Functioning 2026041702– By Keith Torkelson MS, BS

 

How is it continue GAF?
 
Associated Documents
Assess_Self_Care_Value_16101713_WHODAS V2025
01_Assess_SOFAS_15081003_Support V2025
 
Results Up Front
 
Scores by and for Keith “Buster” Torkelson MS, BS
In Real Time – 100 MAX
Various Functioning Scores

First Some Housekeeping

Sourcing – Generative AI

Does Generative AI Plagiarise?

>AI or generative AI creates material without sourcing each line.  In this way, AI paragraphs are plagiarized.  Because you don’t create the work yourself, you may also be plagiarising.  We feel that in the future, policies are going to change regarding quoting AI with citations. In our reports, we provide enough citation material so that the reader can find the reference.  There will be four categories of material:  Referenced material, AI-generated material, ghostwritten material, and original work.  How is it that AI retaining material word-for-word is beneficial?  AI is beneficial in incidences that the original material you authored is less comprehensible than the AI material.  In our newer publications, we put the AI-generated text and other reference material in italics.  Part of this paragraph was paraphrased, and part of it is original work.  We are going to let Papersowl the free plagiarism checker, have a shot at evaluating this paragraph.  Of course, if we were submitting this report for academia it would all be paraphrased or original with the proper credit, AKA proper citations. One of the reasons why AI is considered beneficial is that it can save time.  Using material generated by AI is highly efficient. 

https://papersowl.com/free-plagiarism-checker

Generative AI Plagiarises - Provides No Sources
Plagiarism and Generative AI - AI Tools and Resources
University of South Florida
https://guides.lib.usf.edu/AI/plagiarism
Oct 2, 2025

>In its’ current incarnation, Google Generative AI does not source the material it assembles and outputs to you.  Online, there is much discussion about cheating and plagiarism.  At its’ core, that is what AI is all about!  Efficiency.  We call the material that a particular query yields a “Hitpage”.  If the consensus was to do it old school, then on the given hitpage, they should not put the AI material first.  On your hit page, the first material might best be all the reference material that the AI used in the summary.  To make the most out of AI we need to approve free usage when the assignment is not for academic purposes.  The AI summary might best be moved down the hitpage.  Another source suggests assuming AI generative content is your ghost writer.  AI generates new images and text.  Remember, whatever rubric criteria the instructor and institution delineate takes precedence over anything we say.  This paragraph was original work.  For years, we have preferred original work.  This generative AI thing is going to have far-reaching consequences.  One last thing, each AI-generated result should be time-stamped.

Content - Can GAF scores be converted to SOFAS scores?

Yes, GAF and SOFAS scores can be converted to each other through a process called equipercentile linking, as they have been found to be highly correlated. This conversion method is used in research to compare data from studies that used different scales, acknowledging that they measure similar aspects of a person's functioning.

Equipercentile Linking

Equipercentile linking is a psychometric method used to equate or link different tests by finding scores on each test that have the same percentile rank, allowing them to be considered equivalent. This method is useful for comparing scores from different test forms, creating conversion tables, and adjusting for differences in test difficulty, especially when the score distributions are non-linear or not normally distributed. It involves creating a common measurement scale by matching scores that correspond to the same percentile.

Improvement

>Periodically, Buster has been evaluated by professionals about his functioning and the severity of his symptoms.  Functioning can be reported as Global Assessment of Functioning (GAF).  GAFs appear to have been phased out with the DSM5.0.  The people in the know recommend the WHO Disability Assessment Schedule (WHODAS 2.0) and or the Social and Occupational Functioning Assessment Scale (SOFAS).  Some sources say the three scores: GAF, SOFAS, and WHODAS are interchangeable.  Other sources say they aren’t.  We will say they are interchangeable.  On June 7, 2012, a professional evaluated Keith “Buster” Torkelson’s GAF.  Bum-Soo Lee, MD, gave Buster a GAF of 35/45.  It was in a hospital setting, and Buster only goes to the hospital when he is gravely ill or gravely disabled.  In 2022, Buster self-scored with a GAF of 51-60.  On October 15, 2025 (W), Dr. Rimal B. Bera, MD, gave Buster a GAF of 78.  Without going back to school full-time or working full-time Buster’s GAF really can’t improve.

