From DSM-IV to the future: three decades of evolution in psychiatric classification and what lies ahead

Psychiatric classification systems have evolved significantly over the past three decades. This article critically examines the transition from DSM-IV and ICD-10 to the more recent DSM-5-TR and ICD-11, analysing key conceptual shifts, including the redefinition of diagnostic criteria, the inclusion of emerging disorders, and the removal of outdated or stigmatizing categories. Particular attention is paid to the growing limitations of categorical models in capturing clinical heterogeneity and comorbidity. In response, dimensional approaches and precision psychiatry have gained prominence, aiming to integrate symptom severity, biomarkers, and neurobiological correlates into diagnostic decision-making. The manuscript explores future trajectories for psychiatric nosology, including the potential role of artificial intelligence, the recognition of novel syndromes such as eco-anxiety and digital addictions, and the need for culturally sensitive frameworks. It also provides stakeholder-specific recommendations—addressed to clinicians, researchers, policymakers, and educators—summarized in a dedicated table. These forward-looking strategies emphasize the importance of ethical, interdisciplinary, and inclusive practices in updating diagnostic systems. Ultimately, the future of psychiatric classification lies in striking a balance between scientific rigor, sociocultural relevance, and individual variability, ensuring that future manuals serve both clinical utility and human dignity.