problems has been studied (Milner et al., 1988; Robertson and Milner, 1985). Although the instrument appears to be valid and reliable for identifying physically abusive parents needing treatment, a study of the practical uses of the instrument revealed that it was being applied for inappropriate purposes such as differentiating between physically abusive parents and neglectful parents (Milner, 1989).
In addition to considering psychological and psychosocial dimensions of violent behaviors, psychiatric classifications also assess organic disorders. For example, DSM-III-R recommends classification on three dimensions: clinical symptoms and conditions that are the focus of attention or treatment but are not attributable to a mental disorder (e.g., adult antisocial behavior); developmental and personality disorders; and physical disorders and conditions. For research and for some clinical settings, two additional dimensions are recommended for evaluation: severity of psychosocial stressors and global assessment of functioning. For each axis, practitioners are urged to provide assessments of their confidence in the evaluation. Some DSM-III-R classes are residual categories to be used after other diagnoses are ruled out. For example, intermittent explosive disorder, characterized by violent episodes, can only be used after ruling out "psychotic disorders, Organic Personality Syndrome, Antisocial and Borderline Personality Disorders, Conduct Disorder, or intoxication with a psychoactive substance" (American Psychiatric Association, 1987:321).
Although a primary diagnosis is recommended, the DSM-III-R classification provides for the occurrence of multiple, not necessarily discrete, disorders, and the editors (Spitzer and Williams, 1987) stress that disorders rather than people are being classified. The disorders are arranged hierarchically, with organic disorders given precedence over other types of disorders (if the organic disorder is responsible for initiating and maintaining the disturbance) and more pervasive disorders given precedence over less pervasive ones (e.g., schizophrenia over dysthymia).
The categories available in the DSM-III-R for classifying outbursts of aggression or rage include:
Organic personality syndrome usually due to structural damage to the brain (e.g., neoplasms and head trauma)
Dementia (disturbance of higher cortical functioning)
Several categories of intoxication, including alcohol, amphetamines,