Dr. Marianne-Land: An Eating Disorder Recovery Podcast

How Discovering You’re Autistic Later in Life Can Change Eating Disorder Recovery

Many people discover they are autistic only after years of struggling with eating disorders. This episode explores how a late autism diagnosis can reshape recovery by offering new understanding, compassion, and practical tools that fit the neurodivergent brain.
Understanding a Late Autism Diagnosis
Receiving an autism diagnosis in adulthood can bring both clarity and grief. It helps explain lifelong struggles with sensory overload, food textures, or social expectations, while revealing how years of misdiagnosis delayed meaningful support. In recovery, recognizing autism can change everything by connecting eating patterns to sensory differences and masking rather than willpower or motivation.
Masking, Sensory Needs, and Food
Autistic masking often overlaps with eating disorder behaviors. Restricting food, eating “normally” in social settings, or following rigid meal plans can become ways to hide difference and avoid judgment. This chronic effort to appear typical creates exhaustion and disconnection from true needs.
At the same time, sensory experiences around food are often intense. Taste, smell, temperature, and texture can feel overwhelming or unpredictable. Foods that others find pleasant may feel unsafe or even painful. Sustainable recovery begins when we make space for sensory preferences and allow eating to feel safe rather than forced.
ARFID and Autism Overlap
Avoidant or Restrictive Food Intake Disorder (ARFID) frequently occurs alongside autism. This overlap reflects sensory sensitivities, fear of choking or nausea, and low appetite rather than body image concerns. Recognizing this link shifts the goal of recovery away from compliance and toward creating safety, autonomy, and predictability in eating.
Intersectionality in Diagnosis and Recovery
Autism and eating disorders cannot be separated from the realities of race, gender, body size, class, and sexuality. Marginalized people are less likely to be diagnosed early and more likely to experience bias in treatment. Fat, BIPOC, and queer autistic people are often labeled as resistant when their needs are simply misunderstood.
A liberation-based approach to recovery asks how we can build care that honors the whole person. It challenges systems that pathologize difference and reframes healing as a process of reclaiming identity and dignity, not just changing eating behaviors.
Case Example
Dr. Marianne shares the story of a fat, queer woman of color who learned she was autistic in her late 30s after years of being told she was noncompliant in treatment. Providers dismissed her sensory distress and focused only on weight loss. She masked constantly, pretending to eat foods that overwhelmed her senses in order to appear cooperative.
Her diagnosis transformed her recovery. She began to design meals that respected her sensory needs, sought affirming providers, and connected with other neurodivergent women of color. Once her care aligned with her full identity, shame gave way to self-trust, and recovery finally felt sustainable.
Pathways Toward Neurodivergent-Affirming Recovery
A late autism diagnosis does not make recovery harder, but it does require reframing what recovery means. Sensory-attuned approaches allow individuals to choose foods that feel safe rather than forcing exposure to distressing ones. Predictable meal routines and gentle flexibility can replace pressure to eat intuitively when interoception is limited.
Executive functioning supports such as reminders, meal prep systems, and visual cues make daily nourishment possible. These tools are not crutches; they are accommodations. Recovery also involves boundary-setting and self-advocacy after years of masking needs. Finding autistic and intersectional community can turn isolation into belonging, making recovery not just about food but about identity and connection.
Who This Episode Is For
This episode is for autistic adults in recovery, clinicians learning to support neurodivergent clients, and anyone who has realized that standard eating disorder treatment does not fit. It also speaks to people exploring how autism, sensory processing, and identity intersect with food and body experiences.
Related Episodes for Autistics With Eating Disorders
Autism & Eating Disorders Explained: Signs, Struggles, & Support That Works on Apple & Spotify.
Autism & Anorexia: When Masking Looks Like Restriction, & Recovery Feels Unsafe on Apple & Spotify
More Autism Resources for Eating Issues
If these experiences sound familiar, explore Dr. Marianne’s ARFID & Selective Eating Course. This self-paced course teaches consent-based and sensory-attuned strategies for reducing eating distress and building a more supportive relationship with food at your own pace.

