Episodios

  • When Safe Foods Stop Working: ARFID Plateaus, Burnout, & What Helps

    When Safe Foods Stop Working: ARFID Plateaus, Burnout, & What Helps
    Mar 27 2026
    What does it mean when your safe foods suddenly stop working? If you live with ARFID (Avoidant Restrictive Food Intake Disorder), this experience can feel confusing, scary, and isolating. A food that felt reliable can suddenly feel impossible, leaving you wondering if your eating challenges are getting worse or if you are doing something wrong. In this episode of Dr. Marianne-Land, Dr. Marianne explores why this happens and offers a compassionate, neurodivergent-affirming framework for understanding ARFID plateaus, safe food loss, and burnout. Rather than framing this as a setback, this conversation reframes it as a shift in nervous system capacity, where stress, sensory load, and life context all influence how food feels from day to day. Through a relatable case example, you will hear how safe foods can change during periods of increased demand and how support, not pressure, can help restore flexibility over time. What Is ARFID and Why Safe Foods Matter Avoidant Restrictive Food Intake Disorder (ARFID) is an eating disorder characterized by limited food intake linked to sensory sensitivities, fear of aversive consequences, or low interest in eating. Safe foods often become essential because they provide predictability and reduce sensory overwhelm. In this episode, Dr. Marianne explains how safe foods function as a form of nervous system support rather than simply preference, and why relying on them is both adaptive and necessary for many people. ARFID Burnout: Why Safe Foods Suddenly Stop Working Many people with ARFID experience periods where even their most reliable foods become harder to eat. This episode introduces the concept of ARFID burnout, where the cumulative effort of eating, decision making, and sensory processing leads to exhaustion. When the nervous system is overwhelmed, tolerance for even familiar foods can decrease. Dr. Marianne explores how stress, illness, fatigue, and life transitions can all narrow capacity and make eating feel more difficult, even when nothing about the food itself has changed. ARFID and Decision Fatigue Around Food Eating with ARFID often requires ongoing problem solving, which can create significant mental load. This episode highlights how decision fatigue plays a role in eating challenges, especially when every meal requires evaluating options, anticipating sensory experiences, and managing uncertainty. Reducing the number of decisions required around food can help create more stability and make eating feel more accessible. When Safe Foods Stop Working: What Helps If your safe foods are not working the way they used to, this episode offers practical and compassionate ways to respond without increasing pressure. Dr. Marianne discusses how supporting the nervous system, rather than forcing food, can help rebuild capacity over time. The episode explores ways to create a more flexible structure around eating, including expanding the range of low-effort meals, reducing cognitive load, and adjusting expectations so that eating feels more doable in the moment. The focus is on creating sustainability rather than perfection. ARFID Recovery Is Not Linear In this episode, Dr. Marianne emphasizes that ARFID recovery is not linear. Shifts in food tolerance are not signs of failure, but reflections of changing capacity. Learning how to respond with flexibility, curiosity, and support can help create a more sustainable relationship with food over time, especially during periods when things feel harder. Related Episodes 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 If you are looking for deeper support, Dr. Marianne offers a virtual, self-paced ARFID and selective eating course designed to help you better understand your eating patterns through a neurodivergent-affirming and trauma-informed lens. The course includes practical tools to support sensory needs, reduce overwhelm, and build a more sustainable approach to eating. Learn more at drmariannemiller.com
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    14 m
  • Fear of Food: How Eating Pressures & Diet Culture Create Food Anxiety & Eating Disorder Recovery Struggles

    Fear of Food: How Eating Pressures & Diet Culture Create Food Anxiety & Eating Disorder Recovery Struggles
    Mar 25 2026
