June 26, 2024 • 66 mins
This week we are talking all things neurodivergence & eating disorder recovery with Dr. Marianne Miller.
Dr. Marianne has been in the mental health field for 27 years and has specialized in eating disorders for the last 12 years. She was a full-time academic for 12 years and had a part-time eating disorder practice for much of that time until she left the university and went into private practice full-time in 2018. Dr. Marianne loves working with eating disorders as a therapist and a coach. She takes a non-diet, feminist approach that helps people of all genders live empowered, authentic lives. She embraces the Health at Every Size model, and is neurodivergent and LGBTQIA+ affirming.
We talked to Dr. Marianne about:
- How eating disorders & disordered eating behavior can be a coping mechanism for neurodivergent folks who struggle with feeling out of place in a society that emphasizes conformity and suppresses emotional expression.
- The complexities of eating disorder treatment for neurodivergent individuals & the limitations of standardized treatments, like cognitive behavioral therapy.
- What neurodivergent-affirming care looks like & how we can create more inclusive and effective therapeutic environments.
- And so much more!
Want to connect more with Dr. Marianne?
- Follow her on Instagram @drmariannemiller
- Visit her website
- Listen to Dr. Marianne-Land: An Eating Disorder Recovery Podcast
- Join her $99/month Dr. Marianne-Land's Binge Eating Recovery Membership Program
- Sign up for 1:1 binge eating recovery coaching via her Elite Binge Eating Recovery Method
Referenced in this episode:
The Neurodivergent Friendly Workbook of DBT Skills by Sonny Jane Wise
Stay in touch with the pod on IG @satisfactionfactorpod!
And here's where you can continue to find us:
Sadie Simpson: www.sadiesimpson.com or IG @sadiemsimpson
Naomi Katz: www.happyshapes.co or IG @happyshapesnaomi
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Naomi Katz (00:03):
Welcome to Satisfaction Factor, the podcast
where we explore how ditchingdiet culture makes our whole
lives more satisfying.
Welcome back to SatisfactionFactor.
I'm Naomi Katz, an intuitiveeating and body image coach.
Sadie Simpson (00:25):
I'm Sadie Simpson , a group fitness instructor and
personal trainer.
Naomi Katz (00:29):
So we've got a great guest this week that we think
you're really going to love.
But before we dive in, just aquick reminder about the
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We know it can be hard to findanti-diet community that's
aligned with your values,especially if you're the first
in your family or friend groupto make moves towards ditching
(00:50):
diet culture, and that's why wecreated the Satisfaction Space.
If you've ever found yourselflistening to the podcast and
wanting to add something to theconversation or ask a question,
this space was created for you.
The Satisfaction Space is ouronline membership community that
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(01:11):
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Membership to the SatisfactionSpace is just $10 a month and
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thesatisfactionspacemnco, andthat link always lives in our
(01:32):
show notes.
Sadie Simpson (01:34):
We also have merch.
We have a handful of designs onTeePublic that can be printed
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whatever else you like.
T-shirts and sweatshirts comein sizes up to 5X and you can
check that out at the link inour show notes.
Naomi Katz (01:49):
So today we are talking to Dr Marianne Miller
about the intersection ofneurodivergence and eating
disorders.
Dr Marianne has been in themental health field for 27 years
and has specialized in eatingdisorders for the last 12 years.
She was a full-time academicfor 12 years and had a part-time
eating disorder practice formuch of that time, until she
(02:11):
left the university and wentinto private practice full-time
in 2018.
Dr Marianne loves working witheating disorders as a therapist
and a coach.
She takes a non-diet, feministapproach that helps people of
all genders live empowered,authentic lives.
She embraces the health atevery size model and is
neurodivergent and LGBTQIA plusaffirming.
(02:34):
So, without further ado, let'stalk to Marianne.
Marianne welcome.
Thank you so much for beinghere with us today.
Thanks for having me.
We are very excited to talk toyou all about neurodivergence
and eating disorders.
We think that's a topic thatour listeners are really going
to be interested in and be ableto learn a lot from you about.
(02:56):
Can you tell us a little bitabout your experience with diet
culture and maybe how that's ledyou to the work that you do
today, and maybe how?
Dr. Marianne Miller (03:04):
that's led you to the work that you do
today.
Sure, I grew up in a family oforigin with a lot of diet
culture messages.
It was a very restrictivefamily that sent a lot of
restrictive messages about foodand it really prioritized
fitness, prioritized appearanceand really idealized the thin
(03:28):
body.
And I also grew up in an era,you know grew up in the late 70s
, 80s when people just didn'treally know about eating
disorders.
We knew a little bit aboutanorexia and bulimia, but it was
very, very little.
It was kind of seen as justextreme, outlier cases and
(03:51):
people didn't really know aboutit.
And so so any sort of dietingor obsession about food, eating
and body image was in, at leastin my family of origin, seen as
the norm.
And so I began dieting when Iwas in elementary school and
(04:16):
that was very much supported bymy family when I lost weight in
elementary school and that wasvery validated not only by my
family but by, like teachers and, you know, parents of other
kids that I knew and that kindof thing and so.
And then I got into like teenmagazines, because of course
(04:42):
back then we didn't have socialmedia, but it was all about like
the teen magazines.
Uh, cause, of course, back thenwe didn't have social media but
it was all about, like the teenmagazines, and so they really
promoted dieting and and being,you know, really um, lifted up
the thin white ideal and um, andthat was just really pressured
and emphasized.
(05:03):
And there was also, I think youknow, my parents also had like
really weird patterns aroundfood.
That was was like restrict,restrict, restrict.
And then with the occasionallike indulgence night and and
(05:25):
how that was seen as, that wasseen as like normal, of kind of
this all or nothing way to lookat food.
There was no gray, there was no, you know, a food abundance.
It was really about foodscarcity.
Now we didn't have foodinsecurity I did have, you know,
(05:48):
I grew up privileged enough tonot have to have food insecurity
and there was food scarcity inthat it was kind of an
ingredient only household, andso that was.
It was very, very difficult.
And then when I was in middleschool I developed like, looking
(06:10):
back, I developed anorexia andwhat would many would call
atypical anorexia.
And so because, like, on theoutside I wasn't severely
underweight and I did dropweight but I was restricting a
lot of calories and I basically,for two years was was
(06:37):
restricting calories to thepoint at which, like, my period
stopped and I thought that thatwas just normal.
Like nobody like not mypediatrician, definitely not my
parents Like nobody even reallythought that that was normal.
It's just like, oh yay, shelost weight, she's healthier
quote.
You know that thing.
And then it really wasn't untila couple of years ago.
(07:00):
When I look back okay, let melook at all the criteria boom,
boom, boom.
Okay, yeah, I had anorexia,right and yeah, and then in high
school, um, it was anorexicbehaviors, um, that, uh, when
that shifted, when I got mydriver's license, because then
(07:23):
then I had access to food, andso then it turned into, I would
say, like a binge eatingdisorder where I was binging and
restricting Because if there'sbinge eating, there's always
restricting going on with abinge eating disorder.
And then you know again, dietculture was incredibly prevalent
(07:45):
.
I'm neurodivergent and so myparticular flavor of
neurodiversity is sensoryprocessing sensitivity, and so
what that means is that if youlook at people as bugs and
(08:06):
everyone has, like theneurotypical people have two to
four antenna that they'regetting in information from the
world around them, and I havelike a hundred antenna.
So people with sensoryprocessing sensitivity, have
(08:26):
very heightened senses.
You know, you think, sights,hearing, smell, taste.
Naomi Katz (08:33):
I love this analogy of the bugs.
Dr. Marianne Miller (08:35):
Yeah, thank you.
Yeah, and so, and so I likefrom an early age I never really
felt like I fit in.
You know emotions my family isvery emotionally constipated, my
(08:55):
dad is British, my mom is fromthe South, um, uh, she's, and it
really kind of there was thismessage of like you put on you
know the stiff upper lip, likeeverything's fine, we don't talk
(09:16):
about our emotions.
