Dr. Marianne-Land: An Eating Disorder Recovery Podcast

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.
Listen and Share
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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.

What Is Mechanical Eating? Pros, Cons, & How It Can Work When Eating Feels Hard (ARFID, Binge Eating, Restriction)

If eating feels inconsistent, overwhelming, or like something you are constantly negotiating with, mechanical eating might be the tool you have heard about but are not sure how to use. In this episode, I break down what mechanical eating actually is, the pros and cons, and why it can help when eating feels hard, especially if you are navigating ARFID, binge eating, anorexia, or restrictive eating patterns. We are also going to talk about why mechanical eating does not work for everyone and how to adapt it in a way that supports your nervous system, your sensory needs, and your autonomy.
Mechanical eating is a structured eating approach used in eating disorder recovery where you eat at consistent, planned times instead of relying on hunger cues. This often includes meals and snacks spaced throughout the day, regardless of whether you feel hungry. It is commonly used when hunger cues feel unreliable, delayed, or confusing, and when “just listen to your body” does not feel accessible.
Why Mechanical Eating Helps When Eating Feels Hard
When eating feels chaotic or unpredictable, mechanical eating creates an external structure that your body can begin to rely on. This structure supports more consistent nourishment, stabilizes blood sugar and energy, and reduces the intensity of binge urges and restriction cycles. Over time, it can help your body relearn hunger and fullness cues in a way that feels safer and more predictable.
Mechanical eating can also reduce decision fatigue. If you already know when you are eating, you are not starting from zero each time, which can make eating feel more manageable, especially if you experience executive functioning challenges or overwhelm around food.
Mechanical Eating and Eating Disorders
Mechanical eating is often used in recovery from ARFID, binge eating disorder, anorexia, and restrictive eating patterns. In ARFID, sensory sensitivities, fear, or lack of interest in food can override hunger signals. In binge eating, irregular eating patterns can lead to intense hunger and strong urges. In restrictive eating, hunger cues are often diminished or disconnected.
By introducing consistency, mechanical eating can interrupt these patterns and support more regulated eating over time, helping your body receive nourishment in a more predictable way.
Pros of Mechanical Eating
Mechanical eating can provide a stabilizing foundation in eating disorder recovery. It creates predictable structure when hunger cues feel unreliable and reduces chaotic eating patterns that can contribute to binge eating or restriction. It can support nervous system regulation by introducing consistency and help prevent extreme hunger, which often increases urgency around food.
Over time, mechanical eating may also help reconnect you with your internal cues, making hunger and fullness feel more accessible and less confusing.
Cons of Mechanical Eating
Mechanical eating is not a one-size-fits-all approach. It can feel rigid or rule-based, especially if you have a history of perfectionism or strict food rules. For people with a strong need for autonomy, including those with Pervasive Desire for Autonomy, it can feel like pressure or loss of control, which may lead to resistance.
It can also overlook sensory sensitivities in ARFID if the focus is only on timing rather than food tolerability. Eating without hunger can feel disconnected or unnatural at first, which can make the process feel discouraging if this is not expected or supported.
Why Mechanical Eating Does Not Work for Everyone
For many neurodivergent individuals, including those with autism, ADHD, or sensory processing differences, mechanical eating often needs to be adapted. If food feels unsafe, overwhelming, or intolerable, structure alone will not resolve that. If eating feels like pressure, your nervous system may push back as a protective response.
This episode explores how to recognize when mechanical eating needs to be adjusted rather than pushed through, and how to shift the approach so that it feels more supportive and sustainable.
How to Make Mechanical Eating More Flexible and Supportive
Mechanical eating works best when it is adapted to your specific needs and capacity. This can include prioritizing safe foods in ARFID, simplifying meals to reduce effort, and using repetition to lower the cognitive load of eating. Flexibility in timing can also make a difference, allowing you to adjust your plan when your body feels shut down instead of forcing a rigid schedule.
Supporting your nervous system before and during eating, and reducing pressure wherever possible, can help mechanical eating feel less like a power struggle and more like a form of support.
Mechanical Eating, Neurodivergence, and Nervous System Support
This episode takes a neurodivergent-affirming approach to mechanical eating by addressing sensory needs, executive functioning challenges, and autonomy. It explores why pressure can increase resistance and how to create an approach that works with your nervous system rather than against it.
Mechanical eating can be helpful, but only when it is aligned with how your brain and body actually function.
Final Thoughts on Mechanical Eating
Mechanical eating can create stability when eating feels hard. It can reduce overwhelm, support more consistent nourishment, and help regulate patterns in ARFID, binge eating, and restriction. At the same time, it is not the only path to recovery, and it is not meant to override your autonomy or lived experience.
The goal is not perfect structure. The goal is support that actually fits you.
Related Episodes
Mechanical Eating in Lifelong Eating Disorder Recovery: Benefits, Limits, & Who It Helps Most on Apple & Spotify.
Intuitive vs. Mechanical Eating: Can They Coexist? on Apple & Spotify.
Work With Dr. Marianne
If you are struggling with ARFID, binge eating, or restrictive eating and want support that is neurodivergent-affirming and individualized, I offer therapy and coaching for clients in California, Washington, D.C., and globally. You deserve support that fits your brain, your body, and your life. Check out my website drmariannemiller.com for more info.

