Psychosocial functioning in the context of diagnosis: assessment and theoretical issues

Psychosocial functioning is an important focus of attention in the revision of the Diagnostic and Statistical Manual of Mental Disorders. Researchers and clinicians are converging upon the opinion that psychometrically strong, comprehensive assessment of individuals' functioning is needed to characterize disorder fully. Also shared is the realization that existing theory and research in this domain have critical shortcomings. The authors urge that the field reexamine the empirical evidence and address theoretical issues to guide future development of the construct and its measurement. The authors first discuss several theoretical issues relevant to the conceptualization and assessment of functioning: (a) definitions of functioning, (b) the role of functioning in defining disorder, and (c) understanding functioning within environmental contexts. The authors then present data regarding empirical domains of psychosocial functioning and their interrelations. Self-reported data on multiple domains of psychosocial functioning were collected from 429 participants. Factor-analytic results (promax rotation) suggest a 4-factor structure of psychosocial functioning: Well-Being, Basic Functioning, Self-Mastery, and Interpersonal and Social Relationships. Finally, the authors propose an integration of theory and empirical findings, which they believe will better incorporate psychosocial functioning into future diagnostic systems.