    If eating feels stressful, overwhelming, or even scary, you are not alone. Fear of food is incredibly common, especially for people navigating eating disorder recovery or trying to unlearn years of diet culture messaging. What often gets labeled as “lack of willpower” is actually something much deeper. It is learned fear. In this episode, Dr. Marianne explores how fear of food develops, why it feels so real in the body, and how diet culture conditions people to distrust their own eating instincts. This conversation moves beyond surface-level advice and gets into the psychological and nervous system layers of food anxiety. How Diet Culture Creates Food Anxiety and Food Rules Diet culture teaches people to categorize food into rigid binaries such as “good” and “bad,” while also tying eating behaviors to morality and self-worth. Over time, this creates internalized food rules that can feel impossible to break. These rules often lead to anxiety, restriction, and a growing sense that eating must be controlled at all times. Dr. Marianne explains how these patterns develop gradually and why they are often reinforced by praise, healthcare messaging, and social norms. What begins as an attempt to feel in control can slowly turn into fear of specific foods, fear of eating freely, and fear of losing control. Fear of Food in Eating Disorder Recovery Fear of food is a central experience in many eating disorders, including anorexia, bulimia, binge eating disorder, and ARFID. Even when someone intellectually understands that food is not dangerous, their nervous system may still react with anxiety. This episode breaks down why that happens and how long-term restriction strengthens food fear over time. Dr. Marianne shares how the brain begins to associate certain foods with danger and why reintroducing those foods can feel so overwhelming. Neurodivergence, Sensory Needs, and Food Anxiety For neurodivergent individuals, including those with ADHD and autism, food anxiety can be layered with sensory sensitivities, executive functioning challenges, and differences in hunger awareness. Diet culture often ignores these realities, which can make eating feel even more complicated. Dr. Marianne discusses why a neurodivergent-affirming approach to eating disorder recovery is essential and how honoring sensory needs and autonomy can reduce fear and increase safety around food. Rebuilding Trust With Food After Diet Culture Healing fear of food is not about forcing yourself to “just eat” or pushing through anxiety. It is about gradually helping the nervous system learn that eating is safe again. Dr. Marianne introduces the concept of microdosing uncertainty as a way to take small, manageable steps toward flexibility with food. She also explores how questioning food rules, creating supportive eating environments, and working with the nervous system can help reduce food anxiety over time. Recovery is not about perfect eating. It is about building a relationship with food that is less governed by fear and more grounded in trust. You Are Not Broken If you feel afraid of food, it does not mean you are failing. It means you have learned to associate eating with danger in a culture that constantly reinforces those fears. This episode offers a compassionate and practical framework for understanding food anxiety and beginning the process of healing. Related Episodes SkinnyTok & Anorexia: How Harmful Trends Thrive Despite TikTok’s Ban with Jen Tomei @askjenup on Apple and Spotify. ARFID, PDA, and Autonomy: Why Pressure Makes Eating Harder on Apple & Spotify. When PDA Drives ARFID: Understanding Food Refusal, Control, & Safety on Apple & Spotify. Work With Dr. Marianne If you are struggling with fear of food, eating disorder recovery, or food anxiety, you can work with Dr. Marianne through therapy or coaching. Services are available in California, Texas, Washington, D.C., and globally. You can also explore Dr. Marianne’s self-paced course on ARFID and selective eating, which includes neurodivergent-affirming, sensory-supportive approaches to rebuilding trust with food. Learn more at drmariannemiller.com
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    16 m
  • Autism, ADHD, & Eating Disorders: Recovery, Sensory Needs, & Late Diagnosis With Margo White, CPN @margo_wholebodynutrition

    Autism, ADHD, & Eating Disorders: Recovery, Sensory Needs, & Late Diagnosis With Margo White, CPN @margo_wholebodynutrition
    Mar 23 2026
