Dr. Marianne-Land: An Eating Disorder Recovery Podcast

ARFID and PDA can make eating feel difficult even when no one is telling you what, when, or how much to eat. For autistic and neurodivergent people with Avoidant/Restrictive Food Intake Disorder (ARFID) and a PDA profile, hunger, meal schedules, food preparation, and even personal recovery goals can sometimes begin to feel like demands. In this solo episode, Dr. Marianne explains how ARFID, autism, PDA, sensory sensitivities, executive functioning, and interoception can intersect around food. A person may genuinely want to eat and still struggle to initiate eating. For some people, the thought “I need to eat” creates additional resistance, especially when eating already requires significant sensory and executive-function effort. ARFID, PDA & Demand Avoidance Around Food Dr. Marianne discusses why demand avoidance isn't always caused by another person applying pressure. Hunger cues, scheduled meals and snacks, meal plans, and self-imposed recovery goals can create their own sense of expectation. She also explains why this experience shouldn't automatically be interpreted as stubbornness, lack of motivation, or unwillingness to recover. You'll learn how autism and ARFID can make the process of eating more complex through sensory differences, low interest in food, fear of choking or vomiting, inconsistent hunger cues, transitions, decision fatigue, and executive-function challenges. When PDA is part of the picture, even a desired activity such as eating a familiar safe food may become harder to access once it feels required. Neurodivergent-Affirming ARFID Support Dr. Marianne offers practical ways to make nourishment more accessible without losing sight of nutritional and medical needs. She discusses low-lift eating, safe foods, sensory accommodations, reducing food preparation demands, simplifying choices, flexible eating environments, and autonomy-supportive language. For parents supporting an autistic child or teen with ARFID and PDA, the episode also offers a different question to consider when eating breaks down: What is making food difficult to access right now? Sensory overload, nausea, fear, executive dysfunction, transitions, too many choices, or the eating environment may each require a different type of support. ARFID Treatment, Medical Safety & Autonomy ARFID can have serious medical and nutritional consequences. Reducing unnecessary pressure does not mean ignoring inadequate nutrition, dehydration, nutritional deficiencies, weight loss, or medical instability. Appropriate ARFID treatment may include medical monitoring, nutrition support, and mental health care. The goal of neurodivergent-affirming ARFID care isn't to eliminate every expectation around eating. It's to support adequate nourishment with as much collaboration, predictability, sensory accommodation, dignity, and autonomy as safely possible. Learn More About ARFID Want a deeper understanding of ARFID treatment, autism, ADHD, PDA, sensory needs, food avoidance, and selective eating? Dr. Marianne's self-paced ARFID & Selective Eating course is designed for adults with ARFID, parents and caregivers, and providers. It uses a neurodivergent-affirming, sensory-attuned, trauma-informed approach to understanding why eating becomes difficult and what may help. Learn more and purchase the course at drmariannemiller.com/arfid. Dr. Marianne Miller is an eating disorder therapist with nearly 30 years of experience in the mental health field. She specializes in ARFID, anorexia, bulimia, binge eating, autism, ADHD, and neurodivergent-affirming eating disorder therapy. She provides eating disorder and ARFID therapy in California and Washington, D.C., including the San Diego area, as well as consultation and coaching for people outside those locations. Visit drmariannemiller.com to learn more about working with Dr. Marianne, her ARFID course, and other eating disorder recovery resources. Related Episodes PDA, ARFID, & Food Avoidance: Why “Just Eat” Doesn't Work & What to Do Instead on Apple & Spotify. When PDA Drives ARFID: Understanding Food Refusal, Control, & Safety on Apple & Spotify. ARFID, PDA, and Autonomy: Why Pressure Makes Eating Harder on Apple & Spotify. Why Sensory-Attuned Care Matters More Than Exposure in ARFID Treatment on Apple & Spotify.

Tradwife culture is having a moment, but what happens when traditional femininity, purity culture, the thin ideal, and disordered eating begin to overlap? In this SOLO episode, Dr. Marianne Miller examines the growing popularity of tradwives and renewed interest in conservative Christianity among some young women. She considers why messages about modesty, discipline, self-denial, homemaking, and being a “good woman” may feel especially appealing during a time of uncertainty, loneliness, and cultural change. Tradwives, Purity Culture, & the Thin Ideal Tradwife content often presents an idealized picture of femininity: beautiful homes, homemade food, motherhood, marriage, modesty, and clearly defined gender roles. Yet many of the women who represent this aesthetic online are also conventionally attractive and thin. Dr. Marianne asks whether the resurgence of traditional femininity is happening alongside another cultural shift: the return of an increasingly narrow thin ideal. In the age of GLP-1 medications, “what I eat in a day” videos, wellness culture, and shrinking celebrity bodies, young women are once again receiving powerful messages about how much physical space they should occupy. Disordered Eating, Diet Culture, & the “Good Girl” Diet culture and purity culture can also share a familiar vocabulary: discipline versus indulgence, clean versus contaminated, good versus bad, and control versus temptation. For people vulnerable to eating disorders, self-denial can easily receive praise. Food restriction may look like discipline. Compulsive exercise may look like dedication. Orthorexia may look like wellness. Ignoring hunger may look like self-control. This episode also examines a striking contradiction in tradwife culture: women may be celebrated for producing abundant homemade food for their families while still being expected to maintain thin bodies themselves. Feed everyone else, but keep your own appetite contained. Eating Disorder Recovery Means Reclaiming Appetite Dr. Marianne expands the meaning of “shrinking” beyond body size. Women have long been encouraged to minimize their hunger, anger, sexuality, ambition, needs, and voices. Eating disorders can turn those cultural expectations inward. Eating disorder recovery can involve reclaiming appetite in a much broader sense: permission to want food, pleasure, rest, relationships, independence, motherhood or no motherhood, a career or homemaking, and a life that does not require becoming smaller to belong. Rather than mocking women drawn to tradwife culture or conservative Christianity, Dr. Marianne encourages curiosity about what these movements may provide: certainty, community, spirituality, belonging, structure, or relief from hustle culture. At the same time, we can question any system that ties women's goodness to restraint, purity, desirability, self-denial, or thinness. In this episode: tradwives and eating disorders, disordered eating, the thin ideal, purity culture, conservative Christianity, diet culture, orthorexia, wellness culture, GLP-1s, body image, traditional femininity, women and food, and eating disorder recovery. Work With Dr. Marianne Dr. Marianne Miller is an eating disorder therapist with nearly 30 years of experience in mental health. She specializes in ARFID, anorexia, bulimia, binge eating, neurodivergence, autism, ADHD, and complicated relationships with food and body image. Learn more about eating disorder therapy with Dr. Marianne in California and Washington, D.C., her neurodivergent-affirming ARFID resources and course, and additional support at drmariannemiller.com.

Eating disorder recovery often requires developing a relationship with food, hunger, movement, and body size that differs sharply from what society considers “normal.” In this conversation, Dr. Marianne welcomes back psychotherapist Shira Collings, LPC, to discuss a powerful question: Can eating disorder recovery become its own form of neurodivergence? Shira describes neurodivergence as a way of thinking, processing information, or living that diverges from dominant social expectations. From this perspective, rejecting diet culture, anti-fat bias, intentional weight loss, and rigid rules about “healthy eating” can place someone outside the cultural norm. Recovery may change how a person understands nourishment, pleasure, rest, exercise, body acceptance, and the right to eat without trying to control their body size. Eating Disorder Recovery in the Ozempic and GLP-1 Era Dr. Marianne and Shira discuss why eating disorder recovery can feel especially isolating in the Ozempic and GLP-1 era. As weight loss becomes culturally celebrated again, people in recovery may experience grief, loneliness, body-image distress, or renewed pressure to shrink themselves. They also examine the growing tendency to call hunger, cravings, and thoughts about food “food noise.” For many people recovering from anorexia, bulimia, binge eating, chronic dieting, or other eating disorders, noticing hunger and responding to food cravings represent meaningful signs of healing. Treating these experiences as problems that should disappear can undermine body trust and reinforce disordered eating beliefs. Hunger Cues, Neurodivergence, and Body Trust Hunger does not feel the same for everyone. Autistic people, ADHDers, highly sensitive people, and others with neurodivergent eating experiences may not notice traditional hunger cues such as a growling stomach. Hunger might appear as lightheadedness, difficulty concentrating, irritability, thoughts about food, emotional changes, or a desire for sensory regulation through eating. Dr. Marianne shares how ADHD hyperfocus can interfere with recognizing when she needs food and why mechanical eating helps her nourish herself consistently. Shira explains that eating without experiencing a specific type of physical hunger does not mean someone is eating incorrectly. Rebuilding body trust can include recognizing your individual hunger signals and releasing the fear of eating “too much.” Diet Culture, Anti-Fat Bias, and the Fear of Eating Too Much The conversation also addresses how anti-fat bias, purity culture, healthmaxxing, and moral judgments about food teach people to distrust hunger and reject pleasure. Larger-bodied people often face added pressure to become the “good fatty” by pursuing weight loss, exercising frequently, or proving that they eat according to society's definition of health. Sustainable eating disorder recovery may mean letting go of the belief that you must control your weight to deserve nourishment, rest, pleasure, care, or belonging. Dr. Marianne and Shira acknowledge how difficult this work can feel when friends, family members, healthcare providers, therapists, treatment programs, and social media continue to reinforce diet culture. About Shira Collings, LPC Shira Collings is a feminist, neurodiversity-affirming, LGBTQIA+-affirming, fat-affirming, and disability justice-aligned psychotherapist. Their specialties include eating disorders, body image, reproductive mental health, trauma, grief, and loss. Shira supports clients in healing from external and internalized oppression and creating lives aligned with their values. Learn more about Shira at threadandthreshold.com or follow them on Instagram at @threadandthreshold.therapy. In This Eating Disorder Recovery Episode Dr. Marianne and Shira discuss eating disorder recovery as neurodivergence, hunger cues in autism and ADHD, mechanical eating, body trust, food noise, Ozempic and GLP-1 medications, anti-fat bias, diet culture, body acceptance, fear of eating too much, weight-neutral recovery, and the loneliness of rejecting cultural expectations around food and body size.  Related Episodes What If You're Not Broken? Neurodivergence, Sanism, Eating Disorders, & Radical Acceptance With Shira Collings, LPC on Apple & Spotify. About Dr. Marianne Miller Dr. Marianne Miller is an eating disorder therapist with nearly 30 years of mental health experience. She specializes in ARFID, binge eating, anorexia, and bulimia through a neurodivergent-affirming, sensory-attuned, trauma-informed, and weight-neutral approach. Dr. Marianne provides therapy in California and Washington, D.C., as well as coaching for clients worldwide. Learn more about working with her, her self-paced ARFID course, and her Binge Eating Recovery Membership at drmariannemiller.com.

Autism and eating disorders can create a complicated relationship with food rigidity, routines, sensory needs, and predictability. For autistic people recovering from anorexia, ARFID, bulimia, or other eating disorders, repetitive eating patterns aren't always symptoms that need to be challenged. Sometimes autistic food routines and preferred foods make consistent nourishment more accessible. In this solo episode, Dr. Marianne explores the difference between autistic food rigidity and eating disorder rigidity, including why they can be difficult to separate. Sensory processing differences, executive functioning challenges, autistic inertia, interoceptive differences, and a strong preference for sameness can all shape autistic eating and eating disorder recovery. Autism, Food Rigidity & Eating Disorder Recovery A familiar breakfast, preferred brand, predictable meal schedule, or small rotation of foods may look rigid from the outside. For an autistic person, however, these routines can reduce sensory overwhelm, decision fatigue, and the executive functioning demands involved in eating. Dr. Marianne explains why autism and eating disorder recovery may require a different definition of flexibility. Mechanical eating and predictable meal routines can be particularly helpful for autistic people who experience inconsistent hunger cues or difficulty interpreting internal body signals. You'll also learn how the same autistic traits can sometimes complicate recovery. Changes to meal timing, unfamiliar foods, unexpected sensory experiences, and disruptions to established routines can create significant distress. What appears to be eating disorder resistance may actually involve autistic sensory needs, difficulty with transitions, interoceptive differences, or a need for predictability. Autism, ARFID, Anorexia & Sensory Issues With Food Food variety is another area where neurodivergent eating disorder treatment requires nuance. Expanding someone's range of foods can be important when limited intake creates nutritional or medical concerns, particularly with autism and ARFID. But eating more variety isn't automatically the same as eating disorder recovery. Dr. Marianne discusses how sensory sensitivities can overlap with ARFID, anorexia, and other restrictive eating disorders, and why clinicians need to understand what a food behavior is doing before trying to change it. Avoiding a food because of texture, smell, temperature, or unpredictability isn't necessarily the same as avoiding it because of eating disorder fears about calories, weight, or body shape. Sometimes both are present. Related Episodes   Neurodivergent-Affirming Eating Disorder Treatment Successful autistic eating disorder recovery doesn't require making someone's eating look neurotypical. An autistic person may continue to plan meals, repeat breakfasts, rely on preferred foods, check restaurant menus ahead of time, use sensory accommodations, and maintain predictable eating routines after the eating disorder has significantly improved. Dr. Marianne also explains how autistic traits can become recovery strengths. A preference for routine can support regular meals and snacks, pattern recognition can help identify situations where nourishment breaks down, and understanding sensory needs can make eating more sustainable. Rather than automatically trying to eliminate food rigidity in autism, neurodivergent-affirming eating disorder treatment asks a more useful question: Does this pattern strengthen the eating disorder, or does it help this person stay nourished? Dr. Marianne specializes in autism, ADHD, ARFID, anorexia, bulimia, binge eating, and neurodivergent eating disorder recovery. Learn more about working with Dr. Marianne and her eating disorder therapy services at drmariannemiller.com. You can also explore her self-paced ARFID & Selective Eating course for adults with ARFID, parents and caregivers, and eating disorder providers.

Eating disorder recovery can feel surprisingly scary, even when you genuinely want to get better. Letting go of restriction, binge eating, purging, compulsive exercise, food rules, or body checking can trigger intense fear because eating disorder behaviors often serve functions that go far beyond food and body image. In this solo episode, Dr. Marianne explores why recovery from anorexia, bulimia, binge eating disorder, ARFID, and other restrictive eating disorders can feel unsafe. When an eating disorder has become connected to predictability, emotional regulation, control, or relief from anxiety and sensory overload, changing those patterns may feel threatening rather than freeing. Fear of Weight Gain, Food Anxiety, & Losing Control Fear of weight gain is one of the most recognized parts of eating disorder recovery, but the fear underneath it can be more complicated. Body changes may bring up concerns about weight stigma, identity, sensory discomfort, social judgment, loss of control, or being treated differently by others. Dr. Marianne discusses why food anxiety and fear of eating cannot always be addressed by simply challenging the food itself. Understanding what the eating disorder behavior has been doing for you can help uncover what needs additional support during recovery. Autism, ADHD, Neurodivergence, & Eating Disorders Neurodivergent people may experience additional challenges during eating disorder recovery. Autism, ADHD, sensory processing differences, interoception, executive functioning, transitions, routines, and PDA can all shape someone's relationship with food and change. A neurodivergent-affirming approach to eating disorder treatment recognizes that predictability and sensory accommodations can be genuine needs. Recovery does not have to mean stripping away every source of structure or forcing someone to tolerate overwhelming uncertainty. Nervous System Safety in Eating Disorder Recovery Instead of asking only, “How do I stop this eating disorder behavior?” it can help to ask what the behavior has been accomplishing. Restriction may create structure. Binge eating may provide regulation or relief. Exercise may offer predictability. Food rules may reduce uncertainty. Eating disorder recovery can include building new sources of safety, regulation, flexibility, support, and autonomy so the eating disorder no longer has to carry so much responsibility. Related Episodes 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. Eating Disorder Therapy & ARFID Support With Dr. Marianne Dr. Marianne Miller is an eating disorder therapist specializing in anorexia, bulimia, binge eating, ARFID, and neurodivergent-affirming eating disorder treatment. Learn more about therapy and working with Dr. Marianne at drmariannemiller.com. Dr. Marianne also offers consultation services. For additional ARFID support, Dr. Marianne's self-paced ARFID & Selective Eating course offers a neurodivergent-affirming, sensory-attuned approach for adults with ARFID, parents and caregivers, and providers. Learn more at drmariannemiller.com/arfid.

Supporting a child or teen with an eating disorder can leave parents caught between the urgency to help them eat and the fear that increasing control will create more conflict around food. In this episode, Dr. Marianne welcomes psychologist and psychoanalyst Dr. Tom Wooldridge to discuss how parents can help a child with an eating disorder by replacing control with connection. Drawing from his book, Ending the Food Fight: Replacing Control with Connection to Help Your Child Heal from an Eating Disorder, Dr. Wooldridge offers a different way to understand eating disorders in children and teens, anorexia recovery, family dynamics, and the role of parents in eating disorder treatment. WHAT YOU'LL LEARN Dr. Marianne and Dr. Wooldridge discuss why weight restoration and nutritional rehabilitation are essential in anorexia treatment, but may not address everything happening beneath eating disorder behaviors. A young person may restore weight and normalize eating while still struggling with perfectionism, obsessive thinking, emotional regulation, or other patterns that contributed to the eating disorder. Understanding these underlying dynamics can be an important part of longer-term eating disorder recovery and relapse prevention. They also explore how an eating disorder can sometimes function as a source of order, regulation, or safety when a child's internal world feels overwhelming. Dr. Wooldridge explains how attachment and emotional safety can help us understand why moving away from anorexia, binge eating, or other eating disorder behaviors can feel threatening, even when a young person wants to recover. PARENTS, CONNECTION & EATING DISORDER RECOVERY When a child or teen has anorexia or another eating disorder, parents may feel frightened, frustrated, angry, or desperate to make their child eat. Dr. Wooldridge describes three important areas for parents supporting eating disorder recovery in children and adolescents: self-regulation, emotional attunement, and the ability to reflect on both their child's internal experience and their own. The conversation introduces mentalization, a way of becoming curious about the thoughts, feelings, fears, and needs that may be driving a child's behavior rather than responding only to the behavior itself. For parents navigating anorexia treatment or adolescent eating disorder recovery, this can create space between the understandable urge to react and the ability to respond with greater connection and emotional attunement. Dr. Marianne and Dr. Wooldridge also discuss perfectionism and eating disorders, family dynamics, and intergenerational patterns around food, weight, and body image. Parents may carry their own histories of dieting, body shame, weight stigma, trauma, or perfectionism. Recognizing what belongs to the parent and what belongs to the child can help interrupt the unconscious transmission of these patterns. Importantly, replacing control with connection does not mean abandoning structure, nutritional rehabilitation, medical monitoring, or professional eating disorder treatment. Children and teens with anorexia and other eating disorders need appropriate treatment and a qualified care team. Connection provides an emotional foundation that can support that work. ABOUT DR. TOM WOOLDRIDGE Dr. Tom Wooldridge is a board-certified psychologist and psychoanalyst, founding dean of the School of Psychology at Golden Gate University, and an eating disorder specialist. His books include: Understanding Anorexia Nervosa in Males  Psychoanalytic Treatment of Eating Disorders: When Words Fail and Bodies Speak  Ending the Food Fight: Replacing Control with Connection to Help Your Child Heal from an Eating Disorder. His work brings together eating disorder treatment, anorexia recovery, psychoanalytic therapy, attachment, family relationships, perfectionism, and the psychological factors underlying eating disorders. EATING DISORDER & ARFID SUPPORT WITH DR. MARIANNE If you are looking for an eating disorder therapist, ARFID therapist, anorexia therapist, or neurodivergent-affirming eating disorder therapy, Dr. Marianne Miller provides eating disorder therapy for clients in California and Washington, D.C. Her work includes support for anorexia, bulimia, binge eating disorder, ARFID, autism, ADHD, and complex or long-term eating disorders. Dr. Marianne also offers a self-paced ARFID & Selective Eating Course for adults with ARFID, parents and caregivers of children and teens with ARFID, and providers who want to learn more about neurodivergent-affirming ARFID treatment. Visit Dr. Marianne's website to learn more about eating disorder therapy in California, ARFID treatment, eating disorder recovery, parent support, and neurodivergent-affirming eating disorder care, or to explore the ARFID course and additional resources.

