Dr. Marianne-Land: An Eating Disorder Recovery Podcast

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

Why do some people with autism, ADHD, or AuDHD rely on the same safe foods every day, while certain textures or smells make eating feel impossible? In this episode, therapist and AuDHD advocate Patrick Casale shares how food sensory issues, texture aversion, and safe foods shape eating patterns for many neurodivergent adults.
In this conversation, Dr. Marianne Miller speaks with Patrick about his experience of late-diagnosed autism and ADHD and how sensory sensitivities affect food choices, routines, and daily life. Patrick describes intense texture aversions, smell sensitivity, and the role safe foods play in creating nervous system stability.
They also explore the internal tension many people with AuDHD experience between routine and novelty. Eating the same foods repeatedly can feel regulating and predictable, yet the ADHD side of the brain may crave variety and change. Patrick shares how this push and pull can make food decisions unexpectedly stressful.
The discussion also touches on body dysmorphia in men, the pressure of toxic masculinity around appearance and strength, and why many men struggling with body image or eating concerns remain invisible in eating disorder conversations.
Patrick also reflects on unmasking and self-advocacy, including honoring sensory needs, choosing comfortable clothing, and setting boundaries around overwhelming social expectations.
About Patrick Casale
Patrick Casale is an AuDHD TEDx speaker, therapist, podcaster, and consultant. He is the founder of All Things Private Practice and Resilient Mind Counseling.
Patrick hosts the All Things Private Practice podcast and co-hosts Divergent Conversations with Dr. Megan Neff of Neurodivergent Insights. He also writes about late-discovered autism and ADHD on Substack in his newsletter The Grief Relief Paradox.
Connect with Patrick on Instagram: @patrick.casale
Related Episodes
“Stuck” Isn’t Lazy: Inertia in ADHD, Autism, & Eating Disorder Recovery With Stacie Fanelli, LCSW on Apple & Spotify.
Autism & Eating Challenges: Understanding Sensory Needs, Routines, & Safety on Apple & Spotify.
Work With Dr. Marianne Miller
Dr. Marianne Miller is a licensed marriage and family therapist who specializes in eating disorders, ARFID, binge eating disorder, and neurodivergent experiences with food. Check out her website at drmariannemiller.com.
To learn more about therapy with Dr. Marianne Miller or explore her self-paced virtual courses on eating disorder recovery, visit her website.
Topics discussed: AuDHD, autism and ADHD, food sensory issues, texture aversion, safe foods, body dysmorphia in men, neurodivergent eating.

