"It's beautiful and it's messy and it's tragic": exploring the role of compassion in the eating disorder recovery processes of 2S/LGBTQ + Canadians.

ABSTRACT

This research explores experiences of compassion among 2S/LGBTQ + Canadians living with eating disorders in the context of eating disorder treatment and community support. There is a growing body of scholarship showing disparities in eating disorder care for those within 2S/LGBTQ + communities. Among the reported concerns is a potential lack of compassion in eating disorder treatment and recovery settings, something which may serve to exacerbate feelings of isolation and perpetuate misunderstandings of 2S/LGBTQ + people's experiences. In an effort to understand these dynamics more deeply, we conducted semi-structured interviews with 2S/LGBTQ + Canadians who have experienced eating disorder care. The data collected were then subjected to Foucauldian discourse analysis, which produced three interconnected discursive considerations feeling lack of structural compassion, 2S/LGBTQ + communities as places of respite, and 2S/LGBTQ + caregiving. One of the common threads among these discursive considerations was cis-heteronormativity ingrained in eating disorder treatment settings and health care systems more broadly. Our findings underscore the critical need for more enhanced compassion for 2S/LGBTQ + patients in eating disorder care settings. We conclude that compassion, when implemented on the levels of individual clinicians, policy and procedure, and institutions, may represent an avenue toward disrupting ingrained cis-heteronormativity and the associated discursive power structures contained in health care systems.

Two-Spirit, lesbian, gay, bisexual, transgender, queer and other sexually or gender diverse (2S/LGBTQ+) are at increased risk for eating disorders often related to minority stress, discrimination, and heteronormative gender expectations. Compassion is believed to be a fundamental aspect of healthcare that builds human connections and enhances positive outcomes. Healthcare, however, is steeped in heteronormative assumptions that may further isolate many 2S/LGBTQ+ patients. This study explored how 2S/LGBTQ+ Canadians living with eating disorders felt about their care and the role of compassion in their recovery journeys. We found that these individuals often felt misunderstood and isolated during treatment. However, they often experienced understanding by connecting with other 2S/LGBTQ+ people both in care and in the community, which provided the compassionate spaces lacking in their healthcare experiences. These findings highlight a need for making healthcare more compassionate for 2S/LGBTQ+ people. This can be done by changing policies, mandatory training for healthcare professionals, and treatment that recognizes and discusses minority stresses, uses trauma-informed practices, and gender-affirming approaches. By doing such items, standard norms can be challenged and the care for 2S/LGBTQ+ people living with eating disorders can be improved.