'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.

'I'm still su!c!dal when you're done with the paperwork': an inductive framework thematic analysis of #camhs on TikTok.

BACKGROUND: Young people are sharing their experiences of Child and Adolescent Mental Health Services (CAMHS) in the United Kingdom on TikTok. Little is known about the content of these videos and their influence on young people's attitudes towards seeking professional mental health support. METHODS: This study explored how CAMHS is represented in a sample of 100 #camhs TikTok videos using participatory inductive framework thematic analysis. RESULTS: Four themes were developed alongside young people as co-researchers: (a) CAMHS can be frustrating and unhelpful, but sometimes life-saving, (b) Young people can feel their distress is invalidated by CAMHS, (c) CAMHS makes young people feel responsible for their distress, and (d) Young people may not feel CAMHS professionals are trustworthy. Video content described dismissive responses to expressions of suicidal ideation, professional knowledge being privileged over lived experience, and breaches of confidentiality. Some shared positive experiences of CAMHS helping to keep them safe. CONCLUSIONS: Together, the themes reflect a representation of CAMHS as a service where adults are powerful and young people occupy a subjugated position. This may influence young people's professional help-seeking behaviour. Recommendations for clinical practice and future research are presented.

'A ward full of emotional, aggressive people': Social climate and interpersonal relationships in forensic settings caring for patients with borderline personality disorder.

Therapeutic relationships play a central role in maintaining a positive social climate in forensic settings. The interpersonal difficulties characteristic of Borderline Personality Disorder, alongside the secure environment of forensic wards, can make developing positive therapeutic relationships with this patient group challenging. Qualitative interviews aimed to explore how ward staff understand and experience the interaction of interpersonal relationships and social climate when caring for patients with Borderline Personality Disorder on forensic wards. Interviews with 11 staff members working across UK forensic inpatient settings were analysed using Reflexive Thematic Analysis and reported following COREQ guidelines. Six interrelated themes were generated; three describe relational cycles that occur between ward staff and patients with Borderline Personality Disorder and three describe systemic factors that influence the context in which ward staff operate. From these themes, an integrative model was developed to summarise how factors in the wider forensic system and the interpersonal relationships between staff and patients with Borderline Personality Disorder in forensic wards influence one another, affecting staff experiences of the social climate of forensic settings. The model illustrates how complex cycles within the therapeutic relationships with staff and patients with Borderline Personality Disorder can interact with systemic influences in the wider forensic context to influence staff experiences of forensic settings. Clinical implications of the model are discussed, offering recommendations for improving therapeutic relationships and the social climate on forensic wards caring for patients with Borderline Personality Disorder, to better support staff and patient wellbeing.

Using a trauma-informed care framework to explore social climate and borderline personality disorder in forensic inpatient settings.

Tensions between therapeutic and security needs on forensic wards can create a social climate which is challenging for both mental health nurses and patients. Social climate refers to the physical, social and emotional conditions of a forensic ward which influence how these environments are experienced. For patients with borderline personality disorder (BPD), previous trauma means that the social climate of forensic settings may be experienced as retraumatising, negatively impacting the outcomes and wellbeing of both patients and mental health nurses. Trauma-informed care (TIC) has been offered as a contemporary framework for mental health nursing in inpatient units which aims to create a therapeutic social climate. In this critical review, we drew widely on literatures examining the social climate in forensic settings, the relationships between patients with BPD and staff (including mental health nurses), and the experiences of patients with BPD in forensic and inpatient settings to draw out the implications of scrutinising these literatures through the lens of TIC. Attending to the physical, social and emotional conditions of social climate in secure settings highlights how forensic wards can mirror trauma experiences for patients with BPD. Implementing TIC in these contexts has the potential to evoke positive shifts in the social climate, thus reducing the risk of retraumatisation and leading to improved outcomes for patients and staff.

Psychosocial impact of androgenetic alopecia on men: A systematic review and meta-analysis.

