Dr. Marianne-Land: An Eating Disorder Recovery Podcast

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

In this episode of Dr. Marianne-Land, I speak with fat activist, TEDx speaker, author, DEI expert, and podcast host Vinny Welsby (they/them) about anti-fat bias in healthcare, weight stigma in medicine, and the real-world harm fat patients experience when seeking medical care. Vinny, who shares extensively about fat liberation, weight-inclusive care, and dismantling diet culture on Instagram at @fierce.fatty, brings both lived experience and data into this conversation. This episode centers on Vinny's survey of 270 fat people, in which 99.25% reported experiencing weight-based discrimination in healthcare. These findings expose how common medical weight stigma, anti-fatness, and provider bias truly are, and why so many fat people delay or avoid healthcare altogether. Weight Stigma in Healthcare: Survey Data and Lived Experience We break down what those survey results actually mean for patients. Vinny shares stories of medical dismissal, misdiagnosis, delayed treatment, and humiliation in healthcare settings, including being told to lose weight instead of receiving appropriate medical evaluation. We discuss how weight stigma shows up through provider assumptions, lack of size-inclusive equipment, routine weighing without consent, and dismissive or dehumanizing language. This section highlights how anti-fat bias in healthcare leads to worse physical health outcomes, increased medical trauma, and deep mistrust of medical systems. Medical Trauma, Nervous System Effects, and Avoiding Care We explore how repeated experiences of weight stigma activate the nervous system and create medical trauma. Even scheduling an appointment can trigger fear, shame, and exhaustion. Vinny and I talk about how this chronic stress contributes to people avoiding preventive care, delaying diagnosis, and experiencing worsening health conditions as a result. This conversation connects anti-fat bias, mental health, eating disorders, and healthcare avoidance, naming how the system often blames fat bodies for the very harm it causes. Intersectionality: Fatness, Gender, Queerness, and Neurodivergence A major focus of this episode is intersectionality. Vinny shares how anti-fatness intersected with being trans, nonbinary, queer, neurodivergent, and disabled, and how shame around body size limited access to identity exploration and self-expression. We talk about how weight stigma compounds oppression, especially for people with multiple marginalized identities. We also discuss how white privilege can reduce some harms while never eliminating weight-based discrimination, and why weight-inclusive healthcare must address racism, transphobia, ableism, and fatphobia together. What Weight-Inclusive Healthcare Actually Requires We challenge the idea that good intentions equal good care. This section explores what weight-inclusive healthcare truly requires, including provider education, consent-based weighing, size-inclusive furniture and equipment, respectful language, and accountability when harm occurs. We discuss why many providers believe they are weight-inclusive while continuing to practice weight-centered and stigmatizing care. Unlearning Anti-Fatness, Shame, and Diet Culture We close with guidance for beginning the process of unlearning anti-fatness. Vinny shares how shame thrives in isolation and how bringing it into the light reduces its power. We discuss diet culture, binary thinking, and how critical thinking helps people question harmful beliefs about weight, health, morality, and worth. This episode invites listeners to ask who benefits when people are taught to hate their bodies, and how compassion, curiosity, and community support healing. Who This Episode Is For This episode is for fat people, eating disorder survivors, clinicians, healthcare providers, and anyone who wants to understand how weight stigma in healthcare causes harm and what needs to change. About My Guest: Vinny Welsby (They/Them) Vinny Welsby is a fat activist, DEI leader, TEDx speaker, bestselling author of Fierce Fatty, and host of the Fierce Fatty Podcast. They work with individuals through Fierce Fatty and with organizations through Weight Inclusive Consulting, providing education and training on dismantling anti-fat bias in healthcare and beyond. You can find Vinny at fiercefatty.com and on Instagram at @fierce.fatty. Related Episodes When Doctors Harm: Medical Weight Stigma & Eating Disorders on Apple & Spotify. Having Anorexia in a Larger Body: Navigating Medical Anti-Fat Bias & Lack of Care with Sharon Maxwell @heysharonmaxwell on Apple & Spotify. Content Caution This episode includes discussion of medical trauma, weight stigma, eating disorders, healthcare discrimination, and systemic oppression. The harm described in this episode is real, widespread, and systemic.

In this solo episode of Dr. Marianne Land, Dr. Marianne Miller explores one of the most overlooked drivers of Avoidant Restrictive Food Intake Disorder, or ARFID: the powerful intersection of autonomy and sensory needs. This episode unpacks why pressure based approaches consistently fail people with ARFID and how choice, consent, and nervous system safety create real pathways toward healing. Rather than framing ARFID as defiance or avoidance, this conversation centers ARFID as a protective response rooted in sensory overwhelm and a deep need for bodily autonomy. Why Autonomy Matters in ARFID For many neurodivergent people, autonomy is not optional. It is a core safety requirement. Dr. Marianne explains how pressure around food activates threat responses in the nervous system, often leading to shutdown, panic, or increased food avoidance. When autonomy gets removed through medical pressure, family conflict, or exposure approaches that override consent, ARFID symptoms often intensify. This episode reframes autonomy not as resistance, but as a stabilizing force that helps people survive overwhelming eating environments. Sensory Processing and Nervous System Safety Sensory sensitivity plays a central role in ARFID. Texture, smell, temperature, and unpredictability can trigger immediate nervous system distress. In this episode, Dr. Marianne explains how these sensory reactions are involuntary and protective, not behavioral choices. Safe foods become anchors that help regulate the nervous system, and honoring sensory needs becomes essential for sustainable eating disorder recovery. When sensory experiences are respected, the body no longer needs to protect itself through restriction. Why Pressure Fails and Choice Heals Pressure based interventions often backfire in ARFID treatment. Dr. Marianne explores how even well-intentioned encouragement can teach the nervous system that eating is unsafe. Pressure increases fear, deepens avoidance, and damages trust. In contrast, choice restores safety. When people with ARFID control the pace, timing, and nature of food exploration, curiosity becomes possible. Choice supports regulation, builds self-trust, and creates space for gentle expansion without retraumatization. A Neurodivergent-Affirming Approach to ARFID Recovery This episode highlights what ARFID care can look like when it centers consent, collaboration, and sensory attunement. Dr. Marianne discusses how liberation-centered treatment prioritizes nervous system regulation over compliance, honors lived experience, and rejects one-size-fits-all exposure models. Recovery becomes sustainable when dignity, agency, and sensory truth guide the process. Intersectionality, Identity, and Autonomy Autonomy carries different weight depending on lived experience. Dr. Marianne addresses how fat individuals, disabled individuals, neurodivergent people, and those with chronic illness often experience repeated violations of autonomy in medical and social settings. For many, eating becomes another site of control and harm. This episode situates ARFID within broader systems of stigma and explains why restoring autonomy is especially critical for people with marginalized identities. Mid-Episode Invitation During the episode, Dr. Marianne shares more about her self-paced ARFID and Selective Eating Course. The course offers neurodivergent-affirming, trauma-informed tools that support autonomy, sensory safety, and nervous system regulation. It is designed for individuals with ARFID, caregivers, and clinicians seeking a more compassionate and effective framework for healing. Who This Episode Is For This episode is for anyone living with ARFID, supporting someone with ARFID, or working professionally with eating disorders and neurodivergence. It is especially relevant for listeners who have felt harmed by pressure based treatment, misunderstood by providers, or blamed for sensory needs they cannot control. Related Episodes on ARFID --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. Listen and Learn More If ARFID has shaped your relationship with food, your body, or your sense of safety, this episode offers a validating and science-informed perspective. To learn more about Dr. Marianne's virtual, self-paced ARFID and Selective Eating Course or to explore therapy and educational resources, visit her website drmariannemiller.com.

Chewing and spitting is an eating disorder behavior that often remains hidden due to intense shame and misunderstanding. Many people do not know how to talk about it, and many providers never ask. In this solo episode, Dr. Marianne Miller offers a clear, compassionate explanation of chewing and spitting in eating disorders, naming why this behavior develops and why it deserves nuanced care rather than judgment. This episode centers eating disorder recovery, ARFID, neurodivergent sensory experiences with food, and the nervous system roots of eating behaviors that are often moralized or overlooked. Why Chewing and Spitting Is So Often Misunderstood Chewing and spitting is frequently framed as a single behavior with a single cause. This narrow understanding creates harm. When providers assume chewing and spitting always reflects restriction or compensatory behavior, people with ARFID and sensory-based eating challenges are misdiagnosed or pressured into unsafe treatment. When providers minimize chewing and spitting in restrictive eating disorders, people lose access to support at moments of increasing distress. This episode explains why chewing and spitting must be understood through multiple pathways to ensure accurate diagnosis and ethical care. Pathway One: Chewing and Spitting in Restrictive and Compensatory Eating Disorders In restrictive or compensatory eating disorders, chewing and spitting often functions as a way to avoid swallowing food while still experiencing taste. It may emerge during periods of significant restriction, intense hunger, or fear of weight gain. Some people use chewing and spitting to interrupt binge urges or as a purge-adjacent behavior. In this pathway, the behavior reflects deprivation, internal conflict, and rising eating disorder severity. Shame, secrecy, and fear of judgment frequently follow, making it harder for individuals to seek support or speak openly about what they are experiencing. Pathway Two: Chewing and Spitting in ARFID and Neurodivergent Sensory-Based Eating Chewing and spitting can also emerge in ARFID and neurodivergent sensory-based eating for reasons entirely unrelated to weight or dieting. In this pathway, the behavior reflects sensory overwhelm, swallowing discomfort, texture sensitivity, interoceptive differences, or nervous system safety needs. Autistic and ADHD individuals may chew food to explore taste while spitting to avoid gagging, panic, or sensory overload. When this pathway is misunderstood as compensatory eating disorder behavior, people often feel pathologized rather than supported. This episode explains how sensory wiring, disability, and safety needs shape this experience. Why Differentiating These Two Pathways Matters in Recovery Accurately identifying the function of chewing and spitting is essential for healing. Restrictive and compensatory pathways require approaches that address deprivation, shame, trauma, and rigid food rules. Sensory-based pathways require approaches that build safety, honor autonomy, and work with the nervous system rather than against it. Dr. Marianne explains why a one-size-fits-all model fails and how differentiation creates clarity, trust, and more sustainable eating disorder recovery. Intersectionality, Bias, and Systemic Harm This episode also explores how anti-fat bias, racism, ableism, and medical bias shape who receives care and who gets believed. People in larger bodies often experience intense pressure to restrict, which can intensify chewing and spitting behaviors. People of color frequently face delayed or missed eating disorder diagnoses. Neurodivergent individuals are often misunderstood or dismissed when their eating challenges are sensory-based. Understanding chewing and spitting requires naming these systemic harms rather than blaming individuals. A Compassionate Path Forward Chewing and spitting is not a moral failure or a sign of weakness. It is a behavior rooted in nervous system responses, lived experience, and survival. This episode offers language, validation, and clarity for anyone who has struggled with chewing and spitting, supported someone who has, or wants a more nuanced understanding of eating disorders and ARFID. Healing begins with understanding, safety, and compassion. About Dr. Marianne Miller Dr. Marianne Miller is a licensed marriage and family therapist specializing in eating disorder recovery, ARFID, binge eating, and neurodivergent-affirming therapy. She offers therapy for individuals in California, Texas, and Washington D.C., and teaches the self-paced, virtual ARFID and Selective Eating Course.

