Reliability and validity of DSM-IV axis V

Objective: The authors investigated the reliability and convergent and disc riminant validity of the DSM-IV Global Assessment of Functioning Scale and two experimental DSM-IV axis V global rating scales, the Global Assessment of Relational Functioning Scale and the Social and Occupational Functioning Assessment Scale. Method: Forty-four patients admitted to a university-based outpatient commu nity clinic were rated by trained clinicians on the three DSM-IV axis V sca les. Patients also completed self-report measures of DSM-IV symptoms as wel l as measures of relational, social, and occupational functioning. Results: The Global Assessment of Functioning Scale, Global Assessment of R elational Functioning Scale, and Social and Occupational Functioning Assess ment Scale all exhibited very high levels of interrater reliability. Factor analysis revealed that the Global Assessment of Relational Functioning Sca le and the Social and Occupational Functioning Assessment Scale are each mo re related to the Global Assessment of Functioning Scale individually than they are to each other. The Global Assessment of Functioning Scale was sign ificantly related to concurrent patient responses on the SCL-90-R global se verity index. The Social and Occupational Functioning Assessment Scale was significantly related to concurrent patient responses on the SCL-90-R globa l severity index and to a greater degree with both the Social Adjustment Sc ale global score and the Inventory of Interpersonal Problems total score. A lthough the Global Assessment of Relational Functioning Scale was not signi ficantly related to any of the three self-report measures, it was related t o the presence of clinician-rated axis II pathology. Conclusions: The three axis V scales can be scored reliably. The Global Ass essment of Relational Functioning Scale and the Social and Occupational Fun ctioning Assessment Scale evaluate different constructs. These findings sup port the validity of the Global Assessment of Functioning Scale as a scale of global psychopathology; the Social and Occupational Functioning Assessme nt Scale as a measure of problems in social, occupational, and interpersona l functioning; and the Global Assessment of Relational Functioning Scale as an index of personality pathology. The authors discuss further refinement and use of the three axis V measures in treatment research.