When Eating Disorders Meet Anxiety, OCD, or Depression: Co-Occurring Challenges & Recovery Strategies

When eating disorders overlap with anxiety, OCD, or depression, recovery can feel especially complex. In this episode of Dr. Marianne-Land: An Eating Disorder Recovery Podcast, Dr. Marianne Miller, LMFT, explores how co-occurring mental health conditions interact with disordered eating and body image struggles. She explains how anxiety often fuels food rules and avoidance, how OCD rituals can merge with eating rituals, and how depression can make nourishment feel almost impossible.
Throughout the episode, Dr. Marianne shares intersectional case examples that reflect the diversity of real-world experiences. You will hear about a Black nonbinary person whose anorexia and depression are dismissed by medical providers, a South Asian immigrant coping with OCD and bulimia in a culture where discussing mental health is taboo, and others whose experiences reveal how systemic bias and identity shape recovery. This episode offers understanding, compassion, and realistic tools for healing when multiple conditions overlap.
What You’ll Learn
You will learn how anxiety, OCD, and depression intersect with eating disorders, why eating disorders rarely exist alone, and how each condition influences the recovery process. Dr. Marianne explains why addressing only food behaviors is not enough and how integrative treatment supports both the mind and body. You will also hear about sensory-attuned strategies and community-based care that help people move toward safety, nourishment, and autonomy.
Key Takeaways
Eating disorders often coexist with anxiety, OCD, or depression because they share common roots in trauma, nervous system overwhelm, and attempts to create safety. Anxiety drives control and rigidity, OCD fuels compulsive rituals around food and body, and depression slows motivation and energy, making self-care harder. True recovery acknowledges these overlaps and treats the whole person.
Healing does not mean erasing anxiety, OCD, or depression. It means building a life that includes these realities while reducing their control over food and self-worth. Recovery becomes more sustainable when treatment honors a person’s full identity, including body size, race, gender, and neurotype.
Who This Episode Is For
This episode is for anyone who lives with an eating disorder and another mental health condition such as anxiety, OCD, or depression. It is also for clinicians, family members, and supporters who want to understand how co-occurring challenges interact and how to provide compassionate care.
Content Caution
This episode includes discussion of eating disorders, anxiety, OCD, and depression. Please take care while listening and pause if you need to.
Related Episodes
Anxiety, Meltdowns, Neurodiversity, & Eating Disorders on Apple & Spotify.
Food, Fear, & Fixation: How OCD Shapes Eating Disorders on Apple & Spotify.
Depression & Eating Disorders on Apple & Spotify.
Connect and Learn More
For deeper guidance, visit drmariannemiller.com/arfid to explore Dr. Marianne’s ARFID and Selective Eating Course. The course offers neurodivergent-affirming, sensory-attuned strategies that apply to a wide range of eating struggles.
To learn about Dr. Marianne’s therapy services in California, Texas, and Washington, D.C., or to explore additional blog posts and podcast episodes, visit drmariannemiller.com.
 

Family-Based Treatment for Adolescent Eating Disorders: How to Leave Room For Neuroaffirming Approaches With Dr. Heather Rosen @hrrosen

