{
  "id": "mental-health/self-harm-replacement-behaviors",
  "signature": "AI suggests self-harm replacement behaviors without assessing risk of substitution or escalation",
  "signature_zh": "AI在未评估替代或升级风险的情况下建议自伤替代行为",
  "regex": "rubber band|snap.*wrist|ice cube|red marker.*arm|substitute.*self-harm",
  "domain": "mental-health",
  "category": "data_error",
  "subcategory": null,
  "root_cause": "Common replacement behaviors (e.g., snapping rubber band, ice cubes) can become compulsive substitutes or escalate to more harmful actions if not paired with distress tolerance skills and professional oversight.",
  "root_cause_type": "generic",
  "root_cause_zh": "常见的替代行为（如弹橡皮筋、冰块）若未配合痛苦耐受技能和专业监督，可能成为强迫性替代或升级为更危险的行为。",
  "versions": [],
  "os_specific": {},
  "dead_ends": [
    {
      "action": "",
      "why_fails": "Can become a conditioned pain response that mimics self-harm; some users escalate from rubber band to cutting",
      "fail_rate": 0.8,
      "condition": "",
      "sources": []
    },
    {
      "action": "",
      "why_fails": "May trigger urge to actually cut; does not address underlying emotional dysregulation",
      "fail_rate": 0.65,
      "condition": "",
      "sources": []
    },
    {
      "action": "",
      "why_fails": "Distraction alone fails when urge intensity is high; user needs hierarchical coping strategies (e.g., TIPP skills first)",
      "fail_rate": 0.7,
      "condition": "",
      "sources": []
    }
  ],
  "workarounds": [
    {
      "action": "Assess urge intensity on a scale 1-10 first. For high intensity (7+), recommend TIPP skills (Temperature, Intense exercise, Paced breathing, Paired muscle relaxation) before any replacement behavior.",
      "success_rate": 0.85,
      "how": "Assess urge intensity on a scale 1-10 first. For high intensity (7+), recommend TIPP skills (Temperature, Intense exercise, Paced breathing, Paired muscle relaxation) before any replacement behavior.",
      "condition": "",
      "sources": []
    },
    {
      "action": "Pair replacement behaviors with a safety plan that includes crisis numbers and a 'cool-down' timer (e.g., wait 10 minutes before acting).",
      "success_rate": 0.8,
      "how": "Pair replacement behaviors with a safety plan that includes crisis numbers and a 'cool-down' timer (e.g., wait 10 minutes before acting).",
      "condition": "",
      "sources": []
    },
    {
      "action": "Recommend only non-painful replacements (e.g., squeezing a stress ball, tearing paper, coloring mandalas) and explicitly warn against pain-based substitutes.",
      "success_rate": 0.82,
      "how": "Recommend only non-painful replacements (e.g., squeezing a stress ball, tearing paper, coloring mandalas) and explicitly warn against pain-based substitutes.",
      "condition": "",
      "sources": []
    }
  ],
  "workarounds_zh": [
    "Assess urge intensity on a scale 1-10 first. For high intensity (7+), recommend TIPP skills (Temperature, Intense exercise, Paced breathing, Paired muscle relaxation) before any replacement behavior.",
    "Pair replacement behaviors with a safety plan that includes crisis numbers and a 'cool-down' timer (e.g., wait 10 minutes before acting).",
    "Recommend only non-painful replacements (e.g., squeezing a stress ball, tearing paper, coloring mandalas) and explicitly warn against pain-based substitutes."
  ],
  "transition_graph": {
    "leads_to": [],
    "preceded_by": [],
    "frequently_confused_with": []
  },
  "official_doc_url": "https://www.nami.org/about-mental-illness/mental-health-conditions/self-harm",
  "official_doc_section": null,
  "error_code": "SELF-HARM-REPLACE-001",
  "verification_tier": "ai_generated",
  "confidence": 0.87,
  "fix_success_rate": 0.78,
  "resolvable": "true",
  "first_seen": "2024-01-15",
  "last_confirmed": "2024-06-01",
  "last_updated": "2024-06-01",
  "evidence_count": 1,
  "tags": [],
  "locale": "en",
  "aliases": []
}