Chronic Binge Eating Disorder: Why It Persists & What Real Recovery Looks Like

Chronic binge eating disorder is not a failure of willpower. It is a nervous system pattern shaped by restriction, shame, trauma, and unmet needs.
In this solo episode, Dr. Marianne Miller explores why binge eating becomes chronic, how dieting and food scarcity fuel the cycle, and what real recovery actually looks like for adults living with long-term binge eating disorder. If you feel stuck in the binge cycle, this conversation offers clarity, compassion, and a realistic path forward.
Chronic Binge Eating Disorder Is Not About Weakness
Many people living with chronic binge eating disorder believe that if they were more disciplined, more motivated, or more in control, the behavior would stop. This episode challenges that harmful narrative. Chronic binge eating disorder persists because powerful biological and psychological systems are involved. Restriction increases hunger hormones and food preoccupation. Stress activates survival responses. Shame reinforces secrecy and isolation.
Dr. Marianne explains why binge eating makes sense in context and why understanding the function of the behavior is essential for sustainable binge eating recovery.
Why Binge Eating Becomes Chronic
Long-term binge eating disorder rarely develops in a vacuum. Dieting, weight stigma, trauma, sensory overload, executive functioning strain, and chronic stress all contribute to the cycle. When the body experiences restriction or perceived scarcity, it responds with urgency. When the nervous system feels overwhelmed, binge eating can temporarily regulate distress.
This episode explores how biological drives, nervous system regulation, and shame interact to keep binge eating disorder chronic, even when someone desperately wants change.
Neurodivergence, Sensory Needs, and Binge Eating Disorder
For many adults, chronic binge eating disorder intersects with ADHD, autism, and other forms of neurodivergence. Food may provide stimulation, grounding, predictability, or relief from decision fatigue. Traditional binge eating treatment models often overlook these factors.
Dr. Marianne discusses how a neurodivergent-affirming approach to binge eating recovery can reduce shame and increase effectiveness by supporting sensory needs and executive functioning rather than ignoring them.
What Real Recovery From Chronic Binge Eating Disorder Looks Like
Mainstream recovery messaging often centers perfection and dramatic transformation. Real recovery from chronic binge eating disorder is usually quieter and more gradual. It begins with safety rather than control. It focuses on consistent nourishment, nervous system regulation, and shame reduction.
This episode outlines how sustainable binge eating recovery involves stabilizing food intake, reducing restriction, expanding coping strategies, and building self-compassion. Progress is measured not by perfection, but by increased flexibility, dignity, and safety in the body.
Related Episodes
Healing Binge Eating Disorder: One Woman’s Journey Toward Body Trust & Food Freedom With Dr. Michelle Tubman, M.D. @wayzahealth on Apple & Spotify.
Lived Experience of Having Both Bulimia & Binge Eating Disorder With Milda Zolubaite @nutrition.path on Apple & Spotify.
ADHD & Binge Eating Disorder With Toni Rudd @the.binge.dietitian on Apple & Spotify.
Join the Binge Eating Recovery Membership
If you are navigating chronic binge eating disorder and want ongoing, compassionate support, Dr. Marianne’s Binge Eating Recovery Membership offers structured guidance rooted in neurodivergent-affirming, trauma-informed, and weight-inclusive care.
Inside the membership, you will learn practical tools for nervous system regulation, reduce shame around binge eating, and build sustainable recovery strategies in community.
Learn more at: drmariannemiller.com
Key Topics in This Episode
Chronic binge eating disorderLong-term binge eating patternsBinge eating recovery for adultsRestriction and binge cycleNervous system regulation and foodNeurodivergence and binge eatingShame and eating disordersWeight-inclusive eating disorder treatment

