Dr. Marianne-Land: An Eating Disorder Recovery Podcast

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

What happens to eating disorder recovery when the culture around you starts celebrating weight loss again?
In this deeply personal solo episode, Dr. Marianne continues sharing her eating disorder recovery story and talks about something that has surprised her: the return of body insecurities during the Age of Ozempic. After recovering from a decades-long history of anorexia, binge eating disorder, orthorexia, and bulimia, she rarely spends much time thinking about her body size. But the rise of Ozempic and other GLP-1 medications like Zepbound and Wegovy has changed the cultural conversation around weight, thinness, and fat bodies.
During the height of the body diversity movement, living in a larger body felt different. Plus-size clothing became more visible. Larger bodies appeared in advertising. Conversations about weight stigma, fatphobia, body neutrality, and fat liberation entered the mainstream. Now, many of those gains seem to be disappearing as celebrities become smaller, plus-size departments vanish from stores, and thinness once again becomes something we're expected to pursue.
When Eating Disorder Recovery Meets the Age of Ozempic
Dr. Marianne shares what it's like to encounter old eating disorder and body image thoughts after years of recovery. Sometimes those thoughts arrive unexpectedly: Look at that celebrity. They did it. Why can't I?
Having that thought doesn't mean eating disorder recovery has failed. Recovery doesn't necessarily erase decades of conditioning around weight and body size. Instead, it can help us recognize internalized weight bias when it resurfaces and decide whether we want to listen to it.
Dr. Marianne also discusses an important distinction: wanting a smaller body isn't necessarily the same thing as wanting relief from anti-fat bias. Sometimes the thought, Life would be easier if I were thinner, reflects a painful reality about how fat people are treated rather than a genuine desire to change one's body.
The World Is Getting Smaller for Fat People
Anti-fat bias doesn't exist only in our thoughts. It shows up in the physical world.
Plus-size clothing departments have disappeared from many stores, forcing people in larger bodies to shop online. Airplane seats continue to create accessibility barriers for larger passengers. Cars, restaurant booths, waiting-room chairs, theaters, and other public spaces frequently fail to accommodate body diversity.
The message can become impossible to ignore: if the world won't make more space for you, you're expected to make yourself smaller.
Dr. Marianne explores the mental health toll of repeatedly navigating environments that weren't designed for your body. Constantly wondering whether a seat will fit, whether a store carries your size, or whether a healthcare provider will blame your symptoms on weight creates an enormous cognitive and emotional burden.
Defending the Right to Be Fat
Dr. Marianne shares a recent dream in which she found herself defending her fatness to another person. When she woke up, she realized how closely the dream reflected the experience of living in a larger body today.
Fat people often have to defend their right to exist without pursuing intentional weight loss. They may have to advocate for appropriate healthcare, accessible seating, clothing, travel accommodations, and the basic right to occupy space without apology.
That emotional labor takes energy. For neurodivergent people, the burden can become even greater. Autistic people and ADHDers may already expend significant energy navigating sensory needs, executive functioning, uncertainty, masking, and environments that weren't designed for neurodivergent nervous systems. When neurodivergence intersects with anti-fat bias and other forms of marginalization, the cumulative mental health toll can become significant.
Internalized Weight Bias Doesn't Mean You've Failed at Recovery
Eating disorder recovery happens in the real world, not in a protected bubble.
You can appreciate your body and still feel hurt by weight stigma. You can reject diet culture and feel grief when plus-size clothing disappears. You can practice fat acceptance and still have moments when you wonder whether life would be easier in a smaller body.
Those experiences don't erase recovery.
Sometimes what looks like body dissatisfaction is actually grief, anger, exhaustion, or a desire to move through the world without constantly having to advocate for your right to belong.
Dr. Marianne shares the question that helps her separate internalized weight bias from her own values: Do I actually want a different body, or do I want a different world?
Related Episodes
How a Part of Me Wanted to Take a Weight-Loss Drug on Apple & Spotify.
My Eating Disorder Recovery Story on Apple & Spotify.
Finding Liberation-Focused Eating Disorder Support
If the Age of Ozempic has stirred up old body image struggles, eating disorder thoughts, or internalized weight bias, you don't have to navigate those experiences alone.
Finding an eating disorder therapist or provider who understands weight stigma can make a profound difference. Liberation-focused, trauma-informed, neurodivergent-affirming eating disorder treatment can create space to examine these experiences without making weight loss the goal.
If you'd like to work with Dr. Marianne, she provides eating disorder therapy in California for adolescents and adults navigating anorexia, bulimia, binge eating disorder, ARFID, body image concerns, and neurodivergence. If you live elsewhere, Dr. Marianne also offers consultations and coaching for individuals, families, and professionals.
Learn more about working with Dr. Marianne at drmariannemiller.com.