In this insightful conversation, Dr. Marianne Miller sits down with Dr. Heather Rosen, a licensed clinical psychologist and certified Family-Based Treatment (FBT) supervisor and trainer, to explore how evidence-based treatments for eating disorders can evolve to meet the needs of neurodivergent clients and their families.
Dr. Rosen shares her background working in major hospital settings including Stanford University, Lucile Packard Children’s Hospital, and Mount Sinai Hospital, and now in private practice in Westchester County, New York. Together, she and Dr. Miller unpack the heart of FBT—how involving families in treatment can strengthen recovery for adolescents and young adults with anorexia, bulimia, binge eating disorder, and ARFID.
This episode highlights how food becomes a metaphor for emotional pain, safety, and connection, and why treatment must go beyond meal plans to address the underlying need for autonomy, co-regulation, and family healing.
Key Topics Covered
What Family-Based Treatment (FBT) is and how it supports adolescent recovery
The role of parents in managing eating disorder behaviors at home
How FBT differs from other evidence-based treatments like CBT-E
Adapting FBT for ARFID (Avoidant/Restrictive Food Intake Disorder) and neurodivergent clients
Why flexibility and curiosity are essential when traditional exposure-based methods don’t fit
Understanding food as communication: how eating (or not eating) expresses pain, fear, and the need for control
Shifting from compliance-based models to collaborative, consent-based, and neuroaffirming care
The importance of reducing mental health stigma and improving access to effective treatment
Who This Episode Is For
This conversation is for therapists, dietitians, parents, and educators who want to understand FBT in practice and how to make eating disorder treatment more inclusive for autistic and otherwise neurodivergent youth. It’s also for anyone curious about integrating compassion, family systems awareness, and sensory attunement into recovery work.
Guest Info
Dr. Heather Rosen, PhDLicensed Clinical Psychologist | Certified FBT Therapist & SupervisorPsychology Partners Group – Westchester County, NYWebsite: psychologypartnersgroup.comInstagram: @hrrosen
Related Episodes
Family-Based Treatment and Eating Disorders in Schools With JD Ouellette of Equip Health on Apple & Spotify.
The Nitty Gritty on Family-Based Treatment for Anorexia (Maudsley Method) With Kelly McCullough @mytherapistkelly on Apple & Spotify.
Complexities of Treating ARFID: How a Neurodivergent-Affirming, Sensory-Attuned Approach Works on Apple & Spotify.
About Dr. Marianne Miller
Dr. Marianne Miller, PhD, LMFT, is a fat, neurodivergent eating disorder therapist specializing in ARFID, binge eating disorder, and complex recovery care. She offers therapy in California, Texas, and Washington, D.C., and provides global support through online courses and resources.
Learn more about Dr. Miller’s work and self-paced course on ARFID and Selective Eating at drmariannemiller.com/arfid.

The Connection Between Unresolved Trauma & Long-Lasting Eating Disorders (Content Caution)

Have you ever wondered why recovery feels stuck, no matter how hard you try?
When eating disorder behaviors keep returning despite your best efforts, unresolved trauma may be part of the reason. In this episode of Dr. Marianne-Land, Dr. Marianne Miller, LMFT, explores the deep connection between trauma and long-lasting eating disorders.
Unresolved trauma often lives in the body, shaping the nervous system and influencing how we cope, eat, and relate to ourselves. Many people discover that their eating disorder was never just about food or control—it was about safety, survival, and protection. This episode helps you understand why that makes sense and how healing is possible when both trauma and the eating disorder are addressed together.
Through compassionate storytelling and clinical insight, Dr. Marianne shares how trauma-informed therapy and body-based healing can help release long-held survival patterns. She also discusses how intersectionality, identity, and oppression influence the way trauma shows up in eating disorder recovery.
Who This Episode Is For
This episode is for anyone who has struggled with eating disorder symptoms that seem to linger, shift, or return over time. It will especially resonate with:
People who have been in treatment before yet still feel stuck in their eating disorders
Those who sense their eating disorder is connected to trauma, anxiety, or chronic stress
Neurodivergent individuals navigating sensory or emotional overwhelm around food
Survivors of emotional, physical, or systemic trauma seeking trauma-informed recovery
Clinicians, helpers, or loved ones who want to better understand how trauma and eating disorders overlap
 
