Podcast appearances and mentions of marianne miller

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

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

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

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

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

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

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

Today, I have a returning guest to the podcast and I'm talking to Dr. Marianne Miller, an eating disorder therapist, educator, consultant, and host of the Dr. Marianne-Land podcast. She specialises in neurodivergent-affirming treatment for ARFID, autism, ADHD, PDA profiles, anorexia nervosa, bulimia nervosa, and binge eating disorder. Through virtual consultation, she partners with organizations throughout the United States and internationally to help clinicians build greater confidence in working with neurodivergent clients and to create treatment environments where autistic and ADHD individuals can recover without masking who they are. Today, Dr. Marianne is going to educate us more about neurodivergence, eating disorders and particularly focusing on ARFID. She explores why neurodivergent people are vulnerable to eds and disordered eating. She explains more about relationship with food and neurodiversity. She talks about how treatment can be adapted to support neurodivergent people to heal. I hope that you enjoy the episode. To find out more about Dr. Marianne's work: https://www.drmariannemiller.com/  

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

When does trying to be healthy cross the line into rigid or disordered eating? Healthmaxxing focuses on optimizing nutrition, protein, exercise, sleep, steps, and other health metrics. But for someone with an eating disorder or history of disordered eating, healthmaxxing can become another way to follow rigid rules, compulsively track behaviors, and disconnect from the body. In this episode of Dr. Marianne-Land, Dr. Marianne talks with registered dietitian and eating disorder specialist Amy Ornelas, RD, about healthmaxxing, diet culture, protein obsession, fitness trackers, compulsive exercise, and eating disorder recovery. Is Healthmaxxing the New Diet Culture? Healthmaxxing may look different from traditional dieting, but some of the messages sound familiar: eat the “right” foods, maximize protein, hit your steps, exercise consistently, track your metrics, and keep improving. Dr. Marianne and Amy discuss how healthmaxxing can become a socially acceptable form of rigid or disordered behavior. For someone recovering from an eating disorder, relying on an Apple Watch, Oura Ring, calorie tracker, or wellness influencer may also make it harder to rebuild trust in hunger, fullness, fatigue, and other body cues. Protein, Fitness Trackers, & Compulsive Exercise Protein has become one of the biggest trends in nutrition and wellness culture. Amy compares today's protein obsession to previous diet trends, including the fat-free craze of the 1980s and 1990s. Protein matters, but maximizing protein at every meal doesn't automatically make eating healthier. Dr. Marianne and Amy also unpack step counts, exercise goals, calorie tracking, and wearable fitness devices. Fitness data can provide useful information for some people, but it can also reinforce compulsive exercise, perfectionism, and eating disorder behaviors. Your body's needs change. Rest, relationships, sleep, pleasure, and spontaneity matter too. Eating Disorder Recovery & Rebuilding Body Trust Eating disorders can make hunger, fullness, fatigue, emotion, and physical sensations difficult to interpret. That uncertainty can make external rules and health metrics especially appealing. Amy explains how eating disorder nutrition therapy can provide appropriate structure as someone rebuilds nourishment and reconnects with their body. Unlike an algorithm or influencer, individualized nutrition support considers a person's history, eating disorder behaviors, physical needs, and recovery. Dr. Marianne and Amy also discuss what happens when fitness becomes part of your identity. Letting go of compulsive exercise or rigid health behaviors can raise a difficult question: Who am I if I'm no longer the person who always works out, eats a certain way, or prioritizes fitness? Recovery can create room to discover an identity beyond food, weight, exercise, and optimization. What You'll Learn You'll hear Dr. Marianne and Amy discuss healthmaxxing and disordered eating, diet culture and wellness culture, protein obsession and nutrition trends, fitness trackers and calorie tracking, compulsive exercise and step goals, fitness identity, hunger and fullness cues, body trust, and nutrition therapy in eating disorder recovery. They also ask a bigger question: What happens when trying to optimize your health starts taking away from your life? About Amy Ornelas, RD Amy Ornelas is a registered dietitian and eating disorder specialist with more than two decades of experience. She incorporates nutrition therapy, somatic therapy, yoga, and intuitive practices into her work with adolescents and adults. Her own eating disorder recovery helped shape her commitment to helping people move away from diet culture, rigid food rules, body image struggles, and disconnection from their bodies. Instagram: @amyornelasRD Website: i-heart-nutrition.com Related Episodes Have you ever had the experience of suddenly feeling huge in your body, even though nothing about your body has actually changed? That moment of intense body distress is incredibly common in eating disorder recovery. But what if that feeling is not really about body size at all? In this episode of Dr. Marianne-Land, Dr. Marianne Miller is joined by Amy Ornelas, RDN, an eating disorder dietitian, yoga teacher, and somatic therapy practitioner, to explore what body distress may actually be signaling underneath the surface. Together, they unpack how thoughts like “I feel