{
  "id": "mental-health/self-harm-substitution-escalation",
  "signature": "AI enables self-harm substitution behaviors (e.g., snapping rubber band, holding ice) without assessing risk of escalation or substitution",
  "signature_zh": "人工智能在未评估升级或替代风险的情况下助长自我伤害替代行为（如弹橡皮筋、握冰块）",
  "regex": "self-harm.*substitution|substitution.*self-harm|rubber band.*self-harm|ice.*self-harm|alternative.*self-harm",
  "domain": "mental-health",
  "category": "data_error",
  "subcategory": null,
  "root_cause": "Self-harm substitution behaviors can become harmful themselves (e.g., ice burns, rubber band welts) or escalate to more severe methods; they should be used only as part of a broader distress tolerance plan under professional guidance.",
  "root_cause_type": "generic",
  "root_cause_zh": "自我伤害替代行为本身可能变得有害（如冰烧伤、橡皮筋伤痕）或升级为更严重的方法；它们应仅在专业指导下的更广泛痛苦耐受计划中使用。",
  "versions": [
    {
      "version": "DSM-5-TR",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    },
    {
      "version": "ICD-11",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    },
    {
      "version": "DBT Skills Training Manual (Linehan)",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    }
  ],
  "os_specific": {},
  "dead_ends": [
    {
      "action": "",
      "why_fails": "Suggesting 'snap a rubber band on your wrist' can cause welts, bruising, or become a new form of self-harm.",
      "fail_rate": 0.75,
      "condition": "",
      "sources": []
    },
    {
      "action": "",
      "why_fails": "Advising 'hold ice' without specifying duration or wrapping can cause frostbite or nerve damage.",
      "fail_rate": 0.7,
      "condition": "",
      "sources": []
    }
  ],
  "workarounds": [
    {
      "action": "Provide substitution with safety parameters: 'If you feel the urge to self-harm, you can try holding an ice cube in your hand for no more than 10 seconds, wrapped in a cloth. This gives a strong sensation without causing injury. If you do it more than 3 times a day, please seek professional help.'",
      "success_rate": 0.72,
      "how": "Provide substitution with safety parameters: 'If you feel the urge to self-harm, you can try holding an ice cube in your hand for no more than 10 seconds, wrapped in a cloth. This gives a strong sensation without causing injury. If you do it more than 3 times a day, please seek professional help.'",
      "condition": "",
      "sources": []
    },
    {
      "action": "Focus on distress tolerance skills: 'Instead of substitution, let's try a DBT skill: TIPP (Temperature, Intense exercise, Paced breathing, Paired muscle relaxation). For temperature, splash cold water on your face. This activates the dive reflex and calms the nervous system.'",
      "success_rate": 0.78,
      "how": "Focus on distress tolerance skills: 'Instead of substitution, let's try a DBT skill: TIPP (Temperature, Intense exercise, Paced breathing, Paired muscle relaxation). For temperature, splash cold water on your face. This activates the dive reflex and calms the nervous system.'",
      "condition": "",
      "sources": []
    },
    {
      "action": "Assess for escalation risk: 'Before recommending any substitution, I need to ask: have you ever used substitution methods before? Did they lead to more severe self-harm? If so, substitution may not be safe for you.'",
      "success_rate": 0.85,
      "how": "Assess for escalation risk: 'Before recommending any substitution, I need to ask: have you ever used substitution methods before? Did they lead to more severe self-harm? If so, substitution may not be safe for you.'",
      "condition": "",
      "sources": []
    }
  ],
  "workarounds_zh": [
    "提供带有安全参数的替代行为：'如果你有自伤冲动，可以尝试手握冰块，用布包裹，不超过10秒。这能提供强烈感觉而不造成伤害。如果一天做超过3次，请寻求专业帮助。'",
    "专注于痛苦耐受技能：'与其替代，不如试试DBT的TIPP技能。对于温度，用冷水泼脸30秒。这激活潜水反射并镇静神经系统。'",
    "评估升级风险：'在推荐任何替代方法之前，我需要问：你以前用过替代方法吗？它们是否导致了更严重的自伤？如果是，替代方法可能对你来说不安全。'"
  ],
  "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": "SELFHARM-SUBST-ESCAL-006",
  "verification_tier": "ai_generated",
  "confidence": 0.86,
  "fix_success_rate": 0.8,
  "resolvable": "true",
  "first_seen": "2024-02-14",
  "last_confirmed": "2024-06-01",
  "last_updated": "2024-06-01",
  "evidence_count": 1,
  "tags": [],
  "locale": "en",
  "aliases": []
}