Plus, we, we are really focusedon what other people think
about us and, um, especially asgirls, um and women, you have to
be quiet and silent, and thatpart of some um I was.
I grew up in a evangelicalChristian faith and our
particular religious group, um,was very sexist and misogynistic
(09:37):
and so it really, you know,silenced girls voices and you
know I never really felt like Iconnected well with, especially
in groups, because groups werejust really overwhelming for me.
And yet I was criticized byfamily members because like why
(09:58):
are you sitting at the back?
Like you need to be in thefront where the popular girls
are, and that kind of thing, andso I just never really felt
accepted for who I was and so Ikind of turned all of those
things inward, and dieting andchanging my body and focusing on
(10:18):
food was a way for me tosurvive that situation.
It was really a survival,survival mechanism, sure.
And so, whether it wasrestricting food or whether it
was, um using food to using foodto like, um, soothe myself
(10:39):
through binge eating, um, when II did have money, like
allowance and stuff, I would, Iwould spend it.
I would go down to Kmart andget snacks, and snacks the type
of snacks that weren't allowedin my household, and so I'd have
to hide them.
And then, if I had them, I hadto eat them quickly because I
(11:01):
was afraid that my parents wouldfind them.
So, just a really like warped,like very like psychologically
dysfunctional relationship withfood, coupled with being
neurodivergent, progressive, Iwould say it's very misogynistic
(11:25):
and it's ableist.
In diet culture.
It is misogynistic, it'sableist, it's a lot of ists
(11:50):
racist, I mean, it's just.
I think it was definitely aperfect storm.
Plus, biologically, I had thepredisposition to develop an
eating disorder.
Um, because they run rampant infamily, extended family, those
kinds of.
So so what I really struggledwith, I think, was just like
(12:11):
feeling like I was okay, sure.
Because, I like from a young ageI just felt like something was
really inherently wrong orbroken in myself and I think a
lot of that was was because of,like, maybe some attachment,
insecure attachment issuesgrowing up, but a lot of it was
(12:34):
just being neurodivergent in away that people like had no idea
, like people knew nothing, youknow.
Naomi Katz (12:41):
Yeah, that's definitely something we haven't
really.
I mean, I feel like we're stillonly scraping the surface of it
.
Dr. Marianne Miller (12:48):
Oh, barely, yeah, barely, and I was very,
you know, I think also there'ssome other like traits that I
have of some other flavors ofneurodiversity, but sensory
processing sensitivity isdefinitely the one that I
(13:11):
identify with heartily.
Sadie Simpson (13:14):
So, yeah.
Dr. Marianne Miller (13:18):
So, and because I'm such a deep feeler
and thinkers things going on theoutside, you know I would
internalize it, and so dietculture definitely became part
of my internal you know makeupand internal life.
(13:38):
And it really wasn't until Igot the right help for my eating
disorder recovery in my 30s I'm51.
And it wasn't until that when Istarted like reading it was
very, it was a really, really um, it was very helpful for me to
(14:16):
just hear from other people, uh,that took a stance that was
different from anti-fat bias andweight discrimination and fat
phobic, and so that wasincredibly helpful for me.
And then eventually that becamemore mainstream.
(14:37):
Not no, it's still notmainstream.
I mean to be very clear it'sstill not mainstream, but more
there's more awareness.
When social media startedcoming out and then people began
talking about it, you know,like Gen Z, right now they know
what fat phobia is Right andlike, so, so that that is very
(15:01):
helpful.
Naomi Katz (15:02):
So that is very helpful, so definitely for sure.
So you know it kind of itsounds like you know we talk
about eating disorders as like abiopsychosocial issue and like
it sounds like your story, likeyou can really hear how all of
those elements really cametogether to create this kind of
perfect storm for you.
And it's just, I think.
(15:25):
I think that's something thatpeople that's really important
for people to understand abouteating disorders is that like
it's not just the diet culture,like it's not just the genetic
predisposition, it's not justanything, it's like this
combination of factors that cometogether like that.
And yeah, it's just like and wecan really hear that in your
(15:48):
story.
Dr. Marianne Miller (15:50):
Yeah, yeah.
And I would add it'sbiopsychosocial, spiritual,
because there was a lot of likespiritual, religious repression
and oppression and I had a veryrich spiritual inner life.
That was not.
(16:10):
That was very, very repressedbecause of the type of doctrine
I was being taught and so and so.
And it doesn't matter howpeople define spirituality, even
if it's just like a connectionwith the world around you or
(16:30):
with the universe or nature orwhatever, or a God or, you know,
higher power, whatever you wantto call it, I do think that
there's like a spiritual elementto it.
And then the other thing I wasgoing to mention in response to
your statement is that I, um,yes, you know, diet culture
(16:54):
involves a lot of differentthings, and to grow up and
develop an eating disorder, it'sa multifaceted, very complex
thing, and that's why it's soimportant to find treatments by
people who are reallyexperienced and trained in
eating disorders, not just fromtherapists who like, oh, you
(17:17):
know, I have a few clients witheating disorders, Like I I'm an
eating disorder therapist and98% of my clients have eating
disorders Like that's what I doand so cause I had to get a ton
of specialized training,specialized supervision, is it's
not taught in graduate school,and so so it, because it's a
(17:40):
very complex issue.
That said, the way that I see itis, people are born with a
biological predisposition andthen environmental factors, and
that includes diet.
Culture really flips the switch, you know, and sometimes it can
be trauma.
Sometimes it can be, you know,you know very different,
(18:01):
different kinds of trauma.
Trauma whether it's like a oneevent or a chronic trauma.
It could be diet culture, itcould be family of origin issues
or being neurodivergent in aneurotypical world.
It's like, you know, all ofthose things combined, yeah
absolutely so.
Naomi Katz (18:20):
I want to get more into kind of how neurodivergence
intersects with eatingdisorders and how it reflects
some of these things that we'retalking about.
But before we do that, justkind of as background, how would
you define neurodivergence andlike what kind of things would
you say fall under that umbrellaterm?
Dr. Marianne Miller (18:42):
Okay, so initially in 1998, an Australian
woman and her name escapes meright now started the term
neurodivergent or neurodiversityum to apply only to people on
the autism spectrum, becausethey really wanted to um, kind
(19:06):
of the movement that that cameout of really wanted to
de-pathologize um autism and andso it's moving from saying,
okay, people on the autismspectrum they're not bad,
they're not, they don't have,it's not a moral failing, it's
not anything, they just havedifferent brains that just work
(19:27):
differently.
So the neurodivergent versusneurotypical.
So I would say what's happenedrecently, especially in the last
five years, neurodiversity hasthe umbrella has broadened to
include other types of differentkinds of brains, including
(19:52):
sensory processing sensitivity,like me, which is also known as
the highly sensitive person, andthat term was coined in the
nineties.
It includes and these things canoverlap Like a lot of people on
the spectrum have sensoryissues, and then they there are.
(20:17):
It also can include people withADHD.
I think after being on thespectrum that was like the next
thing they added was ADHD andthen and then they started
thinking about other things likeOCD, and some people even
include, like people who havegeneralized anxiety disorder or
(20:40):
major depressive disorder, andthe way it's involved, evolved
now is that people are justsaying you can define it.
You know, if you feel like yourbrain works differently, you
know and you don't want to likeuse any sort of label or
category and this, beingneurodivergent, seems to fit for
(21:03):
you, then you can claim that asyour own and it's really not up
to anyone else to define thatfor you.
It's you to define that.
It's your.
You know your privilege, Iguess, or your your choice to
define it for yourself.
Naomi Katz (21:23):
I really love that, because we know there's often a
ton of obstacles to likeactually getting a diagnosis of
any of these things likeobviously the cost, the access,
any of these things likeobviously the cost, the access,
all of that stuff.
