Do new labels solve old problems? Conceptual, ethical, and clinical challenges of constructing restrictive eating behaviours as "self-harm".

The concept of "Restrictive Intake Self-Harm" ("RISH") has recently been introduced to conceptualise divergent and/or complex presentations of restrictive eating behaviours as a form of self-harm, rather than symptoms of an eating disorder. Whilst this may represent a well-intentioned response to poorly met clinical needs, it also raises significant conceptual, ethical, and clinical concerns. This paper, written by authors with clinical, academic, and lived experience, situates "RISH" within a broader history of premature classificatory expansion in eating disorders, whereby new terminology has been introduced with insufficient empirical support and a lack of substantive coproduction with people with lived experience. Our analysis highlights the unintended consequences of this approach and how conflating restriction with self-injurious behaviour risks conceptual ambiguity, diagnostic misclassification, and the diversion of patients away from specialist services and evidence-based treatments that may benefit them. We advocate an empirical, data-driven approach to understanding the heterogeneous nature of restrictive eating and its diverse biological, psychological, social, and cultural drivers, across diagnoses. In clinical practice, greater skill in differential diagnosis and collaborative, individualised formulation is needed, alongside reform of service design to facilitate more integrated care. Vitally, terminology and care pathways for disordered eating need to be meaningfully coproduced with the people who need them, recognising the plurality and legitimacy of experiential knowledge as central to creating more inclusive and attuned care.