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

Mechanical eating refers to eating on a consistent schedule, usually every three to four hours, regardless of hunger cues. It is commonly introduced in early eating disorder treatment to stabilize nourishment and interrupt restriction or binge cycles.
In this episode, Dr. Marianne explains how mechanical eating creates physiological rhythm in a body that has experienced disruption. Eating disorders affect digestion, blood sugar, hormones, and nervous system regulation. Mechanical eating restores predictability and reduces biological chaos.
Lifelong recovery invites a deeper question. Is structure still serving you years into recovery, or has it become rigid?
How Mechanical Eating Supports Your GI System, Blood Sugar, and Mood
Mechanical eating is not just about timing. It directly supports digestive health, metabolic stability, and emotional regulation.
Regular nourishment helps the gastrointestinal system relearn movement and tolerance after restriction. It can reduce bloating, reflux, constipation, nausea, and abdominal pain that often occur when eating patterns have been irregular.
Mechanical eating also stabilizes blood sugar levels. Long gaps without food can lead to shakiness, irritability, brain fog, dizziness, and intense urgency to eat. Consistent intake smooths those fluctuations and supports steady energy throughout the day.
Because the brain depends on adequate fuel, mechanical eating also improves mood regulation. Anxiety, irritability, and low mood often intensify when nourishment is inconsistent. Stabilizing blood sugar reduces these physiological stress responses and creates a more regulated emotional baseline.
For many people, these benefits make mechanical eating a powerful and supportive tool.
When Mechanical Eating May Stop Fitting
Lifelong eating disorder recovery requires flexibility. A strategy that was essential in early recovery may need to evolve over time.
Mechanical eating can become rigid if the clock replaces internal cues entirely. Some people experience anxiety if eating times shift. Others notice that hunger cues remain muted even after years of structure. For neurodivergent individuals, strict schedules may conflict with executive functioning variability, sensory sensitivities, or fluctuating energy.
This episode explores how to recognize when mechanical eating is supportive and when it may need to be adapted. Recovery is not about perfect adherence. It is about building a sustainable, compassionate relationship with food and body over time.
Who Mechanical Eating Helps Most in Long-Term Recovery
Mechanical eating often benefits people who need predictable physiological regulation, reduced decision fatigue, and steady nourishment despite unreliable hunger signals. It can be especially helpful during stress, illness, life transitions, or periods of emotional overwhelm.
Rather than seeing mechanical eating as a permanent rule, Dr. Marianne reframes it as a flexible tool that can be used when needed and modified when necessary.
Lifelong recovery allows room for adaptation.
ARFID, Selective Eating, and Mechanical Eating
For individuals with ARFID or selective eating, mechanical eating alone is often not enough. Sensory sensitivity, fear of aversive consequences, and low appetite require neurodivergent-affirming and sensory-attuned approaches.
Dr. Marianne’s ARFID and Selective Eating Course provides structured, trauma-informed, and liberation-centered support for people who need more than traditional eating disorder recovery tools. In the course, she addresses nervous system regulation, sensory safety, and realistic long-term change.
Learn more about the ARFID course and therapy options at drmariannemiller.com.
Related Episodes
Intuitive vs. Mechanical Eating: Can They Coexist? on Apple & Spotify.
Orthorexia, Quasi-Recovery, & Lifelong Eating Disorder Struggles with Dr. Lara Zibarras @drlarazib on Apple & Spotify.
The Truth About "High-Functioning" People With Lifelong Eating Disorders on Apple & Spotify.
Understanding Harm Reduction: Why "Full Recovery" May Not Be the Goal for Lifelong Eating Disorders on Apple & Spotify.
Key Topics Covered in This Episode
Mechanical eating in lifelong eating disorder recoveryChronic eating disorders and long-term recoveryGI system healing and digestive regulationBlood sugar stabilization and binge-restrict cyclesMood regulation and nervous system safetyNeurodivergent-affirming eating disorder treatmentARFID and selective eating support
If this episode resonated with you, consider sharing it with someone navigating long-term eating disorder recovery. And if you are looking for therapy or structured support grounded in liberation, sensory attunement, and autonomy, visit drmariannemiller.com to learn more about working with Dr. Marianne Miller.
Take gentle care of yourself.

Resilience Skills for Body Image & Disordered Eating: Cultivating Confidence With Rachelle Heinemann, LMHC, LPC

