Legal conceptions of impairment: Implications for the assessment of psychiatric disabilities

The measurement of functional impairment is hardly a mere academic enterprise, given the current demand for clinical evaluations of disability status. For instance, witness the recent controversies over US military veterans seeking benefits through certification of psychiatric disability (e.g., McNally & Frueh, 2012) or individuals convicted of murder who may feign intellectual disability to avoid the death penalty (e.g., Chafetz & Biondolillo, 2012). More generally, individuals seeking access to specialized accommodations and services in school or at work are pursuing assessments that establish their qualification as having a disability. To satisfy those requests, clinicians have to understand how the law defines disability and the level of documentation required to establish that an individual has a disability. These legal definitions of disability push clinicians to shift focus from the familiar terrain of symptom counts and psychological test scores to the less traveled path of assessing impairment in actual functioning.