Podcast appearances and mentions of marianne miller

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

In this episode of Dr. Marianne-Land, Dr. Marianne Miller explores one of the most misunderstood experiences in eating disorder recovery: binge eating and shame. She explains why binge eating is not caused by lack of willpower. It develops from deprivation, unmet emotional needs, and internalized shame. You will learn how restriction fuels binge urges, how shame keeps you stuck, and how compassion-based recovery helps you rebuild trust with food and your body. Why Binge Eating Isn't About Willpower Many people believe binge eating happens because they lack control. In truth, binge eating is a biological and emotional response to restriction. When your body senses scarcity, it does what it was designed to do: it pushes you to eat. Dr. Marianne discusses how diet culture and fear-based food rules create deprivation and shame. The body responds to this deprivation by seeking safety through eating, sometimes in large quantities. The solution is not to control yourself more, but to give your body the consistent nourishment and compassion it needs. How Shame Fuels the Binge Cycle Shame is one of the strongest emotional drivers of binge eating. After a binge, thoughts like “I failed again” or “I'll start over tomorrow” appear. Those thoughts lead to more restriction, which triggers another binge. Dr. Marianne explains how shame disconnects you from your body and keeps you in a cycle of punishment and control. The shift begins when you replace blame with curiosity. Asking “What does my body need right now?” helps you reconnect to your needs instead of silencing them. The Biology Behind Binge Eating Binge eating is a predictable response to restriction. When your body does not receive enough food, hunger hormones increase, reward pathways in the brain intensify, and cravings become urgent. Binge eating is your body's attempt to restore balance. Mental restriction has the same effect. When you label foods as bad or forbidden, your body perceives danger and increases urgency around those foods. Regular meals, adequate nutrition, and permission to eat satisfying foods restore body trust and calm the nervous system. Emotional Safety and Recovery Binge eating is often a way to self-soothe when emotions feel too big or overwhelming. If you have been taught that sadness, anger, or fear are unsafe, food may have become your most accessible form of comfort. Dr. Marianne talks about creating emotional safety through self-soothing, sensory grounding, and compassion. When your nervous system feels supported, the intensity of binge urges begins to soften. From Control to Compassion Recovery is not about fighting yourself into change. It begins when you stop using control as protection and start practicing compassion. Dr. Marianne shares ways to replace critical self-talk with kind, curious reflection. Instead of saying “I have no willpower,” try “My body is asking for care.” That language shift helps rewire your nervous system to expect gentleness instead of punishment. Reclaiming Pleasure and Satisfaction Food is meant to be enjoyable, not a test of discipline. When you allow yourself to experience satisfaction without guilt, eating becomes calmer and more connected. Dr. Marianne encourages listeners to practice mindful eating, notice textures and flavors, and reconnect with the sensory experience of food. Pleasure is not indulgence; it is information that helps you understand what your body needs. Content Caution This episode includes open discussion about binge eating and emotional distress related to food and body image. Please listen with care and take breaks as needed. Who This Episode Helps This episode is for anyone who feels stuck in binge-restrict cycles or wants to understand the emotional roots of binge eating. It is also helpful for clinicians supporting clients with binge eating disorder, and for neurodivergent listeners who need a sensory-attuned and trauma-informed approach to recovery. Related Episodes on Binge Eating Binge Eating in Midlife: Why It Starts (or Resurfaces) in Your 30s, 40s, 50s on Apple & Spotify. Binge Eating Urges: Why They Happen & How to Manage Them Without Shame on Apple & Spotify. How to Manage Triggers & Cravings During Recovery From Binge Eating & Bulimia on Apple & Spotify. Join the Binge Eating Recovery Membership If you are ready to heal your relationship with food, Dr. Marianne invites you to join her Binge Eating Recovery Membership at drmariannemiller.com. This membership offers accessible lessons, community support, and practical tools to help you move beyond shame, regulate emotions, and create consistency with food without dieting or control. Inside, you will learn how to rebuild body trust, reduce binge frequency, and practice compassionate recovery at your own pace.