The adverse psychosocial impact of androgenetic alopecia (AGA) is often framed as an essential motivation for developing efficacious treatments to halt hair loss or promote regrowth, especially since AGA is common among men but does not result in physically harmful or life-limiting consequences. Yet, empirical evidence documenting the impact of AGA on men's psychological wellbeing and quality of life is patchy and has not previously been subject to systematic review. This systemic review and meta-analyses aim to integrate and evaluate evidence regarding the psychosocial impact of AGA on men. A database and manual reference search identified English-language articles which reported: 1) empirical research; of ii) psychosocial distress (mental health, depression, anxiety, self-esteem, or quality of life); and iii) data separately for male AGA participants. Screening of 607 articles resulted in 37 (6%) for inclusion. PRISMA guidelines, the (modified) AXIS quality assessment tool, and independent extraction were deployed. Heterogeneity in measures and study aims, moderate study quality (M = 7.37, SD = 1.31), probable conflicts of interest (78%) and biased samples (68%) suggest that results should be treated cautiously. Meta-analyses revealed no impact on depression (pooled M = 8.8, 95% CI = 6.8-10.8) and moderate impact on quality of life (pooled m = 9.12, 95% CI = 6.14-12.10). Men with AGA were found to have average or better mental health compared to those without AGA. Overall, there was limited evidence of a severe impact on mental health and quality of life for men experiencing hair loss, with most studies evidencing (at best) a moderate impact. Good dermatological care includes accurately educating about the psychosocial impact of AGA on men, taking care not to overstate levels of distress, and screening for distress using validated measures which have clear clinical thresholds.

'I don't live in my body somehow': metaphorical talk in women's accounts of vaginismus and dyspareunia.

Vaginismus and dyspareunia are common sexual difficulties; they often take a long time to be appropriately diagnosed, and their origins remain unclear. This paper examines the metaphors used by women to describe bodily experiences associated with vaginismus and dyspareunia, and highlights the contribution this form of analysis can make to the study of sexuality and sexual difficulties. A secondary analysis was conducted on primary data from biographic interviews exploring women's experiences of sexual pain and difficulties with sexual intercourse. Metaphor analysis was used to analyse a data subset of 28 interviews translated from German into English. Metaphorical concepts lying at the basis of the metaphors used were identified and grouped into three themes: characterisation of sexual difficulties; split body and 'self'; and sexual agency and objectification. Results are discussed with in the context of literature regarding the function of metaphors and the utility of metaphor analysis for research, and healthcare research and interventions more generally.

Psychology's medicalization of male baldness.

Male baldness is physically benign though it is increasingly described as a "disease" based on claims that it is profoundly distressing. The medicalization of baldness was assessed using data extracted from a review of 37 male baldness psychosocial impact studies. Findings revealed most studies likely had commercial influences (78%), represented baldness as a disease (77%), were conducted on biased samples (68%), and advocated for baldness products/services (60%), omitting their limitations (68%). Health psychologists should challenge baldness medicalization so that men can make informed choices about what, if anything, they do with their baldness.

Labouring on orgasms: embodiment, efficiency, entitlement and obligations in heterosex.

Women's orgasms have long been subject to vociferous scientific debate, but over the last 10-15 years a small but growing body of largely feminist qualitative research has begun to explore how the sociocultural construction of orgasm finds contemporary articulation in popular culture and in lay accounts of heterosex. This work is explicitly concerned with gendered power relations and how these operate. This paper provides a critical review and synthesis of this work by exploring three discursive imperatives: (1) orgasm and the coital imperative (2) efficient orgasms and hard work (3) and the ethic of reciprocity. Drawing on these insights, this paper outlines how a focus on embodiment, on situated meaning-making and on everyday sexual practices would further extend our understanding of the social construction of orgasm. Finally, the paper argues for the importance of locating these processes of meaning-making in relation to socially structured material realities.

Making death 'good': instructional tales for dying in newspaper accounts of Jade Goody's death.

Facilitating a 'good' death is a central goal for hospices and palliative care organisations. The key features of such a death include an acceptance of death, an open awareness of and communication about death, the settling of practical and interpersonal business, the reduction of suffering and pain, and the enhancement of autonomy, choice and control. Yet deaths are inherently neither good nor bad; they require cultural labour to be 'made over' as good. Drawing on media accounts of the controversial death of UK reality television star Jade Goody, and building on existing analyses of her death, we examine how cultural discourses actively work to construct deaths as good or bad and to position the dying and those witnessing their death as morally accountable. By constructing Goody as bravely breaking social taboos by openly acknowledging death, by contextualising her dying as occurring at the end of a life well lived and by emphasising biographical continuity and agency, newspaper accounts serve to position themselves as educative rather than exploitative, and readers as information-seekers rather than ghoulishly voyeuristic. We argue that popular culture offers moral instruction in dying well which resonates with the messages from palliative care.

