The Global Assessment of Functioning is a numeric scale used by mental health clinicians
and physicians to rate subjectively the social, occupational, and psychological functioning
of adults, e.g., how well or adaptively one is meeting various problems-in-living.
The scale is presented and described in the DSM-IV-TR on page 34.
The score is often given as a range.
The GAF is no longer included in the DSM-5.
The new DSM-5 includes a WHODAS outline, which takes the GAF score's place.
It is a survey and check box that is less likely to be subjective.
Development, history and exclusion from DSM-5 The DSM-IV records the development of the
GAF scale.
The beginnings of the scale started in 1962 with the publication of the Health-Sickness
Rating Scale by Luborsky et al. al in the paper "Clinicians Judgements of Mental Health".
This was subsequently revised in 1976 as the Global Assessment Scale in the paper "The
Global Assessment Scale:Procedure for Measuring Overall Severity of Psychiatric Disturbance"
by Endicorr et al.
This was further modified and published as the Global Assessment of Functioning Scale
in the DSM-III-R and DSM-IV.
The related SOFAS scale was initially described in a paper by Goldman et al. in 1992 in the
paper 'Revising Axis V for DSM-IV: A review of measures of social functioning' by Goldman
et al. and was subsequently included in the DSM-IV within the section 'Criteria Sets and
Axes Provided for Further Study'.
The SOFAS scale is similar to the GAF but only looks at social and occupational functioning
rather than symptoms, and the SOFAS is usually used to rate the current period.
In DSM-5 the multiaxial system was removed including Axis-5 disability and the DSM-5
task force recommended the GAF be dropped.
However for a measure of global disability the WHO Disability Assessment Schedule was
included in assessment measures section.
Scale 91 - 100 No symptoms.
Superior functioning in a wide range of activities, life's problems never seem to get out of hand,
is sought out by others because of his or her many positive qualities.
81 - 90 Absent or minimal symptoms, 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.
71 - 80 If symptoms are present, they are transient and expectable reactions to psychosocial
stressors; no more than slight impairment in social, occupational, or school functioning.
61 - 70 Some mild symptoms or some difficulty in social, occupational, or school functioning,
but generally functioning pretty well, has some meaningful interpersonal relationships.
51 - 60 Moderate symptoms or moderate difficulty in social, occupational, or school functioning.
41 - 50 Serious symptoms or any serious impairment in social, occupational, or school functioning.
31 - 40 Some impairment in reality testing or communication or major impairment in several
areas, such as work or school, family relations, judgment, thinking, or mood.
21 - 30 Behavior is considerably influenced by delusions or hallucinations or serious
impairment, in communication or judgment or inability to function in almost all areas
11 - 20 Some danger of hurting self or others or occasionally fails to maintain minimal
personal hygiene or gross impairment in communication.
1 - 10 Persistent danger of severely hurting self or others or persistent inability to
maintain minimal personal hygiene or serious suicidal act with clear expectation of death.
0 Inadequate information Use in litigation
Montalvo v. Barnhart, 2005 U.S. Dist.
LEXIS 44133.(RAMS 2011) Montalvo attempts to substitute “overall
level of functioning and carrying out activities of daily living” with “social, occupational,
or school functioning."
It is possible to see the possibility of some degree of overlap because "Social functioning"
is arguably a subset of overall functioning and Activities of daily living.
However, some have argued that equivalence is not clearly stated in DSM-IV-TR.
GAF levels are commonly used by the Veterans Benefits Administration of the United States
Department of Veterans Affairs in determining the appropriate level of disability compensation
to be paid to veterans who suffer from service connected psychiatric disorders.
The emphasis by the Veterans Administration on using the GAF score has, however, decreased
in recent years.
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.”
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders,
Fourth Edition, Washington, DC 1994.
The agency noted the GAF is just one tool used by clinicians to develop the clinical
picture.
It cannot be used in isolation from the rest of the evidence to make a disability decision.
Unlike the Veteran's Administration, the Commissioner of Social Security has specifically declined
to endorse the GAF scale for use in the disability programs, and has stated that the GAF scale
"does not have a direct correlation to the severity requirements in our mental disorders
listings."
Revised Medical Criterial for Evaluating Mental Disorders and Traumatic Brain Injury, 65 Fed.
Reg. 50, 746-50, 764-65 See also
Diagnostic classification and rating scales used in psychiatry
DSM-IV Codes Children's Global Assessment Scale
References ^ The Humane Guide to VA Benefits for Veterans
with PTSD Hall RC.
Global assessment of functioning.
A modified scale.
Psychosomatics. 1995 May-Jun;36(3):267-75.
PMID 7638314.
The modified Global Assessment of Functioning
scale has more detailed criteria and a more structured scoring system than the original
GAF.
External links Modified Global Assessment of Functioning
– Revised - adapted in 2004 by the Florida DCF Functional Assessment Workgroup from the
original M-GAF reported by S. Caldecott-Hazard & R.C.W.
Hall, 1995