Parenting a child with ARFID (Avoidant/Restrictive Food Intake Disorder) can feel confusing and overwhelming. In this episode, Dr. Marianne Miller shares practical and compassionate strategies for parents who want to help their children eat with less fear and more confidence. You will learn why pressure and negotiation tend to backfire, how to create low-stress mealtimes that build safety, and how to attune to your child's sensory needs through a neurodivergent-affirming approach. Whether your child experiences food texture issues, fear of choking, or intense sensory overwhelm, this episode provides grounded, actionable steps for supporting eating with care and collaboration. Key Topics Covered Understanding ARFID beyond “picky eating” and recognizing it as a real eating disorder rooted in fear, sensory distress, or trauma Why pressure and negotiation can increase distress and decrease trust How sensory context affects eating and what small environmental changes can help Transitioning from authoritative to consent-based parenting that prioritizes autonomy and emotional safety Building trust through predictable, transparent, and compassionate mealtime practices Knowing when to seek professional ARFID-informed, trauma-aware, and neurodivergent-affirming support Who This Episode Is For This episode is for parents, caregivers, and family members who are trying to understand and support a child living with ARFID or selective eating. It is also helpful for therapists, dietitians, educators, and healthcare providers who want to better understand the family dynamics that shape mealtime stress and recovery. Why This Episode Matters Many families are told to use pressure or rewards to encourage eating. While this advice may seem helpful, it often increases distress for children with ARFID. In this episode, Dr. Marianne explains why traditional approaches like “one more bite” or “if you eat your veggies, you can have dessert” can erode trust and worsen fear. Instead, you will hear how shifting toward collaboration, sensory awareness, and emotional safety supports genuine progress. Learning to trust your child's signals and prioritize consent around food can transform your home and restore connection at the table. Content Caution This episode includes discussion of children's eating distress, food avoidance, and anxiety around eating. Please listen with care if these topics may be sensitive for you or your family. Related Episodes ARFID Explained: What It Feels Like, Why It's Misunderstood, & What Helps on Apple & Spotify. Why Sensory-Attuned Care Matters More Than Exposure in ARFID Treatment on Apple & Spotify. ARFID, PDA, and Autonomy: Why Pressure Makes Eating Harder on Apple & Spotify. Complexities of Treating ARFID: How a Neurodivergent-Affirming, Sensory-Attuned Approach Works on Apple & Spotify. Get Additional ARFID Help To learn more about supporting your child's eating with compassion, visit drmariannemiller.com/arfid to explore Dr. Marianne's ARFID & Selective Eating Course. This self-paced, online course provides practical tools, scripts, and real-world examples to help parents reduce mealtime stress, build trust, and approach food in a supportive, neurodivergent-affirming way.

What should every therapist truly understand before working with clients who have eating disorders? In this insightful interview, Dr. Marianne Miller talks with Edie Stark, LCSW (@ediestarktherapy) about what ethical, inclusive care really means. Together, they explore why “gold standard” approaches like Family-Based Treatment (FBT) often miss the mark for neurodivergent, fat, queer, and BIPOC clients. The conversation highlights the importance of cultural humility, anti-fat bias awareness, trauma-informed care, and intersectional understanding in every therapeutic setting. Whether you are a clinician, a student, or someone in recovery who wants to understand what quality treatment should look like, this episode offers a thoughtful look at how therapists can grow, unlearn, and create safe, collaborative spaces for healing. Key Topics Covered Why “gold standard” models like Family-Based Treatment (FBT) do not fit everyone How anti-fat bias and wellness culture shape eating disorder care The importance of cultural humility and intersectionality in therapy Ways to create trauma-informed, consent-based, and collaborative care What ethical practice looks like when working with neurodivergent and marginalized clients How therapists can identify and challenge their own internalized biases Why eating disorder work requires humility, continual learning, and self-reflection Who This Episode Is For Therapists and dietitians who want to provide ethical and inclusive eating disorder care Students and early-career clinicians who are beginning to work with eating disorders Supervisors and consultants who guide others in complex clinical cases People in recovery who want to understand what to expect from truly affirming treatment Anyone curious about how bias, culture, and power dynamics affect eating disorder recovery Other Episodes With Edie The Hidden Risks of Non-Specialized Eating Disorder Treatment on Apple & Spotify. The Diet/Wellness Industry, Accessibility, & Diet Culture on Apple & Spotify. Anti-Fat Bias & the Importance of Advocacy on Apple & Spotify. About My Guest Edie Stark, LCSW, is the founder of Stark Therapy Group in California and Edie Stark Consulting, where she supports therapists through business consulting, case consultation, and supervision. She's also a feature writer for Psychology Today and advocates for ethical, media-accurate portrayals of eating disorders. Connect with Edie on Instagram at @ediestarktherapy and @edies_edits, or visit ediestark.com. About Dr. Marianne Miller Dr. Marianne Miller is a Licensed Marriage & Family Therapist specializing in eating disorders, ARFID, and binge eating disorder. She practices in California, Texas, and Washington D.C., and teaches self-paced, virtual courses through her binge eating recovery membership and her course ARFID and Selective Eating. Learn more at drmariannemiller.com or follow her on Instagram @drmariannemiller.

