Global Assessment of Functioning

Abstract The Global Assessment of Functioning (GAF) is part five of the multiaxial diagnostic system for mental disorders outlined in the Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition–Text Revised (DSM-IV-TR). The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) notes the use of DSM-IV-TR in rating an individual's global functional capacity, which, like disability, is related directly to the effects of impairments. The AMA Guides, Fourth and Fifth Editions, do not provide numeric psychiatric impairment, and shortcomings plague the use of GAF to define disability—but even so, authorities ranging from the State of California to the Veterans Administration rely on GAF scores. A table shows the 100-point scale Global Assessment Scale in which higher scores indicate better functioning. The GAF has been modified to address deficiencies; a decision tree has been added and is summarized; and the editor of DSM-IV-TR has developed a computerized version that reportedly improves reliability and validity. Evaluators should bear in mind that the GAF helps evaluate the individual's functioning in three areas: psychological, social, and occupational (including the activities of daily living). The resulting score facilitates the creation of a treatment plan, evaluates its effectiveness, and predicts outcomes, but evaluators should be aware of its significant limitations.

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DSM–IV and culture: is the classification internationally valid?

Psychiatric Bulletin ◽

10.1192/pb.16.5.257 ◽

1992 ◽

Vol 16 (5) ◽

pp. 257-261 ◽

Cited By ~ 18

Author(s):

Roland Littlewood

Keyword(s):

Mental Disorders ◽

Personality Disorders ◽

Global Assessment ◽

Psychosocial Stressors ◽

Global Assessment Of Functioning ◽

Statistical Manual ◽

Diagnostic And Statistical Manual ◽

Clinical Syndromes ◽

Physical Disorders ◽

Dsm Iv

Although relatively neglected in Britain, the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders has been widely adopted in both Western and non-Western countries (Spitzer, Williams & Skrodol, 1983). The descriptive and multiaxial approach used in DSM-III (1980) and in its revised edition DSM-III-R (1987), together with the introduction of specific criteria for allocating each diagnosis, would seem particularly useful when comparing psychopathologies across societies. In addition to Axes I, II and III (Clinical Syndromes, Developmental and Personality Disorders, Physical Disorders and Conditions), the Manual has two more obviously ‘social’ axes – (IV) Severity of Psychosocial Stressors and (V) Global Assessment of Functioning.

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Revised manual for the Global Assessment of Functioning scale

European Psychiatry ◽

10.1016/j.eurpsy.2017.12.028 ◽

2018 ◽

Vol 51 ◽

pp. 16-19 ◽

Cited By ~ 6

Author(s):

G. Pedersen ◽

Ø. Urnes ◽

B. Hummelen ◽

T. Wilberg ◽

E.H. Kvarstein

Keyword(s):

Mental Disorders ◽

Global Assessment ◽

Global Assessment Of Functioning ◽

Single Measure ◽

Statistical Manual ◽

Psychosocial Impairment ◽

Diagnostic And Statistical Manual ◽

Current Article

AbstractGlobal Assessment of Functioning (GAF) is a single measure of overall psychosocial impairment caused by mental factors, constituting Axis V of the Diagnostic and Statistical manual of Mental disorders, third and fourth versions. Despite its widespread use, several challenges and shortcomings have been discussed the last three decades. The current article describes some of the more serious challenges of the GAF manual, and presents a revised version more in accordance with the nature of this clinical construct. Some crucial aspects of the understanding of GAF and general guidelines for scoring are also discussed.

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DSM-IV-TR: Diagnostic and Statistical Manual of Mental Disorders

The Encyclopedia of Cross-Cultural Psychology ◽

10.1002/9781118339893.wbeccp180 ◽

2013 ◽

pp. 445-447 ◽

Cited By ~ 2

Author(s):

Ruth Chu-Lien Chao ◽

Jessica Manita

Keyword(s):

Mental Disorders ◽

Statistical Manual ◽

Diagnostic And Statistical Manual ◽

Dsm Iv

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The biopsychosocial model, DSM, and neurobiology

Psychiatry Reborn: Biopsychosocial psychiatry in modern medicine ◽

10.1093/med/9780198789697.003.0020 ◽

2020 ◽

pp. 320-324

Author(s):

S. Nassir Ghaemi

Keyword(s):

