Clarification of the procedures for making an Axis V Global Assessment of Functioning rating
Lack of detail in the instructions regarding application of the Global Assessment of Functioning (GAF) rating have led to misinterpretations of how to apply the GAF. One source of confusion is how to operationalize the “current” time frame for the GAF. Does it strictly refer to how that patient appears and functions during the evaluation procedure? This interpretation might result in a misleadingly high GAF, given that some individuals may experience transient improvement in anticipation of receiving help. For clarity, the text now includes a sentence that states “in order to account for day-to-day variability in functioning, the GAF rating for the “current period” is sometimes operationalized as the lowest level of functioning for the past week.”
Another source of confusion involves how to integrate the potentially disparate contributions of psychiatric symptomatology and functioning to the final GAF score. For example, for a patient who is a significant danger to self (justifying a GAF below 20) but is otherwise functioning well at work and with his family (reflecting a GAF above 60), what should the final GAF be? Some GAF users mistakenly average the two together, resulting in a GAF around 40. In fact, the final correct GAF score should always reflect the lower of the two (i.e., in this case, the GAF should be below 20, despite the higher social and occupational functioning). A paragraph has been added to the GAF instructions to clarify this convention.