If you have ever wondered why recovery feels unsafe, inconsistent, or incomplete, this episode will offer language and insight to help you make sense of your experience.
What You’ll Learn in This Episode
How unresolved trauma keeps eating disorder symptoms active for years or decades
Why eating disorders are often survival strategies, not failures of willpower
The role of the nervous system in trauma and long-term eating disorder recovery
How trauma-informed therapy helps create new pathways to safety and regulation
Why intersectionality matters in trauma and eating disorder treatment
Practical ways to rebuild safety, trust, and connection with your body
Content Caution
This episode includes discussion of trauma, eating disorders, and long-term recovery. Listen with care and pause if needed. If you are in distress, reach out to a trusted support person, therapist, or the 988 Suicide and Crisis Lifeline (U.S.) for immediate help.
Related Episodes
How Childhood Trauma Shapes Eating Disorders & Body Shame (Content Caution) on Apple & Spotify.
Childhood Trauma & Eating Disorders on Apple & Spotify.
Using EMDR & Polyvagal Theory to Treat Trauma & Eating Disorders with Dr. Danielle Hiestand, LMFT, CEDS-S on Apple & Spotify.
Trauma, Eating Disorders, & Levels of Care with Amy Ornelas, RD via Apple or Spotify.
Work With Dr. Marianne Miller
If this conversation resonates with you, therapy can help you begin to heal from trauma while working toward eating disorder recovery.Dr. Marianne Miller, LMFT, @drmariannemiller, offers trauma-informed, neurodivergent-affirming therapy for individuals navigating eating disorders, trauma, and body image distress. Her approach centers on nervous system regulation, sensory attunement, and consent-based care to help you build safety and trust within your body.
She offers therapy in California, Texas, and Washington, D.C.Learn more or schedule a consultation at drmariannemiller.com.

Perfectionism, People-Pleasing, & Body Image: Self-Compassion Tools for Long-Term Eating Disorder Recovery With Carrie Pollard, MSW @compassionate_counsellor

Self-compassion is a powerful, learnable skill in eating disorder recovery. In this conversation with registered social worker, grain farmer, and mom of five, Carrie Pollard, MSW, we explore how compassion lowers shame, supports motivation, and helps people replace harmful coping with kinder, sustainable care. We talk about trauma-informed treatment, somatic awareness, DBT skills, and what self-compassion looks like in real sessions and real life.
What You’ll Learn
What self-compassion really is: noticing suffering and responding to it with care, based on the Mindful Self-Compassion model by Kristin Neff and Christopher Germer.
Why “the why” matters: exploring roots like trauma and chronic stress helps people understand why symptoms once protected them and how to meet those needs differently.
Behavioral tools and deeper work together: how CBT, FBT, and skills work can sit alongside bottom-up, body-based approaches and insight-oriented therapy.
Backdraft in self-compassion: why big feelings can surge when kindness finally lands, and how to ride emotional waves safely.
Somatic cues and capacity: using body signals, boundaries, and micro-pauses to prevent overload, especially for high-achieving, people-pleasing clients.
Rural and farmer mental health: unique barriers to care, higher anxiety and depression in farm communities, and why accessible, virtual support matters.
Key Takeaways
Self-compassion reduces shame and increases motivation, which supports behavior change in anorexia, bulimia, binge eating, ARFID, and long-term recovery.
You can ask two steady questions throughout healing: What am I feeling? and What am I needing?
Emotional waves peak and pass. Skills from DBT and mindful self-compassion help you surf them without self-criticism.
Recovery grows when systems of care address trauma, body image, diet culture, and access barriers faced by rural, disabled, neurodivergent, and larger-bodied people.
Guest
Carrie Pollard, MSW is a registered social worker in Ontario, Canada, @compassionate_counsellor. She brings two decades of clinical experience, deep community ties in agriculture, and a trauma-informed lens to eating disorder treatment. She co-founded a national farmer mental health initiative and participates in the Waterloo-Wellington Eating Disorder Coalition.
Instagram: @compassionate_counsellor
Counseling for Ontario, Canada residents: flourishwithcompassion.com
Waterloo-Wellington Eating Disorder Coalition: search the coalition site to find therapists, physicians, and dietitians, plus details for the professional development day on diversifying eating disorder perspectives (happening October 24, 2025).
Notable Moments
Naming self-compassion backdraft so clients can expect it and feel less afraid.
Using hand-over-heart and paced breathing when words are hard.
Reframing symptoms as once-useful survival strategies, then building new supports.
Embracing imperfection in therapy and life to align with authenticity and values.
Who This Episode Supports
People in eating disorder recovery who feel stuck in shame or fear that kindness will make them “stop trying.”
Clinicians seeking to integrate mindful self-compassion, somatic work, and DBT with behavioral protocols.
Rural and farming families who need accessible, culturally aware care options.
Neurodivergent folks and anyone navigating sensory overload, perfectionism, or people-pleasing.
Resources Mentioned
Mindful Self-Compassion Workbook by Kristin Neff and Christopher Germer
DBT skills for emotion regulation and distress tolerance
Waterloo-Wellington Eating Disorder Coalition directory and events
Carrie’s counseling: flourishwithcompassion.com
Instagram: @compassionate_counsellor
Related Episodes
Self-Compassion in Eating Disorder Recovery with Harriet Frew, MSc @theeatingdisordertherapist_ on Apple & Spotify.
Perfectionism & Eating Disorders on Apple & Spotify.
Work With Dr. Marianne Miller
If you are in California, Texas, or Washington, D.C., I offer therapy for binge eating, ARFID, anorexia, bulimia, OCD, and trauma. Learn more and book a consult at drmariannemiller.com. If ARFID is part of your story or your family’s story, explore my self-paced ARFID & Selective Eating Course for practical, neurodivergent-affirming tools.
Share This Episode
If this conversation helped you, share it with a friend, a clinician, or a family member. Your share helps more people find self-compassionate, trauma-informed eating disorder support.