Exercise is often framed as self-care, discipline, or proof that someone is “doing the right thing.” But for many people, exercise becomes tangled with shame, control, and self-worth. In this interview, Dr. Marianne Miller sits down with Dr. Lisa Folden, a weight-inclusive physical therapist and Health at Every Size ambassador, to explore how exercise shamefuels body image distress and disordered eating, even when it is disguised as wellness or health. Dr. Lisa shares her personal journey from overexercising, restriction, and rigid fitness rules to intuitive movement rooted in care rather than punishment. Together, they unpack how fitness culture, purity culture, and appearance-based health messaging teach people to judge their bodies and measure their worth through movement, weight, and discipline. This conversation reframes eating disorder recovery through a compassionate, weight-inclusive lens that separates exercise from morality and control. This episode is especially relevant for anyone struggling with eating disorders, chronic disordered eating, exercise guilt, or a painful relationship with movement. Content Caution This episode includes discussion of eating disorders, disordered eating behaviors, food restriction, binge eating patterns, overexercising, body image distress, weight stigma, and shame-based health messaging. Please listen in a way that feels supportive to you. Episode Overview In this conversation, Dr. Marianne and Dr. Lisa explore how exercise shame develops and why it is so deeply connected to body image and eating disorder recovery. Dr. Lisa explains how early experiences with discipline, structure, and purity culture shaped her relationship with food and exercise, reinforcing the belief that bodies must be controlled to be worthy. They discuss how fitness spaces often reward pain, consistency, and weight loss while ignoring mental health, accessibility, and individual needs. The episode also examines how intuitive movement becomes possible when exercise is no longer used to fix or punish the body. Dr. Lisa describes what shifted when she stopped exercising to change her body and began moving in ways that supported her nervous system, energy, and overall well-being. The conversation highlights how ableism and body size bias show up in gyms and wellness spaces, often through subtle judgments about who “belongs” and how bodies should move. Throughout the episode, Dr. Lisa emphasizes that exercise does not determine character and that body image healing requires separating movement from shame, worth, and identity. This reframing is central to sustainable eating disorder recovery and long-term healing. Why This Episode Matters Many people in eating disorder recovery were taught that exercising consistently meant they were good, disciplined, or successful, while rest or inconsistency meant failure. This episode challenges those beliefs and offers a more humane, evidence-informed approach to movement and self-care. It speaks directly to listeners who feel stuck in cycles of overexercising, restriction, binge eating, or chronic guilt around movement, and offers permission to relate to exercise in a way that supports healing rather than harm. About Dr. Lisa Folden Dr. Lisa Folden is a North Carolina–licensed physical therapist, NASM-certified behavior change specialist, and anti-diet, weight-inclusive coach. She is the owner of Healthy Phit Physical Therapy and Wellness Consultants and a Health at Every Size ambassador. Her work focuses on helping people heal their relationship with movement, body image, and food, particularly in the context of eating disorder recovery. She is also a writer, speaker, and mother of three. You can follow Dr. Lisa on Instagram at @healthyphit and read her writing on Substack at DrLisaFolden. Related Episodes --Breaking Up With Diet Culture with Dr. Lisa via Apple or Spotify. --Moralization of Exercise, Eating, & Body Size With Dr. Lisa via Apple or Spotify. About the Host Dr. Marianne Miller is a Licensed Marriage and Family Therapist and eating disorder specialist offering neurodivergent-affirming, trauma-informed support for binge eating disorder, ARFID, anorexia, bulimia, and long-term eating disorders. She hosts Dr. Marianne-Land: An Eating Disorder Recovery Podcast and provides therapy, education, and self-paced recovery programs. Check out her website at drmariannemiller.com or her Instagram @drmariannemiller. Listen Now If exercise has ever felt like punishment, obligation, or proof of worth, this episode offers a different path forward grounded in compassion, autonomy, and care.

In this solo episode, Dr. Marianne explores how autism shapes eating in ways that many providers overlook. Sensory needs, interoception, routines, and safety all influence how autistic people navigate food. Instead of seeing these challenges as resistance, Dr. Marianne reframes them as intelligent body signals that protect a sensitive nervous system. Dr. Marianne explains why autistic eating experiences often get misunderstood. She discusses how overwhelming textures, smells, and sounds affect tolerance for certain foods, how interoceptive confusion can disrupt hunger cues, and how predictability reduces chaos during meals. She also explores the deep need for safety and how early food trauma can lead to long-lasting protective patterns. This episode highlights how autistic people may develop ARFID due to sensory overload, fear, or confusion around internal cues. Dr. Marianne emphasizes the need for neurodivergent affirming care that respects autonomy, consent, and the right to eat in ways that support comfort rather than compliance. Dr. Marianne also examines intersectionality. Autistic people of color, LGBTQIA+ autistic people, and disabled autistic people often face additional barriers to care and experience higher rates of dismissal. Understanding these intersections helps us provide real support. Throughout the episode, Dr. Marianne offers a compassionate framework for supporting autistic eating. She centers curiosity, sensory awareness, co-regulation, predictable routines, and respect for safe foods. She encourages listeners to trust their bodies and seek environments that reduce overwhelm instead of increasing it. Key Topics Covered Sensory Needs and Autistic Eating How texture, smell, sound, and temperature influence food tolerance and how sensory overwhelm shapes avoidance patterns. Interoception and Hunger Cues Why autistic people often experience muted or confusing hunger cues and how supportive routines help. Predictability and Routine Why sameness offers safety during meals and how routine helps regulate the nervous system. Safety and Eating Trauma The long-term effects of force feeding, pressure, and food shame and how safety becomes essential for healing. Autism and ARFID How ARFID develops in autistic people and why care must support autonomy, sensory comfort, and consent. Intersectionality and Access to Care How race, gender, sexuality, class, and disability shape autistic eating experiences and influence the support people receive. Compassionate Support Strategies How validation, sensory awareness, predictable rhythms, and co-regulation improve access to nourishment. Content Caution In this episode, I discusseeating challenges, restriction patterns, sensory overload, trauma, and ARFID. Please listen gently and take breaks if needed. Who This Episode Supports This episode is for autistic adults, parents of autistic children, providers who want to offer neurodivergent affirming care, and anyone who wants a deeper understanding of autistic eating experiences. It is also supportive for people exploring ARFID symptoms rooted in sensory needs, trauma histories, or routines that feel protective. Related Episodes Autism & Eating Disorders Explained: Signs, Struggles, & Support That Works on Apple & Spotify. The Invisible Hunger: How Masking Shows Up in Eating Disorder Recovery on Apple & Spotify. How Masking Neurodivergence Can Fuel Eating Disorders on Apple & Spotify. Autism & Anorexia: When Masking Looks Like Restriction, & Recovery Feels Unsafe on Apple & Spotify. Work With Dr. Marianne If you want support that honors your sensory needs and your autonomy, you can learn more about my therapy services in California, Texas, and Washington, D.C., as well as global coaching options at drmariannemiller.com. You can also explore my ARFID and selective eating course and my binge eating and bulimia membership for additional tools. You deserve care that meets your body where it is.