When eating disorders overlap with anxiety, OCD, or depression, recovery can feel especially complex. In this episode of Dr. Marianne-Land: An Eating Disorder Recovery Podcast, Dr. Marianne Miller, LMFT, explores how co-occurring mental health conditions interact with disordered eating and body image struggles. She explains how anxiety often fuels food rules and avoidance, how OCD rituals can merge with eating rituals, and how depression can make nourishment feel almost impossible. Throughout the episode, Dr. Marianne shares intersectional case examples that reflect the diversity of real-world experiences. You will hear about a Black nonbinary person whose anorexia and depression are dismissed by medical providers, a South Asian immigrant coping with OCD and bulimia in a culture where discussing mental health is taboo, and others whose experiences reveal how systemic bias and identity shape recovery. This episode offers understanding, compassion, and realistic tools for healing when multiple conditions overlap. What You'll Learn You will learn how anxiety, OCD, and depression intersect with eating disorders, why eating disorders rarely exist alone, and how each condition influences the recovery process. Dr. Marianne explains why addressing only food behaviors is not enough and how integrative treatment supports both the mind and body. You will also hear about sensory-attuned strategies and community-based care that help people move toward safety, nourishment, and autonomy. Key Takeaways Eating disorders often coexist with anxiety, OCD, or depression because they share common roots in trauma, nervous system overwhelm, and attempts to create safety. Anxiety drives control and rigidity, OCD fuels compulsive rituals around food and body, and depression slows motivation and energy, making self-care harder. True recovery acknowledges these overlaps and treats the whole person. Healing does not mean erasing anxiety, OCD, or depression. It means building a life that includes these realities while reducing their control over food and self-worth. Recovery becomes more sustainable when treatment honors a person's full identity, including body size, race, gender, and neurotype. Who This Episode Is For This episode is for anyone who lives with an eating disorder and another mental health condition such as anxiety, OCD, or depression. It is also for clinicians, family members, and supporters who want to understand how co-occurring challenges interact and how to provide compassionate care. Content Caution This episode includes discussion of eating disorders, anxiety, OCD, and depression. Please take care while listening and pause if you need to. Related Episodes Anxiety, Meltdowns, Neurodiversity, & Eating Disorders on Apple & Spotify. Food, Fear, & Fixation: How OCD Shapes Eating Disorders on Apple & Spotify. Depression & Eating Disorders on Apple & Spotify. Connect and Learn More For deeper guidance, visit drmariannemiller.com/arfid to explore Dr. Marianne's ARFID and Selective Eating Course. The course offers neurodivergent-affirming, sensory-attuned strategies that apply to a wide range of eating struggles. To learn about Dr. Marianne's therapy services in California, Texas, and Washington, D.C., or to explore additional blog posts and podcast episodes, visit drmariannemiller.com.  

