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.

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.

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.

“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.

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.

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.

Eating disorders in Black women Missed diagnosis in emergency medicine Low heart rate and medical risk in eating disorders Bulimia without classic symptoms Medical weight bias in ER care Race, stigma, and underdiagnosis Media representation and clinical awareness Liberation-informed eating disorder therapy

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.

-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

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.

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 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.

When self-criticism ramps up during eating disorder recovery, it can feel confusing or discouraging, especially when behaviors are beginning to change. This episode explores why that intensification is often part of the healing process rather than a sign that recovery is going wrong.

In this solo episode, Dr. Marianne Miller explains why the inner critical voice often gets louder as eating disorder behaviors decrease and familiar control systems loosen. Instead of framing self-criticism as simply negative self-talk, this episode examines it as a regulatory strategy shaped by nervous system threat, social pressure, and internalized ableism.

Recovery often collides with a world that expects bodies and minds to function efficiently, consistently, and quietly. In this section, Dr. Marianne names how those expectations become internalized as harsh self-judgment, especially for neurodivergent people, people with chronic illness, and those navigating long-term eating disorders.

You’ll hear how internalized ableism fuels self-criticism when recovery requires pacing, support, repetition, or accommodation, and why needing these supports does not mean recovery is failing.

Many people try to argue with or silence self-critical thoughts in recovery. This episode explains why that approach often backfires and intensifies the inner voice instead.

Dr. Marianne explores how the inner critic functions as a response to perceived threat and why understanding its role is more effective than trying to eliminate it.

This episode offers compassionate, neurodivergent-affirming ways to respond to self-criticism without turning recovery into another performance. The focus is on reducing threat, supporting regulation, and loosening the critic’s authority rather than suppressing it.

A brief clinical vignette illustrates how self-criticism rooted in internalized ableism can show up even when healing is actively underway.

For people with long-term or chronic eating disorders, progress often looks different than expected. This section reframes recovery as a process that prioritizes safety, accommodation, and sustainability over efficiency or perfection.

Loud self-criticism does not mean failure. It often signals that a system is reorganizing in response to change.

Recovery is not about proving you can function the way the world demands. It is about building a life that supports your nervous system, your needs, and your humanity.

This Is Body Grief: How Ableism, Intersectionality, & Eating Disorders Shape Our Body Experiences With Jayne Mattingly on Apple & Spotify.

Size Inclusivity & Ableism: Why Body Acceptance is More Than Just "Loving Your Curves" on Apple & Spotify.

Ableism and Common Myths About Diabetes with Kim Rose, RD @the.bloodsurgar.nutritionist on Apple & Spotify.

If this episode resonated and you want structured, neurodivergent-affirming support, you can learn more about my self-paced ARFID course. The course is designed for teens and adults navigating avoidant and restrictive eating patterns and focuses on sensory needs, nervous system safety, and realistic, sustainable change without shame or pressure.

Eating disorder recovery in midlife often looks very different than recovery earlier in life. For many adults over 40, anorexia and bulimia are not new struggles but long standing patterns shaped by decades of survival, responsibility, and adaptation. This episode explores why recovery after 40 requires a different lens and why difficulty healing is not a personal failure.

In this solo episode, Dr. Marianne Miller examines how anorexia and bulimia persist into midlife and what actually supports healing at this stage of life. Rather than focusing on willpower or symptom control, this conversation centers nervous system safety, autonomy, grief, and the cumulative impact of stress and systemic harm.

You will hear how hormonal changes, aging bodies, chronic stress, caregiving roles, and identity related oppression all shape midlife eating disorder recovery. This episode also addresses why traditional treatment models often fall short for adults over 40 and how neurodivergent affirming, weight inclusive, and harm reduction oriented care can offer a more sustainable path forward.

Recovery after 40 is not about catching up or starting over. It is about choosing care that fits the life you are living now.

Anorexia and bulimia in midlife and why recovery changes after 40. Why long standing eating disorder patterns often reflect adaptation, not resistance. How the body communicates differently in midlife through hunger, fatigue, pain, and stress. The role of grief, fear, and ambivalence in midlife eating disorder recovery Intersectionality in recovery, including the effects of weight stigma, racism, ableism, and anti-queer and anti-trans bias. Neurodivergence, sensory sensitivity, and why many adults were never supported earlier in life. Why harm reduction and pacing often support recovery better than urgency. What weight inclusive, autonomy centered therapy can look like for adults over 40.

Adults over 40 navigating anorexia or bulimia. People with long term or recurring eating disorder patterns. Neurodivergent adults and those with sensory sensitivities. Fat people and others harmed by weight stigma in healthcare. Anyone who has felt left behind by traditional eating disorder treatment.

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.

Dr. Marianne Miller is a licensed marriage and family therapist specializing in eating disorder therapy for adults, including anorexia, bulimia, binge eating disorder, and ARFID. Her work centers neurodivergent affirming, weight inclusive, and harm reduction approaches that honor safety, agency, and lived context.

Dr. Marianne works with adults in California, Texas, and Washington DC. Therapy is grounded in an understanding of how trauma, systemic oppression, and nervous system overwhelm shape eating struggles across the lifespan.

Learn more about working with Dr. Marianne and current therapy availability by visiting her website drmariannemiller.com.

This episode discusses eating disorders, recovery, and midlife body changes. Listener discretion is advised.