    What if the eating challenges you have struggled with were never just about food? In this deeply validating and expansive conversation, Dr. Marianne sits down with Margo White, CPN, to explore the intersection of autism, ADHD, and eating disorders through a neurodivergent-affirming lens. Margo shares her lived experience of being late-identified as autistic and ADHD, and how years of unmet needs, sensory overwhelm, and trauma shaped her relationship with food, her body, and herself. This episode gently reframes eating disorders not as isolated problems, but as meaningful adaptations that develop in response to a nervous system trying to survive. Autism, ADHD, and Eating Disorders: Understanding the Overlap Autism and ADHD are closely connected with eating disorders, yet this relationship is often misunderstood or overlooked in traditional treatment models. Margo shares how her neurodivergent brain shaped her early experiences, including sensory sensitivities, difficulty feeling connected, and a persistent sense of not fitting in. Without the language or support to understand these experiences, food became a place of predictability, comfort, and regulation. This conversation expands the narrative around anorexia and other eating disorders by exploring how they can emerge from unmet needs, overwhelm, and the need for safety, rather than solely from body image concerns. Late Diagnosis of Autism and ADHD: A Turning Point in Recovery Receiving a late diagnosis of autism and ADHD can be a profound shift. Margo describes this as a “lightbulb moment,” where years of confusion and self-blame suddenly made sense. Patterns that once felt like personal failures became understandable responses to a neurodivergent brain navigating a world that was not built for it. This reframe is often a critical piece of healing. When people understand their brain, they can begin to meet their needs more directly, which can significantly change their relationship with food and reduce reliance on eating disorder behaviors. Sensory Needs, Food Preferences, and ARFID A core part of this conversation focuses on sensory needs and how they shape eating. Many autistic and ADHD individuals experience strong preferences around texture, temperature, predictability, and even the utensils they use. Margo and Dr. Marianne explore how these preferences are often mislabeled as disordered when they are actually reflections of a neurodivergent nervous system. They discuss how something as simple as using a specific spoon or eating foods in a certain order can be rooted in sensory comfort rather than pathology. The conversation also highlights the overlap between ARFID and neurodivergence, and how nervous system regulation can expand flexibility with food over time. Rather than forcing exposure or compliance, a neurodivergent-affirming approach centers safety, choice, and collaboration. Anorexia, Trauma, and the Search for Safety Margo shares openly about her experience with anorexia and how it developed within the context of bullying, low self-worth, and unmet emotional needs. Food and restriction became ways to create structure and a sense of control when everything else felt overwhelming and unpredictable. This part of the episode reframes eating disorders as protective strategies. While harmful, they often emerge to help someone cope with distress, regulate emotions, or navigate an environment that feels unsafe. Understanding this function can shift how we approach recovery, moving away from blame and toward compassion. Neurodivergent-Affirming Eating Disorder Recovery Recovery, especially for neurodivergent people, is not about forcing oneself into rigid food rules or expectations. Margo shares how her healing involved learning about her brain, honoring her sensory needs, and creating environments that felt safe enough for her nervous system to relax. Instead of trying to eliminate comfort eating or achieve perfection with food, she learned to build flexibility and trust. Recovery became less about control and more about responsiveness, allowing her to eat in ways that supported her body while respecting her sensory experiences. This approach offers a powerful alternative to traditional models that can unintentionally increase shame or overwhelm. Body Changes, Weight Gain, and Healing from Weight Stigma A deeply important part of recovery is navigating body changes. Margo speaks candidly about gaining weight in recovery and how this brought up past trauma from being bullied in a larger body. These experiences did not disappear simply because her behaviors changed. Instead, they required ongoing processing and support. This section explores how weight stigma shapes both eating disorders and recovery, and how individuals can begin to build safety and acceptance in their bodies over time. Margo also speaks about reclaiming the word “fat” as neutral, separating it from the harm that society has attached to it. ARFID in Autism and ADHD: ...