TikTok reshapes the way people talk about bodies, beauty, and wellness. What looks like gentle self care often hides restrictive eating patterns, thinness pressure, and aesthetic rules that reward shrinking. In this episode, Dr. Marianne Miller explores how TikTok rebrands diet culture by disguising restriction inside trends like “anti bloat,” “glow up,” “clean girl body,” and “body recomposition.” Dr. Marianne explains why these trends spread quickly, why they create a strong pull for people with eating disorders, and why neurodivergent viewers may feel especially drawn to routines that promise control or calm. She describes how glow up narratives romanticize disappearance and how thinness becomes a transformation story. You will learn how to identify coded diet language and how to stay grounded while moving through online spaces that promote harmful messaging. What You Will Learn in This Episode 1. How TikTok Rebrands Diet Culture Dr. Marianne explains how “anti bloat” routines and glow up challenges present restriction as wellness. She highlights how these messages look soft and soothing even though they pressure people to shrink and control their bodies. 2. How Coded Restriction Language Shows Up Online You will learn how creators use soothing audio, soft visuals, and vague terms to disguise patterns that mirror disordered eating. Dr. Marianne names the phrases that quietly promote thinness. 3. Why Neurodivergent Viewers and People With Eating Disorders Feel Drawn In Structured routines and visuals can feel comforting or predictable. Dr. Marianne describes how this pull can feel stronger for neurodivergent listeners or anyone living with long-term food struggles. 4. How Glow-Up Culture Romanticizes Shrinking Dr. Marianne explores how glow up narratives frame thinness as success, transformation, or emotional strength. These stories reward disappearance and pressure people to strive for smaller bodies. 5. Intersectionality and Harmful Messaging Dr. Marianne names the ways thinness aesthetics reinforce cultural pressures for people in larger bodies, people of color, neurodivergent individuals, transgender and nonbinary people, and anyone who already experiences scrutiny or marginalization. 6. How to Strengthen Your Relationship With TikTok You will learn practical strategies to identify harmful patterns, curate your feed, follow body liberation voices, and stay centered in your own needs while using the platform. Content Caution This episode includes discussion of thinness trends, restrictive routines, and coded dieting messages on TikTok. If you feel overwhelmed or activated, please pause and return when you feel grounded. Who This Episode Supports This episode supports: • people recovering from eating disorders • neurodivergent listeners who feel drawn to routines or calming visuals • people in larger bodies who feel erased by glow up narratives • trauma survivors who feel pulled toward control-based content • clinicians, parents, and helpers who want to understand the pressures their clients or teens face online • anyone curious about how diet culture hides inside wellness language Resources Listeners may find support through: • body liberation and fat liberation educators • research on social media and disordered eating • neurodivergent-affirming eating disorder resources • trauma-informed recovery frameworks Related Episode SkinnyTok & Anorexia: How Harmful Trends Thrive Despite TikTok's Ban with Jen Tomei @askjenup on Apple and Spotify. Work With Dr. Marianne Miller Learn more about therapy, coaching, binge eating support, ARFID resources, and upcoming clinician trainings at drmariannemiller.com. Explore the blog, podcast show notes, and all available offerings.

What if the problem is not your motivation to recover, but a system that makes eating disorder treatment almost impossible to afford? In this conversation, I sit down again with Leslie Jordan Garcia @liberatiwellness. Leslie is a wellness strategist, certified eating disorder recovery coach, and Treatment Access Program Manager at Project HEAL. In this episode, we discuss real, concrete pathways to free and low-cost eating disorder care. We also talk about why you cannot separate eating disorder recovery from social justice, intersectionality, and body hierarchies. Leslie breaks down how Project HEAL removes financial and systemic barriers, how people from marginalized communities can apply, and how providers can join the Healer's Circle to offer justice-focused, values-aligned care. In this episode, we talk about What Project HEAL is and how it works to remove financial and systemic barriers to eating disorder care in the United States The four major Project HEAL programs and how to apply for: Community Care groups for BIPOC folks Cash assistance that covers tertiary costs like rent, pet boarding, and transportation Outpatient treatment placement with sliding scale and pro bono providers Insurance navigation support and help with single case agreements Who qualifies for Project HEAL services, including people in all U.S. states and territories, and how they prioritize folks from communities that are historically and systemically marginalized How Leslie matches people with “unicorn providers” who are fat positive, HAES aligned, queer affirming, trauma aware, and non Christian based when needed The difference it makes when someone helps you navigate insurance, access care, and complete applications, especially when executive functioning is low or things feel overwhelming How economic precarity, layoffs, food insecurity, and shifting insurance policies are driving an uptick in applications for eating disorder treatment assistance Why intersectional, identity affirming care is not optional in eating disorder recovery, especially for BIPOC, queer, trans, disabled, and fat clients How Leslie's social justice consulting work with universities, community colleges, and health organizations helps them: Reimagine intake forms and client facing processes Address promotion and salary inequities Create transformational circles where teams talk about harm, stereotypes, and systemic barriers How body hierarchies, food moralization, school fitness testing, and lunch shaming fuel eating disorders for kids and adults Why many people use eating disorders as a survival tool in the context of trauma, capitalism, surveillance, and unsafe systems What true equity and belonging could mean for decreasing the occurrence and severity of eating disorders About our guest: Leslie Jordan Garcia Leslie Jordan Garcia is a wellness strategist, certified eating disorder recovery coach, and social justice consultant dedicated to healing and liberation. She holds dual master's degrees in business and public health and has more than a decade of experience across military, public health, and nonprofit sectors. Through her practice, Liberati Wellness, Leslie offers HAES aligned eating disorder recovery support, inclusive movement support, and equity and identity affirming care. Leslie also partners with organizations like Austin Health Commons and the Hogg Foundation to embed equity and justice into health systems and helping professions. She currently serves as the Treatment Access Program Manager at Project HEAL, where she manages cash assistance and treatment placement and works to match clients with values aligned, culturally responsive providers. You can find Leslie's coaching and consulting work at Liberati Wellness and on Instagram at @liberatiwellness. Inside Project HEAL's pathways to care In this episode, Leslie explains how Project HEAL supports people who are struggling with eating disorders and facing financial and systemic barriers to treatment. She walks us through the main programs: Informed ED (for professionals) A learning program for clinicians and dietitians who are newer to eating disorder treatment. It helps them build skills, reduce harm, and align their work with justice focused values so they can better support clients whose eating disorders are uncovered in general mental health or medical settings. Community Care A free, BIPOC only, 8 week support and process group focused on body liberation, community care, and healing from white supremacist body hierarchies. Cash Assistance Program A program that does not pay individuals directly, but instead covers tertiary costs that often block access to care. This can include rent, transportation, pet boarding, or other essential expenses so that people can actually attend the level of care their team recommends. Treatment Placement Leslie coordinates outpatient treatment placement, connecting people with dietitians, therapists, and other providers who offer sliding scale or pro bono care, especially when insurance does not cover enough dietitian sessions or mental health support. Insurance Navigation Project HEAL helps people understand their insurance benefits, locate in network providers, and pursue options like single case agreements when an appropriate provider is out of network. Leslie also mentions a time limited clinical assessment program for people who know they are struggling in their relationship with food and body but have never had a formal diagnosis. All of these services are free to applicants, and one application can cover multiple programs at once. Who can apply to Project HEAL Leslie shares that Project HEAL is U.S. based, and that includes all 50 states, Alaska, Hawaii, and U.S. territories such as Guam. Anyone in those locations can apply. Project HEAL prioritizes people from communities that have been historically and systemically marginalized, including: BIPOC communities Queer and trans communities People in larger bodies Disabled and chronically ill folks People navigating religious trauma and other layered identities Leslie's role includes reading applications through an intersectional lens, tracking diversity demographics, and making sure that people who face the largest gaps in access are not overlooked. She also notes that if the application itself feels overwhelming, Project HEAL can connect applicants with someone who will help them complete it, which is especially important when executive functioning is low. Intersectionality, social justice, and eating disorder recovery Throughout the conversation, Leslie and I look at how eating disorders are never just about appearance. They are deeply tied to: Trauma and chronic stress How we perceive our bodies and how we believe others perceive our bodies Economic instability, job insecurity, and food insecurity Surveillance of bodies in workplaces, schools, and medical settings Racism, anti-fat bias, ableism, transmisia, and other forms of oppression Leslie talks about clients who restrict food so their children can eat when jobs cut hours, and how people in larger bodies often avoid eating at work because of constant surveillance and judgment, only to experience intense hunger and binge episodes later. We explore how body hierarchies, moralization of food, school fitness testing, and lunch policing create conditions where an eating disorder can become a primary coping strategy. Leslie describes how, over time, this can become deeply embedded, with the brain chemistry colluding with the eating disorder to create a sense of safety that the larger system fails to provide. For Leslie, social justice work is inseparable from eating disorder work. If people had secure access to food, safe housing, living wages, and genuine body equity, many would not need to rely on eating disorders to feel safer, visible, or invisible. Justice work inside systems Leslie also describes her justice work with institutions, including: Facilitating Transformational Circles where diverse team members connect as humans and then talk honestly about processes that exclude or harm people Supporting clinics that operate in queer neighborhoods yet do not see queer clients, and helping them examine what in their client facing processes is pushing people away Working with community colleges on salary and promotion inequities, examining reviews, ranking systems, and feedback processes that keep certain groups from advancing Helping organizations rework intake forms, policies, and internal culture so that equity, belonging, and justicebecome real practices rather than buzzwords She reminds us that what often gets labeled as “DEI” is actually about justice, accessibility, and belonging for everyone, including veterans, people who breastfeed, people who need ramps and accessible bathrooms, and more. How to connect with Project HEAL and Leslie To apply for Project HEAL's Treatment Access programs Visit the Project HEAL website at projectheal.org and look for the section on Treatment Access. One application lets you indicate which services you want, including cash assistance, treatment placement, insurance navigation, and clinical assessment while that program is still active. Both individuals seeking care and providers who want to join the Healer's Circle start on the same site. Providers can share their identities, specialties, body size, languages spoken, and communities they love to serve, which helps Leslie make strong intersectional matches. To work with Leslie as a coach or consultant You can learn more about Leslie's equity and identity affirming eating disorder recovery coaching and social justice consulting at: Website: Liberati Wellness liberatiwellness.com Instagram: @liberatiwellness She currently has a reduced capacity for one to one clients but continues to support individuals and teams through coaching, collaboration with therapists and dietitians, and organizational justice work. If this episode resonated with you If you are struggling with an eating disorder and feel blocked by money, insurance, or access, I hope this episode helps you feel less alone and more resourced. There are people and organizations actively working to break financial barriers to care. If you know someone who could benefit from free or low-cost eating disorder support, especially someone from a marginalized community, please consider sharing this episode with them. You can also support this work by: Following @liberatiwellness and @projectheal Sharing Project HEAL's application info with your community If you are a provider, applying to join the Healer's Circle and offering sliding scale or pro bono care And as always, thank you for listening and for being part of this conversation about justice, embodiment, and eating disorder recovery.

