Dr. Marianne-Land: An Eating Disorder Recovery Podcast

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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