Dr. Marianne-Land: An Eating Disorder Recovery Podcast

OCD & Eating Disorders: Why Food Rules, Rituals, & “Not Feeling Right” Take Over

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

Does Rejection Ruin Your Whole Day? Here's One Reason Why: RSD, ADHD, & Eating Disorders

Does one awkward interaction, unanswered text, or small piece of feedback ruin your entire day? You may not be “too sensitive.” You may be experiencing Rejection Sensitive Dysphoria (RSD), especially if you also live with ADHD or an eating disorder. In this episode, Dr. Marianne explores why rejection can feel emotionally and physically painful, why shame spirals happen so quickly, and how emotional overwhelm can shape eating patterns, body image, and self-worth.
What Is Rejection Sensitive Dysphoria (RSD)?
Dr. Marianne breaks down what RSD actually is and why perceived criticism, disconnection, or rejection can trigger such intense emotional reactions. She explores how ADHD nervous systems often process emotions differently and why even subtle social shifts can feel catastrophic. This episode also examines how years of feeling misunderstood, corrected, excluded, or “too much” can shape the way neurodivergent people experience relationships and emotional safety.
ADHD, Emotional Regulation, & Eating Disorders
This episode explores the powerful overlap between ADHD, emotional regulation challenges, and eating disorders. Dr. Marianne discusses how rejection can quickly trigger binge eating urges, emotional eating, restrictive eating patterns, perfectionism, body image spirals, masking, and all-or-nothing thinking. She also explains why many neurodivergent people struggle to “move on” after rejection and why emotional pain can linger in the body long after the moment itself has passed.
Why Food Often Becomes Part of the Coping Cycle
When rejection activates the nervous system, the brain often searches for relief. For some people, food becomes soothing, grounding, or numbing. For others, appetite disappears completely and restriction begins to feel safer or more controlled. Dr. Marianne explains why these patterns are not about lack of willpower and why eating disorder behaviors often function as attempts to regulate overwhelming emotional states.
Anti-Fat Bias, Ableism, & Emotional Pain
Rejection does not happen in isolation. Dr. Marianne explores how anti-fat bias, ableism, stigma, and chronic misunderstanding can intensify emotional pain and increase sensitivity to rejection. She also discusses why marginalized people often carry higher levels of hypervigilance in social situations and why intersectionality matters when talking about ADHD, eating disorders, and nervous system regulation.
Neurodivergent-Affirming Tools That Can Help
Dr. Marianne shares supportive strategies for navigating RSD and eating disorder recovery, including sensory supports, low-lift eating approaches, nervous system regulation, and ways to reduce shame spirals without relying on punishment or rigid food rules. This episode focuses on building more self-understanding and creating coping tools that actually fit neurodivergent brains and lived experiences.
Related Episodes
Rejection Sensitive Dysphoria (RSD) & Eating Disorders: The Emotional Toll of Feeling “Too Much" on Apple & Spotify.
Eating Disorders & ADHD: Neurodivergent-Affirming Recovery With Taylor Ashley, RP @taylorashleytherapy on Apple and Spotify.
ADHD & Bulimia: Dopamine, Impulsivity, & the Hidden Link to Binge Eating With Kirsten Book, PMHNP-BC on Apple and Spotify.
Work With Dr. Marianne
Dr. Marianne Miller is a Licensed Marriage and Family Therapist (LMFT) specializing in eating disorders, ARFID, binge eating disorder, neurodivergence, ADHD, and emotional regulation challenges. She offers therapy and coaching for people navigating food struggles, shame, sensory sensitivities, and overwhelming emotional experiences. Check out her self-paced, virtual, ARFID and Selective Eating Course.
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Late-Diagnosed Autism, ADHD, & “Neurohybridity”: Why Some People Never Fit One Label With Dr. Emma Offord @divergentlives

