February 27, 2024
Provided Images/Renfrew Center
The Renfrew Center in Philadelphia has been treating people with eating disorders since 1985. It started as a single inpatient facility and has expanded to treat people nationwide, including nonbinary and transgender patients.
One year ago, a complex web of stressors led Rei to attempt suicide.
"I've been on my path to recovery for about a year now," said Rei, who identifies as a-gender. "It's been a really hard year. It's been a journey."
Along the way, Rei, who wanted to use just their chosen name for privacy, learned that in addition to their struggles with chronic pain, depression and post-traumatic stress disorder, they also were battling an eating disorder – "which I didn't even know I had," Rei said.
Rei, 34, accessed treatment at The Renfrew Center, the first residential eating disorder facility in the country, which started in 1985 as a single inpatient treatment facility for adolescent girls and young women on its 27-acre campus in Northwest Philadelphia. Renfrew now offers inpatient, outpatient and virtual treatment for eating disorders nationwide, including services at facilities in Center City and Radnor, Delaware County. Renfrew has helped more than 100,000 cisgender girls and adult women, as well as transgender and nonbinary individuals.
Research shows that LGBT adults and adolescents experience a greater incidence of eating disorders than their cisgender counterparts. LGBTQ youth who have been diagnosed with an eating disorder at any point in their lives are nearly four times more likely to have attempted suicide in the past year than those who have never been diagnosed with an eating disorder.
People in LGBTQ+ communities also are at a higher risk of being exposed to hate crimes and being isolated than cisgender people, which can heighten anxiety and distress and aggravate struggles they may have with body image and food, said Kristin Szostak, regional assistant vice president at Renfrew.
Renfrew strives to be as "inclusive as possible with the priority to create a safe space that is compassionate and understanding," Szostak said. "While every team member may not have that lived experience, we still want to be able to provide that compassion, that connection and that sense of humanity. … Everyone can relate to an emotion while every team member may not have that lived experience."
Some patients use gender neutral pronouns and a chosen name in treatment, but use their given name and pronouns in family sessions, depending on the situation and where they are in their journeys, Szostak said. If people "don't feel safe and secure in the community they aren't going to be able to focus on the treatment."
The process of making changes so that people can live in their gender identity, or transitioning, "doesn't happen overnight. It's a gradual process, and not everyone is going to be supportive of that," Szostak said, highlighting a stressor transgender and nonbinary individuals – who each travel unique paths – may face that can cause or aggravate an eating disorder.
Some people with eating disorders, and some who identify as nonbinary, struggle with "...where do I fit," Szostak said. "I want to just be who I am, and I have so many external expectations being placed on me. How do I build my own internal knowledge to prevent these expectations being placed on me?"
Others may not have had access to gender-affirming medical care through hormone treatment or surgery and may have resorted to measures such as extreme exercise and restrictive food intake as a way to stay thin, Szostak said. They also may have abused protein and other supplements to build muscle mass.
Rei has struggled with avoidant restrictive food intake disorder – "it's like picky eating exponentially turned up" – and gone entire days without eating. They said this is partly due to a chronic pain condition that has spurred doctors repeatedly to urge them to lose weight.
"I just thought I wasn't worth food," Rei said. "It was very much, if I didn't accomplish something in a day, I wasn't worthy of eating."
In addition to helping Rei learn new coping skills, such as how to handle the anxiety of eating a wider variety of food, Renfrew offered a Sexuality and Gender Equality support group that was particularly helpful, Rei said. "I got to meet other a-gender individuals. I don't normally get to do that."
Rei said their inpatient and outpatient treatment at Renfrew was "transformative."
They are able to talk to their therapist about their eating disorder, which they weren't able to do before. They are able to be more open with their spouse about their feelings about food and meals. They are helping their parents gain a new perspective about them and their eating patterns, Rei said.
"It's not worth it to hold onto your disordered eating for an image or expectations, because your body needs nutrients," Rei said.
"Most of the models that we see on Instagram who are nonbinary or a-gender are very thin," Rei added, noting that the implication is that "you have to look thin to look androgynous … so there's a lot of pressure to achieve that in order to look androgynous."
But Rei has learned to approach their own body with a greater sense of neutrality – striving to observe their body without judgment – they said.
Need support? If you or someone you know is struggling or in crisis, help is available. Call or text 988 or chat online at 988lifeline.org. The 988 Suicide & Crisis Lifeline provides 24/7 free and confidential support for people in distress. It also offers prevention and crisis resources for you or your loved ones. Contact the National Alliance for Eating Disorders by visiting its website or by calling the free helpline at (866) 662-1235.