Can you have anorexia and struggle with binge eating, too? If you find yourself moving between food restriction and binge eating, you may wonder whether your eating disorder has changed or whether you're somehow failing at recovery. In this solo episode, Dr. Marianne talks about the binge-restrict cycle, why eating disorder symptoms can shift over time, and what it means when binge eating shows up during anorexia recovery. Binge eating after restriction does not automatically mean you have binge eating disorder (BED). Extreme hunger, reactive eating, subjective binges, and eating that feels out of control can all occur in the context of restriction and long-term eating disorder recovery. WHAT YOU'LL LEARN Dr. Marianne discusses why restriction can make food feel increasingly urgent, why returning to restriction after a binge can keep the cycle going, and why subtle forms of restriction are easy to miss. She also explains why restriction may feel safer or more familiar than binge eating, especially for people who have lived with anorexia nervosa or other eating disorders for years or decades. For neurodivergent people with ADHD, autism, or AuDHD, food restriction can also become intertwined with routine, sensory needs, predictability, executive functioning, autonomy, and nervous system regulation. You'll learn why binge eating doesn't erase a history of anorexia, why eating more isn't automatically evidence of BED, and why the goal isn't necessarily to determine which eating disorder you "really" have. BREAKING THE BINGE-RESTRICT CYCLE What happens after a binge or an episode of eating more than you intended matters. Skipping meals, delaying breakfast, cutting portions, avoiding certain foods, or exercising to compensate can restart the restriction-binge cycle. Instead, Dr. Marianne discusses returning to consistent nourishment, identifying hidden restriction, getting curious about what preceded the binge, and resisting the pull to romanticize anorexia when binge eating feels frightening. For people with chronic or long-term eating disorders, progress may mean recognizing the cycle sooner, reducing its intensity, and responding to difficult eating experiences without punishment or compensation. EATING DISORDER THERAPY & SUPPORT If you're navigating anorexia, binge eating, bulimia, ARFID, or a long-term eating disorder that doesn't fit neatly into one diagnostic category, Dr. Marianne offers neurodivergent-affirming, sensory-attuned, trauma-informed eating disorder therapy. Learn more about eating disorder therapy, working with Dr. Marianne, and additional resources at drmariannemiller.com. Topics include: anorexia, anorexia recovery, binge eating, binge eating disorder, BED, binge-restrict cycle, restriction-binge cycle, restrictive eating, extreme hunger, reactive eating, chronic eating disorders, long-term eating disorder recovery, neurodivergent eating disorders, autism and eating disorders, ADHD and eating disorders, eating disorder therapy, and eating disorder recovery. RELATED EPISODES ADHD & Bulimia: Dopamine, Impulsivity, & the Hidden Link to Binge Eating With Kirsten Book, PMHNP-BC on Apple and Spotify. Beyond Anorexia: The Truth About Long-Term Restrictive Eating on Apple and Spotify. Why Eating Feels So Chaotic With ADHD: Binge Eating, Bulimia, & Executive Function Challenges on Apple and Spotify.

Food rationing and scarcity fears can show up in eating disorders in surprising ways. You might save the last few bites even though you're still hungry, carefully make favorite foods “last,” become anxious when safe foods run low, or hesitate to eat something because you're worried you won't have it later. In this solo episode, Dr. Marianne explores how food scarcity anxiety can affect people with anorexia, bulimia, ARFID, and other eating disorders. Restriction can teach the brain and body that food is scarce, even when food is physically available. Over time, saving food may start to provide a sense of certainty, predictability, or safety. WHAT YOU'LL LEARN You'll hear about why people with anorexia may ration foods they enjoy, how the restrict-binge-purge cycle in bulimia can create a sense of food urgency, and why ARFID safe foods may become especially difficult to use when someone fears running out. Dr. Marianne also discusses how autism, ADHD, sensory differences, executive functioning, and food insecurity can shape scarcity fears. For neurodivergent people, keeping backup foods may actually support eating. The important question is whether those foods remain available to eat or become so protected that using them creates anxiety. ARFID, AUTISM, & SAFE FOODS For people with ARFID and autism, food availability can carry additional meaning. A brand change, discontinued product, altered texture, different packaging, or unavailable restaurant item can eliminate a previously reliable food. Protecting or stocking safe foods may therefore reflect a genuine need for sensory predictability rather than weight or body image concerns. Understanding the reason behind the behavior can help parents, providers, and people with ARFID respond with more flexibility and less pressure. If you want to learn more, Dr. Marianne's self-paced ARFID and Selective Eating course covers ARFID treatment through a neurodivergent-affirming, sensory-attuned, trauma-informed approach, including autism, ADHD, PDA, autonomy, safe foods, sensory differences, and nervous system regulation. Learn more at drmariannemiller.com/arfid. KEY TAKEAWAYS Food rationing isn't always about restriction. Sometimes you're saving certainty, sensory predictability, pleasure, permission, or tomorrow's sense of safety. Rather than immediately trying to eliminate the behavior, consider asking: What am I afraid will happen if this food is gone? That answer can help identify whether you need more consistent nourishment, greater access to safe foods, support with anorexia or bulimia recovery, practical backup foods, or repeated experiences of learning that food can be eaten today and become available again tomorrow. If you're looking for eating disorder therapy, ARFID therapy, anorexia treatment, bulimia treatment, or neurodivergent-affirming eating disorder support, visit drmariannemiller.com to learn more about working with Dr. Marianne. RELATED EPISODES Food Allergy Anxiety & ARFID: When Safety Fears Shape Eating & Family Life With Tamara Hubbard @foodallergycounselor on Apple & 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.  

What happens when years of hearing that you talk too much turn into the belief that you are simply too much? In this episode, Dr. Marianne welcomes back eating disorder therapist Stacie Fanelli for a conversation about hyperverbalism, ADHD, autism, and eating disorders. They discuss why some neurodivergent people process thoughts and emotions through talking, why hyperverbal communication is often misunderstood, and how repeated messages about being “too loud,” “too emotional,” or “too much” can create lasting shame. Stacie explains how this shame can extend beyond communication and relationships into body image and eating disorder behaviors. For some autistic and ADHD people, the desire to become smaller, quieter, less visible, or less burdensome can become intertwined with food restriction, weight loss, and eating disorder symptoms. They also discuss neurodivergent masking and unmasking, rejection sensitivity, fear of being misunderstood, anti-fat bias, and the vulnerability that can follow sharing a lot with another person. Hyperverbalism does not cause eating disorders or body shame. Instead, this conversation looks at how eating disorders can capitalize on an existing belief that your natural way of existing is excessive. WHAT YOU'LL LEARN Stacie and Dr. Marianne discuss how hyperverbalism can show up in autistic and ADHD adults, why talking can serve as a form of processing and regulation, and why traditional expectations about communication can leave neurodivergent people feeling ashamed of how they naturally connect with others. You'll also hear how “I talk too much” can gradually become “I take up too much space,” why eating disorders may offer the illusion of becoming less visible or burdensome, and how neurodivergent-affirming eating disorder therapy can address these experiences without encouraging more masking. They also examine why eating disorder recovery is not about teaching neurodivergent people to communicate more like neurotypical people. Healing can include learning how to navigate relationships, advocate for your needs, and take up physical and conversational space without believing you must become a smaller version of yourself to deserve connection. WHO THIS EPISODE IS FOR This conversation may especially resonate with autistic, ADHD, and other neurodivergent adults who struggle with eating disorders, body shame, masking, rejection sensitivity, or the persistent feeling of being “too much.” It may also be helpful for eating disorder therapists, dietitians, clinicians, partners, and loved ones who want to better understand neurodivergent communication and eating disorder recovery. CONNECT WITH STACIE FANELLI Stacie Fanelli is an eating disorder therapist whose work focuses on the intersection of eating disorders, ADHD, autism, and neurodivergence. You can read her blog, including “The Loneliness of Being Hyper Verbal,” and learn more about her work at autonomousmindstherapy.com. Follow Stacie on Instagram: @EDADHD_therapist RELATED EPISODES WITH STACIE “Stuck” Isn't Lazy: Inertia in ADHD, Autism, & Eating Disorder Recovery on Apple and Spotify. Recovering Again: Navigating Eating Disorders After a Late Neurodivergent Diagnosis (Part 1) on Apple and Spotify. Recovering Again: Navigating Eating Disorders After a Late Neurodivergent Diagnosis (Part 2) on Apple and Spotify. Minding the Gap: The Intersection Between AuDHD & Eating Disorders on Apple and Spotify. WORK WITH DR. MARIANNE Looking for neurodivergent-affirming eating disorder support? Dr. Marianne Miller is an eating disorder therapist specializing in ARFID, binge eating, anorexia, bulimia, and neurodivergence, including autism and ADHD. Learn more about eating disorder therapy, coaching, and Dr. Marianne's self-paced ARFID & Selective Eating course at drmariannemiller.com.

Why does eating feel easier, more appealing, or more intense at night for some neurodivergent people? In this solo episode, Dr. Marianne explores Night Eating Syndrome (NES), ADHD, autism, and neurodivergent eating patterns through a neurodivergent-affirming lens. Rather than assuming nighttime eating comes from a lack of willpower, she looks at what may be happening across the entire day. ADHD and autism can affect interoception, hunger cues, executive functioning, sensory processing, sleep, circadian rhythms, and appetite regulation. Hyperfocus, masking, sensory overload, stimulant medication, and difficulty transitioning between tasks can also make daytime eating harder. By evening, the body may finally have the opportunity to catch up. What You'll Learn Dr. Marianne discusses why neurodivergent people may miss or misinterpret hunger cues during the day, how ADHD hyperfocus and executive functioning can delay meals, and why autistic people may find it easier to eat once sensory and social demands decrease. You'll also learn how masking and sensory overload can disconnect people from physical needs, why food can provide sensory regulation and stimulation, and how delayed eating can contribute to stronger nighttime hunger. The episode also explains the differences between Night Eating Syndrome and Binge Eating Disorder, including why eating more at night does not automatically mean someone is binge eating. Night Eating and the Restrict-Eat Cycle Fear about nighttime eating can create another problem: restriction the following day. Someone may eat more at night, feel guilty, skip breakfast or restrict during the day, and then become intensely hungry again that evening. For people with inconsistent hunger cues, ADHD, autism, or an eating disorder history, stricter food rules may reinforce the very pattern they are trying to change. Dr. Marianne also discusses low morning appetite, mechanical eating, sleep differences, circadian rhythms, and nighttime nervous system regulation. Sometimes nighttime is the first part of the day when a neurodivergent person feels safe, quiet, unmasked, and free from demands. Understanding that context can change the way we think about nighttime eating. A Neurodivergent-Affirming Approach to Night Eating Instead of asking only, “How do I stop eating at night?” this episode encourages a different question: What is making eating harder or less accessible earlier in the day? Night eating may provide important information about unmet nutritional needs, sensory safety, executive functioning, appetite timing, nervous system regulation, or the need for autonomy and decompression. If you're navigating Night Eating Syndrome, ADHD, autism, binge eating, anorexia, bulimia, ARFID, or another complicated relationship with food, Dr. Marianne offers neurodivergent-affirming, sensory-attuned, trauma-informed support. Learn more about therapy, coaching, courses, and other resources at drmariannemiller.com.

What happens when you've spent years working on eating disorder recovery, but anorexia or bulimia still shows up? Long-term eating disorder recovery can feel exhausting, especially when you understand your patterns but still struggle with restriction, bingeing, purging, compulsive exercise, or persistent food and body image thoughts. Knowing why something happens doesn't always make it easy to change. In this solo episode, Dr. Marianne explores what it means to feel stuck in recovery from chronic anorexia and bulimia and shares five practical strategies for approaching long-standing eating disorder patterns differently. Through the fictional story of Tiana, a woman whose eating disorder has shifted between anorexia, bingeing, purging, and compulsive exercise over many years, Dr. Marianne examines how recovery can continue even when progress doesn't look dramatic. What You'll Learn You'll learn how to recognize eating disorder recovery progress beyond complete symptom elimination, identify smaller places to interrupt the binge-restrict cycle, and create an eating plan that actually works when your capacity is low. Dr. Marianne also discusses why persistent eating disorder behaviors may serve important functions, how neurodivergence can complicate eating and recovery, and why you don't have to feel completely ready before taking a recovery-supportive action. The episode includes practical strategies for mechanical eating, low-lift nourishment, binge eating and restriction, purging urges, compensatory exercise, body image distress, and getting back to regular eating after a difficult day. Chronic Anorexia & Bulimia Recovery Can Still Change Living with an eating disorder for years or decades does not mean every part of your recovery will always look the same. Sometimes getting unstuck means eating breakfast after a binge or purge instead of compensating. It might mean keeping easy foods available when executive functioning is low, eating lunch before extreme hunger hits, or recognizing that one difficult meal does not have to become a week of restriction. For people with ADHD, autism, or other forms of neurodivergence, eating disorder treatment may also need to account for sensory needs, interoception, hyperfocus, executive functioning, transitions, and nervous system regulation. Recovery doesn't always happen through one major breakthrough. Sometimes meaningful change starts with making the next recovery-supportive choice easier to access. Work With Dr. Marianne If you're struggling with anorexia, bulimia, binge eating, ARFID, or a long-term eating disorder, Dr. Marianne offers neurodivergent-affirming, sensory-attuned, trauma-informed eating disorder therapy and coaching. Learn more about working with Dr. Marianne, explore the ARFID & Selective Eating course, and find additional eating disorder and neurodivergence resources at drmariannemiller.com. Follow Dr. Marianne on Instagram @drmariannemiller for more conversations about eating disorders, ARFID, autism, ADHD, body image, and neurodivergent-affirming recovery. 

What if binge eating isn't a willpower problem at all? Dr. Marianne welcomes back nutritionist and eating disorder specialist Marcelle Rose @marcellerosenutrition, author of The Binge Freedom Method, for a conversation about binge eating recovery without dieting. Marcelle works with people experiencing binge eating, bulimia, restrictive eating, and emotional eating, and her approach looks beyond food to understand what may actually be driving these patterns. What You'll Learn Dr. Marianne and Marcelle discuss why dieting and restriction can fuel binge eating, how sleep and physiology can affect hunger and cravings, and why reducing shame matters in binge eating recovery. They also talk about body image, weight stigma, emotional regulation, and rebuilding trust with food and your body. Marcelle shares the four pillars of The Binge Freedom Method: Nourish, Balance, Think, and Feel. Her framework incorporates nutrition, physiology, thoughts and beliefs, emotions, and body image rather than treating binge eating as simply a problem of self-control. Check out a free chapter of the book HERE! ADHD and Binge Eating A major focus of the conversation is the connection between ADHD and binge eating. ADHD can make eating consistently difficult, especially when executive functioning challenges, distraction, overwhelm, or hyperfocus interfere with recognizing hunger and stopping to eat. Marcelle and Dr. Marianne discuss practical ADHD-friendly strategies such as simplifying meals, eating familiar foods, using reminders, creating flexible routines, and reducing the cognitive load around breakfast and meal planning. They also discuss why support and accommodations can matter more than rigid expectations when neurodivergent people struggle to eat regularly. Binge Eating, Body Image, and Food Freedom Recovery involves more than stopping binge eating. Marcelle shares how clients can gradually move away from self-blame, chronic dieting, and the belief that they simply need more willpower. You'll also hear about body image healing, weight stigma, diet culture, regular eating, self-compassion, and what it can look like when food finally takes up less space in your mind. If you struggle with binge eating disorder, emotional eating, ADHD and binge eating, the binge-restrict cycle, chronic dieting, or body image, this conversation offers a compassionate alternative to another diet. Related Episodes With Marcelle Rose Disordered Eating in Midlife: Stress, Life Changes, & Perimenopause on Apple & Spotify. WTF Is Happening to My Body?! Gut Health & Midlife Unpacked on Apple & Spotify. Related Episodes on Binge Eating, ADHD, Bulimia ADHD & Bulimia: Dopamine, Impulsivity, & the Hidden Link to Binge Eating With Kirsten Book, PMHNP-BC on Apple and Spotify. Why Eating Feels So Chaotic With ADHD: Binge Eating, Bulimia, & Executive Function Challenges on Apple and Spotify. Connect With Dr. Marianne Looking for support with an eating disorder or a difficult relationship with food? Dr. Marianne Miller is an eating disorder therapist specializing in ARFID, binge eating, anorexia, bulimia, and neurodivergent-affirming eating disorder care. Visit DrMarianneMiller.com to learn more about working with Dr. Marianne, her ARFID & Selective Eating course, and other resources. Listen to more episodes of Dr. Marianne-Land for conversations about eating disorder recovery, ADHD, autism, ARFID, binge eating, body image, and neurodivergent-affirming care.

Why Food Feels So Regulating: Autism, ADHD, Eating Disorders, & the Nervous System Why can eating feel so calming, stimulating, or grounding? For many autistic people, ADHDers, and people with eating disorders, food does more than satisfy hunger. Eating can provide sensory input, emotional regulation, predictability, stimulation, and nervous system support. In this solo episode, Dr. Marianne explores food as self-regulation, co-regulation, and stimming, including why chewing, crunching, sipping, familiar foods, and repetitive eating experiences may help a neurodivergent nervous system feel more organized. She also discusses how these needs can intersect with autism, ADHD, anorexia, bulimia, binge eating disorder, and ARFID. What You'll Learn You'll learn why autistic and ADHD people may use food for sensory regulation, how eating can function as a form of stimming, and why "emotional eating" doesn't always capture what's actually happening. Dr. Marianne also explains why restriction can feel regulating for some people with anorexia, how food may help an overwhelmed or understimulated ADHD nervous system, why predictable safe foods can provide sensory security with ARFID, and how binge eating or bulimia can become intertwined with attempts to regulate distress. Rather than asking only, "How do I stop this eating behavior?" Dr. Marianne encourages a different question: "What is my nervous system getting from this?" Food, Stimming, & Neurodivergent Eating Food can provide powerful sensory experiences through taste, temperature, texture, chewing, swallowing, crunching, and repetition. For some neurodivergent people, these sensations can help increase stimulation, reduce overwhelm, support focus, or create predictability. Recovery doesn't have to mean eliminating food as a source of comfort or regulation. Instead, it can involve understanding what food provides and gradually expanding the ways your nervous system accesses safety, sensory input, connection, and support. Eating Disorder & Neurodivergent-Affirming Support If you're navigating ARFID, anorexia, bulimia, binge eating, autism, ADHD, sensory eating challenges, or neurodivergent eating disorder recovery, Dr. Marianne offers a neurodivergent-affirming, sensory-attuned, trauma-informed approach. Dr. Marianne provides eating disorder therapy in California and Washington, D.C., including telehealth and in-person services in San Diego, as well as coaching and consultation worldwide. Learn more about working with Dr. Marianne and find additional eating disorder and neurodivergence resources at drmariannemiller.com.

Anorexia in a Larger Body: How to Talk About Your Eating Disorder When Others Don't Understand Can you have anorexia in a larger body? Yes. Yet weight stigma and stereotypes about what an eating disorder "looks like" can make it difficult to feel believed, receive appropriate anorexia treatment, or talk about your experience with others. In this solo episode, Dr. Marianne discusses anorexia in larger bodies from both a clinical and lived-experience perspective. As an eating disorder therapist who has experienced anorexia and now lives in a larger body, she understands the complicated experience of having an eating disorder history that other people may not recognize. Anorexia, Atypical Anorexia, and Weight Stigma Anorexia and restrictive eating disorders occur across the weight spectrum. Body size cannot tell you how much someone restricts, how distressed they feel around food, or how much support they need. Dr. Marianne explores atypical anorexia, weight stigma, eating disorder recovery, and the painful experience of receiving compliments about weight loss when restriction is harming your health. How to Talk About Anorexia With Others What do you say when someone tells you that you "don't look anorexic"? Learn practical ways to talk about anorexia with family, friends, and healthcare providers, set boundaries around weight and body comments, advocate for weight-inclusive care, and respond when people don't understand your eating disorder. Work With Dr. Marianne If you're navigating anorexia, atypical anorexia, restrictive eating, or eating disorder recovery, Dr. Marianne offers neurodivergent-affirming, trauma-informed, weight-inclusive support. Learn more about eating disorder therapy, coaching, and consultation at drmariannemiller.com.

How can harm reduction support eating disorder recovery when full recovery feels complicated, nonlinear, or far away? Dr. Marianne welcomes back journalist, professor, and author Mallary Tenore Tarpley, MFA, for a conversation about eating disorder harm reduction, anorexia recovery, long-term eating disorder recovery, and the pressure to achieve full recovery. Mallary is the author of Slip: Life in the Middle of Eating Disorder Recovery, a memoir that combines her lived experience with extensive research on how people actually experience eating disorder recovery. Eating Disorder Harm Reduction and Full Recovery Eating disorder recovery often gets framed in black-and-white terms: you are either sick or fully recovered. Mallary challenges that binary without dismissing the possibility of full recovery. For Slip, Mallary surveyed more than 700 people with lived experience of eating disorders and interviewed approximately 175 survey respondents, clinicians, and researchers. Of those surveyed, 85% identified with what she calls the “middle place,” the gray area between acute illness and full recovery. Dr. Marianne and Mallary discuss why rigid definitions of recovery can create shame for people navigating long-term anorexia recovery, lingering eating disorder thoughts, slips, relapse, and ongoing recovery work. What Does Eating Disorder Recovery Actually Mean? Recovery involves more than weight, food intake, or eliminating visible eating disorder behaviors. Mallary describes recovery through changes in identity, cognitive freedom, mental bandwidth, and physical well-being. She shares how her eating disorder once consumed her thoughts and identity. Now, eating disorder thoughts may still appear, but they no longer dictate her life in the same way. Dr. Marianne connects this with her own lived experience and discusses how reducing food and body preoccupation can create more capacity for relationships, work, interests, and life outside the eating disorder. Harm Reduction, Slips, and All-or-Nothing Recovery Mallary explains how harm reduction in eating disorder recovery can help someone move forward without demanding immediate perfection. Instead of treating an eating disorder thought or behavior as proof of failure, harm reduction creates room to notice what happened, reduce risk, and make another choice. Mallary shares a vulnerable example involving making grilled cheese for herself and her children. When a lingering eating disorder impulse influenced how she prepared her own sandwich, she noticed it, changed course, and moved forward without shaming herself. Dr. Marianne and Mallary also discuss neurodivergent eating disorder recovery, including how autism, ADHD, perfectionism, certainty-seeking, trauma, and nervous system needs can make rigid treatment expectations especially difficult. Slip: Life in the Middle of Eating Disorder Recovery Mallary's book, Slip: Life in the Middle of Eating Disorder Recovery, combines memoir, journalism, and research to challenge simplistic narratives about eating disorders and recovery. Drawing from her own history with anorexia and changing eating disorder symptoms alongside the experiences of hundreds of others, Mallary asks what recovery can look like when it does not follow a clean before-and-after story. Mallary also shares what she is researching next, including optimization culture, the thin ideal, healthmaxxing, anti-aging pressures, body image, and cultural messages that encourage us to treat our bodies as endless projects requiring improvement. If you have ever wondered whether your eating disorder recovery “counts” because you still struggle, this conversation offers a more flexible way to understand healing, progress, and recovery. Follow Mallary on Instagram: @mallarytenoretarpley Go to her Substack: https://mallary.substack.com Related Episodes Check out "The Middle Place in Eating Disorder Recovery: How Slips Can Be Stepping Stones With Mallary Tenore Tarpley, MFA @mallarytenoretarpley" on Apple or Spotify: Listen to “'Slips'” in Eating Disorder Recovery in 2026: Why Setbacks Are Part of Progress, Not Failure (With Mallary Tenore Tarpley, MFA)" on Dr. Marianne-Land Podcast on Apple or Spotify. Work With Dr. Marianne Looking for eating disorder therapy, ARFID treatment, or neurodivergent-affirming eating disorder support? Dr. Marianne works with people navigating ARFID, anorexia, bulimia, binge eating, long-term eating disorders, autism, ADHD, and complex relationships with food and body image. Visit DrMarianneMiller.com to learn more about working with Dr. Marianne through therapy or coaching, explore her ARFID & Selective Eating Course for individuals, parents, and providers, and find additional eating disorder and neurodivergent-affirming resources. You can also listen to more episodes of Dr. Marianne-Land for conversations about eating disorder recovery, ARFID, autism, ADHD, body image, and creating a more sustainable relationship with food.

