the way that feels most supportive for you and take pauses as needed. Work With Dr. Marianne If this conversation resonated, you are not alone. I provide neurodivergent-affirming, trauma-informed, weight-inclusive eating disorder therapy for adults in California, Texas, and Washington, D.C., along with worldwide coaching support. You can learn more or schedule a consultation at drmariannemiller.com. Listen Next If you found this episode meaningful, you may also connect with conversations on ARFID in adults, medical trauma in eating disorder care, chronic eating disorders and harm reduction, neurodivergence and restrictive eating, and complex medical complications such as low heart rate, gastrointestinal illness, MCAS, and recovery in higher-weight bodies. Here are some episodes to listen next: Atypical Anorexia Explained: Why Restriction Happens at Every Body Size on Apple or Spotify. Atypical Anorexia: Mental & Physical Health Risks, Plus How the Term is Controversial on Apple or Spotify. Chronic Eating Disorders in 2026: What Hope Can Actually Look Like on Apple and Spotify. Why Some Eating Disorders Don't Resolve: Understanding Chronic Patterns & What Actually Supports Change on Apple and Spotify. When PDA Drives ARFID: Understanding Food Refusal, Control, & Safety on Apple & Spotify. ARFID Explained: What It Feels Like, Why It's Misunderstood, & What Helps on Apple & Spotify.

When self-criticism ramps up during eating disorder recovery, it can feel confusing or discouraging, especially when behaviors are beginning to change. This episode explores why that intensification is often part of the healing process rather than a sign that recovery is going wrong. In this solo episode, Dr. Marianne Miller explains why the inner critical voice often gets louder as eating disorder behaviors decrease and familiar control systems loosen. Instead of framing self-criticism as simply negative self-talk, this episode examines it as a regulatory strategy shaped by nervous system threat, social pressure, and internalized ableism. Internalized Ableism in Eating Disorder Recovery Recovery often collides with a world that expects bodies and minds to function efficiently, consistently, and quietly. In this section, Dr. Marianne names how those expectations become internalized as harsh self-judgment, especially for neurodivergent people, people with chronic illness, and those navigating long-term eating disorders. You'll hear how internalized ableism fuels self-criticism when recovery requires pacing, support, repetition, or accommodation, and why needing these supports does not mean recovery is failing. The Inner Critic and Nervous System Threat Many people try to argue with or silence self-critical thoughts in recovery. This episode explains why that approach often backfires and intensifies the inner voice instead. Dr. Marianne explores how the inner critic functions as a response to perceived threat and why understanding its role is more effective than trying to eliminate it. Responding to Self-Criticism Without Shame This episode offers compassionate, neurodivergent-affirming ways to respond to self-criticism without turning recovery into another performance. The focus is on reducing threat, supporting regulation, and loosening the critic's authority rather than suppressing it. A brief clinical vignette illustrates how self-criticism rooted in internalized ableism can show up even when healing is actively underway. Nonlinear Eating Disorder Recovery For people with long-term or chronic eating disorders, progress often looks different than expected. This section reframes recovery as a process that prioritizes safety, accommodation, and sustainability over efficiency or perfection. Loud self-criticism does not mean failure. It often signals that a system is reorganizing in response to change. A Gentle Reminder Recovery is not about proving you can function the way the world demands. It is about building a life that supports your nervous system, your needs, and your humanity. Related Episodes This Is Body Grief: How Ableism, Intersectionality, & Eating Disorders Shape Our Body Experiences With Jayne Mattingly on Apple & Spotify. Size Inclusivity & Ableism: Why Body Acceptance is More Than Just "Loving Your Curves" on Apple & Spotify. Ableism and Common Myths About Diabetes with Kim Rose, RD @the.bloodsurgar.nutritionist on Apple & Spotify. Work With Me and Learn More If this episode resonated and you want structured, neurodivergent-affirming support, you can learn more about my self-paced ARFID course. The course is designed for teens and adults navigating avoidant and restrictive eating patterns and focuses on sensory needs, nervous system safety, and realistic, sustainable change without shame or pressure.

Eating disorder recovery in midlife often looks very different than recovery earlier in life. For many adults over 40, anorexia and bulimia are not new struggles but long standing patterns shaped by decades of survival, responsibility, and adaptation. This episode explores why recovery after 40 requires a different lens and why difficulty healing is not a personal failure. In this solo episode, Dr. Marianne Miller examines how anorexia and bulimia persist into midlife and what actually supports healing at this stage of life. Rather than focusing on willpower or symptom control, this conversation centers nervous system safety, autonomy, grief, and the cumulative impact of stress and systemic harm. You will hear how hormonal changes, aging bodies, chronic stress, caregiving roles, and identity related oppression all shape midlife eating disorder recovery. This episode also addresses why traditional treatment models often fall short for adults over 40 and how neurodivergent affirming, weight inclusive, and harm reduction oriented care can offer a more sustainable path forward. Recovery after 40 is not about catching up or starting over. It is about choosing care that fits the life you are living now. In this episode, we cover: Anorexia and bulimia in midlife and why recovery changes after 40. Why long standing eating disorder patterns often reflect adaptation, not resistance. How the body communicates differently in midlife through hunger, fatigue, pain, and stress. The role of grief, fear, and ambivalence in midlife eating disorder recovery Intersectionality in recovery, including the effects of weight stigma, racism, ableism, and anti-queer and anti-trans bias. Neurodivergence, sensory sensitivity, and why many adults were never supported earlier in life. Why harm reduction and pacing often support recovery better than urgency. What weight inclusive, autonomy centered therapy can look like for adults over 40. Who this episode is for: Adults over 40 navigating anorexia or bulimia. People with long term or recurring eating disorder patterns. Neurodivergent adults and those with sensory sensitivities. Fat people and others harmed by weight stigma in healthcare. Anyone who has felt left behind by traditional eating disorder treatment. Related episodes: The Hidden Pain of Midlife Anorexia: Why Coping Breaks Down & What Heals on Apple & Spotify. Why Is Anorexia Showing Up Again in Midlife? You're Not Imagining It on Apple & Spotify. Midlife Bulimia Recovery: Coping With the Internal Chaos on Apple & Spotify. Welcome to the Jungle: Eating Disorders in Midlife & Our Personal Recovery Stories with Amy Ornelas, RD on Apple & Spotify. About working with Dr. Marianne Miller Dr. Marianne Miller is a licensed marriage and family therapist specializing in eating disorder therapy for adults, including anorexia, bulimia, binge eating disorder, and ARFID. Her work centers neurodivergent affirming, weight inclusive, and harm reduction approaches that honor safety, agency, and lived context. Dr. Marianne works with adults in California, Texas, and Washington DC. Therapy is grounded in an understanding of how trauma, systemic oppression, and nervous system overwhelm shape eating struggles across the lifespan. Learn more about working with Dr. Marianne and current therapy availability by visiting her website drmariannemiller.com. Content note This episode discusses eating disorders, recovery, and midlife body changes. Listener discretion is advised.