Extended GAF Results (17 Items)
GAF Extended Derivation – Using Charlie Mack (DOM) as a Model
DOM = Dying Old Man
Sample of Data

Insert Charley Mack Photos

Determining the Dying Old Man (DOM) cutoff with functioning

>Until now, in this document, there is no assessment to evaluate at what point a male human begins to die.  Here we introduce our applied Extended GAF Results 17 Items measurement tool. 

We set the cutoff at 33% functionality, where higher scores are favorable.  Is being bedridden in a skilled nursing facility really living?  We use our derived assessment tool to be as objective as possible.  As you age above 65, it is hard to gain ground with your functionality.  Charlie Mack, above, had to have his leg cut off.  Physically, he was dying, yet mentally, he was in pretty good shape,

What is the difference between physically dying and mentally dying?

Physical death is the irreversible cessation of vital bodily functions, such as heartbeat and respiration, leading to the body's decomposition. Mental death, also known as "psychic death" or "giving up," is a loss of will to live that can occur due to severe trauma or emotional despair, and can precede or even contribute to physical death. The key difference is that physical death is a biological event, while mental death is a psychological one.

List of Dying Old Men (DOM) and Died Too Young (DTY) - Sample

HM = Home Mate | RM = Room Mate | FAM = Family | NB = Neighbor | SP = Service Partner

GAF Extended Derivation – Using DOM Charlie Mack (17 Items)
Self-score for Keith “Buster” Torkelson MS

DOM = Dying Old Man | RT = Real Time

GAF Extended Derivation – Using Charlie Mack (17 Items)
Buster Scores Buster

ADL Assessment

Associated with Activities of Daily Living

Functioning

20120607-Bum Soo Lee, MD reports functioning/symptom severity = 35/45
Taken from Medical Record
High Scores are Favorable
We assume this score is 35 for functioning and 45 for symptom severity
 

Interpretation

Reference - Level of Functioning

Reference - Symptom Severity

WHO-DAS and Segueing into SOFAS
High Scores Indicate – Better Functioning
Normal Cutoff – Predict 80
Assessment = Global Assessment of Functioning - Items = 1 x 10 ranges
Score MAX = 100

Aside - DIG OUT BSL Western Med Anaheim RECORD

Translating Legacy GAF Scores to SOFAS

Global Assessment of Functioning for Older Adults

Assessing a older adult's global functioning involves looking at their mental, social, and physical capabilities using tools like the World Health Organization Disability Assessment Schedule (WHODAS), which replaced the Global Assessment of Functioning (GAF) scale in the DSM-5. A comprehensive geriatric assessment is also recommended, as it provides a more detailed and structured evaluation of an older adult's functional abilities, cognitive status, and overall well-being through a team-based approach.

Why WHODAS doesn’t substitute for a GAF or SOFAS score?

WHODAS does not substitute for GAF or SOFAS because they measure different things and have different goals; the WHODAS 2.0 was designed to be a measure of disability, while GAF measured both symptoms and functioning, and SOFAS specifically assesses social and occupational functioning. While the GAF has been removed from the DSM-5 due to issues with reliability and its conflation of symptoms and functioning, the WHODAS 2.0 is recommended as a replacement measure for assessing disability. However, GAF and WHODAS are not directly interchangeable, and SOFAS may still be used for its specific focus on social and occupational roles.

Metadata > Combined Scores
GAF_14010603_Tracker_DAG V2017-Results
BND_GAF_14010603_Tracker_DAG V2017-Results
 
Global Assessment of Functioning (GAF) – Axis V – History
Ratings from professionals are recorded in Medical Records
Personal Health Record

Last Reviewed: 20251105-W:

Table of GAF Scores for Keith E Torkelson (2011-2025)

GAF Score Directly Equal Percent of Functioning

Note - When no score is reported, we apply our Extended GAF
SOFAS After GAF

2014 DSM Changes – Apply SOFAS

Is the Global Assessment of Functioning (GAF) being used?

