Axis V: Global assessment of functioning of 45. Axis I: Rule out adjustment reaction, not otherwise specified, secondary to medical complications (309.9). Axis II: Deferred. Axis III: See above. Axis IV: Current psychosocial stressors include prolonged hospitalization.
Axis I: Major depression, recurrent type. Axis II: Neurological factors affecting physical condition, histrionic personality. 1. Atypical chest pain. 2. Gastroesophageal reflux disease. 3. Hypertension. Axis IV: Husband’s illness. Axis V: Global assessment of functioning 44 upon evaluation, past year 55.
AXIS V: Current global assessment of functioning equals 60, past year 80. Axis I: 296.33. Major depressive disorder, recurrent, without psychotic features. Axis II: Borderline intellectual functioning and borderline personality features, provisional. Axis III: None reported. Axis IV: Problems related to his legal status and social environment.
The reporting of overall functioning on Axis V can be done using the Global Assessment of Functioning (GAF) Scale. The GAF Scale may be particularly useful in tracking the clinical progress of individuals in global terms, using a single measure. The GAF Scale is to be rated with respect only to psychological, social, and occupational functioning.
A GAF of 41 to 50 means that the patient has serious symptoms . . . OR any serious impairment in social, occupational, or school functioning (e.g., no friends, unable to keep a job). A GAF rating of 51 to 60 signals the existence of moderate difficulty in social or occupational functioning.
In psychiatry, the severity of illness can be scored by Global Assessment of Functioning (GAF). GAF is known worldwide and it is Axis V of the internationally accepted Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Text Revision (DSM-IV-TR) [12].
A score of 0 represents total impairment, and a score of 100 would represent normal functioning. A GAF score below 50 represents serious to severe social impairment.
60 – 51: Moderate symptoms, or moderate difficulty in social, occupational, or school functioning. 50 – 41: Serious symptoms, or any serious impairment in social, occupational, or school functioning.
Axis V is the global assessment of functioning (GAF) in three major areas: social, occupational, and psychological. Because patients with the same diagnosis can differ widely in the severity of their symptoms and their overall ability to cope, the GAF attempts to quantify the overall functioning of an individual.
Doctors can determine a person's GAF score using several items of information, including:talking to the person.interviewing the person's family members or caretakers.reviewing the person's medical records.reviewing a person's police or court records detailing their behavioral history.
The average scores are comparable to the WHODAS 5-point scale, which allows the clinician to think of the individual's disability in terms of none (0-0.49), mild (0.5-1.49), moderate (1.5-2.49), severe (2.5-3.49), or extreme (3.5-4).
A GAF score of 91-100 is normal, while lower scores indicate psychosocial problems that make life difficult for the person under evaluation. The Global Assessment of Functioning (GAF) Scale is used by mental health professionals to evaluate an individual's' psychological, social, and occupational functioning.
Level of functioning is something that is assessed by a practitioner regarding a client in order to determine a proper levels of care. It is an evaluative finding intended to reflect how effectively an individual is able to perform in various personal, interpersonal, and community domains.
Axis V is for reporting the clinician's judgment of the individual's overall level of functioning. This information is useful in planning treatment and measuring its impact, and in predicting outcome. The reporting of overall functioning on Axis V can be done using the Global Assessment of Functioning (GAF) Scale.
Axis I disorders tend to be the most commonly found in the public. They include anxiety disorders, such as panic disorder, social anxiety disorder, and post-traumatic stress disorder. Other examples of Axis I disorders are as follows: Dissociative disorders. Eating disorders (anorexia nervosa, bulimia nervosa, etc.)
MODIFIED - GLOBAL ASSESSMENT OF FUNCTIONING Scale (mGAF)
Measures of global functioning are typically ratings of a clinician's judgment about a child or adolescent's overall functioning in day-to-day activities at school, at home, and in the community. 114 Measures of global functioning are useful for identifying need for treatment, as well as for monitoring treatment effects and predicting treatment outcome. The importance of global functioning is reflected in the placement of the Global Assessment of Functioning—which stipulates that impairment in one of more areas of functioning is necessary in order to meet criteria for a diagnosis—as Axis V on the DSM-IV. The Global Assessment of Functioning is a scale of a mental health continuum from 1 to 100 with 10 anchor descriptions; higher scores reflect better functioning. For example, a score between 31 and 40 would be given for a child with major functional impairment in several areas (frequently beats up younger children, is unruly at home, and is failing in school); a score between 61 and 70 is given to a child with mild symptoms (mild depressed mood) or some difficulties in functioning (disruptive in school) but who generally functions fairly well and who has good social relationships. Shaffer and colleagues modified the anchors of the Global Assessment of Functioning to pertain better to youth, creating the Children's Global Assessment Scale (CGAS). 115 This instrument yields one score and has been used in a large number of psychiatric outcome studies, especially medication-related research. 111
The GAF used in the DSM-IV is updated from an earlier version, the Global Assessment Scale ( GAS), by eliminating overly subjective criteria and stressing the importance of especially dangerous symptoms.
At 2-month follow-up the score was 61 . The score had decreased from the postretraining assessment (67), though it remained at a higher level compared to the preintervention level of functioning, indicating maintenance of improvement despite cessation of regular intervention sessions.
