Multiaxial Assessment

91

90

81

80

71

70

Global Assessment of Functioning (GAF) ScaleConsider psychological, social, and occupational functioning on a hypothetical con-tinuum of mental health-illness. Do not include impairment in functioning due tophysical (or environmental) limitations.

Code (Note: Use intermediate codes when appropriate, e.g., 45, 68, 72.)

100 Superior functioning in a wide range of activities, life's problems never seem toget out of hand, is sought out by others because of his or her many positive qual-ities. No symptoms.

Absent or minimal symptoms (e.g., mild anxiety before an exam), good functioningin all areas, interested and involved in a wide range of activities, socially effec-tive, generally satisfied with life, no more than everyday problems or concerns(e.g., an occasional argument with family members).

If symptoms are present, they are transient and expectable reactions to psycho-social stressors (e.g., difficulty concentrating after family argument); no more thanslight impairment in social, occupational, or school functioning (e.g., temporarilyfalling behind in schoolwork).

Some mild symptoms (e.g., depressed mood and mild insomnia) OR some difficulty in| social, occupational, or school functioning (e.g., occasionartruancy, or theft within the

61 household), but generally functioning pretty well, has some meaningful interper-sonal relationships.

60 Moderate symptoms (e.g., flat affect and circumstantial speech, occasional panic attacks)| OR moderate difficulty in social, occupational, or school functioning (e.g., few

51 friends, conflicts with peers or co-workers).

50 Serious symptoms (e.g., suicidal ideation, severe obsessional rituals, frequent shoplifting)| OR any serious impairment in social, occupational, or school functioning (e.g., no

41 friends, unable to keep a job).

40 Some impairment in reality testing or communication (e.g., speech is at times illogi-| cal, obscure, or irrelevant) OR major impairment in several areas, such as work or

31 school, family relations, judgment, thinking, or mood (e.g., depressed man avoidsfriends, neglects family, and is unable to work; child frequently beats up younger children,is defiant at home, and is failing at school).

30 Behavior is considerably influenced by delusions or hallucinations OR serious| impairment in communication or judgment (e.g., sometimes incoherent, acts grossly

21 inappropriately, suicidal preoccupation) OR inability to function in almost all areas(e.g., stays in bed all day; no job, home, or friends).

20 Some danger of hurting self or others (e.g., suicide attempts without clear expectation| of death; frequently violent; manic excitement) OR occasionally fails to maintain min-

11 imal personal hygiene (e.g., smears feces) OR gross impairment in communication(e.g., largely incoherent or mute).

10 Persistent danger of severely hurting self or others (e.g., recurrent violence) OR per-| sistent inability to maintain minimal personal hygiene OR serious suicidal act

1 with clear expectation of death.

0 Inadequate information.

The rating of overall psychological functioning on a scale of 0-100 was operationalized by Luborskyin the Health-Sickness Rating Scale (Luborsky L: "Clinicians' Judgments of Mental Health." Archivesof Genera/ Psychiatry 7:407-417, 1962). Spitzer and colleagues developed a revision of the Health-Sickness Rating Scale called the Global Assessment Scale (GAS) (Endicott J, Spitzer RL, Fleiss Ji, CohenJ: "The Global Assessment Scale: A Procedure for Measuring Overall Severity of Psychiatric Distur-bance." Archives of General Psychiatry 33:766-771, 1976). A modified version of the GAS was includ-ed in DSM-III-R as the Global Assessment of Functioning (GAF) Scale.

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Multiaxiai Aasessment

Examples of How to RecordResults of a DSM-IV Multiaxial Evaluation

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Example 1:Axis I 296.23 Major Depressive Disorder, Single Episode, Severe Without

Psychotic Features305.00 Alcohol Abuse

Axis II 301.6 Dependent Personality DisorderFrequent use of denial

Axis III NoneAxis IV Threat of job lossAxis V GAF = 35 (current)

Dysthymic DisorderReading DisorderNo diagnosisOtitis media, recurrentVictim of child neglect

GAF = 53 (current)

Example 2:Axis I

Axis IIAxis IIIAxis IV

300.4315.00V71.09382.9

AxisV

Example 3:Axis I

Axis HAxis II

Axis IVAxisV

293.83 -,Mood Disorder Due to Hypothyroidism, With DepressiveFeatures

V71.09 No diagnosis, histrionic personality features244.9 Hypothyroidism365.23 Chronic angle-closure glaucoma

NoneGAF = 45 (on admission)GAF = 65 (at discharge)

Example 4:Axis IAxis IIAxis IIIAxis IVAxisV

V61.10 Partner Relational ProblemV71.09 No diagnosis

NoneUnemployment

GAF = 83 (highest level past year)