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

ARFID Doesn’t Have to Look Extreme to Be Real: The Overlooked Middle Ground

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

Autistic Adults Who Struggle to Eat: POTS, Eating Disorders & What Helps

If eating feels impossible, like your body shuts down, pushes back, or feels worse after you try, this episode explains why. For many autistic adults, eating challenges are shaped by POTS, nervous system differences, and misunderstood patterns that often get labeled as eating disorders. Here’s what’s actually happening and small steps that can help.
What POTS Is and Why It Changes Eating
POTS, or Postural Orthostatic Tachycardia Syndrome, affects how your body regulates heart rate, blood pressure, and circulation. When you move from lying down to sitting or standing, your body may struggle to move blood efficiently. This can lead to dizziness, fatigue, nausea, and a racing heart.
Eating adds another layer. Digestion requires blood flow and energy. After you eat, your body redirects resources to your digestive system. If your system is already working hard to manage circulation, this shift can increase symptoms. You might feel more dizzy, more fatigued, or more nauseous after meals. Over time, your body can start to associate eating with feeling worse, which makes it harder to initiate or sustain eating.
Autism, Interoception, and Why Hunger Cues Can Feel Unclear
Many autistic adults experience differences in interoception, or the ability to read internal body signals. Hunger, fullness, thirst, and early signs of nausea can feel inconsistent, delayed, muted, or overwhelming.
When interoception is already variable and you add POTS, where internal signals can shift quickly and intensely, it becomes harder to know when to eat, how much to eat, or what your body needs. You might not feel hunger until you are already depleted, or you might feel a mix of signals that are difficult to interpret.
Sensory Overload and Why Food Can Feel Like Too Much
Eating is a sensory experience. Texture, temperature, smell, taste, and the physical act of chewing and swallowing all require processing. If your nervous system is already managing dizziness, nausea, or a racing heart, sensory input can quickly become overwhelming.
Foods that once felt manageable can start to feel like too much. Eating can shift from neutral to overstimulating or even unsafe. This is a nervous system response, not a character trait.
Fatigue, Energy Limits, and Why Meals Get Skipped
POTS fatigue can feel like your body loses access to energy, especially when upright. Many autistic adults already navigate energy limits across the day. When eating requires planning, preparing food, sitting upright, tolerating sensory input, and managing symptoms afterward, it can exceed what your body has available.
So meals get delayed, minimized, or skipped. Not because you do not care, but because the cost is too high in that moment.
When This Gets Misread as an Eating Disorder
Low appetite, early fullness, avoiding food because it makes you feel worse, or going long stretches without eating can look like restriction from the outside. Sometimes these patterns are diagnosed as anorexia or another restrictive eating disorder without fully understanding the physiological and neurological context.
At the same time, someone can experience both. You can be autistic, have POTS, and have an eating disorder. These experiences can overlap and reinforce each other, which means support needs to reflect the full picture.
Why Eating Can Feel Worse Before It Feels Better
After eating, blood shifts toward digestion. For someone with POTS, this can increase dizziness, fatigue, and nausea in the short term. Your body learns quickly that eating leads to discomfort.
At the same time, not eating can worsen symptoms over time by affecting blood volume and blood sugar stability. This creates a loop where both options feel hard.
Small Steps That Can Make Eating More Accessible
Instead of raising expectations, this is about lowering the barrier to entry.
Start with smaller, more frequent eating opportunities. Even a few bites, a snack, or a drink with calories can be a meaningful step when full meals feel like too much.
Experiment with position. If sitting upright increases symptoms, try eating in a more supported or slightly reclined position, or resting before and after eating.
Simplify food choices. Repeating foods that feel predictable and manageable can reduce decision-making and sensory load. Convenience foods are valid.
Use gentle external cues if hunger signals are unclear. Timers, visual reminders, or pairing eating with another activity can help create structure without pressure.
Notice timing. Are there moments in the day when your symptoms feel slightly more manageable? Those windows can support eating.
Hydration and electrolytes, if part of your care plan, can support your body’s ability to tolerate both standing and eating.
Shifting the Question
If eating feels impossible, the question is not “What is wrong with me?” It becomes “What is my body responding to, and what would make this easier?”
This shift opens the door to more flexible, compassionate approaches that work with your nervous system instead of against it.
The Bigger Picture: Being Seen in the Complexity
Autistic adults are often misunderstood in healthcare settings. POTS can be underdiagnosed or dismissed. Eating disorders are frequently overlooked in people who do not fit expected presentations. When these experiences overlap, needs are often minimized or misinterpreted.
Your lived experience matters. Your body is communicating something real.
Related Episodes
Chronic Illness, Wellness Culture, & Eating Disorder Recovery: Taking an Anti-Diet Approach With Abbie Attwood, MS, @abbieattwoodwellness on Apple and Spotify.
Anti-Fat Bias in Healthcare & Chronic Illness: Healing Body Image in a Marginalized Body With Ivy Felicia @iamivyfelicia on Apple and Spotify.
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.
Autism & Eating Challenges: Understanding Sensory Needs, Routines, & Safety on Apple & Spotify.
Work With Dr. Marianne
If you are struggling to eat and it feels more complex than what typical advice addresses, you are not alone. I work with many people navigating eating challenges alongside neurodivergence and chronic conditions. Together, we build approaches that fit your nervous system, your energy, and your lived reality.
You can learn more about working with me through therapy or coaching on my website drmariannemiller.com.
You can also follow me on Instagram @drmariannemiller or email me directly at hello@drmariannemiller.com.
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If Everyone Is Getting Smaller, This Might Be Why: GLP-1s, Tradwives, & Eating Disorder Pressure With Anne Richardson @theeatingdisordernutritionist

