Explosive outbursts in children and adolescents have been long identified by clinicians and have been described using many different conceptualizations and terms. The topography of explosive outbursts is complex, heterogeneous, and includes the interactions of different emotional and behavioral constructs. Included here are pre-existing central nervous system vulnerabilities including psychiatric and neurologic diagnoses, various contributing emotions that generally carry a negative valence, and aggressive behaviors that are usually overt and reactive. Emotional impulsivity and deficient emotional self-regulatory mechanisms may contribute to episode severity and duration.