{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T14:31:13Z","timestamp":1785421873777,"version":"3.56.0"},"reference-count":12,"publisher":"Royal College of Psychiatrists","license":[{"start":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T00:00:00Z","timestamp":1777939200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nd\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["BJPsych Bull"],"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:p>Restrictive intake self-harm (RISH) describes a\u00a0pattern 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.<\/jats:p>","DOI":"10.1192\/bjb.2026.10242","type":"journal-article","created":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T09:34:31Z","timestamp":1777973671000},"page":"1-4","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":0,"title":["Restrictive intake self-harm in NHS settings: understanding relational dynamics and iatrogenic risk"],"prefix":"10.1192","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9625-0797","authenticated-orcid":false,"given":"Susan G.","family":"Simpson","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/028g18b61","id-type":"ROR","asserted-by":"publisher"}],"name":"Adelaide University"},{"name":"Schema Therapy Scotland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirsty","family":"Gillings","sequence":"additional","affiliation":[{"name":"NHS Tayside"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"170","published-online":{"date-parts":[[2026,5,5]]},"reference":[{"key":"S2056469426102423_ref9","doi-asserted-by":"publisher","DOI":"10.1002\/pmh.1533"},{"key":"S2056469426102423_ref12","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.158.4.547"},{"key":"S2056469426102423_ref1","volume-title":"Eating Disorders: Recognition and Treatment","year":"2017"},{"key":"S2056469426102423_ref2","doi-asserted-by":"publisher","DOI":"10.5498\/wjp.v12.i4.558"},{"key":"S2056469426102423_ref10","unstructured":"10 Ellison, C , Philpot, U , Fenton, C , Fuller, SJ , Leighton, C , Ecclestone, L , et al. Restrictive Intake Self-Harm (RISH): Practice Considerations for the Management of RISH across Care Settings and Age. Insight Eating, 2025 (https:\/\/insighteating.co.uk\/rish\/ [accessed 21 Jan 2026])."},{"key":"S2056469426102423_ref11","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2024.11.054"},{"key":"S2056469426102423_ref5","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare13151914"},{"key":"S2056469426102423_ref8","doi-asserted-by":"publisher","DOI":"10.1002\/erv.761"},{"key":"S2056469426102423_ref4","doi-asserted-by":"publisher","DOI":"10.1136\/flgastro-2024-102823"},{"key":"S2056469426102423_ref7","volume-title":"A Secure Base: Clinical Applications of Attachment Theory","author":"Bowlby","year":"1988"},{"key":"S2056469426102423_ref3","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(20)30566-6"},{"key":"S2056469426102423_ref6","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp24X740109"}],"container-title":["BJPsych Bulletin"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S2056469426102423","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T09:34:33Z","timestamp":1777973673000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S2056469426102423\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,5]]},"references-count":12,"alternative-id":["S2056469426102423"],"URL":"https:\/\/doi.org\/10.1192\/bjb.2026.10242","relation":{},"ISSN":["2056-4694","2056-4708"],"issn-type":[{"value":"2056-4694","type":"print"},{"value":"2056-4708","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,5]]},"assertion":[{"value":"\u00a9 The Author(s), 2026. Published by Cambridge University Press on behalf of Royal College of Psychiatrists","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NoDerivatives licence (https:\/\/creativecommons.org\/licenses\/by-nd\/4.0\/), which permits re-use, distribution, and reproduction in any medium, provided that no alterations are made and the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}]}}