ARFID, PDA, & Autonomy: Why Pressure Makes Eating Harder

Why does pressuring someone to eat often make things worse, especially when they are neurodivergent? In this solo episode, Dr. Marianne Miller explores the intersection of ARFID (Avoidant/Restrictive Food Intake Disorder) and PDA, which can be understood as either Pathological Demand Avoidance or Pervasive Drive for Autonomy. She breaks down how demands around eating, even gentle ones, can increase distress and shut down the nervous system for people with this profile.

You will learn why pressure often intensifies food refusal and how honoring autonomy can become a foundation for safety, regulation, and healing. Dr. Marianne shares what helps instead, from sensory-attuned environments to co-regulation to collaborative care that supports autonomy instead of undermining it.

This episode is especially relevant for those searching for support with ARFID and PDA, whether you're navigating a Pervasive Drive for Autonomy or supporting someone with autism and food refusal challenges. Dr. Marianne discusses key elements of ARFID therapy in California, Texas, and Washington, D.C., with attention to neurodivergent-affirming approaches for sensory-based eating challenges. Topics include autonomy-centered care, the connection between PDA and eating avoidance, sensory accommodations, and how pressure around food can disrupt progress. This conversation is ideal for anyone exploring eating disorder support that moves beyond compliance and toward collaboration.

Whether you are someone navigating ARFID and PDA yourself, or a clinician or caregiver offering support, this episode will offer a compassionate, liberation-focused, neurodivergent-affirming lens on what really helps and why.

🧠 Topics Covered:

• What ARFID is and how it differs from body image-based eating disorders

• What PDA looks like and why many prefer the term Pervasive Drive for Autonomy

• Why pressure, even subtle, can shut down eating

• How the nervous system responds to loss of autonomy

• The difference between defiance and nervous system survival

• Why same foods, routines, and sensory predictability matter

• How to support eating through choice, collaboration, and autonomy

• Co-regulation and sensory accommodations as vital tools

• Why internal demands can feel just as overwhelming as external ones

• The power of trust, pacing, and honoring difference

🧭 Related Episodes on ARFID, PDA, & Autonomy:

• Adult ARFID Explained: Real-Life Strategies for Managing Food & Nutrition with Caroline Holbrook, RD on Apple & Spotify.
• Stuck on Empty: Autistic Inertia, ARFID & the Struggle to Eat on Apple & Spotify.
• PDA & Eating Disorders: Why the Pervasive Drive for Autonomy Matters in Recovery on Apple & Spotify.
• The Complexities of Treating ARFID: How a Neurodivergent-Affirming, Sensory-Attuned Approach Works on Apple & Spotify.

⚠️ Content Cautions:

This episode includes discussion of food refusal, eating challenges, shutdowns, and nervous system dysregulation. Please listen with care and take breaks if needed.

💻 Learn More & Get Support:

Want support that respects autonomy, sensory needs, and neurodivergence?
Dr. Marianne’s self-paced course on ARFID and Selective Eating is available for individuals, parents, and providers.
Explore it here: https://www.drmariannemiller.com/arfid

INTERESTED IN HANGING OUT MORE IN DR. MARIANNE-LAND?

• Follow me on Instagram @drmariannemiller
• Look into my self-paced, virtual, anti-diet, subscription-based curriculum. It is called Dr. Marianne-Land's Binge Eating Recovery Membership.
• Check out my blog.
• Want more information? Email me at hello@mariannemiller.com