# AI recommends self-harm substitution behaviors (e.g., snapping rubber band, holding ice) without assessing risk of escalation or providing psychological support

- **ID:** `mental-health/self-harm-substitution`
- **Domain:** mental-health
- **Category:** harmful_advice
- **Error Code:** `SH-SUBST-006`
- **Verification:** ai_generated
- **Fix Rate:** 73%

## Root Cause

Self-harm substitution behaviors (e.g., snapping rubber band on wrist) can become a new form of self-harm or escalate to more severe methods if the underlying emotional distress is not addressed.

## Workarounds

1. **First, validate the emotion: 'I hear that you're in a lot of pain right now. It's okay to feel this way. Let's find a way to cope that doesn't involve hurting yourself.' Then provide a hierarchy of distress tolerance skills: 1) TIPP (Temperature, Intense exercise, Paced breathing, Paired muscle relaxation). 2) Use a 'soothe box' with sensory items (e.g., stress ball, scented lotion, textured fabric). 3) Call a crisis line (988 in US).** (80% success)
   ```
   First, validate the emotion: 'I hear that you're in a lot of pain right now. It's okay to feel this way. Let's find a way to cope that doesn't involve hurting yourself.' Then provide a hierarchy of distress tolerance skills: 1) TIPP (Temperature, Intense exercise, Paced breathing, Paired muscle relaxation). 2) Use a 'soothe box' with sensory items (e.g., stress ball, scented lotion, textured fabric). 3) Call a crisis line (988 in US).
   ```
2. **Provide a 'urge surfing' script: 'Notice the urge to self-harm. Don't fight it or act on it. Imagine it as a wave that will crest and fall. Rate the urge from 1-10 every 2 minutes. Most urges last 15-30 minutes. Distract yourself with a puzzle, a game, or calling a friend until the urge passes.'** (75% success)
   ```
   Provide a 'urge surfing' script: 'Notice the urge to self-harm. Don't fight it or act on it. Imagine it as a wave that will crest and fall. Rate the urge from 1-10 every 2 minutes. Most urges last 15-30 minutes. Distract yourself with a puzzle, a game, or calling a friend until the urge passes.'
   ```
3. **If user insists on a physical sensation, recommend 'safe' alternatives: 'Splash cold water on your face (not holding ice). Take a cold shower for 30 seconds. Eat a sour candy. Listen to loud music. These provide sensory input without risk of injury.'** (72% success)
   ```
   If user insists on a physical sensation, recommend 'safe' alternatives: 'Splash cold water on your face (not holding ice). Take a cold shower for 30 seconds. Eat a sour candy. Listen to loud music. These provide sensory input without risk of injury.'
   ```

## Dead Ends

- **** — Telling user to 'snap a rubber band on your wrist' can mimic the pain sensation of self-harm and reinforce the behavior. (45% fail)
- **** — Suggesting 'hold ice cubes' can cause frostbite if done repeatedly or for too long, and the cold sensation may be triggering. (35% fail)
- **** — Recommending 'draw on yourself with red marker' can be invalidating for users who feel their distress is not taken seriously. (30% fail)