Axis V


Axis V - Global Assessment of Functioning Scale

Axis V is part of the DSM "multiaxial" system for assessment. The five axis model is designed to provide a comprehensive diagnosis that includes a complete picture of not just acute symptoms but of the entire scope of factors that account for a patient's mental health. This page explains DSM Axis V

Axis V is for Global Assessment of Functioning (GAF), a reflection of the evaluating clinician's judgement of a patient's ability to function in daily life. The 100 point scale measures psychological, social and occupational functioning.

From a diagnostic perspective, the GAF takes a practical view of a patient's mental health. GAF ratings are not only applied to the time the patient enters the doctor's office but are applied over time to monitor progress; ratings are given for different time frames such as "current" or "past week" along with relative ratings such as "highest level in past year."

From a healthcare management perspective, the GAF provides quantifiable information that is used to measure eligibility for treatment programs, insurance benefits, disability benefits, etc.

Range of Axis V GAF ratings

The 100 point scale regardes the top rating level of 91-100 as "superior functioning," which essentially identifies a person without symptoms.

At the middle of the scale, a rating of 41-50 is for symptoms that lead to antisocial behavior (kleptomania) or social dysfunction (inability to keep a job).

The bottom of the scale, 1-10, rates those who pose a threat to themselves or others, who cannot maintain their personal hygiene, or who are suicidal - these patients are mostly dysfunctional on a daily basis and in need of serious help.

Axis V in DSM-5

The next edition of the DSM is scheduled for publication in May, 2013. Working groups are reviewing the multiaxial system to try to bring it more into line with the international reporting standards of the ICD (WHO International Classification of Diseases) with the goal of having a global approach to mental health diagnosis. Axis V is being reviewed as part of this process. The American Psychiatric Association states,

...regarding Axis V, which allows clinicians to rate a patient’s overall level of functioning, the Impairment and Disability Study Group is discussing ways in which disability and distress can be better assessed in DSM-5. They have recommended that DSM-5 more closely follow the concepts outlines in the WHO International Family of Classifications, in which disorders and their associated disabilities are conceptually distinct and assessed separately.

An example of a Five axis diagnosis

Axis V is only one of five axes used in a DSM assessment. Here is an example of a five-axis diagnosis from Substance Abuse Assessment and Diagnosis: A Comprehensive Guide for Counselors and Helping Professionals by Gerald A. Juhnke, Routledge, 2002

  • Axis I: Adjustment Disorder with Depressed Mood, Alcohol Abuse, Cannabis Abuse
  • Axis II: No Diagnosis of Axis II
  • Axis III: Hypothyroidism
  • Axis IV: None
  • Axis V: GAF = 50 (on admission), GAF = 62 (on discharge)

Related Reading

Click below to find more related articles on Axis V.


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