Therapists in the field of college mental health counseling commonly voice an ambivalent orientation towards the utilization of formal psychological diagnostic systems yet often use diagnostic terms. Knowledge of the current and emerging diagnostic systems may contribute to greater syntheses of these differing approaches. This article will first present and contrast the newly published Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) with the International Classification of Diseases and Related Health Problems (ICD-10, the system that that rest of the world has used for more than two decades and the United States will have to use in 2015) and the ICD-11 (which the rest of the world will use in 2015 and the United States will adopt a few years thereafter). This will be briefly followed by a comparison to the psychosocially-based Psychodynamic Diagnostic Manual, one of the currently available alternatives, and a presentation about an alternative diagnostic system being developed internationally, the Person-centered Integrative Diagnostic model. The discussion section of the article will focus on clinical utility versus possible current and long-term negative effects of college students receiving psychiatric diagnoses and the pros and cons of the current and emerging diagnostic systems.