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

Does it matter whether your eating disorder therapist has personally recovered from anorexia or bulimia?
In this solo episode of Dr. Marianne-Land, I explore that question from two perspectives: as an eating disorder therapist and as someone who spent about 25 years navigating anorexia, binge eating, orthorexia, bulimia, compulsive exercise, and the long road to recovery.
Lived experience does not replace professional training, and professional training does not require lived experience. Both forms of knowledge have value. In this episode, I share how my personal recovery has shaped my clinical work and why that perspective can be especially meaningful for autistic people, ADHDers, AuDHDers, and other neurodivergent adults recovering from anorexia and bulimia.
What You'll Learn
You'll hear five lessons that have transformed the way I understand eating disorder recovery. We discuss why what appears to be resistance is often nervous system overwhelm, how to tell the difference between neurodivergent traits and eating disorder symptoms, why shame rarely creates lasting recovery, how safety supports sustainable healing, and why recovery ultimately becomes about building a meaningful life instead of simply eliminating symptoms.
Why Neurodivergent People Often Need a Different Recovery Conversation
Traditional eating disorder treatment does not always account for sensory processing differences, executive functioning challenges, autistic burnout, ADHD, interoceptive differences, or the ways trauma and neurodivergence can intersect with anorexia and bulimia.
In this episode, I explain why understanding your nervous system can make recovery feel more compassionate, more realistic, and more sustainable. Rather than forcing yourself to fit a rigid recovery model, you can begin building an approach that respects both your neurodivergence and your recovery goals.
Who This Episode Is For
This episode is for adults recovering from anorexia nervosa, atypical anorexia, bulimia nervosa, chronic eating disorders, or long-term restrictive eating. It's also for autistic adults, ADHDers, AuDHD adults, highly sensitive people, therapists, dietitians, parents, caregivers, and anyone who wants a deeper understanding of neurodivergent-affirming eating disorder treatment.
Mentioned in This Episode
If you want to learn more about sensory processing, autonomy, nervous system regulation, and neurodivergent-affirming approaches to eating, check out my ARFID and Selective Eating Course. Although the course focuses on ARFID, many of the concepts also apply to neurodivergent people recovering from anorexia, bulimia, and other eating disorders.
Related Episodes
Harm Reduction for Eating Disorders: How Lived Experience Shapes Recovery, Support, & Long-Term Healing on Apple & Spotify.
Lived Experience of ARFID in Autistics & ADHDers: Sensory Survival & Misunderstandings With Dr. Panicha McGuire, LMFT, RPT on Apple & Spotify.
Unmasking in Eating Disorder Recovery: What Neurodivergent People Need to Know About Safety & Healing via Apple & Spotify.
Connect With Dr. Marianne Miller
If you're looking for eating disorder therapy in California or Washington, D.C., or eating disorder coaching from anywhere in the world, I'd love to help. I specialize in anorexia, bulimia, ARFID, binge eating disorder, autism, ADHD, AuDHD, and neurodivergent-affirming eating disorder treatment.
Visit www.drmariannemiller.com to learn more about working with me, explore my ARFID course, and listen to more episodes of Dr. Marianne-Land.
If you found this episode helpful, please follow the podcast, leave a rating or review on Apple Podcasts or on Spotify, and share it with someone who could benefit from hearing that recovery does not have to look the same for everyone.

