Reliability and validity of DSM-IV axis V

Area of Science:

• Psychiatry and Mental Health Assessment
• Psychometric Validation
• Clinical Psychology

Background:

• The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) Axis V includes global assessment scales crucial for evaluating patient functioning.
• Assessing reliability and validity of these scales is essential for accurate clinical diagnosis and treatment planning.

Purpose of the Study:

• To investigate the reliability and convergent and discriminant validity of the DSM-IV Global Assessment of Functioning Scale (GAF).
• To evaluate two experimental DSM-IV Axis V scales: the Global Assessment of Relational Functioning Scale (GARF) and the Social and Occupational Functioning Assessment Scale (SOFAS).

Main Methods:

• Forty-four outpatients at a university clinic were rated by clinicians using the three DSM-IV Axis V scales.
• Patients completed self-report measures assessing DSM-IV symptoms and relational, social, and occupational functioning.

Main Results:

• All three scales (GAF, GARF, SOFAS) showed very high interrater reliability.
• Factor analysis indicated GARF and SOFAS measure distinct constructs, each more related to GAF individually than to each other.
• GAF correlated with SCL-90-R global severity; SOFAS correlated with SCL-90-R, Social Adjustment Scale, and Inventory of Interpersonal Problems.
• GARF showed a significant relationship with clinician-rated Axis II pathology but not with self-report measures.

Conclusions:

• The three Axis V scales are reliably scored.
• GARF and SOFAS assess different constructs, supporting their distinct validity.
• Findings support GAF for global psychopathology, SOFAS for social/occupational/interpersonal issues, and GARF for personality pathology.
• Further refinement and use of these scales in treatment research are discussed.