Functional neurological disorder (FND) is continuing to gain increasing recognition globally as a valid and potentially treatable disorder. Iatrogenic harm towards patients with FND is significant, however, and has been around for centuries. Despite advances in our understanding around the aetiology, pathophysiology and treatment of FND, many aspects of such harm continue to persist. Avoidance of iatrogenic harm has been highlighted by clinicians as one of the most important therapeutic considerations in FND; however, the sources and range of potential harms, or indeed ways to mitigate them, have not previously been summarized. Using a combination of clinical and research experience and scoping review methodology, this review aims to describe the main sources of iatrogenic harm towards patients with FND, including harm from misdiagnosis, delayed diagnosis and treatment, direct harm from professional interactions, other stigma-related harms, harm related to diagnostic overshadowing and over-diagnosis of FND. We also describe some potential ways to address and prevent such harms, such as ways to reduce misdiagnosis with a focus on rule in signs, optimizing teaching and communication, ensuring parity of FND with other medical conditions and continued integration of patient and professional organizations.

中文翻译：

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功能性神经障碍的医源性危害


功能性神经障碍 （FND） 作为一种有效且可能可治疗的疾病，在全球范围内越来越受到认可。然而，对 FND 患者的医源性伤害是显着的，并且已经存在了几个世纪。尽管我们对 FND 的病因、病理生理学和治疗的理解取得了进展，但这种伤害的许多方面仍然存在。临床医生强调，避免医源性伤害是 FND 中最重要的治疗考虑因素之一;然而，之前尚未总结潜在危害的来源和范围，或者实际上是减轻这些危害的方法。结合临床和研究经验以及范围综述方法，本综述旨在描述对FND患者医源性伤害的主要来源，包括误诊造成的伤害、延误诊断和治疗、专业互动的直接伤害、其他与耻辱相关的伤害、与FND的诊断掩盖和过度诊断相关的伤害。我们还描述了一些解决和预防此类伤害的潜在方法，例如减少误诊的方法，重点是标志规则、优化教学和沟通、确保 FND 与其他医疗条件相同以及患者和专业组织的持续整合。