During a recent hospitalization, the usual assessment was made of my loved one's progress. The report included the "multiaxial" system for assessment found in the Diagnostic and Statistical Manual of Mental Disorders. The latest version is the DSM-V - the current edition published in 2013. Interestingly, the multiaxial system was dropped from the DSM-V. Here is a link to the history and discussion about the DSM-V and the multiaxial system.
As part of this update to DSM-V, a new scale was developed called the World Health Organization Disability Assessment Schedule 2.0. Here is a link to this scale. It's not clear to me that this new scale gets at what is on a person's mind although the questions do investigate a person's ability to function.
Since the multiaxial system is still in use here and probably elsewhere, I thought it a good idea to post about it. For those not in the profession or not familiar with the multiaxial system, this system was designed to provide what is considered by the psychiatric profession to be a comprehensive diagnosis or picture of the entire scope of factors that account, it is believed, for a patient's mental health.
Next, I list the categories I found on the report with a simple description of each of the five. Note that these are examples only:
Axis 1 - the clinical disorders and mental illnesses including, e.g., bipolar disorder, generalized anxiety disorder, severe depression, schizophrenia, substance abuse disorders, and eating disorders such as anorexia
Axis 2 - long standing personality and developmental disorders, e.g. what is known as borderline personality disorder
Axis 3 - general medical conditions, acute medical conditions and physical disorders e.g. osteoporosis, cardiac arrhythmias, acute weight loss
Axis 4 - psychosocial and environmental factors believed to be contributing to the patient's mental health, e.g. death of a loved one or family member, acute trauma, serious illness of family member
Axis 5 - the Global Assessment of Functioning (GAF) Scale
Perhaps because Axis 5 had never been included in previous reports provided to me or the Axis category had never included any information, I'd never known about Axis 5 or what is called the GAF Scale. The scale provides a hypothetical continuum of mental health-illness looking at psychological, social and occupational functioning, ranging from 100 (superior) to less than 10 (persistent danger of severely hurting self or others; inability to maintain minimal personal hygiene; or serious suicidal act with clear expectation of death). The assessment is usually made by at least one and hopefully two or more psychiatrists. Here in Arizona, what is known as the Title 36 process involves the independent assessment of a person by two psychiatrists.
Here is a link to a comprehensive GAF Scale.
A score of anything at 50-41 points to serious symptoms (e.g. suicidal ideation, severe obsessional rituals, frequent shoplifting) or any serious impairment in social occupational, or school functioning (e.g. no friends, unable to keep a job). As one descends to, say, 10 the person is in persistent danger of severely hurting self or commits a serious suicidal act with clear expectation of death. As one climbs the scale above 50, one encounters moderate to mild to minimal symptoms and tops out at superior functioning.
The number I found on the report represented, I was told, where my loved one stood and it shocked me. Shocked me because if her providers and insurers knew of this score, they knew she was more than seriously mentally ill. Suicidal ideation comes into the picture at 50. After learning about the scale and what the number meant, I felt I was armed with even more valid information to insist on hospitalization for an extended period of time. My family member just completed 7 weeks of inpatient hospitalization and has been moved, in spite of a continuing low number on the GAF Scale, to a step-down in spite of our and another professional's objections.
Yet, for the first time, we and the team were able to obtain inpatient hospital treatment until our loved one's weight reached a BMI of 19.4. The goal was higher than that but how grateful we were that the hospital staff worked hard to help see this achievement - a miracle and hopefully a precedent for others in the State of Arizona where a bill to to study the impact of required treatment for eating disorders for those with the low/no income insurance known as AHCCCS was snuffed out in committee.
I decided to write about this scale here because it seems to me that this scale and the score given to a loved one with multiple diagnoses might help a family obtain inpatient or residential treatment paid for by health insurance. At the very least, the score might help a family get their loved one into a safe place for more than a short period of time.
Information is provided about eating disorders, particularly of adults, to parents and other loved ones written by a parent who is in recovery from an eating disorder.
Welcome
When I created this blog, I was "getting on" in my early sixties, hence the blog name. However, my adult daughter's eating disorder and co-occurring emotional dysregulation disorder and other co-morbidities - ongoing for about 33 years - became and was our focus as we attempted to help her get into recovery. By learning about, reflecting on, reading about, attending conferences and writing about eating and brain disorders, I created a place to blog what I've learned. I hope this blog will be of use to others, especially families of and adult sufferers themselves to help them get into recovery. I update posts from time and the update date will be present at the top of the post.
Sadly, my daughter passed away in early October 2021 mainly because her body became so malnourished that she was immunocompromised, contracted a severe infection that was not properly addressed during an earlier hospital stay the month before, and developed an overwhelming non-covid pneumonia following surgery to save her life. I believe she should have been able to receive palliative care but Arizona, our country, and even the professionals trained in the treatment of eating disorders, particularly anorexia, are not "there" yet. I address the issue of palliative care in a recent post below, initially written in November 2021. I am not a certified eating disorder specialist. I am an Expert by Experience and college-educated with a BA in Community Work with an additional certificate in a one-year program in Business Administration from the same institution.
I am passionate about all of this because, as Shakespeare wrote in The Taming of the Shrew, Act 4, Scene 3: "My tongue will tell the anger [and sadness] of my heart or else my heart, concealing it, will break. And, rather than it shall, I will be free even to the uttermost, as I please in words."[2016]
Travel Guide
If you're new to my blog, I recommend you begin on the right side and take a look at the "Of Note" offerings. Read Dr. Cynthia Bulik's recent published interview (5/4/22) "Rethinking Eating Disorders" if you want to print an easy-to-understand professional's expert opinion about anorexia for your family doctor or the therapist. [Early intervention is absolutely critical. For those whose eating disorder is categorized as entrenched or severe and enduring, read the editorial comment by Stephen Touyz and Philipa Hay for a new approach about treatment. It is possible for your loved one to recover! I have also attached a link here for additional papers on the subject of severe and entrenched eating disorders. If you are a family member or friend of an adult with an eating disorder and have been at this for awhile, I refer you to the posts within the title "Adult Eating Disorders and Recovery Tools" found in the Index on the right hand side of this site. As well, in the "Of Note" section take a look at those posts with an asterisk. If you're a parent and need support, look for posts in the Index about parent support or parent toolbox.
In my opinion, the best book to buy, to refer to constantly and to share with members of the medical/psychiatric profession is "Sick Enough: A Guide to the Medical Complications of Eating Disorders" by Jennifer L. Gaudiani MD, CEDS, FAED. "Dr. Gaudiani aims to improve medical diagnosis and treatment, motivate recovery, and validate the lived experiences of individuals of all body shapes and sizes, while firmly rejecting dieting culture."
I recommend two groups who will support you on your journey - F.E.A.S.T and the National Alliance for Eating Disorders. Both maintain websites and Facebook private groups.