Restricted intake self-harm (RISH): a composite case example and guidance for management

Restricted intake self-harm (RISH) is a newly described form of disordered eating presentation as a method of self-harm. The function of this behaviour is most typically to regulate emotion, communicate distress and elicit medicalised care for an unmet need. The characteristics of RISH and how it may be distinguished from anorexia nervosa (AN) are considered. A composite case series example, drawn from clinical practice, is presented, which spans a patient’s journey from their first presentation as a child and into adulthood. Optimal approaches to management, including the concept of positive risk management within a multidisciplinary framework, are described. The risks of exacerbation from using an AN treatment approach and from prolonged inpatient stays are highlighted. Awareness of this presentation is important for nutrition support teams and gastroenterologists to support early recognition, optimal signposting and liaison with appropriate services which are detailed.