No, the Global Assessment of Functioning (GAF) is not being used in the latest edition of the diagnostic manual, the DSM-5, but it is still used in some clinical and research settings. The GAF was removed from the DSM-5 because of issues with its reliability and clinical utility, and the manual now recommends that clinicians use the World Health Organization Disability Assessment Schedule (WHODAS 2.0) instead.

Doctor’s still use the Global Assessment of Functioning

While the Global Assessment of Functioning (GAF) scale was officially removed from the DSM-5 in 2013 due to21 lack of conceptual clarity and poor reliability, it is still used by some doctors, particularly in insurance, legal, and veteran affairs (VA) contexts to track treatment progress, determine disability benefits, and evaluate mental health severity.

Can you use the SOFAS instead of the GAF?

Yes, the SOFAS (Social and Occupational Functioning Assessment Scale) can be used instead of the GAF (Global Assessment of Functioning) because research shows they are "practically exchangeable" and have strong correlations. The main difference is that SOFAS separates symptom assessment from functioning assessment, providing a more detailed view of a person's social and occupational performance without being confounded by their symptoms. The GAF has also been removed from the DSM-5 and replaced with the WHODAS 2.0, but the SOFAS remains a valid alternative for measuring functioning.

Doctor Commentary
2014 – Bum Soo Lee, MD, says, “You look better.”
2016 – Bum Soo Lee, MD, says, “You would make a good doctor.”
Date Unknown – Bum Soo Lee, MD says, “You are a nice guy.”
2018 – Graduate from BSL MD (2017) to RBB MD (2018)

FYI - 1989 – Arnold P Deutsch, MD, approves Buster’s return to Veterinary School.  Buster demonstrated Resilience.  Buster returns to Veterinary School, making grades as a full-time student for two quarters.

FYI > SOFAS = Social and Occupational Functioning Assessment Scale

https://static1.squarespace.com/static/5a0df2b3692ebe9b1a7973e0/t/5bd23d67104c7bbae6aa4a29/15405049361

SOFAS stands for Social and Occupational Functioning Assessment Scale. It is a global rating scale, ranging from 0 to 100, used to assess a person's social and occupational functioning, independent of their overall psychological symptom severity. The scale considers impairments caused by both physical and mental health issues and was developed as an alternative to the Global Assessment of Functioning (GAF) Scale, which was formerly part of the Diagnostic and Statistical Manual of Mental Disorders (DSM).

Equipercentile linking of scales measuring functioning and symptoms: Examining the GAF, SOFAS, CGI-S, and PANSS

https://www.sciencedirect.com/science/article/abs/pii/S0924977X14002430

By MT Samara · 2014 · Cited by 84

Derived from Abstract

>This document discusses managing assessment results as percentiles so they can be compared with each other as if Apples to Apples.  The four assessments evaluated were the Global Assessment of Functioning (GAF), Clinical Global Impressions Scale (CGI), Positive and Negative Syndrome Scale (PANSS), and Social and Occupational Functioning Assessment Scale (SOFAS).  In the study, they collected data five times: Baseline and at 6, 12, 18, and 24 months.  GAF and SOFAS are negatively correlated with PANSS and CGI. In other words, high GAF scores are associated with low PANSS scores.  The study evaluated 1208 patients with schizoid features.  The study includes a conversion table.  This paragraph was completely original, yet the checker said it is only 76.1% original.  Therefore, we reworked it.

For the above paragraph

https://papersowl.com/free-plagiarism-checker

Workability Assessment Inventory

The Work Ability Index (WAI) is a widely used questionnaire that assesses a worker's capacity to perform their job, considering health status, resources, and job demands. Ranging from 7 to 49 points, it categorizes work ability into four levels—poor, medium, good, or very good—to guide occupational health interventions and support.