How do you support weight restoration when your autistic child needs nutrition, but pressure around food makes eating even harder? For autistic children, teens, and adolescents with a PDA profile (Pathological Demand Avoidance or Pervasive Drive for Autonomy), weight restoration for ARFID, anorexia, and other restrictive eating disorders can become especially complicated. Parents may know that their child urgently needs more nutrition, yet direct demands, rigid meal expectations, sensory overwhelm, and medical procedures can increase distress and food refusal. In this solo episode, Dr. Marianne Miller discusses weight restoration in autistic children and teens with ARFID or anorexia, including how PDA, sensory processing differences, interoception, executive functioning, and nervous system overwhelm can affect eating disorder recovery. Autism, PDA, ARFID, and Anorexia During Weight Restoration Weight restoration involves more than getting enough calories into a child's body. Autistic children and adolescents may experience intense sensory sensitivities around food, difficulty identifying hunger and fullness cues, strong needs for predictability, executive functioning challenges, and distress when eating becomes a demand. Dr. Marianne explains why these differences need to become part of the treatment plan instead of being treated as behaviors that must be overcome. She also discusses an important distinction between ARFID and anorexia in autistic teens, including why some young people can experience features of both restrictive eating disorders. Why Pressure Around Food Can Backfire With a PDA Profile When an autistic child has a PDA profile, even necessary requests can activate a threat response. During eating disorder recovery, parents may find themselves repeatedly asking their child to eat another bite, finish a supplement, follow a meal plan, or complete a snack. The stakes are real. So is the child's nervous system response. You'll learn why reducing unnecessary demands does not mean abandoning weight restoration and how parents can protect medical safety without turning every meal into a power struggle. Medical Management of Eating Disorders in Autistic Children and Teens Medical stabilization can present additional challenges for autistic children and adolescents with ARFID or anorexia. Blood draws, vital signs, unfamiliar providers, hospital environments, bright lights, noise, disrupted routines, physical examinations, and unexpected procedures can create significant sensory and nervous system overload. Dr. Marianne discusses how autistic shutdowns, meltdowns, reduced communication, or refusal may reflect overwhelm rather than "noncompliance." She also explains why autism-informed and trauma-informed medical care matters when a young person requires medical monitoring or stabilization for a restrictive eating disorder. Supporting Eating Disorder Medical Management at Home Parents often become an important part of the medical management team during weight restoration. Under the guidance of a physician or eating disorder treatment team, some families may monitor aspects of their child's health at home between appointments. Dr. Marianne discusses practical ways parents can organize medical information, pay attention to changes in symptoms, create more predictable eating routines, reduce sensory demands, use preferred foods strategically, and communicate more effectively with medical providers. You'll also hear why home monitoring should complement, rather than replace, appropriate medical care and why concerning physical symptoms require prompt evaluation from your child's healthcare team. Neurodivergent-Affirming Tips for Weight Restoration This episode offers practical ideas for supporting an autistic child or teen through weight restoration, including creating predictable meal routines, prioritizing adequate nutrition before pushing food variety, making sensory accommodations, offering meaningful choices, reducing unnecessary conflict around food, and building a collaborative treatment team. For children with autism, PDA, ARFID, or anorexia, medical safety and autonomy do not have to exist on opposite sides of treatment. Neurodivergent-affirming eating disorder care can take malnutrition seriously and still respect sensory needs, communication differences, autonomy, trauma history, and nervous system regulation. Related Episodes PDA, ARFID, & Food Avoidance: Why “Just Eat” Doesn't Work & What to Do Instead on Apple & Spotify. When PDA Drives ARFID: Understanding Food Refusal, Control, & Safety on Apple & Spotify. ARFID, PDA, and Autonomy: Why Pressure Makes Eating Harder on Apple & Spotify. Why Sensory-Attuned Care Matters More Than Exposure in ARFID Treatment on Apple & Spotify. Eating Disorder Therapy in California and Parent Consultation Worldwide If your child, adolescent, or teen has ARFID, anorexia, autism, PDA, or another restrictive eating disorder, Dr. Marianne offers neurodivergent-affirming eating disorder therapy in California, including in-person services in San Diego and telehealth throughout California. For families outside California, Dr. Marianne also provides parent consultation worldwide for parents navigating ARFID, restrictive eating, autism, PDA, sensory challenges, weight restoration, and eating disorder recovery. Go to drmariannemiller.com and schedule a free, 15-minute phone or Zoom consultation. You can also learn more through Dr. Marianne's ARFID and Selective Eating Course, created for parents, providers, and others who want practical, neurodivergent-affirming strategies for understanding ARFID, autism, sensory processing, autonomy, trauma, and eating. If weight restoration has become a battle in your family, you do not have to choose between taking your child's medical needs seriously and respecting their neurodivergence. Support can account for both.

What happens to eating disorder recovery when the culture around you starts celebrating weight loss again? In this deeply personal solo episode, Dr. Marianne continues sharing her eating disorder recovery story and talks about something that has surprised her: the return of body insecurities during the Age of Ozempic. After recovering from a decades-long history of anorexia, binge eating disorder, orthorexia, and bulimia, she rarely spends much time thinking about her body size. But the rise of Ozempic and other GLP-1 medications like Zepbound and Wegovy has changed the cultural conversation around weight, thinness, and fat bodies. During the height of the body diversity movement, living in a larger body felt different. Plus-size clothing became more visible. Larger bodies appeared in advertising. Conversations about weight stigma, fatphobia, body neutrality, and fat liberation entered the mainstream. Now, many of those gains seem to be disappearing as celebrities become smaller, plus-size departments vanish from stores, and thinness once again becomes something we're expected to pursue. When Eating Disorder Recovery Meets the Age of Ozempic Dr. Marianne shares what it's like to encounter old eating disorder and body image thoughts after years of recovery. Sometimes those thoughts arrive unexpectedly: Look at that celebrity. They did it. Why can't I? Having that thought doesn't mean eating disorder recovery has failed. Recovery doesn't necessarily erase decades of conditioning around weight and body size. Instead, it can help us recognize internalized weight bias when it resurfaces and decide whether we want to listen to it. Dr. Marianne also discusses an important distinction: wanting a smaller body isn't necessarily the same thing as wanting relief from anti-fat bias. Sometimes the thought, Life would be easier if I were thinner, reflects a painful reality about how fat people are treated rather than a genuine desire to change one's body. The World Is Getting Smaller for Fat People Anti-fat bias doesn't exist only in our thoughts. It shows up in the physical world. Plus-size clothing departments have disappeared from many stores, forcing people in larger bodies to shop online. Airplane seats continue to create accessibility barriers for larger passengers. Cars, restaurant booths, waiting-room chairs, theaters, and other public spaces frequently fail to accommodate body diversity. The message can become impossible to ignore: if the world won't make more space for you, you're expected to make yourself smaller. Dr. Marianne explores the mental health toll of repeatedly navigating environments that weren't designed for your body. Constantly wondering whether a seat will fit, whether a store carries your size, or whether a healthcare provider will blame your symptoms on weight creates an enormous cognitive and emotional burden. Defending the Right to Be Fat Dr. Marianne shares a recent dream in which she found herself defending her fatness to another person. When she woke up, she realized how closely the dream reflected the experience of living in a larger body today. Fat people often have to defend their right to exist without pursuing intentional weight loss. They may have to advocate for appropriate healthcare, accessible seating, clothing, travel accommodations, and the basic right to occupy space without apology. That emotional labor takes energy. For neurodivergent people, the burden can become even greater. Autistic people and ADHDers may already expend significant energy navigating sensory needs, executive functioning, uncertainty, masking, and environments that weren't designed for neurodivergent nervous systems. When neurodivergence intersects with anti-fat bias and other forms of marginalization, the cumulative mental health toll can become significant. Internalized Weight Bias Doesn't Mean You've Failed at Recovery Eating disorder recovery happens in the real world, not in a protected bubble. You can appreciate your body and still feel hurt by weight stigma. You can reject diet culture and feel grief when plus-size clothing disappears. You can practice fat acceptance and still have moments when you wonder whether life would be easier in a smaller body. Those experiences don't erase recovery. Sometimes what looks like body dissatisfaction is actually grief, anger, exhaustion, or a desire to move through the world without constantly having to advocate for your right to belong. Dr. Marianne shares the question that helps her separate internalized weight bias from her own values: Do I actually want a different body, or do I want a different world? Related Episodes How a Part of Me Wanted to Take a Weight-Loss Drug on Apple & Spotify. My Eating Disorder Recovery Story on Apple & Spotify. Finding Liberation-Focused Eating Disorder Support If the Age of Ozempic has stirred up old body image struggles, eating disorder thoughts, or internalized weight bias, you don't have to navigate those experiences alone. Finding an eating disorder therapist or provider who understands weight stigma can make a profound difference. Liberation-focused, trauma-informed, neurodivergent-affirming eating disorder treatment can create space to examine these experiences without making weight loss the goal. If you'd like to work with Dr. Marianne, she provides eating disorder therapy in California for adolescents and adults navigating anorexia, bulimia, binge eating disorder, ARFID, body image concerns, and neurodivergence. If you live elsewhere, Dr. Marianne also offers consultations and coaching for individuals, families, and professionals. Learn more about working with Dr. Marianne at drmariannemiller.com.

When does trying to be healthy cross the line into rigid or disordered eating? Healthmaxxing focuses on optimizing nutrition, protein, exercise, sleep, steps, and other health metrics. But for someone with an eating disorder or history of disordered eating, healthmaxxing can become another way to follow rigid rules, compulsively track behaviors, and disconnect from the body. In this episode of Dr. Marianne-Land, Dr. Marianne talks with registered dietitian and eating disorder specialist Amy Ornelas, RD, about healthmaxxing, diet culture, protein obsession, fitness trackers, compulsive exercise, and eating disorder recovery. Is Healthmaxxing the New Diet Culture? Healthmaxxing may look different from traditional dieting, but some of the messages sound familiar: eat the “right” foods, maximize protein, hit your steps, exercise consistently, track your metrics, and keep improving. Dr. Marianne and Amy discuss how healthmaxxing can become a socially acceptable form of rigid or disordered behavior. For someone recovering from an eating disorder, relying on an Apple Watch, Oura Ring, calorie tracker, or wellness influencer may also make it harder to rebuild trust in hunger, fullness, fatigue, and other body cues. Protein, Fitness Trackers, & Compulsive Exercise Protein has become one of the biggest trends in nutrition and wellness culture. Amy compares today's protein obsession to previous diet trends, including the fat-free craze of the 1980s and 1990s. Protein matters, but maximizing protein at every meal doesn't automatically make eating healthier. Dr. Marianne and Amy also unpack step counts, exercise goals, calorie tracking, and wearable fitness devices. Fitness data can provide useful information for some people, but it can also reinforce compulsive exercise, perfectionism, and eating disorder behaviors. Your body's needs change. Rest, relationships, sleep, pleasure, and spontaneity matter too. Eating Disorder Recovery & Rebuilding Body Trust Eating disorders can make hunger, fullness, fatigue, emotion, and physical sensations difficult to interpret. That uncertainty can make external rules and health metrics especially appealing. Amy explains how eating disorder nutrition therapy can provide appropriate structure as someone rebuilds nourishment and reconnects with their body. Unlike an algorithm or influencer, individualized nutrition support considers a person's history, eating disorder behaviors, physical needs, and recovery. Dr. Marianne and Amy also discuss what happens when fitness becomes part of your identity. Letting go of compulsive exercise or rigid health behaviors can raise a difficult question: Who am I if I'm no longer the person who always works out, eats a certain way, or prioritizes fitness? Recovery can create room to discover an identity beyond food, weight, exercise, and optimization. What You'll Learn You'll hear Dr. Marianne and Amy discuss healthmaxxing and disordered eating, diet culture and wellness culture, protein obsession and nutrition trends, fitness trackers and calorie tracking, compulsive exercise and step goals, fitness identity, hunger and fullness cues, body trust, and nutrition therapy in eating disorder recovery. They also ask a bigger question: What happens when trying to optimize your health starts taking away from your life? About Amy Ornelas, RD Amy Ornelas is a registered dietitian and eating disorder specialist with more than two decades of experience. She incorporates nutrition therapy, somatic therapy, yoga, and intuitive practices into her work with adolescents and adults. Her own eating disorder recovery helped shape her commitment to helping people move away from diet culture, rigid food rules, body image struggles, and disconnection from their bodies. Instagram: @amyornelasRD Website: i-heart-nutrition.com Related Episodes 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 "I Feel Huge" Versus "What I'm Actually Feeling": Translating Body Distress Into Emotions" via Apple or Spotify. 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. Work With Dr. Marianne If healthmaxxing, compulsive exercise, rigid food rules, body image concerns, or anxiety around eating have become tangled up with your eating disorder, Dr. Marianne offers a neurodivergent-affirming, trauma-informed approach to eating disorder recovery. Dr. Marianne specializes in ARFID, binge eating, anorexia, and bulimia, including the ways eating disorders intersect with autism, ADHD, sensory needs, and trauma. She offers eating disorder therapy in California and Washington, D.C., as well as virtual coaching for people elsewhere. She also offers a self-paced ARFID & Selective Eating course for adults with ARFID, parents and caregivers, and providers. Visit drmariannemiller.com to learn more about working with Dr. Marianne. Follow @drmariannemiller on Instagram and listen to Dr. Marianne-Land on Apple Podcasts and Spotify.

Does it matter whether your eating disorder therapist has personally recovered from anorexia or bulimia? In this solo episode of Dr. Marianne-Land, I explore that question from two perspectives: as an eating disorder therapist and as someone who spent about 25 years navigating anorexia, binge eating, orthorexia, bulimia, compulsive exercise, and the long road to recovery. Lived experience does not replace professional training, and professional training does not require lived experience. Both forms of knowledge have value. In this episode, I share how my personal recovery has shaped my clinical work and why that perspective can be especially meaningful for autistic people, ADHDers, AuDHDers, and other neurodivergent adults recovering from anorexia and bulimia. What You'll Learn You'll hear five lessons that have transformed the way I understand eating disorder recovery. We discuss why what appears to be resistance is often nervous system overwhelm, how to tell the difference between neurodivergent traits and eating disorder symptoms, why shame rarely creates lasting recovery, how safety supports sustainable healing, and why recovery ultimately becomes about building a meaningful life instead of simply eliminating symptoms. Why Neurodivergent People Often Need a Different Recovery Conversation Traditional eating disorder treatment does not always account for sensory processing differences, executive functioning challenges, autistic burnout, ADHD, interoceptive differences, or the ways trauma and neurodivergence can intersect with anorexia and bulimia. In this episode, I explain why understanding your nervous system can make recovery feel more compassionate, more realistic, and more sustainable. Rather than forcing yourself to fit a rigid recovery model, you can begin building an approach that respects both your neurodivergence and your recovery goals. Who This Episode Is For This episode is for adults recovering from anorexia nervosa, atypical anorexia, bulimia nervosa, chronic eating disorders, or long-term restrictive eating. It's also for autistic adults, ADHDers, AuDHD adults, highly sensitive people, therapists, dietitians, parents, caregivers, and anyone who wants a deeper understanding of neurodivergent-affirming eating disorder treatment. Mentioned in This Episode If you want to learn more about sensory processing, autonomy, nervous system regulation, and neurodivergent-affirming approaches to eating, check out my ARFID and Selective Eating Course. Although the course focuses on ARFID, many of the concepts also apply to neurodivergent people recovering from anorexia, bulimia, and other eating disorders. Related Episodes Harm Reduction for Eating Disorders: How Lived Experience Shapes Recovery, Support, & Long-Term Healing on Apple & Spotify. Lived Experience of ARFID in Autistics & ADHDers: Sensory Survival & Misunderstandings With Dr. Panicha McGuire, LMFT, RPT on Apple & Spotify. Unmasking in Eating Disorder Recovery: What Neurodivergent People Need to Know About Safety & Healing via Apple & Spotify. Connect With Dr. Marianne Miller If you're looking for eating disorder therapy in California or Washington, D.C., or eating disorder coaching from anywhere in the world, I'd love to help. I specialize in anorexia, bulimia, ARFID, binge eating disorder, autism, ADHD, AuDHD, and neurodivergent-affirming eating disorder treatment. Visit www.drmariannemiller.com to learn more about working with me, explore my ARFID course, and listen to more episodes of Dr. Marianne-Land. If you found this episode helpful, please follow the podcast, leave a rating or review on Apple Podcasts or on Spotify, and share it with someone who could benefit from hearing that recovery does not have to look the same for everyone.

Many people with eating disorders get labeled as perfectionists. Sometimes that's accurate. Sometimes it's only part of the story. In this episode of the Dr. Marianne-Land Podcast, I explore the overlap between OCD and eating disorders, perfectionism, anxiety, autism, ADHD, and the cognitive effects of malnutrition. I explain why similar behaviors can have very different underlying causes and why understanding those differences can change the course of eating disorder treatment and recovery. If you've ever found yourself stuck in food rules, body checking, repetitive thoughts, calorie calculations, reassurance-seeking, or endless self-doubt, this episode offers a more nuanced way to understand what's happening beneath the surface. Rather than focusing only on what behaviors look like, I discuss why identifying their function leads to more effective and compassionate care. What You'll Learn In this episode, you'll learn how perfectionism differs from OCD in eating disorder recovery and why the distinction matters. I discuss why intrusive thoughts, compulsive checking, and reassurance-seeking are often mistaken for perfectionism, how anorexia nervosa and other restrictive eating disorders can increase obsessive thinking, and why starvation affects cognitive flexibility and mental rigidity. I also explain how autism, ADHD, sensory needs, and routine dependence can sometimes resemble OCD while reflecting very different underlying experiences. Finally, I share why understanding the function of eating disorder behaviors helps clinicians, individuals, and families choose more effective treatment approaches. OCD, Perfectionism, and Eating Disorders Perfectionism has long been associated with anorexia nervosa, bulimia nervosa, and other eating disorders. At the same time, many people who believe they're simply perfectionists may also experience OCD, significant anxiety, or both. Looking only at outward behaviors can miss what is actually maintaining the cycle of restriction, compulsions, fear, and distress. In this episode, I discuss why food-related rituals, repeated checking, body checking, calorie counting, and reassurance-seeking may look similar across different conditions while serving very different purposes. Understanding those differences helps people receive more individualized, neurodivergent-affirming care instead of one-size-fits-all treatment. Why Neurodivergence Makes the Picture More Complex Autism, ADHD, ARFID, sensory processing differences, and nervous system regulation can all influence eating behaviors, routines, and food preferences. Predictability and consistency often help neurodivergent people reduce overwhelm and make eating feel safer. Those experiences are not automatically signs of OCD or perfectionism. I explain why clinicians need to understand the role of sensory processing, cognitive load, executive functioning, and nervous system regulation before drawing conclusions about repetitive eating behaviors. This perspective supports more accurate assessment and more compassionate eating disorder treatment. Why This Matters for Recovery Recovery looks different depending on what's driving the behavior. Someone whose eating disorder is fueled primarily by perfectionism may need different interventions than someone struggling with OCD, autism, or multiple overlapping conditions. When treatment targets the underlying process instead of the surface behavior alone, recovery often becomes more individualized, effective, and sustainable. Understanding the "why" behind eating disorder behaviors creates opportunities for greater self-compassion and more meaningful healing. This Episode Is For You If... This episode is for anyone recovering from anorexia, bulimia, ARFID, binge eating disorder, or another eating disorder who has wondered whether perfectionism tells the whole story. It's also for autistic, ADHD, and AuDHD individuals, parents, caregivers, therapists, dietitians, physicians, and other professionals who want a more nuanced understanding of OCD, perfectionism, neurodivergence, and eating disorder recovery. Related Episodes OCD & Eating Disorders: Why Food Rules, Rituals, & “Not Feeling Right” Take Over on Apple & Spotify. When Eating Disorders Meet Anxiety, OCD, or Depression: Co-Occurring Challenges & Recovery Strategies on Apple & Spotify. Obsessions, Compulsions, and Control: How OCD Intertwines With Eating Disorders on Apple & Spotify. Food, Fear, & Fixation: How OCD Shapes Eating Disorders on Apple & Spotify. Work With Dr. Marianne Miller If you're looking for a neurodivergent-affirming eating disorder therapist, I provide therapy for adults and adolescents throughout California and Washington, D.C. I also offer parent consultation and eating disorder coaching worldwide. My practice specializes in ARFID therapy, anorexia treatment, bulimia treatment, binge eating disorder therapy, autism and ADHD, and neurodivergent-affirming eating disorder care. I use a sensory-attuned, trauma-informed, autonomy-supportive approach that honors each person's unique nervous system and lived experience. Learn more about therapy, consultation, my ARFID & Selective Eating Course, and additional resources at www.drmariannemiller.com. If you enjoyed this episode, please follow the Dr. Marianne-Land Podcast, leave a rating or review on Apple Podcasts or on Spotify, and share this episode with someone who may benefit from a more compassionate understanding of OCD, perfectionism, and eating disorder recovery.