Confidence is not about loving how you look. It is about resilience, safety, and agency in eating disorder recovery.
In this thoughtful and grounded conversation, Dr. Marianne Miller sits down with therapist, educator, and podcast host Rachelle Heinemann, LMHC, LPC @raquelleheinemann, to explore the deeper emotional and relational layers beneath body image distress and disordered eating.
Rather than focusing only on surface-level body image strategies, this episode examines how confidence develops through resilience, meaningful connection, personal agency, and small intentional steps taken over time. Together, they discuss why traditional approaches to body image may feel incomplete, how unsafe environments can intensify negative body thoughts, and what it truly means to cultivate confidence in the context of eating disorder recovery.
This conversation offers compassionate, clinically informed insight for anyone navigating body image struggles, low self-esteem, chronic disordered eating patterns, or the long path of healing.
What We Explore in This Episode
The relationship between body image, confidence, and disordered eating.
Why confidence is better understood as resilience rather than appearance or personality.How safety, stress, and environmental context influence body image distress.The role of agency, assertiveness, and small achievable steps in recovery.Why meaningful, supportive relationships are foundational to confidence building.How deeper emotional needs often drive body image pain more than physical appearance.Practical ways to begin cultivating resilience in eating disorder recovery.
A Different Way to Understand Confidence
Many conversations about confidence center on visibility, charisma, or loving one’s body at all times. In this episode, Raquelle offers a more compassionate and realistic framework: confidence as an internal, flexible resilience that can grow even when fear, uncertainty, or body image distress are still present.
Through clinical stories and lived therapeutic insight, this discussion reframes confidence as something that develops through curiosity, connection, and repeated small acts of courage, rather than perfection or performance.
About Rachelle Heinemann, LMHC, LPC
Rachelle Heinemann is a licensed mental health counselor in New York and a licensed professional counselor in New Jersey. She specializes in working with individuals experiencing disordered eating, eating disorders, anxiety, depression, and relationship challenges.
She teaches courses on eating disorders and body image, provides continuing education for clinicians, and hosts the podcast Understanding Disordered Eating. Raquelle also contributes leadership within the International Association of Eating Disorder Professionals New York.
Her confidence and resilience workbook, discussed in this episode, guides readers through curiosity, connection, and small actionable steps toward meaningful and sustainable change.
Resources and Links
Rachelle’s Confidence & Resilience Workbook:
(Use code PODCAST to download for free.)
Understanding Disordered Eating PodcastBergen Mental Health GroupFollow Rachelle on Instagram: @rachelleheinemann
Related Episodes
DIVING DEEP to Help Folks Recover From Eating Disorders, With Rachelle Heinemann, LMHC, CEDS, @rachelleheinemann on Apple and Spotify.
When Exercise Becomes Punishment: Body Image, Shame, & Disordered Eating With Dr. Lisa Folden @healthyphit on Apple and Spotify.
Work With Dr. Marianne Miller
Dr. Marianne Miller is a licensed marriage and family therapist specializing in:
Eating disorder recoveryARFID and selective eatingBinge eating disorderNeurodivergent-affirming careBody liberation and weight-inclusive healing
Therapy and coaching are available in California, Texas, Washington, DC, and worldwide.
You can also explore:
The ARFID & Selective Eating CourseThe Binge Eating Recovery MembershipMore episodes of the Dr. Marianne-Land Podcast on body image, neurodivergence, and long-term recovery
Listen, Follow, and Share
If this episode resonated with you, consider following the podcast, leaving a review, or sharing it with someone who may need compassionate, evidence-informed support for body image and eating disorder recovery.
Your support helps more people find liberation-oriented, neurodivergent-affirming care.

Why Eating Disorder Recovery Can Stall Even When You’re Doing Everything Right

Many people enter eating disorder recovery believing that effort guarantees progress. Follow the meal plan. Use the coping skills. Stay consistent. When recovery still feels stuck, shame often follows. This episode explores a different truth. Recovery can stall even when you are doing everything right, and stalled progress usually reflects misalignment rather than failure.
Dr. Marianne examines the hidden reasons eating disorder recovery plateaus, including nervous system overload, limited capacity, chronic stress, trauma history, neurodivergence, and lack of structural support. She explains why compliance without regulation rarely leads to sustainable healing and why recovery models that ignore real-world context can unintentionally increase distress.
This conversation also centers intersectionality. Systems of oppression such as racism, anti-fat bias, ableism, homophobia, transphobia, and medical discrimination shape both eating disorder development and recovery access. When treatment ignores these realities, people may feel blamed for struggles that are deeply structural. Understanding this context can transform how stalled recovery is interpreted and supported.
Listeners will gain a more compassionate and clinically grounded framework for understanding recovery plateaus, along with language that reduces shame and opens space for more humane, sustainable healing paths.
In This Episode
Dr. Marianne explores why motivation does not equal capacity and why nervous system regulation must accompany behavior change. She discusses how grief, identity shifts, and emotional exposure often emerge during recovery and can be mistaken for failure. She also explains why neurodivergent people frequently experience recovery mismatch due to sensory, executive functioning, and interoceptive differences that traditional treatment overlooks.
The episode highlights the emotional toll of constant self-monitoring, the importance of therapeutic fit, and the role of intersectional stress in shaping recovery progress. Most importantly, it reframes stalled recovery as meaningful clinical information rather than personal weakness.
Who This Episode Is For
This episode is for people who feel stuck in eating disorder recovery despite working hard. It is also for clinicians, loved ones, and advocates seeking a more intersectional, nervous-system-informed understanding of recovery plateaus.
Related Episodes
“Slips” in Eating Disorder Recovery in 2026: Why Setbacks Are Part of Progress, Not Failure (With Mallary Tenore Tarpley, MFA) on Apple and Spotify.
The Middle Place in Eating Disorder Recovery: How Slips Can Be Stepping Stones With Mallary Tenore Tarpley, MFA @mallarytenoretarpley on Apple and Spotify.
Slips, Setbacks, & Relapses in Eating Disorder Recovery on Apple and Spotify.
Work With Dr. Marianne Miller
If recovery feels confusing, stalled, or misaligned, you do not have to navigate it alone. Dr. Marianne Miller is a Licensed Marriage and Family Therapist who specializes in eating disorder recovery through a neurodivergent-affirming, trauma-informed, and liberation-oriented lens. Learn more about therapy, coaching, virtual courses, and recovery support at her website drmariannemiller.com.