Adolescents' and parents' experiences of managing the psychosocial impact of appearance change during cancer treatment.

Using combined qualitative data from multiple case study interviews and an online survey, this study explored the impact of appearance change on 22 adolescents receiving cancer treatment aged 13 to 18 years and six of their parents. Data were analyzed using template analysis. Appearance changes were a major concern. Adolescents typically struggled to adapt to new experiences and concerns related to this highly sensitive issue. Many felt anxious and self-conscious and were reluctant to reveal appearance changes in public. These feelings were compounded by the negative reactions of others (e.g., staring, teasing, and inappropriate questioning), which sometimes lead to avoidance of social activity and threats of noncompliance. Parents of these children felt ill-prepared to manage appearance-related anxieties. Adolescents wanted support to develop the practical and social skills necessary to maintain a "normal" appearance and manage the negative responses of others. However, some adolescents showed resilience and, with support from friends and family, developed strategies to manage their altered appearance and its social consequences. These strategies are explored, which can inform interventions to support adolescents and parents.

Women's experiences of an altered appearance during chemotherapy: an indication of cancer status.

This study explores breast cancer patients' experiences of chemotherapy treatment, with a focus on the impact of an altered appearance during this time. We present two key themes from the thematic analysis of interviews with 19 women: anxiety that chemotherapy will render them identifiable as a ;person-with-cancer'; and problematic interactions with others. We discuss how changes in appearance can reveal disease status to others, demonstrate the personal impact of temporary changes to appearance, relate these findings to literature on psychosocial aspects of disfigurement and consider the provision of psychosocial care for women experiencing an altered appearance during chemotherapy.

Using photographs to capture women's experiences of chemotherapy: reflecting on the method.

This article examines the value of using the photo-elicitation method for generating health-related narratives. Drawing on research in which women kept a photographic record of their experiences of chemotherapy treatment for breast cancer, this research explored how this method (a) produced elaborate accounts of illness experiences through an exploration of the process of representing experiences and through an interrogation of the images themselves; (b) allowed an opportunity to capture experiences over time and a way of capturing the past, which can then be reexplored from the present; (c) enabled patients to retain control over their images of themselves and how they choose to represent their experiences; and (d) provided a window into the private, everyday experiences of patients away from a health care setting.

Anticipating an altered appearance: women undergoing chemotherapy treatment for breast cancer.

Chemotherapy treatment for cancer can have a profound impact on appearance, and is often experienced as distressing. Few qualitative studies explore experiences of chemotherapy, and seldom focus on the process of anticipation and preparation for an altered appearance. We report findings from an interview study of 19 women which explored their expectations of chemotherapy-induced hair loss, their anticipated reactions to hair loss and how women intend to prepare for an altered appearance. The results demonstrate that women are active in anticipating hair loss and adopt a range of different strategies to manage their alopecia--even before it has occurred. Four key themes were identified: (a) anticipating hair loss, (b) coming to terms with the inevitability of hair loss, (c) becoming ready, and (d) taking control. We argue that this can be seen as a form of anticipatory coping, which involves affective and behavioural rehearsal so that women can feel more in control of their experience of the side effects of chemotherapy treatment for cancer. We suggest seeing these activities as a form of anticipatory coping, and understanding the psychological reasons why women engage in these activities, may help nursing professionals to better support women through this often traumatic time.

(De)constructing body image.

The reification of body image leads to unarticulated ideological and conceptual assumptions that obscure the most dynamic and productive features of the construct. These assumptions are that body image: (1) 'exists'; (2) is a socially mediated product of perception; (3) is 'internal' and 'of the individual'; (4) can be treated and measured as if real; and (5) individuals' respond to body image measures as if neutrally providing information about pre-existing images held in their heads. We argue that it is more useful to consider body imaging as a process, an activity rather than a product.

Discourse analysis and the experience of ECT.

The authors present a discourse analysis of an influential paper on the experience of electroconvulsive therapy (ECT). By focusing on how patients are construed in this article, they deconstruct the ways in which the case for ECT as 'helpful and not particularly frightening' is made. They argue that, as with all academic writing, a discourse of scientific objectivity can be used to privilege certain views and promote certain interests.