Many people with eating disorders get labeled as perfectionists. Sometimes that's accurate. Sometimes it's only part of the story.
In this episode of the Dr. Marianne-Land Podcast, I explore the overlap between OCD and eating disorders, perfectionism, anxiety, autism, ADHD, and the cognitive effects of malnutrition. I explain why similar behaviors can have very different underlying causes and why understanding those differences can change the course of eating disorder treatment and recovery.
If you've ever found yourself stuck in food rules, body checking, repetitive thoughts, calorie calculations, reassurance-seeking, or endless self-doubt, this episode offers a more nuanced way to understand what's happening beneath the surface. Rather than focusing only on what behaviors look like, I discuss why identifying their function leads to more effective and compassionate care.
What You'll Learn
In this episode, you'll learn how perfectionism differs from OCD in eating disorder recovery and why the distinction matters. I discuss why intrusive thoughts, compulsive checking, and reassurance-seeking are often mistaken for perfectionism, how anorexia nervosa and other restrictive eating disorders can increase obsessive thinking, and why starvation affects cognitive flexibility and mental rigidity. I also explain how autism, ADHD, sensory needs, and routine dependence can sometimes resemble OCD while reflecting very different underlying experiences. Finally, I share why understanding the function of eating disorder behaviors helps clinicians, individuals, and families choose more effective treatment approaches.
OCD, Perfectionism, and Eating Disorders
Perfectionism has long been associated with anorexia nervosa, bulimia nervosa, and other eating disorders. At the same time, many people who believe they're simply perfectionists may also experience OCD, significant anxiety, or both. Looking only at outward behaviors can miss what is actually maintaining the cycle of restriction, compulsions, fear, and distress.
In this episode, I discuss why food-related rituals, repeated checking, body checking, calorie counting, and reassurance-seeking may look similar across different conditions while serving very different purposes. Understanding those differences helps people receive more individualized, neurodivergent-affirming care instead of one-size-fits-all treatment.
Why Neurodivergence Makes the Picture More Complex
Autism, ADHD, ARFID, sensory processing differences, and nervous system regulation can all influence eating behaviors, routines, and food preferences. Predictability and consistency often help neurodivergent people reduce overwhelm and make eating feel safer. Those experiences are not automatically signs of OCD or perfectionism.
I explain why clinicians need to understand the role of sensory processing, cognitive load, executive functioning, and nervous system regulation before drawing conclusions about repetitive eating behaviors. This perspective supports more accurate assessment and more compassionate eating disorder treatment.
Why This Matters for Recovery
Recovery looks different depending on what's driving the behavior. Someone whose eating disorder is fueled primarily by perfectionism may need different interventions than someone struggling with OCD, autism, or multiple overlapping conditions. When treatment targets the underlying process instead of the surface behavior alone, recovery often becomes more individualized, effective, and sustainable.
Understanding the "why" behind eating disorder behaviors creates opportunities for greater self-compassion and more meaningful healing.
This Episode Is For You If...
This episode is for anyone recovering from anorexia, bulimia, ARFID, binge eating disorder, or another eating disorder who has wondered whether perfectionism tells the whole story. It's also for autistic, ADHD, and AuDHD individuals, parents, caregivers, therapists, dietitians, physicians, and other professionals who want a more nuanced understanding of OCD, perfectionism, neurodivergence, and eating disorder recovery.
Related Episodes
OCD & Eating Disorders: Why Food Rules, Rituals, & “Not Feeling Right” Take Over on Apple & Spotify.
When Eating Disorders Meet Anxiety, OCD, or Depression: Co-Occurring Challenges & Recovery Strategies on Apple & Spotify.
Obsessions, Compulsions, and Control: How OCD Intertwines With Eating Disorders on Apple & Spotify.
Food, Fear, & Fixation: How OCD Shapes Eating Disorders on Apple & Spotify.
Work With Dr. Marianne Miller
If you're looking for a neurodivergent-affirming eating disorder therapist, I provide therapy for adults and adolescents throughout California and Washington, D.C. I also offer parent consultation and eating disorder coaching worldwide.
My practice specializes in ARFID therapy, anorexia treatment, bulimia treatment, binge eating disorder therapy, autism and ADHD, and neurodivergent-affirming eating disorder care. I use a sensory-attuned, trauma-informed, autonomy-supportive approach that honors each person's unique nervous system and lived experience.
Learn more about therapy, consultation, my ARFID & Selective Eating Course, and additional resources at www.drmariannemiller.com.
If you enjoyed this episode, please follow the Dr. Marianne-Land Podcast, leave a rating or review on Apple Podcasts or on Spotify, and share this episode with someone who may benefit from a more compassionate understanding of OCD, perfectionism, and eating disorder recovery.

