Beyond Cumulative Scores: Distinct Patterns of Adverse Childhood Experiences and Their Differential Impact on Emotion, Borderline Personality Traits, and Executive Function.

Adverse childhood experiences (ACEs) are associated with long-lasting and multifaceted consequences for mental health. Despite established dose-response effects of ACEs on mental health, the specificity of ACE pattern effects remains understudied, especially on executive function. This study aims to explore how specific patterns of ACEs, beyond just cumulative scores, differentially impact emotional symptoms, personality and cognitive function. This study recruited 2515 college students from several universities in northern China. Demographic characteristics, depression, anxiety, borderline personality traits, and executive function (Wisconsin Card Sort Test) were assessed. Latent class analysis was used to identify patterns of ACEs. Data were analysed using χ-test, ANCOVA, and multivariate linear regression methods. Pattern-oriented and cumulative-oriented approaches were compared to predict the effects of ACEs. Three distinct patterns of ACEs were identified: low adversity (LA), multiple adversity (MA), and family environment adversity (FA). FA with the highest number of ACEs was uniquely linked to executive function impairments, while both MA and cumulative ACEs significantly predicted higher anxiety, depression, and borderline personality traits. The pattern-oriented method was more sensitive to capturing the diverse outcomes of executive function impairment than cumulative scores. Our findings highlight the importance of moving beyond cumulative scores and considering specific ACEs patterns to understand their differential impact on mental health. Identifying FA as a distinct pattern with specific consequences for executive function offers valuable insights into developing targeted prevention strategies tailored to specific risk profiles.