Um, and then not to mention thefact that, like gender impacts
the way people are diagnosed,like so many women are diagnosed
(21:45):
much later in life, if they'rediagnosed at all, because most
of the studies and thediagnostic criteria are based on
men, and like all of this stuff.
Yeah right.
Exactly White boys white boys inparticular.
Yes, and so you know it's likebeing able to go off your own
(22:07):
lived experience andunderstanding of your own brain.
I think is really important forthese conversations.
I mean, it's similar to likegetting an eating disorder
diagnosis is really difficultfor a lot of people, and so,
like you can, like you mighthave a valid eating disorder
story even if you've nevergotten an actual diagnosis for
(22:30):
it, and these are things thatare really important for us to
start to recognize in this field, and so hearing you define
neurodivergence that way, likeit makes a lot of sense and it
(22:51):
really focuses on neurodiversityin women.
Dr. Marianne Miller (22:58):
And I forgot the author.
Maybe you could look it up andput it in the show notes or
something like that.
But it's written by ajournalist who realized that she
had a lot of flavors ofneurodiversity and so she kind
of explains her journey and thenshe defines, like, all the
(23:19):
different types, and it's it's,it's especially good for adult
women to read that and it's very, very validating.
Naomi Katz (23:26):
Yeah, yeah, absolutely so.
One of the things that youmentioned was that, you know,
sort of an eating disorder canfunction as almost like a
protection or coping mechanismas, like you know, possibly be
due to trying to function with aneurodivergent brain in a
(23:48):
neurotypical world, and so maybecan you expand a little bit on
that.
Like, does that makeneurodivergent folks more
susceptible to things likeeating disorders?
How does it change theirexperience with eating disorders
?
Dr. Marianne Miller (24:23):
I'm creating this ARFID course, an
self-paced online course thatI'm going to launch sometime,
probably mid to late July, and Iwas doing some research on it
or for it prior to thisrecording.
And one thing that someresearchers are just beginning
(24:55):
to look at barely is, you know,the co-occurrence of autism
spectrum disorders and ARFID,which is avoidant, restrictive
food intake disorder, and so youknow that again, barely, and
that's not including you knowthey're not looking at ADHD,
they're not looking at SPS,they're not looking at those
kinds of things.
And so I mean it's difficult assomeone who was a former
researcher because I was aprofessor for so many years and
(25:20):
for my dissertation it would bevery difficult to use the
overarching variable ofneurodiversity You'd have to
really focus on, really have tofocus on one of those like
(25:41):
diagnosis things, and I thinkthere is a way for you to do
some type of qualitativeresearch where people are
self-identified asneurodivergent, and so it's kind
of a different way ofinterpreting the data that it
would be difficult to look atany sort of correlations between
(26:05):
neurodiversity and eatingdisorders.
That said, there is someresearch on ADHD and eating
disorders that among people whohave ADHD there's a higher
prevalence of eating disorders,which kind of makes sense given
(26:28):
the impulsivity factors of ADHDand I would say the rejection
sensitive dysphoria that's alsocomes as a result of ADHD.
I have not seen any research onsensory processing sensitivity,
which it is a veryunder-researched area anyway.
(26:51):
It's mostly like autism andADHD, that's it so well, and OCD
and major depression anxiety,but they don't really
researchers really don'tconsider that as part of
neurodiversity.
Right now, again, this is allemerging, everything is changing
.
(27:11):
We're in a very fluid time whereour understandings of it is
emerging and I think that'simportant to take that into
consideration.
I do think that someday downyears it'll probably be at least
a decade or two that there willbe um, more research on
(27:34):
different neurotypes and um andthe prevalence of different
eating disorders and variousneurotypes and so um, and it'll
be interesting to see howneurotypes are mapped out and
and what that ends up being um.
My worry with that is that thatmight turn out to be
(27:58):
exclusionary, because that's thething is, anytime you reduce
things down to a measurablevariable that you can research,
you're you're being exclusionary.
So anytime you say you have tomeet all these criteria for a
particular, you know diagnosis,you're being exclusionary.
So that's why it's important toboth have quantitative research
(28:19):
where you're looking at likepercentages and numbers and
statistics, and qualitativeresearch where you're looking at
the lived experience.
And that's where I think thefield of neurodiversity and
intersecting eating disorders Ithink can benefit is just really
to lean into what do we knowabout lived experience?
(28:42):
And let's talk about that andgather our data that way for
qualitatively versusquantitatively, yeah, or in
addition to quantitatively, Iwould say.
Naomi Katz (28:56):
Sure, Like, let's look at the whole picture.
Let's look at the whole picture.
Yeah, yeah, that absolutelymakes sense.
So once you know, okay, soyou're, you're, you are a
neurodivergent person.
You have, you've gotten adiagnosis of an eating disorder
perhaps, or you're experiencingan eating disorder.
How does the experience ofbeing neurodivergent impact
(29:22):
recovery?
You know the way we interactwith different treatment methods
and things like that.
Like, does does the experienceof the eating disorder, does the
experience of recovery lookdifferent for somebody who's
neurodivergent?
Dr. Marianne Miller (29:37):
Yes, and unfortunately the vast majority
of treatment protocols don'ttake that into consideration.
Don't take that intoconsideration.
So, for example, likestraightforward cognitive
(29:57):
behavioral therapy that is used,that's kind of the tried and
true eating disorder recoveryapproach.
It's CBTE, that's what it'scalled, and not all of the
things that you do in CBT-Ewould work for people who are
neurodivergent.
It certainly did not work withme, you know, and thankfully I
(30:21):
had a therapist who did some CBTstuff but she did not like go
all in CBT because my brain justwould have been like nope and
it would have been too painful.
So she, she leaned heavily intolike object relations theory
and family systems theory, inaddition to some CBT and then
(30:45):
acceptance, commitment therapy,that kind of thing.
So that combination worked verywell with me and I think it's
very important that to tailor,tailor treatment to individuals
particular needs.
And unfortunately, becausethere's this very homogenized
approach to eating disordertreatment, partially because
(31:10):
you've got like University ofCalifornia, san Diego, that has,
you know, a very like worldrenowned eating disorder
treatment center.
Stanford does as well.
There's some on the East Coastbased in universities.
I think Duke has one andanother one on the East Coast
(31:32):
and in order to test, quotethese methods.
You have to have a very scripted, you know, homogenized way of
doing things and in order tomeasure whether it's effective,
(31:52):
and I get it and it's nothelpful for people who are
neurodivergent, and so so theymight get some benefit from it,
but not in a way that reallytailors to their unique needs.
And actually what I found issometimes they can be
pathologized and seen astreatment resistant, and that's
(32:17):
just really brutal.
And and then for me, you know,I I never went into a treatment
program, but oh my gosh, if Iwould have have, that would have
been so awful for me.
Um, I mean, I really needed toget to a place where I was just
seeing one therapist.
I did find a group that I wentfor a while, but then after a
(32:40):
while, like it was, it got to betoo much and too
overstimulating for me and and Ihad to just like do my my own
work by my own research, inaddition to individual therapy.
Naomi Katz (32:56):
Yeah, you know I don't.
I don't work with people witheating disorders, but I
certainly work with folks whoare dealing with a recovery from
, like, disordered eatingpatterns, and a number of my
clients are neurodivergent and Ihave seen so many times things
that come up with like sensoryoverwhelm and like either with
(33:21):
foods that they're trying tointroduce or like, or just the
process itself or, like I know,sometimes even like the feeling,
like feeling hunger andfullness cues can like add to
sensory overwhelm and likethere's just a lot of stuff that
like I feel like would bereally important to address in
(33:44):
eating disorder treatment andrecovery, but in a standardized
treatment setting isn't reallygoing to be addressed.
And then it's so easy for peoplewho are struggling with that to
look like they're non-compliant, which is like a beyond
horrible thing to say about apatient in any context.