Why Eating Disorders in Black Women Are Missed: What "The Pitt" Shows About ER Care & Medical Weight Bias

In this solo episode, Dr. Marianne Miller explores how the Emmy-winning and Golden Globe–winning medical drama The Pitt portrays eating disorders, emergency medicine, and bias in ways that feel both culturally meaningful and clinically relevant. She reflects on how the show separates two critical themes across seasons: the medical system’s tendency to miss eating disorders in Black women, and the role of weight bias in emergency department diagnosis and care.
Drawing from years of clinical experience, Dr. Miller discusses how many clients first encounter medical crisis in emergency rooms, often because of dangerously low heart rates, dizziness, fainting, or other complications linked to disordered eating. She explains how ER responses vary widely, and how bias, time pressure, and assumptions about body size or race can shape whether clinicians recognize eating disorder symptoms.
The episode highlights a season two storyline in which a Black woman presents to the ER without classic eating disorder signs, making diagnosis more complex. Dr. Marianne examines why missing textbook symptoms often leads clinicians to overlook bulimia and other eating disorders, especially in populations that medicine historically underdiagnoses. She also reflects on how the show names this reality directly and why that representation matters for visibility, validation, and future care.
Dr. Marianne then turns to season one’s depiction of a physician challenging a resident’s assumption that body weight predicts health. She explores how medical weight bias affects diagnosis, delays treatment, and reinforces stigma in emergency medicine. She also shares the change she wishes the episode had made, noting that many people with bulimia live in bodies that are not thin, and that anti-fat bias and racial bias together create additional barriers for Black women seeking care.
Throughout the episode, Dr. Marianne centers a liberation-informed lens that honors intersectionality, context, nervous system safety, and autonomy in eating disorder recovery. She invites listeners to consider how accurate media representation can shift clinical awareness and expand who medicine recognizes as deserving care.
You can watch The Pitt on HBO and HBO Max.
Topics Covered in This Episode
Eating disorders in Black womenMissed diagnosis in emergency medicineLow heart rate and medical risk in eating disordersBulimia without classic symptomsMedical weight bias in ER careRace, stigma, and underdiagnosisMedia representation and clinical awarenessLiberation-informed eating disorder therapy
Related Episodes
Boundaries, Therapy While Black, & Eating Disorders with Kaela Farrise, LMFT on Apple and Spotify.
Avoidance, Body Image Standards, & the Notion of the Strong, Black Woman with Jasmine Jacquess, MA, PLPC on Apple and Spotify.
Recommended Books
-Not All Black Girls Know How to Eat: A Story of Bulimia, by Stephanie Covington-Armstrong
-The Body Is Not An Apology, 2nd ed., by Sonya Renee Taylor
-Fearing the Black Body: The Racial Origins of Fat Phobia, by Dr. Sabrina Strings
Resources and Support
If you are looking for eating disorder therapy that centers intersectionality, lived context, and liberation-informed care, you can learn more about working with Dr. Marianne Miller through therapy or consultation on her website, drmariannemiller.com. Her approach honors autonomy, neurodivergence, trauma history, body diversity, and systemic realities that shape recovery.
You deserve care that sees the full picture of your life, not just symptoms on a chart.