This solo episode explores the quiet places where anorexia meets identity and expression. Dr. Marianne Miller speaks to the lived moments where someone learns to hide parts of themselves and how restriction becomes a language for survival. She examines how identity formation, self-expression, and body-based fear interact in ways that often remain hidden. The episode centers queer, trans, gender-expansive, and questioning listeners along with anyone who has felt pressure to quiet their identity in order to navigate the world. Dr. Marianne describes how anorexia rises when identity feels unsafe, unrecognized, or tightly controlled. She explains how restriction becomes a strategy to manage visibility, vulnerability, dysphoria, and the cultural pressure to stay small. The episode invites listeners to imagine recovery as a process of expanding expression, reclaiming autonomy, and restoring connection to their authentic self. Key Themes in This Episode Dr. Marianne examines the links between anorexia, identity, and self-expression. She describes how gender expectations and cultural norms shape the body story. She explains how queer and trans people often restrict to soften dysphoria or to quiet unwanted attention. She explores the way over-performance and people-pleasing silence authentic expression and strengthen restrictive behavior. She looks at the sensory landscape of anorexia and describes how neurodivergent experiences influence embodiment and identity. She also highlights the role of intersectionality. Race, culture, queerness, disability, and body size shape how someone expresses themself and how safe that expression feels. These intersections help explain why anorexia often becomes a predictable response to environments that restrict identity or punish authenticity. Why This Episode Matters Mainstream conversations about anorexia often focus on food without addressing identity, expression, and cultural pressure. Many listeners learn early that their identity takes up too much space. Many learn that desire, gender expression, and emotional truth need to stay hidden. This episode challenges the idea that anorexia develops inside a vacuum. Instead, it shows how anorexia forms inside relationships, systems, and environments that silence real expression. The episode offers validation for anyone who felt forced to shrink in order to stay safe. It expands the understanding of anorexia so listeners can see their experiences reflected with accuracy, compassion, and liberation. Who This Episode Supports This episode supports listeners who navigate anorexia while holding queer, trans, or gender-expansive identities. It supports people who experience identity suppression or dysphoria and who use restriction to manage that conflict. It supports neurodivergent listeners whose sensory experiences shape their relationship with their body and their identity. It also supports clinicians, loved ones, and community members who want a more accurate and compassionate understanding of anorexia. Resources Mentioned Liberation-based healing models Trauma-informed care Queer embodiment research Neurodivergent eating disorder literature Content Caution This episode discusses anorexia, restrictive eating, identity conflict, gender dysphoria, sexuality, sensory overwhelm, and the lived experience of shrinking to stay safe. Please listen with care and pause whenever your body needs space. Related Episodes Queer Mental Health & Eating Disorders: How Stress Shows Up in the Body & Brain With Winter Groeschl, NCC, LPC (@eatingdisorderrevealed): Apple & Spotify. LGBTQIA+, the Coming Out Process, & Eating Disorders: Apple & Spotify LGBTQIA+ & Eating Disorders: Apple & Spotify Learn More and Get Support Dr. Marianne Miller provides therapy and coaching for anorexia, ARFID, binge eating disorder, bulimia, trauma, and body-based fear. She supports clients across California, Texas, Washington D.C., and internationally. Explore additional episodes of the Dr. Marianne Land podcast for conversations about eating disorder recovery, neurodiversity, identity, embodiment, and body liberation. Check out her website at drmariannemiller.com. Follow her on Instagram @drmariannemiller.

In this episode, Dr. Marianne Miller explores the reality that many people with lifelong eating disorders do not resonate with the traditional idea of full recovery. She explains why harm reduction can offer a compassionate and sustainable path for individuals who have lived with chronic anorexia, long term bulimia, binge eating disorder, ARFID, and other long standing eating disorders. This conversation centers trauma history, neurodivergence, sensory needs, oppression, and the intersectional barriers that prevent many people from reaching what treatment programs often define as full recovery. If you have lived with an eating disorder for decades, if you have experienced trauma or misdiagnosis, if you are neurodivergent, or if you live in a marginalized body that has faced medical discrimination, you may find this episode deeply validating. Harm reduction gives you realistic recovery goals that respect your lived experience, your nervous system, and your access needs. What You Will Learn in This Episode Dr. Marianne explains how harm reduction works in eating disorder recovery and how it differs from traditional recovery models. She shows how harm reduction supports safety, stabilization, and dignity for people who have navigated chronic eating disorders for most of their lives. You will learn why the nervous system sometimes cannot tolerate pressure toward full recovery and why a flexible, collaborative approach can feel more aligned for many people. You will hear how sensory issues, interoception challenges, executive functioning differences, autistic burnout, and ADHD related overwhelm shape eating patterns for neurodivergent individuals. You will learn how trauma history, attachment ruptures, racialized stress, gender based discrimination, medical fatphobia, and identity marginalization influence both the development of eating disorders and the recovery process. Key Topics Covered This episode covers a wide range of topics that matter deeply for people with chronic eating disorders. These topics include how harm reduction supports stabilization when the long term eating disorder has become intertwined with survival. You will hear why the phrase full recovery can feel unrealistic or even harmful for people who have lived with their eating disorder for decades. Dr. Marianne explains how harm reduction creates safety, reduces shame, increases autonomy, and supports people who need a gentler and more individualized approach. The episode explores the role of neurodiversity in eating disorder recovery. This includes how sensory sensitivities shape food choices, how interoception differences impact hunger awareness, how executive functioning challenges influence meal consistency, and why many autistic and ADHD individuals need accessible, predictable, and customized strategies. You will also learn how intersectional oppression shapes health outcomes for people of color, queer and trans individuals, disabled individuals, fat individuals, and anyone living across multiple marginalized identities. Dr. Marianne describes what harm reduction can look like in daily life, from maintaining safe foods to creating sensory friendly meals to reducing medical instability in small, sustainable steps. She shares how this approach honors personal history and current capacity and how it helps many people live with more stability and less suffering. Who This Episode Is For This episode is for anyone living with a lifelong eating disorder who has felt pressure to pursue full recovery even when that expectation does not align with their reality. It is for people with chronic anorexia, chronic bulimia, long term binge eating disorder, ARFID shaped by sensory needs, and individuals with complex trauma who feel overwhelmed by traditional treatment expectations. This episode is also for neurodivergent individuals who live with autistic sensory profiles, ADHD impulsivity, interoception challenges, and executive functioning struggles that interfere with eating. It is for people living in marginalized bodies who have experienced medical discrimination or misdiagnosis. It is for professionals who want to learn how to apply harm reduction to eating disorder treatment in inclusive, neurodivergent affirming, and identity informed ways. Why This Episode Matters Many people with chronic or lifelong eating disorders feel invisible in mainstream recovery culture. They hear messages that full recovery is the only worthy goal and feel ashamed when their body or nervous system cannot meet those expectations. This episode names that truth with compassion. Harm reduction is a valid and ethical approach that honors lived experience and brings relief to people who need safety more than perfection. This episode matters because it acknowledges the role of trauma, neurodivergence, sensory needs, and intersectionality in long term eating disorders. It challenges the idea that recovery must look the same for everyone. It shows that you deserve care even if your healing does not follow a traditional blueprint. Your life still holds value and possibility. Related Episodes Orthorexia, Quasi-Recovery, & Lifelong Eating Disorder Struggles with Dr. Lara Zibarras @drlarazib on Apple & Spotify. Navigating a Long-Term Eating Disorder on Apple & Spotify. Why Eating Disorder Recovery Feels Unsafe: Facing Ambivalence in Long-Term Struggles on Apple & Spotify. Perfectionism, People-Pleasing, & Body Image: Self-Compassion Tools for Long-Term Eating Disorder Recovery With Carrie Pollard, MSW @compassionate_counsellor on Apple & Spotify. Resources and Support If you want more resources on lifelong eating disorders, harm reduction, ARFID, sensory based eating, and neurodivergent affirming care, visit drmariannemiller.com where you will find blog posts, guides, and links to specialized support. You can also explore my ARFID course and binge eating recovery membership options if you want deeper help with binge eating disorder, bulimia, ARFID, or long term eating disorder recovery. My work supports clients in California, Texas, Washington DC, and internationally through coaching. Join the Conversation If this episode resonated with your experience of a lifelong eating disorder or if you are curious about harm reduction as a recovery model, I would love to hear your thoughts. You can connect with me on Instagram at @drmariannemiller and share what stood out to you. For More Dr. Marianne-Land Podcast Episodes To explore more episodes on eating disorders, neurodiversity, trauma, and body liberation, listen to the full archive on your favorite podcast platform.

