Many clinicians do not understand severe dysregulation in young children and have in recent years been inclined to a diagnosis of bipolar disorder, therefore turning to the use of medications too easily. The evaluation of young dysregulated children will always be difficult. This panel uses brief video footage to explore the clinical histories of three children and the contribution mental regulatory processes may make to dysregulated behaviors. It then looks at the various directions therapeutic work may take. Discussion encompasses the use of psychoanalytic concepts, aspects of the patient’s early history, ways of relating, and characterologic enactments; as well as the possible contributions of genetic, cognitive, and neurodevelopmental endowments.