Dr. Marianne-Land: An Eating Disorder Recovery Podcast

Family Dynamics & Eating Disorders: How Early Relationships Shape Disordered Eating

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

Harm Reduction for Long-Term Eating Disorders: Peer Support, Healing, & Hope With Johanna Scoglio, M.Ed., M.B.A.

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

Fear of Uncertainty in Eating Disorder Recovery: Why It Feels So Terrifying + 5 Practical Skills That Help

Eating disorder recovery can feel frightening for reasons that go far deeper than food, weight, or body image. One of the most powerful drivers of eating disorder behaviors is fear of uncertainty. When recovery removes rigid rules and predictable routines, the nervous system can interpret that loss of certainty as danger.
In this episode, Dr. Marianne explores how fear of uncertainty operates underneath many eating disorder behaviors and why letting go of control can feel destabilizing. She explains the psychology of intolerance of uncertainty and how eating disorders such as anorexia, bulimia, binge eating disorder, and ARFID can develop as attempts to create predictability in an overwhelming world.
Intolerance of Uncertainty and Eating Disorders
Many people with eating disorders experience what psychologists call intolerance of uncertainty. This means the brain interprets ambiguity and unpredictability as unsafe. Instead of thinking “I don’t know what will happen but I can cope,” the nervous system may assume that something bad will happen if there is not a clear plan or outcome.
Eating disorder behaviors can temporarily reduce this distress. Restrictive eating, binge eating, purging, body checking, and rigid food rules can create the illusion of certainty. These patterns often lower anxiety in the short term, which reinforces the cycle and makes recovery feel more intimidating.
Dr. Marianne explains how this dynamic shows up in eating disorder recovery and why the loss of rigid control can trigger powerful anxiety responses.
Why Uncertainty Feels Especially Hard for Neurodivergent People
For many listeners, fear of uncertainty is intensified by neurodivergence, trauma history, or systemic stress. Changes in routine, fluctuating internal cues, sensory differences, and executive functioning challenges can all make unpredictability feel overwhelming.
Dr. Marianne discusses how autism, ADHD, and other neurodivergent experiences can interact with eating disorders and recovery. She also highlights how weight stigma, ableism, racism, and other systemic pressures can make uncertainty in eating disorder recovery feel even riskier.
Understanding these contexts helps shift the conversation from shame to compassion.
Microdosing Uncertainty in Eating Disorder Recovery
A key concept introduced in this episode is microdosing uncertainty. Instead of forcing dramatic change, recovery can involve practicing small, manageable exposures to unpredictability.
Dr. Marianne explains how gradually introducing small shifts in eating patterns, routines, or body-related behaviors can help retrain the nervous system. These repeated experiences allow the brain to learn that uncertainty does not automatically lead to catastrophe.
Microdosing uncertainty can help expand the window of tolerance and make eating disorder recovery feel more sustainable.
Five Practical Skills for Managing Fear of Uncertainty
This episode also explores five practical skills that can help people tolerate uncertainty in eating disorder recovery.
Dr. Marianne discusses the importance of practicing small exposures to uncertainty, accurately naming nervous system reactions, creating compassionate structure that reduces overwhelm, regulating anxiety through body-based techniques, and cultivating contextual self-compassion.
These skills help widen emotional capacity so recovery does not feel like stepping into chaos. Instead, listeners can gradually build confidence in their ability to navigate unpredictability.
Related Episodes
An Open Letter to the Body: Listening to the Part That Fears Getting Better on Apple and Spotify.
Eating Disorders as Safety Systems: Why Letting Go Can Trigger Fear on Apple and Spotify.
If Recovery Feels Unsafe Right Now: A Guided Moment for Eating Disorder Recovery Fear on Apple and Spotify.
Expanding Freedom Beyond Eating Disorder Rules
Eating disorders often promise certainty, but they narrow life in the process. Recovery may introduce unpredictability, yet it also expands possibilities for nourishment, flexibility, connection, and autonomy.
Dr. Marianne emphasizes that recovery is not about eliminating uncertainty. The goal is to build the capacity to live meaningfully alongside it.
Therapy and Self-Paced Eating Disorder Recovery Courses
If this episode resonates with you and you are looking for additional support, you can visit Dr. Marianne’s website to learn more about therapy and self-paced recovery courses.
Dr. Marianne is a Licensed Marriage and Family Therapist specializing in eating disorders, including ARFID, binge eating disorder, anorexia, and bulimia. She offers therapy services in California, Texas, and Washington DC and provides virtual courses for people seeking flexible recovery resources.
You can learn more about therapy and courses at drmariannemiller.com.

GI Issues in Eating Disorder Recovery: Why Bloating, Constipation, & Stomach Pain Happen & How Healing Is Possible

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.

“I Feel Huge” vs What I’m Actually Feeling: Translating Body Distress Into Emotions With Amy Ornelas, RDN

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: @amyornelasRDWebsite: 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.

Why Weight Stigma Harms Everyone: Anti-Fat Bias in Health, Mental Health, & Eating Disorder Recovery

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.

Beyond Anorexia: The Truth About Long-Term Restrictive Eating

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 invisibleSubtle undereating and socially normalized food restrictionARFID and sensory-based restrictive eating patternsBeing neurodivergent, experiencing interoception, and having eating issues.Atypical anorexia and restrictive eating in higher-weight bodiesWeight stigma and diagnostic gaps in eating disorder careChronic restrictive eating and long-term nervous system changesWhat 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.

Autism, ADHD, & Food Sensory Issues: Navigating Eating Challenges With Patrick Casale

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: Why It Persists & What Real Recovery Looks Like

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 disorderLong-term binge eating patternsBinge eating recovery for adultsRestriction and binge cycleNervous system regulation and foodNeurodivergence and binge eatingShame and eating disordersWeight-inclusive eating disorder treatment

Mechanical Eating in Lifelong Eating Disorder Recovery: Benefits, Limits, & Who It Helps Most

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 recoveryChronic eating disorders and long-term recoveryGI system healing and digestive regulationBlood sugar stabilization and binge-restrict cyclesMood regulation and nervous system safetyNeurodivergent-affirming eating disorder treatmentARFID 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.