20181010-W: Inspected & Corrections Made
Measures Employability 11 Item Screener

Consumer = Keith “Buster” Torkelson

Last Reviewed: 20260415-W:

Table – Work Ability Scores (WAS) for Work Ability Screener (MSG, 2010)

Appendix

GAF Related Documents

Functioning 2026041601– By Keith Torkelson MS, BS

 

Contents

• Codes
• GAF Summary - Data
• Development Stream
• Dis-functioning and Mal-Behavior Score 10 Items (LSF)
• Social Behavior Benefit Status Score 15 Items (HSF)
• Content
• Timeline – Key Events & Major Milestones
• Signs & Symptoms Screener 9 Items (LSF)
• Severity of Symptoms Qualitative
• Content
• Functionality Comparison
• Excerpts from 2 Articles

Note
20170602-F: Copied as whole into: Assess_GAF_17060204_Results
 
Global Assessment of Functioning (GAF) – Axis V – History
Result - Functioning/Severity of Symptoms

Date	Eligible Professional	Result	Note
2011 AVG	Alan Vu, MD	60/65	Registered student @ Cypress College, Outcome 4.0 GPA
201201			Non-sleep Able Environment Cascade Begin Catastrophic Losses
20120319	HCA: Wilfert, MFT II	40/NR
20120420	Ravinder Singh, MD	30/NR
201205	“Doctor” Daniels		Temp practitioner Fails to sustain Clozapine
20120518	Thymes, MD ER Doctor	NR	Not Reported
20120607	Bum-Soo Lee, MD	35/45	Western Med Anaheim Prescribes Restoril to compensate for no Clozapine
During 2012	Unknown		SSA Declares Lower Functioning & Cannot manage money
2013 May	DSM Changes		GAF Dropped
During 2014	Bum Soo Lee, MD		“You look better” “You are a nice guy”
20160815	Self-Score	70/NR
2018	Rimal B Bera MD		New doctor does not report GAF, SOFAS or WHODAS
20251015	Rimal B Bera MD	78/NR	Asked him to report

 

Table of GAF Scores for Keith E Torkelson (2011-2025) – Last Updated and Reviewed: 20260415-W:

Shared In
05_Daily_Assess_Satisfaction_18081301_OCHCA
GAF (MSG) Adaptation - Impairment Summary (GAF-MSG-Beta 9 Item Screener)

 

Assessment Considerations

 

• GAF
• GAF Derivations
• SOFAS
• WAI
• WHODAS

 

Quantifying Gains and Losses

Impact of Losses versus Gains

Losses have a greater psychological impact than gains, a concept known as loss aversion, where the pain of losing is often twice as intense as the pleasure of winning. While gains feel good, losses drive stronger emotional responses, often causing people to act conservatively to avoid losses, even at the cost of potential gains.

Development Stream

Table - Behavior Inventory – Functionality
GAF (MSG) Adaptation
Dis-function Assessment 10 Item Screener
Buster Evaluating Buster

20200406-M: Low Scores are Favorable

Progress setting things Right

Progress setting things right is characterized as a process of continuous, incremental improvement rather than a single, perfect leap. It involves taking "messy action" to correct mistakes, learning from failures, and focusing on consistent forward motion over perfect execution.

Baseline for Corona Scare

As of April 2026, COVID-19 shows low, stable activity with nationwide declines in infections, though it remains a lingering threat with seasonal surges. Over 99% of the U.S. population has some immunity, meaning the virus generally causes less severe illness than at its peak, shifting the focus to protecting high-risk individuals.

Metadata > [ORIGIN]
04_Case_Study_Mikel_Roby_19052901_Notes I
13_Media_Case_Mikel_Profiling_19081202_Working V2020
 
Table - Behavior Inventory
Social Behavior Benefit Inventory 15 Items (Functionality)
HSF = High Scores are Favorable
Buster scores Buster

First Generated: 20190814-W: 20200406-M: Baseline before Corona Threat

Catastrophic Baseline at time of catastrophic losses

A "catastrophic baseline" at the time of catastrophic losses refers to the new, elevated level of expected losses that insurance companies and risk managers must now use for forecasting, as historical averages are no longer adequate to predict the frequency and severity of modern disaster events.

