Restrictive intake self-harm (RISH) describes a pattern of severe food and fluid restriction whose functions emerge primarily for reasons other than weight or shape psychopathology. RISH exhibits a distinct phenomenology from anorexia nervosa, rooted in conditional caregiving, attachment disruption and maladaptive internal working models that inhibit direct help-seeking. This paper draws on attachment theory and evidence on the functions of eating-disordered behaviour to argue that three relational configurations (boundary confusion, subjugation of needs and escalating distress signalling) create vulnerability to RISH and shape how individuals use restriction within relational contexts. It further proposes that risk-driven thresholds, hospital admissions and crisis-responsive models that characterise NHS care delivery may inadvertently reinforce these dynamics by validating the belief that suffering is required to access care. Highly restrictive and directive treatment plans for those with RISH can result in the escalation of dietary restriction, trauma and clinical deterioration. Medicalisation of care can also inadvertently reinforce care-seeking behaviour through restriction. A relational framework is therefore essential for understanding RISH, providing interventions that minimise iatrogenic harm and offering relational experiences in which needs can be expressed and met without bodily deterioration.
Simpson et al. (Tue,) studied this question.