When you live with a chronic illness, food restriction is often framed as “medical,” “necessary,” or “just being responsible.” But for many people, especially those with eating disorder histories, that kind of guidance doesn't support health. It fuels fear, shame, isolation, and disordered eating patterns that are hard to unwind. In this episode, Dr. Marianne is joined by Vanessa Connolly, a registered dietitian nutritionist and board-certified kidney nutrition specialist, for a grounded, compassionate conversation about what happens when restriction is prescribed rather than chosen and why that matters so deeply for eating disorder recovery. Together, they unpack how diet culture shows up in chronic illness care, how weight stigma and medical bias shape food advice, and why many people are quietly harmed by guidance that prioritizes control over nourishment. In This Conversation, We Explore This episode looks at how chronic illness care can unintentionally recreate the same dynamics that drive eating disorders, especially for people who have already spent years being told their bodies are the problem. We talk about how fear-based food rules around labs, numbers, and diagnoses often strip people of cultural foods, social connection, and bodily trust. You'll hear why blanket dietary restrictions are rarely neutral, how they can worsen food fear and disordered eating, and what a more supportive, humane approach to nutrition can look like. Vanessa also explains why focusing on what can be added rather than taken away, including fiber, balance, and satisfaction, supports both physical health and psychological safety. This episode names the emotional cost of food policing, family surveillance, and medical dismissal, especially for people in larger bodies and those navigating multiple marginalized identities. Topics Covered We discuss eating disorder recovery alongside chronic illness, including chronic kidney disease, diabetes, and high blood pressure, without defaulting to diet culture or weight-centric care. This conversation includes medical gaslighting and delayed diagnoses, how lab values like GFR are often misunderstood or minimized, and why many patients are never fully informed about what's happening in their own bodies. We also explore anti-fat bias in healthcare, intersectionality, cultural food loss, and how shame and restriction can isolate people from their communities at the very moment they need support the most. Why This Episode Matters If you've ever felt afraid to eat after a diagnosis, confused by conflicting medical advice, or worried that “doing everything right” is actually making things worse, this episode is for you. This is not a conversation about willpower, compliance, or perfect eating. It's about restoring agency, reducing harm, and finding ways to care for your body that don't require sacrificing your relationship with food. About the Guest Vanessa Connolly is a registered dietitian nutritionist and board-certified kidney nutrition specialist with over 20 years of experience supporting people with chronic kidney disease. Her work centers on helping clients preserve kidney function without unnecessary restriction, food fear, or shame. She is deeply committed to accessible, weight-inclusive, and judgment-free care. You can find Vanessa on Instagram and TikTok @grainandgreen.kidneys, where she shares practical, anti-diet education about kidney health and chronic illness. Related Episodes The Real Talk on Kidney-Friendly Diets & Disordered Eating With Vanessa Connelly, RD @grainandgreen.kidneys on Apple and Spotify. Chronic Illness, Wellness Culture, & Eating Disorder Recovery: Taking an Anti-Diet Approach With Abbie Attwood, MS, @abbieattwoodwellness on Apple and Spotify. Anti-Fat Bias in Healthcare & Chronic Illness: Healing Body Image in a Marginalized Body With Ivy Felicia @iamivyfelicia on Apple and Spotify. Support Beyond This Episode If eating feels complicated, unsafe, or overwhelming after years of restriction, diagnosis-driven food rules, or medical trauma, you don't have to navigate that alone. Dr. Marianne offers eating disorder therapy and support for people navigating binge eating disorder, ARFID, anorexia, bulimia, and long-term eating struggles, including when chronic illness or medical advice is part of the picture. Services are available in California, Texas, Washington, D.C., and worldwide. Go to drmariannemiller.com for more information.

Avoidant Restrictive Food Intake Disorder does not end in childhood. Many adults live for years, even decades, with ARFID that goes unnamed, misunderstood, or incorrectly treated. In this solo episode, Dr. Marianne Miller explores why ARFID in adults is so often missed, how misdiagnosis shapes harmful care pathways, and what adult-appropriate support actually requires. This conversation centers adults who never felt seen in eating disorder spaces, who were told their struggles were anxiety, habits, or personality traits, and who learned to adapt quietly rather than receive care that fit. Why ARFID in Adults Is Frequently Missed ARFID still gets framed as a childhood diagnosis in many clinical settings. When adults present with long-standing food avoidance, fear of adverse consequences, or limited food variety, providers often overlook ARFID entirely. This section explores how outdated training and pediatric-focused models contribute to delayed recognition and missed diagnosis. Common Misdiagnoses That Delay ARFID Treatment Adults with ARFID are frequently misdiagnosed with anorexia, generalized anxiety disorders, gastrointestinal conditions, or trauma responses. Dr. Miller explains how weight-centered assumptions and surface-level assessments obscure the nervous system and sensory drivers of ARFID, leading to treatment that does not address the real issue. Why So Many Adults Go Untreated for Years Many adults with ARFID become highly skilled at adapting. They plan their lives around food access, avoid social eating, and manage significant cognitive and emotional labor behind the scenes. Because this adaptation often looks like functioning, providers underestimate the depth of distress and delay appropriate intervention. Neurodivergence, Trauma, and Medical History in Adult ARFID ARFID in adults frequently overlaps with neurodivergence, chronic illness, trauma, and complex medical experiences. This episode discusses how sensory processing differences, interoceptive challenges, and past food-related or medical harm shape adult eating patterns and must be addressed in care. What Adult-Appropriate ARFID Care Actually Looks Like Effective ARFID treatment for adults requires flexibility, collaboration, and respect for autonomy. Dr. Miller outlines why rigid eating disorder models often fail adults with ARFID and what support looks like when it centers nervous system safety, lived experience, and real-world practicality. Late Diagnosis Does Not Mean Failure If you received an ARFID diagnosis later in life, or are only now recognizing yourself in this conversation, this section offers validation. Delayed diagnosis reflects systemic gaps, not personal shortcomings. There is no expiration date on care, understanding, or support. Related Episodes When PDA Drives ARFID: Understanding Food Refusal, Control, & Safety on Apple & Spotify. ARFID Explained: What It Feels Like, Why It's Misunderstood, & What Helps on Apple & Spotify. Why Sensory-Attuned Care Matters More Than Exposure in ARFID Treatment on Apple & Spotify. Complexities of Treating ARFID: How a Neurodivergent-Affirming, Sensory-Attuned Approach Works on Apple & Spotify. Support and Resources Dr. Marianne shares information about her virtual, self-paced, ARFID and Selective Eating course, designed for adults seeking neurodivergent-affirming, trauma-aware support that does not rely on pressure, shame, or one-size-fits-all approaches.  You can find information about ARFID therapy on her website at drmariannemiller.com. Also check out her blog on ARFID topics. If this episode resonated, consider sharing it with someone who has struggled to find language or care for long-standing eating challenges. ARFID in adults deserves recognition, respect, and treatment that fits.

Living with a chronic eating disorder often means wanting recovery and fearing it at the same time. Many people feel torn between change and safety, hope and grief, relief and loss. This solo episode explores why that ambivalence is not a failure, but a meaningful part of chronic eating disorder recovery. In this episode, Dr. Marianne Miller explains how dialectical thinking from DBT supports people with long-term eating disorders by allowing two truths to exist at once. Rather than forcing either-or recovery narratives, dialectics centers the AND. It helps people work with fear, attachment, and survival strategies without shame. This episode focuses on the internal experience of recovery, not just behavior change. It is not a safety systems episode or a harm reduction overview. It is about how people live inside ambivalence and how radical acceptance creates space for movement without forcing certainty. Dialectical Thinking and the AND in Eating Disorder Recovery Dialectical thinking recognizes that two things can be true at the same time. In eating disorder recovery, this might look like wanting relief while still relying on eating disorder behaviors to feel regulated. These experiences are not contradictions to fix. They reflect adaptation, nervous system learning, and lived reality. Rigid recovery binaries often increase shame and disengagement, especially for people with chronic or long-standing eating disorders. Living in the AND supports flexibility, honesty, and continued engagement in care. Why Ambivalence Is Not Resistance Ambivalence is often misinterpreted as resistance in eating disorder treatment. This episode challenges that belief directly. Ambivalence is information from a nervous system that learned how to survive. For many people who are fat, disabled, neurodivergent, BIPOC, LGBTQIA+, chronically ill, or medically harmed, recovery fear is shaped by real systems. Weight stigma, medical trauma, racism, ableism, and lack of access to affirming care all matter. Fear does not mean failure. Radical Acceptance Without Giving Up Radical acceptance does not mean liking what is happening or giving up on recovery. It means naming reality so shame stops driving the process. When people stop fighting themselves for being ambivalent, curiosity, flexibility, and choice become more possible. This episode reframes radical acceptance as a tool for supporting sustainable change in chronic eating disorder recovery. Redefining Success in Chronic Eating Disorders Recovery does not have to mean certainty or symptom elimination. It can mean increased tolerance for uncertainty, moments of choice, and the ability to say, “I am struggling and still worthy of care.” Dialectical thinking offers a compassionate, realistic framework for long-term eating disorder recovery. Related Episodes Chronic Eating Disorders in 2026: What Hope Can Actually Look Like on Apple and Spotify. Why Some Eating Disorders Don't Resolve: Understanding Chronic Patterns & What Actually Supports Change on Apple and Spotify. When an Eating Disorder Becomes Chronic: Recovery Tools for Persistent Anorexia & Bulimia on Apple and Spotify. Support and Resources Dr. Marianne Miller offers a self-paced, virtual ARFID and Selective Eating course grounded in neurodivergent-affirming, trauma-informed care. The course focuses on safety, flexibility, and realistic change over time for people with restrictive, avoidant, or long-standing eating struggles. Links and details are available in the show notes. Work with Dr. Marianne in therapy if you live in California, Texas, or Washington D.C. Go to drmariannemiller.com to schedule a free, 15-minute consultation call. You do not have to choose one truth. You can want recovery and fear letting go. You can live in the AND.