huge” can often reflect emotional activation, overwhelm, grief, shame, anger, or stress rather than a literal change in body size. Amy explains how eating disorder behaviors such as restriction, binge eating, and purging can alter brain chemistry and disconnect people from their internal emotional world. When those behaviors begin to shift in recovery, many people suddenly find themselves face to face with emotions that may have been numbed or pushed aside for years. This can feel confusing, intense, and sometimes even frightening. Dr. Marianne and Amy talk about how eating disorders can function as powerful survival strategies that help people manage overwhelming emotional states. Rather than demonizing these behaviors, they explore how they often develop as adaptive coping mechanisms in environments where emotional expression was discouraged, dismissed, or unsafe. The conversation also highlights how family dynamics, culture, trauma, and neurodivergence can shape the way people learn to relate to their emotions. Many individuals grow up hearing messages that they are too sensitive, too emotional, or should simply get over what they feel. Over time, these messages can make emotional awareness feel dangerous or overwhelming. Amy introduces the role of somatic therapy in eating disorder recovery and explains how body-based approaches can help people reconnect with their internal sensations in a gradual and supportive way. Instead of forcing emotional processing, somatic work focuses on building safety in the nervous system and slowly increasing the capacity to notice and tolerate emotional states. Dr. Marianne and Amy also discuss how body image distress can function as a powerful distraction. It can feel easier to focus anger, fear, or grief on the body than to confront deeper sources of pain, such as relational conflict, social stress, or systemic injustice. Learning to translate body distress into emotional language can help people understand what their internal system is truly trying to communicate. This episode also addresses an important reality in eating disorder recovery: sometimes people appear more emotionally dysregulated as they begin healing. That increase in emotional expression can actually be a sign that someone is reconnecting with their inner world after years of emotional numbing. Amy shares several practical tools that can help people begin reconnecting with their emotions, including brief emotional check-ins throughout the day, asking simple questions about what feelings may be present when eating disorder urges arise, and using movement to help emotional energy move through the body. Dr. Marianne also brings in a neurodivergent-affirming lens, discussing how stimming, rocking, sensory soothing, and other nervous system supports can help people stay connected to themselves during emotionally intense moments. Together, they emphasize that emotions are not problems to eliminate. They are information from our internal systems that help guide us toward safety, boundaries, authenticity, and healing. In this episode, we discuss How eating disorder behaviors can numb or redirect difficult emotions. Why recovery often brings a surge of feelings to the surface, What somatic therapy is and how it can support eating disorder recovery. Why the thought “I feel huge” often reflects emotional distress rather than body change. How trauma, family systems, and culture shape emotional expression. Why body image distress can act as a distraction from deeper pain. The difference between compartmentalizing emotions and avoiding them. Why increased emotional intensity can be a sign of progress in recovery. Practical ways to begin noticing and naming emotions during recovery. How neurodivergent people may benefit from stimming and sensory supports. About the guest Amy Ornelas, RDN, is a registered dietitian nutritionist, eating disorder specialist, yoga teacher, and somatic therapy practitioner based in California. She works with individuals, families, and groups and integrates nutrition care with somatic and nervous system–informed approaches to eating disorder recovery. Connect with Amy Ornelas Instagram: @amyornelasRD Website: i-heart-nutrition.com Listen if you are Experiencing intense body image distress during eating disorder recovery. Trying to understand why recovery can bring more emotion, not less. Curious about somatic therapy and body-based approaches to healing. Looking for tools to help manage urges to restrict, binge, or purge. Interested in understanding the emotional layers beneath body distress. Related episodes On "I Feel Huge" Versus "What I'm Actually Feeling": Translating Body Distress Into Emotions" via Apple or Spotify. On Eating Disorders as a Coping Strategy for Deeper Pain via Apple or Spotify. On Eating Disorders in Midlife & Our Personal Recovery Stories via Apple or Spotify. On Atypical Anorexia via Apple or Spotify On Eating Disorder Recovery, Higher Level of Care, & Renourishment via Apple or Spotify On Reconnecting With Your Body in Eating Disorder Recovery via Apple or Spotify On Trauma, Eating Disorders, & Levels of Care via Apple or Spotify. Work With Dr. Marianne If healthmaxxing, compulsive exercise, rigid food rules, body image concerns, or anxiety around eating have become tangled up with your eating disorder, Dr. Marianne offers a neurodivergent-affirming, trauma-informed approach to eating disorder recovery. Dr. Marianne specializes in ARFID, binge eating, anorexia, and bulimia, including the ways eating disorders intersect with autism, ADHD, sensory needs, and trauma. She offers eating disorder therapy in California and Washington, D.C., as well as virtual coaching for people elsewhere. She also offers a self-paced ARFID & Selective Eating course for adults with ARFID, parents and caregivers, and providers. Visit drmariannemiller.com to learn more about working with Dr. Marianne. Follow @drmariannemiller on Instagram and listen to Dr. Marianne-Land on Apple Podcasts and Spotify.