ADHD & Bulimia: Dopamine, Impulsivity, & the Hidden Link to Binge Eating With Kirsten Book, PMHNP-BC

If you have ADHD and struggle with bulimia or binge eating, it may not be about willpower at all. It may be about dopamine, impulsivity, and a nervous system that has been trying to regulate itself the only way it knows how.
In this episode of the podcast, I sit down with psychiatric nurse practitioner Kirsten Book to unpack the often-missed connection between ADHD and eating disorders. We move beyond surface-level explanations and into what is actually happening in the brain, including how dopamine dysregulation, executive functioning challenges, and emotional intensity can drive patterns of bingeing, restricting, and purging.
ADHD and Bulimia: The Dopamine Connection
Kirsten shares her lived experience of recovering from bulimia and being diagnosed with ADHD later in life. She describes how starting ADHD treatment shifted everything. Instead of feeling constantly out of control, she experienced something many people with ADHD and eating disorders rarely feel, which is a pause. A moment to decide what to do next. That shift in impulsivity and regulation can be a turning point in recovery.
We break down how ADHD affects dopamine regulation and why the brain begins to seek out stimulation through food. Binge eating, restriction, and purging can all increase dopamine in the short term, which reinforces these patterns even when they create long-term distress.
Why ADHD Gets Missed in Eating Disorders
Many people, especially girls and women, are never screened for ADHD. Instead, they are diagnosed with anxiety or depression. This episode explores how untreated ADHD can show up as emotional dysregulation, difficulty focusing, chaotic eating patterns, and a constant sense of being overwhelmed.
Kirsten explains why comprehensive screening matters and how identifying ADHD can completely change the direction of treatment. When ADHD is addressed directly, many people experience a reduction in binge eating urges and a greater sense of stability with food.
Executive Function, Impulsivity, and Eating Patterns
ADHD affects the brain’s executive functioning, including planning, organization, and follow-through. This makes consistent eating much harder than it looks from the outside. Skipped meals, irregular eating, and impulsive food choices are not random. They are connected to how the brain manages energy, attention, and motivation.
We also talk about interoception and why people with ADHD may feel disconnected from hunger and fullness cues. This disconnection can lead to both undereating and overeating, creating cycles that feel confusing and hard to interrupt.
The Role of Dopamine in Binge Eating and Restriction
This episode offers a clear explanation of how different eating disorder behaviors interact with dopamine. Binge eating and highly palatable foods can create a surge in dopamine, reinforcing cravings and compulsive eating. Restriction can also increase dopamine in a different way, which helps explain why it can feel rewarding even when it is harmful.
Over time, these patterns can change how the brain responds to reward, making it harder to feel regulated without them. Understanding this helps reduce shame and opens the door to more effective, targeted support.
ADHD Treatment and Eating Disorder Recovery
We talk through how psychiatric medications can support both ADHD and eating disorder recovery. This includes the role of stimulants, SSRIs, and other medications in improving impulse control, emotional regulation, and the ability to follow through with consistent eating.
Kirsten also addresses common concerns about medication, especially for parents. She emphasizes the importance of asking questions, understanding risks and benefits, and approaching treatment with openness rather than fear. Medication is not the only tool, but for many people, it creates the stability needed to fully engage in recovery.
This Is Not About Willpower
If your eating feels chaotic, impulsive, or out of control, there may be more going on beneath the surface. ADHD changes how the brain processes reward, attention, and regulation. When that is not understood, eating disorder behaviors can become a way to cope.
You deserve support that looks at the full picture, including your brain, your nervous system, and the ways you have learned to get through the day.
Connect With Kirsten Book, PMHNP-BC
Kirsten Book is a dual-certified psychiatric mental health nurse practitioner and family nurse practitioner who specializes in working with children, adolescents, and adults navigating eating disorders, ADHD, anxiety, and depression.
You can learn more about her work and concierge psychiatric services at her website. She is licensed in California, Illinois, Arizona, and Washington. She is also active on Facebook, and LinkedIn. The best way to reach her directly is via email at kbook@kirstenbook.com.
Related Episodes
Bulimia Recovery & ADHD Diagnosis: One Woman’s Journey to Healing With Kirsten Book, PMHNP-BC, @bookconciergepsych 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.
Eating Disorders & ADHD: Neurodivergent-Affirming Recovery With Taylor Ashley, RP @taylorashleytherapy on Apple & Spotify.
Work With Dr. Marianne
If you are looking for eating disorder support that integrates neurodivergent-affirming care, I offer therapy and coaching for ARFID, binge eating disorder, anorexia, and bulimia.
I work with clients across California and Washington, D.C., as well as offer coaching more broadly in the U.S. and worldwide. My approach focuses on sensory needs, nervous system regulation, executive functioning, and building sustainable eating patterns that actually work for your life.
You can visit my website drmariannemiller.com to learn more about working with me and explore current offerings, including therapy, coaching, and self-paced programs.
Share This Episode on Bulimia and ADHD
If this episode resonated with you, share it with someone who needs to hear it and follow the podcast so you do not miss upcoming episodes on ADHD, ARFID, binge eating, and neurodivergent-affirming recovery.

