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Am J Psychiatry 1992; 149:1148-1156
Copyright © 1992 by American Psychiatric Association
Revising axis V for DSM-IV: a review of measures of social functioning
HH Goldman, AE Skodol and TR Lave
Department of Psychiatry, University of Maryland School of Medicine, Baltimore 21201.
OBJECTIVE: Axis V, which uses the Global Assessment of Functioning Scale in
the multiaxial system of DSM-III-R, is under review for DSM- IV. This
article examines what is known about axis V and selectively reviews the
literature on measures of social functioning to identify potential
alternatives to the Global Assessment of Functioning Scale. METHOD: About
25 studies on the use, reliability, and validity of axis V in DSM-III and
DSM-III-R are reviewed. In addition, nearly 30 measures of social
functioning are reviewed and analyzed as potential substitutes for the
Global Assessment of Functioning Scale. The analysis focuses on the
strengths and weaknesses of each measure for assessing functioning on axis
V. RESULTS: Axis V measures are modestly reliable and valid but not widely
used. The authors identify and discuss two particular limitations of the
Global Assessment of Functioning Scale: 1) the combination of measures of
symptoms and measures of social functioning on a single axis and 2) the
exclusion of physical impairments from the rating of functioning.
CONCLUSIONS: None of the measures of social functioning reviewed is clearly
superior to the Global Assessment of Functioning Scale for use on axis V. A
modified version of the Global Assessment of Functioning Scale, separating
the measures of social and occupational functioning from the measures of
symptoms and psychological functioning, is proposed for field testing,
along with a new set of instructions permitting the rating of limitations
due to both physical and mental impairments.
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