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

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

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

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

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

Do you spend the entire day feeling in control around food, only to find yourself eating far more than expected at night? If nighttime eating leaves you feeling confused, ashamed, or convinced that you lack willpower, this episode may offer a different perspective. Many people with Night Eating Syndrome focus on what happens after dinner without realizing that the story often begins much earlier. Delayed meals, subtle restriction, chronic stress, ADHD, autism, masking, trauma, sensory overwhelm, and nervous system exhaustion can all shape eating patterns that become more intense in the evening. When we look only at nighttime eating, we often miss the conditions that created it. In this episode of the Dr. Marianne-Land Podcast, Dr. Marianne Miller explores Night Eating Syndrome through a neurodivergent-affirming, trauma-informed lens. She discusses why nighttime eating is often a predictable response to unmet physiological and emotional needs rather than a sign of laziness, lack of discipline, or personal failure. Understanding Night Eating Syndrome Night Eating Syndrome, often called NES, involves consuming a significant portion of daily food intake during the evening hours or after waking during the night. Many people with Night Eating Syndrome notice little appetite earlier in the day and increasing hunger as the day progresses. Although Night Eating Syndrome can overlap with binge eating disorder, the two experiences are not identical. Understanding the distinction can help people find more effective support and avoid treatments that fail to address the underlying drivers of nighttime eating. Why Nighttime Eating Often Starts Earlier in the Day One of the most overlooked aspects of Night Eating Syndrome is the role of daytime deprivation. Restriction does not always look like skipping meals or intentionally dieting. Sometimes it shows up as rushing through meals, ignoring hunger cues, eating foods that never feel satisfying, relying on caffeine to suppress appetite, or becoming so busy that nourishment consistently falls to the bottom of the priority list. Over time, the body responds to those unmet needs. For many people, nighttime becomes the point when hunger, exhaustion, stress, and emotional depletion can no longer be ignored. ADHD, Autism, Masking, and Eating at Night Neurodivergent adults often face unique challenges around food and eating. ADHD can make meal planning, meal timing, and hunger awareness more difficult. Autism can influence sensory experiences, interoception, routines, and food preferences. Many neurodivergent people also spend significant energy masking throughout the day, navigating sensory demands, social expectations, and executive functioning challenges. By evening, the nervous system may be depleted. Food can become a source of grounding, comfort, regulation, predictability, stimulation, or relief. This episode explores how neurodivergence can shape nighttime eating patterns in ways that are frequently misunderstood within traditional eating disorder treatment models. The Connection Between Restriction and Night Eating Syndrome Many people blame nighttime eating for their distress while overlooking the role of restriction. Whether restriction stems from dieting, weight stigma, food rules, sensory challenges, executive functioning barriers, or chronic stress, the body often responds by increasing attention to food and hunger later in the day. Rather than viewing nighttime eating as evidence of a lack of control, Dr. Marianne encourages listeners to consider what their body may be trying to communicate. Weight Stigma, Diet Culture, and Shame Diet culture frequently rewards people for disconnecting from hunger and ignoring physical needs. At the same time, society often condemns the very eating behaviors that emerge when deprivation accumulates. This contradiction leaves many people feeling trapped in cycles of guilt and self-criticism. In this episode, Dr. Marianne examines how anti-fat bias, productivity culture, and cultural pressure to suppress needs can contribute to Night Eating Syndrome and nighttime eating struggles. What You'll Learn You'll learn how Night Eating Syndrome differs from binge eating disorder, why subtle forms of restriction often go unnoticed, how ADHD and autism can influence eating patterns, why masking and burnout can increase vulnerability to nighttime eating, and how shame frequently keeps people stuck in cycles that make sense from a nervous system perspective. You'll also gain a more compassionate framework for understanding nighttime eating and practical ways to begin approaching these patterns with curiosity instead of self-judgment. Related Episodes Anorexia & Night Eating Syndrome: Why Restriction Fuels Night Eating & What Helps on Apple & Spotify. Night Eating Syndrome on Apple & Spotify (my 2nd most popular podcast episode of all time!) Understanding Night Eating Syndrome: Executive-Function Tools for Real Recovery on Apple & Spotify. Why Am I Eating at Night? Understanding Night Eating Syndrome in Your 30s, 40s, & 50s on Apple & Spotify. Work With Dr. Marianne Miller If you are struggling with Night Eating Syndrome, binge eating disorder, ARFID, anorexia, bulimia, chronic dieting, or neurodivergent eating challenges, support is available. Dr. Marianne Miller is a licensed eating disorder therapist providing therapy throughout California and Washington, D.C. She also offers coaching services worldwide. Her work integrates eating disorder treatment, neurodivergent-affirming care, trauma-informed approaches, and weight-inclusive support for adults, teens, and families. Learn more about therapy, coaching, courses, and resources at www.drmariannemiller.com. You can also follow Dr. Marianne on Instagram at @drmariannemiller and subscribe to the Dr. Marianne-Land Podcast on Apple Podcasts, Spotify, or your favorite podcast platform.