“Stuck” Isn’t Lazy: Inertia in ADHD, Autism, & Eating Disorder Recovery With Stacie Fanelli, LCSW

ADHD, autism, and eating disorders through the lens of inertia. What if feeling stuck is not laziness, resistance, or lack of motivation?
In this conversation, Dr. Marianne Miller speaks with ADHD and neurodivergent-affirming therapist Stacie Fanelli, LCSW, @edadhd_therapist, about how autistic inertia, ADHD hyperfocus, and executive functioning differences shape restriction, bingeing, and symptom cycling. They explore why recovery approaches built on willpower and choice can deepen shame for neurodivergent people and how capacity-aware care offers a different path.
Inertia outside of the ED can be a trigger for EDs existentially because of the sense of “stuckness” it creates; then, the ED swoops in and offers a sense of control. 
This episode reframes stuckness as a nervous system experience rather than a character flaw and introduces compassionate, liberation-centered recovery grounded in harm reduction, radical acceptance, and real support for neurodivergent healing.
Contact Stacie
https://www.autonomousmindstherapy.com
Related Episodes
Recovering Again: Navigating Eating Disorders After a Late Neurodivergent Diagnosis (Part 1) With Stacie Fanelli, LCSW @edadhd_therapist on Apple and Spotify.
Recovering Again: Navigating Eating Disorders After a Late Neurodivergent Diagnosis (Part 2) With Stacie Fanelli, LCSW @edadhd_therapist on Apple and Spotify.
Minding the Gap: The Intersection Between AuDHD & Eating Disorders With Stacie Fanelli, LCSW on Apple and Spotify.
 

Why Eating Still Breaks Down for Neurodivergent People With Long-Term Eating Disorders

Why does eating still feel impossible for neurodivergent people with long-term eating disorders, even after insight, treatment, and real effort?
In this episode, Dr. Marianne Miller explores the hidden sensory, executive functioning, and nervous system friction that causes eating to keep breaking down in daily life. This conversation moves beyond motivation, fear foods, and traditional recovery advice to name the invisible moments when hunger arrives too late, meals require overwhelming cognitive energy, sensory overload interrupts eating, masking replaces body awareness, or a nervous system crash follows nourishment.
You’ll learn why neurodivergent eating disorder recovery often stalls inside standard treatment models, how chronic eating disorders can reflect adaptation rather than failure, and what actually supports sustainable nourishment for people living with ARFID, anorexia, bulimia, binge eating disorder, and long-term restrictive or chaotic eating patterns.
This episode offers a neurodivergent-affirming, trauma-informed, and weight-inclusive framework for understanding why eating still feels so hard—and how recovery can begin by reducing friction instead of increasing pressure.
If you’re searching for realistic eating disorder recovery, support for ARFID in adults, or compassionate care that centers sensory needs and autonomy, this conversation is for you. You can also check out my self-paced, virtual ARFID course or other resources on my website, drmariannemiller.com.
Related Episodes
Unmasking, Embodiment, & Trust: A Neurodivergent Approach to Eating Disorder Recovery With Dr. Emma Offord @divergentlives via 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.