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    28 m
  • Restrictive Eating in Midlife: Why Eating Disorders Can Begin After 40

    Restrictive Eating in Midlife: Why Eating Disorders Can Begin After 40
    Mar 20 2026
    Most people still believe eating disorders only begin in adolescence or early adulthood. But restrictive eating can develop later in life, and midlife can be a particularly vulnerable time. Changes in the body, new health conditions, medications, major life transitions, and cultural pressure around aging can all shape someone’s relationship with food. In this episode of Dr. Marianne-Land, Dr. Marianne explores why restrictive eating in midlife is more common than many people realize and why it often goes unnoticed. She discusses how bodies change as we mature, how medications and medical diagnoses can alter appetite and body composition, and why restrictive eating may be socially accepted or even praised in older adults. This conversation also looks at the emotional and cultural factors that can make midlife a turning point in someone’s relationship with food. If eating has become more rigid, stressful, or rule-driven later in life, you are not alone. Eating disorders after 40 are real, and recovery is possible. Restrictive Eating in Midlife Restrictive eating in midlife often develops gradually. Someone may begin skipping meals, cutting out food groups, or eating less in response to body changes, stress, or health concerns. What begins as small adjustments can slowly become more rigid and anxiety-driven. Dr. Marianne explains how restrictive eating patterns in midlife can sometimes be mistaken for healthy lifestyle changes. Because restriction is often praised in adults, it can be difficult for people to recognize when eating has become disordered. Eating Disorders After 40 and Late-Onset Eating Disorders Eating disorders after 40 are more common than many people realize. Research and clinical experience show that late-onset eating disorders can develop during midlife due to life transitions, hormonal changes, chronic stress, or new medical conditions. In this episode, Dr. Marianne discusses why people who develop eating disorders later in life often feel confused or isolated. Because eating disorders are so frequently associated with youth, many adults struggle to understand what they are experiencing. Body Changes in Midlife and Restrictive Eating Bodies naturally change as we age. Hormones shift, metabolism evolves, and body composition often changes during midlife. Perimenopause, menopause, sleep changes, stress, and shifting activity levels can all influence appetite and energy levels. Dr. Marianne explores how body changes in midlife can create distress or uncertainty for many people, especially in a culture that pressures individuals to maintain the same body size throughout adulthood. These experiences can lead some people to try to manage body changes through restrictive eating. Health Conditions, Medications, and Changes in Eating Patterns Midlife is also a time when many people begin navigating new health diagnoses or medications. Certain medications can change appetite, digestion, metabolism, or body composition. Medical conversations about weight or health markers can also increase attention on food and eating behaviors. Dr. Marianne discusses how health conditions and medications can unintentionally contribute to restrictive eating patterns when people feel pressure to control body changes or manage symptoms through food restriction. Why Restrictive Eating Can Be Socially Accepted in Midlife Restrictive eating in older adults often goes unnoticed because it may be socially encouraged. Eating less, avoiding certain foods, or losing weight is frequently framed as discipline or commitment to health. Dr. Marianne explains how diet culture and weight stigma can reinforce restrictive eating behaviors, making it harder for people to recognize when their relationship with food has become rigid or distressing. Eating Disorder Recovery in Midlife Recovery from restrictive eating is possible at any stage of life. Midlife can even bring strengths to the recovery process, including deeper self-awareness, life experience, and a clearer sense of personal values. In this episode, Dr. Marianne discusses how recovery can include building a more compassionate relationship with the body, recognizing that bodies naturally change over time, and challenging cultural messages that equate worth with body size or control over food. Related Episodes Anorexia & Bulimia After 40: Understanding Midlife Recovery & Change on Apple & Spotify. The Hidden Pain of Midlife Anorexia: Why Coping Breaks Down & What Heals on Apple & Spotify. Why Is Anorexia Showing Up Again in Midlife? You're Not Imagining It on Apple & Spotify. Midlife Bulimia Recovery: Coping With the Internal Chaos on Apple & Spotify. Welcome to the Jungle: Eating Disorders in Midlife & Our Personal Recovery Stories with Amy Ornelas, RD on Apple & Spotify. Work With Dr. Marianne Dr. Marianne Miller is a licensed marriage and family therapist specializing in eating disorder recovery. She supports people navigating restrictive eating, binge eating disorder...