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

Why Eating Feels So Chaotic With ADHD: Binge Eating, Bulimia, & Executive Function Challenges

If eating feels chaotic, unpredictable, or hard to keep up with, especially with ADHD, there are real reasons for that. This episode breaks down why eating can feel all over the place, not because you are doing something wrong, but because your brain is being asked to manage a process that depends heavily on executive functioning, timing, and regulation across the entire day.
In this solo episode, Dr. Marianne explores the connection between ADHD, binge eating disorder, and bulimia, including how impulsivity, dopamine, and executive function challenges shape eating patterns in ways that are often misunderstood. You will hear why eating may feel easy to delay and then suddenly urgent, why follow-through can feel inconsistent, and why this pattern is not about willpower.
ADHD and Eating Disorders: Why Eating Feels So Chaotic
Eating regularly requires more than hunger. It depends on time awareness, task initiation, decision-making, and the ability to shift attention. ADHD directly affects these processes, which means eating can feel disorganized, delayed, or unpredictable. This episode explains why chaotic eating patterns often reflect executive function challenges, not a lack of effort or care.
Impulsivity, Dopamine, and Binge Eating
Impulsivity in ADHD is not just about acting quickly. It reflects differences in how the brain pauses and redirects. When binge urges show up, they can feel immediate and intense. At the same time, dopamine differences in ADHD can make food a fast and effective way to shift focus, regulate emotions, or create relief. This episode explores how these systems interact and why food can become a powerful regulator.
Executive Function Challenges and Follow-Through With Eating
Executive function challenges can make it harder to plan, prepare, and initiate eating, even when you want to. You might forget to eat, delay eating, or feel overwhelmed by decisions. This episode breaks down how these patterns develop and why eating consistency is not just about intention, but about access to executive functioning in real time.
Restriction, Glucose, and Intensified ADHD Traits
When eating gets delayed or inconsistent, even unintentionally, glucose levels can drop. This affects the brain’s ability to regulate attention, impulses, and emotions. Lower glucose can intensify ADHD traits, making it even harder to initiate eating or pause during urges. This episode explains how this cycle develops and why it can feel so hard to interrupt.
Why This Is Not About Willpower
Chaotic eating patterns are often framed as a lack of discipline, but this episode reframes them through a neurodivergent-affirming lens. When your brain is under-fueled and your executive functioning is stretched, it makes sense that eating feels harder to manage. Understanding this can reduce shame and open up more supportive approaches.
Related Episodes
Midlife Bulimia Recovery: Coping With the Internal Chaos on Apple and Spotify.
Eating Disorders & ADHD: Neurodivergent-Affirming Recovery With Taylor Ashley, RP @taylorashleytherapy on Apple and Spotify.
ADHD & Bulimia: Dopamine, Impulsivity, & the Hidden Link to Binge Eating With Kirsten Book, PMHNP-BC on Apple and Spotify.
Work With Dr. Marianne
If you are navigating ADHD, binge eating, bulimia, or eating patterns that feel chaotic and hard to predict, you do not have to figure this out alone. Dr. Marianne works with many clients with ADHD in both therapy and coaching, helping them understand their brain, reduce shame, and build ways of eating that are actually doable in real life. You can learn more about working with Dr. Marianne via her website, drmariannemiller.com.