(34:04):
But like, especially what'swhat's really hard is within
eating disorder treatment, likeespecially residential programs
will kick people out if they, ifthey think that they're being
non-compliant and so it likeliterally prevents you from
getting the treatment that youneed because you can't, because
(34:25):
the treatment's not made for youbecause you can't, because the
treatment's not made for you,correct.
Dr. Marianne Miller (34:36):
And I to add to that, a lot of that is
driven by insurance and whetheran insurance will pay and how
much.
You know, compliance is neededand recovery is needed to be
seen in order for the insurancecompany to keep paying for it.
And so it all boils down tonumbers and measurements.
That doesn't fit, you know,numbers don't fit folks who are
(34:59):
neurodivergent.
And so I mean it's toughbecause there's a lot of people
who need a higher level of care.
Because there's a lot of peoplewho need a higher level of care
, and sometimes I think it itcan be detrimental, you know,
for people who areneurodivergent.
I mean sometimes it's better toget an outpatient team set up
with a therapist and a dietitianand a medical provider, but
(35:23):
only if the person is medicallystable.
You know enough to have that.
But if they're not medicallystable enough, you kind of just
have to grit your teeth andrefer them to, you know, the
higher level of care or thehospital or whatever.
It's just it's just reallyunfortunate that it's that way.
(35:45):
I think educating theindividual, if it's an adult, or
the families, if it's a minor,I think is really important.
Just saying this is not goingto solve the address the entire
puzzle and just be aware thatyour kid is neuro, neuro spicy
(36:05):
and and so the neuro spicy pieceis something that you'll have
to manage on on your end andjust know.
You know I think it's importantfor when you are ready for
outpatient work that you workwith a neurodivergent affirming
(36:26):
you know therapist, or even atherapist who is neurodivergent
themselves, that really get thatpiece.
Naomi Katz (36:34):
Yeah, who are able to like understand what they're
looking at and like like, notjust assume that you're not
following the rules or you'rebeing difficult and, like you
know, I think there's a lot ofwhen it comes to neurodivergence
, trying to fit a like square, around peg, in a square hole or
(36:56):
vice versa, and it's it's likewhy won't you do the thing?
And it's like you literallycan't do the thing.
And so, seeing a provider who'sable to be like okay, how can
we change the thing?
Like how can we, how can wehave the thing, meet you instead
of trying to force you into thething.
Dr. Marianne Miller (37:18):
Exactly, and I think one great workbook
is the the neurodivergentfriendly DBT skills workbook
friendly dbt skills workbook um,so it's a dialectical behavior
therapy workbook and um, a lotof people with lived experience
who are neurodivergent find ummany of the dialectical behavior
(37:39):
therapy skills to be not um ashelpful or just it, just a pure
dT just doesn't work for peopleLike if I have someone who
really needs DBT and they haveADHD, that's totally not going
to work.
Because with purest DBT youhave to like fill out all these
(38:01):
cards and you know, and do theskills and do the chart, you
know all that kind of stuff, andyou have someone whose brain is
like ping ponging everywhere.
That's just not going to work.
So and and even if I have theworkbook, like and I say, oh, do
this, you know, do two pages ofthe workbook in the next week,
(38:21):
yeah, that's not going to happen.
So what do I do?
I go through the workbook withthem in session and then we talk
about it and just take a littlebit at a time.
And that workbook is excellent.
If you could put that in theshow notes as well.
It's by Sunny.
Oh, I always forget their name.
That person is neurodivergentas well.
It's not specific to eatingdisorders and I use it with
(38:44):
people with who areneurodivergent and have eating
disorders, because it helpsoffset any kind of like
incongruence that might come upwhen just using purist DBT
skills or CBT skills.
Naomi Katz (39:04):
We will definitely put that in the show notes and I
am also going to make myself anote to go get that book.
Dr. Marianne Miller (39:11):
It is amazing it's on Amazon.
It is so good.
Naomi Katz (39:16):
Fantastic, yeah.
So in general, what do youthink that folks should look for
in a treatment provider or atreatment plan when they are
approaching eating disorderrecovery with neurodivergence?
Is there anything they shouldwatch out for, anything that
they should look forspecifically?
Dr. Marianne Miller (39:38):
Well, I would ask them what their
experience is like with eatingdisorders and I and how much
work they've done with eatingdisorders.
And I wouldn't take anythingless than five years with eating
disorders because of just thecomplexity and I get it.
(40:01):
You know, people who are juststarting out are probably like,
ah Marianne, why are you sayingthat?
And I'm like like I get it.
I started out too and I wasgoing through supervision on my
own.
I had been a therapist for likemany, many years prior to that
and then I was getting anadditional supervision and
(40:21):
training so I already had likethe therapeutic foundation and
then I was being supervised so Icould talk about the cases as I
was starting out my eatingdisorder practice, um, which
began 12 years ago, so, um, so Iwould say at least five years
and then at least 70% of theirum caseload to be eating
(40:44):
disorders.
You just need someone thatthat's their lens and then ask
whether they're neurodivergent,friendly, um, you know how, how
many of their clients like whatis a rough percentage of their
clients that are neurodivergent?
I would say for me it'sprobably like 70 percent.
Naomi Katz (41:09):
uh are neurodivergent of my clients 65
to 70, and then um, and thenlike 98 well, those are really
great tips for like questions toask as people are trying to
find treatment, because I thinksometimes it's so hard to know
like what questions to ask.
(41:29):
Because you can say like oh,are you neurodivergent friendly?
And people can say yes, becausein their minds they don't like
discriminate or they don't youknow, but like no, like I need
to know that you haveexperienced like not just that
you're like fine withneurodivergent people, but like
that you actually know how towork with neurodivergent people.
Dr. Marianne Miller (41:50):
Yeah, and I would say to add to that,
having I would.
I would just say, hey, how,what kind of?
In what ways do you modify your, your approach to therapy with
(42:11):
people who are neurodivergent,Like, and if they can't answer
that question, that's a big,that's like a red flag.
Naomi Katz (42:18):
Yeah, that is a.
That's a great question also.
Dr. Marianne Miller (42:22):
So, speaking of finding providers,
Speaking of finding providers,how do people find you and work
with you?
So they can go to my website atdrmarianemillercom, and my name
is spelled the French way,which is M-A-R-I-A-N-N-E, so
(42:43):
drmarianemillercom.
They can also follow me onInstagram, which is at Dr
Marianne Miller, and I have apodcast which is Dr Marianne
land and eating disorderrecovery podcast.
That's, we talk about allthings neurodiversity and eating
(43:06):
disorders and all of the things.
So you know, it can be a veryhelpful resource for people who
are struggling with eatingdisorders and who may identify
as being neurodivergent.
Naomi Katz (43:19):
That's fantastic, and we will absolutely put links
to all of those things in ourshow notes as well, so people
can find you.
So, before we wrap up, wealways ask one final question of
all of our guests, and that iswhat is satisfying for you right
now.
Dr. Marianne Miller (43:34):
Satisfying.
Okay, I have two answers.
The first thing that came upwas I make my own trail mix and
I'm going to eat some rightafter I'm looking at it right
now.
And then also one of my speciallike I said, actually my main
(43:59):
special interest is Star Wars,and there's a new Star Wars show
that's on right now called theAcolyte, so that is incredibly
satisfying to watch a new StarWars content.
That is awesome, I.
So that is incrediblysatisfying to watch new star
wars content that is awesome.
Naomi Katz (44:12):
I love that.
I have to ask a follow-upquestion what is in your trail
mix?
Dr. Marianne Miller (44:16):
oh, okay, uh, uh, almonds um pumpkin seeds
, walnuts, raisins and m?
Oh.
Sadie Simpson (44:28):
I was waiting for what like chocolatey type thing
.
Naomi Katz (44:33):
That does sound like a truly satisfying trail mix.
Well, marianne, thank you so somuch for talking this through
with us today and giving us justso much good information.