Anorexia & Night Eating Syndrome: Why Restriction Fuels Night Eating & What Helps

Night eating can feel confusing, distressing, and isolating for people living with anorexia, especially when restriction shapes daytime eating. Many adults limit food during the day and then experience intense hunger, urgency to eat, or automatic eating at night. This pattern often creates shame and the belief that recovery is failing.
In this episode, Dr. Marianne Miller explains why anorexia and night eating syndrome frequently overlap and how daytime restriction drives nighttime eating through biological survival responses and nervous system stress. She reframes night eating as adaptation rather than loss of control and challenges treatment messages that rely on shame or rigid control. This conversation centers trauma-informed, neurodivergent-affirming eating disorder recovery and introduces non-punitive tools that support regulation, safety, and sustainable change.
Why Anorexia and Night Eating Syndrome Often Occur Together
Many clinical frameworks treat anorexia and night eating syndrome as separate or opposing diagnoses. In practice, restriction, energy deficit, and nervous system activation during the day often lead the body to seek nourishment at night when threat levels feel lower. Night eating in anorexia does not reflect a failure of discipline. It reflects a biological and neurological survival response to deprivation, chronic stress, and unmet energy needs. Understanding this connection reduces shame and opens the door to more effective, compassionate eating disorder treatment.
How Daytime Restriction Fuels Nighttime Eating
Restriction includes more than eating small amounts of food. It can involve delaying meals, limiting food variety, suppressing hunger signals, or following rigid food rules that keep the body in a constant state of vigilance. When restriction continues across the day, the body tracks energy debt, stress hormones rise, and hunger intensifies. Nighttime may become the first moment when eating feels possible or safe. This cycle explains why night eating in anorexia can persist even when someone feels committed to recovery.
Why Shame and Control Do Not Resolve Night Eating
Common advice such as eating more during the day often overlooks nervous system safety, trauma history, and neurodivergent sensory needs. Increasing pressure or tightening rules usually strengthens the restriction and night eating cycle rather than resolving it. Reducing shame and supporting regulation creates conditions where change can occur without punishment or fear.
Supportive Approaches That Address Root Causes
Recovery-supportive care focuses on safety, predictability, and nervous system regulation rather than control. Daytime nourishment becomes more sustainable when eating feels safe enough and emotionally tolerable. Removing moral judgment from night eating reduces the restriction-shame cycle that keeps symptoms active. Gentle structure can support regulation without imposing rigid rules, and trauma-informed, neurodivergent-affirming treatment allows the body to receive nourishment without overwhelming threat. When these conditions develop, night eating often softens naturally over time.
Who This Episode Is For
This episode speaks to adults living with anorexia and night eating syndrome, people who restrict during the day and eat at night, and individuals navigating chronic eating disorders or recovery that feels stalled despite effort. It also supports neurodivergent adults managing sensory needs around food and anyone seeking weight-inclusive, trauma-informed eating disorder therapy that honors autonomy and lived experience.
Related Episodes
Night Eating Syndrome on Apple & Spotify (my 2nd most popular podcast episode of all time!)
Understanding Night Eating Syndrome: Executive-Function Tools for Real Recovery on Apple & Spotify.
Why Am I Eating at Night? Understanding Night Eating Syndrome in Your 30s, 40s, & 50s on Apple & Spotify.
Work With Dr. Marianne Miller
If you are looking for eating disorder therapy in California or support for anorexia, night eating syndrome, ARFID, or binge eating disorder, Dr. Marianne Miller offers neurodivergent-affirming, liberation-centered care for adults. You can learn more about therapy services, recovery resources, and ways to work together by visiting her website, drmariannemiller.com. You deserve support that works with your body, respects your nervous system, and honors your autonomy in recovery.

Anorexia in Higher-Weight Bodies: Rethinking “Atypical Anorexia” & the Restrictive Eating Spectrum With Dr. Jennifer Gaudiani, MD @gaudianiclinic