In this insightful conversation, Dr. Marianne Miller sits down with Dr. Heather Rosen, a licensed clinical psychologist and certified Family-Based Treatment (FBT) supervisor and trainer, to explore how evidence-based treatments for eating disorders can evolve to meet the needs of neurodivergent clients and their families. Dr. Rosen shares her background working in major hospital settings including Stanford University, Lucile Packard Children's Hospital, and Mount Sinai Hospital, and now in private practice in Westchester County, New York. Together, she and Dr. Miller unpack the heart of FBT—how involving families in treatment can strengthen recovery for adolescents and young adults with anorexia, bulimia, binge eating disorder, and ARFID. This episode highlights how food becomes a metaphor for emotional pain, safety, and connection, and why treatment must go beyond meal plans to address the underlying need for autonomy, co-regulation, and family healing. Key Topics Covered What Family-Based Treatment (FBT) is and how it supports adolescent recovery The role of parents in managing eating disorder behaviors at home How FBT differs from other evidence-based treatments like CBT-E Adapting FBT for ARFID (Avoidant/Restrictive Food Intake Disorder) and neurodivergent clients Why flexibility and curiosity are essential when traditional exposure-based methods don't fit Understanding food as communication: how eating (or not eating) expresses pain, fear, and the need for control Shifting from compliance-based models to collaborative, consent-based, and neuroaffirming care The importance of reducing mental health stigma and improving access to effective treatment Who This Episode Is For This conversation is for therapists, dietitians, parents, and educators who want to understand FBT in practice and how to make eating disorder treatment more inclusive for autistic and otherwise neurodivergent youth. It's also for anyone curious about integrating compassion, family systems awareness, and sensory attunement into recovery work. Guest Info Dr. Heather Rosen, PhD Licensed Clinical Psychologist | Certified FBT Therapist & Supervisor Psychology Partners Group – Westchester County, NY Website: psychologypartnersgroup.com Instagram: @hrrosen Related Episodes Family-Based Treatment and Eating Disorders in Schools With JD Ouellette of Equip Health on Apple & Spotify. The Nitty Gritty on Family-Based Treatment for Anorexia (Maudsley Method) With Kelly McCullough @mytherapistkelly on Apple & Spotify. Complexities of Treating ARFID: How a Neurodivergent-Affirming, Sensory-Attuned Approach Works on Apple & Spotify. About Dr. Marianne Miller Dr. Marianne Miller, PhD, LMFT, is a fat, neurodivergent eating disorder therapist specializing in ARFID, binge eating disorder, and complex recovery care. She offers therapy in California, Texas, and Washington, D.C., and provides global support through online courses and resources. Learn more about Dr. Miller's work and self-paced course on ARFID and Selective Eating at drmariannemiller.com/arfid.

Have you ever wondered why recovery feels stuck, no matter how hard you try? When eating disorder behaviors keep returning despite your best efforts, unresolved trauma may be part of the reason. In this episode of Dr. Marianne-Land, Dr. Marianne Miller, LMFT, explores the deep connection between trauma and long-lasting eating disorders. Unresolved trauma often lives in the body, shaping the nervous system and influencing how we cope, eat, and relate to ourselves. Many people discover that their eating disorder was never just about food or control—it was about safety, survival, and protection. This episode helps you understand why that makes sense and how healing is possible when both trauma and the eating disorder are addressed together. Through compassionate storytelling and clinical insight, Dr. Marianne shares how trauma-informed therapy and body-based healing can help release long-held survival patterns. She also discusses how intersectionality, identity, and oppression influence the way trauma shows up in eating disorder recovery. Who This Episode Is For This episode is for anyone who has struggled with eating disorder symptoms that seem to linger, shift, or return over time. It will especially resonate with: People who have been in treatment before yet still feel stuck in their eating disorders Those who sense their eating disorder is connected to trauma, anxiety, or chronic stress Neurodivergent individuals navigating sensory or emotional overwhelm around food Survivors of emotional, physical, or systemic trauma seeking trauma-informed recovery Clinicians, helpers, or loved ones who want to better understand how trauma and eating disorders overlap If you have ever wondered why recovery feels unsafe, inconsistent, or incomplete, this episode will offer language and insight to help you make sense of your experience. What You'll Learn in This Episode How unresolved trauma keeps eating disorder symptoms active for years or decades Why eating disorders are often survival strategies, not failures of willpower The role of the nervous system in trauma and long-term eating disorder recovery How trauma-informed therapy helps create new pathways to safety and regulation Why intersectionality matters in trauma and eating disorder treatment Practical ways to rebuild safety, trust, and connection with your body Content Caution This episode includes discussion of trauma, eating disorders, and long-term recovery. Listen with care and pause if needed. If you are in distress, reach out to a trusted support person, therapist, or the 988 Suicide and Crisis Lifeline (U.S.) for immediate help. Related Episodes How Childhood Trauma Shapes Eating Disorders & Body Shame (Content Caution) on Apple & Spotify. Childhood Trauma & Eating Disorders on Apple & Spotify. Using EMDR & Polyvagal Theory to Treat Trauma & Eating Disorders with Dr. Danielle Hiestand, LMFT, CEDS-S on Apple & Spotify. Trauma, Eating Disorders, & Levels of Care with Amy Ornelas, RD via Apple or Spotify. Work With Dr. Marianne Miller If this conversation resonates with you, therapy can help you begin to heal from trauma while working toward eating disorder recovery. Dr. Marianne Miller, LMFT, @drmariannemiller, offers trauma-informed, neurodivergent-affirming therapy for individuals navigating eating disorders, trauma, and body image distress. Her approach centers on nervous system regulation, sensory attunement, and consent-based care to help you build safety and trust within your body. She offers therapy in California, Texas, and Washington, D.C. Learn more or schedule a consultation at drmariannemiller.com.