Again, I know our listeners aregoing to benefit from this so
much.
I benefited from this a ton I'msure Sadie did too.
So thank you so much for yourtime and for being here with us
(44:56):
today.
We really appreciate you.
Dr. Marianne Miller (44:59):
I'm honored to have been a guest.
Sadie Simpson (45:01):
A big thank you again to Marianne for coming to
talk to us and if you enjoyedthis episode, consider leaving
us a rating or review in ApplePodcasts or Spotify.
Those ratings and reviews helpus reach more people, which
means more people get to hearthe anti-diet message, and you
can always find us on Instagramat satisfactionfactorpod.
That's it for us this week.
We'll see you next time.
(45:22):
Bye.
Welcome to Satisfaction Factor, the podcast
where we explore how ditchingdiet culture makes our whole
lives more satisfying.
Welcome back to SatisfactionFactor.
I'm Naomi Katz, an intuitiveeating and body image coach.
Sadie Simpson (00:25):
I'm Sadie Simpson , a group fitness instructor and
personal trainer.
Naomi Katz (00:29):
So we've got a great guest this week that we think
you're really going to love.
But before we dive in, just aquick reminder about the
Satisfaction Space, our onlinepodcast community.
We know it can be hard to findanti-diet community that's
aligned with your values,especially if you're the first
in your family or friend groupto make moves towards ditching
(00:50):
diet culture, and that's why wecreated the Satisfaction Space.
If you've ever found yourselflistening to the podcast and
wanting to add something to theconversation or ask a question,
this space was created for you.
The Satisfaction Space is ouronline membership community that
includes a private virtualcommunity of folks outside of
Facebook, bonus content duringthe podcast, off weeks, monthly
(01:11):
live virtual hangouts with usand a community feed where you
can post your comments orquestions and get feedback from
us as well as from your fellowcommunity members.
Membership to the SatisfactionSpace is just $10 a month and
can be canceled at any time, andyou can enroll at
thesatisfactionspacemnco, andthat link always lives in our
(01:32):
show notes.
Sadie Simpson (01:34):
We also have merch.
We have a handful of designs onTeePublic that can be printed
as stickers, t-shirts,sweatshirts, mugs, tote bags and
whatever else you like.
T-shirts and sweatshirts comein sizes up to 5X and you can
check that out at the link inour show notes.
Naomi Katz (01:49):
So today we are talking to Dr Marianne Miller
about the intersection ofneurodivergence and eating
disorders.
Dr Marianne has been in themental health field for 27 years
and has specialized in eatingdisorders for the last 12 years.
She was a full-time academicfor 12 years and had a part-time
eating disorder practice formuch of that time, until she
(02:11):
left the university and wentinto private practice full-time
in 2018.
Dr Marianne loves working witheating disorders as a therapist
and a coach.
She takes a non-diet, feministapproach that helps people of
all genders live empowered,authentic lives.
She embraces the health atevery size model and is
neurodivergent and LGBTQIA plusaffirming.
(02:34):
So, without further ado, let'stalk to Marianne.
Marianne welcome.
Thank you so much for beinghere with us today.
Thanks for having me.
We are very excited to talk toyou all about neurodivergence
and eating disorders.
We think that's a topic thatour listeners are really going
to be interested in and be ableto learn a lot from you about.
(02:56):
Can you tell us a little bitabout your experience with diet
culture and maybe how that's ledyou to the work that you do
today, and maybe how?
Dr. Marianne Miller (03:04):
that's led you to the work that you do
today.
Sure, I grew up in a family oforigin with a lot of diet
culture messages.
It was a very restrictivefamily that sent a lot of
restrictive messages about foodand it really prioritized
fitness, prioritized appearanceand really idealized the thin
(03:28):
body.
And I also grew up in an era,you know grew up in the late 70s
, 80s when people just didn'treally know about eating
disorders.
We knew a little bit aboutanorexia and bulimia, but it was
very, very little.
It was kind of seen as justextreme, outlier cases and
(03:51):
people didn't really know aboutit.
And so so any sort of dietingor obsession about food, eating
and body image was in, at leastin my family of origin, seen as
the norm.
And so I began dieting when Iwas in elementary school and
(04:16):
that was very much supported bymy family when I lost weight in
elementary school and that wasvery validated not only by my
family but by, like teachers and, you know, parents of other
kids that I knew and that kindof thing and so.
And then I got into like teenmagazines, because of course
(04:42):
back then we didn't have socialmedia, but it was all about like
the teen magazines.
Uh, cause, of course, back thenwe didn't have social media but
it was all about, like the teenmagazines, and so they really
promoted dieting and and being,you know, really um, lifted up
the thin white ideal and um, andthat was just really pressured
and emphasized.
(05:03):
And there was also, I think youknow, my parents also had like
really weird patterns aroundfood.
That was was like restrict,restrict, restrict.
And then with the occasionallike indulgence night and and
(05:25):
how that was seen as, that wasseen as like normal, of kind of
this all or nothing way to lookat food.
There was no gray, there was no, you know, a food abundance.
It was really about foodscarcity.
Now we didn't have foodinsecurity I did have, you know,
(05:48):
I grew up privileged enough tonot have to have food insecurity
and there was food scarcity inthat it was kind of an
ingredient only household, andso that was.
It was very, very difficult.
And then when I was in middleschool I developed like, looking
(06:10):
back, I developed anorexia andwhat would many would call
atypical anorexia.
And so because, like, on theoutside I wasn't severely
underweight and I did dropweight but I was restricting a
lot of calories and I basically,for two years was was
(06:37):
restricting calories to thepoint at which, like, my period
stopped and I thought that thatwas just normal.
Like nobody like not mypediatrician, definitely not my
parents Like nobody even reallythought that that was normal.
It's just like, oh yay, shelost weight, she's healthier
quote.
You know that thing.
And then it really wasn't untila couple of years ago.
(07:00):
When I look back okay, let melook at all the criteria boom,
boom, boom.
Okay, yeah, I had anorexia,right and yeah, and then in high
school, um, it was anorexicbehaviors, um, that, uh, when
that shifted, when I got mydriver's license, because then
(07:23):
then I had access to food, andso then it turned into, I would
say, like a binge eatingdisorder where I was binging and
restricting Because if there'sbinge eating, there's always
restricting going on with abinge eating disorder.
And then you know again, dietculture was incredibly prevalent
(07:45):
.
I'm neurodivergent and so myparticular flavor of
neurodiversity is sensoryprocessing sensitivity, and so
what that means is that if youlook at people as bugs and
(08:06):
everyone has, like theneurotypical people have two to
four antenna that they'regetting in information from the
world around them, and I havelike a hundred antenna.
So people with sensoryprocessing sensitivity, have
(08:26):
very heightened senses.
You know, you think, sights,hearing, smell, taste.
Naomi Katz (08:33):
I love this analogy of the bugs.
Dr. Marianne Miller (08:35):
Yeah, thank you.
Yeah, and so, and so I likefrom an early age I never really
felt like I fit in.
You know emotions my family isvery emotionally constipated, my
(08:55):
dad is British, my mom is fromthe South, um, uh, she's, and it
really kind of there was thismessage of like you put on you
know the stiff upper lip, likeeverything's fine, we don't talk
(09:16):
about our emotions.
Plus, we, we are really focusedon what other people think
about us and, um, especially asgirls, um and women, you have to
be quiet and silent, and thatpart of some um I was.
I grew up in a evangelicalChristian faith and our
particular religious group, um,was very sexist and misogynistic
(09:37):
and so it really, you know,silenced girls voices and you
know I never really felt like Iconnected well with, especially
in groups, because groups werejust really overwhelming for me.
And yet I was criticized byfamily members because like why
(09:58):
are you sitting at the back?
