{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T12:11:30Z","timestamp":1793189490207,"version":"4.5.0"},"reference-count":20,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100009457","name":"Region Sj\u00e6lland","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100009457","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Reliable diagnosis is a cornerstone of medical practice, yet concerns about diagnostic reliability have long haunted psychiatry. In the 1970s, the US\u2013UK Diagnostic Project revealed striking international discrepancies in diagnostic practice. Although operationalized diagnostic criteria were introduced to improve reliability, contemporary evidence indicates that substantial problems persist. To investigate this, we conducted a large-scale international study of diagnostic reliability among medical doctors using standardized clinical case vignettes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Material and methods<\/jats:title>\n                    <jats:p>\n                      In this cross\u2212sectional study, medical doctors working in adult psychiatry across 19 countries from two continents assigned ICD\u221210 diagnoses to written cases. Each doctor was randomly assigned two of nine available cases. Inter\u2212rater reliability among medical doctors was assessed using Krippendorff\u2019s\n                      <jats:italic>\u03b1<\/jats:italic>\n                      . Diagnostic variability at case-level was quantified using Shannon entropy. We also calculated diagnostic accuracy as concordance with predefined best-estimate reference diagnoses.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 1,038 medical doctors provided 1,902 diagnostic assessments across nine cases. Inter\u2212rater reliability among medical doctors was modest (Krippendorff\u2019s\n                      <jats:italic>\u03b1<\/jats:italic>\n                      \u00a0=\u00a00.48), indicating that diagnostic agreement between two doctors occurred in roughly 55% of cases. Overall diagnostic accuracy was 66%, with the lowest accuracy observed for cases depicting schizophrenia spectrum disorders. Diagnostic disagreements followed systematic patterns, with schizophrenia cases frequently misclassified as OCD, personality disorder, or bipolar disorder.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Diagnostic inter\u2212rater reliability among medical doctors remains limited, even under standardized conditions. The observed patterns of misclassification suggest that the variability in diagnostic assessments reflects systematic differences in clinical interpretation rather than random error, pointing to challenges in assessing psychopathology as well as ambiguities in psychiatric classification.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpsyt.2026.1891625","type":"journal-article","created":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T06:03:46Z","timestamp":1785305026000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Reliability of psychiatric diagnoses in the 21st century"],"prefix":"10.3389","volume":"17","author":[{"given":"Mateo","family":"Boberg","sequence":"first","affiliation":[{"name":"Psychiatry East, Central and Western Zealand Hospital, University Hospital of Copenhagen","place":["Roskilde, Denmark"]},{"name":"Department of Clinical Medicine, University of 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Bordeaux, SANPSY, CNRS, UMR 6033, CHU de Bordeaux","place":["Bordeaux, France"]},{"name":"Universitaire de M\u00e9decine du Sommeil, CHU de Bordeaux, Place Am\u00e9lie Raba L\u00e9on","place":["F-33000 Bordeaux, France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Borut","family":"Skodlar","sequence":"additional","affiliation":[{"name":"University Psychiatric Clinic Ljubljana","place":["Ljubljana, Slovenia"]},{"name":"Medical Faculty, University of Ljubljana","place":["Ljubljana, Slovenia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie","family":"Nordgaard","sequence":"additional","affiliation":[{"name":"Psychiatry East, Central and Western Zealand Hospital, University Hospital of Copenhagen","place":["Roskilde, Denmark"]},{"name":"Department of Clinical Medicine, University of Copenhagen","place":["K\u00f8benhavn N, Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,29]]},"reference":[{"key":"B1","volume-title":"Psychiatric Diagnosis in New York and London: A Comparative Study of Mental Hospital Admissions","author":"Cooper","year":"1972"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.1971.01750140027006","article-title":"Diagnostic criteria of American and British psychiatrists","volume":"25","author":"Kendell","year":"1971","journal-title":"Arch Gen Psychiatry"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.125.4.341","article-title":"A re-analysis of the reliability of psychiatric diagnosis","volume":"125","author":"Spitzer","year":"1974","journal-title":"Br J Psychiatry"},{"key":"B4","volume-title":"Diagnostic and Statistical Manual of Mental Disorders (Dsm-Iii)","year":"1980"},{"key":"B5","volume-title":"ICD-10: International Statistical Classification of Diseases and Related Health Problems: Tenth Revision","year":"1992"},{"key":"B6","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1176\/appi.ajp.160.1.4","article-title":"Distinguishing between the validity and utility of psychiatric diagnoses","volume":"160","author":"Kendell","year":"2003","journal-title":"Am J Psychiatry"},{"key":"B7","doi-asserted-by":"crossref","DOI":"10.1353\/book.98242","volume-title":"Philosophical Issues in Psychiatry: The Nature and Sources of Historical Change. 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