'Cheering on from the side-lines': The perceived impact of romantic partner's commentary and behaviour on maintaining women's appearance anxiety.

Objectives: Appearance anxiety (AA) is a probable risk factor for body dysmorphic disorder and a prevalent and debilitating concern. Extant literature suggests that romantic partners' commentary and accommodation behaviour may contribute to women's appearance concerns. The aim of this study is to explore how women experience and make sense of romantic partner feedback about their appearance.

Design: Qualitative semi-structured interview study.

Methods: Semi-structured interviews with 13 cis-gender women explored how they make sense of appearance anxiety in the context of romantic relationships. Reflexive thematic analysis with a hybrid inductive-deductive coding approach was utilised, drawing on cognitive behavioural theory (CBT) as a theoretical lens to interpret the data.

Results: Four themes were created from the data: (1) 'Then he said to me … you could probably tone up a bit': Maintaining cycles; (2) 'I think those comments down the line do eventually help': breaking out of maintenance cycles, (3) 'It's like they're talking in a foreign language'; beliefs as a filter and (4) 'Cheering me on from the side-lines'; romantic partner a supportive coach. These themes highlight the perceived unhelpful (e.g. accommodation of behaviours) and helpful (e.g. affection) impact of romantic partners' behaviours and commentary on participants' AA.

Conclusions: Romantic partners are perceived by women to have a potent impact on their AA. Clinical practice implications include involving romantic partners in treatment, and clinicians using their formulation and CBT skills (e.g. Socratic questioning), to understand and target these possible maintenance processes within couples.