What happens when years of eating disorder treatment reduce symptoms but never fully address the trauma underneath? In this episode of the Dr. Marianne-Land Podcast, I welcome Jennifer Lancaster, LCSW, for a conversation about complex trauma treatment for eating disorders, including the role of EMDR therapy, ketamine-assisted psychotherapy (KAP), attachment trauma, nervous system healing, and shame recovery. Whether you're recovering from anorexia, bulimia, ARFID, binge eating disorder, or another eating disorder, understanding the connection between trauma and eating disorders can open new possibilities for healing.
Jennifer is a licensed clinical social worker and founder of Houston Healing Collective. Drawing on more than a decade of experience treating eating disorders and complex trauma, she explains why many clients arrive after years of therapy saying they understand why they struggle but still feel trapped in the same patterns. We discuss how trauma-informed treatment can move beyond symptom management by addressing the underlying experiences that shaped the nervous system in the first place.
Why Complex Trauma Often Fuels Eating Disorders
Complex trauma is not always one catastrophic event. It can develop through repeated experiences of emotional neglect, attachment disruptions, chronic criticism, unsafe relationships, community violence, poverty, or growing up without feeling consistently seen, safe, or emotionally supported. Jennifer shares how her own experiences and years of clinical work helped her recognize that many eating disorders function as adaptive responses to unresolved trauma rather than isolated illnesses.
We also discuss why many people in eating disorder recovery become frustrated when treatment focuses primarily on changing behaviors without creating space to process traumatic experiences. Although symptom stabilization remains important, Jennifer explains why many clients eventually seek treatment that addresses the deeper emotional wounds beneath restrictive eating, binge eating, purging, or other eating disorder symptoms.
EMDR Therapy for Trauma and Eating Disorders
Jennifer explains how she integrates EMDR therapy into eating disorder treatment. She discusses the importance of building trust, strengthening nervous system regulation, assessing readiness, and helping clients expand their window of tolerance before trauma reprocessing begins. She also describes how EMDR allows people to process traumatic memories without needing to repeatedly tell every painful detail, making the work feel more manageable for many survivors of complex trauma.
Ketamine-Assisted Psychotherapy Explained
If you've been curious about ketamine-assisted therapy for PTSD, trauma, or eating disorders, Jennifer offers an accessible explanation of how this treatment works. She discusses why ketamine differs from traditional psychiatric medications, how it may temporarily increase neuroplasticity, and why those changes can create opportunities for deeper therapeutic work. We also talk about the brain's default mode network, rigid thinking patterns, and why many people experience new perspectives during treatment that previously felt impossible to access.
One of the most important messages in this episode is that ketamine itself is not the treatment. Jennifer emphasizes that preparation, psychotherapy, and thoughtful integration before and after medicine sessions are what help lasting healing occur. Rather than replacing therapy, ketamine-assisted psychotherapy works alongside trauma-focused treatment approaches like EMDR and other evidence-informed therapies.
Healing Shame Through Safe Relationships
Jennifer also shares her own experience receiving ketamine-assisted therapy and how it transformed her relationship with shame. She describes participating in a therapeutic group experience where she felt safe enough to openly share parts of her story for the first time. That experience inspired her to develop group ketamine retreats because she witnessed how healing can deepen when people experience connection, compassionate witnessing, and emotional safety alongside trauma treatment.
Our conversation also explores why shame often survives in isolation but begins to loosen when people experience safe therapeutic relationships. Whether treatment happens individually or in a carefully facilitated group setting, safety remains the foundation of meaningful trauma recovery.
Who Should Listen
This episode is for adults recovering from anorexia, bulimia, ARFID, binge eating disorder, or other eating disorders. It is also valuable for parents, caregivers, therapists, dietitians, physicians, and other healthcare professionals who want a deeper understanding of complex trauma, EMDR therapy, ketamine-assisted psychotherapy, PTSD, attachment trauma, and trauma-informed eating disorder treatment.
In This Episode
Jennifer explains how complex trauma contributes to eating disorders, why attachment wounds often remain hidden beneath eating disorder symptoms, how EMDR therapy helps people process traumatic memories, what ketamine-assisted psychotherapy actually involves, why preparation and integration matter just as much as the medicine itself, how neuroplasticity may support healing, why shame often decreases through safe therapeutic relationships, and how trauma-informed care can help people move beyond surviving toward genuine recovery.
Content Cautions
This episode includes discussion of eating disorders, anorexia, bulimia, ARFID, PTSD, complex trauma, childhood adversity, attachment trauma, emotional neglect, shame, poverty, community violence, psychedelic-assisted psychotherapy, and ketamine-assisted therapy.
Listen to Related Episodes
Using EMDR & Polyvagal Theory to Treat Trauma & Eating Disorders With Dr. Danielle Hiestand, LMFT, CEDS-S on Apple & Spotify.
The Connection Between Unresolved Trauma & Long-Lasting Eating Disorders (Content Caution) on Apple & Spotify.
How Childhood Trauma Shapes Eating Disorders & Body Shame (Content Caution) on Apple & Spotify.
Childhood Trauma & Eating Disorders on Apple & Spotify.
Connect With Jennifer Lancaster
Jennifer Lancaster is the founder of Houston Healing Collective, where she specializes in complex trauma treatment, EMDR therapy, ketamine-assisted psychotherapy, eating disorder treatment, psychotherapy intensives, and therapeutic retreats. Learn more through Houston Healing Collective or follow her on Instagram at @_jenlightened.
Work With Dr. Marianne Miller
If you're looking for a California eating disorder therapist, Washington, DC eating disorder therapist, ARFID therapist, anorexia therapist, bulimia therapist, or binge eating disorder therapist, I provide neurodivergent-affirming, trauma-informed eating disorder therapy throughout California and Washington, DC, along with eating disorder coaching worldwide. If you or your child has ARFID or selective eating, be sure to explore my self-paced ARFID & Selective Eating Course for practical, evidence-informed support. Check out my website at drmariannemiller.com for all the latest info!

