From the Guidelines
GAF, or Global Assessment of Functioning, is a numerical scale (0-100) used by mental health clinicians to rate a person's overall psychological, social, and occupational functioning. This scale is utilized to track a patient's progress over time and communicate their level of functioning to other healthcare providers 1. The GAF scale ranges from 0 to 100, with higher scores (91-100) indicating superior functioning with no symptoms, while lower scores represent increasing impairment, with scores below 30 indicating serious functional difficulties.
When using GAF, clinicians evaluate how well a person manages daily activities, maintains relationships, and handles work responsibilities, alongside the severity of their symptoms. Some studies, such as Ghaziuddin et al. (1996) and Moise and Petrides (1996), have used GAF as an outcome criterion to measure the effectiveness of treatments like electroconvulsive therapy (ECT) in adolescents with various psychiatric diagnoses 1.
Key points about GAF include:
- It is a numerical scale (0-100) used to rate psychological, social, and occupational functioning
- Higher scores indicate better functioning, while lower scores indicate more severe impairment
- The scale is used to track patient progress and communicate with other healthcare providers
- GAF was formerly part of the DSM-IV multiaxial assessment system but was replaced in DSM-5 with the WHODAS 2.0 due to concerns about reliability and the mixing of symptom severity with functional impairment in a single measure 1. Despite this change, many clinicians and institutions still use GAF because of its simplicity and familiarity.
From the Research
Definition of GAF
- The Global 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 2.
- It is used to assess the adequacy of global ratings of patients' psychosocial functioning, which are an integral part of the current system for obtaining multidimensional psychiatric diagnoses 3.
Purpose and Use of GAF
- The GAF scale is used to evaluate the level of psychosocial functioning in patients with mental disorders, including substance use disorders and psychiatric disorders 3.
- It is also used to assess the effectiveness of treatments, such as cognitive-behavioral therapy and medication, in improving psychosocial functioning in patients with mental disorders 4.
Limitations and Challenges of GAF
- Despite its widespread use, several challenges and shortcomings have been discussed regarding the GAF manual, including its conceptual and clinical value 2, 3.
- Patients' clinical diagnoses and psychiatric symptoms were found to be stronger predictors of GAF ratings than their social and occupational functioning, raising questions about the validity of the GAF scale 3.