It is unrealistic to expect that the quality of psychiatric diagnoses can be much greater than that of diagnoses in other areas of medicine, where diagnoses are largely based on evidence that can be directly observed. Psychiatric diagnoses continue to be based on inferences derived from patient self-reports or observations of patient behavior. Nevertheless, we propose that the standard of evaluation of the test-retest reliability of DSM-5 be consistent with what is known about the reliability of diagnoses in other areas of medicine. Intrarater reliability is almost never assessed for psychiatric diagnosis because it is difficult to ensure blinding of two diagnoses by the same clinician viewing, for example, the same diagnostic interview. However, where intrarater reliability has been assessed for standard medical diagnostic procedures, it is common to see intrarater kappa values between 0.6 and 0.8 (4, 5), but there are exceptions (e.g., 0.54 for assessment of hand films for osteoarthrosis ).