Like you need to be in thefront where the popular girls
are, and that kind of thing, andso I just never really felt
accepted for who I was and so Ikind of turned all of those
things inward, and dieting andchanging my body and focusing on
(10:18):
food was a way for me tosurvive that situation.
It was really a survival,survival mechanism, sure.
And so, whether it wasrestricting food or whether it
was, um using food to using foodto like, um, soothe myself
(10:39):
through binge eating, um, when II did have money, like
allowance and stuff, I would, Iwould spend it.
I would go down to Kmart andget snacks, and snacks the type
of snacks that weren't allowedin my household, and so I'd have
to hide them.
And then, if I had them, I hadto eat them quickly because I
(11:01):
was afraid that my parents wouldfind them.
So, just a really like warped,like very like psychologically
dysfunctional relationship withfood, coupled with being
neurodivergent, progressive, Iwould say it's very misogynistic
(11:25):
and it's ableist.
In diet culture.
It is misogynistic, it'sableist, it's a lot of ists
(11:50):
racist, I mean, it's just.
I think it was definitely aperfect storm.
Plus, biologically, I had thepredisposition to develop an
eating disorder.
Um, because they run rampant infamily, extended family, those
kinds of.
So so what I really struggledwith, I think, was just like
(12:11):
feeling like I was okay, sure.
Because, I like from a young ageI just felt like something was
really inherently wrong orbroken in myself and I think a
lot of that was was because of,like, maybe some attachment,
insecure attachment issuesgrowing up, but a lot of it was
(12:34):
just being neurodivergent in away that people like had no idea
, like people knew nothing, youknow.
Naomi Katz (12:41):
Yeah, that's definitely something we haven't
really.
I mean, I feel like we're stillonly scraping the surface of it
.
Dr. Marianne Miller (12:48):
Oh, barely, yeah, barely, and I was very,
you know, I think also there'ssome other like traits that I
have of some other flavors ofneurodiversity, but sensory
processing sensitivity isdefinitely the one that I
(13:11):
identify with heartily.
Sadie Simpson (13:14):
So, yeah.
Dr. Marianne Miller (13:18):
So, and because I'm such a deep feeler
and thinkers things going on theoutside, you know I would
internalize it, and so dietculture definitely became part
of my internal you know makeupand internal life.
(13:38):
And it really wasn't until Igot the right help for my eating
disorder recovery in my 30s I'm51.
And it wasn't until that when Istarted like reading it was
very, it was a really, really um, it was very helpful for me to
(14:16):
just hear from other people, uh,that took a stance that was
different from anti-fat bias andweight discrimination and fat
phobic, and so that wasincredibly helpful for me.
And then eventually that becamemore mainstream.
(14:37):
Not no, it's still notmainstream.
I mean to be very clear it'sstill not mainstream, but more
there's more awareness.
When social media startedcoming out and then people began
talking about it, you know,like Gen Z, right now they know
what fat phobia is Right andlike, so, so that that is very
(15:01):
helpful.
Naomi Katz (15:02):
So that is very helpful, so definitely for sure.
So you know it kind of itsounds like you know we talk
about eating disorders as like abiopsychosocial issue and like
it sounds like your story, likeyou can really hear how all of
those elements really cametogether to create this kind of
perfect storm for you.
And it's just, I think.
(15:25):
I think that's something thatpeople that's really important
for people to understand abouteating disorders is that like
it's not just the diet culture,like it's not just the genetic
predisposition, it's not justanything, it's like this
combination of factors that cometogether like that.
And yeah, it's just like and wecan really hear that in your
(15:48):
story.
Dr. Marianne Miller (15:50):
Yeah, yeah.
And I would add it'sbiopsychosocial, spiritual,
because there was a lot of likespiritual, religious repression
and oppression and I had a veryrich spiritual inner life.
That was not.
(16:10):
That was very, very repressedbecause of the type of doctrine
I was being taught and so and so.
And it doesn't matter howpeople define spirituality, even
if it's just like a connectionwith the world around you or
(16:30):
with the universe or nature orwhatever, or a God or, you know,
higher power, whatever you wantto call it, I do think that
there's like a spiritual elementto it.
And then the other thing I wasgoing to mention in response to
your statement is that I, um,yes, you know, diet culture
(16:54):
involves a lot of differentthings, and to grow up and
develop an eating disorder, it'sa multifaceted, very complex
thing, and that's why it's soimportant to find treatments by
people who are reallyexperienced and trained in
eating disorders, not just fromtherapists who like, oh, you
(17:17):
know, I have a few clients witheating disorders, Like I I'm an
eating disorder therapist and98% of my clients have eating
disorders Like that's what I doand so cause I had to get a ton
of specialized training,specialized supervision, is it's
not taught in graduate school,and so so it, because it's a
(17:40):
very complex issue.
That said, the way that I see itis, people are born with a
biological predisposition andthen environmental factors, and
that includes diet.
Culture really flips the switch, you know, and sometimes it can
be trauma.
Sometimes it can be, you know,you know very different,
(18:01):
different kinds of trauma.
Trauma whether it's like a oneevent or a chronic trauma.
It could be diet culture, itcould be family of origin issues
or being neurodivergent in aneurotypical world.
It's like, you know, all ofthose things combined, yeah
absolutely so.
Naomi Katz (18:20):
I want to get more into kind of how neurodivergence
intersects with eatingdisorders and how it reflects
some of these things that we'retalking about.
But before we do that, justkind of as background, how would
you define neurodivergence andlike what kind of things would
you say fall under that umbrellaterm?
Dr. Marianne Miller (18:42):
Okay, so initially in 1998, an Australian
woman and her name escapes meright now started the term
neurodivergent or neurodiversityum to apply only to people on
the autism spectrum, becausethey really wanted to um, kind
(19:06):
of the movement that that cameout of really wanted to
de-pathologize um autism and andso it's moving from saying,
okay, people on the autismspectrum they're not bad,
they're not, they don't have,it's not a moral failing, it's
not anything, they just havedifferent brains that just work
(19:27):
differently.
So the neurodivergent versusneurotypical.
So I would say what's happenedrecently, especially in the last
five years, neurodiversity hasthe umbrella has broadened to
include other types of differentkinds of brains, including
(19:52):
sensory processing sensitivity,like me, which is also known as
the highly sensitive person, andthat term was coined in the
nineties.
It includes and these things canoverlap Like a lot of people on
the spectrum have sensoryissues, and then they there are.
(20:17):
It also can include people withADHD.
I think after being on thespectrum that was like the next
thing they added was ADHD andthen and then they started
thinking about other things likeOCD, and some people even
include, like people who havegeneralized anxiety disorder or
(20:40):
major depressive disorder, andthe way it's involved, evolved
now is that people are justsaying you can define it.
You know, if you feel like yourbrain works differently, you
know and you don't want to likeuse any sort of label or
category and this, beingneurodivergent, seems to fit for
(21:03):
you, then you can claim that asyour own and it's really not up
to anyone else to define thatfor you.
It's you to define that.
It's your.
You know your privilege, Iguess, or your your choice to
define it for yourself.
Naomi Katz (21:23):
I really love that, because we know there's often a
ton of obstacles to likeactually getting a diagnosis of
any of these things likeobviously the cost, the access,
any of these things likeobviously the cost, the access,
all of that stuff.
Um, and then not to mention thefact that, like gender impacts
the way people are diagnosed,like so many women are diagnosed
(21:45):
much later in life, if they'rediagnosed at all, because most
of the studies and thediagnostic criteria are based on
men, and like all of this stuff.
Yeah right.
Exactly White boys white boys inparticular.
Yes, and so you know it's likebeing able to go off your own
(22:07):
lived experience andunderstanding of your own brain.
I think is really important forthese conversations.
I mean, it's similar to likegetting an eating disorder
diagnosis is really difficultfor a lot of people, and so,
like you can, like you mighthave a valid eating disorder
story even if you've nevergotten an actual diagnosis for
(22:30):
it, and these are things thatare really important for us to
start to recognize in this field, and so hearing you define
neurodivergence that way, likeit makes a lot of sense and it
(22:51):
really focuses on neurodiversityin women.