What happens when chronic illness meets wellness culture, diet culture, and the desperate search for answers in a system that continues to fail so many people? In this episode, I talk with Abbie Attwood, MS, @abbieattwoodwellness, an anti diet, weight inclusive nutrition therapist and host of the Full Plate Podcast. Abbie and I explore how chronic illness, medical gaslighting, and the pressure to find a cure can intersect with disordered eating. We talk about the ways wellness messaging pushes restrictive food rules, how OCD and anxiety deepen vulnerability to this messaging, and how food fear can feel like control when life feels unpredictable. We also discuss athlete identity, compulsive exercise, thin privilege, masking, neurodivergence, and the grief that comes when illness or injury forces people to rethink who they are. This conversation opens space for nuance, compassion, and the reality that healing happens inside context, not perfection. Content Caution We talk about chronic illness, disordered eating, exercise compulsion, and food restriction. Please take care of yourself as you listen. Key Topics We Cover 1. How wellness culture preys on vulnerability Abbie discusses how chronic illness created a perfect storm for disordered eating, especially when wellness messaging promised control, cures, and answers that science did not support. 2. Chronic illness and the search for control We talk about how desperation, medical dismissal, and misinformation make people more likely to turn to restrictive food rules and elimination diets. 3. OCD, anxiety, and increased vulnerability to wellness culture Abbie shares how her undiagnosed OCD and lifelong anxiety made the rigid, all or nothing tone of wellness culture feel reassuring, while actually deepening harm. 4. Athlete identity, loss, and compulsive movement We explore how losing movement due to chronic illness or injury can destabilize identity, trigger grief, and reignite disordered behaviors around exercise. 5. Masking, neurodivergence, and the pressure to perform wellness We discuss how neurodivergent masking can hide exhaustion and overwhelm, and how the pressure to perform health or discipline can push people deeper into food and exercise rigidity. 6. Chronic illness culture, shame, and blame We look at how chronic illness culture and wellness culture both place responsibility on the individual, leading to shame and self blame when bodies do not behave as expected. 7. What real nourishment looks like when illness limits capacity Abbie talks about the need for compassion, ease, adding rather than restricting, and honoring energy limitations instead of forcing strict food rules. Who This Episode Is For People navigating chronic illness and food anxiety Listeners recovering from eating disorders Neurodivergent folks who feel pressured to mask or follow rigid health rules Athletes or former athletes grieving changes in movement Anyone tangled in wellness culture messaging Clinicians who want a deeper understanding of how chronic illness intersects with disordered eating People who struggle with shame when illness reduces their capacity About Today's Guest Abbie Attwood, MS, is an anti diet, weight inclusive nutrition therapist, writer, and host of the Full Plate Podcast. She provides virtual nutrition therapy and body image support through Abbie Attwood Wellness and writes a widely loved Substack newsletter on healing our relationships with food and body. You can find her at @abbieattwoodwellness and abbieattwoodwellness.com. Links Mentioned Abbie Attwood Wellness Substack: abbieattwoodwellness.substack.com Abbie's website: abbieattwoodwellness.com Instagram: @abbieattwoodwellness Full Plate Podcast Related Episodes Breaking Up With Diet Culture with Dr. Lisa Folden, @healthyphit on Apple & Spotify. How Eating Disorder Recovery Heals Life Overall via Apple or Spotify. Overexercising, ADHD, & Eating Disorders with @askjenup Jenny Tomei 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 Me If you want support for binge eating disorder, ARFID, chronic eating struggles, or complex eating disorder patterns shaped by trauma, neurodivergence, or chronic illness, you can connect with me at drmariannemiller.com for therapy in California, Texas, or Washington D.C. I also offer global coaching and specialized courses.

What happens when an eating disorder has been part of your life for years or even decades. In this solo episode, Dr. Marianne Miller explores what recovery can look like when anorexia or bulimia becomes chronic, persistent, or long-term. Drawing from her experience as a therapist specializing in eating disorders, Dr. Marianne offers trauma-informed, neurodivergent-affirming, and body-liberation tools that help people reconnect with their bodies, support their nervous systems, and rebuild trust when recovery feels unreachable. This episode provides compassionate guidance for anyone who has lived with an eating disorder for a long time and wonders if healing is still possible. It also supports clinicians, loved ones, and helpers who want to understand the realities of severe and enduring eating disorders with more depth, nuance, and humanity. Why This Episode Matters People with chronic anorexia or bulimia often feel overlooked by treatment models that expect rapid transformation or complete symptom remission. Many have cycled through recovery attempts and relapse, often carrying shame for not recovering quickly enough. Dr. Marianne reframes chronic eating disorders as endurance rather than failure. She introduces recovery approaches that honor the nervous system, acknowledge survival strategies, and center autonomy, safety, and dignity. Key Topics Covered This episode explores why chronic anorexia and bulimia develop and why they persist over time. It highlights how survival strategies become deeply wired into the nervous system and how shame, trauma, sensory overload, and systemic oppression shape long-term eating disorders. Listeners learn how to use persistence instead of perfection, how to rebuild interoceptive awareness, how to support sensory needs, and how to regulate the nervous system in ways that feel gentle and sustainable. The episode also introduces self-compassion as a powerful tool that helps soften shame and create the conditions for real healing. Dr. Marianne explains how relational safety, autonomy, and body trust become essential for long-term recovery. Listeners also hear how intersectionality influences chronicity and why marginalized people often face more barriers to care. Who This Episode Is For This episode supports people living with chronic anorexia or bulimia, people who feel exhausted by long-term recovery efforts, and people who wonder if healing is still possible after many years of struggle. It also supports therapists, dietitians, physicians, and loved ones who want to understand chronic eating disorders through a neurodivergent-affirming, sensory-attuned, and trauma-informed lens. Content Caution This episode discusses chronic anorexia and bulimia, including references to restriction, purging, and trauma. Please listen with care and take breaks if you need to ground or regulate. Your comfort and safety matter. Related Episodes on Lifelong Eating Disorders Orthorexia, Quasi-Recovery, & Lifelong Eating Disorder Struggles with Dr. Lara Zibarras @drlarazib on Apple & Spotify. Navigating a Long-Term Eating Disorder on Apple & Spotify. Why Eating Disorder Recovery Feels Unsafe: Facing Ambivalence in Long-Term Struggles on Apple & Spotify. Perfectionism, People-Pleasing, & Body Image: Self-Compassion Tools for Long-Term Eating Disorder Recovery With Carrie Pollard, MSW @compassionate_counsellor on Apple & Spotify. Learn More and Get Support If this episode resonates with you, visit drmariannemiller.com to learn more about therapy, coaching, and resources for eating disorder recovery, including chronic anorexia and chronic bulimia. Dr. Marianne offers care that emphasizes autonomy, collaboration, and nervous system safety. You do not have to heal alone. You can also listen to more episodes of Dr. Marianne-Land on all major podcast platforms.

Most providers still don't recognize ARFID when it's right in front of them. In this episode, Dr. Marianne Miller unpacks why Avoidant/Restrictive Food Intake Disorder remains so misunderstood—and how that misunderstanding harms children and adults who live with it. Dr. Marianne explains what ARFID really is, how it shows up across neurotypes, and why messages like “just try harder” damage safety, trust, and nervous system regulation. Through a neurodivergent-affirming lens, she explores how bias, pressure, and diet-culture thinking keep ARFID invisible and why it's time for providers to see the reality of this eating disorder. Why This Episode Matters For too long, ARFID has been dismissed as “picky eating.” This episode reframes ARFID as a real, body-based eating disorder rooted in sensory processing, fear, or trauma—not defiance or willpower. Dr. Marianne highlights the emotional and physiological impact of being told to “try harder,” and how that phrase erodes autonomy, increases shame, and dysregulates the body. When we understand ARFID as a nervous-system and safety-based challenge, our entire approach to care changes. Listening replaces forcing. Collaboration replaces control. Compassion replaces shame. Key Topics Covered What ARFID Really Is: Understanding sensory-based, fear-based, and low-interest eating patterns that have nothing to do with dieting or body image. Why Professionals Miss It: How traditional training and diet-culture frameworks erase ARFID from diagnosis and treatment. The Harm of “Try Harder” Messages: Exploring what happens when people are shamed or pressured to eat against their nervous system's limits. The Neurodivergent Lens: How autism, ADHD, and other forms of neurodivergence intersect with eating, safety, and sensory regulation. The Role of Bias: Why marginalized identities—fat, BIPOC, neurodivergent, or gender-diverse people—are more likely to be misunderstood or dismissed. What Support Looks Like: How neurodivergent-affirming, sensory-attuned, and autonomy-based care creates safety and possibility. Who This Episode Is For Therapists, dietitians, and physicians who want to understand ARFID beyond stereotypes. Parents who feel blamed or overwhelmed by their child's restricted eating. Adults who have lived with food fear or sensory eating struggles and never had language for it. Neurodivergent people who want their experiences around food to be seen, validated, and supported. Content Caution This episode includes discussion of eating behaviors, sensory distress, and medical dismissal related to ARFID. Please take care of yourself and listen in a way that feels safe for your body and nervous system. Related Episodes ARFID Explained: What It Feels Like, Why It's Misunderstood, & What Helps on Apple & Spotify. Why Sensory-Attuned Care Matters More Than Exposure in ARFID Treatment on Apple & Spotify. 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. Learn More and Get Support If you want to understand ARFID more deeply or build sensory-attuned support skills, check out Dr. Marianne's self-paced ARFID & Selective Eating Course. This training explores sensory processing, collaborative care, and trauma-informed strategies for clinicians, parents, and community members. Visit drmariannemiller.com/arfid to learn more.