When Your Autistic Child Has ARFID & Anorexia: Signs, Misdiagnosis, & What to Do Next

If your autistic child’s eating feels more complex than anyone seems to understand, this episode may put words to what you’ve been seeing. Because when ARFID and anorexia overlap in autistic kids, the signs often get missed, misunderstood, or explained away in ways that don’t actually help. And when that happens, families can feel stuck, blamed, or pushed into approaches that increase distress instead of creating safety.
In this episode, I’m breaking down what it really looks like when ARFID and anorexia coexist, why this overlap is so often misdiagnosed, and what to do next if you’re trying to support your child in a way that actually fits how their brain and body work. If you’ve been told it’s “just sensory” or “just anorexia” and neither explanation fully makes sense, this conversation will help you understand why.
What ARFID and Anorexia Look Like in Autistic Children
ARFID and anorexia are often treated as completely separate diagnoses, but in autistic kids, the reality is frequently more nuanced. ARFID is commonly rooted in sensory differences, predictability, and nervous system safety, while anorexia can involve restriction tied to fear, control, or distress around the body. When these experiences overlap, eating patterns can shift in ways that don’t fit neatly into one category, making it harder for providers to recognize what’s really happening.
We explore how long-standing sensory-based food restriction can evolve, how new food rules or avoidance patterns may emerge, and why autistic children may not express body-related concerns in expected ways. Understanding this distinction is critical for getting the right kind of support.
Why Misdiagnosis Happens So Often
Many autistic children fall through the cracks when it comes to eating disorder diagnosis. Some are labeled as having ARFID only, which can minimize medical and psychological risk when anorexia is also present. Others are diagnosed with anorexia without consideration for sensory needs, interoception, or nervous system regulation, which can lead to treatment approaches that feel overwhelming or unsustainable.
In this episode, I explain why common eating disorder frameworks often miss autistic presentations, how masking and communication differences play a role, and why a one-size-fits-all approach to treatment can backfire.
When Autistic Traits Look Like Anorexia
Not all restrictive eating in autistic children is driven by anorexia. Some behaviors that appear concerning from the outside are actually rooted in autistic traits. Repetitive eating patterns, strong preferences for sameness, difficulty with transitions, and distress around internal body sensations can all influence how a child eats.
We unpack how these patterns can be misinterpreted, why it matters to differentiate them, and how misunderstanding these behaviors can lead to increased pressure instead of meaningful support.
Understanding ARFID Plus
You may have heard the term ARFID Plus, which is sometimes used to describe when ARFID co-occurs with another eating disorder, often anorexia. In autistic children, this can look like long-standing sensory-based restriction layered with additional fears, rules, or patterns that extend beyond sensory needs alone.
I walk through what ARFID Plus can look like in real life, why it is often overlooked, and how recognizing this overlap can change the way you approach support and care.
Why Agency and Autonomy Matter in Eating Support
One of the most important shifts in supporting autistic children with eating challenges is moving away from compliance-based approaches and toward collaboration. When eating becomes something that is done to a child instead of with them, the nervous system can respond with protection, which may look like shutdown, refusal, or increased rigidity.
In this episode, I explain why facilitating agency and autonomy is not optional but essential. You’ll learn how supporting choice, predictability, and collaboration can help create the conditions where eating is actually possible, and why pushing too hard can reinforce both ARFID patterns and anorexia-related restriction.
What to Do Next
If you are recognizing your child in this episode, the next step is not to force a single explanation or diagnosis. It is to step back and look at the full picture. Sensory needs, interoception, nervous system regulation, autistic traits, and eating disorder patterns can all exist at the same time. And support needs to reflect that complexity.
In this episode, I offer a framework for thinking about eating in a more integrated way, so you can move toward approaches that prioritize safety, trust, and sustainability instead of urgency and control.
Related Episodes
Can ARFID and Anorexia Co-Exist? on Apple and Spotify.
ARFID in Adults vs ARFID in Children on Apple and Spotify.
Work With Dr. Marianne
If you’re looking for support that understands the overlap between autism, ARFID, and anorexia, I work with neurodivergent individuals and families navigating exactly this kind of complexity. I offer therapy in California and coaching more broadly, with a focus on neurodivergent-affirming, collaborative care that meets you and your child where you are.
You can learn more about working with me by visiting my website, drmariannemiller.com.

