Beyond the Scars: An Analysis of Adverse Childhood Experiences and the Interconnections Between Emotion Dysregulation, Dissociation, and Trauma in Patients with Borderline Personality Disorder

<b>Background/Objectives</b>: Borderline Personality Disorder (BPD) frequently overlaps with trauma-related conditions, particularly PTSD and Complex PTSD (cPTSD). Adverse Childhood Experiences (ACEs)-especially emotional and sexual abuse-are considered key factors in the development of emotion dysregulation and dissociation. This study investigates the impact of different ACE dimensions on borderline symptomatology, emotion dysregulation, and dissociative symptoms. <b>Methods</b>: Eighty-three BPD patients were assessed using standardized self-report questionnaires: CTQ-SF (ACEs), DERS (emotion dysregulation), DES (dissociation), BSL-23 (borderline symptoms), and PDS-3 (post-traumatic symptoms). Analyses included bivariate correlations, Structural Equation Modeling (SEM), and Exploratory Graph Analysis (EGA). <b>Results</b>: Emotional abuse significantly predicted borderline symptoms, while sexual abuse predicted dissociation. Emotion dysregulation was strongly associated with both borderline and dissociative symptoms, emerging as a central node in the symptom network. EGA confirmed the clustering of dissociative symptoms with sexual abuse and the centrality of emotion dysregulation across domains. <b>Conclusions</b>: Findings support the role of specific ACEs in shaping the clinical expression of BPD. Emotion dysregulation acts as a key transdiagnostic factor linking trauma history to borderline and dissociative features. These results underscore the importance of trauma-informed assessments and interventions, such as DBT and DBT-PTSD, tailored to individual ACE profiles.