Why do eating disorders and ADHD so often overlap, and why does standard eating disorder treatment frequently fail neurodivergent people? In this episode of Dr. Marianne-Land, I'm joined by Taylor Ashley @taylorashleytherapy, Registered Psychotherapist based in Guelph, Ontario, who specializes in eating disorders, ADHD, trauma, body image, and neurodivergence. Taylor brings both professional expertise and lived experience to this conversation, offering a deeply honest look at how eating disorders can function as coping and regulation systems for neurodivergent brains. Together, we unpack why recovery often looks different for people with ADHD, why hunger cues may never fully return for some, and how approaches like mechanical eating, HAES-informed care, and trauma-informed therapy can make recovery more accessible and sustainable. In This Episode, We Discuss: Eating Disorders and ADHD We explore why ADHD and eating disorders frequently co-occur, including how dopamine regulation, anxiety, and nervous system overload shape behaviors like restricting, purging, and binging. Neurodivergent-Affirming Eating Disorder Recovery Taylor explains why traditional eating disorder treatment models often miss neurodivergent needs and how affirming care prioritizes sensory safety, autonomy, and individualized support. Mechanical Eating vs Intuitive Eating We talk openly about why intuitive eating is not realistic or safe for many neurodivergent people and how mechanical eating can be a supportive, valid recovery strategy. Sensory Processing, Clothing, and Body Image From sports uniforms to fabric textures, we discuss how sensory sensitivities and body shame intersect and how these experiences can quietly drive eating disorder behaviors. Brain Chemistry, Dopamine, and Regulation Taylor breaks down how restricting, purging, and binging can temporarily regulate dopamine and serotonin, especially for people with ADHD, and why this makes eating disorders feel grounding and hard to let go of. Trauma-Informed and IFS-Informed Approaches We explore Internal Family Systems (IFS) and how understanding the protective role of eating disorder behaviors can reduce shame and support long-term change. HAES-Informed and Weight-Inclusive Care We discuss why Health at Every Size–informed treatment matters, how weight-focused care can cause harm, and what to look for when building a neurodivergent-affirming outpatient treatment team. When Inpatient Treatment Is Not the Right Fit Taylor shares why inpatient programs can be unsafe for neurodivergent people when they lack sensory awareness and flexibility, and how intensive outpatient support can sometimes be a better option. Who This Episode Is For This episode is for: People with ADHD and eating disorders Neurodivergent adults navigating recovery Clinicians and therapists working in eating disorder treatment Anyone who feels like standard recovery advice has never fit their brain or body About Taylor Ashley, RP Taylor Ashley is a Registered Psychotherapist based in Guelph, Ontario, specializing in eating disorders, ADHD, trauma, neurodivergence, and body image. Her work centers neurodivergent-affirming, trauma-informed, and HAES-aligned care. Taylor brings lived experience, deep compassion, and clinical insight to her work with individuals seeking recovery that actually fits their nervous system. Follow Taylor on Instagram: @taylorashleytherapy Learn more: taylorashleytherapy.com Related Episodes  Unmasking, Embodiment, & Trust: A Neurodivergent Approach to Eating Disorder Recovery With Dr. Emma Offord @divergentlives via Apple & Spotify. Unmasking in Eating Disorder Recovery: What Neurodivergent People Need to Know About Safety & Healing via Apple & Spotify. Recovering Again: Navigating Eating Disorders After a Late Neurodivergent Diagnosis (Part 1) With Stacie Fanelli, LCSW @edadhd_therapist via Apple & Spotify. Final Note If eating disorder recovery has felt inaccessible, overwhelming, or unsafe in the past, this conversation offers validation, language, and concrete reframes that may finally make things click.

What does hope really mean when an eating disorder has lasted for years or decades? In 2026, many people with chronic eating disorders feel left out of recovery conversations that prioritize fast change, early intervention, and visible transformation. This episode offers a different framework. One that respects long-term patterns, nervous system survival, neurodivergence, and harm reduction. This conversation is for anyone who has wondered whether recovery is still possible for them, or whether traditional recovery models ever truly fit in the first place. Understanding Chronic Eating Disorders Chronic eating disorders are often misunderstood as failures or lack of motivation. In reality, long-term eating disorder patterns usually develop as adaptive responses to unmet needs for safety, regulation, autonomy, or predictability. These patterns persist not because someone is resistant to change, but because they once worked. In 2026, more clinicians are beginning to recognize eating disorders as learned survival systems rather than character flaws. This shift changes how care is offered and how hope becomes possible. Why Traditional Recovery Hope Often Falls Apart Many people with long-term eating disorders have been harmed by how hope is framed in treatment. When hope depends on symptom elimination, linear progress, or compliance with rigid models, it becomes fragile. Setbacks then feel like proof that recovery has failed. For chronic eating disorders, hope cannot be conditional. It must be able to coexist with fluctuation, stress, and ongoing vulnerability without turning into another source of shame. What Hope Can Actually Look Like for Long-Term Eating Disorders Hope in chronic eating disorder recovery often looks quieter and more realistic than cultural narratives suggest. It may involve increased choice instead of total freedom, fewer all-or-nothing spirals, or the ability to pause before acting on urges. For many people, hope shows up as nourishment that feels neutral rather than terrifying, or as eating with accommodations that respect sensory and nervous system needs. This kind of hope does not erase struggle. It changes how much control the eating disorder has over daily life. Progress Beyond Symptom Elimination Progress in long-term eating disorder recovery often happens beneath the surface. It can appear as quicker nervous system recovery after distress, reduced intensity of urges, or increased ability to name internal experiences instead of dissociating from them. These changes matter. They reflect learning, regulation, and increased safety, even when symptoms remain present. Measuring progress by lived experience rather than symptom checklists allows hope to grow more sustainably. Neurodivergence, Trauma, and Treatment Fit Many people with chronic eating disorders are neurodivergent, trauma-exposed, or both. Historically, eating disorder treatment has often failed to account for sensory needs, autonomy, and nervous system regulation. When care does not fit, people are frequently blamed rather than supported. In 2026, more neurodivergent-affirming and trauma-informed approaches are emerging. These frameworks recognize eating disorder behaviors as attempts at regulation and protection, not defiance. When care adapts to the person instead of forcing conformity, change becomes more possible. Harm Reduction and Chronic Eating Disorders Harm reduction plays a critical role in supporting people with long-term eating disorders. Rather than demanding full recovery as the only acceptable outcome, harm reduction focuses on reducing risk, increasing stability, and supporting safety in the present moment. For many people, harm reduction offers a form of hope that does not collapse under pressure. In 2026, this approach is increasingly recognized as legitimate, ethical eating disorder care. Letting Go of Cure-Based Recovery Models One of the most hopeful shifts for chronic eating disorders is releasing the idea that cure is the only meaningful goal. People deserve care, dignity, and support regardless of whether they reach full symptom remission. Many individuals experience greater peace when they stop chasing recovery narratives that were never designed for them and begin building lives that work with their nervous systems rather than against them. You Are Not Too Late If an eating disorder has been part of your life for a long time, you are not behind and you are not broken. You did not miss your chance at support. Hope does not require erasing your history or minimizing what you have survived. Hope can exist alongside chronicity. Related Episodes Why Some Eating Disorders Don't Resolve: Understanding Chronic Patterns & What Actually Supports Change on Apple and Spotify. When an Eating Disorder Becomes Chronic: Recovery Tools for Persistent Anorexia & Bulimia on Apple and Spotify. Work With Me I offer eating disorder therapy, consultation, and educational resources that center chronic eating disorders, neurodivergence, trauma-informed care, and harm reduction. My work is designed for people who have already tried standard recovery paths and need something more humane and realistic. You deserve support that meets you where you are in 2026. Check out my website at drmariannemiller.com for info about therapy, coaching, and virtual, self-paced courses.