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

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

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

Have you ever looked at a plate of food, known you needed to eat, and still felt like your brain and body simply couldn't do it?
Many people assume this experience reflects a lack of willpower or motivation. In reality, sensory overload, trauma, ARFID, and food restriction can all make eating feel genuinely inaccessible. When your nervous system stays in survival mode, even choosing, preparing, and tolerating food can become overwhelming.
In this episode, I explain why eating can feel impossible, how sensory processing and trauma influence appetite and food intake, and why restriction often creates a cycle that makes eating even harder. I also share the fictional story of Jasper to illustrate how nervous system overload, chronic stress, and inadequate nutrition can quietly reinforce one another. If you've ever wondered why food feels so much harder for you than it seems to be for everyone else, this conversation offers a compassionate, neurodivergent-affirming perspective.
WHAT YOU'LL LEARN
You'll learn why eating requires much more than hunger and willpower, and how sensory processing, executive functioning, and nervous system regulation all influence your ability to nourish yourself. I explain how trauma can shape eating patterns long after stressful experiences have ended and why many people develop food avoidance without consciously trying to restrict.
I also discuss the overlap between ARFID, restrictive eating disorders, autism, ADHD, sensory sensitivities, and chronic stress. Finally, I share practical ways to approach eating with curiosity instead of shame so you can better understand what your nervous system may be communicating.
WHO THIS EPISODE IS FOR
This episode is for adults and teens with ARFID, anorexia, atypical anorexia, or other restrictive eating disorders. It's also for neurodivergent people with autism, ADHD, or sensory processing differences who find eating exhausting or overwhelming.
Parents, caregivers, therapists, dietitians, physicians, and other providers will also gain a deeper understanding of why food avoidance often reflects nervous system overload rather than defiance or a lack of motivation.
CONTENT CAUTION
This episode includes discussion of ARFID, anorexia, restrictive eating disorders, food restriction, trauma, sensory overload, and food avoidance.
TAKEAWAYS
Eating difficulties don't always begin with body image concerns or intentional dieting. Sometimes a nervous system carrying chronic stress, trauma, or sensory overload simply doesn't have enough capacity to manage the complex task of eating.
Food restriction can also become both a consequence of these struggles and a factor that keeps them going. As nutrition decreases, flexibility often narrows, sensory sensitivity may increase, and eating can become even more difficult. Understanding that cycle allows us to replace self-blame with curiosity and build recovery from a place of compassion rather than criticism.
RELATED EPISODES
What Is Mechanical Eating? Pros, Cons, & How It Can Work When Eating Feels Hard (ARFID, Binge Eating, Restriction) on Apple & Spotify.
ARFID, PDA, and Autonomy: Why Pressure Makes Eating Harder on Apple & Spotify.
Complexities of Treating ARFID: How a Neurodivergent-Affirming, Sensory-Attuned Approach Works on Apple & Spotify.
The Connection Between Unresolved Trauma & Long-Lasting Eating Disorders (Content Caution) on Apple & Spotify.
RESOURCES
If you or someone you love struggles with ARFID or selective eating, check out my self-paced ARFID & Selective Eating Course. I created it for adults, parents, caregivers, and providers who want a neurodivergent-affirming, sensory-attuned, trauma-informed approach to treatment and recovery.
To learn more about working with me for eating disorder therapy in San Diego, California or virtually throughout California and Washington, D.C., or coaching worldwide, visit my website at drmariannemiller.com.
CONNECT WITH DR. MARIANNE MILLER
If this episode helped you better understand your relationship with food, please subscribe, leave a review, and share it with someone who may need to hear this conversation.
You can also connect with me on Instagram @drmariannemiller for more education on ARFID, binge eating disorder, anorexia, bulimia, neurodivergence, trauma, sensory processing, and eating disorder recovery.