The impact of adverse childhood experiences on emotional regulation in adult ED patients

Background Emotional regulation is critical in emergency departments (EDs), yet little is known about how early life adversity affects emotional functioning in these settings. Adverse Childhood Experiences (ACEs) are linked to long-term behavioral challenges, but their impact on real-time coping during acute care remains underexplored. Objective This study examined whether ACEs predict emotional dysregulation and use of cognitive emotion regulation strategies among adult ED patients. Methods In this cross-sectional study, 58 adult patients presenting to a single academic ED completed self-report measures including the ACE Inventory, the Difficulties in Emotion Regulation Scale (DERS), and the Emotion Regulation Questionnaire (ERQ-Cognitive Reappraisal). Correlation, t -test, and linear regression analyses were used to assess associations between ACE scores and emotional regulation outcomes. Results Participants with ≥4 ACEs had significantly higher DERS scores ( p  = .006) and higher ERQ Cognitive Reappraisal scores ( p  = .049) compared to those with fewer ACEs. Regression analysis confirmed that ACEs significantly predicted both emotional dysregulation (β = 1.04, p  < .001) and cognitive reappraisal use (β = 0.36, p  = .040). ACEs were also strongly associated with difficulties in goal-directed behavior, a DERS subscale (β = 0.26, p  = .0002). Conclusion ACEs significantly predict both emotional dysregulation and use of cognitive regulation strategies in ED patients. These findings support the value of trauma-informed care and ACE screening to identify high-risk individuals and tailor support during acute care encounters. Limitations This cross-sectional design limits causal inference. Self-report measures may be subject to recall bias, and the single-center sample may limit generalizability.