Not all eating disorder behaviors feel distressing. For many neurodivergent people, certain eating patterns can feel calming, organizing, or regulating rather than intrusive or unwanted. This solo episode explores the often misunderstood difference between egosyntonic and egodystonic eating disorder behaviors, with a specific focus on neurodivergent experiences. Dr. Marianne Miller breaks down why distress is not a reliable indicator of risk, how soothing routines can still create long-term concerns, and how clinicians and individuals can assess eating behaviors without pathologizing neurodivergence. This conversation centers nuance, consent, and nervous system safety rather than urgency or moral judgment. What Does Egosyntonic vs Egodystonic Mean in Eating Disorders? Egodystonic eating disorder behaviors feel unwanted and distressing. They often clash with a person's values or sense of self and can feel out of control. Egosyntonic behaviors, on the other hand, feel aligned with the self. They may feel logical, helpful, or necessary, even when others express concern. This episode explains why egosyntonic does not mean harmless and why egodystonic does not automatically mean more severe. These terms describe internal experience, not medical or nutritional risk. Neurodivergence, Regulation, and Eating Disorder Behaviors Neurodivergent nervous systems often rely on structure, predictability, and repetition for regulation. Food routines, sameness, timing, or tracking can reduce sensory overload and cognitive demand. What feels regulating internally may look concerning externally. Dr. Marianne explores how clinicians and loved ones often misread neurodivergent regulation as pathology, or dismiss concern when distress is absent. This section highlights why both reactions miss the full picture. Why Distress Is Not a Reliable Marker of Risk Many eating disorder assessments rely too heavily on visible distress. This episode explains why distress can fluctuate and why the absence of distress does not equal safety. Neurodivergent people may feel calm and regulated even as food variety narrows, rigidity increases, or nourishment decreases. The episode emphasizes the importance of looking beyond how a behavior feels in the moment and instead examining how it shapes health, flexibility, and daily life over time. Where Is the Line Between Regulation and Harm? This episode directly addresses the question many people ask but rarely get answered clearly. The line is not about whether a behavior feels soothing. It is not about motivation or readiness for change. It is about what the behavior requires and what it takes away over time. Dr. Marianne outlines how to evaluate eating behaviors through function, sustainability, and long-term consequences without shaming, coercion, or urgency. A Neurodivergent-Affirming Approach to Care This conversation is not about taking away coping strategies or forcing change. Removing regulation without replacement can destabilize neurodivergent people and increase risk. Instead, this episode discusses how to preserve safety while reducing long-term harm through added supports, sensory accommodations, and gradual expansion. The focus stays on consent, autonomy, and respect for identity. Who This Episode Is For This episode is for neurodivergent teens and adults who feel confused when eating behaviors feel helpful but raise concern from others. It is also for clinicians who want to assess eating disorders without relying solely on distress or external appearance. If you have ever thought, this does not feel like a problem to me, but other people seem worried, this episode speaks directly to that experience. Related Episodes Unmasking, Embodiment, & Trust: A Neurodivergent Approach to Eating Disorder Recovery With Dr. Emma Offord @divergentlives via Apple & Spotify. Unmasking in Eating Disorder Recovery: What Neurodivergent People Need to Know About Safety & Healing via Apple & Spotify. Autism & Anorexia: When Masking Looks Like Restriction, & Recovery Feels Unsafe via Apple & Spotify. Recovering Again: Navigating Eating Disorders After a Late Neurodivergent Diagnosis (Part 1) With Stacie Fanelli, LCSW @edadhd_therapist via Apple & Spotify. Work With Dr. Marianne Miller Dr. Marianne Miller is a licensed marriage and family therapist specializing in eating disorder recovery with a neurodivergent-affirming, trauma-informed approach. She works with teens and adults navigating ARFID, binge eating disorder, and long-term eating disorder patterns. Go to her website at drmariannemiller.com for information on therapy and online, self-paced courses.

What happens when medical care reduces a whole human being to a number on a scale? In this episode of Dr. Marianne-Land, I'm joined by Ivy Felicia, Body Relationship Coach and founder of Luxuriant Life, for a deeply grounding conversation about anti-fat bias in healthcare, chronic illness, and what it actually takes to build peace with your body in a system that often causes harm. Ivy shares her lived experience as a Black woman of size navigating PCOS, autoimmune illness, thyroid disease, and repeated medical dismissal. We talk openly about the moment a provider told her weight loss surgery was the only option and what it meant to be treated as disposable when she declined. That moment became a turning point that reshaped her relationship with her body and ultimately led to the creation of her Body Relationship Method, a size-inclusive, weight-neutral approach grounded in compassion, self-trust, and holistic wellness. Throughout this conversation, we explore how chronic illness, medical trauma, and anti-fat bias intersect, and why body positivity is not always accessible or supportive for people living in pain, disability, or marginalized bodies. Ivy explains why she centers body peace rather than body love, and how choosing neutrality and non-violence toward your body can be a more realistic and healing place to start. We also discuss the role of spirituality and surrender in healing a relationship with your body. Ivy describes how prayer, connection to nature, journaling, and honoring ancestors support her through periods of overwhelm, and why taking healing one breath at a time can feel far more attainable than one day at a time when you live with chronic pain or illness. This episode also dives into internalized anti-fat bias and internalized ableism. Ivy shares how listening, witnessing, and affirming someone's lived experience can be profoundly reparative, especially for people who have spent years being dismissed or erased by medical systems. We talk about visibility, self-advocacy, and how being truly heard can help people reclaim their voice and their worth. If you've ever felt disconnected from your body because of chronic illness, eating disorder recovery, medical trauma, or weight stigma, this conversation offers a gentler way forward. There is no finish line here. There is no pressure to love your body. There is space to move toward peace, at your own pace, one breath at a time. About Ivy Felicia Ivy Felicia is a Body Relationship Coach, certified holistic wellness practitioner, speaker, and founder of Luxuriant Life, LLC. She is the creator of the Body Relationship Method, a trademarked, size-inclusive, weight-neutral approach that helps people heal body image, navigate chronic illness with compassion, and rebuild self-trust. Through coaching, community, and education, Ivy supports people in marginalized bodies in cultivating peace with their bodies without dieting, scale-based wellness, or toxic positivity. Work With Ivy Felicia Ivy offers support through her Body Relationship Circle membership, group coaching programs, and one-on-one coaching. You can learn more and sign up for her newsletter at ivyfelicia.com. Follow Ivy on Instagram and Threads at @iamivyfelicia. Content Note This episode includes discussion of anti-fat bias in healthcare, chronic illness, medical dismissal, and weight loss surgery recommendations. Want More Support? If anti-fat bias, chronic illness, or medical trauma has impacted your relationship with food or your body, you're not alone. I offer eating disorder therapy and recovery support with a liberation-oriented, neurodivergent-affirming, trauma-informed approach. I work with clients in California, Texas, Washington, D.C., and globally via coaching and education. You can learn more about working with me and explore my courses and resources at drmariannemiller.com. Listen in, take a breath, and remember: peace is allowed to come before love.