Clinical psychologist Dr. Dana Harron joins me to discuss how couples can approach difficult conversations about eating disorders with honesty, care, and mutual respect. Together we explore what makes these conversations emotionally charged, how to prepare for them, and how partners can support each other without taking on the role of therapist or monitor. Dr. Harron offers practical guidance from her book Loving Someone With an Eating Disorder and her work at Monarch Wellness & Psychotherapy. You'll learn what helps these conversations go more smoothly, how to create safety before and after hard talks, and when to bring in a therapist who understands both eating disorders and couples dynamics. Content Caution This episode discusses eating disorders, disordered eating behaviors, and relationship stress that can arise during recovery. Some listeners may find certain details activating. Please take care of yourself while listening, and pause or skip ahead as needed. About Our Guest Dana Harron, PsyD is a clinical psychologist and founder of Monarch Wellness & Psychotherapy in Washington, D.C. She specializes in trauma, parenting, and eating disorders. She is the author of Loving Someone With an Eating Disorder: Supporting, Nurturing, and Connecting With Your Partner and is currently writing Parenting Beyond Trauma. You can find her work at monarchwellness.com and on Instagram at @monarchwellnesspsychotherapy. What You'll Learn How to prepare before opening up about your eating disorder to a partner Why I-statements and emotional honesty matter more than having all the answers The best times and places for difficult conversations about food and body image What to say when your partner asks questions you cannot answer yet How to plan a follow-up discussion and build routine check-ins Why post-conversation decompression helps the nervous system reset What couples therapy can look like when one partner struggles with an eating disorder How to balance support and autonomy without creating a power differential Conversation Highlights Dr. Harron shares how her book was inspired by the lack of resources for partners of adults with eating disorders. Tips for partners on when to speak, when to listen, and how to avoid meal-time conversations about food behaviors. The importance of humor, co-regulation, and small moments of levity in recovery. How systemic patterns in relationships can reinforce eating disorder behaviors. Why “honesty” in recovery is about emotional congruence, not just full disclosure. Key Takeaways for Couples Prime the moment: Let your partner know a sensitive topic is coming and ask for what you need—listening, reassurance, or space. Avoid high-stress times: Skip conversations around meals or when one partner is emotionally depleted. Plan ongoing conversations: Short, consistent check-ins build predictability and reduce tension. Use shared recovery language: I-statements and gentle curiosity create safety and understanding. Involve professionals: A therapist or dietitian trained in eating disorders can guide communication and prevent relational burnout. Related Episodes You're Not Too Much: Setting Boundaries & Asking for What You Need in Eating Disorder Recovery on Apple & Spotify. "Boundaries, Therapy While Black, & Eating Disorders" on Apple & Spotify Work With Dr. Marianne If you or your partner are navigating eating disorder recovery and want support that honors both of your needs, I offer therapy in California, Texas, and Washington, D.C., and global coaching for couples and individuals. My approach is neurodivergent-affirming, sensory-attuned, trauma-informed, and consent-based. Learn more or schedule a consultation at drmariannemiller.com. Learn With Me Explore my ARFID & Selective Eating Course to understand sensory challenges, reduce distress around meals, and improve communication within your household. Episode Credits Host: Dr. Marianne Miller, LMFT Guest: Dr. Dana Harron, Monarch Wellness & Psychotherapy (@monarchwellnesspsychotherapy) If this episode resonates, share it with a partner, therapist, or loved one who may benefit from a more compassionate way to talk about eating disorders and recovery.

Is ARFID genetic? In this episode of Dr. Marianne-Land: An Eating Disorder Recovery Podcast, Dr. Marianne Miller explores the newest 2025 research on Avoidant/Restrictive Food Intake Disorder (ARFID) and what it means for diagnosis and treatment. You will hear how twin studies show that ARFID has a strong genetic component, why large projects like EDGI2 and the ARIES study are changing the research landscape, and how updated diagnostic criteria in 2025 are helping clinicians better identify and support people with ARFID. The episode also highlights brain scan findings that explain why food can feel overwhelming, threatening, or unappealing, and treatment studies that show real recovery progress through virtual care and ARFID-specific tools. Key Findings from ARFID Research Genetics play a big role in ARFID but do not determine your destiny 2025 research reveals important connections between ARFID, brain differences, gut health, and sensory processing Updated diagnostic criteria are improving accuracy and access to treatment ARFID-specific tools such as the PARDI-AR-Q and EDY-Q provide a more accurate picture of progress Treatment outcomes for children, teens, and adults are encouraging, including in virtual care settings Why ARFID Diagnosis and Treatment Matter ARFID is not caused by poor parenting or lack of willpower. It reflects the way a sensitive brain and body respond to the world. With consent-based, sensory-attuned, and neurodivergent-affirming care, meaningful recovery is possible. Related Podcast Episodes on ARFID 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. Adult ARFID Explained: Real-Life Strategies for Managing Food & Nutrition with Caroline Holbrook, RD on Apple & Spotify. ARFID and Selective Eating Course If you are ready for practical, step-by-step tools to support ARFID, explore my ARFID and Selective Eating Course at drmariannemiller.com/arfid. This course is designed for families and professionals who want compassionate and effective strategies for ARFID care.