What happens when years of eating disorder treatment reduce symptoms but never fully address the trauma underneath? In this episode of the Dr. Marianne-Land Podcast, I welcome Jennifer Lancaster, LCSW, for a conversation about complex trauma treatment for eating disorders, including the role of EMDR therapy, ketamine-assisted psychotherapy (KAP), attachment trauma, nervous system healing, and shame recovery. Whether you're recovering from anorexia, bulimia, ARFID, binge eating disorder, or another eating disorder, understanding the connection between trauma and eating disorders can open new possibilities for healing. Jennifer is a licensed clinical social worker and founder of Houston Healing Collective. Drawing on more than a decade of experience treating eating disorders and complex trauma, she explains why many clients arrive after years of therapy saying they understand why they struggle but still feel trapped in the same patterns. We discuss how trauma-informed treatment can move beyond symptom management by addressing the underlying experiences that shaped the nervous system in the first place. Why Complex Trauma Often Fuels Eating Disorders Complex trauma is not always one catastrophic event. It can develop through repeated experiences of emotional neglect, attachment disruptions, chronic criticism, unsafe relationships, community violence, poverty, or growing up without feeling consistently seen, safe, or emotionally supported. Jennifer shares how her own experiences and years of clinical work helped her recognize that many eating disorders function as adaptive responses to unresolved trauma rather than isolated illnesses. We also discuss why many people in eating disorder recovery become frustrated when treatment focuses primarily on changing behaviors without creating space to process traumatic experiences. Although symptom stabilization remains important, Jennifer explains why many clients eventually seek treatment that addresses the deeper emotional wounds beneath restrictive eating, binge eating, purging, or other eating disorder symptoms. EMDR Therapy for Trauma and Eating Disorders Jennifer explains how she integrates EMDR therapy into eating disorder treatment. She discusses the importance of building trust, strengthening nervous system regulation, assessing readiness, and helping clients expand their window of tolerance before trauma reprocessing begins. She also describes how EMDR allows people to process traumatic memories without needing to repeatedly tell every painful detail, making the work feel more manageable for many survivors of complex trauma. Ketamine-Assisted Psychotherapy Explained If you've been curious about ketamine-assisted therapy for PTSD, trauma, or eating disorders, Jennifer offers an accessible explanation of how this treatment works. She discusses why ketamine differs from traditional psychiatric medications, how it may temporarily increase neuroplasticity, and why those changes can create opportunities for deeper therapeutic work. We also talk about the brain's default mode network, rigid thinking patterns, and why many people experience new perspectives during treatment that previously felt impossible to access. One of the most important messages in this episode is that ketamine itself is not the treatment. Jennifer emphasizes that preparation, psychotherapy, and thoughtful integration before and after medicine sessions are what help lasting healing occur. Rather than replacing therapy, ketamine-assisted psychotherapy works alongside trauma-focused treatment approaches like EMDR and other evidence-informed therapies. Healing Shame Through Safe Relationships Jennifer also shares her own experience receiving ketamine-assisted therapy and how it transformed her relationship with shame. She describes participating in a therapeutic group experience where she felt safe enough to openly share parts of her story for the first time. That experience inspired her to develop group ketamine retreats because she witnessed how healing can deepen when people experience connection, compassionate witnessing, and emotional safety alongside trauma treatment. Our conversation also explores why shame often survives in isolation but begins to loosen when people experience safe therapeutic relationships. Whether treatment happens individually or in a carefully facilitated group setting, safety remains the foundation of meaningful trauma recovery. Who Should Listen This episode is for adults recovering from anorexia, bulimia, ARFID, binge eating disorder, or other eating disorders. It is also valuable for parents, caregivers, therapists, dietitians, physicians, and other healthcare professionals who want a deeper understanding of complex trauma, EMDR therapy, ketamine-assisted psychotherapy, PTSD, attachment trauma, and trauma-informed eating disorder treatment. In This Episode Jennifer explains how complex trauma contributes to eating disorders, why attachment wounds often remain hidden beneath eating disorder symptoms, how EMDR therapy helps people process traumatic memories, what ketamine-assisted psychotherapy actually involves, why preparation and integration matter just as much as the medicine itself, how neuroplasticity may support healing, why shame often decreases through safe therapeutic relationships, and how trauma-informed care can help people move beyond surviving toward genuine recovery. Content Cautions This episode includes discussion of eating disorders, anorexia, bulimia, ARFID, PTSD, complex trauma, childhood adversity, attachment trauma, emotional neglect, shame, poverty, community violence, psychedelic-assisted psychotherapy, and ketamine-assisted therapy. Listen to Related Episodes Using EMDR & Polyvagal Theory to Treat Trauma & Eating Disorders With Dr. Danielle Hiestand, LMFT, CEDS-S on Apple & Spotify. The Connection Between Unresolved Trauma & Long-Lasting Eating Disorders (Content Caution) on Apple & Spotify. How Childhood Trauma Shapes Eating Disorders & Body Shame (Content Caution) on Apple & Spotify. Childhood Trauma & Eating Disorders on Apple & Spotify. Connect With Jennifer Lancaster Jennifer Lancaster is the founder of Houston Healing Collective, where she specializes in complex trauma treatment, EMDR therapy, ketamine-assisted psychotherapy, eating disorder treatment, psychotherapy intensives, and therapeutic retreats. Learn more through Houston Healing Collective or follow her on Instagram at @_jenlightened. Work With Dr. Marianne Miller If you're looking for a California eating disorder therapist, Washington, DC eating disorder therapist, ARFID therapist, anorexia therapist, bulimia therapist, or binge eating disorder therapist, I provide neurodivergent-affirming, trauma-informed eating disorder therapy throughout California and Washington, DC, along with eating disorder coaching worldwide. If you or your child has ARFID or selective eating, be sure to explore my self-paced ARFID & Selective Eating Course for practical, evidence-informed support. Check out my website at drmariannemiller.com for all the latest info!

If the idea of ARFID treatment feels just as overwhelming as ARFID itself, you're not alone. Many people avoid seeking help because they worry treatment will involve pressure, forced food exposures, or having their sensory experiences dismissed. In this episode of Dr. Marianne-Land, Dr. Marianne Miller explains what neurodivergent-affirming ARFID treatmentactually looks like. She discusses why understanding the function of food avoidance matters, how autism, ADHD, trauma, sensory processing differences, and executive functioning can shape eating challenges, and why collaboration and autonomy are essential parts of effective treatment. Whether you're an adult with ARFID, the parent of a child with ARFID, or a healthcare professional looking to better understand Avoidant Restrictive Food Intake Disorder, this episode offers a compassionate, evidence-informed look at what meaningful treatment can be. What You'll Learn In this episode, you'll learn why ARFID treatment should begin with understanding rather than immediately trying to change eating behaviors. Dr. Marianne explains how neurodivergent-affirming care differs from compliance-based approaches and why treatment should account for sensory processing, nervous system regulation, executive functioning, and trauma history. She also discusses what exposure work can look like when it's collaborative, respectful, and tailored to the individual instead of relying on pressure or coercion. Finally, she explains why successful ARFID recovery is not about eating every food, but about creating a safer, more flexible, and less distressing relationship with eating. Who This Episode Is For This episode is for adults living with ARFID, parents and caregivers of children or teens with ARFID, autistic and ADHD individuals with restrictive eating, healthcare professionals seeking a neurodivergent-affirming understanding of ARFID, and anyone wondering what to expect from ARFID treatment. Why a Neurodivergent-Affirming Approach Matters ARFID doesn't look the same for everyone. Some people experience intense sensory sensitivities, while others struggle because of fear of choking, vomiting, gastrointestinal discomfort, or a longstanding lack of interest in food. Many people experience more than one of these patterns at the same time. Effective treatment begins by understanding why eating feels difficult rather than assuming all food avoidance has the same cause. A neurodivergent-affirming, sensory-attuned, trauma-informed approach recognizes that meaningful progress comes from working with the nervous system instead of against it. Learn More About ARFID If you'd like a deeper understanding of ARFID, autism, ADHD, sensory processing differences, trauma, and evidence-informed treatment approaches, check out Dr. Marianne's self-paced ARFID and Selective Eating Course. The course is designed for adults, parents, caregivers, and professionals who want practical, neurodivergent-affirming strategies that move beyond compliance-based treatment. Related Episodes When Safe Foods Stop Working: ARFID Plateaus, Burnout, & What Helps 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. 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 If you or your child are struggling with ARFID, Dr. Marianne Miller provides ARFID therapy for clients in California, Texas, and Washington, DC, along with coaching services worldwide. Learn more about therapy, coaching, courses, and additional resources at www.drmariannemiller.com. Connect With Dr. Marianne Website: www.drmariannemiller.com ARFID & Selective Eating Course: www.drmariannemiller.com/arfid Instagram: @drmariannemiller

If eating still feels overwhelming after years of living with anorexia or bulimia, you're not alone. Long-term eating disorders often make every meal feel mentally, emotionally, and physically exhausting, even when you're deeply committed to recovery. In this episode of Dr. Marianne-Land, eating disorder therapist Dr. Marianne Miller shares five practical, compassionate strategies to help reduce eating overwhelm, manage food anxiety, and make meals feel more manageable. If you're recovering from anorexia, bulimia, or another long-term restrictive eating disorder, this episode offers realistic tools that support sustainable recovery instead of perfection. Why Eating Can Still Feel So Hard Many people believe eating should feel easy after years of recovery work. In reality, long-term anorexia and bulimia often leave behind deeply ingrained patterns involving the brain, nervous system, and learned responses to food. Dr. Marianne explains why eating can continue to feel overwhelming long after someone decides they want recovery, and why those struggles do not mean you're failing or doing recovery incorrectly. Five Practical Ways to Reduce Eating Overwhelm Dr. Marianne walks through five strategies that can help make meals feel more manageable. She discusses how breaking eating into smaller, achievable steps can reduce overwhelm, why simplifying food decisions conserves mental energy, and how shifting your definition of success away from comfort can support long-term healing. She also explores ways to support your nervous system before and during meals and explains why consistency matters more than striving for the perfect recovery day. Recovery Is Built One Meal at a Time When you've lived with an eating disorder for years, it's easy to believe that every difficult meal means you're moving backward. This episode offers a different perspective. Recovery rarely happens through dramatic breakthroughs. More often, it develops through ordinary moments of choosing nourishment, returning after setbacks, and continuing to practice recovery skills even when eating still feels difficult. Those small decisions add up over time and become the foundation for lasting change. Who This Episode Is For This episode is for adults recovering from anorexia, bulimia, chronic restrictive eating, or long-term eating disorders who continue to feel overwhelmed by meals. It's also helpful for family members, loved ones, and clinicians who want to better understand why eating can remain challenging even after years of treatment and recovery work. Related Episodes Beyond Anorexia: The Truth About Long-Term Restrictive Eating on Apple and Spotify. 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. Navigating a Long-Term Eating Disorder on Apple & Spotify. When an Eating Disorder Becomes Chronic: Recovery Tools for Persistent Anorexia & Bulimia on Apple and Spotify. Work With Dr. Marianne Miller If you're looking for compassionate, neurodivergent-affirming, trauma-informed support for anorexia, bulimia, binge eating disorder, ARFID, or other eating challenges, I'd love to help. I provide therapy for adults throughout California and Washington, D.C., as well as coaching for clients worldwide. Learn more about working with me at www.drmariannemiller.com. You can also follow me on Instagram @drmariannemiller for more education and practical recovery resources, and subscribe to Dr. Marianne-Land on Apple Podcasts, Spotify, or your favorite podcast platform.

Why do so many autistic and ADHD girls grow up believing they're simply "too much," anxious, or broken? In this episode, I sit down with licensed marriage and family therapist, author, and neurodiversity advocate Jamie Roberts @neurodivergenttherapist to talk about why autism and ADHD so often go undiagnosed in girls, how masking hides neurodivergence, and what changes when people finally receive answers later in life. We also explore the overlap between neurodivergence, eating disorders, anxiety, body image, and identity, along with what true neurodivergent-affirming care can look like. What You'll Learn Jamie shares her own journey to a late diagnosis of autism and ADHD and explains why so many girls first receive diagnoses like anxiety or depression instead of having their neurodivergence recognized. We discuss perfectionism, people-pleasing, masking, sensory differences, and why many neurodivergent girls become experts at hiding their struggles. We also talk about healing your inner teen, embracing authenticity after years of masking, and learning that taking up space is not something you have to earn. Jamie explains why neurodiversity-affirming therapy focuses on understanding rather than changing who someone is, and why autonomy, identity, and self-acceptance matter so much for long-term well-being. We Also Discuss How autism and ADHD often present differently in girls Why anxiety and depression can mask underlying neurodivergence The emotional impact of receiving a late autism diagnosis Masking, perfectionism, and people-pleasing Healing your inner teen after years of feeling misunderstood The relationship between neurodivergence, body image, and eating disorders Why compliance-based approaches can harm neurodivergent people Universal Design and creating environments that work for everyone Jamie's new book, Neurodiversity for Teen Girls. About Jamie Roberts Jamie Roberts, LMFT, is a licensed marriage and family therapist, speaker, and author specializing in neurodivergent-affirming mental health care for teens and young adults. She is the founder of Neuropebble, a neuroaffirming clinical training platform, and Equilibrium Counseling Services. Jamie openly shares her own experience with late-diagnosed autism and ADHD while helping clinicians, parents, and neurodivergent individuals better understand neurodiversity through education, advocacy, and practical support. Follow Jamie on Instagram @neurodivergenttherapist and @neuropebble. Related Episodes Late-Diagnosed Autism, ADHD, & “Neurohybridity”: Why Some People Never Fit One Label With Dr. Emma Offord @divergentlives on Apple & Spotify. 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. About Dr. Marianne Miller I'm Dr. Marianne Miller, PhD, LMFT, an eating disorder therapist, neurodivergent-affirming clinician, and host of Dr. Marianne-Land. I specialize in ARFID, binge eating disorder, anorexia, and bulimia while supporting neurodivergent adults, teens, athletes, and LGBTQIA+ clients through a sensory-attuned, trauma-informed, weight-neutral approach. I provide therapy throughout California and coaching worldwide. Learn more at www.drmariannemiller.com and follow me on Instagram @drmariannemiller. Listen and Subscribe If this conversation helped you better understand late-diagnosed autism, ADHD, masking, or neurodivergence in girls and women, please follow Dr. Marianne-Land, leave a rating and review, and share this episode with someone who has spent years wondering why they always felt different. Your support helps more people find neurodivergent-affirming information and compassionate eating disorder care.

Have you ever looked at a plate of food, known you needed to eat, and still felt like your brain and body simply couldn't do it? Many people assume this experience reflects a lack of willpower or motivation. In reality, sensory overload, trauma, ARFID, and food restriction can all make eating feel genuinely inaccessible. When your nervous system stays in survival mode, even choosing, preparing, and tolerating food can become overwhelming. In this episode, I explain why eating can feel impossible, how sensory processing and trauma influence appetite and food intake, and why restriction often creates a cycle that makes eating even harder. I also share the fictional story of Jasper to illustrate how nervous system overload, chronic stress, and inadequate nutrition can quietly reinforce one another. If you've ever wondered why food feels so much harder for you than it seems to be for everyone else, this conversation offers a compassionate, neurodivergent-affirming perspective. WHAT YOU'LL LEARN You'll learn why eating requires much more than hunger and willpower, and how sensory processing, executive functioning, and nervous system regulation all influence your ability to nourish yourself. I explain how trauma can shape eating patterns long after stressful experiences have ended and why many people develop food avoidance without consciously trying to restrict. I also discuss the overlap between ARFID, restrictive eating disorders, autism, ADHD, sensory sensitivities, and chronic stress. Finally, I share practical ways to approach eating with curiosity instead of shame so you can better understand what your nervous system may be communicating. WHO THIS EPISODE IS FOR This episode is for adults and teens with ARFID, anorexia, atypical anorexia, or other restrictive eating disorders. It's also for neurodivergent people with autism, ADHD, or sensory processing differences who find eating exhausting or overwhelming. Parents, caregivers, therapists, dietitians, physicians, and other providers will also gain a deeper understanding of why food avoidance often reflects nervous system overload rather than defiance or a lack of motivation. CONTENT CAUTION This episode includes discussion of ARFID, anorexia, restrictive eating disorders, food restriction, trauma, sensory overload, and food avoidance. TAKEAWAYS Eating difficulties don't always begin with body image concerns or intentional dieting. Sometimes a nervous system carrying chronic stress, trauma, or sensory overload simply doesn't have enough capacity to manage the complex task of eating. Food restriction can also become both a consequence of these struggles and a factor that keeps them going. As nutrition decreases, flexibility often narrows, sensory sensitivity may increase, and eating can become even more difficult. Understanding that cycle allows us to replace self-blame with curiosity and build recovery from a place of compassion rather than criticism. RELATED EPISODES What Is Mechanical Eating? Pros, Cons, & How It Can Work When Eating Feels Hard (ARFID, Binge Eating, Restriction) 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. The Connection Between Unresolved Trauma & Long-Lasting Eating Disorders (Content Caution) on Apple & Spotify. RESOURCES If you or someone you love struggles with ARFID or selective eating, check out my self-paced ARFID & Selective Eating Course. I created it for adults, parents, caregivers, and providers who want a neurodivergent-affirming, sensory-attuned, trauma-informed approach to treatment and recovery. To learn more about working with me for eating disorder therapy in San Diego, California or virtually throughout California and Washington, D.C., or coaching worldwide, visit my website at drmariannemiller.com. CONNECT WITH DR. MARIANNE MILLER If this episode helped you better understand your relationship with food, please subscribe, leave a review, and share it with someone who may need to hear this conversation. You can also connect with me on Instagram @drmariannemiller for more education on ARFID, binge eating disorder, anorexia, bulimia, neurodivergence, trauma, sensory processing, and eating disorder recovery.

Why do some people with ADHD feel like no amount of food is ever enough? Why can you finish a satisfying meal and still find yourself searching the pantry, thinking about dessert, or feeling like something is missing? In this solo episode of Dr. Marianne-Land, I explore the often-overlooked connection between ADHD and binge eating disorder (BED). I explain why many ADHDers describe feeling like a "bottomless pit" around food, why satisfaction can remain elusive even when physical hunger has passed, and why traditional cognitive behavioral therapy (CBT) doesn't always address the executive functioning and nervous system challenges that drive binge eating. Using the fictional case example of Zoe, we look beyond willpower and self-control to better understand how ADHD can shape reward processing, food thoughts, understimulation, sensory needs, and the search for regulation. If you've ever wondered why your relationship with food feels different from what most recovery advice describes, this episode offers a compassionate, neurodivergent-affirming perspective. WHAT YOU'LL LEARN You'll learn why ADHD and binge eating frequently occur together, how executive functioning differences can influence eating behavior, and why the feeling of "never being satisfied" isn't always about physical hunger. I also discuss why food often becomes a source of stimulation after mentally demanding days, how shame keeps many people stuck, and why ADHD-informed eating disorder treatment may look very different from traditional CBT. WHO THIS EPISODE IS FOR This episode is for adults with ADHD, binge eating disorder, compulsive overeating, chronic food thoughts, or food noise. It's also for anyone who has worked on emotional eating, stopped dieting, or completed eating disorder treatment but still feels confused by persistent urges to eat. Therapists, dietitians, and other eating disorder professionals who work with neurodivergent clients will also find this discussion helpful. IN THIS EPISODE We explore why binge eating isn't always driven by restriction, how ADHD changes the way many people experience reward and satisfaction, why executive functioning matters in eating disorder recovery, and what clinicians often miss when they focus only on changing thoughts or behaviors. I also explain how approaching binge eating with curiosity instead of self-criticism can open the door to more effective, sustainable healing. RELATED EPISODES ADHD & Bulimia: Dopamine, Impulsivity, & the Hidden Link to Binge Eating With Kirsten Book, PMHNP-BC on Apple and Spotify. Why Eating Feels So Chaotic With ADHD: Binge Eating, Bulimia, & Executive Function Challenges on Apple and Spotify. Eating Disorders & ADHD: Neurodivergent-Affirming Recovery With Taylor Ashley, RP @taylorashleytherapy on Apple and Spotify. RESOURCES If you're looking for additional support, check out my Binge Eating Recovery Membership, where you'll find practical tools, education, and guidance through a neurodivergent-affirming, weight-neutral lens. You can also explore my ARFID & Selective Eating course, blog, podcast archive, and additional recovery resources at www.drmariannemiller.com. WORK WITH DR. MARIANNE MILLER I'm Dr. Marianne Miller, PhD, LMFT, an eating disorder therapist specializing in ADHD, binge eating disorder, ARFID, anorexia, bulimia, and neurodivergent-affirming care. I provide virtual therapy throughout California, TWashington, DC, as well as coaching worldwide. If this episode helped you better understand your relationship with food, please follow Dr. Marianne-Land, leave a rating or review on Apple and Spotify Podcasts, and share this episode with someone who has spent years wondering why food never seems like enough.