If you are in an activated state right now, this episode meets you where you are. You do not need to make decisions or figure anything out while you listen. The focus is on calming the body first, not fixing the behavior. Dr. Marianne guides you through simple, accessible grounding and nervous system regulation that can help reduce urgency without judgment or pressure. This episode is designed to be replayed during urge peaks and listened to in real time. Urges Are Signals, Not Commands Urges often show up when something feels overwhelming, unsafe, or out of control. This episode reframes urges as signals from the nervous system rather than failures or moral flaws. You will hear reminders that urges are learned responses meant to create relief, even when they no longer serve you. This compassionate perspective can help soften shame and create space for choice, even when the urge still feels loud. Support for Restricting, Bingeing, and Purging Urges Whether your urge is to restrict, binge, purge, compensate, avoid food, or delay eating, this episode centers safety and connection. It offers reassurance that you are not broken for having urges and that even small shifts in support can matter. This is a listen for one minute at a time. Five percent safer still counts. Listen When You Need Support Right Now You can return to this episode whenever urges spike. Let it keep you company. Let it remind you that this moment has edges and that you are not alone in it. If you need additional support beyond this episode, working with an eating disorder therapist can help you build more tools for navigating urges with care and compassion. Check out drmariannemiller.com for more resources. #EatingDisorderRecovery #UrgeSupport #NervousSystemRegulation

When ARFID is shaped by a PDA profile, eating challenges are not simply about sensory preferences, fear foods, or appetite. PDA, or a pervasive drive for autonomy, means the nervous system experiences demands as threats. Even gentle encouragement around eating can trigger shutdown, panic, or refusal. In this episode, Dr. Marianne Miller explains why PDA fundamentally changes how ARFID shows up and why traditional explanations often miss what is really happening beneath the surface. Food Refusal Is a Nervous System Safety Response Food refusal in PDA-driven ARFID is not defiance or manipulation. It is a protective response rooted in survival. When autonomy feels compromised, refusal becomes the fastest way to restore safety. This episode reframes refusal as communication and explores how control is not the goal, but a tool the nervous system uses to stay regulated. How Eating Becomes a Threat Instead of Nourishment For PDA nervous systems, eating can shift from a neutral or pleasurable act into a moment of danger. Being observed, reminded, praised, or monitored can turn food into a demand. Dr. Marianne breaks down how this happens in both children and adults with ARFID, and why eating often becomes harder the more support is applied. Case Examples of PDA and ARFID Across the Lifespan This episode includes clinical case examples that illustrate how PDA-driven ARFID can look very different on the surface while operating from the same nervous system logic. One example focuses on a child who eats until attention is placed on them. Another highlights an adult who deeply wants recovery but feels trapped by structured treatment approaches. These examples help clarify why motivation alone does not resolve PDA-related eating challenges. Why Traditional ARFID Treatment Often Fails PDA Nervous Systems Many standard ARFID interventions rely on structure, goals, exposure, and accountability. For PDA profiles, these tools can unintentionally increase threat and shutdown. Dr. Marianne explains why treatment plans that ignore autonomy often backfire and how mislabeling this response as resistance can cause harm. What Actually Supports PDA-Affirming ARFID Care Supportive care for PDA and ARFID prioritizes safety, consent, and flexibility. This does not mean removing all structure, but changing how structure functions. The episode explores what real choice looks like, why opt-out options matter, and how slowing down can create conditions where eating feels safer over time. A Neurodivergent-Affirming Reframe for Caregivers and Adults If ARFID has felt impossible to “fix,” this episode offers a compassionate reframe. PDA-driven eating challenges are not failures of willpower or commitment. They reflect a nervous system doing its best to survive. Understanding this opens the door to approaches that are more humane, effective, and sustainable. Related Episodes on ARFID and PDA ARFID Explained: What It Feels Like, Why It's Misunderstood, & What Helps on Apple & Spotify. Why Sensory-Attuned Care Matters More Than Exposure in ARFID Treatment on Apple & Spotify. ARFID, PDA, and Autonomy: Why Pressure Makes Eating Harder on Apple & Spotify. Complexities of Treating ARFID: How a Neurodivergent-Affirming, Sensory-Attuned Approach Works on Apple & Spotify. Work With Dr. Marianne Miller Dr. Marianne Miller is a licensed marriage and family therapist who specializes in ARFID, binge eating disorder, and long-term eating disorder recovery. She offers therapy, consultation, and a virtual, self-paced ARFID course grounded in neurodivergent-affirming, sensory-attuned, trauma-informed care. Learn more at drmariannemiller.com

What if eating disorder recovery was not defined by a clean, linear arc, but by honesty, self-compassion, and forward movement even when setbacks happen? In this January 2026 conversation, Dr. Marianne Miller welcomes back journalist, author, and professor Mallary Tenore Tarpley, MFA, to reflect on how readers have responded to her book SLIP: Life in the Middle of Eating Disorder Recovery, and how the language of “slips” is quietly reshaping how people understand recovery. Mallary shares what has surprised her most since the book's release, including the volume of messages from readers who finally feel seen in what she calls the “middle place,” the gray space between acute illness and full recovery. Many readers describe relief in having language for a recovery that is still in progress, one that allows for growth without demanding perfection. Throughout the conversation, Mallary and Dr. Marianne explore why slips are not evidence of failure, but often signs that someone is actively engaging in recovery. They unpack how shame around setbacks can cause slips to turn into longer slides, and how naming them openly can interrupt that cycle. This reframing is especially important in 2026, as diet culture and resolution-driven thinking continue to dominate January narratives around control, discipline, and self-improvement. Mallary also discusses how the “middle place” framework has resonated far beyond eating disorder communities. Readers have applied it to grief, addiction, chronic illness, and other long-term healing processes where vulnerability remains even as life becomes fuller. She reflects on the power of shared language in helping loved ones understand ongoing recovery, including parents and partners who may struggle to grasp why symptoms can persist for years. The episode also touches on under-discussed risks during life transitions, including pregnancy and postpartum experiences, where socially reinforced behaviors can quietly reawaken eating disorder patterns. Mallary explains why speaking openly about these realities helps both individuals and clinicians respond with more nuance and care. As the conversation turns toward the new year, Mallary offers a gentler way forward. Instead of setting rigid, all-or-nothing goals, she encourages curiosity, small steps, and values-based intentions that support recovery over time. Slips, she reminds us, can coexist with progress, and often do. This episode is for anyone who feels caught between wanting change and fearing it, for those exhausted by perfectionism, and for anyone who needs permission to keep moving forward without pretending to be “all better.” Follow Mallary on Instagram: @mallarytenoretarpley Learn more about her book: SLIP: Life in the Middle of Eating Disorder Recovery Check out another episode with Mallary on Apple or Spotify.

This brief guided episode is designed for moments when eating disorder recovery feels unsafe, overwhelming, or frightening. It is meant to be listened to when fear spikes, urges intensify, or doubt about recovery takes over. Rather than offering education or advice, this guided moment focuses on nervous system support. Dr. Marianne gently names why fear can surge when eating disorder behaviors loosen and why this response does not mean recovery is failing. The episode centers the experience of being in the middle of recovery, when the body is adjusting to change and searching for safety. Listeners are invited to pause, slow down, and orient to the present moment without needing to make decisions, take action, or push through discomfort. This guided listen affirms that fear during recovery often reflects protection, not weakness, and that safety can come alongside change. This episode can be replayed as often as needed. It is especially supportive for people in eating disorder recovery who experience panic, urgency, or nervous system overwhelm when behaviors begin to shift. Content Caution This episode discusses eating disorder recovery and fear responses. No weights, numbers, or specific behaviors are described. This is a gentle, non-instructional guided listen. How to Use This Episode This guided moment is best used during periods of heightened anxiety, uncertainty, or fear related to eating disorder recovery. Listeners may choose to listen while seated, lying down, or moving gently. There is no requirement to follow instructions or reach a particular outcome. Who This Episode Is For This episode is for adults in eating disorder recovery who feel unsafe when change begins, people experiencing recovery anxiety or fear of letting go, and anyone who needs nervous system support rather than information. It may also be helpful for clinicians and providers to share with clients during acute moments of distress. About Dr. Marianne Miller Dr. Marianne Miller is a licensed marriage and family therapist, eating disorder specialist, and host of the Dr. Marianne-Land podcast. Her work centers neurodivergent-affirming, trauma-informed, and liberation-focused approaches to eating disorder recovery. Dr. Marianne also offers a self-paced course on ARFID and selective eating designed to prioritize safety, autonomy, and nervous system care. Learn more at drmariannemiller.com.