What happens when you live with a severe eating disorder in a larger body yet the medical system refuses to see it? In this powerful conversation, Sharon Maxwell (she/they) shares her story of surviving anorexia in a fat body, advocating for herself inside medical systems that consistently denied her care, and reclaiming joy, autonomy, and embodiment after years of harm. Sharon is an educator, speaker, and fat activist who dedicates her work to dismantling anti fat bias and eradicating weight stigma in healthcare and society. Their story and activism have been featured in the New York Times Magazine, The Tamron Hall Show, The Wall Street Journal, NPR, 60 Minutes, and more. Together, we explore the realities of receiving medical care while fat, why compassionate providers save lives, how weight stigma shaped Sharon's early life and nearly cost her her life, and why reclaiming joy becomes an act of resistance. This episode holds so much wisdom, solidarity, and truth telling for anyone in eating disorder recovery, anyone harmed by medical weight stigma, and anyone committed to building a safer world for people in larger bodies. What We Cover in This Episode Sharon's Early Story and Reclaiming Joy Sharon shares a surprising fun fact about being a lifelong pianist and how taking jazz lessons helped them reclaim creativity after growing up in a restrictive religious cult that controlled every aspect of music, expression, and embodied joy. They describe how jazz has become part of their healing and identity reconstruction. Growing Up Fat, Undiagnosed, and Unseen Sharon lived in a fat body their entire life and struggled with anorexia for nineteen years. They went undiagnosed because medical providers only saw their body size. When Sharon arrived with obvious symptoms of an eating disorder, providers dismissed the symptoms and blamed their body. They describe how weight stigma prevented treatment and reinforced eating disorder patterns. The Doctor Who Changed Everything Sharon describes the first doctor who recognized the eating disorder and offered real compassion. That moment shifted the trajectory of their life. We discuss how rare this experience is and why truly compassionate medical care can be lifesaving for people living in larger bodies. Medical Trauma and the Cost of Weight Stigma Sharon shares painful stories about: Being denied necessary medical procedures because of body size. Experiencing trauma at gynecological appointments. Nearly dying from untreated tonsillitis because providers assumed weight was the cause rather than treating the actual condition. The emotional and financial toll of weight stigma across childhood and adulthood. We discuss how the healthcare system misattributes the financial cost of weight stigma to the O-word and how this distorts public health narratives and patient care. Eating Disorders in Larger Bodies Sharon explains how anti fat bias prevents providers from seeing eating disorders in fat patients. They highlight how common anorexia is in larger bodies and how life threatening it becomes when medical systems refuse to diagnose or treat it. How Anti Fat Bias Harms Everyone Sharon and I talk about how dismantling anti fat bias supports every person in eating disorder recovery. Recovery requires divesting from anti fat bias, reconnecting with the body, and understanding how these biases shape thoughts and behaviors across all sizes. Intersectionality and Medical Harm We explore how harms escalate for people with multiple marginalized identities, including Black patients, Indigenous patients, trans patients, and fat patients who also face racism, transphobia, or medical gatekeeping. Advocacy, Boundaries, and Medical Self Protection Sharon shares concrete strategies for preparing for medical appointments, including: Bringing notes to stay grounded when hyperarousal hits. Recording appointments for recall and safety. Bringing a support person. Taking intentional rest time afterward. Establishing boundaries and walking out when providers violate consent. We discuss how exhausting it is to prepare for appointments that should be safe and how necessary these strategies become for survival. Why Sharon Became a Fat Activist After nearly dying because of weight stigma, Sharon left the classroom to educate clinicians, providers, and communities about anti fat bias. They now work with medical systems and general audiences to deconstruct bias, build safer care practices, and illuminate the threads of anti fat culture that harm everyone. Imagining an Ideal World Sharon answers the signature Dr. Marianne Land question. Their ideal world includes accessible spaces for play, joy, rest, and creativity for all bodies. It includes medical care rooted in compassion, humanity, and dignity, and it includes ice cream for everyone with options for all bodies and needs. Who This Episode Is For This episode supports: People in fat bodies who have experienced medical trauma. Listeners who lived with eating disorders in larger bodies without diagnosis or care. Providers wanting to unlearn weight stigma and offer safer treatment. Clinicians seeking to understand the intersection of eating disorders and anti fat bias. Anyone navigating healthcare systems that dismiss or harm them. People exploring intersectionality, fat liberation, and neurodivergent affirming care. Key Themes Eating disorders in larger bodies are real, severe, and often missed. Anti fat bias in healthcare prevents accurate diagnosis and lifesaving treatment. Medical trauma compounds over years and affects every modality of care. Compassionate providers save lives. Medical self advocacy is necessary but exhausting. Intersectionality affects both access to and quality of care. Joy and play become powerful acts of resistance. People in larger bodies deserve safety, dignity, and accurate medical treatment. Related Episodes 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. What Is Atypical Anorexia? Challenging Weight Bias in Eating Disorder Treatment with Emma Townsin, RD @food.life.freedom on Apple or Spotify. When Doctors Harm: Medical Weight Stigma & Eating Disorders on Apple & Spotify. Fat Vulnerability & Our Eating Disorder Recovery Stories on Apple & Spotify. Connect With Sharon Maxwell Follow Sharon on Instagram and all social platforms at @heysharonmaxwell. Learn More and Get Support For therapy, courses, and resources on eating disorders, ARFID, binge eating, and neurodivergent affirming care, visit my website at drmariannemiller.com and explore support options inside my binge eating recovery membership and ARFID programs.

In this solo episode, Dr. Marianne Miller, LMFT, speaks directly to the body that carries fear, memory, and longing for safety. Through a poetic open letter, she explores why recovery can feel unsafe even when life begins to stabilize. Instead of treating fear as resistance, she reframes it as communication and wisdom. In this episode, she invites listeners to move from fighting their bodies to listening to them. Dr. Marianne explores how trauma, neurodivergence, and systemic oppression live in the body, and how tenderness can become a bridge between fear and trust. It is not a set of instructions. It is an act of witnessing. Why This Episode Matters Many people in eating disorder recovery are told that getting better should feel empowering. But for those whose bodies have been sites of trauma, shame, or disconnection, recovery can feel unbearable. This episode reframes that discomfort as an intelligent response from the body, not as failure or lack of willpower. By turning recovery into a dialogue instead of a demand, listeners learn how to approach healing at the pace of safety. Dr. Marianne shares how fear is not the opposite of progress but a sign that the body is asking for gentler evidence that the world can hold it safely. Her trauma-informed, neurodivergent-affirming, and liberation-based approach helps listeners replace control with curiosity and build trust with the body through compassion. Key Topics Covered In this episode, Dr. Marianne reflects on: The nervous system's memory of trauma and how it interprets safety Why the body resists calm and how to rebuild trust slowly The grief that comes with letting go of control and perfectionism How sensory sensitivities and neurodivergence affect recovery pacing The intersectional realities that make safety harder for fat, queer, trans, BIPOC, and neurodivergent people What it means to redefine “getting better” as coming home to yourself Listeners will come away with a new way to understand their bodies. They will learn that healing does not require pushing through fear but learning to listen to what fear is trying to protect. Who This Episode Is For This episode is for anyone who has ever felt frightened by their own progress in recovery. It will resonate with: People in eating disorder recovery who feel ambivalent about healing Neurodivergent listeners who experience overwhelm or shutdown during recovery Fat, queer, trans, and BIPOC individuals navigating systems that equate safety with conformity Clinicians and caregivers who want to understand the embodied realities of fear and healing It is also for those who need permission to slow down, to stop performing readiness, and to honor the body as a partner in recovery rather than an obstacle. Content Caution This episode includes discussion of eating disorder recovery, body distrust, trauma, and the emotional experience of fear during healing. It also references restriction, bingeing, and body-based distress without graphic detail. Please take care while listening. Pause or return to the episode later if it feels overwhelming. You are encouraged to have support in place as you engage with this material. Related Episodes How Childhood Trauma Shapes Eating Disorders & Body Shame (Content Caution) 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. Why Letting Go 0f Restriction Feels Unsafe in Eating Disorder Recovery on Apple & Spotify. Learn More and Get Support To continue exploring how to build safety with your body, visit drmariannemiller.com. There you will find: The ARFID & Selective Eating Course, a self-paced program offering sensory-attuned and neurodivergent-affirming tools for individuals and caregivers. The Binge Eating Recovery Membership, a space for ongoing support, education, and compassionate community that moves beyond diet culture. Blog posts, podcast episodes, and free resources on trauma-informed, consent-based, and liberation-centered recovery. Each offering is grounded in curiosity, respect, and collaboration.

What happens when your survival strategy becomes the thing standing between you and full recovery? In this episode of Dr. Marianne-Land: An Eating Disorder Recovery Podcast, Dr. Marianne Miller explores how masking and camouflaging shape the lives of neurodivergent people living with eating disorders. Through a trauma-informed, neurodivergent-affirming lens, she unpacks how chronic masking affects body trust, executive functioning, and safety in recovery. This conversation goes beyond the surface, offering insight into the deep intersection between identity, safety, and healing for autistic and ADHD people navigating disordered eating. Why This Episode Matters Masking, also known as camouflaging, is often praised as adaptability, but for many neurodivergent people it is a survival response that comes at a high cost. When you spend years performing normalcy, you can lose touch with your body's natural rhythms, sensations, and needs. This episode reveals how masking contributes to disordered eating patterns and burnout, and why many neurodivergent individuals struggle to connect with hunger, fullness, and safety cues. Dr. Marianne explains how unmasking can become an essential part of recovery when it is grounded in safety and choice. She also highlights the collective responsibility of clinicians, families, and communities to create environments where authenticity does not come with punishment. Key Themes Covered What masking and camouflaging look like for autistic and ADHD people How chronic masking disconnects you from body cues and emotions The relationship between executive function burnout and chaotic eating Masking inside therapy and recovery spaces How unmasking becomes a healing process when safety is prioritized The crucial role of neurodivergent-affirming, sensory-aware support The realities of intersectionality and why unmasking is not equally safe for everyone The Big Intersectionality Caveat Unmasking can be freeing, but it is not always safe. For people living at the intersections of multiple marginalized identities, such as people of color, fat people, queer and trans individuals, and those with disabilities, authentic self-expression often carries real risks. Systems rooted in racism, fatphobia, ableism, and heteronormativity still punish difference. In this segment, Dr. Marianne offers guidance on how to navigate those risks without self-betrayal. She invites listeners to think of unmasking as a gradual and relational process rather than a demand for constant transparency. Authenticity must coexist with safety, and strategic masking can be a legitimate survival tool. Recovery is not about abandoning the mask everywhere; it is about finding and creating spaces where the mask can come off without harm. Who This Episode Is For This episode is for: Neurodivergent adults and teens in eating disorder recovery Autistic and ADHD individuals struggling with food, body image, or ARFID Therapists seeking to provide neurodivergent-affirming, sensory-informed care People navigating multiple marginalized identities who feel unsafe unmasking in treatment Parents and partners who want to better understand masking, executive functioning, and sensory needs in eating behaviors Content Caution This episode includes discussion of eating disorder behaviors, masking fatigue, and systemic oppression. Listener discretion is advised, especially if you are in early recovery or working through trauma related to identity or body shame. Related Episodes Autism & Anorexia: When Masking Looks Like Restriction, & Recovery Feels Unsafe via Apple & Spotify. Recovering Again: Navigating Eating Disorders After a Late Neurodivergent Diagnosis (Part 1) With Stacie Fanelli, LCSW @edadhd_therapist via Apple & Spotify. Stuck on Empty: Autistic Inertia, ARFID & the Struggle to Eat via Apple & Spotify Minding the Gap: The Intersection Between AuDHD & Eating Disorders With Stacie Fanelli, LCSW @edadhd_therapist via Apple & Spotify Our Personal Neurodivergent Stories via Apple & Spotify. Learn More and Get Support If today's episode resonated with you, explore Dr. Marianne's ARFID & Selective Eating Course, a self-paced, neurodivergent-affirming resource that supports sensory-based eating, autonomy, and compassion in recovery. Learn more at drmariannemiller.com.