What happens when you stop viewing yourself through a pathology lens and start seeing your differences as part of your identity instead of evidence that something is wrong with you? In this thought-provoking conversation, I sit down with Shira Collings, LPC, a neurodiversity-affirming, fat-affirming, LGBTQIA+ affirming, disability justice-aligned therapist, to explore neurodivergence as a social identity and how that perspective can transform the way we think about eating disorders, mental health, and recovery. Together, we discuss the concept of sanism, the oppression faced by people whose minds fall outside societal expectations of "normal," and how shame often develops when people internalize messages that they are broken, defective, or in need of fixing. We also examine the overlap between neurodiversity, anti-fatness, eating disorder recovery, and disability justice. Shira shares their personal journey with neurodivergence, anxiety, depression, eating disorders, and self-acceptance. We discuss why many people identify as neurodivergent without pursuing formal diagnosis, how neurodivergence can function as a cultural identity, and why community often plays a powerful role in healing. We also unpack radical acceptance, harm reduction, and the limitations of all-or-nothing recovery narratives. Instead of focusing on perfection, we explore how people can reduce suffering, increase self-compassion, and build lives that align with their values. In This Episode, We Discuss Neurodivergence as a social identity rather than a diagnosis The origins of the neurodiversity paradigm What sanism is and how it affects mental health care Self-diagnosis, formal diagnosis, and personal identity The intersection of neurodiversity, eating disorders, and anti-fatness How shame fuels both mental health struggles and eating disorders Radical acceptance and self-compassion Harm reduction approaches in eating disorder recovery Why recovery does not need to be all-or-nothing How disability justice can reshape the way we support neurodivergent people About Shira Collings Shira Collings, LPC (she/they), is a feminist, neurodiversity-affirming, LGBTQIA+ affirming, fat-affirming, and disability justice-aligned psychotherapist. They specialize in reproductive mental health, eating disorders, body image concerns, trauma, grief, and loss. Shira supports clients in healing from internalized and systemic oppression while building lives that align with their values. Follow Shira on Instagram: @threadandthreshold.therapy Website: threadandthreshold.com Who This Episode Is For This episode is for neurodivergent people, eating disorder survivors, therapists, advocates, caregivers, and anyone who has ever wondered whether they have spent too much of their life trying to fix parts of themselves that were never broken. Key Takeaway Healing does not always come from becoming someone different. Sometimes healing begins when you stop treating yourself like a problem to solve and start approaching yourself with curiosity, compassion, and acceptance. Related Episodes Why Eating Still Breaks Down for Neurodivergent People With Long-Term Eating Disorders via Apple & Spotify. 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 I specialize in ARFID, binge eating disorder, anorexia, bulimia, and neurodivergent-affirming eating disorder care. I provide therapy in California and Washington, DC, as well as coaching and educational resources worldwide. Learn more at www.drmariannemiller.com On my website, you can also explore my ARFID & Selective Eating Course, Binge Eating Recovery Membership, and additional resources for neurodivergent eating disorder recovery. If you enjoyed this episode, please follow the podcast, leave a rating or review, and share it with someone who may need to hear this message.

Have you ever wondered whether ARFID is something a person lives with forever? It's one of the most common questions people ask after an ARFID diagnosis, yet the answer is rarely as straightforward as people hope. Adults with ARFID, parents of children with ARFID, and even clinicians often want to know what recovery really looks like, whether meaningful change is possible, and how neurodivergence influences the long-term course of Avoidant Restrictive Food Intake Disorder. In this episode of Dr. Marianne-Land, Dr. Marianne Miller explores the question, "Is ARFID lifelong?" through a neurodivergent-affirming, trauma-informed lens. She examines how conversations about ARFID recovery often become oversimplified and why many people focus on the wrong markers when trying to determine whether treatment is working. The discussion moves beyond food variety alone and considers broader questions about quality of life, flexibility, self-understanding, sensory processing, and participation in meaningful life experiences. Is ARFID Lifelong? Many people assume there are only two possible outcomes: either ARFID completely disappears or nothing changes. The reality is often far more nuanced. Dr. Marianne discusses why the future cannot be predicted by a diagnosis alone and how growth, adaptation, treatment, accommodations, and self-understanding can shape a person's relationship with food over time. What Does ARFID Recovery Look Like? Recovery from ARFID does not always fit traditional eating disorder narratives. In this episode, Dr. Marianne explores how recovery may involve reduced distress around food, increased flexibility, improved nutrition, greater participation in social experiences, and less time spent managing food-related anxiety. She also examines why quality of life deserves a central place in conversations about recovery. ARFID, Autism, ADHD, and Neurodivergence ARFID frequently overlaps with autism, ADHD, sensory processing differences, OCD, anxiety, chronic illness, and other neurodivergent experiences. Understanding these intersections can dramatically change how people view treatment, accommodations, and long-term outcomes. Dr. Marianne discusses why neurodivergent-affirming care matters and why recovery may look different from person to person. Why the Question Matters For many people, the question "Is ARFID lifelong?" is not simply about food. It is often about identity, hope, relationships, travel, family experiences, social connection, and the desire to spend less mental energy managing meals. Dr. Marianne explores the emotional weight behind this question and why understanding the future can feel so important after years of struggle. In This Episode, You'll Learn You'll learn why ARFID recovery is rarely a simple yes-or-no answer, how sensory processing and neurodivergence influence treatment outcomes, why quality of life matters alongside food variety, and how people can experience meaningful growth even when challenges remain. You'll also gain a deeper understanding of why conversations about ARFID often benefit from curiosity, flexibility, and a broader definition of recovery. Related Episodes When Safe Foods Stop Working: ARFID Plateaus, Burnout, & What Helps 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 About ARFID If you're looking for neurodivergent-affirming support for ARFID and selective eating, check out Dr. Marianne Miller's self-paced ARFID & Selective Eating Course. Designed for adults with ARFID, parents, caregivers, and providers, the course explores sensory processing, nervous system regulation, autism, ADHD, family dynamics, food flexibility, accommodations, and practical strategies that move beyond shame, pressure, and one-size-fits-all approaches. Learn more at: https://www.drmariannemiller.com/arfid About Dr. Marianne Miller Dr. Marianne Miller is a licensed marriage and family therapist, eating disorder therapist, and host of the Dr. Marianne-Land podcast. She specializes in ARFID, binge eating disorder, anorexia, bulimia, and neurodivergent-affirming eating disorder care. Dr. Marianne developed the Neurodivergent-Affirming Integrative Therapy for ARFID (NAIT-AR) framework and provides therapy, coaching, courses, and educational resources for individuals, families, and professionals. Website: https://www.drmariannemiller.com Instagram: @drmariannemiller

Have you ever wondered where your beliefs about food, weight, and body image actually came from? Many people assume their eating disorder, body dissatisfaction, or disordered eating patterns developed entirely from personal experiences. In reality, family food rules, generational diet culture, and inherited beliefs about bodies often shape our relationship with food long before we recognize what's happening. In this episode of Dr. Marianne-Land, I explore how eating disorders can develop within family systems, why body shame often travels across generations, and what happens when you begin questioning the food and body rules you inherited. Through the story of a fictional client named Esme, we examine how childhood messages about weight, dieting, health, and appearance can become deeply embedded in adulthood, even when they were never spoken directly. Whether you're recovering from anorexia, binge eating disorder, bulimia, ARFID, chronic dieting, or longstanding body image struggles, this conversation offers a compassionate look at the ways family history and diet culture can influence recovery. What You'll Learn In this episode, you'll learn how family food rules shape eating behaviors and body image across generations, why children often absorb beliefs about food and weight without realizing it, and how multigenerational diet culture can contribute to eating disorders and disordered eating. You'll also learn why inherited beliefs often feel like facts, how anti-fat bias and cultural beauty standards influence family conversations about bodies, and why recovery frequently involves examining long-held assumptions about food, health, worth, and appearance. Why Family Systems Matter in Eating Disorder Recovery Eating disorders rarely develop in a vacuum. Many people grow up surrounded by messages about dieting, weight loss, body size, exercise, and food morality that seem completely normal at the time. Those messages often become part of a family's culture, shaping how people think about hunger, fullness, health, self-worth, and belonging. When clients begin recovery, they often discover that some of the rules guiding their relationship with food did not originate with them. Instead, those beliefs may have traveled through multiple generations, influenced by diet culture, weight stigma, sexism, anti-fat bias, food scarcity, trauma, and larger social systems. Recognizing these patterns can create opportunities for healing, self-compassion, and greater freedom around food. Who This Episode Is For This episode is for anyone recovering from an eating disorder, struggling with body image, questioning family food rules, or trying to understand how childhood experiences continue to affect their relationship with food. It may be especially helpful for people navigating anorexia recovery, binge eating recovery, bulimia recovery, ARFID recovery, chronic dieting, weight cycling, body image concerns, or the emotional impact of growing up in a family where weight and appearance received significant attention. Related Episodes Family Dynamics & Eating Disorders: How Early Relationships Shape Disordered Eating on Apple & Spotify. How Childhood Trauma Shapes Eating Disorders & Body Shame (Content Caution) on Apple & Spotify. Childhood Trauma & Eating Disorders on Apple & Spotify. Work With Dr. Marianne Miller If you're struggling with an eating disorder, disordered eating, ARFID, binge eating, body image concerns, or the long-term effects of family food rules and diet culture, I offer eating disorder therapy and coaching services designed to help you build a more peaceful and sustainable relationship with food and your body. I specialize in ARFID, binge eating disorder, anorexia, bulimia, neurodivergent eating challenges, and eating disorder recovery for adults and teens. Learn more about working with me at www.drmariannemiller.com. Connect With Me Website: www.drmariannemiller.com Instagram: @drmariannemiller If this episode resonates with you, please subscribe, leave a review, and share it with someone who may benefit from this conversation.

What happens when children struggle with body image and restrictive eating? In this conversation, I welcome back eating disorder advocate, educator, and JenUp founder Jenny Tomei @askjenup to discuss a troubling trend she is seeing in schools across the UK. Children as young as elementary school age are making comments about each other's bodies, judging what peers eat at lunch, and absorbing diet culture messages long before most adults realize it. Jenny shares what students, teachers, and parents are telling her about body image concerns, food shame, social media pressure, and the growing influence of TikTok on how young people think about food, weight, and appearance. We also discuss why some students avoid eating at school altogether, how body-based teasing affects children, and what adults can do to create safer environments around food. Later in the episode, we explore concerns about weight loss injections and GLP-1 medications being used with young people, the messages children receive about success and thinness, and why eating disorder prevention efforts need to start much earlier than many schools currently address them. What You'll Learn Children as young as elementary school age are already absorbing diet culture messages and making comments about peers' bodies and food choices. Many students avoid eating lunch at school because they fear judgment, teasing, or unwanted attention. Social media trends on TikTok continue to shape how young people think about weight loss, nutrition, and appearance. Food policing and body-based comments can increase shame and elevate eating disorder risk. Parents, teachers, and other adults play a powerful role in shaping children's relationships with food and body image. Digital literacy skills can help young people question nutrition myths and appearance-focused content online. Growing interest in GLP-1 medications and weight loss injections raises important concerns about youth health and eating disorder prevention. Early intervention and prevention efforts can help create safer school environments around food, bodies, and self-worth. About Jenny Tomei Jenny Tomei is an eating disorder advocate, speaker, educator, and founder of JenUp Community CIC. Drawing from her own recovery from anorexia and compulsive exercise, Jenny works with schools, students, educators, and families throughout the United Kingdom and internationally to increase awareness of eating disorders, challenge harmful body image messages, and promote early prevention. Through JenUp, she delivers workshops, staff trainings, and educational programs focused on body image, disordered eating, social media literacy, and mental health awareness. Who This Episode Is For Parents concerned about body image issues, food anxiety, or eating disorder risk in children and teens. Teachers, school counselors, and educators who want to create more supportive environments around food and body image. Eating disorder professionals, therapists, dietitians, and healthcare providers. Anyone interested in eating disorder prevention, youth mental health, and the influence of social media on young people. Connect With Jenny Tomei Follow Jenny on Instagram at @askjenup. Check out her TikTok: @JenUpCommunity Learn more about her work through JenUp at JenUp.com. Listen to her JenUp podcast Apple & Spotify. Other Episodes With Jenny Tomei SkinnyTok & Anorexia: How Harmful Trends Thrive Despite TikTok's Ban with Jenny Tomei @askjenup on Apple & Spotify. Overexercising, ADHD, & Eating Disorders with @askjenup Jenny Tomei on Apple & Spotify. Work With Dr. Marianne Miller I provide eating disorder therapy for adults in California and Washington, DC, along with coaching services worldwide. I specialize in ARFID, binge eating disorder, anorexia, bulimia, neurodivergent eating challenges, and complex relationships with food. You can learn more about working with me, my ARFID and Selective Eating Course, and my Binge Eating Recovery Membership at DrMarianneMiller.com.

Do you spend the entire day feeling in control around food, only to find yourself eating far more than expected at night? If nighttime eating leaves you feeling confused, ashamed, or convinced that you lack willpower, this episode may offer a different perspective. Many people with Night Eating Syndrome focus on what happens after dinner without realizing that the story often begins much earlier. Delayed meals, subtle restriction, chronic stress, ADHD, autism, masking, trauma, sensory overwhelm, and nervous system exhaustion can all shape eating patterns that become more intense in the evening. When we look only at nighttime eating, we often miss the conditions that created it. In this episode of the Dr. Marianne-Land Podcast, Dr. Marianne Miller explores Night Eating Syndrome through a neurodivergent-affirming, trauma-informed lens. She discusses why nighttime eating is often a predictable response to unmet physiological and emotional needs rather than a sign of laziness, lack of discipline, or personal failure. Understanding Night Eating Syndrome Night Eating Syndrome, often called NES, involves consuming a significant portion of daily food intake during the evening hours or after waking during the night. Many people with Night Eating Syndrome notice little appetite earlier in the day and increasing hunger as the day progresses. Although Night Eating Syndrome can overlap with binge eating disorder, the two experiences are not identical. Understanding the distinction can help people find more effective support and avoid treatments that fail to address the underlying drivers of nighttime eating. Why Nighttime Eating Often Starts Earlier in the Day One of the most overlooked aspects of Night Eating Syndrome is the role of daytime deprivation. Restriction does not always look like skipping meals or intentionally dieting. Sometimes it shows up as rushing through meals, ignoring hunger cues, eating foods that never feel satisfying, relying on caffeine to suppress appetite, or becoming so busy that nourishment consistently falls to the bottom of the priority list. Over time, the body responds to those unmet needs. For many people, nighttime becomes the point when hunger, exhaustion, stress, and emotional depletion can no longer be ignored. ADHD, Autism, Masking, and Eating at Night Neurodivergent adults often face unique challenges around food and eating. ADHD can make meal planning, meal timing, and hunger awareness more difficult. Autism can influence sensory experiences, interoception, routines, and food preferences. Many neurodivergent people also spend significant energy masking throughout the day, navigating sensory demands, social expectations, and executive functioning challenges. By evening, the nervous system may be depleted. Food can become a source of grounding, comfort, regulation, predictability, stimulation, or relief. This episode explores how neurodivergence can shape nighttime eating patterns in ways that are frequently misunderstood within traditional eating disorder treatment models. The Connection Between Restriction and Night Eating Syndrome Many people blame nighttime eating for their distress while overlooking the role of restriction. Whether restriction stems from dieting, weight stigma, food rules, sensory challenges, executive functioning barriers, or chronic stress, the body often responds by increasing attention to food and hunger later in the day. Rather than viewing nighttime eating as evidence of a lack of control, Dr. Marianne encourages listeners to consider what their body may be trying to communicate. Weight Stigma, Diet Culture, and Shame Diet culture frequently rewards people for disconnecting from hunger and ignoring physical needs. At the same time, society often condemns the very eating behaviors that emerge when deprivation accumulates. This contradiction leaves many people feeling trapped in cycles of guilt and self-criticism. In this episode, Dr. Marianne examines how anti-fat bias, productivity culture, and cultural pressure to suppress needs can contribute to Night Eating Syndrome and nighttime eating struggles. What You'll Learn You'll learn how Night Eating Syndrome differs from binge eating disorder, why subtle forms of restriction often go unnoticed, how ADHD and autism can influence eating patterns, why masking and burnout can increase vulnerability to nighttime eating, and how shame frequently keeps people stuck in cycles that make sense from a nervous system perspective. You'll also gain a more compassionate framework for understanding nighttime eating and practical ways to begin approaching these patterns with curiosity instead of self-judgment. Related Episodes Anorexia & Night Eating Syndrome: Why Restriction Fuels Night Eating & What Helps on Apple & Spotify. 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 struggling with Night Eating Syndrome, binge eating disorder, ARFID, anorexia, bulimia, chronic dieting, or neurodivergent eating challenges, support is available. Dr. Marianne Miller is a licensed eating disorder therapist providing therapy throughout California and Washington, D.C. She also offers coaching services worldwide. Her work integrates eating disorder treatment, neurodivergent-affirming care, trauma-informed approaches, and weight-inclusive support for adults, teens, and families. Learn more about therapy, coaching, courses, and resources at www.drmariannemiller.com. You can also follow Dr. Marianne on Instagram at @drmariannemiller and subscribe to the Dr. Marianne-Land Podcast on Apple Podcasts, Spotify, or your favorite podcast platform.

What happens when anorexia no longer feels like something you struggle with and starts feeling like who you are? Many people with long-term anorexia, so-called "atypical" anorexia, and restrictive eating disorders fear recovery for reasons that go far beyond food. They worry about losing structure, purpose, safety, achievement, or even their sense of self. In this episode, I explore the powerful connection between anorexia and identity, why recovery can feel emotionally disorienting, and how people begin rebuilding a life that feels larger than the eating disorder. Whether you've lived with anorexia for years, support someone in recovery, or work in the eating disorder field, this conversation offers a compassionate look at one of the most overlooked barriers to healing. Why Anorexia Can Become Part of Your Identity I explain how long-term restrictive eating disorders often become intertwined with self-worth, achievement, emotional regulation, relationships, and daily routines. I also discuss why recovery can feel like losing a familiar version of yourself, even when you desperately want freedom. The Hidden Fear Behind Anorexia Recovery Many people assume that food is the hardest part of recovery. While nutritional rehabilitation matters, identity loss often creates an equally powerful challenge. I explore why letting go of anorexia can trigger grief, uncertainty, and fear, especially when the eating disorder has shaped your life for years. How Neurodivergence, Trauma, and Oppression Shape Eating Disorders I discuss how autism, ADHD, sensory processing differences, trauma, perfectionism, and chronic stress can influence restrictive eating patterns. I also examine how social pressures around thinness, productivity, compliance, and self-sacrifice affect women, queer people, trans people, people of color, disabled people, immigrants, fat people, and other marginalized communities. A Case Example: When Recovery Feels Like Losing Yourself Through the story of Angela, a composite case example, I illustrate how anorexia can become a trusted coping system and why recovery often requires building safety, flexibility, and self-trust rather than simply eliminating symptoms. Rebuilding Identity Beyond the Eating Disorder Recovery involves much more than changing eating behaviors. It often includes discovering values, interests, relationships, boundaries, creativity, and sources of meaning that exist outside the eating disorder. I share practical ways people begin reconnecting with themselves while navigating the uncertainty that recovery can bring. Key Takeaways Anorexia can become deeply intertwined with identity, especially after years of living with the disorder. Fear of recovery often reflects fear of losing safety, predictability, or self-understanding. Grief can be a normal part of healing and does not mean you want to stay sick. People in all body sizes can experience anorexia and restrictive eating disorders. Recovery creates opportunities to build a life that feels larger, richer, and more flexible than the eating disorder. Related Episodes The Quiet Places Where Anorexia Meets Identity & Expression on Apple & Spotify. “Slips” in Eating Disorder Recovery in 2026: Why Setbacks Are Part of Progress, Not Failure (With Mallary Tenore Tarpley, MFA) on Apple & Spotify. Chronic Eating Disorders in 2026: What Hope Can Actually Look Like on Apple & Spotify. Work With Dr. Marianne Miller If you are looking for support with anorexia, ARFID, binge eating disorder, bulimia, chronic eating disorders, or neurodivergent eating challenges, I would love to help. I provide eating disorder therapy for clients in California and Washington, D.C., along with coaching services worldwide. My practice specializes in neurodivergent-affirming, trauma-informed, weight-neutral care for adults, teens, and families. Learn more at www.drmariannemiller.com or connect with me on Instagram @drmariannemiller.