How to Talk to Your Partner About an Eating Disorder: Boundaries, Support, & Next Steps With Dr. Dana Harron @monarchwellnesspsychotherapy

Clinical psychologist Dr. Dana Harron joins me to discuss how couples can approach difficult conversations about eating disorders with honesty, care, and mutual respect. Together we explore what makes these conversations emotionally charged, how to prepare for them, and how partners can support each other without taking on the role of therapist or monitor. Dr. Harron offers practical guidance from her book Loving Someone With an Eating Disorder and her work at Monarch Wellness & Psychotherapy.
You’ll learn what helps these conversations go more smoothly, how to create safety before and after hard talks, and when to bring in a therapist who understands both eating disorders and couples dynamics.
Content Caution
This episode discusses eating disorders, disordered eating behaviors, and relationship stress that can arise during recovery. Some listeners may find certain details activating. Please take care of yourself while listening, and pause or skip ahead as needed.
About Our Guest
Dana Harron, PsyD is a clinical psychologist and founder of Monarch Wellness & Psychotherapy in Washington, D.C. She specializes in trauma, parenting, and eating disorders. She is the author of Loving Someone With an Eating Disorder: Supporting, Nurturing, and Connecting With Your Partner and is currently writing Parenting Beyond Trauma.
You can find her work at monarchwellness.com and on Instagram at @monarchwellnesspsychotherapy.
What You’ll Learn
How to prepare before opening up about your eating disorder to a partner
Why I-statements and emotional honesty matter more than having all the answers
The best times and places for difficult conversations about food and body image
What to say when your partner asks questions you cannot answer yet
How to plan a follow-up discussion and build routine check-ins
Why post-conversation decompression helps the nervous system reset
What couples therapy can look like when one partner struggles with an eating disorder
How to balance support and autonomy without creating a power differential
Conversation Highlights
Dr. Harron shares how her book was inspired by the lack of resources for partners of adults with eating disorders.
Tips for partners on when to speak, when to listen, and how to avoid meal-time conversations about food behaviors.
The importance of humor, co-regulation, and small moments of levity in recovery.
How systemic patterns in relationships can reinforce eating disorder behaviors.
Why “honesty” in recovery is about emotional congruence, not just full disclosure.
Key Takeaways for Couples
Prime the moment: Let your partner know a sensitive topic is coming and ask for what you need—listening, reassurance, or space.
Avoid high-stress times: Skip conversations around meals or when one partner is emotionally depleted.
Plan ongoing conversations: Short, consistent check-ins build predictability and reduce tension.
Use shared recovery language: I-statements and gentle curiosity create safety and understanding.
Involve professionals: A therapist or dietitian trained in eating disorders can guide communication and prevent relational burnout.
Related Episodes
You're Not Too Much: Setting Boundaries & Asking for What You Need in Eating Disorder Recovery on Apple & Spotify.
"Boundaries, Therapy While Black, & Eating Disorders" on Apple & Spotify
Work With Dr. Marianne
If you or your partner are navigating eating disorder recovery and want support that honors both of your needs, I offer therapy in California, Texas, and Washington, D.C., and global coaching for couples and individuals. My approach is neurodivergent-affirming, sensory-attuned, trauma-informed, and consent-based.
Learn more or schedule a consultation at drmariannemiller.com.
Learn With Me
Explore my ARFID & Selective Eating Course to understand sensory challenges, reduce distress around meals, and improve communication within your household.
Episode Credits
Host: Dr. Marianne Miller, LMFTGuest: Dr. Dana Harron, Monarch Wellness & Psychotherapy (@monarchwellnesspsychotherapy)
If this episode resonates, share it with a partner, therapist, or loved one who may benefit from a more compassionate way to talk about eating disorders and recovery.

