Since the initial description of catatonia in 1874, three different distinct clinical and neurobiological frameworks have emerged. The first emphasizes psychomotor and affective aspects, building on Karl Ludwig Kahlbaum’s legacy. The second focuses on motor symptoms alone, influenced by the work of Emil Kraepelin and Eugen Bleuler. The third introduces the Wernicke–Kleist–Leonhard concept of psychomotor abnormalities such as catatonia as a significant neuropsychiatric framework. This chapter critically examines all three frameworks from both scientific and clinical perspectives, highlighting their advantages and disadvantages in research and treatment. The chapter will also delve into common synergies between neurobiological and clinical studies, discussing how these can inform the day-to-day management of catatonia. Furthermore, we will analyze the current classification systems of DSM-5 and ICD-11 and their relation to the described frameworks, with a focus on their strengths and weaknesses in diagnosing catatonia. Finally, this chapter will introduce a novel approach that links neural correlates and subjective experience of catatonia through their spatial (space) and temporal (time) patterns. This chapter will provide a comprehensive overview of diagnostic approaches and their clinical implications.