A Medical Necessity

Medical necessity refers to healthcare services or supplies needed to prevent, diagnose, or treat an illness, injury, or its symptoms, adhering to generally accepted standards of medical practice. It must be clinically appropriate in type, frequency, and duration, and not primarily for the convenience of the patient or provider.

Meaningful Engagements

Meaningful engagement is the respectful, equitable, and active inclusion of individuals—particularly those with lived experience—in decision-making processes, shifting power from institutions to people to improve outcomes. It transforms participation from passive consultation into collaborative, purpose-driven action that values diverse expertise, fosters trust, and builds relationships.

Aside - Impact of Corona Scare

The "corona scare" (COVID-19 pandemic) caused a 25% increase in global prevalence of anxiety and depression, driven by isolation, fear of infection, and financial stress. It profoundly impacted mental health, particularly among women, youth, and healthcare workers, while triggering massive economic disruptions and a shift to virtual communication.

Life-Long-learner

Graduate Programs ...A lifelong learner is an individual who voluntarily and continuously pursues knowledge for personal or professional growth, driven by curiosity rather than necessity. This mindset embraces learning as a lifelong journey, utilizing both formal education and informal experiences to adapt to change.

Aside - 20190812-M: Update in the face of Mikel

GAF Interpretation

71-80

If symptoms are present, they are transient and expectable reactions to psychosocial stressors (e.g., difficulty concentrating after family argument); no more than slight impairment in social, occupational or school functioning (e.g., temporarily failing behind in schoolwork).

61-70

Some mild symptoms (e.g. depressed mood and mild insomnia) OR some difficulty in social, occupational, or school functioning (e.g., occasional truancy, or theft within the household), but generally functioning pretty well, has some meaningful interpersonal relationships.

Catastrophic Loss as Indicated by Global Assessment of Functioning (GAF)

A Global Assessment of Functioning (GAF) score of 40 or below indicates severe, catastrophic impairment in functioning, social, or occupational areas. Scores in the 1–30 range suggest severe danger of harm to self/others, inability to communicate, or gross impairment in daily living, often requiring hospitalization.

Catastrophic Loss as Indicated by Incarceration

Incarceration represents a catastrophic loss, causing profound, long-lasting damage to individuals, families, and communities, often creating "collateral consequences" that extend far beyond the initial sentence. It results in severe mental health deterioration, such as PTSD and depression, economic ruin, broken family bonds, and lost opportunities for housing and employment.

DSM-5

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) is the standard classification of mental disorders used by mental health professionals in the U.S. and worldwide, published by the American Psychiatric Association (APA). It provides a common language for diagnosis, outlining criteria for each disorder to improve consistency in clinical practice, research, and insurance. The most current version is the DSM-5-TR (Text Revision), published in 2022, which includes updates and clarifications to the original DSM-5.

SOFAS

The Social and Occupational Functioning Assessment Scale (SOFAS) is a 1-100 clinician-rated scale measuring an individual's level of social, occupational, and school functioning, specifically excluding the severity of psychological symptoms. It was derived from the GAF scale, with higher scores (91–100) indicating superior functioning and lower scores (1–10) indicating severe impairment.

WHODAS

WHODAS-The World Health Organization Disability Assessment Schedule (WHODAS 2.0) is a 12- or 36-item tool used to measure health and disability across six functional domains (cognition, mobility, self-care, getting along, life activities, and participation). It assesses difficulty over the past 30 days, producing a score from 0 to 100.

Retirement of the GAF

The Global Assessment of Functioning (GAF) scale was officially removed from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), released in 2013. It was replaced due to concerns regarding its conceptual clarity, questionable reliability, and lack of clear guidelines for use in clinical practice.

