“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.

Eating Disorders in Sexual and Gender Minority Adolescents

“…In schools that explicitly condemn homophobic bullying, respond swiftly to such incidents, and incorporate LGBT topics into their curriculum, sexual and gender minority students report increased feelings of belonging and reduced truancy rates [ 25 •]. Although underexplored in the literature, familial compassion and understanding also contribute to decreased fear of victimization from parents based on sexual orientation [ 68 ]. Family acceptance also markedly diminishes the prevalence of suicidal thoughts and suicide attempts among sexual minority individuals with nearly half the individuals from highly accepting families reporting these symptoms compared to individuals with low family acceptance [ 69 ].…”

“…Medical treatments, such as gender reconstructive surgery, fertility preservation, and continued health screening for sexual and gender minority individuals, are incredibly complex [ 9 , 58 , 81 ], which can potentially result in more stress and fear regarding receiving treatment. During these treatments, sexual and gender minority individuals have expressed perceiving a lack of understanding and compassion from healthcare providers [ 9 , 68 ], primarily due to a lack of education and perpetuation of cis-heteronormative treatment models. The confluence of identity-based trauma, societal pressures, and specific medical challenges faced by sexual and gender minority adolescents underscores the need to develop a knowledgeable and empathetic healthcare workforce capable of navigating sexual and gender minority individuals’ specific challenges and enhancing their health outcomes [ 9 , 68 , 81 ].…”

“…Policy reform within social and healthcare institutions may improve access to and outcomes of eating disorder treatment for sexual and gender minority adolescents [ 36 •, 58 ]. Gender-affirming and trauma-informed interventions have yielded positive health outcomes, such as less emotional internalization, better psychological functioning, and a greater sense of belonging in sexual and gender minority adolescents with eating disorders [ 9 , 68 , 82 ]. Integration of sexual and gender minority health and eating disorder care into standard medical curricula may better enable healthcare providers to provide sensitive care and improve health outcomes in sexual and gender minority adolescents [ 9 , 68 , 83 ].…”