Can you recover from binge eating disorder after years, or even decades, of struggling? In this inspiring episode, I sit down with a longtime friend and recovery coach to discuss her personal binge eating recovery journey. After living in the binge eating cycle for 14 years, she found a path to lasting freedom and has been binge-free since 2002. She shares how binge eating remained hidden from everyone around her, the turning points that led her toward healing, and why recovery was a gradual process rather than an overnight transformation. We also explore the role that spirituality played in her recovery, how awareness became a powerful tool for change, and why hope is essential for anyone struggling with an eating disorder. Whether you're dealing with binge eating disorder, emotional eating, chronic dieting, body image concerns, or food obsession, this conversation offers encouragement and practical wisdom. The Hidden Reality of Binge Eating Disorder One of the most powerful themes in this conversation is how invisible binge eating disorder can be. Despite suffering daily, my guest appeared successful, healthy, and in control from the outside. Behind the scenes, however, she was living a secret life consumed by binge eating, calorie counting, body checking, and relentless self-criticism. Her story is a reminder that eating disorders do not always fit stereotypes and that many people suffer silently for years before seeking help. Why Recovery Takes Time If you've ever felt discouraged because recovery isn't happening fast enough, this episode is for you. We discuss how recovery often unfolds through increasing awareness rather than dramatic breakthroughs. My guest shares how she slowly learned to recognize her binge eating urges earlier and earlier, eventually developing the ability to choose different responses. This gradual process helped her build a foundation for lasting recovery rather than temporary change. The Role of Spirituality in Recovery Spirituality became a central part of my guest's healing journey. We explore how spiritual practices helped her move away from perfectionism, control, and isolation while developing greater trust, self-compassion, and connection. Although spirituality may look different for everyone, this conversation highlights how finding meaning, purpose, and connection can support recovery from binge eating disorder. Journaling, Awareness, and Healing We also talk about the surprising power of journaling. My guest has been journaling for more than four decades and shares how writing has helped her uncover patterns, process emotions, and gain insights that she couldn't access through thinking or talking alone. Her experience offers a compelling perspective on why self-reflection can be such a valuable recovery tool. About My Guest My guest, Deb Elbaz, is a binge eating recovery coach who has spent more than 20 years helping women heal their relationships with food, their bodies, and themselves. Drawing from her own experience of recovering from binge eating disorder, she now helps women find freedom from the binge-restrict cycle while developing deeper self-awareness and self-trust. 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. Connect with Deb Website: DebElbaz.com Instagram: @debelbazcoach YouTube: Deb Elbaz Connect with Dr. Marianne Miller Website: DrMarianneMiller.com Instagram: @drmariannemiller Subscribe, Rate, and Review If this episode resonated with you, please subscribe, rate, and review the podcast. Your support helps more people struggling with binge eating disorder, emotional eating, body image issues, and eating disorders discover that recovery is possible.

What happens when eating disorder recovery does not look neat, linear, or complete? In this episode of the Dr. Marianne-Land podcast, Dr. Marianne Miller explores the emotional reality of living with a chronic eating disorder, including long-term anorexia, bulimia, binge eating disorder, ARFID, and restrictive eating disorders that persist for years or decades. This conversation examines the grief, shame, exhaustion, and isolation many people experience when they do not relate to polished recovery narratives or dramatic “before-and-after” transformations. Dr. Marianne discusses how eating disorders can become intertwined with identity, nervous system regulation, trauma, neurodivergence, sensory processing differences, OCD, ADHD, autism, chronic illness, and anti-fat bias. She also explores why many people feel invisible inside traditional eating disorder treatment spaces, especially when recovery feels nonlinear, partial, or emotionally complicated. Rather than framing recovery as all-or-nothing, this episode offers a more nuanced conversation about hope, harm reduction, quality of life, and what meaningful healing can look like when vulnerability still exists. Dr. Marianne also discusses the emotional burden of perfectionism in eating disorder recovery and why redefining progress may help people reconnect with themselves more compassionately. In This Episode, Dr. Marianne Addresses the Following Topics: Chronic Eating Disorders & Long-Term Recovery How chronic eating disorders can affect identity, relationships, emotional regulation, and quality of life over time, including the hidden grief many people carry when recovery feels more complicated than expected. Eating Disorders, Neurodivergence, & Nervous System Differences How autism, ADHD, sensory processing differences, executive functioning struggles, OCD, trauma, and chronic illness can shape eating disorder recovery in ways that traditional treatment models often miss. Anti-Fat Bias & Eating Disorder Misdiagnosis Why people in larger bodies are frequently overlooked, misdiagnosed, or praised for dangerous eating disorder symptoms because of weight stigma and diet culture. Redefining Hope Beyond Perfect Recovery A compassionate conversation about recovery ambivalence, harm reduction, emotional complexity, and why meaningful healing does not always require perfection or complete symptom elimination. ARFID & Selective Eating Support Dr. Marianne also shares resources for ARFID and selective eating support, including her self-paced virtual course grounded in neurodivergent-affirming care. Get more information at drmariannemiller.com/arfid. Related Episodes 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. About Dr. Marianne Miller Dr. Marianne Miller is a Licensed Marriage and Family Therapist specializing in eating disorders, ARFID, binge eating disorder, neurodivergent-affirming care, and body liberation. She provides therapy and coaching for adults, teens, and families and works with clients throughout California, Washington, D.C., and globally through coaching and educational offerings. Check out her website at drmariannemiller.com. Listen & Connect Follow the Dr. Marianne-Land podcast on Apple Podcasts and Spotify for conversations about eating disorders, ARFID, binge eating disorder, neurodivergence, chronic illness, trauma, body image, anti-fat bias, and recovery outside rigid wellness culture narratives.

What happens when eating disorder recovery starts colliding with nervous system overwhelm? In this episode of the Dr. Marianne-Land podcast, Dr. Marianne Miller explores one of the most confusing parts of restrictive eating disorder recovery: learning how to tell the difference between genuine nervous system dysregulation and eating disorder avoidance disguised as self-protection. Many people with anorexia, ARFID, orthorexia, chronic dieting histories, OCD, autism, ADHD, trauma, or sensory processing challenges struggle to know when they truly need accommodations and support versus when the eating disorder is quietly shrinking their world through avoidance. This episode explores why restrictive eating disorders often borrow the language of nervous system regulation, why food anxiety does not always mean danger, and why recovery sometimes requires gentle exposure to discomfort instead of waiting to feel completely “safe” before eating. When “Listening to Your Body” Gets Complicated in Eating Disorder Recovery Social media often promotes messages about protecting your peace, avoiding discomfort, and never forcing yourself into situations that feel activating. But what happens when restrictive eating disorders begin using that language to reinforce food fear, rigidity, and avoidance? In this episode, Dr. Marianne talks about: Anxiety Around Eating and Restrictive Eating Disorders Why anxiety during meals does not automatically mean you are unsafe. How starvation and undernourishment intensify emotional dysregulation, obsessive thinking, rigidity, panic, sensory sensitivity, and distress tolerance difficulties. Why many people get trapped waiting to feel calm enough to eat while restriction continues worsening nervous system symptoms. ARFID, Autism, ADHD, and Sensory Food Struggles Why neurodivergent people often need both accommodations and recovery support at the same time. How sensory overwhelm, executive functioning challenges, contamination fears, and burnout can complicate restrictive eating disorder recovery. Why recovery does not need to become harsh or punishing in order to challenge avoidance patterns. Restrictive Eating Disorders and the “Shrinking Life” Pattern How anorexia, ARFID, and restrictive eating disorders gradually narrow food choices, social experiences, spontaneity, travel, and daily functioning. Why temporary anxiety relief from food avoidance can increase long-term nervous system sensitivity. How to begin recognizing when the eating disorder is quietly gaining more control over your life. Neurodivergent-Affirming Support for ARFID and Selective Eating Dr. Marianne also shares more about her ARFID and selective eating course, which explores restrictive eating through a neurodivergent-affirming lens. The course addresses sensory sensitivities, executive functioning challenges, nervous system regulation, autonomy needs, accommodations, and gentle food expansion without shame-based recovery approaches. Related Episodes Fear of Uncertainty in Eating Disorder Recovery: Why It Feels So Terrifying + 5 Practical Skills That Help on Apple and Spotify. 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. About Dr. Marianne Miller Dr. Marianne Miller, LMFT is a fat eating disorder therapist, podcast host, and educator specializing in ARFID, binge eating disorder, anorexia, neurodivergence, OCD, and restrictive eating disorders. She provides eating disorder therapy and coaching for people across California, Washington, D.C., Texas, and globally through coaching services. Dr. Marianne is especially passionate about neurodivergent-affirming eating disorder care for autistic clients and ADHDers navigating complex relationships with food, sensory overwhelm, and body image distress. Check out her website at drmariannemiller.com. Listen and Subscribe to the Dr. Marianne-Land Podcast If this episode resonated with you, please subscribe, leave a review, and share this episode with someone navigating restrictive eating recovery, ARFID, anorexia, food anxiety, or nervous system dysregulation.

If you've done years of eating disorder recovery work and suddenly find old trauma surfacing, you are not alone. In this deeply honest conversation, Dr. Marianne Miller and Debbie Saroufim explore the complicated overlap between eating disorders, trauma recovery, body image, nervous system responses, and healing after survival mode. They discuss why trauma can emerge later in recovery, how eating disorders sometimes function as protection, and what happens when old coping strategies no longer work. Debbie shares personal experiences with trauma recovery, sexual trauma, body image struggles, EMDR, Internal Family Systems (IFS)/parts work, parenting, co-parenting, and navigating major life transitions while continuing the recovery process. Together, they unpack the emotional reality of healing in a world shaped by diet culture, misogyny, fatphobia, and systemic oppression. CONTENT CAUTION This episode includes discussion of trauma, sexual trauma, PTSD symptoms, body image distress, eating disorders, dissociation/freezing responses, misogyny, and systemic oppression. Eating Disorders and Trauma Recovery Many people assume eating disorder recovery means the hardest part is over. But for some people, healing from eating disorder behaviors can uncover trauma that had been buried underneath survival strategies for years. Dr. Marianne Miller and Debbie Saroufim discuss how eating disorders can function as protection, why trauma may surface later in recovery, and how recovery does not make people immune to pain, grief, fear, or nervous system overwhelm. The conversation explores the relationship between trauma and eating disorders, including how body image struggles, restrictive eating, binge eating, compulsive behaviors, and nervous system responses can become intertwined with survival. They also discuss the emotional shock that can happen when eating disorder symptoms are no longer the primary coping mechanism and unresolved trauma begins demanding attention. PTSD Symptoms, Nervous System Responses, and Survival Mode This episode examines trauma responses like freezing, dissociation, hypervigilance, minimization, emotional shutdown, and nervous system dysregulation. Debbie shares how experiences from adolescence resurfaced decades later during trauma recovery work and how those memories affected her relationships, parenting, body image, and sense of safety in the world. Dr. Marianne Miller and Debbie Saroufim also discuss the connection between trauma, body image, misogyny, fatphobia, oppression, and diet culture. They explore how living in a culture shaped by systemic inequality and body oppression can create chronic emotional stress that deeply affects mental health and eating disorder recovery. EMDR, Internal Family Systems (IFS), and Parts Work Dr. Marianne Miller and Debbie Saroufim discuss how EMDR and Internal Family Systems (IFS)/parts work can help people process trauma and eating disorder recovery with greater self-compassion. Debbie explains how parts work helped her understand eating disorder thoughts as information instead of commands and how learning to “unblend” from different parts of herself changed her recovery process. The conversation also explores how eating disorders can begin as protective adaptations, why self-compassion can feel inaccessible during trauma recovery, and how nervous system regulation becomes an important part of healing. They discuss the idea that multiple truths can coexist at once and why recovery often requires compassion for every part of the self, including the parts carrying fear, shame, anger, grief, or overwhelm. Fat Liberation, Body Image, and Intergenerational Trauma This episode also explores the connection between fat liberation, trauma, body image, and intergenerational trauma. Debbie discusses how body image struggles are shaped by cultural messaging and systemic oppression rather than appearance alone. Dr. Marianne Miller and Debbie Saroufim talk about how trauma can be passed through generations, how children absorb messages about bodies and safety, and why many people are trying to break cycles of shame and silence within their families. They also discuss the emotional complexity of parenting while healing, the pressure many people feel to “fully recover,” and the reality that recovery is often ongoing maintenance work rather than a final destination. About Debbie Saroufim Debbie Saroufim is a body acceptance coach in Los Angeles, California. She helps people all over the world build resilience against diet culture and heal their relationship with food and body image through a harm reduction and fat liberation lens. Her work focuses on body image healing, eating disorder recovery support, trauma-informed coaching, and helping people navigate life in a world shaped by body oppression and systemic inequality. Debbie works with people of all body sizes through individual and group coaching and is passionate about bringing conversations about body diversity and fat liberation into schools and community spaces. Find Debbie Saroufim on Instagram at @bodyacceptance_coach and at thebodyacceptancecoach.com. Listen to Other Episodes With Debbie When Weight Loss Isn't a Win: Eating Disorders, Stress, & Body Image Confusion (Content Warning) on Apple or Spotify. Anti-Fat Bias in Schools and Society on Apple or Spotify. How Eating Disorder Recovery Heals Life Overall on Apple or Spotify. Let's Talk Recovery: Ditching Diet Culture & Crushing Eating Disorder Thoughts on Apple or Spotify. About Dr. Marianne Miller Dr. Marianne Miller is a San Diego, California-based Licensed Marriage and Family Therapist (LMFT), eating disorder therapist, podcast host, and advocate specializing in eating disorders, ARFID, binge eating disorder, body image, neurodivergence, and trauma-informed care. She works with adults, teens, and children and is known for her neurodivergent-affirming, fat-liberation-informed approach to eating disorder recovery. Dr. Marianne Miller provides eating disorder therapy (California) and coaching (worldwide) for people struggling with ARFID, anorexia, bulimia, binge eating disorder, OCD, body image distress, and complex relationships with food. Her work focuses on compassionate, evidence-based support that honors the role of nervous system regulation, sensory experiences, executive functioning, and systemic oppression in recovery. She is the host of the Dr. Marianne-Land podcast, where she explores eating disorders, mental health, neurodiversity, trauma, body image, and recovery through honest, nuanced conversations with clinicians, advocates, and people with lived experience. Learn more about Dr. Marianne Miller, therapy services, coaching, and courses at drmariannemiller.com. If this episode resonated with you, please subscribe, rate, and review the Dr. Marianne-Land podcast on Apple Podcasts and Spotify. Your support helps more people find eating disorder recovery, trauma recovery, ARFID support, binge eating support, body image support, and neurodivergent-affirming mental health resources.

Why do so many people with anorexia go undiagnosed simply because of their body size? In this episode of the Dr. Marianne-Land podcast, eating disorder therapist Dr. Marianne Miller explores anorexia in higher-weight bodies, restrictive eating disorders, weight bias in healthcare, and the dangerous myths surrounding “atypical anorexia.” This conversation unpacks how restrictive eating can become normalized, praised, or completely overlooked when someone does not fit the stereotype of anorexia. What Is Atypical Anorexia? Dr. Marianne explains why the term “atypical anorexia” can be misleading and why anorexia is not defined by weight alone. She explores how food restriction, fear around eating, compulsive control, and intense preoccupation with food can occur in bodies of all sizes. The episode also examines why so many people struggle to recognize their own eating disorder symptoms when culture continually tells them they are “healthy” or “doing well.” Restrictive Eating Disorders in Higher-Weight Bodies This episode takes a deeper look at hidden restriction, chronic dieting, skipped meals, rigid food rules, and the restrictive eating spectrum. Dr. Marianne discusses how eating disorders in larger bodies are frequently missed by healthcare providers, loved ones, and even the individuals experiencing them. She also explores how praise for weight loss can reinforce dangerous patterns and delay support. Medical Risks of Anorexia in Larger Bodies Anorexia in higher-weight bodies carries real psychological and medical risks. Dr. Marianne explains how undernourishment affects the body regardless of size, including impacts on heart rate, hormones, cognition, bone health, anxiety, and nervous system functioning. This episode challenges the harmful assumption that someone must appear underweight before restriction becomes medically serious. Weight Bias, Misdiagnosis, & Eating Disorder Stigma Weight stigma and anti-fat bias continue to shape eating disorder treatment and diagnosis. Dr. Marianne explores how medical gaslighting, diet culture, and stereotypes about anorexia contribute to delayed diagnosis and inadequate care. She also discusses how intersectionality, neurodivergence, disability, race, and gender identity can further complicate recognition and access to support. Neurodivergence, Restriction, & Eating Disorders This episode also examines how sensory sensitivities, executive functioning differences, autism, ADHD, and nervous system regulation can influence eating patterns and restrictive behaviors. Dr. Marianne discusses why neurodivergent people may experience eating disorders differently and why individualized, affirming care matters. Eating Disorder Recovery Without Stereotypes Recovery begins with recognizing that eating disorders do not have one look. This conversation encourages listeners to move away from appearance-based assumptions and toward a more nuanced understanding of anorexia, restrictive eating, and body diversity. Dr. Marianne also shares why support matters before symptoms escalate and why people in higher-weight bodies deserve compassionate, specialized eating disorder care. Related Episodes Anorexia in Higher-Weight Bodies: Rethinking “Atypical Anorexia” & the Restrictive Eating Spectrum With Dr. Jennifer Gaudiani, MD @gaudianiclinic on Apple & Spotify. 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. Work With Dr. Marianne Miller Dr. Marianne Miller is a Licensed Marriage and Family Therapist (LMFT) specializing in eating disorders, ARFID, binge eating disorder, anorexia, bulimia, OCD, and neurodivergent-affirming care. She offers eating disorder therapy and coaching for adults in California, Washington, D.C., and globally through coaching services. Visit Dr. Marianne's website to learn more about therapy, coaching, ARFID support, and eating disorder recovery resources.

You show up. You succeed. You keep functioning. Meanwhile, food, eating, body image, or restrictive behaviors may quietly consume an enormous amount of mental and emotional energy. In this episode of the Dr. Marianne-Land podcast, Dr. Marianne Miller explores the hidden reality of high-functioning eating disorders and why so many people get overlooked simply because they appear “fine” from the outside. This conversation examines how anorexia, bulimia, binge eating disorder, ARFID, and other restrictive eating patterns can exist inside people who maintain careers, relationships, caregiving roles, and daily responsibilities. Dr. Marianne also discusses why perfectionism, masking, executive functioning challenges, and neurodivergence can make eating disorders harder to recognize and harder to treat. Why High-Functioning People With Eating Disorders Get Missed Many people assume eating disorders only become serious when someone visibly falls apart. This episode challenges that belief and explores how people with eating disorders often continue functioning at a high level while struggling privately with food obsession, body image distress, binge eating, restriction, compulsive exercise, or sensory-based eating challenges. Dr. Marianne discusses how high-functioning individuals often minimize their own suffering because they are still meeting expectations at work, school, or home. She also explores how healthcare providers, loved ones, and society frequently overlook eating disorders in people who do not fit narrow stereotypes. Neurodivergence, Executive Functioning & Eating Disorders This episode also explores the connection between neurodivergence and eating struggles. Dr. Marianne discusses how ADHD, autism, sensory sensitivities, and executive functioning challenges can complicate meal planning, eating consistency, food variety, hunger awareness, and nervous system regulation. You'll hear discussion around low-lift eating, food predictability, sensory-safe foods, masking, and the emotional exhaustion that can come from constantly pushing through internal distress while appearing capable on the outside. Intersectionality & Invisible Struggle Dr. Marianne also examines how anti-fat bias, gender expectations, neurodivergence, and other intersecting identities shape who gets believed, diagnosed, and supported. Many high-functioning people spend years feeling dismissed because they do not look like the stereotype of someone with an eating disorder. This episode highlights why eating disorders deserve attention long before someone reaches a visible crisis point. Recovery Support for High-Functioning Eating Disorders Dr. Marianne shares compassionate, neurodivergent-affirming approaches to recovery that reduce overwhelm instead of increasing pressure. She discusses building supportive structure around eating, reducing friction with meals, reconnecting with internal cues, and allowing support into areas of life that may have stayed hidden for years. If you've ever thought, “I'm still functioning, so maybe it's not that bad,” this episode is for you. Related Episodes Why High Achievers Can Develop Anorexia & Bulimia: Perfectionism, Control, & Hidden Struggles on Apple & Spotify. 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 Miller Dr. Marianne Miller is a Licensed Marriage and Family Therapist specializing in eating disorders, ARFID, binge eating disorder, restrictive eating, neurodivergence, and sensory-related eating challenges. She offers therapy and coaching support for individuals navigating complex relationships with food, eating, and body image. For therapy, coaching, podcast episodes, and resources, visit Dr. Marianne's website drmariannemiller.com.

