Well typically when someone says, "Are you really that upset??" & then when "Really Upset" is used when expressing themselves or trying to express themselves, they are asking them point blank "Are you upset??" Meaning they are obviously showing somewhat of a sign of being distraught or emotional About something. When the question "Are you REALLY that upset??!!" They are practically scratching their head trying to figure out why/if they Are really that upset, because usually if someone sYsi, " Are you really that upset??!!" They are either A. Trying to come up with some logical explanation as to why they're "Really that upset?!!" Then when someone is Asked "Are you upset?" It is usually because the individual(s) are visually showing signs of being upset about something, or the person knows why they're upset, but is curious "If they're upset??!" Usually indicating that there is a reason why this person should naturally be upset. If that makes sense. I hope I put it well enough for you to now see the difference in the two different questions/concerns!!!