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    15 m
  • Family Dynamics & Eating Disorders: How Early Relationships Shape Disordered Eating

    Family Dynamics & Eating Disorders: How Early Relationships Shape Disordered Eating
    Mar 18 2026
    Many people in eating disorder recovery eventually wonder how their early environment may have shaped their relationship with food. Questions about family dynamics and eating disorders often come up in therapy, especially when someone is trying to understand why certain patterns around food, body image, and control feel so deeply ingrained. Eating disorders such as anorexia, bulimia, binge eating disorder, and ARFID do not develop from a single cause. Research shows that eating disorders emerge through a complex combination of biological vulnerability, personality traits, neurodivergence, trauma, life stress, and cultural pressures. Family dynamics are only one piece of this puzzle, but they can strongly influence how children learn to relate to food, bodies, emotions, and control. In this episode of the Dr. Marianne-Land Podcast, Dr. Marianne Miller, eating disorder therapist, explores how family relationships, childhood experiences, and early emotional environments can shape patterns of disordered eating that continue into adulthood. How Family Dynamics Can Shape Disordered Eating Children learn about food and bodies long before they are able to critically question the messages around them. Family dynamics often influence beliefs about body size, self-worth, and emotional expression. In some families, diet culture and body criticism are normalized through comments about weight, food choices, or appearance. In others, emotions may be discouraged or minimized, leaving children to cope with distress on their own. These experiences can contribute to the development of disordered eating behaviors such as restriction, binge eating, or cycles of control around food. Family environments can also shape how children understand achievement, perfectionism, and control. When approval is linked to discipline or performance, some individuals learn to use food and body control as a way to gain safety, validation, or stability. These patterns do not mean families intentionally create eating disorders. Often caregivers are doing their best while navigating the same cultural pressures around weight, food, and health that affect all of us. A Case Example of Family Dynamics and Eating Disorders In the episode, Dr. Marianne shares a clinical case example illustrating how family dynamics can influence eating disorder development over time. A client grew up in a household where discipline, achievement, and self-control were highly valued. Food was discussed frequently in terms of “good” and “bad,” and comments about body size were common among relatives. As the client entered adolescence and experienced normal body changes, these messages began to feel increasingly intense. Restricting food initially created a sense of control and calm during a time of pressure and uncertainty. Over time, those behaviors gradually developed into an eating disorder. This example highlights an important truth. Eating disorders often develop as coping strategies, particularly when someone is trying to manage overwhelming emotions, social pressure, or a sense of instability. Diet Culture, Anti-Fat Bias, and Family Messages About Bodies Family dynamics do not exist in isolation. They are shaped by larger cultural forces such as diet culture, anti-fat bias, racism, and ableism. These systems influence how bodies are discussed, how health is interpreted, and how children learn to evaluate themselves. For example, children in larger bodies may receive more scrutiny around food. Neurodivergent children may experience pressure to control eating behaviors or mask sensory needs. Cultural messages about worth, discipline, and appearance often filter directly into family conversations about food and bodies. Understanding these intersections can help people recognize that their relationship with food developed within a much larger social context. Healing Family Patterns in Eating Disorder Recovery Exploring family dynamics in eating disorder recovery is not about blame. Instead, it offers insight into how early experiences shaped coping strategies. Many people discover that their eating disorder once served a function. It may have helped them regulate emotions, manage uncertainty, or create a sense of control in difficult situations. Recognizing that function can help people develop new coping tools that support long-term eating disorder recovery. Healing often includes building more compassionate relationships with food, learning new emotional regulation skills, and establishing boundaries around conversations about weight, dieting, and body criticism when necessary. Recovery is possible, even when eating patterns feel deeply rooted in early experiences. Related Episodes How Childhood Trauma Shapes Eating Disorders & Body Shame (Content Caution) on Apple & Spotify. Childhood Trauma & Eating Disorders on Apple & Spotify. The Connection Between Unresolved Trauma & Long-Lasting Eating Disorders (Content Caution) on Apple & Spotify. Work With Dr. ...
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    18 m
  • Harm Reduction for Long-Term Eating Disorders: Peer Support, Healing, & Hope With Johanna Scoglio, M.Ed., M.B.A.

    Harm Reduction for Long-Term Eating Disorders: Peer Support, Healing, & Hope With Johanna Scoglio, M.Ed., M.B.A.