Dr. Marianne Miller (22:58):
And I forgot the author.
Maybe you could look it up andput it in the show notes or
something like that.
But it's written by ajournalist who realized that she
had a lot of flavors ofneurodiversity and so she kind
of explains her journey and thenshe defines, like, all the
(23:19):
different types, and it's it's,it's especially good for adult
women to read that and it's very, very validating.
Naomi Katz (23:26):
Yeah, yeah, absolutely so.
One of the things that youmentioned was that, you know,
sort of an eating disorder canfunction as almost like a
protection or coping mechanismas, like you know, possibly be
due to trying to function with aneurodivergent brain in a
(23:48):
neurotypical world, and so maybecan you expand a little bit on
that.
Like, does that makeneurodivergent folks more
susceptible to things likeeating disorders?
How does it change theirexperience with eating disorders
?
Dr. Marianne Miller (24:23):
I'm creating this ARFID course, an
self-paced online course thatI'm going to launch sometime,
probably mid to late July, and Iwas doing some research on it
or for it prior to thisrecording.
And one thing that someresearchers are just beginning
(24:55):
to look at barely is, you know,the co-occurrence of autism
spectrum disorders and ARFID,which is avoidant, restrictive
food intake disorder, and so youknow that again, barely, and
that's not including you knowthey're not looking at ADHD,
they're not looking at SPS,they're not looking at those
kinds of things.
And so I mean it's difficult assomeone who was a former
researcher because I was aprofessor for so many years and
(25:20):
for my dissertation it would bevery difficult to use the
overarching variable ofneurodiversity You'd have to
really focus on, really have tofocus on one of those like
(25:41):
diagnosis things, and I thinkthere is a way for you to do
some type of qualitativeresearch where people are
self-identified asneurodivergent, and so it's kind
of a different way ofinterpreting the data that it
would be difficult to look atany sort of correlations between
(26:05):
neurodiversity and eatingdisorders.
That said, there is someresearch on ADHD and eating
disorders that among people whohave ADHD there's a higher
prevalence of eating disorders,which kind of makes sense given
(26:28):
the impulsivity factors of ADHDand I would say the rejection
sensitive dysphoria that's alsocomes as a result of ADHD.
I have not seen any research onsensory processing sensitivity,
which it is a veryunder-researched area anyway.
(26:51):
It's mostly like autism andADHD, that's it so well, and OCD
and major depression anxiety,but they don't really
researchers really don'tconsider that as part of
neurodiversity.
Right now, again, this is allemerging, everything is changing
.
(27:11):
We're in a very fluid time whereour understandings of it is
emerging and I think that'simportant to take that into
consideration.
I do think that someday downyears it'll probably be at least
a decade or two that there willbe um, more research on
(27:34):
different neurotypes and um andthe prevalence of different
eating disorders and variousneurotypes and so um, and it'll
be interesting to see howneurotypes are mapped out and
and what that ends up being um.
My worry with that is that thatmight turn out to be
(27:58):
exclusionary, because that's thething is, anytime you reduce
things down to a measurablevariable that you can research,
you're you're being exclusionary.
So anytime you say you have tomeet all these criteria for a
particular, you know diagnosis,you're being exclusionary.
So that's why it's important toboth have quantitative research
(28:19):
where you're looking at likepercentages and numbers and
statistics, and qualitativeresearch where you're looking at
the lived experience.
And that's where I think thefield of neurodiversity and
intersecting eating disorders Ithink can benefit is just really
to lean into what do we knowabout lived experience?
(28:42):
And let's talk about that andgather our data that way for
qualitatively versusquantitatively, yeah, or in
addition to quantitatively, Iwould say.
Naomi Katz (28:56):
Sure, Like, let's look at the whole picture.
Let's look at the whole picture.
Yeah, yeah, that absolutelymakes sense.
So once you know, okay, soyou're, you're, you are a
neurodivergent person.
You have, you've gotten adiagnosis of an eating disorder
perhaps, or you're experiencingan eating disorder.
How does the experience ofbeing neurodivergent impact
(29:22):
recovery?
You know the way we interactwith different treatment methods
and things like that.
Like, does does the experienceof the eating disorder, does the
experience of recovery lookdifferent for somebody who's
neurodivergent?
Dr. Marianne Miller (29:37):
Yes, and unfortunately the vast majority
of treatment protocols don'ttake that into consideration.
Don't take that intoconsideration.
So, for example, likestraightforward cognitive
(29:57):
behavioral therapy that is used,that's kind of the tried and
true eating disorder recoveryapproach.
It's CBTE, that's what it'scalled, and not all of the
things that you do in CBT-Ewould work for people who are
neurodivergent.
It certainly did not work withme, you know, and thankfully I
(30:21):
had a therapist who did some CBTstuff but she did not like go
all in CBT because my brain justwould have been like nope and
it would have been too painful.
So she, she leaned heavily intolike object relations theory
and family systems theory, inaddition to some CBT and then
(30:45):
acceptance, commitment therapy,that kind of thing.
So that combination worked verywell with me and I think it's
very important that to tailor,tailor treatment to individuals
particular needs.
And unfortunately, becausethere's this very homogenized
approach to eating disordertreatment, partially because
(31:10):
you've got like University ofCalifornia, san Diego, that has,
you know, a very like worldrenowned eating disorder
treatment center.
Stanford does as well.
There's some on the East Coastbased in universities.
I think Duke has one andanother one on the East Coast
(31:32):
and in order to test, quotethese methods.
You have to have a very scripted, you know, homogenized way of
doing things and in order tomeasure whether it's effective,
(31:52):
and I get it and it's nothelpful for people who are
neurodivergent, and so so theymight get some benefit from it,
but not in a way that reallytailors to their unique needs.
And actually what I found issometimes they can be
pathologized and seen astreatment resistant, and that's
(32:17):
just really brutal.
And and then for me, you know,I I never went into a treatment
program, but oh my gosh, if Iwould have have, that would have
been so awful for me.
Um, I mean, I really needed toget to a place where I was just
seeing one therapist.
I did find a group that I wentfor a while, but then after a
(32:40):
while, like it was, it got to betoo much and too
overstimulating for me and and Ihad to just like do my my own
work by my own research, inaddition to individual therapy.
Naomi Katz (32:56):
Yeah, you know I don't.
I don't work with people witheating disorders, but I
certainly work with folks whoare dealing with a recovery from
, like, disordered eatingpatterns, and a number of my
clients are neurodivergent and Ihave seen so many times things
that come up with like sensoryoverwhelm and like either with
(33:21):
foods that they're trying tointroduce or like, or just the
process itself or, like I know,sometimes even like the feeling,
like feeling hunger andfullness cues can like add to
sensory overwhelm and likethere's just a lot of stuff that
like I feel like would bereally important to address in
(33:44):
eating disorder treatment andrecovery, but in a standardized
treatment setting isn't reallygoing to be addressed.
And then it's so easy for peoplewho are struggling with that to
look like they're non-compliant, which is like a beyond
horrible thing to say about apatient in any context.
(34:04):
But like, especially what'swhat's really hard is within
eating disorder treatment, likeespecially residential programs
will kick people out if they, ifthey think that they're being
non-compliant and so it likeliterally prevents you from
getting the treatment that youneed because you can't, because
(34:25):
the treatment's not made for youbecause you can't, because the
treatment's not made for you,correct.
Dr. Marianne Miller (34:36):
And I to add to that, a lot of that is
driven by insurance and whetheran insurance will pay and how
much.
You know, compliance is neededand recovery is needed to be
seen in order for the insurancecompany to keep paying for it.
And so it all boils down tonumbers and measurements.
That doesn't fit, you know,numbers don't fit folks who are
(34:59):
neurodivergent.
