The prevalence and impact of child trauma and adverse life events are of such significance and financial cost as to become a major public health issue in the United States. Often the most complex mental health presentations with transdiagnostic implications occur in children who have chronic interpersonal trauma exposures (eg, child abuse, domestic violence, community violence, war refugees). These exposures are such that normal development is disrupted by traumatic stress, neurobehavioral, and functional problems that lead to significant mental health morbidity such as traumatic stress disorders, including PTSD. Symptoms of outbursts and dysregulation are actual PTSD DSM-5 criteria. The potential lifelong symptoms secondary to the level of dysregulation in emotion and behavior following chronic, interpersonal trauma have contributed to diagnostic struggle and proposals for complex trauma disorders put forward (unsuccessfully) for several DSM editions. Of note, ICD-11 now includes complex PTSD. Nevertheless, documented rates of outbursts in children with PTSD have been hard to find. We will provide an overview of trauma and PTSD comorbidities that increase case complexities and that often lead to presentations necessitating residential, inpatient levels of care. A new research study assessing rates of outbursts in children with PTSD will be described. Trauma-informed systems and trauma-specific interventions are critical to managing dysregulated children exposed to trauma/maltreatment and the related sequela. Treatments and trauma-informed strategies that have been developed for trauma populations with dysregulation presentations will be described. Outbursts related to emotional dysregulation in trauma populations will be important to characterize, and intervening in other transdiagnostic presentations requires a trauma-informed approach to the management of outbursts.