# AI suggests self-harm replacement behaviors without assessing risk of substitution or escalation

- **ID:** `mental-health/self-harm-replacement-behaviors`
- **Domain:** mental-health
- **Category:** data_error
- **Error Code:** `SELF-HARM-REPLACE-001`
- **Verification:** ai_generated
- **Fix Rate:** 78%

## 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.

## Workarounds

1. **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.** (85% success)
   ```
   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.
   ```
2. **Pair replacement behaviors with a safety plan that includes crisis numbers and a 'cool-down' timer (e.g., wait 10 minutes before acting).** (80% success)
   ```
   Pair replacement behaviors with a safety plan that includes crisis numbers and a 'cool-down' timer (e.g., wait 10 minutes before acting).
   ```
3. **Recommend only non-painful replacements (e.g., squeezing a stress ball, tearing paper, coloring mandalas) and explicitly warn against pain-based substitutes.** (82% success)
   ```
   Recommend only non-painful replacements (e.g., squeezing a stress ball, tearing paper, coloring mandalas) and explicitly warn against pain-based substitutes.
   ```

## Dead Ends

- **** — Can become a conditioned pain response that mimics self-harm; some users escalate from rubber band to cutting (80% fail)
- **** — May trigger urge to actually cut; does not address underlying emotional dysregulation (65% fail)
- **** — Distraction alone fails when urge intensity is high; user needs hierarchical coping strategies (e.g., TIPP skills first) (70% fail)