Regardless of where one stands on the issue of including the disorder in DSM-5, it is clear that the field can benefit from more developmental research on severe anger outbursts and chronic irritability. Children and adolescents who have persistent, explosive irritability and anger are highly impaired, and outbursts of rage are a frequent precipitant of inpatient hospitalization (7). It is imperative for clinicians to search for potential causes of severe irritability in an individual child, whether it be psychosocial stressors, history of maltreatment, family conflict, learning or communication disorders, other axis I psychiatric disorders, or some combination of these or other factors. Although effective treatment of underlying mood, anxiety, autism spectrum, or behavioral disorders can result in substantial improvements, significant numbers of these youths do not respond adequately to existing therapies. For many of these poor responders, the severity of the anger appears to be far out of proportion to any contributing psychosocial factors, and our current diagnostic system does not have a good place for them. One can conclude that at this time, not enough scientific data about these kids are available to create a new diagnosis. However, we should all agree on the vital importance of this problem and the need to expand our efforts to better understand the complex construct of irritability so that we can improve the assessment, diagnosis, and treatment of some of our sickest children.