And so I mean it's toughbecause there's a lot of people
who need a higher level of care.
Because there's a lot of peoplewho need a higher level of care
, and sometimes I think it itcan be detrimental, you know,
for people who areneurodivergent.
I mean sometimes it's better toget an outpatient team set up
with a therapist and a dietitianand a medical provider, but
(35:23):
only if the person is medicallystable.
You know enough to have that.
But if they're not medicallystable enough, you kind of just
have to grit your teeth andrefer them to, you know, the
higher level of care or thehospital or whatever.
It's just it's just reallyunfortunate that it's that way.
(35:45):
I think educating theindividual, if it's an adult, or
the families, if it's a minor,I think is really important.
Just saying this is not goingto solve the address the entire
puzzle and just be aware thatyour kid is neuro, neuro spicy
(36:05):
and and so the neuro spicy pieceis something that you'll have
to manage on on your end andjust know.
You know I think it's importantfor when you are ready for
outpatient work that you workwith a neurodivergent affirming
(36:26):
you know therapist, or even atherapist who is neurodivergent
themselves, that really get thatpiece.
Naomi Katz (36:34):
Yeah, who are able to like understand what they're
looking at and like like, notjust assume that you're not
following the rules or you'rebeing difficult and, like you
know, I think there's a lot ofwhen it comes to neurodivergence
, trying to fit a like square, around peg, in a square hole or
(36:56):
vice versa, and it's it's likewhy won't you do the thing?
And it's like you literallycan't do the thing.
And so, seeing a provider who'sable to be like okay, how can
we change the thing?
Like how can we, how can wehave the thing, meet you instead
of trying to force you into thething.
Dr. Marianne Miller (37:18):
Exactly, and I think one great workbook
is the the neurodivergentfriendly DBT skills workbook
friendly dbt skills workbook um,so it's a dialectical behavior
therapy workbook and um, a lotof people with lived experience
who are neurodivergent find ummany of the dialectical behavior
(37:39):
therapy skills to be not um ashelpful or just it, just a pure
dT just doesn't work for peopleLike if I have someone who
really needs DBT and they haveADHD, that's totally not going
to work.
Because with purest DBT youhave to like fill out all these
(38:01):
cards and you know, and do theskills and do the chart, you
know all that kind of stuff, andyou have someone whose brain is
like ping ponging everywhere.
That's just not going to work.
So and and even if I have theworkbook, like and I say, oh, do
this, you know, do two pages ofthe workbook in the next week,
(38:21):
yeah, that's not going to happen.
So what do I do?
I go through the workbook withthem in session and then we talk
about it and just take a littlebit at a time.
And that workbook is excellent.
If you could put that in theshow notes as well.
It's by Sunny.
Oh, I always forget their name.
That person is neurodivergentas well.
It's not specific to eatingdisorders and I use it with
(38:44):
people with who areneurodivergent and have eating
disorders, because it helpsoffset any kind of like
incongruence that might come upwhen just using purist DBT
skills or CBT skills.
Naomi Katz (39:04):
We will definitely put that in the show notes and I
am also going to make myself anote to go get that book.
Dr. Marianne Miller (39:11):
It is amazing it's on Amazon.
It is so good.
Naomi Katz (39:16):
Fantastic, yeah.
So in general, what do youthink that folks should look for
in a treatment provider or atreatment plan when they are
approaching eating disorderrecovery with neurodivergence?
Is there anything they shouldwatch out for, anything that
they should look forspecifically?
Dr. Marianne Miller (39:38):
Well, I would ask them what their
experience is like with eatingdisorders and I and how much
work they've done with eatingdisorders.
And I wouldn't take anythingless than five years with eating
disorders because of just thecomplexity and I get it.
(40:01):
You know, people who are juststarting out are probably like,
ah Marianne, why are you sayingthat?
And I'm like like I get it.
I started out too and I wasgoing through supervision on my
own.
I had been a therapist for likemany, many years prior to that
and then I was getting anadditional supervision and
(40:21):
training so I already had likethe therapeutic foundation and
then I was being supervised so Icould talk about the cases as I
was starting out my eatingdisorder practice, um, which
began 12 years ago, so, um, so Iwould say at least five years
and then at least 70% of theirum caseload to be eating
(40:44):
disorders.
You just need someone thatthat's their lens and then ask
whether they're neurodivergent,friendly, um, you know how, how
many of their clients like whatis a rough percentage of their
clients that are neurodivergent?
I would say for me it'sprobably like 70 percent.
Naomi Katz (41:09):
uh are neurodivergent of my clients 65
to 70, and then um, and thenlike 98 well, those are really
great tips for like questions toask as people are trying to
find treatment, because I thinksometimes it's so hard to know
like what questions to ask.
(41:29):
Because you can say like oh,are you neurodivergent friendly?
And people can say yes, becausein their minds they don't like
discriminate or they don't youknow, but like no, like I need
to know that you haveexperienced like not just that
you're like fine withneurodivergent people, but like
that you actually know how towork with neurodivergent people.
Dr. Marianne Miller (41:50):
Yeah, and I would say to add to that,
having I would.
I would just say, hey, how,what kind of?
In what ways do you modify your, your approach to therapy with
(42:11):
people who are neurodivergent,Like, and if they can't answer
that question, that's a big,that's like a red flag.
Naomi Katz (42:18):
Yeah, that is a.
That's a great question also.
Dr. Marianne Miller (42:22):
So, speaking of finding providers,
Speaking of finding providers,how do people find you and work
with you?
So they can go to my website atdrmarianemillercom, and my name
is spelled the French way,which is M-A-R-I-A-N-N-E, so
(42:43):
drmarianemillercom.
They can also follow me onInstagram, which is at Dr
Marianne Miller, and I have apodcast which is Dr Marianne
land and eating disorderrecovery podcast.
That's, we talk about allthings neurodiversity and eating
(43:06):
disorders and all of the things.
So you know, it can be a veryhelpful resource for people who
are struggling with eatingdisorders and who may identify
as being neurodivergent.
Naomi Katz (43:19):
That's fantastic, and we will absolutely put links
to all of those things in ourshow notes as well, so people
can find you.
So, before we wrap up, wealways ask one final question of
all of our guests, and that iswhat is satisfying for you right
now.
Dr. Marianne Miller (43:34):
Satisfying.
Okay, I have two answers.
The first thing that came upwas I make my own trail mix and
I'm going to eat some rightafter I'm looking at it right
now.
And then also one of my speciallike I said, actually my main
(43:59):
special interest is Star Wars,and there's a new Star Wars show
that's on right now called theAcolyte, so that is incredibly
satisfying to watch a new StarWars content.
That is awesome, I.
So that is incrediblysatisfying to watch new star
wars content that is awesome.
Naomi Katz (44:12):
I love that.
I have to ask a follow-upquestion what is in your trail
mix?
Dr. Marianne Miller (44:16):
oh, okay, uh, uh, almonds um pumpkin seeds
, walnuts, raisins and m?
Oh.
Sadie Simpson (44:28):
I was waiting for what like chocolatey type thing
.
Naomi Katz (44:33):
That does sound like a truly satisfying trail mix.
Well, marianne, thank you so somuch for talking this through
with us today and giving us justso much good information.
Again, I know our listeners aregoing to benefit from this so
much.
I benefited from this a ton I'msure Sadie did too.
So thank you so much for yourtime and for being here with us
(44:56):
today.
We really appreciate you.
Dr. Marianne Miller (44:59):
I'm honored to have been a guest.
Sadie Simpson (45:01):
A big thank you again to Marianne for coming to
talk to us and if you enjoyedthis episode, consider leaving
us a rating or review in ApplePodcasts or Spotify.
Those ratings and reviews helpus reach more people, which
means more people get to hearthe anti-diet message, and you
can always find us on Instagramat satisfactionfactorpod.
That's it for us this week.
We'll see you next time.
(45:22):
Bye.
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