    Mar 16 2026
    What happens when traditional recovery messaging does not fit someone’s lived reality? For many people living with long-term eating disorders, the expectation of full recovery can feel overwhelming, unrealistic, or even invalidating. In these situations, harm reduction for eating disorders offers another path forward, one that centers dignity, autonomy, safety, and compassion. In this episode of the Dr. Marianne-Land Podcast, Dr. Marianne speaks with Johanna Scoglio, M.Ed., M.B.A., founder of Dragonfly’s Dream, a nonprofit rooted in lived experience and dedicated to supporting people with long-term eating disorders through harm reduction, peer support, and mind-body healing. Johanna brings both professional expertise and personal insight to this conversation. Together, she and Dr. Marianne explore how harm reduction approaches can support individuals who have been living with eating disorders for many years and may feel overlooked by traditional treatment models. This episode offers a thoughtful and compassionate discussion about chronic eating disorders, community care, and new ways of thinking about healing. Understanding Harm Reduction for Long-Term Eating Disorders Harm reduction is an approach that focuses on reducing suffering and increasing safety, rather than insisting on a single definition of recovery. In the context of long-term eating disorders or chronic eating disorders, harm reduction acknowledges that healing is complex and that people deserve support even if their symptoms do not disappear entirely. Johanna explains that harm reduction is not about giving up on healing. Instead, it is about meeting people where they are and supporting meaningful improvements in quality of life. For many individuals living with persistent eating disorders, this may mean reducing medical risk, building sustainable coping strategies, improving emotional well-being, and creating environments where eating and nourishment feel safer. Rather than framing recovery as all-or-nothing, harm reduction allows space for nuance, flexibility, and compassion. The Role of Peer Support in Eating Disorder Healing A key focus of Johanna’s work is peer support for eating disorders. Many people living with long-term eating disorders report feeling isolated or misunderstood, especially when their experiences fall outside standard recovery narratives. Peer support can create powerful spaces where individuals feel seen, understood, and less alone. Johanna shares how peer-led communities offer validation and connection. When people speak openly with others who have lived through similar experiences, shame often begins to soften. Peer support can also provide practical strategies, encouragement, and hope that healing is still possible, even when the journey looks different than expected. For many individuals, peer support becomes a vital complement to therapy, medical care, or other forms of treatment. It reminds people that they are not alone and that their experiences matter. Expanding the Conversation About Eating Disorder Recovery This episode also explores how the eating disorder field can broaden its understanding of recovery. Traditional treatment models often emphasize full symptom elimination as the only successful outcome. While full recovery is possible for many people, others may experience a more complicated path. Johanna and Dr. Marianne discuss how harm reduction frameworks allow clinicians, families, and communities to support individuals without judgment. Instead of labeling someone as failing recovery, harm reduction acknowledges the realities of persistent eating disorders and prioritizes safety, dignity, and compassionate care. By shifting the focus toward quality of life, connection, and incremental change, harm reduction can help people build more sustainable relationships with food, their bodies, and their communities. About Johanna Scoglio Johanna Scoglio, M.Ed., M.B.A., is the founder of Dragonfly’s Dream, a nonprofit organization dedicated to supporting individuals living with long-term eating disorders. Her work centers on harm reduction, peer support, and mind-body healing, with the goal of creating spaces where people can access compassionate and realistic support. Through advocacy, education, and community building, Johanna is helping expand the conversation around chronic eating disorders, recovery pathways, and inclusive care. Johanna recently published a book: When the Water Still Holds Me: Letters Through the Tides of a Long-Term Eating Disorder You can learn more about it and purchase it HERE. Here is her website: https://shimmeringseaglass.com/ Related Episodes 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. Orthorexia, Quasi-Recovery, & Lifelong Eating Disorder Struggles with Dr. Lara Zibarras @drlarazib ...
