Characteritics of bulimia, medical concerns, treatment alternatives, and family issues are presented for the counselor working with clients in a nonhospitalized setting.

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The Global Assessment of Functioning (GAF) is part five of the multiaxial diagnostic system for mental disorders outlined in the Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition–Text Revised (DSM-IV-TR). The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) notes the use of DSM-IV-TR in rating an individual's global functional capacity, which, like disability, is related directly to the effects of impairments. The AMA Guides, Fourth and Fifth Editions, do not provide numeric psychiatric impairment, and shortcomings plague the use of GAF to define disability—but even so, authorities ranging from the State of California to the Veterans Administration rely on GAF scores. A table shows the 100-point scale Global Assessment Scale in which higher scores indicate better functioning. The GAF has been modified to address deficiencies; a decision tree has been added and is summarized; and the editor of DSM-IV-TR has developed a computerized version that reportedly improves reliability and validity. Evaluators should bear in mind that the GAF helps evaluate the individual's functioning in three areas: psychological, social, and occupational (including the activities of daily living). The resulting score facilitates the creation of a treatment plan, evaluates its effectiveness, and predicts outcomes, but evaluators should be aware of its significant limitations.

Chapter 14, Mental and Behavioral Disorders, in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, defines a process for assessing permanent impairment, including providing numeric ratings, for persons with specific mental and behavioral disorders. These mental disorders are limited to mood disorders, anxiety disorders, and psychotic disorders, and this chapter focuses on the evaluation of brain functioning and its effects on behavior in the absence of evident traumatic or disease-related objective central nervous system damage. This article poses and answers questions about the sixth edition. For example, this is the first since the second edition (1984) that provides a numeric impairment rating, and this edition establishes a standard, uniform template to translate human trauma or disease into a percentage of whole person impairment. Persons who conduct independent mental and behavioral evaluation using this chapter should be trained in psychiatry or psychology; other users should be experienced in psychiatric or psychological evaluations and should have expertise in the diagnosis and treatment of mental and behavioral disorders. The critical first step in determining a mental or behavioral impairment rating is to document the existence of a definitive diagnosis based on the current edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders. The article also enumerates the psychiatric disorders that are considered ratable in the sixth edition, addresses use of the sixth edition during independent medical evaluations, and answers additional questions.