Global Assessment of
Psychopathological Interference to Conscience Functioning

Barbara M. Stilwell, M.D.
[December 2, 1999]

Level 1

Acute feeling of estrangement in a major attachment relationship(s) due to moral conflict(s). Strong desire to mend the relationship
Episodes of mounting anxiety and/or despair over moral conflicts within self or with others
Acute value dissonance
a. questioning of values or behavior that were formerly accepted as right or wrong
b. questioning of behavior in self, others, or the world formerly not considered in moral terms
Episodes of behavior that show
_____ disruption in respect for authority
_____ disruption in the pursuit of fairness and caring
among peers
_____ disruption in self-worth
Belief that one ought to pursue goodness in self, relationships, and the world is preserved

Level 2

Ongoing feelings of estrangement in a major attachment relationship(s) due to moral conflict(s). Loss of desire or feeling of futility about mending the relationship(s)
Protracted feelings of anxiety and/or despair over moral conflict within self or with others
Ongoing value dissonance
a. questioning of values or behavior that were formerly
accepted as right or wrong
b. questioning of behavior in self, others, or the world
formerly not considered in moral terms
Ongoing pattern of behavior that shows
_____ disruption in respect for authority
_____ disruption in the pursuit of fairness and caring
among peers
_____ disruption in self-worth
Belief that one ought to pursue goodness of self, relationships, and the world is questioned but not abandoned

Level 3

Acute episodes of feeling estranged from the goodness-pursuing mandates of conscience
Episodes of mounting anxiety and/or despair over struggle between good and bad within self
Episodic devaluation of the authority of one's conscience, the worth of pursuing fairness and caring among peers, or finding goodness in the self
An internal war between good and bad is reflected in erratic, emotionally charged contradictory behavior
Belief that one ought to pursue goodness in self, relationships, and the world is seriously doubted

Level 4

Ongoing feeling of estrangement from the goodness-pursuing mandates of conscience. Moral identity is fragmented or dissociated into good and bad selves
_____Moral-emotional confusion is pervasive or
_____Emotional expression is consistent with the moral identity that is operative at the time
When bad self is dominant, pursuit of evil is idealized and justified
Behavior is "comfortably antisocial" when bad self is dominant.
_____anti-authoritarian
_____anti-peers
_____pro-bad self
Belief that one ought to pursue goodness in self, relationships, and the world is erratically challenged by satisfaction in pursuing badness

Level 5

Moral identity consolidates around
_____ pursuit of evil or
_____ indifference to right and wrong
Positive emotions
_____ consolidate around triumph of evil or
_____ become completely disconnected from moral
values
Pursuit of evil or living without a moral framework becomes the authority of conscience, governs relationships with others, and maintains self-esteem
Behavior is consistent with
_____ antisocial moral values or
_____ indifference to morality
Belief that one ought to pursue badness or live outside of a moral system is accepted