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    33 m
  • Fear of Uncertainty in Eating Disorder Recovery: Why It Feels So Terrifying + 5 Practical Skills That Help

    Fear of Uncertainty in Eating Disorder Recovery: Why It Feels So Terrifying + 5 Practical Skills That Help
    Mar 13 2026
    Eating disorder recovery can feel frightening for reasons that go far deeper than food, weight, or body image. One of the most powerful drivers of eating disorder behaviors is fear of uncertainty. When recovery removes rigid rules and predictable routines, the nervous system can interpret that loss of certainty as danger. In this episode, Dr. Marianne explores how fear of uncertainty operates underneath many eating disorder behaviors and why letting go of control can feel destabilizing. She explains the psychology of intolerance of uncertainty and how eating disorders such as anorexia, bulimia, binge eating disorder, and ARFID can develop as attempts to create predictability in an overwhelming world. Intolerance of Uncertainty and Eating Disorders Many people with eating disorders experience what psychologists call intolerance of uncertainty. This means the brain interprets ambiguity and unpredictability as unsafe. Instead of thinking “I don’t know what will happen but I can cope,” the nervous system may assume that something bad will happen if there is not a clear plan or outcome. Eating disorder behaviors can temporarily reduce this distress. Restrictive eating, binge eating, purging, body checking, and rigid food rules can create the illusion of certainty. These patterns often lower anxiety in the short term, which reinforces the cycle and makes recovery feel more intimidating. Dr. Marianne explains how this dynamic shows up in eating disorder recovery and why the loss of rigid control can trigger powerful anxiety responses. Why Uncertainty Feels Especially Hard for Neurodivergent People For many listeners, fear of uncertainty is intensified by neurodivergence, trauma history, or systemic stress. Changes in routine, fluctuating internal cues, sensory differences, and executive functioning challenges can all make unpredictability feel overwhelming. Dr. Marianne discusses how autism, ADHD, and other neurodivergent experiences can interact with eating disorders and recovery. She also highlights how weight stigma, ableism, racism, and other systemic pressures can make uncertainty in eating disorder recovery feel even riskier. Understanding these contexts helps shift the conversation from shame to compassion. Microdosing Uncertainty in Eating Disorder Recovery A key concept introduced in this episode is microdosing uncertainty. Instead of forcing dramatic change, recovery can involve practicing small, manageable exposures to unpredictability. Dr. Marianne explains how gradually introducing small shifts in eating patterns, routines, or body-related behaviors can help retrain the nervous system. These repeated experiences allow the brain to learn that uncertainty does not automatically lead to catastrophe. Microdosing uncertainty can help expand the window of tolerance and make eating disorder recovery feel more sustainable. Five Practical Skills for Managing Fear of Uncertainty This episode also explores five practical skills that can help people tolerate uncertainty in eating disorder recovery. Dr. Marianne discusses the importance of practicing small exposures to uncertainty, accurately naming nervous system reactions, creating compassionate structure that reduces overwhelm, regulating anxiety through body-based techniques, and cultivating contextual self-compassion. These skills help widen emotional capacity so recovery does not feel like stepping into chaos. Instead, listeners can gradually build confidence in their ability to navigate unpredictability. Related Episodes An Open Letter to the Body: Listening to the Part That Fears Getting Better on Apple and Spotify. Eating Disorders as Safety Systems: Why Letting Go Can Trigger Fear on Apple and Spotify. If Recovery Feels Unsafe Right Now: A Guided Moment for Eating Disorder Recovery Fear on Apple and Spotify. Expanding Freedom Beyond Eating Disorder Rules Eating disorders often promise certainty, but they narrow life in the process. Recovery may introduce unpredictability, yet it also expands possibilities for nourishment, flexibility, connection, and autonomy. Dr. Marianne emphasizes that recovery is not about eliminating uncertainty. The goal is to build the capacity to live meaningfully alongside it. Therapy and Self-Paced Eating Disorder Recovery Courses If this episode resonates with you and you are looking for additional support, you can visit Dr. Marianne’s website to learn more about therapy and self-paced recovery courses. Dr. Marianne is a Licensed Marriage and Family Therapist specializing in eating disorders, including ARFID, binge eating disorder, anorexia, and bulimia. She offers therapy services in California, Texas, and Washington DC and provides virtual courses for people seeking flexible recovery resources. You can learn more about therapy and courses at drmariannemiller.com.