What if your body size determined whether or not doctors believed you had anorexia? In this solo episode of Dr. Marianne-Land: An Eating Disorder Recovery Podcast, Dr. Marianne Miller, LMFT, challenges the diagnosis of atypical anorexia and reveals why this label fails people who deserve to be taken seriously. This category is not about atypical symptoms. It is about anti-fat bias. People in larger bodies who restrict food, obsess about weight, and experience medical complications are often told they cannot truly have anorexia because they do not look emaciated. This episode explains why that belief is harmful, how it delays treatment, and the real medical risks that exist at any body size. Dr. Marianne also explores how anti-fat bias, weight stigma, and cultural stereotypes erase the experiences of marginalized people, especially fat, queer, neurodivergent, disabled, and BIPOC communities. She challenges providers and listeners to recognize anorexia for what it is: a serious illness in every body, not only in those that match the stereotype. If you have ever been given the label “atypical anorexia,” this episode will affirm what you may already know. Your suffering is valid, you deserve care, and you do not need to prove how sick you are in order to receive treatment. What You'll Learn in This Episode Why the label “atypical anorexia” exists and how it reinforces anti-fat bias The medical risks of anorexia that occur across all body sizes How stereotypes harm people in larger bodies with eating disorders The role of intersectionality in who gets overlooked and dismissed How to move toward weight-inclusive eating disorder treatment Who This Episode Is For People in recovery from atypical anorexia or restrictive eating Families supporting a loved one with an eating disorder Providers seeking to understand anti-fat bias in treatment settings Anyone who has ever been told they were not “sick enough” Related Episodes Atypical Anorexia Explained: Why Restriction Happens at Every Body Size on Apple or Spotify. Atypical Anorexia with Amy Ornelas, RD on Apple or Spotify. Atypical Anorexia: Mental & Physical Health Risks, Plus How the Term is Controversial on Apple or Spotify. What Is Atypical Anorexia? Challenging Weight Bias in Eating Disorder Treatment with Emma Townsin, RD @food.life.freedom on Apple or Spotify. Connect With Dr. Marianne Miller I am Dr. Marianne Miller, LMFT, a fat eating disorder therapist specializing in anorexia, ARFID, bulimia, and binge eating disorder. I provide therapy in California, Texas, and Washington, D.C., and offer online resources worldwide.

Standard eating disorder treatment often assumes that one model will work for everyone. But for neurodivergent people, such as autistic folks, ADHDers, and those with sensory processing differences, this approach can feel like being handed a map that doesn't match the terrain you're actually walking. Instead of support, clients often experience shame, retraumatization, or the sense that recovery is out of reach. What's In This Episode In this episode of Dr. Marianne-Land: An Eating Disorder Recovery Podcast, Dr. Marianne Miller explores why one-size-fits-all treatment fails neurodivergent clients and what affirming, individualized care looks like. She discusses how sensory sensitivities shape eating experiences, how ADHD executive functioning challenges complicate meal planning and follow-through, and how trauma and systemic oppression create additional effects that amplify struggles. She also outlines what neurodivergent-affirming eating disorder treatment looks like in practice: sensory-attuned, trauma-informed, flexible, and rooted in autonomy and consent. Content Caution In this episode, I discuss eating disorder treatment, recovery challenges, and the effects of trauma. Please listen with care and step away if needed. If you or someone you love lives with ARFID, selective eating, or eating struggles connected to autism, ADHD, or have other types of neurodivergent traits, know that recovery is possible with the right support. Check Out Related Neuroaffirming Episodes How Masking Neurodivergence Can Fuel Eating Disorders on Apple & Spotify. Complexities of Treating ARFID: How a Neurodivergent-Affirming, Sensory-Attuned Approach Works on Apple and Spotify. ARFID & Neurodiversity on Apple and Spotify. Minding the Gap: The Intersection Between AuDHD & Eating Disorders With Stacie Fanelli, LCSW on Apple and Spotify. Get Neurodivergent-Affirming Eating Disorder Help For deeper guidance, check out Dr. Marianne's ARFID and Selective Eating Course, which offers practical, compassionate strategies that are neurodivergent-affirming, trauma-informed, and sensory-attuned. If you're located in California, Texas, or Washington, D.C., you can work directly with Dr. Marianne in therapy to create a path to recovery that actually fits your life. Learn more at drmariannemiller.com.