Why does eating disorder recovery sometimes feel more frightening after change has already begun? In this solo episode, Dr. Marianne Miller explores a critical but rarely discussed phase of eating disorder recovery: the point where behaviors start to loosen, yet fear, panic, and urges intensify instead of easing. This episode reframes eating disorders not as irrational habits to eliminate, but as safety systems shaped by the nervous system. Dr. Marianne explains how restriction, binge eating, purging, rigidity, and food avoidance can reduce threat, create predictability, and manage sensory or emotional overwhelm. When those behaviors begin to shift, the body may respond with alarm, even when recovery is wanted. Rather than focusing on early recovery or long-term outcomes, this conversation stays inside the middle of recovery. The place where letting go feels destabilizing, progress triggers panic, and people begin to question whether healing is actually safe. Dr. Marianne unpacks why fear at this stage does not signal failure, lack of motivation, or resistance, but reflects survival-based nervous system logic. This episode also centers how neurodivergence, trauma histories, and intersectional oppression amplify fear during recovery. For autistic and ADHD individuals, transitions, loss of structure, and sensory changes can intensify nervous system activation. For people with chronic trauma or marginalized identities, eating disorder behaviors may have provided protection in a world that felt unsafe long before recovery began. Listeners will hear why the belief that “safety comes after behaviors stop” often backfires, and why scaffolding, autonomy, pacing, and compassion are essential when eating disorder behaviors start to loosen. This episode is especially relevant for adults with long-term eating disorders, people feeling stuck in recovery, and clinicians seeking trauma-informed, neurodivergent-affirming approaches to eating disorder treatment. Content Caution This episode discusses eating disorders, recovery-related fear, and nervous system responses to change. No weights, numbers, or explicit behavioral instructions are included. Listener discretion is advised. What This Episode Covers Dr. Marianne discusses eating disorders as safety systems, fear of recovery, anxiety during eating disorder treatment, and why symptom spikes often occur after progress begins. The episode explores the role of the nervous system, trauma, neurodivergence, and intersectionality in eating disorder recovery, and explains why grief, panic, and doubt can emerge when behaviors that once felt protective start to loosen. This conversation also highlights why safety, autonomy, and nervous system support must come alongside behavior change, not after it. Who This Episode Is For This episode is for adults with eating disorders who feel afraid to let go of behaviors, people experiencing recovery anxiety or fear of change, and anyone who feels stuck in the middle of eating disorder recovery. It is also for therapists, providers, and caregivers who want to better understand why eating disorder behaviors can feel necessary, and why fear does not mean someone is failing at recovery. Related Episode An Open Letter to the Body: Listening to the Part That Fears Getting Better on Apple and Spotify. About Dr. Marianne Miller Dr. Marianne Miller is a licensed marriage and family therapist and eating disorder specialist offering therapy, consultation, and education rooted in neurodivergent-affirming, trauma-informed, and liberation-focused care. She is the host of the Dr. Marianne-Land podcast and the creator of a self-paced course on ARFID and selective eating for adults and providers. Learn more at drmariannemiller.com.

What does a low heart rate really mean in athletes? When is it a normal adaptation to training, and when is it a sign that something is medically wrong? In this interview, Dr. Marianne Miller speaks with Megan Hellner, RD and Katherine Hill, MD, co-founders of AthleatMD, about one of the most misunderstood issues in athlete health. Together, they unpack how low heart rate, underfueling, and performance pressure can intersect in ways that are often minimized or missed entirely in both sports medicine and eating disorder care. Content Caution This episode includes discussion of eating disorders, Relative Energy Deficiency in Sport (REDS), medical instability, low heart rate, weight loss, body image pressure, and athletic injury. Listener discretion is encouraged. What Is Relative Energy Deficiency in Sport (REDS)? Relative Energy Deficiency in Sport occurs when an athlete's energy intake does not meet the demands of training, daily functioning, and, for young athletes, growth and development. Dr. Hill explains that REDS can occur with or without an eating disorder and that many athletes develop REDS unintentionally due to intense schedules, high training loads, or lack of accurate nutrition guidance. Although REDS is a relatively new diagnostic framework, its medical consequences are not new. Energy deficiency affects nearly every system in the body, including the heart, bones, hormones, digestion, immune function, and mental health. Importantly, many athletes with REDS do not appear thin, which contributes to how frequently the condition is overlooked. Low Heart Rate in Athletes: Fitness or Medical Red Flag? A low resting heart rate is often praised as evidence of elite fitness, yet this episode challenges that assumption. Dr. Hill and Dr. Hellner explain the difference between mild athletic bradycardia and dangerous cardiac suppression related to undernutrition. They discuss why heart rates in the low 40s or 30s should never be automatically dismissed as “normal for athletes,” particularly when fatigue, injury, missed periods, or hormonal suppression are present. The conversation highlights how REDS and malnutrition can compound athletic adaptations, leading to serious medical risk while athletes are reassured that nothing is wrong. Where Eating Disorder Care and Sports Medicine Fall Short Athletes often exist in a gray area where eating disorder treatment programs and sports medicine settings fail to fully meet their needs. Drs. Hellner and Hill describe how eating disorder programs may underestimate the importance of athletic identity, while sports environments frequently minimize eating disorders and REDS altogether. This disconnect can result in rigid activity bans, delayed diagnosis, or false reassurance that prolongs harm. The episode emphasizes the need for individualized, multidisciplinary decision-making that considers medical stability, psychological safety, and the athlete's relationship with sport. Body Image Pressure and the Athletic Aesthetic Myth The conversation also explores how appearance-based expectations shape athlete health. Dr. Hellner introduces the concept of the athletic aesthetic myth, which falsely assumes that performance requires a specific body type. Dr. Marianne and her guests discuss how coaching culture, social media trends, and gendered body ideals increase risk for REDS and disordered eating. They also highlight the growing visibility of elite athletes across a wide range of body sizes, challenging the belief that leanness equals success. How AthleatMD Supports Athletes With REDS and Eating Disorders AthleatMD provides virtual medical and nutrition care for athletes across many states, serving competitive, recreational, and former athletes. Dr. Hellner explains how assessment focuses on weight history, growth patterns, labs, training load, injury history, and relationship with food and sport, without assuming intentional restriction. Treatment centers on nutrition restoration, medical stabilization, and education, with approaches tailored to the athlete's sport, goals, and developmental stage. For many athletes, restoring adequate energy intake improves both health and performance in ways they did not expect. Who This Episode Is For This episode is especially relevant for athletes experiencing fatigue, injury, or declining performance, as well as parents of young athletes, coaches, therapists, dietitians, and medical providers. It is also an important listen for anyone questioning whether “fit” always means healthy in sport. Related Episode Eating Disorders & Athletes: The Pressure to Perform on Apple & Spotify. About Today's Guests Dr. Megan Hellner and Dr. Katherine Hill are the co-founders of AthleatMD (@athleatmd), a virtual, multidisciplinary practice specializing in medical and nutrition care for athletes with eating disorders and Relative Energy Deficiency in Sport (REDS). Their work focuses on bridging the long-standing gap between sports performance and eating disorder treatment. About the Host Dr. Marianne Miller is a Licensed Marriage and Family Therapist and the host of Dr. Marianne-Land: An Eating Disorder Recovery Podcast. She provides neurodivergent-affirming, trauma-informed care for eating disorders, including anorexia, bulimia, binge eating disorder, and ARFID, and works with clients in California, Texas, and Washington, D.C. Learn more about working with Dr. Marianne and explore her courses and podcast at drmariannemiller.com.