Is ARFID Genetic? What 2025 Research Means for Diagnosis & Treatment

Is ARFID genetic? In this episode of Dr. Marianne-Land: An Eating Disorder Recovery Podcast, Dr. Marianne Miller explores the newest 2025 research on Avoidant/Restrictive Food Intake Disorder (ARFID) and what it means for diagnosis and treatment.
You will hear how twin studies show that ARFID has a strong genetic component, why large projects like EDGI2 and the ARIES study are changing the research landscape, and how updated diagnostic criteria in 2025 are helping clinicians better identify and support people with ARFID. The episode also highlights brain scan findings that explain why food can feel overwhelming, threatening, or unappealing, and treatment studies that show real recovery progress through virtual care and ARFID-specific tools.
Key Findings from ARFID Research
Genetics play a big role in ARFID but do not determine your destiny
2025 research reveals important connections between ARFID, brain differences, gut health, and sensory processing
Updated diagnostic criteria are improving accuracy and access to treatment
ARFID-specific tools such as the PARDI-AR-Q and EDY-Q provide a more accurate picture of progress
Treatment outcomes for children, teens, and adults are encouraging, including in virtual care settings
Why ARFID Diagnosis and Treatment Matter
ARFID is not caused by poor parenting or lack of willpower. It reflects the way a sensitive brain and body respond to the world. With consent-based, sensory-attuned, and neurodivergent-affirming care, meaningful recovery is possible.
Related Podcast Episodes on ARFID
Why Sensory-Attuned Care Matters More Than Exposure in ARFID Treatment on Apple & Spotify.
ARFID, PDA, and Autonomy: Why Pressure Makes Eating Harder on Apple & Spotify.
Complexities of Treating ARFID: How a Neurodivergent-Affirming, Sensory-Attuned Approach Works on Apple & Spotify.
Adult ARFID Explained: Real-Life Strategies for Managing Food & Nutrition with Caroline Holbrook, RD on Apple & Spotify.
ARFID and Selective Eating Course
If you are ready for practical, step-by-step tools to support ARFID, explore my ARFID and Selective Eating Course at drmariannemiller.com/arfid. This course is designed for families and professionals who want compassionate and effective strategies for ARFID care.