Clinical Practice ◽

Mental Disorders ◽

Scientific Research ◽

Diagnostic System ◽

Conventional Wisdom ◽

New Approach ◽

Statistical Manual ◽

Diagnostic And Statistical Manual ◽

The Past ◽

Psychiatric Conditions

This chapter explores the need for a new approach in psychiatry other than the biopsychosocial (BPS) model, the Diagnostic and Statistical Manual of Mental Disorders (DSM), and neurobiology. Pierre Loebel and Julian Savulescu, in their introduction to this book, laid out an honourable purpose, seeking to make sense of psychiatric conditions holistically. They hoped the BPS model could serve this purpose. The model has done so in part, but also, after half a century of effort, it has failed to do so in the end. The goals are worthy and the seekers of those goals have integrity. But perhaps their intentions will be best served by something else, a successor to the past BPS model, built on a rejection of a false DSM diagnostic system as well as a purely neurobiological approach to research. In the end, what Loebel and his colleagues want to do is to preserve a place for humanism in psychiatry, and to link clinical practice to solid scientific research. These laudable principles can be achieved only by a radical departure from the DSM-based neurobiological conventional wisdom of the present and the past.

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The MIRECC Version of the Global Assessment of Functioning Scale: Reliability and Validity

Psychiatric Services ◽

10.1176/ps.2007.58.4.529 ◽

2007 ◽

Vol 58 (4) ◽

pp. 529-535 ◽

Cited By ~ 31

Author(s):

Noosha Niv ◽

Amy N. Cohen ◽

Greer Sullivan ◽

Alexander S. Young

Keyword(s):

Global Assessment ◽

Reliability And Validity ◽

Global Assessment Of Functioning ◽

Scale Reliability

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Social Anxiety and Premorbid Personality Disorders in Paranoid Schizophrenic Patients Treated With Clozapine

CNS Spectrums ◽

10.1017/s1092852900021635 ◽

2000 ◽

Vol 5 (9) ◽

pp. 29-43 ◽

Cited By ~ 9

Author(s):

Stefano Pallanti ◽

Leonardo Quercioli ◽

Adolfo Pazzagli

Keyword(s):

Social Anxiety ◽

Mental Disorders ◽

Social Phobia ◽

Personality Disorders ◽

Paranoid Schizophrenia ◽

Anxiety Symptoms ◽

Premorbid Personality ◽

Statistical Manual ◽

Diagnostic And Statistical Manual ◽

Dsm Iv

AbstractThe concept of anxiety as a distinct comorbid disorder in schizophrenia has recently been rediscovered after having been neglected for a long period of time due to both theoretical and clinical approaches adopted from the appearance of the first edition of the Diagnostic and Statistical Manual of Mental Disorders in 1950. This rediscovery was accentuated by the fact that the concept of comorbidity in various psychiatric disorders has recently won widespread favor within the scientific community, and that the use of atypical neuroleptic medication to treat patients with schizophrenia has been reported to lead to the emergence of anxiety symptoms. Of the atypical neuroleptic medications used to treat schizophrenia, clozapine has most frequently been reported to induce anxiety symptoms. In this paper, 12 cases of patients with paranoid schizophrenia who developed social phobia during clozapine treatment are reported, and their response to fluoxetine augmentation is assessed. Premorbid personality disorders were also investigated; patients were assessed using the Structured Clinical Interview for DSM-III-R—Patient Version and the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (DSM-III-R=Diagnostic and Statistical Manual of Mental Disorders, Third Edition Revised; DSM-IV=Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition). In addition, the Scale for the Assessment of Negative Symptoms, the Scale for the Assessment of Positive Symptoms, the Liebowitz Social Anxiety Scale (LSAS), the Frankfurt Beschwerde Fragebogen (Frankfurt Questionnaire of Complaints), and the Brief Psychiatric Rating Scale were used to rate clinical symptomatology. All patients were reevaluated after 12 weeks of cotreatment with clozapine and fluoxetine. In 8 (66.6%) of the 12 cases, symptoms responded (≥35% LSAS score reduction) to an adjunctive regimen of fluoxetine. Furthermore, in 7 (58.3%) of the 12 cases, an anxious personality disorder (avoidant=33.3%; dependent=25%) was identified, but no significant differences in the prevalence of comorbid personality disorders emerged in comparison with a group of 16 patients with paranoid schizophrenia treated with clozapine who did not show symptoms of social phobia. The clinical relevance of the assessment and treatment of anxiety disorders is discussed in light of a clinical therapeutic approach that overcomes the implicit hierarchy of classification. Considering that the onset of anxiety-spectrum disorders (such as social phobia) can occur during the remission of psychotic symptoms in clozapine-treated patients with schizophrenia, a comprehensive approach to pharmacological therapy for patients with schizophrenia (or, at least for those treated with clozapine) should be adopted.

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