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The Global Assessment of Functioning (GAF) is a numeric scale (0 through 100) 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 will include a WHODAS outline, which will take the GAF score's place. It is a survey and check box that is less likely to be subjective.
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 (which was rated 0 to 100) 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 (Social and Occupational Functioning Assessment Scale) 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 (WHODAS 2.0) was included in assessment measures section.
Montalvo v. Barnhart, 2005 U.S. Dist. LEXIS 44133 (W.D.N.Y. 2005).(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 (pp. 25–35). 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 (August 21, 2000)