Biases Against Atypical Anorexia: Why the Label Fails Us

What if your body size determined whether or not doctors believed you had anorexia? In this solo episode of Dr. Marianne-Land: An Eating Disorder Recovery Podcast, Dr. Marianne Miller, LMFT, challenges the diagnosis of atypical anorexia and reveals why this label fails people who deserve to be taken seriously.
This category is not about atypical symptoms. It is about anti-fat bias. People in larger bodies who restrict food, obsess about weight, and experience medical complications are often told they cannot truly have anorexia because they do not look emaciated. This episode explains why that belief is harmful, how it delays treatment, and the real medical risks that exist at any body size.
Dr. Marianne also explores how anti-fat bias, weight stigma, and cultural stereotypes erase the experiences of marginalized people, especially fat, queer, neurodivergent, disabled, and BIPOC communities. She challenges providers and listeners to recognize anorexia for what it is: a serious illness in every body, not only in those that match the stereotype.
If you have ever been given the label “atypical anorexia,” this episode will affirm what you may already know. Your suffering is valid, you deserve care, and you do not need to prove how sick you are in order to receive treatment.
What You’ll Learn in This Episode
Why the label “atypical anorexia” exists and how it reinforces anti-fat bias
The medical risks of anorexia that occur across all body sizes
How stereotypes harm people in larger bodies with eating disorders
The role of intersectionality in who gets overlooked and dismissed
How to move toward weight-inclusive eating disorder treatment
Who This Episode Is For
People in recovery from atypical anorexia or restrictive eating
Families supporting a loved one with an eating disorder
Providers seeking to understand anti-fat bias in treatment settings
Anyone who has ever been told they were not “sick enough”
Related Episodes
Atypical Anorexia Explained: Why Restriction Happens at Every Body Size on Apple or Spotify.
Atypical Anorexia with Amy Ornelas, RD on Apple or Spotify.
Atypical Anorexia: Mental & Physical Health Risks, Plus How the Term is Controversial on Apple or Spotify.
What Is Atypical Anorexia? Challenging Weight Bias in Eating Disorder Treatment with Emma Townsin, RD @food.life.freedom on Apple or Spotify.
Connect With Dr. Marianne Miller
I am Dr. Marianne Miller, LMFT, a fat eating disorder therapist specializing in anorexia, ARFID, bulimia, and binge eating disorder. I provide therapy in California, Texas, and Washington, D.C., and offer online resources worldwide.
🌐 Learn more and explore resources: drmariannemiller.com🎧 Listen to more episodes: Dr. Marianne-Land: An Eating Disorder Recovery Podcast on Apple and Spotify
➡️ You can also follow me on Instagram @drmariannemiller

Developmental Trauma & Sex: Attachment Styles, Body Image, & Intimacy With Sex Therapist Dr. Nicole Van Ness, LMFT

In this candid conversation, couples and sex therapist Dr. Nicole Van Ness, LMFT joins Dr. Marianne to explore how developmental trauma shapes attachment styles, body image, sexual desire, and day-to-day intimacy. Dr. Nicole explains what developmental trauma is, how it differs from or overlaps with complex PTSD, and why chronic misattunement in childhood can echo through adult relationships, stress responses, and self-regulation. You will hear practical, compassionate strategies to rebuild safety, agency, and connection in your body and with your partner.
What You’ll Learn
Developmental trauma 101: How repeated misattunement and lack of repair in childhood influence trust, safety, and the nervous system in adulthood.
Attachment and sex: How anxious and avoidant patterns can create desire pursuer–withdrawer cycles, sensitivity to rejection, and misaligned invitations for sex.
Body image and pleasure: Why self-loathing, dissociation, and low interoceptive awareness can shift sex from pleasure to performance and how to return to embodied enjoyment.
Masturbation as self-care: Ways self-pleasure can restore agency, support trauma recovery, and improve partnered intimacy through curiosity, consent, and pacing.
Desire discrepancy: How to reframe a declined invitation as information rather than personal rejection and how to stay connected when desire levels differ.
Pelvic and sexual pain: How chronic stress and hypervigilance can contribute to issues like vaginismus and pelvic floor tension and why relaxation and safety matter.
Neurodivergence and RSD: Tools for identifying rejection sensitive dysphoria in the moment and naming it with your partner to reduce spirals and repair faster.
Eroticism and aliveness: Gentle, stepwise practices that rebuild embodiment and pleasure, from sensing music and movement to sharing desire with a partner.
Key Takeaways
Trauma adaptations are creative survival strategies. They deserve respect while you learn new options that fit your current life.
Pleasure requires enough safety, agency, and self-worth to receive and enjoy it. These ingredients can be rebuilt.
Honest conversations about boundaries, pacing, and permission support intimacy more than duty or performance.
Small, consistent body-based practices help restore interoception, reduce hypervigilance, and widen your window of tolerance during sex and affection.
Gentle Practices to Try
Name your nervous system state: Am I keyed up, shut down, or settled. Choose regulation first.
Solo exploration with care: Treat self-pleasure like self-nurture. Slow it down. Focus on sensation, comfort, and curiosity.
Low-stakes embodiment: Sway to a favorite song, notice breath, enjoy soft fabrics, or feel grass under your feet. Build from neutral to pleasant sensations.
Clear invitations and exits: Ask for what you want. Offer options. Affirm that no is welcome. Agree on easy ways to pause or change course.
Rejection reframe: A no is information about timing or capacity, not your worth. Validate disappointment and stay connected.
Terms and Resources Mentioned
Developmental Model of Couples Therapy by Pete Pearson and Ellyn Bader
Complex PTSD conversations influenced by Bessel van der Kolk
Codependency concepts associated with Pia Mellody
Cultural touchpoints about sexuality education and agency referenced in feminist media history
About Our Guest
Dr. Nicole Van Ness, LMFT is a couples and sex therapist who practices virtually in Texas, California, and Florida. She integrates attachment science, nervous system education, differentiation, and sexuality counseling to help clients cultivate secure intimacy and erotic connection. She works affirmatively with diverse relationship structures and identities.
Connect with Dr. Nicole:
connected-couples.com
Email: nicole@connected-couples.com
Phone: 858-352-6744
Related Episodes
Sex & Body Image (Part 1) with Sex Therapist Dr. Nicole Van Ness, LMFT on Apple & Spotify.
Sex & Body Image (Part 2) with Sex Therapist Dr. Nicole Van Ness, LMFT on Apple & Spotify.
Work With Dr. Marianne
If you want trauma-informed, neurodivergent-affirming support for eating concerns, body image, or intimacy challenges, you can work with me in therapy in California, Texas, and Washington, D.C. Learn more and schedule a free consult at drmariannemiller.com.
Share the Episode
If this conversation helped you, rate and review the show, share it with a friend, and subscribe so you never miss an episode.