It can be used to track and succinctly communicate the course of psychiatric disorders over time and to monitor response to treatment. An increase in the GAF score from 35 to 55 during the course of an inpatient hospitalization, for example, would suggest that the treatment plan has been at least somewhat effective, whereas a decline from 35 to 20 might suggest that it has not. Reporting the highest and lowest GAF score in the past year along with the current GAF score can also help paint a concise picture of overall function. However, it is important to consider the limitations of the GAF scale in clinical decision-making ( Box 17-8 ). Neither the GAF score alone nor, for that matter, the entire multiaxial assessment can be a substitute for psychiatric clinical skill and judgment.
Scores range from 1 to 100, with high scores denoting superior functioning and low scores denoting significant impairment. The clinician chooses a number based on symptoms in each 10-point range that might describe a patient, moving down the scale until the range that best matches the individual's symptom severity or level of functioning is reached, whichever is worse. In the following example, someone may have been functioning in the 51–60 range, “moderate difficulty in social, occupational, or school functioning (e.g., few friends and conflicts with peers or coworkers).” If that person comes to medical attention after a serious suicidal act, he or she would then be classified in the 1–10 range because the seriousness of the current symptom outweighs the prior level of functioning.
A widely used measure of functioning is the Child and Adolescent Functional Assessment Scale. 116 This measure is a clinician-rated instrument consisting of behavioral descriptions (e.g., is expelled from school, bullies peers) grouped into levels of impairment for each of five domains: role performance (school/work, home, community), behavior toward others, moods/self-harm, substance use, and thinking. The Child and Adolescent Functional Assessment Scale has been shown to have considerable criterion-related and predictive validity and is widely used to evaluate outcome in clinical settings and in clinical research. 111
Same as the Stressors section—once included in the DSM five-axis diagnostic system, the Global Assessment of Functioning has been eliminated from the Diagnostic Criteria section, and its elimination is actually quite a good thing, in my opinion. You should never see a numerical value for GAF, or Global Assessment of Functioning, anymore. This number was a random, misunderstood, and capricious thing in the olden days (prior to May of 2013). But again, a little synopsis of the individual’s social functioning can serve well here, for the casual or lazy reader who is not going to bother to read the whole report and who wants to obtain all of his information about the case and the person from a quick perusal of the end.
Interest in a quantifiable global rating of functioning dates back to as early as 1962 with the publication of the Health-Sickness Rating Scale (which was rated 0 to 100) by Luborsky et al. in the paper "Clinicians' Judgements of Mental Health". This was subsequently revised in 1976 as the Global Assessment Scale (GAS) in the paper "The Global Assessment Scale:Procedure for Measuring Overall Severity of Psychiatric Disturbance" by Endicott et al. The rating scale was further modified and published as the Global Assessment of Functioning Scale in the DSM-III-R and DSM-IV. Some versions of the scale stopped at 90 as the maximum score, and others extended to 100. Because the scale was most often used with people seeking health services, it would be rare to have scores over 90, as they would indicate not just a lack of symptoms, but also "superior functioning."
In disability cases before the Social Security Administration, the agency determines if the GAF is consistent with the narrative report and it is addressed as one technique for capturing the "complexity of clinical situations.". The agency noted the GAF is just one tool used by clinicians to develop the clinical picture.
The Global Assessment of Functioning ( GAF) is a numeric scale used by mental health clinicians and physicians to rate subjectively the social, occupational, and psychological functioning of an individual , e.g., how well one is meeting various problems in living. Scores range from 100 (extremely high functioning) to 1 (severely impaired).
GAF scores were commonly used by the Veterans Benefits Administration (VBA) to help determine disability ratings for service-connected psychiatric disorders. The probative value given to GAF scores diminished since the 2013 publication of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition ( DSM-5 ), which eliminated GAF scores from the Manual's nosology because GAF scores do not demonstrate good reliability or construct validity .
Montalvo attempts to substitute "social, occupational, or school functioning" for "overall level of functioning and carrying out activities of daily living". It is possible to see the recourse of some degree of overlap because "social functioning" is arguably a subset of overall functioning and activities of daily living. However, it is arguable whether equivalence is clearly stated in DSM-IV-TR .
81 – 90 Absent or minimal symptoms (e.g., mild anxiety before an exam), good functioning in all areas, interested and involved in a wide range of activities, socially effective, generally satisfied with life, no more than everyday problems or concerns.
21 – 30 Behavior is considerably influenced by delusions or hallucinations or serious impairment, in communication or judgment (e.g., sometimes incoherent, acts grossly inappropriately, suicidal preoccupation) or inability to function in almost all areas (e.g., stays in bed all day, no job, home, or friends)
The Global Assessment of Functioning, or GAF, scale is used to rate how serious a mental illness may be. It measures how much a person's symptoms affect their day-to-day life on a scale of 0 to 100. It's designed to help mental health providers understand how well the person can do everyday activities.
The GAF is based on a scale that was first used in 1962. It's been updated over time. In 2013, the manual that psychiatrists in the U.S. use to define and classify mental disorders dropped it in favor of a scale designed by the World Health Organization.
Annals of General Psychiatry: "Global Assessment of Functioning: properties and frontier of current knowledge."