The events leading to the publications of DSM-III and DSM-III-R are briefly reviewed. The appointment, in 1988, of a work group for the preparation of DSM-IV, to be published in 1993, represents an attempt to reinsert American Psychiatry in the international sphere while, at the same time, perfects the document on the basis of clinical research findings, emphasis on the prototypical model of operational diagnosis, reduction in the number of Axes, and usefulness for different professional and non professional individuals. Some of the changes currently under consideration in the different subcommittees of the working group are presented.