Why do some eating disorders continue for years or even decades, despite treatment, effort, and a strong desire for change? Long-standing eating disorders are often misunderstood as personal failure or lack of motivation. In reality, persistence usually reflects unmet needs, nervous system strain, and environments that have not supported safety or regulation. What “Chronic” Really Means in Eating Disorder Care In clinical settings, the term chronic simply means persistent over time. It does not mean static, untreatable, or hopeless. Many people with chronic eating disorders experience periods of stability, partial recovery, or symptom shifts rather than full resolution. Progress often occurs in layers rather than in a straight line. Chronic eating disorders appear across diagnoses, including anorexia, bulimia, binge eating disorder, ARFID, and mixed presentations. What matters most is not the duration of symptoms, but the function those symptoms continue to serve. Eating Disorders as Nervous System Survival Strategies Eating disorder behaviors frequently operate as survival responses. They may regulate anxiety, reduce sensory overwhelm, create predictability, or provide relief from emotional distress. When behaviors serve a regulatory purpose, stopping them without replacing that function can feel destabilizing rather than healing. Persistence is rarely about effort. Many people with long-term eating disorders have engaged in extensive treatment and tried multiple approaches. Without safety, the nervous system will continue to rely on familiar strategies. Trauma, Chronic Stress, and Ongoing Threat Long-standing eating disorders often develop in the context of trauma that never fully resolved. Ongoing stressors such as medical trauma, anti-fat bias, racism, ableism, financial insecurity, chronic illness, or identity-based harm can keep the nervous system in survival mode. When threat remains present, recovery models that assume safety already exists often fall short. In these environments, eating disorder behaviors may remain necessary for coping. Neurodivergence and Unmet Support Needs Neurodivergent people experience chronic eating disorders at high rates, yet are frequently underserved by standard treatment models. Sensory sensitivities, executive functioning challenges, and interoceptive differences can make eating overwhelming in ways traditional care does not address. Without accommodation, eating disorder behaviors may persist because they reduce sensory or cognitive overload. Recovery requires adapting care to the person, not forcing the person to adapt to the model. Autonomy, Power, and Control in Recovery Eating disorders often become closely tied to autonomy, especially for people who have experienced chronic control or invalidation. Decisions about food can feel like the last remaining area of choice. When treatment removes autonomy without rebuilding agency, symptoms often intensify. Collaborative, consent-based care that honors choice can create safer conditions for change. What Actually Supports Long-Term Change Sustainable change in chronic eating disorders is built through safety, curiosity, and flexibility. Emotional, sensory, and relational safety allow the nervous system to shift. Curiosity replaces judgment by asking what the eating disorder provides rather than focusing only on stopping it. Accommodation, harm reduction, and connection play central roles. Reducing risk, improving quality of life, and supporting nourishment without demanding perfection create space for gradual change. Rethinking Recovery for Chronic Eating Disorders Recovery does not need to mean the complete absence of symptoms to be meaningful. Increased flexibility, reduced fear, fewer medical crises, and a fuller life matter. Chronic eating disorders reflect complexity, not hopelessness. Who This Episode Is For This episode is for people living with chronic eating disorders, providers working with long-term or complex cases, and anyone seeking a trauma-informed, neurodivergent-affirming perspective on eating disorder recovery. Content Caution Discussion includes eating disorder behaviors, long-term symptoms, trauma, and systemic barriers to care. Related Episodes Relapse in Long-Term Eating Disorders on Apple & Spotify. Orthorexia, Quasi-Recovery, & Lifelong Eating Disorder Struggles with Dr. Lara Zibarras @drlarazib on Apple & Spotify. Navigating a Long-Term Eating Disorder on Apple & Spotify. Why Eating Disorder Recovery Feels Unsafe: Facing Ambivalence in Long-Term Struggles on Apple & Spotify. Perfectionism, People-Pleasing, & Body Image: Self-Compassion Tools for Long-Term Eating Disorder Recovery With Carrie Pollard, MSW @compassionate_counsellor on Apple & Spotify. Learn More Explore neurodivergent-affirming, trauma-informed resources for eating challenges at drmariannemiller.com.

Why does eating sometimes feel distant, foggy, or unreal? Why do meals happen on autopilot, with little connection to hunger, fullness, or satisfaction? In this solo episode, Dr. Marianne Miller explores the often overlooked role of dissociation in eating disorders, especially when trauma and nervous system overwhelm are present. Many people experience eating as disconnected or numb, yet rarely receive language or support that explains why this happens. This episode breaks down how dissociation functions as a survival response, not a failure of recovery. Dr. Marianne explains how trauma, chronic stress, and loss of bodily autonomy can shape the nervous system and disrupt interoceptive awareness, making it difficult to sense hunger, fullness, and internal cues. Listeners will learn how dissociation connects to common eating disorder patterns such as restriction, binge eating, and rigid routines. Rather than viewing these behaviors as resistance or lack of motivation, this episode reframes them as nervous system strategies designed to manage overwhelm and threat. Dr. Marianne also centers neurodivergent experiences, including sensory processing differences and shutdown responses that often get missed in traditional eating disorder treatment. She explains why pressure-based approaches frequently fail neurodivergent people and why safety, accommodation, and choice are essential when eating feels unreal. This episode offers a trauma informed, neurodivergent affirming perspective on recovery, emphasizing that healing does not come from forcing embodiment. Instead, recovery unfolds when the nervous system learns that eating can be safe again. In this episode, you will hear about: Dissociation and eating disorders Trauma and nervous system responses around food Why eating can feel unreal or disconnected Interoception and disrupted hunger and fullness cues Neurodivergence, sensory overwhelm, and eating challenges Why traditional eating disorder treatment often misses dissociation What actually supports recovery when eating feels unreal Midway through the episode, Dr. Marianne shares more about her self-paced ARFID and Selective Eating course, designed for people whose eating struggles are shaped by sensory differences, trauma, and nervous system needs. Related Episodes How Childhood Trauma Shapes Eating Disorders & Body Shame (Content Caution) on Apple & Spotify. Childhood Trauma & Eating Disorders on Apple & Spotify. Using EMDR & Polyvagal Theory to Treat Trauma & Eating Disorders with Dr. Danielle Hiestand, LMFT, CEDS-S on Apple & Spotify. Trauma, Eating Disorders, & Levels of Care with Amy Ornelas, RD via Apple or Spotify. Content Caution This episode includes discussion of eating disorders, trauma, dissociation, sensory overwhelm, and nervous system responses around food. Although no specific behaviors or numbers are described, some listeners may find these topics activating. Please take care of yourself and listen in a way that feels supportive. This episode is for anyone who has felt confused, frustrated, or unseen in eating disorder recovery and wants a framework that finally makes sense.