Why You Can’t Stop Body Checking: Anxiety, Eating Disorders, Autism, & What Actually Helps

If you feel stuck in constant body checking, repeatedly scanning, measuring, or monitoring your body throughout the day, you are not alone and there is a real reason this pattern is so hard to break. Body checking is not about vanity or lack of willpower. It is a nervous system response shaped by anxiety, eating disorders, sensory processing, and a culture that teaches you to constantly evaluate your body.
In this episode, we unpack why body checking becomes compulsive, how it connects to eating disorders, anxiety, and autism, and what actually helps when trying to reduce body monitoring behaviors in a sustainable, neurodivergent-affirming way. If you have ever wondered why you cannot stop checking your body, even when it increases distress, this episode offers a deeper, more compassionate framework for understanding what is really happening.
What Is Body Checking? (Eating Disorders & Body Image)
Body checking includes behaviors like mirror checking, weighing yourself frequently, comparing your body to others, scanning how your clothes fit, or mentally monitoring body size and shape throughout the day. These patterns are strongly linked to eating disorders such as anorexia, bulimia, binge eating disorder, and ARFID, and they often reinforce body image distress and food-related anxiety.
Rather than helping you feel more in control, body checking tends to increase preoccupation with the body over time, creating a cycle that is difficult to interrupt.
Why Body Checking Feels So Hard to Stop (Anxiety & Control)
Body checking is deeply tied to anxiety and the need for certainty. When the nervous system feels overwhelmed, the brain looks for something to track and control. The body becomes that focus because it is always accessible.
Even though body checking may briefly reduce anxiety, it reinforces the cycle long term. The more you check, the more your brain learns that checking is necessary to feel okay. This is why stopping body checking is not about discipline. It is about understanding the anxiety-body checking loop and finding other ways to create safety.
Body Checking in Autism & Neurodivergence (Sensory & Interoception)
For autistic individuals and other neurodivergent people, body checking can serve additional functions related to sensory processing and interoception. Internal body signals may feel unclear or inconsistent, which can lead to relying on external cues like mirrors, touch, or clothing fit to understand what is happening in the body.
At the same time, heightened sensory awareness and pattern recognition can increase focus on subtle body changes. This makes body checking not just about body image, but also about making sense of sensory experiences in a body that may feel unpredictable.
The Hidden Cycle of Body Checking & Eating Disorders
Body checking creates a reinforcing loop. Anxiety increases the urge to check. Checking temporarily reduces distress. The relief fades. The urge returns stronger. Over time, this cycle strengthens eating disorder behaviors, body image distress, and compulsive monitoring.
Understanding this cycle is key to shifting your relationship with body checking. The goal is not immediate elimination, but gradual change that reduces intensity and frequency.
What Actually Helps: Neurodivergent-Affirming Strategies
Reducing body checking requires a different approach than simply trying to stop. In this episode, we explore harm reduction strategies that support long-term change.
We talk about identifying the function of body checking, building alternative ways to regulate anxiety, and using sensory supports that actually work for your nervous system. We also explore how to gently reduce checking behaviors without increasing distress, and how to shift from constant body monitoring toward a more flexible and compassionate relationship with your body.
A Liberation-Based Approach to Body Image & Recovery
Body checking does not exist in isolation. It is shaped by diet culture, weight stigma, and systemic pressure to monitor and control bodies. Recovery is not about perfect body acceptance or never noticing your body again. It is about moving from surveillance to relationship.
This episode offers a neurodivergent-affirming, harm reduction approach to body checking that centers curiosity, flexibility, and sustainability rather than rigid rules.
Related Episodes
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.
Eating Disorders & ADHD: Neurodivergent-Affirming Recovery With Taylor Ashley, RP @taylorashleytherapy on Apple & Spotify.
Work With Dr. Marianne
If you are struggling with body checking, eating disorders, ARFID, binge eating, or anxiety around food and your body, you do not have to navigate this alone. I offer therapy and coaching with a neurodivergent-affirming, liberation-focused approach.
Learn more about working with me athttps://www.drmariannemiller.com