What if anorexia is being missed simply because of body size? In this powerful and deeply validating conversation, I sit down with eating disorder physician Dr. Jennifer Gaudiani, MD @gaudianiclinic to explore why the term “atypical anorexia” can obscure real medical risk, delay diagnosis, and reinforce weight stigma across healthcare systems. We discuss what has changed since the first edition of Sick Enough, why weight stigma remains foundational to eating disorder harm, and how current research is reshaping clinical understanding of restrictive eating, ARFID in adults, digestive illness, neurodivergence, chronic medical conditions, and long-term eating disorder recovery. At the center of this episode is an urgent truth for 2026: severe eating disorder suffering does not require being underweight.
What We Discuss in This Episode
Throughout this conversation, we examine why most people with anorexia are not underweight and how weight stigma continues to shape who gets believed, diagnosed, and treated. Dr. Gaudiani shares what is new and expanded in the second edition of Sick Enough, including updated medical research on binge eating disorder, ARFID across the lifespan, atypical anorexia, and the broader restrictive eating spectrum. We also explore the critical role of gastrointestinal pain, mast cell activation syndrome (MCAS), postural orthostatic tachycardia syndrome (POTS), and complex chronic illness in both driving and worsening restrictive eating patterns. This discussion highlights why many adults with ARFID remain misdiagnosed for years, how neurodivergence such as autism and ADHD intersects with eating disorders, and why neurodivergent-affirming, weight-inclusive, trauma-informed care is essential for meaningful recovery.
Key Themes for Eating Disorder Recovery in 2026
We further discuss harm reduction, autonomy, and realistic pathways for people living with long-term or chronic eating disorders, including how rebuilding trust after medical trauma can reopen the possibility of healing. Rather than framing recovery as “full recovery or nothing,” this episode explores how supporting quality of life, medical stability, and patient-directed goals can actually improve outcomes. These themes reflect major shifts happening in eating disorder treatment in 2026, including movement toward weight-inclusive medicine, trauma-informed care, recognition of ARFID in adults, support for chronic eating disorders, and clinical models that affirm neurodivergent lived experience.
About the Guest
Dr. Jennifer Gaudiani, MD @gaudianiclinic is a board-certified internal medicine physician and one of the leading medical experts in eating disorder care. She is the founder and medical director of the Gaudiani Clinic, a weight-inclusive outpatient medical practice providing specialized treatment for eating disorders, undernourishment related to complex medical conditions, and trauma-informed primary care across the United States via telemedicine. Dr. Gaudiani previously served as medical director at the ACUTE Center for Eating Disorders and is the author of Sick Enough: A Guide to the Medical Complications of Eating Disorders, a widely respected clinical and patient resource now released in a fully updated second edition. Her work centers compassion, autonomy, and dignity for people in all body sizes seeking eating disorder recovery.
Resources Mentioned
Resources referenced in this episode include Sick Enough: A Guide to the Medical Complications of Eating Disorders (Second Edition) and the Gaudiani Clinic, which offers weight-inclusive outpatient medical care for eating disorders throughout the United States.
Content Caution
This episode includes discussion of eating disorders, restrictive eating, ARFID, medical complications, gastrointestinal illness, weight stigma, and medical trauma. Please listen in the way that feels most supportive for you and take pauses as needed.
Work With Dr. Marianne
If this conversation resonated, you are not alone. I provide neurodivergent-affirming, trauma-informed, weight-inclusive eating disorder therapy for adults in California, Texas, and Washington, D.C., along with worldwide coaching support. You can learn more or schedule a consultation at drmariannemiller.com.
Listen Next
If you found this episode meaningful, you may also connect with conversations on ARFID in adults, medical trauma in eating disorder care, chronic eating disorders and harm reduction, neurodivergence and restrictive eating, and complex medical complications such as low heart rate, gastrointestinal illness, MCAS, and recovery in higher-weight bodies.
Here are some episodes to listen next:
Atypical Anorexia Explained: Why Restriction Happens at Every Body Size on Apple or Spotify.
Atypical Anorexia: Mental & Physical Health Risks, Plus How the Term is Controversial on Apple or Spotify.
Chronic Eating Disorders in 2026: What Hope Can Actually Look Like on Apple and Spotify.
Why Some Eating Disorders Don’t Resolve: Understanding Chronic Patterns & What Actually Supports Change on Apple and Spotify.
When PDA Drives ARFID: Understanding Food Refusal, Control, & Safety on Apple & Spotify.
ARFID Explained: What It Feels Like, Why It’s Misunderstood, & What Helps on Apple & Spotify.