Workability Assessment Index

The Work Ability Index (WAI) is a validated questionnaire-based tool used to assess an employee's perceived ability to perform their job, considering health, mental resources, and job demands. Developed by the Finnish Institute of Occupational Health, it rates work capacity on a 7–49 point scale, categorizing results from "poor" to "excellent" to guide occupational health interventions.

 

What is the hallmark of a mental health episode?

The primary hallmark of a mental health episode, particularly a psychotic episode, is a loss of contact with reality. During this time, a person's thoughts and perceptions are severely disturbed, making it difficult for them to distinguish what is real from what is not.

Does hospitalization delineate a mental health episode?

Yes, hospitalization is generally considered a definitive marker of an acute, severe mental health episode. It serves as a clinical threshold indicating that an individual's symptoms have become too severe for outpatient management, posing a safety risk to themselves or others, or resulting in an inability to function.

Reality Testing Intact

Intact reality testing is the psychological ability to accurately distinguish between internal mental experiences (thoughts, feelings, perceptions) and external reality. It involves recognizing hallucinations or delusions as false and maintaining an accurate, logical orientation to the world.

Matrix - Severity of Symptoms – Tracker

“How are your symptoms”?

Table – Severity of Symptoms for Keith E Torkelson

Notes - 20140311 – TU – Appointment w/BS Lee MD
GAF - NSR = Not Spontaneously Reported
About Moving > “It is up to you”
Wellbutrin PRN trial denied
“How Satisfied Are You” Assessment Results
201606 – Titration off Ativan

Matrix - Severity of Symptoms – Tracker - Qualitative
“How is your situation”?
20160811-TH:

 FYI - HRE = Health Related Engagements

 

How is it treatment days?

Treatment days, particularly for cancer or chronic illness, are structured in cycles consisting of active treatment (drugs or therapy) followed by a rest period, designed to manage disease while allowing the body to recover. They can last from a few hours to a full day, often involving procedures like chemo infusions, with side effects, such as fatigue and nausea, that can develop in the days following.

FYI - What Is the Global Assessment of Functioning (GAF) Scale?
Written by Matt Smith - Medically Reviewed by Smitha Bhandari, MD on January 16, 2025
https://www.webmd.com/mental-health/gaf-scale-facts
 
FYI
https://iaap.org/wp-content/uploads/2020/01/GAF-Scale.pdf

GAF = Global Assessment of Functioning - Interpret Range 51–60

Moderate symptoms (e.g., flat affect and circumlocutory speech, occasional panic attacks) or moderate difficulty in social, occupational, or school functioning (e.g., few friends, conflicts with peers or co-workers).

Range 71-80

If symptoms are present, they are transient and expectable reactions to psychosocial stressors (e.g., difficulty concentrating after family argument); no more than slight impairment in social, occupational or school functioning (e.g., temporarily failing behind in schoolwork).

 

Aside - SOFAS - Social and Occupational Functioning Assessment Scale

http://www.kenniscentrum-kjp.nl/app/webroot/files/tmpwebsite/Downloadable_PDFs_Instrumenten/sofas.pdf

71-80

Slight impairment in social, occupational, or school functioning (e.g. infrequent interpersonal conflict, temporarily falling behind in schoolwork).

51-60

Moderate difficulty in social, occupational, or school functioning (e.g., few friends, conflicts with peers or co-workers).

41-50

Serious impairment in social, occupational, or school functioning (e.g., no friends, unable to keep a job)

Case Study
Work Done > Metadata >
https://housingadvisoryboard.blogspot.com/2019/08/mikel-roby-casestudy-by-msg-and.html
 
FYI - [PDF] - Global Assessment of Functioning (GAF) Scale
https://www.albany.edu/counseling_center/docs/GAF.pdf

Global Assessment of Functioning (GAF) Scale. (From DSM-IV-TR, p. 34.)

Consider psychological, social, and occupational functioning on a hypothetical continuum of mental health-illness. Do not include impairment in functioning due to physical (or environmental) limitations.