What happens when a physician, trained to prioritize science and performance, discovers that her own healing requires compassion, spirituality, and trust in her body? In this powerful interview, we explore one woman's story of recovering from binge eating disorder while navigating the pressures of medicine, diet culture, and systemic weight bias. You'll hear how early messages about food and scarcity shaped her relationship with eating, how medical training reinforced body shame, and how she ultimately reconnected to herself through self-compassion, intuitive eating, and body trust. This episode offers both a deeply personal narrative and a professional perspective on how healthcare can move toward weight-neutral, compassionate care. Key Topics Covered How childhood scarcity and fear can shape lifelong eating patterns The pressures physicians face to conform to body ideals in medicine How chronic stress and sleep deprivation in residency can trigger binge eating Why self-compassion—not willpower—became the turning point in recovery What it takes to unlearn diet culture within the healthcare system The rise of GLP-1 medications and how they complicate conversations about body autonomy Healing the disconnect between professional identity and personal recovery Building a weight-neutral, compassionate approach to health and wellbeing Who This Episode Is For This episode is for anyone who has struggled with binge eating, body shame, or internalized weight stigma—especially those in helping professions. It's also for clinicians, therapists, and healthcare providers seeking to understand how medical culture perpetuates harm and how to bring more compassion into patient care. If you've ever felt like your professional role or perfectionism made recovery harder, this episode will remind you that you're not alone—and that healing is possible, even in systems that don't always make room for it. Why This Conversation Matters In a world where doctors are often seen as immune to body image struggles, this story reveals how deeply systemic fatphobia and diet culture reach—even into the halls of medicine. It challenges the myth that knowledge alone heals disordered eating and instead centers nervous system safety, self-compassion, and intuitive wisdom as the foundation for recovery. Resources Mentioned Intuitive Eating by Evelyn Tribole and Elyse Resch Reclaiming Body Trust by Hilary Kinavey and Dana Sturtevant Wayza Health (wayzahealth.com)--Dr. Michelle's website Research on GLP-1 medications and long-term outcomes Center for Body Trust Related Episodes  When Doctors Harm: Medical Weight Stigma & Eating Disorders on Apple & Spotify. Fat Vulnerability & Our Eating Disorder Recovery Stories on Apple & Spotify. Challenges of Weight-Loss Surgery & Medical Anti-Fat Bias on Apple & Spotify. Learn More and Get Support If you or someone you love is navigating binge eating, emotional eating, or recovery after years of dieting, visit drmariannemiller.com to explore specialized support. You'll find resources for binge eating recovery, ARFID support, and neurodivergent-affirming therapy and courses.

What if your nighttime eating isn't a failure of willpower but your body's way of asking for safety, nourishment, and rest? In this solo episode of Dr. Marianne-Land: An Eating Disorder Recovery Podcast, Dr. Marianne Miller explores the misunderstood world of Night Eating Syndrome (NES)—a condition that often hides behind shame and silence. Rather than framing night eating as a “bad habit,” Dr. Marianne offers a compassionate, neurodivergent-affirming lens that reveals what your body and brain are truly communicating when nighttime hunger takes over. She unpacks how executive-function challenges, sensory processing differences, and disrupted circadian rhythmscan contribute to Night Eating Syndrome. You'll learn how to distinguish between waking up at night to eat versus staying up late and bingeing, and why that difference matters for healing. Dr. Marianne also shares practical ways to support your body's natural rhythms using executive-function tools—like creating transition meals, supporting sensory needs, and building low-lift nourishment systems that actually work with your brain. Finally, she offers self-compassion strategies that help calm shame, regulate the nervous system, and restore trust in your body's signals. Key Topics Covered What Night Eating Syndrome really is—and why it's not a moral failure The role of executive-function fatigue in late-night eating cycles How neurodivergent people may have different hunger and sleep patterns than neurotypicals Practical, low-lift tools to support nighttime regulation and nourishment How to distinguish between Night Eating Syndrome and binge eating The importance of self-compassion and curiosity in healing the shame cycle Who This Episode Is For This episode is for anyone who finds themselves eating late into the night and feeling stuck in shame or confusion afterward. It's especially for neurodivergent adults, trauma survivors, and anyone who struggles with inconsistent eating or sleep patterns. Clinicians who work with eating disorders, ARFID, or binge eating may also find this episode helpful for supporting clients with neuroaffirming and compassion-based approaches. Content Caution This episode discusses eating disorder behaviors related to Night Eating Syndrome and binge eating. Listener discretion is advised. Please take care of yourself and pause if you need to. Related Episode on Night Eating Syndrome Night Eating Syndrome on Apple & Spotify (my most popular podcast episode of all time!) Why Am I Eating at Night? Understanding Night Eating Syndrome in Your 30s, 40s, & 50s on Apple & Spotify. Learn More and Get Support If Night Eating Syndrome or binge eating feels familiar to you, support and recovery are possible. Inside my virtual Binge Eating Recovery Membership, you'll find a self-paced, compassionate space to explore the roots of your eating behaviors while building executive-function skills, sensory supports, and self-trust. Learn more at drmariannemiller.com.

Why does recovery from an eating disorder feel so fragile, even after years of hard work? In this episode of Dr. Marianne Land, Dr. Marianne Miller unpacks the realities of relapse in long-term eating disorder recovery—what causes it, how to navigate it, and why recovery doesn't stick in a culture that constantly reinforces shame, anti-fat bias, and unrealistic expectations of healing. Episode Overview This eating disorder relapse podcast episode explores the complexity of staying recovered after years or decades of healing. Dr. Marianne explains how relapse is not a personal failure but rather an opportunity to understand what your body and nervous system are communicating. Through a neurodivergent-affirming and body-liberation lens, she breaks down why recovery ebbs and flows and how you can rebuild stability with compassion instead of judgment. Listeners will learn what it really takes to sustain long-term eating disorder recovery, how trauma and stress can reignite old coping mechanisms, and how to approach relapse as part of the process—not the end of it. Key Topics Covered The real meaning of recovery and why “staying recovered” forever is an unrealistic expectation. How the nervous system and trauma memory create vulnerability to relapse. Why life transitions, burnout, and chronic stress often trigger eating disorder relapse. How anti-fat bias, weight stigma, and cultural messaging undermine sustainable recovery. The unique challenges of neurodivergent eating disorder recovery and how to meet sensory and executive-function needs. How to rebuild body trust after relapse through curiosity, safety, and self-compassion. Practical tools for sustainable recovery strategies that evolve as your life changes. Who This Episode Is For This episode is for anyone living with a long-term eating disorder who feels discouraged by relapse or fears they are “backsliding.” It's also for therapists, dietitians, and family members who want to understand why recovery doesn't stickfor everyone—and how to provide affirming, compassionate support. Why This Episode Matters In a world where recovery is often portrayed as a linear journey, this episode challenges that myth. Relapse in long-term eating disorder recovery is common, but few people talk about it without shame. Dr. Marianne brings honesty, education, and hope to a topic that deserves care. Relapse is not failure, it's feedback. And when you learn to listen to what your body needs, you can rebuild a recovery that truly fits your life. Related Episodes on Long-Term Eating Disorders Orthorexia, Quasi-Recovery, & Lifelong Eating Disorder Struggles with Dr. Lara Zibarras @drlarazib on Apple & Spotify. Navigating a Long-Term Eating Disorder on Apple & Spotify. Why Eating Disorder Recovery Feels Unsafe: Facing Ambivalence in Long-Term Struggles on Apple & Spotify. Perfectionism, People-Pleasing, & Body Image: Self-Compassion Tools for Long-Term Eating Disorder Recovery With Carrie Pollard, MSW @compassionate_counsellor on Apple & Spotify. Learn More and Get Support For more on long-term eating disorder recovery, ARFID, binge eating, body trust, and sustainable recovery strategies, visit drmariannemiller.com.