“Debating” Jillian Michaels: Body Positivity, Eating Disorders & What You Didn’t See on Jubilee With Edie Stark, LCSW @ediestarktherapy

You saw the clip. You saw the reactions. But you didn’t see what actually happened.
In this episode of Dr. Marianne Land, I sit down with eating disorder therapist and fat-positive advocate Edie Stark @ediestarktherapy to unpack what it was really like to be placed in a highly edited, high-pressure “debate” with Jillian Michaels. This conversation pulls back the curtain on how media formats shape narratives, how nuance gets erased, and how anti-fat bias shows up in ways that often go unexamined. If conversations about body positivity, eating disorders, and health have ever felt confusing or overly simplified, this episode offers a more grounded, clinically informed perspective.
What Really Happened Behind the Scenes
Edie walks through her experience from the moment she was contacted to participate to what it felt like entering a space designed for speed, pressure, and spectacle. She shares how little time participants were given to prepare, how decisions were made about who could speak, and how the structure itself limited meaningful dialogue. This part of the conversation highlights how production choices can influence not just what is said, but what is ultimately seen and believed by millions of viewers.
Why This Wasn’t a True Debate
This was not a setting built for thoughtful exchange. It was a format that rewarded quick reactions over depth and tension over understanding. We explore how the pace, editing, and framing made it nearly impossible to have a nuanced conversation about eating disorders, body diversity, and health. When complex topics are reduced to short, high-intensity moments, important context disappears, and the public is left with an incomplete and often misleading picture.
Eating Disorders, Body Positivity, & Fatphobia
At the center of this episode is a deeper conversation about eating disorders and the realities of living in a body in a culture shaped by weight stigma. We talk about why body size alone cannot define health, how anti-fat bias affects people across body sizes, and how systemic factors like racism, stress, and access to care are often ignored in mainstream conversations. Edie also shares why certain medicalized language can feel harmful to many people and how language choices can either support or alienate those seeking help.
The Reality of Viral Backlash & Online Harassment
After the episode aired, Edie experienced an intense wave of online backlash. We talk openly about what it’s like to be misrepresented, to have people form strong opinions based on a short, edited clip, and to navigate the emotional toll of public scrutiny. This part of the conversation also explores how social media amplifies outrage, how quickly misinformation spreads, and how difficult it can be to stay grounded in your values when faced with large-scale criticism.
What This Conversation Is Really About
This episode goes far beyond one moment on camera. It speaks to the larger systems that shape how we understand eating disorders, body image, and health. It is about advocating for people in larger bodies, challenging harmful assumptions, and bringing nuance back into conversations that are often flattened into extremes. If you’ve ever felt like something was missing from mainstream discussions about food and bodies, this conversation names it directly.
Follow Edie Stark
To learn more from Edie Stark and follow her work as an eating disorder therapist and fat-positive advocate, you can connect with her on Instagram @ediestarktherapy and other social platforms. You can also go to her website, starktherapygroup.com or her consultation website ediestark.com. Her work centers compassionate, ethical, and evidence-informed care for individuals navigating eating disorders and body image challenges.
Related Episodes With San Diego Eating Disorder Therapist & Consultant Edie Stark, LCSW
What Your Therapist Needs to Know About Eating Disorders on Apple & Spotify.
The Hidden Risks of Non-Specialized Eating Disorder Treatment on Apple & Spotify.
The Diet/Wellness Industry, Accessibility, & Diet Culture on Apple & Spotify.
Anti-Fat Bias & the Importance of Advocacy on Apple & Spotify.
Link to Jubilee "Surrounded" Episode With Jillian Michaels
Content caution: In this show, participants address anti-fat bias and systemic oppression. Assumptions that being fat automatically means that you're not healthy are a big part of this conversation. I (Dr. Marianne) found it very activating and could only watch about half of it--the half that included Edie's sections. So please take care when you decide whether and how much to watch. https://www.youtube.com/watch?v=M7K87rGoGps
Work With Dr. Marianne
If you’re struggling with binge eating, ARFID, anorexia, bulimia, or feeling overwhelmed around food, support is available. I offer eating disorder therapy and coaching for adults across California, Washington, D.C., Texas, and globally. My approach is neurodivergent affirming and grounded in understanding sensory needs, routines, and the complexity of real-life eating struggles.
You deserve care that sees the full picture of your experience.
Learn more at: drmariannemiller.com
Listen, Share, & Stay Connected
If this episode resonated with you, rate it and share it with someone who needs a more nuanced conversation about eating disorders and body image. Follow Dr. Marianne Land on Apple and Spotify for more episodes on ARFID, binge eating, neurodivergence, and recovery.

Long-Term Anorexia & Restrictive Eating: 5 Strategies That Actually Help

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