Behavior Inventory – GAF Driven - Functionality

Behavior is considerably influenced by delusions or hallucinations OR serious impairment in communication or judgment (e.g., sometimes incoherent, acts grossly inappropriately, suicidal preoccupation) OR inability to function in almost all areas (e.g., stays in bed all day; no job, home, or friends).

QSM GAF (Mikel Roby)
20190812-M: Offering GAF = 30 at best
We had high expectations for Mikel.

Associated Documents > Metadata >

GAF_14010603_Tracker_DAG V2019-Results

20190812-M: Functionality Comparison

Having a Low Functioning Roommate

To handle a roommate with low functioning abilities, communicate openly, be patient, and set clear expectations while focusing on their well-being. You can try to be more patient with their processing time and communication style, offer support without being patronizing, and address any specific issues directly and calmly using "I" statements. If the situation is unsustainable, you may need to have a broader conversation about the experience or speak to a university or accommodation authority.

From > Metadata >
ParaSocial_Surveying_Ref2008082102 v2016
The actual process of rating the global assessment of functioning scale .  K . Yamauchi
Comprehensive Psychiatry - Volume 42, Issue 5, September 2001, Pages 403–409
http://linkinghub.elsevier.com/retrieve/pii/S0010440X01415586
Copyright © 2003 Elsevier Inc. All rights reserved.

Abstract

GAF & Others

The Global Assessment of Functioning Scale (GAF) was developed for the overall assessment of psychological, social, and occupational functioning. While the advantage of the GAF lies in this comprehensiveness, questions have been raised on whether clinicians rate appropriately. To clarify this issue, the actual process of how clinicians assign GAF scores was investigated. A total of 2,462 inpatients of 19 psychiatric hospitals in Japan were assessed by their primary psychiatrists using the following rating scales: GAF, Brief Psychiatric Rating Scale (BPRS), World Health Organization Psychiatric Disability Assessment Schedule (DAS), and physical Activities of Daily Living (ADL) index.

Aside - Functioning and Severity of Symptoms

A tree-based model analysis (also referred to as Automatic Interaction Detector [AID] or Classification and Regression Tree [CART]) was used to construct a statistical model with the GAF score as the dependent variable. The statistically best-fitted tree to predict the GAF score is as follows. The first split is based on the “conceptual disorganization” score in the BPRS, followed by splits based on DAS item scores, such as “conversation” and “underactivity.” The tree model obtained suggests that Japanese clinicians judge the level of global functioning by integrating the information on both the severity of psychiatric symptoms and the level of impaired behaviour and social functioning. This logic structure was clinically acceptable and agreed well with the concept of the GAF.

From > Metadata >
HHS_Measures_GAF_Ref_20090822b V2020
 
Evidence for limited validity of the revised global assessment of functioning scale
https://www.ncbi.nlm.nih.gov/pubmed/8837160
by P Roy-Byrne - ‎1996 - ‎Cited by 126
Psychiatr Serv. 1996 Aug;47(8):864-6.
P Roy-Byrne, C Dagadakis, J Unutzer and R Ries
Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA

The study examined the concurrent validity of the revised Global Assessment of Functioning (GAF) scale, which is highly similar to the Social and Occupational Functioning Assessment Scale (SOFAS) in DSM-IV and which is designed to measure patients' functioning and not their clinical symptoms. Psychiatrists used the revised GAF to rate 337 psychiatric inpatients; the ratings were compared with nurses' ratings of the same sample using Lehman's Quality of Life Scale. Ratings on the revised GAF were most strongly correlated with ratings of clinical symptoms, not functioning. Reliance on the GAF as the only tool to assess patients' functioning may be problematic.

Summary

>As of May 2026, we are retiring our efforts around Functioning.  We will continue our work on Competency in the face of end-of-life planning.  In the end, we accept the GAF score that Rimal B. Bera, MD assigned us.  Buster is 67 now and does not foresee any significant improvement in his GAF and SOFAS.  Buster is relatively well off compared to his 2024-2026 Harvest Retirement cohort.  Buster still drives the car and is satisfied with his current living arrangement.