Discordant Bell

Every encounter raises both outgoing and incoming damage, so its benefit grows with the length of the night.

Use it when

Use it only on a confident clear where growing damage is worth taking equally more damage.

Limit

The incoming-damage increase makes it a poor progression choice when survival is not already stable.

If it is absent

Use Knuckle Bones for boss damage without increasing all damage taken.

When to replace it

Keep it while its condition supports the current route, then replace it when another keepsake solves a more immediate constraint.