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    15 m
  • GI Issues in Eating Disorder Recovery: Why Bloating, Constipation, & Stomach Pain Happen & How Healing Is Possible

    GI Issues in Eating Disorder Recovery: Why Bloating, Constipation, & Stomach Pain Happen & How Healing Is Possible
    Mar 11 2026
    If eating disorder recovery has made your stomach feel worse instead of better, you are not alone. Many people experience bloating, constipation, reflux, stomach pain, and fullness during recovery. These symptoms can feel frightening and discouraging, especially when they show up after you start nourishing your body more consistently. In this solo episode, Dr. Marianne Miller, LMFT, explains why gastrointestinal symptoms are common during eating disorder recovery and why they do not mean recovery is failing. You will learn how restriction affects the digestive system, why symptoms sometimes intensify during early recovery, and what helps the gut heal over time. Dr. Miller also shares practical strategies for coping with GI discomfort while continuing recovery. This episode offers compassionate guidance for navigating one of the most misunderstood parts of eating disorder healing. Why GI Issues Are Common in Eating Disorder Recovery Many people are surprised when digestive symptoms worsen after they begin eating more consistently. Bloating, constipation, reflux, nausea, and stomach pain can make recovery feel confusing or even frightening. In this episode, Dr. Marianne Miller explains how restrictive eating, purging, inconsistent nourishment, and limited food variety affect the gastrointestinal system. When the body does not receive enough energy, digestion slows in order to conserve resources. Motility decreases, stomach emptying may become delayed, and the muscles of the digestive tract lose strength over time. When nourishment increases during recovery, the digestive system must relearn how to function. This recalibration process can temporarily intensify symptoms. While uncomfortable, these changes are often part of the gut rebuilding normal digestive rhythms. Common Digestive Symptoms During Eating Disorder Recovery People in eating disorder recovery frequently report symptoms such as bloating, constipation, reflux, abdominal discomfort, nausea, and early fullness. These symptoms may appear during early refeeding or after increasing meal consistency. Dr. Miller discusses how slowed gastrointestinal motility, microbiome changes, and nervous system activation contribute to these experiences. She also explains why bloating can feel especially distressing in a culture that places intense pressure on stomach appearance and body size. Understanding the physiology behind these symptoms can help reduce fear and prevent the eating disorder from using GI discomfort as justification for returning to restriction. The Gut Is Adaptable and Healing Is Possible One of the most important messages of this episode is that the digestive system is highly adaptable. With consistent nourishment, hydration, and medical support when needed, the gastrointestinal tract can recover significant function. Over time, stomach emptying can improve, bowel patterns can normalize, and abdominal discomfort can decrease. The gut lining regenerates, digestive enzymes adjust, and the microbiome can become more balanced. Recovery does not always follow a straight line, but healing is possible when the body receives consistent energy and care. Practical Ways to Cope With GI Symptoms in Recovery This episode also explores practical ways to cope with digestive discomfort while continuing eating disorder recovery. Dr. Miller discusses the role of mechanical eating in helping retrain digestive rhythms and why regular meals often support gastrointestinal healing. Sensory supports can also help regulate the nervous system, including wearing loose clothing, using a heating pad on the abdomen after meals, and creating calming eating environments. Hydration can support bowel function, and gentle abdominal massage may help stimulate motility. For some individuals, medical providers may recommend medications or short term treatments to reduce symptoms such as constipation, reflux, or delayed gastric emptying. Dr. Miller emphasizes that any movement during eating disorder recovery must be cleared by a medical provider first. If a physician has determined that movement is safe, gentle activities such as short walks or stretching may sometimes support digestion. Medical clearance is essential before incorporating movement into recovery. The Role of Medical Support in GI Healing Because digestive symptoms can overlap with other medical conditions, collaboration with an eating disorder informed medical provider is important. Physicians can help assess symptoms, rule out other causes, and recommend appropriate treatments when needed. Medications or medical supports may be helpful for constipation, reflux, nausea, or delayed gastric emptying. Seeking medical care for GI symptoms does not mean recovery is failing. It means symptoms are being treated compassionately and responsibly. Intersectionality and GI Symptoms Dr. Miller also highlights how systemic bias can affect how digestive symptoms are treated. People in larger bodies may have GI concerns ...
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    12 m