Recovery is often described as freedom, joy, and relief. But for people who have lived with eating disorders for many years or even decades, the reality is much more complicated. In this episode of Dr. Marianne-Land: An Eating Disorder Recovery Podcast, Dr. Marianne explores why recovery can feel unsafe and why ambivalence is such a common part of the process. You will hear about how eating disorders become entangled with identity, daily routines, and survival, and why letting go can feel destabilizing even when it is necessary for healing. Dr. Marianne explains how trauma, systemic oppression, sensory sensitivities, and executive functioning struggles can all make recovery feel threatening to the nervous system. She also shares how grief and ambivalence show up in long-term recovery and why both deserve compassion instead of shame. This episode highlights the importance of trauma-informed, neurodivergent-affirming, and fat-affirming care, and it offers practical ways to build a sense of safety through sensory supports, executive functioning tools, and pacing change. What You Will Learn in This Episode: Why recovery often feels unsafe instead of freeing How ambivalence is a normal and intelligent survival response The role of trauma in making recovery feel threatening How intersectionality and systemic oppression shape recovery experiences Why grief is an important but overlooked part of long-term recovery Sensory and executive functioning strategies that can support safer eating experiences Related Episodes Stages of Change & Ambivalence Around Change in Eating Disorder Recovery with Harriet Frew, MSc, @theeatingdisordertherapist_ on Apple & Spotify. Orthorexia, Quasi-Recovery, & Lifelong Eating Disorder Struggles with Dr. Lara Zibarras @drlarazib on Apple & Spotify. Navigating a Long-Term Eating Disorder on Apple & Spotify. Work With Dr. Marianne If this episode resonates with you and you are ready for support, Dr. Marianne Miller offers eating disorder therapy in California, Texas, and Washington, D.C. Her approach is trauma-informed, sensory-attuned, and affirming of neurodivergent and marginalized identities. Learn more and connect with her at drmariannemiller.com.

Eating in the morning sounds simple, but for many people in eating disorder recovery it feels nearly impossible. Breakfast can bring up anxiety, sensory overwhelm, executive functioning struggles, and old diet culture narratives that equate delaying food with being “good.” In this episode, Dr. Marianne Miller explores why breakfast is so hard, what's happening in the body and mind during mornings, and how oppression and neurodivergence can amplify these challenges. WHAT THIS EPISODE COVERS Why hunger cues may be blunted in the morning for those healing from anorexia, ARFID, binge eating disorder, bulimia, or atypical anorexia. How anxiety, sensory sensitivities, and executive functioning difficulties make mornings especially tough. Why low-lift and “zero spoons” food strategies are key for ADHDers and neurodivergent folks. How systemic oppression and diet culture messages intensify morning eating struggles. Practical steps for making mornings less overwhelming and building breakfast into your routine. CONTENT CAUTION This episode discusses eating disorder recovery challenges and mentions binge urges, food avoidance, and systemic oppression. Please take care of yourself as you listen. WHY THIS MATTERS Morning eating struggles are not a personal failing. They're a reflection of body rhythms, trauma, and cultural messages around food and bodies. Understanding the intersection of physiology, psychology, and oppression allows recovery to be rooted in compassion rather than shame. Whether you're working on ARFID recovery, managing binge urges, or navigating long-term eating disorder challenges, starting the day with nourishment can support stability and healing. EXPLORE MY ARFID & SELECTIVE EATING COURSE If mornings feel like an impossible hurdle, I created the ARFID & Selective Eating Course to support you. It's designed for people who struggle with food avoidance, sensory sensitivities, or anxiety around eating, as well as for parents and providers seeking neurodivergent-affirming strategies. The course is self-paced and packed with practical tools to make eating less overwhelming and more possible. Dr. Marianne Miller, an eating disorder therapist based in San Diego, California, as well as serving eating disorder clients in Los Angeles, the San Francisco Bay Area, Texas, and Washington, D.C., unpacks the biology, psychology, and cultural