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

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

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

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

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

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

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

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

What happens when you relate to parts of autism, ADHD, giftedness, sensory sensitivity, masking, and trauma, but never fully fit into one diagnosis or label? In this timely conversation, Dr. Marianne Miller sits down with neuro-affirming clinical psychologist Dr. Emma Offord to explore “neurohybridity,” a term Emma developed to describe the fluid, overlapping, and mosaic-like nature of neurodivergent identity. Together, they unpack why so many late-diagnosed autistic and ADHD adults, especially women and marginalized people, feel unseen by rigid diagnostic systems and traditional mental health models. This episode explores late-diagnosed autism, ADHD in adults, masking, giftedness, medically unexplained symptoms, trauma, neurodivergence in midlife, and the limitations of the DSM and medicalized language. Dr. Emma Offord shares how safety, environment, nervous system regulation, identity, and lived experience can shape how neurodivergent traits appear and why many people feel they do not fully belong within one category. If you have ever questioned whether you are “autistic enough,” “ADHD enough,” too emotional to be autistic, or too complicated for a single diagnosis, this conversation may help you feel seen in a completely different way. What Is Neurohybridity? Dr. Emma Offord describes neurohybridity as an invitation to move beyond rigid diagnostic boxes and recognize the dynamic nature of neurodivergent experience. Rather than viewing people through fixed categories, neurohybridity acknowledges that many individuals identify with multiple neurotypes, sensory experiences, cognitive styles, and ways of moving through the world. Marianne and Emma discuss how neurodivergent traits can shift depending on context, stress, environment, nervous system safety, masking, trauma, and support systems. They also explore how someone can feel sensory-seeking in one moment and sensory-avoidant in another, emotionally expressive yet highly masked, or deeply connected to multiple neurodivergent identities at once. The conversation also examines how many people become trapped between diagnostic categories and how current systems often fail individuals whose experiences do not fit neatly into one lane. Late-Diagnosed Autism, ADHD, & Misdiagnosis Many neurodivergent adults grow up feeling different without having language for their experiences. Dr. Emma Offord shares how traveling extensively as a child, experiencing grief and loss, and later discovering neurodivergence shaped her understanding of identity and belonging. Marianne and Emma discuss how outdated autism and ADHD stereotypes continue to affect diagnosis, especially for women, emotionally expressive people, and those who have spent years masking. They also explore how traditional diagnostic models can overlook the complexity of lived experience, particularly for people who move between different neurodivergent presentations over time. This episode speaks directly to people who have felt misdiagnosed, unseen, invalidated, or confused by rigid definitions of neurodivergence. The Limits of the Medical Model Marianne and Emma also explore the emotional and systemic consequences of reducing people to diagnostic checklists and symptom categories. They discuss how diagnosis can simultaneously provide