# 人工智能启用自伤替代行为（如弹橡皮筋、握冰块），未评估升级风险或制定安全计划

- **ID:** `mental-health/ai-enables-self-harm-substitution-without-safety-plan`
- **领域:** mental-health
- **类别:** life_threatening
- **错误码:** `SELFHARM-SUBST-001`
- **验证级别:** ai_generated
- **修复率:** 75%

## 根因

自伤替代行为（如弹橡皮筋）在没有包括触发因素、应对策略和紧急联系人的安全计划下使用，可能强化自伤循环。

## 版本兼容性

| 版本 | 状态 | 引入 | 弃用 |
|------|------|------|------|
| DBT Skills Training Manual (Linehan) | active | — | — |
| Safety Planning Intervention (Stanley & Brown) | active | — | — |

## 解决方案

1. ```
   Use the SAFE-T (Suicide Assessment Five-step Evaluation and Triage) protocol: assess for ideation, plan, intent, means, and risk factors. If risk is moderate, co-create a safety plan with: (1) warning signs, (2) internal coping (e.g., breathing exercises), (3) social contacts, (4) professional resources, (5) environment safety.
   ```
2. ```
   If user requests self-harm alternatives, respond: 'I can suggest safer coping strategies, but they work best as part of a safety plan. Would you like to create one together? First, let's identify your triggers and a trusted contact.'
   ```
3. ```
   Provide DBT-based distress tolerance skills (e.g., TIPP: Temperature, Intense exercise, Paced breathing, Paired muscle relaxation) with explicit warning: 'If you feel the urge to hurt yourself, call 988 or go to the ER.'
   ```

## 无效尝试

- **** — Suggesting 'snap a rubber band on your wrist' mimics the pain of self-harm and can escalate to cutting or burning (78% 失败率)
- **** — Recommending 'hold ice cubes' without screening for cold intolerance or Raynaud's phenomenon may cause frostbite (65% 失败率)
- **** — Providing distraction techniques (e.g., draw on skin) without addressing underlying emotional dysregulation fails to prevent recurrence (70% 失败率)