conditioning that make morning eating so difficult. With a neurodivergent-affirming lens, she offers low-lift strategies for ADHD and autistic folks, highlights how systemic oppression and anti-fat bias amplify these struggles, and provides practical tools for building safety and consistency with food in the mornings. CHECK OUT OTHER EPISODES ON MECHANICAL AND INTUITIVE EATING: Anorexia, Accessibility to Care, & Intuitive Eating with @the.michigan.dietitian Lauren Klein, RD on Apple & Spotify. Intuitive vs. Mechanical Eating: Can They Coexist? on Apple & Spotify. From Diet Rock Bottom to Intuitive Eating & Fat-Positive Care: A Eating Disorder Recovery Story with Chelsea Levy, RDN @chelsealevynutrition on Apple & Spotify. ABOUT DR. MARIANNE MILLER & HER WORK Struggling with eating breakfast is a common challenge in eating disorder recovery, whether you're healing from anorexia, bulimia, binge eating disorder, ARFID, or atypical anorexia. In this episode, Dr. Marianne Miller, an eating disorder therapist based in San Diego, California, as well as serving eating disorder clients in Los Angeles, the San Francisco Bay Area, Texas, and Washington, D.C., unpacks the biology, psychology, and cultural conditioning that make morning eating so difficult. With a neurodivergent-affirming lens, she offers low-lift strategies for ADHD and autistic folks, highlights how systemic oppression and anti-fat bias amplify these struggles, and provides practical tools for building safety and consistency with food in the mornings.

Avoidant/Restrictive Food Intake Disorder (ARFID) is one of the most misunderstood eating disorders. Although many people assume it is about being a “picky eater,” the truth is far more complex. ARFID can involve overwhelming sensory sensitivities, intense fears of choking or vomiting, and nervous system responses that make eating feel unsafe. For those living with ARFID, every meal can feel like navigating a minefield. Shame, isolation, and years of being dismissed by others often add to the struggle. WHAT'S IN THIS EPISODE In this episode, Dr. Marianne Miller explores what ARFID really feels like from the inside, why it is so often overlooked or misdiagnosed, and how to shift from shame to self-compassion. She discusses the intersectional barriers that people with ARFID face, from fat folks being dismissed by providers, to autistic and ADHD individuals being mislabeled as “quirky eaters,” to cultural stigma in BIPOC communities. By unpacking these misconceptions, Dr. Marianne shines a light on why ARFID deserves serious recognition and care. Midway through the episode, Dr. Marianne shares details about her self-paced ARFID and Selective Eating Course at drmariannemiller.com/arfid. This resource supports parents, adults, and providers alike with a neurodivergent-affirming, sensory-attuned, and trauma-informed framework. It includes practical tools for creating safety around food, reducing shame, and building flexibility without force. Listeners will also hear about strategies that actually help people with ARFID: validating experiences instead of minimizing them, using sensory-based bridges to expand safe foods, providing trauma-informed care that honors fear as protective, and integrating low-lift routines that work with executive functioning needs. Dr. Marianne explains how true healing is not about eating everything, but about gaining more freedom, more nourishment, and more autonomy. ARFID is not a choice, and it is not a phase. It is a real eating disorder that deserves respect, compassion, and effective support. Tune in to learn why understanding ARFID matters, and how shifting the conversation can open new pathways for care. LISTEN TO OTHER EPISODES ON ARFID 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. Adult ARFID Explained: Real-Life Strategies for Managing Food & Nutrition with Caroline Holbrook, RD on Apple & Spotify. Stuck on Empty: Autistic Inertia, ARFID & the Struggle to Eat on Apple & Spotify. INTERESTED IN HANGING OUT MORE IN DR. MARIANNE-LAND? Follow me on Instagram @drmariannemiller Check out my virtual, self-paced ARFID and Selective Eating course Look into my self-paced, virtual, anti-diet, subscription-based curriculum. It is called Dr. Marianne-Land's Binge Eating Recovery Membership. Live in California, Texas, or Washington D.C. and interested in eating disorder therapy with me? Sign up for a free, 15-minute phone consultation HERE or via my website, and I'll get you to where you need to be! Check out my blog. Want more information? Email me at hello@mariannemiller.com