access to protection, accommodations, and community while also limiting how people understand themselves. The conversation touches on medical trauma, medically unexplained symptoms, intersectionality, research bias, and the ways historically marginalized groups are often excluded from dominant mental health narratives. Together, they explore the need for more collaborative, flexible, neurodivergent-affirming systems of care that allow people to exist beyond narrow definitions. About Dr. Emma Offord Dr. Emma Offord is a neuro-affirming clinical psychologist, coach, speaker, and founder of Divergent Life. Her work focuses on neurodivergence, masking, trauma-informed care, relational safety, identity, and the lived experience of late-discovered neurodivergence. Emma developed the concept of neurohybridity to describe the fluid, dynamic, and interconnected nature of neurodivergent identity. She is currently writing a book exploring these ideas and amplifying the voices of people who have felt unseen or misunderstood within traditional diagnostic systems. Connect With Dr. Emma Offord You can connect with Dr. Emma Offord on Instagram at @divergentlives, through the Divergent Life website, and through This Voice Is Mine: The Unquiet Podcast. Related Episodes With Dr. Emma Offord and on Neurodivergent Needs and Experiences Unmasking, Embodiment, & Trust: A Neurodivergent Approach to Eating Disorder Recovery With Dr. Emma Offord @divergentlives on Apple & Spotify. Why Eating Still Breaks Down for Neurodivergent People With Long-Term Eating Disorders on Apple & Spotify. Unmasking in Eating Disorder Recovery: What Neurodivergent People Need to Know About Safety & Healing via Apple & Spotify. Autism & Anorexia: When Masking Looks Like Restriction, & Recovery Feels Unsafe via Apple & Spotify. Recovering Again: Navigating Eating Disorders After a Late Neurodivergent Diagnosis (Part 1) With Stacie Fanelli, LCSW @edadhd_therapist via Apple & Spotify. Work With Dr. Marianne Dr. Marianne Miller is an eating disorder therapist and LMFT specializing in ARFID, binge eating disorder, autism, ADHD, neurodivergence, and eating disorder recovery. She offers therapy services for clients in California, Washington, D.C., and globally through coaching support. For therapy, coaching, podcast episodes, courses, and other resources, visit Dr. Marianne's website and follow along on Instagram @drmariannemiller.

When Safe Foods Stop Working: ARFID Plateaus, Burnout, & What Helps on Apple & Spotify. ARFID Explained: What It Feels Like, Why It's Misunderstood, & What Helps on Apple & Spotify. Why Sensory-Attuned Care Matters More Than Exposure in ARFID Treatment on Apple & Spotify. Complexities of Treating ARFID: How a Neurodivergent-Affirming, Sensory-Attuned Approach Works on Apple & Spotify. Work With Dr. Marianne Dr. Marianne Miller is a Licensed Marriage and Family Therapist specializing in ARFID, binge eating disorder, and neurodivergent-affirming eating disorder care. She offers therapy and coaching for clients in California, Washington, D.C., and globally. Check out her website drmariannemiller.com.  Follow her on Instagram @drmariannemiller. Email her directly at hello@drmariannemiller.com. Dr. Marianne also has an excellent virtual, self-paced ARFID and Selective Eating Course that's perfect for folks with ARFID who need more understanding and resources. It is neurodivergent-affirming, sensory-attuned, and trauma-informed.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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.

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.

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.

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