What changes when an eating disorder has been part of someone's life for 10, 20, 30, even 40+ years? In this conversation, I'm joined again by my friend and longtime collaborator Jaren Soloff, RD, IBCLC, the founder of Whole Women Nutrition. Together, we talk about why nutrition work looks different in long-term eating disorders, and why the starting point is almost always the same: safety. Jaren shares how decades of reinforcement can make symptoms look “functional” on the surface, while the eating disorder quietly shapes identity, routines, and self-worth. We explore the common pattern of minimizing, the fear that can spike when restriction loosens, and the tender reality that for many people, the eating disorder has served as protection, especially in the context of criticism, attachment wounds, body-based judgment, and the impossible standards placed on women across the lifespan. We also get practical. Jaren walks through what it can look like to make food feel safer through small, doable steps, including DBT-informed tools, sensory supports, and intentionally planned “after-meal” structure that helps the nervous system ride out discomfort without snapping back to restriction. If breakfast feels impossible, or discomfort after eating feels like a dealbreaker, this episode offers compassionate, concrete ways to build tolerance and trust, slowly and steadily. Finally, we talk about the midlife reality so many people face: body changes through perimenopause and menopause, and the way those changes can collide with long-standing eating disorder beliefs. Jaren explains why metabolism may shift with long-term restriction and aging, how loss of lean muscle mass can affect energy needs and health, and why increased fat storage in midlife can be an adaptive, protective process for bone health. We also name the risks of GLP-1 medications for people with eating disorders, including concerns about appetite suppression and the potential for additional lean muscle loss, especially for women in perimenopause and menopause. If you have felt “broken” because your body doesn't respond the way it once did, or if you've carried an eating disorder for decades and wonder whether change is still possible, this conversation offers a grounded, compassionate path forward. You deserve care that moves at your pace, and support that treats safety as the foundation, not an afterthought. In this episode, we cover We discuss why long-term eating disorders require a different nutrition framework, how safety often sits at the center of recovery work, and why minimizing can keep patterns in place even when someone appears to be “functioning.” We talk about learning to tolerate discomfort after eating, building self-soothing skills, and using DBT-informed, sensory-based strategies to create new neural pathways. We explore perimenopause and menopause, including changes in estrogen, lean muscle mass, metabolism, and body fat distribution, and we name how ageism and sexism shape body fear in midlife. We also discuss GLP-1 medications and why they can be especially risky in the context of eating disorders. About Jaren Soloff, RD, IBCLC Jaren Soloff is a registered dietitian and international board-certified lactation consultant. She is the founder of Whole Women Nutrition, where she provides nutrition counseling and lactation support for adolescent girls and adult women, and supports families in raising competent, intuitive eaters. Jaren brings both professional experience and the wisdom of her own recovery journey to her work, with a steady emphasis on compassion, collaboration, and safety. Related Episodes Orthorexia, Quasi-Recovery, & Lifelong Eating Disorder Struggles with Dr. Lara Zibarras @drlarazib on Apple & Spotify. Navigating a Long-Term Eating Disorder on Apple & Spotify. Why Eating Disorder Recovery Feels Unsafe: Facing Ambivalence in Long-Term Struggles on Apple & Spotify. Pregnancy, Postpartum, and Eating Disorder Recovery With Jaren Soloff, RD on Apple and Spotify. Connect with Jaren Website: WholeWomenNutrition.com Instagram: @wholewomennutrition

Anorexia does not disappear with age, and midlife is often when its deeper pain becomes impossible to ignore. In this solo episode, Dr. Marianne Miller explores why anorexia can resurface or intensify in midlife, especially when long-standing coping strategies stop working and the nervous system reaches its limits. This conversation names what so many people experience quietly: hormonal shifts, burnout, identity changes, and unprocessed trauma colliding with a culture that continues to demand shrinking, control, and silence. Dr. Marianne unpacks how perimenopause, menopause, chronic stress, and cumulative life demands can destabilize eating patterns that once felt manageable. She explains why restriction is not about willpower or vanity, but about protection, regulation, and survival, particularly for those who have lived for decades navigating pressure, responsibility, and internalized expectations. The episode also explores how midlife can awaken old wounds related to body, gender, sexuality, safety, and belonging, making anorexia feel like a familiar refuge during times of upheaval. This episode centers the emotional logic of midlife anorexia and highlights how neurodivergence, sensory processing differences, and reduced masking capacity can further complicate eating and recovery later in life. Dr. Marianne offers a compassionate reframe of what healing can look like in midlife, emphasizing nervous system support, steadiness over control, truth-telling, and sustainable care rather than rigid recovery ideals. Listeners will hear a vision of recovery that does not ask people to go back to who they were, but instead supports becoming someone who no longer needs old coping strategies to feel safe. This episode speaks directly to adults navigating long-term or chronic anorexia, relapse in midlife, and the quiet grief that can surface during major life transitions. It is also a vital listen for providers seeking a more humane, trauma-informed, and neurodivergent-affirming understanding of eating disorders across the lifespan. Dr. Marianne closes by reminding listeners that midlife can be a turning point not because of force or discipline, but because deeper understanding becomes possible. Recovery at this stage can mean honoring the body's needs, allowing rest, naming pain that was carried alone, and receiving support that fits one's lived experience. If this episode resonated, you are invited to explore therapy with Dr. Marianne Miller, who offers specialized support for people navigating anorexia, chronic restriction, ARFID, and eating disorders shaped by trauma and neurodivergence. Go to drmariannemiller.com for resources and help.

Have you ever wondered whether your eating disorder behaviors have shifted from coping and self-regulation into self-harm? In this solo episode, Dr. Marianne Miller explores the overlap between eating disorders and self-harm and explains how eating disorder behaviors can gradually become harmful even when they begin as attempts to cope. She examines eating disorder recovery through a trauma-informed, neurodivergent-affirming, and liberation-focused lens and offers clarity without shame or blame. WHAT YOU WILL LEARN IN THIS EPISODE Dr. Marianne explains how eating disorders can function as self-harm and how trauma, dissociation, sensory overwhelm, and chronic stress shape eating disorder behaviors. She discusses neurodivergence and eating disorders, including how autistic and ADHD individuals may rely on eating patterns for regulation. She explores common self-harm behaviors that often co-occur with eating disorders, including cutting, scratching, burning, and other forms of injury, and explains the shared emotional logic behind these behaviors. She clarifies the difference between self-regulation and self-harm and explains how eating disorder behaviors can shift between these roles over time. She outlines how to recognize when an eating disorder moves from regulation into harm by identifying warning signs such as rigidity, shame, dissociation, physical consequences, and isolation. She also describes what breaking the cycle can look like by focusing on safety, agency, and flexible coping rather than punishment or control. THIS EPISODE MAY RESONATE WITH YOU IF You question whether your eating disorder behaviors feel punishing or unsafe. You live with a long-term or chronic eating disorder. You experience self-harm urges alongside an eating disorder. You identify as neurodivergent and struggle with sensory or interoceptive overwhelm. You want a trauma-informed, non-shaming approach to eating disorder recovery. KEY TOPICS This episode explores eating disorders and self-harm, eating disorder recovery, self-harm behaviors and eating disorders, trauma and eating disorders, neurodivergence and eating disorders, dissociation and eating disorders, restriction and binge eating, ARFID and sensory overwhelm, building safety in eating disorder recovery, and trauma-informed eating disorder therapy. CONTENT CAUTION This episode includes discussion of self-harm, including cutting and other forms of injury, eating disorders, trauma, dissociation, and suicidal thinking. Please listen with care and take breaks as needed. RELATED EPISODES Autism & Anorexia: When Masking Looks Like Restriction, & Recovery Feels Unsafe via Apple & Spotify. Recovering Again: Navigating Eating Disorders After a Late Neurodivergent Diagnosis (Part 1) With Stacie Fanelli, LCSW @edadhd_therapist via Apple & Spotify. Minding the Gap: The Intersection Between AuDHD & Eating Disorders With Stacie Fanelli, LCSW @edadhd_therapist via Apple & Spotify ABOUT DR. MARIANNE Dr. Marianne Miller is a licensed marriage and family therapist specializing in eating disorders, including ARFID, binge eating disorder, anorexia, and long-term eating disorder patterns. She takes a neurodivergent-affirming, trauma-informed, and liberation-focused approach and hosts the Dr. Marianne-Land podcast. WORK WITH DR. MARIANNE Dr. Marianne offers eating disorder therapy in California, Texas, and Washington DC, and provides coaching worldwide. Learn more at drmariannemiller.com.