Which is unfortunate because placement along that scale is often used to suggest satisfaction of criteria for outpatient or inpatient treatment including involuntary commitment. This is problematic because, for example, state welfare departments consider disability benefits and assisted living care availability based in part on communication of this pretty flawed assessment value.
As shown below the presentation of Axis IV assessment in the DSM-IV places patient functioning on a scale broken into deciles between 0 and 100. It's arguably an interval scale. There is nothing special here about 0 or 100. Nothing quantitative is actually being measured. Rather a clinician's imprecise and honestly somewhat subjective interpretation of the the presence, absence or severity of criteria in the different deciles is what is being displayed. You can't say that a score of 50 is better than a score of 40 in the same way that a score of 80 is better than a score of 70.
The number of criteria in each decile isn't equal, and weight can and have been applied to criteria subjectively within a decile. THis is addressed by some states who have created more detailed sub assessment within deciles.
Some states and agencies have created more detailed criteria to enable social workers to produce more reliably repeatable results. In general repeatability of scores is a problem between assessors.
A serious flaw with the assessment is that clinicians are told to read through the scale in order and stop when they reach criteria that match their client. Clinicians using this assessment get different scores when working top-down compared to working bottom-up. There is no sense of which of the different scores is more correct. The scores from the bottom-up approach produce assessments that get lower scores. Scores estimated from the top down produce higher scores. If you wanted to deny people disability benefits you'd obviously choose to make assessments from the top down. If you want to get or keep people in commitment, as a profit motivated private hospital might, you'd go from the bottom up. Some state agencies have made an effort to standardize whether the list is considered bottom to top or top to bottom, but this isn't uniform.
From DSM-IV-TR, p. 34
Code (Note: Use intermediate codes when appropriate, e.g., 45, 68, 72.)
100-91
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. No symptoms.
90-81
Absent or minimal symptoms (e.g., mild anxiety before an exam), 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 (e.g. an occasional argument with family members).
80-71
If symptoms are present, they are transient and expectable reactions to
psychosocial stressors (e.g., difficulty concentrating after family argument); no
more than slight impairment in social, occupational or school functioning (e.g.,
temporarily failing behind in schoolwork).
70-61
Some mild symptoms (e.g. depressed mood and mild insomnia)
OR some difficulty in social, occupational, or school functioning (e.g., occasional
truancy, or theft within the household), but generally functioning pretty well, has
some meaningful interpersonal relationships.
60-51
Moderate symptoms (e.g., flat affect and circumstantial speech, occasional panic
attacks)
OR moderate difficulty in social, occupational, or school functioning (e.g.. few
friends, conflicts with peers or co-workers).
50-41
Serious symptoms (e.g.. suicidal ideation, severe obsessional rituals, frequent
shoplifting)
OR any serious impairment in social, occupational, or school functioning (e.g.,
no friends, unable to keep a job).
40-31
Some impairment in reality testing or communication (e.g., speech is at times
illogical, obscure, or irrelevant)
OR major impairment in several areas, such as work or school, family relations,
judgment, thinking, or mood (e.g., depressed man avoids friends, neglects family,
and is unable to work; child frequently beats up younger children, is defiant at home,
and is failing at school).
30-21
Behavior is considerably influenced by delusions or hallucinations
OR serious impairment in communication or judgment (e.g., sometimes
incoherent, acts grossly inappropriately, suicidal preoccupation)
OR inability to function in almost all areas (e.g., stays in bed all day; no job, home,
or friends).
20-11
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 minimal personal hygiene (e.g., smears feces)
OR gross impairment in communication (e.g., largely incoherent or mute).
10-1
Persistent danger of severely hurting self or others (e.g., recurrent violence)
OR persistent inability to maintain minimal personal hygiene
OR serious suicidal act with clear expectation of death.
0 Inadequate information.
What follows is part of a modified GAF that was used in Florida. It shows how greater specification in guidance has been used to get results that are more dependably repeatable between assessors. It's apparent from the lettering of the question groups that this form is intended to be filled in from bottom to top.
Use the Criteria below to determine the individual’s current functional status, then enter rating on back of this form.
90-100
Absent or Minimal Symptoms and no Impairment in Functioning
Group H Criteria: -Minimal or absent symptoms (e.g., mild anxiety before an examination)
-Good functioning in all areas and satisfied with life
-Interested and involved in a wide range of activities
-Socially effective
88-90
No psychological symptoms and no problems of living or functioning
84-87
Minimal symptoms and no everyday problems
81-83
Minimal symptoms and some everyday problems
80
Some Transient Mild Symptoms or temporary Mild Impairment in Functioning
Group G Criteria: -Mild symptoms are present, but they are transient and expectable reactions to psychosocial stressors (e.g., difficulty concentrating after family argument).
-Slight impairment in social, work, or school functioning (e.g., temporarily falling behind in school or work).
78-80
EITHER mild symptom(s) OR mild impairment in social, work or school functioning
74-77
Mild impairment in more than one area of social, work or school functioning
71-73
BOTH mild symptoms AND slight impairment in social, work & school functioning
70
Some Persistent Mild Symptoms or persistent Mild Impairment in Functioning
Group F Criteria: -Mild symptoms are present that are NOT just expectable reactions to psychosocial stressors (e.g., mild or lessened depression and/or mild insomnia)
-Some persistent difficulty in social, work or school functioning (e.g., occasional truancy, theft within the family, or repeated falling behind in school or work)
-But has some meaningful interpersonal relationships
68-70
EITHER mild persistent symptoms OR mild difficulty in social, work, or school functioning
64-67
Mild persistent difficulty in more than one area of social, work or school functioning
61-63
BOTH mild persistent symptoms AND some difficulty in social, work, and school functioning
60
Moderate Symptoms or Moderate Impairment in Functioning
Group E Criteria: -Moderate symptoms (e.g., frequent, moderate depressed mood and insomnia and/or moderate ruminating and obsessing; or occasional anxiety attacks; or flat affect and circumstantial speech; or eating problems and below minimum safe weight without depression).
58-60
EITHER moderate depressed mood, symptoms OR moderate difficulty in social, work, or school functioning
54-57
Moderate difficulty in more than 1 area of social, work or school functioning
51-53
BOTH moderate symptoms AND moderate difficulty in social, work, and school functioning
50
Some Serious Symptoms or Serious Impairment in Functioning
Group D Criteria: -Serious impairment with work, school or housework if a housewife or househusband (e.g., unable to keep job or stay in school, or failing school, or unable to care for family and house)
-Frequent problems with the law (e.g., frequent shoplifting, arrests) or occasional combative behavior
-Serious impairment in relationships with friends (e.g., very few or no friends, or no current friends)
-Serious impairment in judgment (including inability to make decisions, confusion, disorientation)
-Serious impairment in thinking (including constant preoccupation w/thoughts, distorted body image, paranoia)
-Serious impairment in mood (including constant depressed mood plus helplessness and hopelessness, or agitation, or manic mood)
-Serious impairment due to anxiety (panic attacks, overwhelming anxiety)
-Other symptoms: some hallucinations, delusions, or severe obsessional rituals
-Passive suicidal ideation
48-50
1 of the criteria in Group D
44-47
2 of the criteria in Group D
41-43
3 of the criteria in Group D
= new reply since forum marked as read
while in our time it is seen as a result of attempting to be ultra-thin like runway models.