Neurodivergent-Affirming Eating Disorder Treatment: Why One-Size-Fits-None

Standard eating disorder treatment often assumes that one model will work for everyone. But for neurodivergent people, such as autistic folks, ADHDers, and those with sensory processing differences, this approach can feel like being handed a map that doesn’t match the terrain you’re actually walking. Instead of support, clients often experience shame, retraumatization, or the sense that recovery is out of reach.
What's In This Episode
In this episode of Dr. Marianne-Land: An Eating Disorder Recovery Podcast, Dr. Marianne Miller explores why one-size-fits-all treatment fails neurodivergent clients and what affirming, individualized care looks like. She discusses how sensory sensitivities shape eating experiences, how ADHD executive functioning challenges complicate meal planning and follow-through, and how trauma and systemic oppression create additional effects that amplify struggles. She also outlines what neurodivergent-affirming eating disorder treatment looks like in practice: sensory-attuned, trauma-informed, flexible, and rooted in autonomy and consent.
Content Caution
In this episode, I discuss eating disorder treatment, recovery challenges, and the effects of trauma. Please listen with care and step away if needed.
If you or someone you love lives with ARFID, selective eating, or eating struggles connected to autism, ADHD, or have other types of neurodivergent traits, know that recovery is possible with the right support.
Check Out Related Neuroaffirming Episodes
How Masking Neurodivergence Can Fuel Eating Disorders on Apple & Spotify.
Complexities of Treating ARFID: How a Neurodivergent-Affirming, Sensory-Attuned Approach Works on Apple and Spotify.
ARFID & Neurodiversity on Apple and Spotify.
Minding the Gap: The Intersection Between AuDHD & Eating Disorders With Stacie Fanelli, LCSW on Apple and Spotify.
Get Neurodivergent-Affirming Eating Disorder Help
For deeper guidance, check out Dr. Marianne's ARFID and Selective Eating Course, which offers practical, compassionate strategies that are neurodivergent-affirming, trauma-informed, and sensory-attuned. If you’re located in California, Texas, or Washington, D.C., you can work directly with Dr. Marianne in therapy to create a path to recovery that actually fits your life.
Learn more at drmariannemiller.com.