When the diagnosis misses the mark: The psychiatric cost of misdiagnosing hypophosphatasia as fibromyalgia

Figure 1 Flowchart of key concepts contributing to the misdiagnosis of hypophosphatasia as fibromyalgia. Overlooked low alkaline phosphatase, psychogenic misattribution, and gender bias, particularly the credibility gap faced by women, contribute to delayed diagnosis. This delay can result in psychiatric harm, including erosion of trust, depression, and anxiety, and highlights the importance of improved metabolic screening in chronic pain evaluation. HPP: Hypophosphatasia; ALP: Alkaline phosphatase.