What happens when diet culture gets louder, ARFID awareness grows, social media becomes therapy language, and the pressure to be thin starts shaping everyday life again? In this episode of The Dr. Marianne-Land Podcast, I sit down with Lisa Jimenez (@lisajimeneztherapy) for a deeply honest conversation about what eating disorder therapists are actually seeing in 2026. We talk about the resurgence of appearance pressure, the subtle ways eating disorders can hide in plain sight, why more people are finally recognizing ARFID, and how identity, neurodivergence, trauma, and culture all shape recovery. This episode explores the realities many people quietly live with but rarely hear discussed out loud. Lisa Jimenez, LMHC, is an eating disorder therapist based in Miami who specializes in eating disorders, body image, anxiety, trauma, perfectionism, and work with teens, young adults, and queer clients. In this conversation, she shares how her own lived experience with an eating disorder shaped her approach to therapy and why she shifted toward EMDR, parts work, and more collaborative, relational treatment approaches. ARFID, Neurodivergence, and the Changing Eating Disorder Landscape Lisa and I discuss why ARFID is becoming more recognized and why many clinicians are still trying to catch up with the complexity of the diagnosis. We explore how sensory sensitivities, neurodivergence, attachment, trauma, and family dynamics can all affect eating. We also talk about why ARFID treatment requires much more than exposure work alone and why creating emotional and sensory safety matters so deeply in recovery. We also discuss the overlap between eating disorders, autism, ADHD, anxiety, perfectionism, and trauma, along with the growing role social media now plays in helping people identify experiences they previously could not name. Diet Culture, Social Media, and the Pressure to Be Thin in 2026 Diet culture feels especially aggressive right now, and this episode explores how that pressure shows up in both obvious and subtle ways. Lisa and I talk about “clean eating,” wellness culture, compulsive exercise messaging, “what I eat in a day” content, GLP-1 conversations, and the growing normalization of disordered behaviors online. We also discuss how eating disorders often hide behind socially praised behaviors, especially when restriction, over-exercising, or body control become culturally rewarded instead of recognized as signs of distress. Eating Disorders in Larger Bodies This conversation also explores how eating disorders frequently go unnoticed in larger bodies and how weight stigma continues to affect treatment, diagnosis, and recovery. Lisa and I discuss the harmful assumption that eating disorders must “look extreme” to be serious and why many people receive praise for behaviors that are actually rooted in restriction and suffering. We also talk about medical bias, healthcare experiences, and the reality that people can experience anorexia and severe eating disorder symptoms across a wide range of body sizes. Queer Identity, Intersectionality, and Eating Disorders Lisa shares insights from her work with queer clients, teens, and neurodivergent individuals, and we explore how identity and environment intersect with eating disorders in complex ways. We discuss cultural expectations around appearance, family and community pressures, social media influence, and the realities many queer and neurodivergent people face while navigating food and body image struggles. The conversation also examines how eating disorders often function as coping strategies for overwhelm, emotional pain, disconnection, or the pressure to survive in environments that do not feel safe or affirming. Connect With Lisa Jimenez, LMHC Instagram: @lisajimeneztherapy Website: lisajimeneztherapy.com Lisa sees clients virtually throughout Florida and New York and in person in South Miami. Related Episodes The Quiet Places Where Anorexia Meets Identity & Expression on Apple & Spotify. “Slips” in Eating Disorder Recovery in 2026: Why Setbacks Are Part of Progress, Not Failure (With Mallary Tenore Tarpley, MFA) on Apple & Spotify. Chronic Eating Disorders in 2026: What Hope Can Actually Look Like on Apple & Spotify. ARFID Explained: What It Feels Like, Why It's Misunderstood, & What Helps on Apple & Spotify.   Work With Dr. Marianne I'm Dr. Marianne Miller, LMFT (@drmariannemiller). I'm an eating disorder therapist specializing in ARFID, binge eating disorder, anorexia, bulimia, neurodivergence, autism, ADHD, and complex relationships with food and body image. I offer therapy, coaching, and ARFID-focused support for teens and adults. You can also explore my self-paced ARFID and selective eating course on my website drmariannemiller.com/arfid. If this episode resonated with you, please follow, rate, and share The Dr. Marianne-Land Podcast on Apple Podcasts and Spotify.

Do you feel like eating has to happen a certain way or your anxiety spirals? Do food rules, rituals, or intrusive thoughts take over your day in ways that feel exhausting but impossible to stop? In this episode of The Dr. Marianne-Land Podcast, Dr. Marianne Miller explores the complex overlap between OCD and eating disorders, including how compulsions, “just-right” feelings, anxiety, sensory sensitivities, and rigid food patterns can quietly shape someone's relationship with eating. Many people with OCD and eating disorders do not fit stereotypes. Some people struggle with restrictive eating, binge eating, ARFID, food avoidance, or repetitive rituals around meals without realizing that obsessive-compulsive patterns may be part of what is driving the cycle. This episode breaks down why food can become attached to safety, certainty, and relief from distress, and why recovery requires more than simply “stopping” the behavior. Dr. Marianne also explores how neurodivergence, including ADHD and autism, can overlap with OCD and eating disorders in ways that are frequently misunderstood in traditional treatment spaces. What OCD and Eating Disorders Can Look Like Around Food This episode explores how OCD can show up through food rituals, rigid eating rules, repetitive behaviors, intrusive thoughts, contamination fears, and overwhelming “not-right” feelings connected to meals and eating experiences. Dr. Marianne explains why these patterns often become reinforced over time and why eating can begin to feel emotionally loaded, exhausting, and difficult to navigate. The Difference Between Food Preferences, Rituals, and Compulsions Not every food routine is automatically OCD, and not every eating disorder behavior comes from body image concerns. Dr. Marianne discusses the difference between supportive structure versus compulsive rigidity and explains why understanding the function of behaviors matters so much in eating disorder recovery. OCD, Neurodivergence, and Eating Disorders Many autistic people and ADHDers rely on predictability, sensory consistency, and routines to reduce overwhelm. This episode explores how OCD can intensify those needs and why treatment must account for sensory processing, executive functioning, anxiety, and nervous system regulation instead of relying on shame or force. Why “Just Stop the Behavior” Usually Does Not Work When providers or loved ones do not understand OCD and eating disorders, people often receive advice that increases distress instead of helping. Dr. Marianne explains why compulsions and rituals are not simply habits people can turn off instantly and why recovery requires compassion, pacing, flexibility, and support for the nervous system. Recovery From OCD and Eating Disorders This episode also explores what can actually help when food rules and compulsions take over. Dr. Marianne discusses building tolerance for uncertainty, gently interrupting rituals, supporting sensory needs, reducing shame, and creating more flexibility around eating without overwhelming the nervous system. Related Episodes When Eating Disorders Meet Anxiety, OCD, or Depression: Co-Occurring Challenges & Recovery Strategies on Apple & Spotify. Obsessions, Compulsions, and Control: How OCD Intertwines With Eating Disorders on Apple & Spotify. Food, Fear, & Fixation: How OCD Shapes Eating Disorders on Apple & Spotify. Work With Dr. Marianne Miller Dr. Marianne Miller is a Licensed Marriage and Family Therapist (LMFT) and eating disorder therapist who specializes in ARFID, binge eating disorder, anorexia, bulimia, OCD, and neurodivergent-affirming care. She works with teens and adults in California and offers coaching support more broadly. Learn more about therapy, coaching, and eating disorder recovery support on her website drmariannemiller.com. Listen and Subscribe If this episode resonated with you, follow The Dr. Marianne-Land Podcast on your favorite podcast platform and share this episode with someone who feels trapped in food rules, rituals, anxiety, or intrusive thoughts around eating.

Does one awkward interaction, unanswered text, or small piece of feedback ruin your entire day? You may not be “too sensitive.” You may be experiencing Rejection Sensitive Dysphoria (RSD), especially if you also live with ADHD or an eating disorder. In this episode, Dr. Marianne explores why rejection can feel emotionally and physically painful, why shame spirals happen so quickly, and how emotional overwhelm can shape eating patterns, body image, and self-worth. What Is Rejection Sensitive Dysphoria (RSD)? Dr. Marianne breaks down what RSD actually is and why perceived criticism, disconnection, or rejection can trigger such intense emotional reactions. She explores how ADHD nervous systems often process emotions differently and why even subtle social shifts can feel catastrophic. This episode also examines how years of feeling misunderstood, corrected, excluded, or “too much” can shape the way neurodivergent people experience relationships and emotional safety. ADHD, Emotional Regulation, & Eating Disorders This episode explores the powerful overlap between ADHD, emotional regulation challenges, and eating disorders. Dr. Marianne discusses how rejection can quickly trigger binge eating urges, emotional eating, restrictive eating patterns, perfectionism, body image spirals, masking, and all-or-nothing thinking. She also explains why many neurodivergent people struggle to “move on” after rejection and why emotional pain can linger in the body long after the moment itself has passed. Why Food Often Becomes Part of the Coping Cycle When rejection activates the nervous system, the brain often searches for relief. For some people, food becomes soothing, grounding, or numbing. For others, appetite disappears completely and restriction begins to feel safer or more controlled. Dr. Marianne explains why these patterns are not about lack of willpower and why eating disorder behaviors often function as attempts to regulate overwhelming emotional states. Anti-Fat Bias, Ableism, & Emotional Pain Rejection does not happen in isolation. Dr. Marianne explores how anti-fat bias, ableism, stigma, and chronic misunderstanding can intensify emotional pain and increase sensitivity to rejection. She also discusses why marginalized people often carry higher levels of hypervigilance in social situations and why intersectionality matters when talking about ADHD, eating disorders, and nervous system regulation. Neurodivergent-Affirming Tools That Can Help Dr. Marianne shares supportive strategies for navigating RSD and eating disorder recovery, including sensory supports, low-lift eating approaches, nervous system regulation, and ways to reduce shame spirals without relying on punishment or rigid food rules. This episode focuses on building more self-understanding and creating coping tools that actually fit neurodivergent brains and lived experiences. Related Episodes Rejection Sensitive Dysphoria (RSD) & Eating Disorders: The Emotional Toll of Feeling “Too Much" on Apple & Spotify. Eating Disorders & ADHD: Neurodivergent-Affirming Recovery With Taylor Ashley, RP @taylorashleytherapy on Apple and Spotify. ADHD & Bulimia: Dopamine, Impulsivity, & the Hidden Link to Binge Eating With Kirsten Book, PMHNP-BC on Apple and Spotify. Work With Dr. Marianne Dr. Marianne Miller is a Licensed Marriage and Family Therapist (LMFT) specializing in eating disorders, ARFID, binge eating disorder, neurodivergence, ADHD, and emotional regulation challenges. She offers therapy and coaching for people navigating food struggles, shame, sensory sensitivities, and overwhelming emotional experiences. Check out her self-paced, virtual, ARFID and Selective Eating Course. Listen & Subscribe If this episode resonated with you, share it with someone who may need it and follow the Dr. Marianne-Land podcast on your favorite platform.

What happens when you relate to parts of autism, ADHD, giftedness, sensory sensitivity, masking, and trauma, but never fully fit into one diagnosis or label? In this timely conversation, Dr. Marianne Miller sits down with neuro-affirming clinical psychologist Dr. Emma Offord to explore “neurohybridity,” a term Emma developed to describe the fluid, overlapping, and mosaic-like nature of neurodivergent identity. Together, they unpack why so many late-diagnosed autistic and ADHD adults, especially women and marginalized people, feel unseen by rigid diagnostic systems and traditional mental health models. This episode explores late-diagnosed autism, ADHD in adults, masking, giftedness, medically unexplained symptoms, trauma, neurodivergence in midlife, and the limitations of the DSM and medicalized language. Dr. Emma Offord shares how safety, environment, nervous system regulation, identity, and lived experience can shape how neurodivergent traits appear and why many people feel they do not fully belong within one category. If you have ever questioned whether you are “autistic enough,” “ADHD enough,” too emotional to be autistic, or too complicated for a single diagnosis, this conversation may help you feel seen in a completely different way. What Is Neurohybridity? Dr. Emma Offord describes neurohybridity as an invitation to move beyond rigid diagnostic boxes and recognize the dynamic nature of neurodivergent experience. Rather than viewing people through fixed categories, neurohybridity acknowledges that many individuals identify with multiple neurotypes, sensory experiences, cognitive styles, and ways of moving through the world. Marianne and Emma discuss how neurodivergent traits can shift depending on context, stress, environment, nervous system safety, masking, trauma, and support systems. They also explore how someone can feel sensory-seeking in one moment and sensory-avoidant in another, emotionally expressive yet highly masked, or deeply connected to multiple neurodivergent identities at once. The conversation also examines how many people become trapped between diagnostic categories and how current systems often fail individuals whose experiences do not fit neatly into one lane. Late-Diagnosed Autism, ADHD, & Misdiagnosis Many neurodivergent adults grow up feeling different without having language for their experiences. Dr. Emma Offord shares how traveling extensively as a child, experiencing grief and loss, and later discovering neurodivergence shaped her understanding of identity and belonging. Marianne and Emma discuss how outdated autism and ADHD stereotypes continue to affect diagnosis, especially for women, emotionally expressive people, and those who have spent years masking. They also explore how traditional diagnostic models can overlook the complexity of lived experience, particularly for people who move between different neurodivergent presentations over time. This episode speaks directly to people who have felt misdiagnosed, unseen, invalidated, or confused by rigid definitions of neurodivergence. The Limits of the Medical Model Marianne and Emma also explore the emotional and systemic consequences of reducing people to diagnostic checklists and symptom categories. They discuss how diagnosis can simultaneously provide access to protection, accommodations, and community while also limiting how people understand themselves. The conversation touches on medical trauma, medically unexplained symptoms, intersectionality, research bias, and the ways historically marginalized groups are often excluded from dominant mental health narratives. Together, they explore the need for more collaborative, flexible, neurodivergent-affirming systems of care that allow people to exist beyond narrow definitions. About Dr. Emma Offord Dr. Emma Offord is a neuro-affirming clinical psychologist, coach, speaker, and founder of Divergent Life. Her work focuses on neurodivergence, masking, trauma-informed care, relational safety, identity, and the lived experience of late-discovered neurodivergence. Emma developed the concept of neurohybridity to describe the fluid, dynamic, and interconnected nature of neurodivergent identity. She is currently writing a book exploring these ideas and amplifying the voices of people who have felt unseen or misunderstood within traditional diagnostic systems. Connect With Dr. Emma Offord You can connect with Dr. Emma Offord on Instagram at @divergentlives, through the Divergent Life website, and through This Voice Is Mine: The Unquiet Podcast. Related Episodes With Dr. Emma Offord and on Neurodivergent Needs and Experiences Unmasking, Embodiment, & Trust: A Neurodivergent Approach to Eating Disorder Recovery With Dr. Emma Offord @divergentlives on Apple & Spotify. Why Eating Still Breaks Down for Neurodivergent People With Long-Term Eating Disorders on 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 Dr. Marianne Miller is an eating disorder therapist and LMFT specializing in ARFID, binge eating disorder, autism, ADHD, neurodivergence, and eating disorder recovery. She offers therapy services for clients in California, Washington, D.C., and globally through coaching support. For therapy, coaching, podcast episodes, courses, and other resources, visit Dr. Marianne's website and follow along on Instagram @drmariannemiller.

When Safe Foods Stop Working: ARFID Plateaus, Burnout, & What Helps 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. Work With Dr. Marianne Dr. Marianne Miller is a Licensed Marriage and Family Therapist specializing in ARFID, binge eating disorder, and neurodivergent-affirming eating disorder care. She offers therapy and coaching for clients in California, Washington, D.C., and globally. Check out her website drmariannemiller.com.  Follow her on Instagram @drmariannemiller. Email her directly at hello@drmariannemiller.com. Dr. Marianne also has an excellent virtual, self-paced ARFID and Selective Eating Course that's perfect for folks with ARFID who need more understanding and resources. It is neurodivergent-affirming, sensory-attuned, and trauma-informed.

If eating feels impossible, like your body shuts down, pushes back, or feels worse after you try, this episode explains why. For many autistic adults, eating challenges are shaped by POTS, nervous system differences, and misunderstood patterns that often get labeled as eating disorders. Here's what's actually happening and small steps that can help. What POTS Is and Why It Changes Eating POTS, or Postural Orthostatic Tachycardia Syndrome, affects how your body regulates heart rate, blood pressure, and circulation. When you move from lying down to sitting or standing, your body may struggle to move blood efficiently. This can lead to dizziness, fatigue, nausea, and a racing heart. Eating adds another layer. Digestion requires blood flow and energy. After you eat, your body redirects resources to your digestive system. If your system is already working hard to manage circulation, this shift can increase symptoms. You might feel more dizzy, more fatigued, or more nauseous after meals. Over time, your body can start to associate eating with feeling worse, which makes it harder to initiate or sustain eating. Autism, Interoception, and Why Hunger Cues Can Feel Unclear Many autistic adults experience differences in interoception, or the ability to read internal body signals. Hunger, fullness, thirst, and early signs of nausea can feel inconsistent, delayed, muted, or overwhelming. When interoception is already variable and you add POTS, where internal signals can shift quickly and intensely, it becomes harder to know when to eat, how much to eat, or what your body needs. You might not feel hunger until you are already depleted, or you might feel a mix of signals that are difficult to interpret. Sensory Overload and Why Food Can Feel Like Too Much Eating is a sensory experience. Texture, temperature, smell, taste, and the physical act of chewing and swallowing all require processing. If your nervous system is already managing dizziness, nausea, or a racing heart, sensory input can quickly become overwhelming. Foods that once felt manageable can start to feel like too much. Eating can shift from neutral to overstimulating or even unsafe. This is a nervous system response, not a character trait. Fatigue, Energy Limits, and Why Meals Get Skipped POTS fatigue can feel like your body loses access to energy, especially when upright. Many autistic adults already navigate energy limits across the day. When eating requires planning, preparing food, sitting upright, tolerating sensory input, and managing symptoms afterward, it can exceed what your body has available. So meals get delayed, minimized, or skipped. Not because you do not care, but because the cost is too high in that moment. When This Gets Misread as an Eating Disorder Low appetite, early fullness, avoiding food because it makes you feel worse, or going long stretches without eating can look like restriction from the outside. Sometimes these patterns are diagnosed as anorexia or another restrictive eating disorder without fully understanding the physiological and neurological context. At the same time, someone can experience both. You can be autistic, have POTS, and have an eating disorder. These experiences can overlap and reinforce each other, which means support needs to reflect the full picture. Why Eating Can Feel Worse Before It Feels Better After eating, blood shifts toward digestion. For someone with POTS, this can increase dizziness, fatigue, and nausea in the short term. Your body learns quickly that eating leads to discomfort. At the same time, not eating can worsen symptoms over time by affecting blood volume and blood sugar stability. This creates a loop where both options feel hard. Small Steps That Can Make Eating More Accessible Instead of raising expectations, this is about lowering the barrier to entry. Start with smaller, more frequent eating opportunities. Even a few bites, a snack, or a drink with calories can be a meaningful step when full meals feel like too much. Experiment with position. If sitting upright increases symptoms, try eating in a more supported or slightly reclined position, or resting before and after eating. Simplify food choices. Repeating foods that feel predictable and manageable can reduce decision-making and sensory load. Convenience foods are valid. Use gentle external cues if hunger signals are unclear. Timers, visual reminders, or pairing eating with another activity can help create structure without pressure. Notice timing. Are there moments in the day when your symptoms feel slightly more manageable? Those windows can support eating. Hydration and electrolytes, if part of your care plan, can support your body's ability to tolerate both standing and eating. Shifting the Question If eating feels impossible, the question is not “What is wrong with me?” It becomes “What is my body responding to, and what would make this easier?” This shift opens the door to more flexible, compassionate approaches that work with your nervous system instead of against it. The Bigger Picture: Being Seen in the Complexity Autistic adults are often misunderstood in healthcare settings. POTS can be underdiagnosed or dismissed. Eating disorders are frequently overlooked in people who do not fit expected presentations. When these experiences overlap, needs are often minimized or misinterpreted. Your lived experience matters. Your body is communicating something real. Related Episodes 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. 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. Work With Dr. Marianne If you are struggling to eat and it feels more complex than what typical advice addresses, you are not alone. I work with many people navigating eating challenges alongside neurodivergence and chronic conditions. Together, we build approaches that fit your nervous system, your energy, and your lived reality. You can learn more about working with me through therapy or coaching on my website drmariannemiller.com. You can also follow me on Instagram @drmariannemiller or email me directly at hello@drmariannemiller.com. Listen and Share If this episode resonated, share it with someone who might need it. Follow the podcast so you do not miss future episodes.

It feels like everyone around you is getting smaller. This conversation will change how you understand why. In this episode of the podcast, Dr. Marianne Miller sits down with eating disorder nutritionist Anne Richardson @theeatingdisordernutritionist to unpack what's really driving the current push toward thinness. From GLP-1 medications like Ozempic to the rise of tradwife content to the constant noise around food and bodies, this episode goes beyond surface-level trends and into the deeper cultural, political, and psychological forces shaping how we relate to eating, weight, and worth. If your relationship with food or your body has felt more intense, more pressured, or more confusing lately, this conversation will help you make sense of it. GLP-1s, Ozempic, and the New Era of Diet Culture GLP-1 medications have rapidly shifted the landscape of weight loss, but this conversation asks a deeper question: are these medications simply tools, or are they reinforcing a much larger cultural push toward shrinking bodies? Anne and Dr. Marianne explore how conversations about Ozempic and similar drugs have taken over social media and everyday life, creating an environment where body size is once again under constant scrutiny. What might look like a health trend on the surface can quietly intensify eating disorder risk, comparison, and pressure to conform. The “Everyone Is Getting Smaller” Effect When more people begin to lose weight at the same time, it shifts the baseline of what feels “normal.” This episode breaks down the snowball effect that happens when shrinking bodies become more visible, leading others to feel like they need to follow suit—even if they were previously comfortable in their bodies. This dynamic can increase body dissatisfaction across all body sizes and contribute to disordered eating patterns, especially in environments where GLP-1 use becomes normalized or expected. Tradwives, Thinness, and the Return of Restrictive Ideals The rise of tradwife content on platforms like TikTok is not just about lifestyle aesthetics—it often carries messages about femininity, body size, and power. In this conversation, Anne and Dr. Marianne examine how hyper-femininity, thinness, and “being small” are being rebranded as desirable and even virtuous. They explore how these narratives can limit autonomy, reinforce gender roles, and create subtle but powerful pressure to look and behave in specific ways. Is Diet Culture a Distraction? One of the most compelling themes in this episode is the idea that the intense focus on bodies may function as a distraction from larger systemic issues. When attention is constantly redirected toward appearance, food, and weight, it can pull focus away from conversations about power, inequality, and social change. This lens invites a broader understanding of eating disorders—not just as individual struggles, but as experiences shaped by cultural and political forces. Eating Disorders, Power, and Vulnerability Anne shares personal reflections on her experience with anorexia and how disconnection from self can increase vulnerability to external pressures and ideologies. Together, she and Dr. Marianne explore how being undernourished, both physically and emotionally, can make it harder to access agency, voice, and resistance. This conversation reframes recovery as not just about food, but about reclaiming identity, autonomy, and the ability to take up space in the world. The Intersection of Class, Access, and Body Size This episode also highlights how access to GLP-1 medications is shaped by socioeconomic status, creating new layers of inequality. As some people gain access to weight-loss medications and others do not, body size can become further tied to wealth and privilege. At the same time, limited access to food, healthcare, and resources continues to shape eating behaviors and health outcomes, complicating the narrative around choice and control. Why This Matters for Eating Disorder Recovery If you are in eating disorder recovery, or questioning your relationship with food, this cultural moment can feel especially intense. The pressure to shrink, the constant body talk, and the normalization of restrictive behaviors can all make recovery more complex. This episode offers validation for how hard this moment can feel and invites a more compassionate, contextual understanding of your experience. Connect With Anne Richardson Anne Richardson is an eating disorder nutritionist based in the UK, working with clients across the UK and Europe. She shares nuanced, thought-provoking content on Instagram @theeatingdisordernutritionist about eating disorders, recovery, and diet culture. Email: anne@theeatingdisordernutritionist.co.uk Website: https://www.theeatingdisordernutritionist.co.uk/ Related Episodes "We've Gone Back to the 90s": The Return of the Super Skinny Ideal With Anne Richardson @theeatingdisordernutritionist on Apple & Spotify. An Eating Disorder Recovery Story Across Two Countries With Anne Richardson @theeatingdisordernutritionist on Apple & Spotify. How Diet Culture & Purity Culture Fuel Eating Disorders: Unpacking the Trauma Behind the Rules With Cassie Krajewski, LCSW @inneratlastherapy on Apple & Spotify. Work With Dr. Marianne Dr. Marianne Miller is a licensed therapist specializing in eating disorder recovery, including ARFID, binge eating disorder, anorexia, and bulimia. She offers therapy and coaching for clients in California, Washington, D.C., and globally. Check out her website at drmariannemiller.com. You can follow her on Instagram @drmariannemiller.

