Latent class analysis of women with borderline personality disorder: the role of adverse childhood experiences in impulsivity, emotional dysregulation, and neurocognitive profiles

Borderline personality disorder (BPD) is a complex psychiatric condition strongly associated with adverse childhood experiences (ACEs). This study examined how childhood trauma interacts with impulsivity, emotion dysregulation, and cognitive functioning to identify distinct clinical subtypes in women with BPD and inform personalized treatment strategies. In this cross-sectional study, 231 women with BPD completed standardized assessments of childhood trauma (CTQ-SF), impulsivity (Barratt Impulsiveness Scale), and emotion regulation (DERS-SF), along with a neuropsychological battery. An exploratory latent class analysis identified subgroups based on trauma exposure and clinical features. Between-class differences in impulsivity, emotion regulation, and cognitive functioning were examined using ANOVA. Five distinct clinical profiles emerged. The most severe classes—characterized by continuous sexual abuse (17.3%) and early sexual abuse with polysubstance use (25.1%)—showed the highest impulsivity, severe emotion regulation difficulties, and deficits in attention, working memory, and cognitive flexibility. A low-severity class with early sexual abuse (13.4%) exhibited moderate emotion regulation challenges without cognitive impairments. In contrast, two classes without sexual abuse—minimal trauma or violence (31.6%) and violence with substance use (12.6%)—demonstrated better emotional and cognitive functioning, with the low-trauma group displaying the lowest impulsivity and symptom severity. These findings underscore the importance of trauma-informed and cognitively tailored interventions for enhancing therapeutic outcomes in women with BPD. Recognizing the interplay among trauma, impulsivity, emotion dysregulation, and neurocognition may support more effective treatment planning and resource allocation.