Can anxiety about food safety quietly shape the way an entire family eats, lives, and loves? In this episode of Dr. Marianne-Land: An Eating Disorder Recovery Podcast, Dr. Marianne Miller, LMFT, talks with Tamara Hubbard, LCPC, founder of The Food Allergy Counselor and The Academy of Food Allergy Counseling. Together, they explore how food allergy anxiety can affect both children and parents, sometimes leading to ARFID-like eating patterns and significant emotional distress. Tamara shares her journey from being a parent of a child with a peanut allergy to becoming a national leader in the field of food allergy mental health. She discusses how chronic fear and misinformation can cause families to become trapped in cycles of hypervigilance and restriction. She and Dr. Marianne also examine how therapy can help families move toward flexibility, autonomy, and connection at the table. Listeners will hear how Acceptance and Commitment Therapy (ACT) and values-based approaches support parents in balancing safety with freedom, and how addressing anxiety can improve both emotional well-being and quality of life. Key Topics Covered The difference between food allergies and food intolerances and why accurate understanding matters How food allergy anxiety can spread through families and mimic ARFID symptoms The role of parental fear in shaping a child's own food relationship and daily life The risks of restriction-based medical advice, including some functional medicine practices How ACT and mindfulness tools can help parents tolerate fear and stay connected to their values Ways to calm the fight-or-flight response and reduce hypervigilance around food and safety Why collaboration between therapists and allergists creates stronger, safer support for families Who This Episode Is For This episode is for parents and caregivers who want to understand how food allergies, anxiety, and ARFID intersect in family life. It is also for therapists, dietitians, and healthcare providers who want to learn how to support families with evidence-based, trauma-informed, and values-driven care. Food Allergy Resources Mentioned Book: May Contain Anxiety: Managing the Overwhelm of Parenting Children With Food Allergies by Tamara Hubbard, LCPC (Johns Hopkins University Press, 2025) Website: The Food Allergy Counselor for educational articles, therapeutic resources, and directories of food allergy-informed therapists Organization: The Academy of Food Allergy Counseling for clinician training and professional community Article: Allergic Living Magazine Airline Allergy Travel Guide for details on how major airlines handle food allergy policies Advocacy Resource: No Nut Traveler by Leanne Mandelbaum, advocating for safer air travel for people with food allergies Therapeutic Framework: Acceptance and Commitment Therapy (ACT) for managing anxiety and values alignment Cultural Reference: We Can Do Hard Things by Glennon Doyle as a reminder of resilience and self-compassion Content Caution This episode includes discussions of allergic reactions, anaphylaxis, and eating challenges. Please take care while listening if these topics may feel activating or distressing. Learn More and Get ARFID and Selective Eating Support Visit ARFID and Selective Eating Course. This virtual program provides a compassionate, neurodivergent-affirming framework that helps families and clinicians create safety, flexibility, and understanding around food.

Do people praise your discipline while ignoring your struggle with a long-term eating disorder? In this solo episode of Dr. Marianne-Land: An Eating Disorder Recovery Podcast, Dr. Marianne Miller, LMFT, unpacks the cultural myth of the “high-functioning” eating disorder and explores why so many lifelong eating disorders go unnoticed, untreated, or mislabeled as willpower or success. Episode Overview So many people live for decades with an eating disorder that never fully goes away—because the world keeps rewarding them for being productive, disciplined, or “healthy.” Dr. Marianne explains how functioning can become a form of masking, how trauma and safety patterns reinforce chronic disordered eating, and why recovery often requires dismantling the very systems that taught us to perform instead of rest. This episode brings honesty and compassion to those who have felt unseen by treatment models that only recognize crisis, and validation to those who have carried invisible pain behind competence and control. Key Topics Covered What “high-functioning” really means and why it's a harmful label How lifelong eating disorders become normalized and overlooked The hidden costs of functioning and perfectionism Trauma, safety, and why control feels protective How privilege shapes who gets labeled “high-functioning” Recovery pathways for long-term and late-stage eating disorders The difference between surviving and actually living Who This Episode Is For This episode is for anyone who has lived with chronic disordered eating, for those who have been told they “don't look sick,” and for clinicians seeking to better understand the quiet suffering that hides behind high performance. It's also for neurodivergent listeners and those in larger bodies who have felt unseen in traditional eating disorder spaces. Related Episodes   Learn More and Get Support for Lifelong Eating Disorders You can explore therapy, coaching, and recovery resources at drmariannemiller.com. If you're ready to deepen your healing, check out Dr. Marianne's virtual, self-paced ARFID and Selective Eating Course, designed to support autonomy, sensory needs, and manageable recovery. You can also follow Dr. Marianne on Instagram @drmariannemiller.

In this solo episode of Dr. Marianne-Land: An Eating Disorder Recovery Podcast, fat-positive therapist and eating disorder specialist Dr. Marianne Miller, LMFT explains why she no longer uses the label “Atypical Anorexia.” She discusses how anti-fat bias, weight stigma, and systemic discrimination in eating disorder treatment have shaped the diagnostic criteria for anorexia and harmed people in larger bodies. Listeners will learn how the term “atypical” upholds thinness as the standard for illness, why that belief leads to delayed diagnoses, and how shifting our language can expand access to inclusive, weight-neutral, and neurodivergent-affirming eating disorder care. Through clinical insight, real-world examples, and liberation-focused analysis, Dr. Marianne reframes what anorexia recovery truly means: healing one's relationship with food, body, and self without hierarchy, shame, or size bias. Key SEO Topics Covered What Is “Atypical Anorexia”? Understanding the origins of the term and how it reinforces weight stigma and anti-fat bias. Why Thinness Shouldn't Define Anorexia: How body diversity challenges outdated diagnostic models. The Role of Weight Stigma in Anorexia Recovery: How medical bias limits access to eating disorder therapyand treatment coverage. Cultural and Systemic Bias in Eating Disorder Diagnosis: How fatphobia, whiteness, and ableism distort who gets diagnosed. Intersectionality and Neurodivergence: How autism, ADHD, race, and gender identity affect the experience and recognition of anorexia. What Inclusive Eating Disorder Treatment Looks Like: How clinicians can provide weight-inclusive, trauma-informed, neurodivergent-affirming care. Body Liberation and Recovery: Why reclaiming the word “anorexia” for all bodies fosters belonging and healing. Who This Episode Is For This episode is for anyone interested in inclusive anorexia recovery and liberation-centered eating disorder treatment. It's especially for: People in larger bodies who have experienced restriction or medical dismissal. Clinicians seeking to decolonize their approach to eating disorder therapy. Neurodivergent listeners navigating food restriction or sensory challenges. Individuals recovering from anorexia who were told they are “not sick enough.” Advocates, parents, and students learning about anti-fat bias and weight-inclusive recovery models. Why This Conversation Matters The label “Atypical Anorexia” perpetuates harmful myths about body size, illness, and worthiness. It tells people in larger bodies that their pain is less valid and their recovery less urgent. In reality, anorexia occurs in every body size, race, gender, and neurotype. By challenging the term “atypical,” Dr. Marianne advocates for body-liberation-aligned, anti-bias eating disorder therapy that validates all lived experiences. This conversation helps listeners unlearn weight stigma and invites the eating disorder field to adopt inclusive, evidence-based, fat-positive practices that honor every body's right to care and nourishment. Other Episodes on "Atypical Anorexia" Atypical Anorexia Explained: Why Restriction Happens at Every Body Size on Apple or Spotify. Atypical Anorexia with Amy Ornelas, RD on Apple or Spotify. Atypical Anorexia: Mental & Physical Health Risks, Plus How the Term is Controversial on Apple or Spotify. What Is Atypical Anorexia? Challenging Weight Bias in Eating Disorder Treatment with Emma Townsin, RD @food.life.freedom on Apple or Spotify. Learn More and Get Support Visit drmariannemiller.com to learn more about Dr. Marianne Miller's eating disorder therapy, coaching, and educational resources. Her website offers blog posts, podcast transcripts, and tools for people seeking anorexia recovery support, ARFID education, and neurodivergent-affirming treatment.

In this powerful and affirming conversation, Dr. Marianne Miller welcomes Dr. Emma from Divergent Life, a UK-based neuroaffirming clinical psychologist and thought leader. Together, they explore the intersections of neurodivergence, eating disorders, masking, trauma, and embodiment, examining what true safety and self-trust look like in recovery. Dr. Emma shares her journey toward becoming an eating disorder specialist, her resistance to standardized and compliance-based treatment models, and how her activist, trauma-informed, and social justice-oriented approachshapes her work. Listeners will hear both clinicians reflect on their lived experiences, discuss the harm of medicalized narratives, and explore how therapy can become a form of activism, embodiment, and reclamation. Who This Episode Is For This episode is for anyone who has ever felt unseen or invalidated by traditional eating disorder treatment systems. It is especially meaningful for: Neurodivergent individuals who have struggled with masking, sensory sensitivities, or feelings of disconnection from their bodies People in eating disorder recovery who have not found healing in standardized or compliance-based programs Clinicians and therapists who want to practice from a neurodivergent-affirming, trauma-informed, and social justice lens Parents and caregivers of neurodivergent loved ones seeking compassionate, autonomy-honoring approaches Anyone interested in embodiment, body trust, and authentic recovery Key Topics Covered Why standardized and compliance-based eating disorder treatments can be retraumatizing The effects of masking and self-abandonment in neurodivergent people How embodiment and sensory awareness support authentic healing Understanding neurodivergent trauma and nervous system responses Reclaiming autonomy and agency in recovery How therapy can serve as a tool for social justice and liberation The importance of lived experience in guiding compassionate care About the Guest Dr. Emma (she/her) is a neuroaffirming clinical psychologist, coach, and founder of Divergent Life, a UK-based service that challenges outdated mental health systems and centers neurodivergent and trauma-informed care. Through her work, she helps clients move from masking and compliance toward embodiment, agency, and trust in their own inner wisdom. Instagram: @divergentlives Website: divergentlife.co.uk Why This Episode Matters This conversation redefines what healing can look like for neurodivergent people with eating disorders, particularly those who have felt unseen or misunderstood by traditional models. Dr. Marianne and Dr. Emma discuss how masking and system-based approaches can lead to disembodiment and how safety, trust, and agency can guide recovery instead. If you have ever questioned why “one-size-fits-all” therapy has not worked for you, or if you are a clinician seeking to practice in a way that honors autonomy and lived experience, this episode offers deep insight, compassion, and hope. Related Episodes on Neurodivergent Needs & Experiences Recovering Again: Navigating Eating Disorders After a Late Neurodivergent Diagnosis (Part 1) With Stacie Fanelli, LCSW @edadhd_therapist via Apple & Spotify. Stuck on Empty: Autistic Inertia, ARFID & the Struggle to Eat via Apple & Spotify Minding the Gap: The Intersection Between AuDHD & Eating Disorders With Stacie Fanelli, LCSW @edadhd_therapist via Apple & Spotify Our Personal Neurodivergent Stories via Apple & Spotify. Learn More and Get Support Check out  drmariannemiller.com for blog posts, therapy services, more podcast episodes, and other offerings. To learn about Dr. Marianne's ARFID and Selective Eating Course, visit drmariannemiller.com/arfid.