If eating feels chaotic, unpredictable, or hard to keep up with, especially with ADHD, there are real reasons for that. This episode breaks down why eating can feel all over the place, not because you are doing something wrong, but because your brain is being asked to manage a process that depends heavily on executive functioning, timing, and regulation across the entire day. In this solo episode, Dr. Marianne explores the connection between ADHD, binge eating disorder, and bulimia, including how impulsivity, dopamine, and executive function challenges shape eating patterns in ways that are often misunderstood. You will hear why eating may feel easy to delay and then suddenly urgent, why follow-through can feel inconsistent, and why this pattern is not about willpower. ADHD and Eating Disorders: Why Eating Feels So Chaotic Eating regularly requires more than hunger. It depends on time awareness, task initiation, decision-making, and the ability to shift attention. ADHD directly affects these processes, which means eating can feel disorganized, delayed, or unpredictable. This episode explains why chaotic eating patterns often reflect executive function challenges, not a lack of effort or care. Impulsivity, Dopamine, and Binge Eating Impulsivity in ADHD is not just about acting quickly. It reflects differences in how the brain pauses and redirects. When binge urges show up, they can feel immediate and intense. At the same time, dopamine differences in ADHD can make food a fast and effective way to shift focus, regulate emotions, or create relief. This episode explores how these systems interact and why food can become a powerful regulator. Executive Function Challenges and Follow-Through With Eating Executive function challenges can make it harder to plan, prepare, and initiate eating, even when you want to. You might forget to eat, delay eating, or feel overwhelmed by decisions. This episode breaks down how these patterns develop and why eating consistency is not just about intention, but about access to executive functioning in real time. Restriction, Glucose, and Intensified ADHD Traits When eating gets delayed or inconsistent, even unintentionally, glucose levels can drop. This affects the brain's ability to regulate attention, impulses, and emotions. Lower glucose can intensify ADHD traits, making it even harder to initiate eating or pause during urges. This episode explains how this cycle develops and why it can feel so hard to interrupt. Why This Is Not About Willpower Chaotic eating patterns are often framed as a lack of discipline, but this episode reframes them through a neurodivergent-affirming lens. When your brain is under-fueled and your executive functioning is stretched, it makes sense that eating feels harder to manage. Understanding this can reduce shame and open up more supportive approaches. Related Episodes Midlife Bulimia Recovery: Coping With the Internal Chaos on Apple and Spotify. Eating Disorders & ADHD: Neurodivergent-Affirming Recovery With Taylor Ashley, RP @taylorashleytherapy on Apple and Spotify. ADHD & Bulimia: Dopamine, Impulsivity, & the Hidden Link to Binge Eating With Kirsten Book, PMHNP-BC on Apple and Spotify. Work With Dr. Marianne If you are navigating ADHD, binge eating, bulimia, or eating patterns that feel chaotic and hard to predict, you do not have to figure this out alone. Dr. Marianne works with many clients with ADHD in both therapy and coaching, helping them understand their brain, reduce shame, and build ways of eating that are actually doable in real life. You can learn more about working with Dr. Marianne via her website, drmariannemiller.com.

If your autistic child's eating feels more complex than anyone seems to understand, this episode may put words to what you've been seeing. Because when ARFID and anorexia overlap in autistic kids, the signs often get missed, misunderstood, or explained away in ways that don't actually help. And when that happens, families can feel stuck, blamed, or pushed into approaches that increase distress instead of creating safety. In this episode, I'm breaking down what it really looks like when ARFID and anorexia coexist, why this overlap is so often misdiagnosed, and what to do next if you're trying to support your child in a way that actually fits how their brain and body work. If you've been told it's “just sensory” or “just anorexia” and neither explanation fully makes sense, this conversation will help you understand why. What ARFID and Anorexia Look Like in Autistic Children ARFID and anorexia are often treated as completely separate diagnoses, but in autistic kids, the reality is frequently more nuanced. ARFID is commonly rooted in sensory differences, predictability, and nervous system safety, while anorexia can involve restriction tied to fear, control, or distress around the body. When these experiences overlap, eating patterns can shift in ways that don't fit neatly into one category, making it harder for providers to recognize what's really happening. We explore how long-standing sensory-based food restriction can evolve, how new food rules or avoidance patterns may emerge, and why autistic children may not express body-related concerns in expected ways. Understanding this distinction is critical for getting the right kind of support. Why Misdiagnosis Happens So Often Many autistic children fall through the cracks when it comes to eating disorder diagnosis. Some are labeled as having ARFID only, which can minimize medical and psychological risk when anorexia is also present. Others are diagnosed with anorexia without consideration for sensory needs, interoception, or nervous system regulation, which can lead to treatment approaches that feel overwhelming or unsustainable. In this episode, I explain why common eating disorder frameworks often miss autistic presentations, how masking and communication differences play a role, and why a one-size-fits-all approach to treatment can backfire. When Autistic Traits Look Like Anorexia Not all restrictive eating in autistic children is driven by anorexia. Some behaviors that appear concerning from the outside are actually rooted in autistic traits. Repetitive eating patterns, strong preferences for sameness, difficulty with transitions, and distress around internal body sensations can all influence how a child eats. We unpack how these patterns can be misinterpreted, why it matters to differentiate them, and how misunderstanding these behaviors can lead to increased pressure instead of meaningful support. Understanding ARFID Plus You may have heard the term ARFID Plus, which is sometimes used to describe when ARFID co-occurs with another eating disorder, often anorexia. In autistic children, this can look like long-standing sensory-based restriction layered with additional fears, rules, or patterns that extend beyond sensory needs alone. I walk through what ARFID Plus can look like in real life, why it is often overlooked, and how recognizing this overlap can change the way you approach support and care. Why Agency and Autonomy Matter in Eating Support One of the most important shifts in supporting autistic children with eating challenges is moving away from compliance-based approaches and toward collaboration. When eating becomes something that is done to a child instead of with them, the nervous system can respond with protection, which may look like shutdown, refusal, or increased rigidity. In this episode, I explain why facilitating agency and autonomy is not optional but essential. You'll learn how supporting choice, predictability, and collaboration can help create the conditions where eating is actually possible, and why pushing too hard can reinforce both ARFID patterns and anorexia-related restriction. What to Do Next If you are recognizing your child in this episode, the next step is not to force a single explanation or diagnosis. It is to step back and look at the full picture. Sensory needs, interoception, nervous system regulation, autistic traits, and eating disorder patterns can all exist at the same time. And support needs to reflect that complexity. In this episode, I offer a framework for thinking about eating in a more integrated way, so you can move toward approaches that prioritize safety, trust, and sustainability instead of urgency and control. Related Episodes Can ARFID and Anorexia Co-Exist? on Apple and Spotify. ARFID in Adults vs ARFID in Children on Apple and Spotify. Work With Dr. Marianne If you're looking for support that understands the overlap between autism, ARFID, and anorexia, I work with neurodivergent individuals and families navigating exactly this kind of complexity. I offer therapy in California and coaching more broadly, with a focus on neurodivergent-affirming, collaborative care that meets you and your child where you are. You can learn more about working with me by visiting my website, drmariannemiller.com.

You saw the clip. You saw the reactions. But you didn't see what actually happened. In this episode of Dr. Marianne Land, I sit down with eating disorder therapist and fat-positive advocate Edie Stark @ediestarktherapy to unpack what it was really like to be placed in a highly edited, high-pressure “debate” with Jillian Michaels. This conversation pulls back the curtain on how media formats shape narratives, how nuance gets erased, and how anti-fat bias shows up in ways that often go unexamined. If conversations about body positivity, eating disorders, and health have ever felt confusing or overly simplified, this episode offers a more grounded, clinically informed perspective. What Really Happened Behind the Scenes Edie walks through her experience from the moment she was contacted to participate to what it felt like entering a space designed for speed, pressure, and spectacle. She shares how little time participants were given to prepare, how decisions were made about who could speak, and how the structure itself limited meaningful dialogue. This part of the conversation highlights how production choices can influence not just what is said, but what is ultimately seen and believed by millions of viewers. Why This Wasn't a True Debate This was not a setting built for thoughtful exchange. It was a format that rewarded quick reactions over depth and tension over understanding. We explore how the pace, editing, and framing made it nearly impossible to have a nuanced conversation about eating disorders, body diversity, and health. When complex topics are reduced to short, high-intensity moments, important context disappears, and the public is left with an incomplete and often misleading picture. Eating Disorders, Body Positivity, & Fatphobia At the center of this episode is a deeper conversation about eating disorders and the realities of living in a body in a culture shaped by weight stigma. We talk about why body size alone cannot define health, how anti-fat bias affects people across body sizes, and how systemic factors like racism, stress, and access to care are often ignored in mainstream conversations. Edie also shares why certain medicalized language can feel harmful to many people and how language choices can either support or alienate those seeking help. The Reality of Viral Backlash & Online Harassment After the episode aired, Edie experienced an intense wave of online backlash. We talk openly about what it's like to be misrepresented, to have people form strong opinions based on a short, edited clip, and to navigate the emotional toll of public scrutiny. This part of the conversation also explores how social media amplifies outrage, how quickly misinformation spreads, and how difficult it can be to stay grounded in your values when faced with large-scale criticism. What This Conversation Is Really About This episode goes far beyond one moment on camera. It speaks to the larger systems that shape how we understand eating disorders, body image, and health. It is about advocating for people in larger bodies, challenging harmful assumptions, and bringing nuance back into conversations that are often flattened into extremes. If you've ever felt like something was missing from mainstream discussions about food and bodies, this conversation names it directly. Follow Edie Stark To learn more from Edie Stark and follow her work as an eating disorder therapist and fat-positive advocate, you can connect with her on Instagram @ediestarktherapy and other social platforms. You can also go to her website, starktherapygroup.com or her consultation website ediestark.com. Her work centers compassionate, ethical, and evidence-informed care for individuals navigating eating disorders and body image challenges. Related Episodes With San Diego Eating Disorder Therapist & Consultant Edie Stark, LCSW What Your Therapist Needs to Know About Eating Disorders on Apple & Spotify. The Hidden Risks of Non-Specialized Eating Disorder Treatment on Apple & Spotify. The Diet/Wellness Industry, Accessibility, & Diet Culture on Apple & Spotify. Anti-Fat Bias & the Importance of Advocacy on Apple & Spotify. Link to Jubilee "Surrounded" Episode With Jillian Michaels Content caution: In this show, participants address anti-fat bias and systemic oppression. Assumptions that being fat automatically means that you're not healthy are a big part of this conversation. I (Dr. Marianne) found it very activating and could only watch about half of it--the half that included Edie's sections. So please take care when you decide whether and how much to watch. https://www.youtube.com/watch?v=M7K87rGoGps Work With Dr. Marianne If you're struggling with binge eating, ARFID, anorexia, bulimia, or feeling overwhelmed around food, support is available. I offer eating disorder therapy and coaching for adults across California, Washington, D.C., Texas, and globally. My approach is neurodivergent affirming and grounded in understanding sensory needs, routines, and the complexity of real-life eating struggles. You deserve care that sees the full picture of your experience. Learn more at: drmariannemiller.com Listen, Share, & Stay Connected If this episode resonated with you, rate it and share it with someone who needs a more nuanced conversation about eating disorders and body image. Follow Dr. Marianne Land on Apple and Spotify for more episodes on ARFID, binge eating, neurodivergence, and recovery.

Long-term anorexia and restrictive eating are often missed, misunderstood, or minimized—especially when they don't match the stereotype. Anorexia can occur in all body sizes, yet many people in larger or mid-sized bodies go undiagnosed or unsupported for years. If restriction has been part of your life for a long time, this episode offers a different path forward—one that centers harm reduction, flexibility, and real-life support instead of all-or-nothing recovery. What Is Long-Term Anorexia and Restrictive Eating? Long-term anorexia, sometimes referred to as chronic anorexia, involves persistent patterns of restrictive eating that can last for years or decades. These patterns may ebb and flow over time, often influenced by stress, life transitions, health changes, and systemic pressures. Restrictive eating disorders do not always look extreme or obvious, and they are not defined by body size. People in all bodies can experience serious restriction, even when others fail to recognize it. Anorexia Exists in All Body Sizes Weight stigma continues to shape how anorexia is diagnosed and treated. Individuals in smaller bodies are more likely to receive early intervention, while those in larger bodies are often overlooked or even praised for restrictive behaviors. This creates significant barriers to care. Restrictive eating in any body is valid, serious, and deserving of support. The body does not become protected from the effects of restriction based on size. Why a Harm Reduction Approach Matters in Eating Disorder Recovery Harm reduction is a powerful and often underutilized approach for long-term anorexia and restrictive eating. Instead of focusing only on complete symptom elimination, harm reduction prioritizes reducing risk, increasing nourishment, and improving quality of life. This approach is especially important for people who feel stuck in all-or-nothing cycles or who have not found traditional recovery models accessible or sustainable. Strategy 1: Shift From Cure to Harm Reduction Recovery does not have to be all-or-nothing. Shifting from a cure mindset to a harm reduction mindset allows for meaningful progress without perfection. This might include eating something instead of nothing, shortening long gaps between meals, or building in one consistent eating time each day. These changes reduce risk and support stability over time. Strategy 2: Use Mechanical Eating to Support Consistency Mechanical eating is a structured approach to nourishment that does not rely on hunger cues. Long-term restriction can disrupt hunger and fullness signals, making intuitive eating difficult or inaccessible. Eating at regular intervals can support metabolic stability, reduce restriction cycles, and provide a foundation for more consistent nourishment. Strategy 3: Expand What “Enough” Means Restrictive eating often comes with rigid rules about portion sizes, food types, and timing. Expanding what “enough” looks like can happen gradually. Increasing portions, adding foods, or building on safe meals can support progress without overwhelming the nervous system. “Enough” is flexible and can evolve over time. Strategy 4: Support the Nervous System Around Eating Eating is not just behavioral—it is sensory, emotional, and neurological. For many people, especially those who are neurodivergent, food experiences can feel overwhelming or unpredictable. Supporting the nervous system may include creating a consistent eating environment, reducing sensory input, or pairing meals with regulating activities. When the body feels safer, eating becomes more accessible. Strategy 5: Challenge Weight Stigma in Eating Disorder Care Weight stigma plays a major role in delayed diagnosis and inadequate treatment for long-term anorexia. Recognizing that anorexia exists in all bodies is essential for effective care. Challenging these biases—both internally and within systems—can open the door to more accurate support and validation. The Reality of Long-Term Eating Disorder Recovery Long-term anorexia and restrictive eating often involve periods of improvement and periods of increased struggle. These shifts are part of the process and do not mean failure. A harm reduction approach allows for flexibility and adaptation as life circumstances change, supporting ongoing care instead of restarting from scratch. Related Episodes Beyond Anorexia: The Truth About Long-Term Restrictive Eating on Apple and Spotify. 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. Navigating a Long-Term Eating Disorder on Apple & Spotify. When an Eating Disorder Becomes Chronic: Recovery Tools for Persistent Anorexia & Bulimia on Apple and Spotify. Work With Dr. Marianne If you are navigating long-term anorexia, restrictive eating, ARFID, or another eating disorder, you do not have to do this alone. Dr. Marianne Miller, LMFT, offers neurodivergent-affirming, liberation-oriented therapy and coaching for eating disorder recovery in California, Washington, D.C., and globally. Learn more about working together to build a sustainable, supportive approach to eating. Go to my website drmariannemiller.com for more information.

If eating feels inconsistent, overwhelming, or like something you are constantly negotiating with, mechanical eating might be the tool you have heard about but are not sure how to use. In this episode, I break down what mechanical eating actually is, the pros and cons, and why it can help when eating feels hard, especially if you are navigating ARFID, binge eating, anorexia, or restrictive eating patterns. We are also going to talk about why mechanical eating does not work for everyone and how to adapt it in a way that supports your nervous system, your sensory needs, and your autonomy. Mechanical eating is a structured eating approach used in eating disorder recovery where you eat at consistent, planned times instead of relying on hunger cues. This often includes meals and snacks spaced throughout the day, regardless of whether you feel hungry. It is commonly used when hunger cues feel unreliable, delayed, or confusing, and when “just listen to your body” does not feel accessible. Why Mechanical Eating Helps When Eating Feels Hard When eating feels chaotic or unpredictable, mechanical eating creates an external structure that your body can begin to rely on. This structure supports more consistent nourishment, stabilizes blood sugar and energy, and reduces the intensity of binge urges and restriction cycles. Over time, it can help your body relearn hunger and fullness cues in a way that feels safer and more predictable. Mechanical eating can also reduce decision fatigue. If you already know when you are eating, you are not starting from zero each time, which can make eating feel more manageable, especially if you experience executive functioning challenges or overwhelm around food. Mechanical Eating and Eating Disorders Mechanical eating is often used in recovery from ARFID, binge eating disorder, anorexia, and restrictive eating patterns. In ARFID, sensory sensitivities, fear, or lack of interest in food can override hunger signals. In binge eating, irregular eating patterns can lead to intense hunger and strong urges. In restrictive eating, hunger cues are often diminished or disconnected. By introducing consistency, mechanical eating can interrupt these patterns and support more regulated eating over time, helping your body receive nourishment in a more predictable way. Pros of Mechanical Eating Mechanical eating can provide a stabilizing foundation in eating disorder recovery. It creates predictable structure when hunger cues feel unreliable and reduces chaotic eating patterns that can contribute to binge eating or restriction. It can support nervous system regulation by introducing consistency and help prevent extreme hunger, which often increases urgency around food. Over time, mechanical eating may also help reconnect you with your internal cues, making hunger and fullness feel more accessible and less confusing. Cons of Mechanical Eating Mechanical eating is not a one-size-fits-all approach. It can feel rigid or rule-based, especially if you have a history of perfectionism or strict food rules. For people with a strong need for autonomy, including those with Pervasive Desire for Autonomy, it can feel like pressure or loss of control, which may lead to resistance. It can also overlook sensory sensitivities in ARFID if the focus is only on timing rather than food tolerability. Eating without hunger can feel disconnected or unnatural at first, which can make the process feel discouraging if this is not expected or supported. Why Mechanical Eating Does Not Work for Everyone For many neurodivergent individuals, including those with autism, ADHD, or sensory processing differences, mechanical eating often needs to be adapted. If food feels unsafe, overwhelming, or intolerable, structure alone will not resolve that. If eating feels like pressure, your nervous system may push back as a protective response. This episode explores how to recognize when mechanical eating needs to be adjusted rather than pushed through, and how to shift the approach so that it feels more supportive and sustainable. How to Make Mechanical Eating More Flexible and Supportive Mechanical eating works best when it is adapted to your specific needs and capacity. This can include prioritizing safe foods in ARFID, simplifying meals to reduce effort, and using repetition to lower the cognitive load of eating. Flexibility in timing can also make a difference, allowing you to adjust your plan when your body feels shut down instead of forcing a rigid schedule. Supporting your nervous system before and during eating, and reducing pressure wherever possible, can help mechanical eating feel less like a power struggle and more like a form of support. Mechanical Eating, Neurodivergence, and Nervous System Support This episode takes a neurodivergent-affirming approach to mechanical eating by addressing sensory needs, executive functioning challenges, and autonomy. It explores why pressure can increase resistance and how to create an approach that works with your nervous system rather than against it. Mechanical eating can be helpful, but only when it is aligned with how your brain and body actually function. Final Thoughts on Mechanical Eating Mechanical eating can create stability when eating feels hard. It can reduce overwhelm, support more consistent nourishment, and help regulate patterns in ARFID, binge eating, and restriction. At the same time, it is not the only path to recovery, and it is not meant to override your autonomy or lived experience. The goal is not perfect structure. The goal is support that actually fits you. Related Episodes Mechanical Eating in Lifelong Eating Disorder Recovery: Benefits, Limits, & Who It Helps Most on Apple & Spotify. Intuitive vs. Mechanical Eating: Can They Coexist? on Apple & Spotify. Work With Dr. Marianne If you are struggling with ARFID, binge eating, or restrictive eating and want support that is neurodivergent-affirming and individualized, I offer therapy and coaching for clients in California, Washington, D.C., and globally. You deserve support that fits your brain, your body, and your life. Check out my website drmariannemiller.com for more info.

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.