Childhood maltreatments refer to a variety of traumatic events that occur during childhood, including emotional and physical abuse and neglect (Cameron et al., 2018). Meta-analytic evidence indicates that approximately 17.4% of individuals self-report experiences of childhood neglect (Stoltenborgh et al., 2013), while 12.7% report having experienced childhood sexual abuse (Stoltenborgh et al., 2011). Traumatic experiences during childhood have far-reaching consequences (Cicchetti & Toth, 1995), extending beyond immediate harm to include long-term impacts on mental health and overall well-being (Jennissen et al., 2016; World Health Organization, 1999, 2020), as well as disrupted ability to regulate emotions and form stable relationships (Heleniak et al., 2016; McLaughlin & Lambert, 2017). The "Report of the Consultation on Child Abuse Prevention" provides a comprehensive overview of the various types of maltreatment (World Health Organization, 1999), which encompasses Physical Abuse, Emotional Abuse, Sexual Abuse, and Physical and Emotional Neglect. Physical abuse is the actual or potential physical harm resulting from an action or lack of action within a caregiver’s control (Stoltenborgh et al., 2015). Emotional abuse occurs when there is a failure to provide a developmentally appropriate, supportive environment. This encompasses the absence of a primary attachment figure, which is crucial for children to develop a stable and full range of emotional and social competencies. It also includes actions directed at children that cause harm or are likely to harm their physical, mental, or social development, such as denigrating, threatening, intimidating, discriminating, ridiculing, or other non-physical forms of hostile or rejecting behavior (Stoltenborgh et al., 2015). Sexual abuse occurs when children are involved in sexual activity they cannot comprehend, give informed consent for, or are not developmentally prepared to engage in (Stoltenborgh et al., 2015). Finally, the description of Neglect - both physical and emotional - is characterized by a caregiver’s failure to provide for children’s development in areas such as health, education, emotional well-being, nutrition, shelter, and safe living conditions, taking into account the caregiver’s available resources (Stoltenborgh et al., 2015). Increasing awareness of typical child development and the harmful health effects of maltreatment underscores the urgency of addressing this issue.

Individuals with a history of childhood maltreatment show a diminished ability to cope with aversive affective states and experience higher levels of perceived stress (Hager & Runtz, 2012; Hong et al., 2018; Vranceanu et al., 2007). An expanding body of research suggests that early life maltreatment is associated with long-term increases in sensitivity to stressful life events, increasing the likelihood of psychopathology and unfavorable health consequences (Scorza et al., 2022). Neurobiological evidence further indicates that maltreated individuals have alterations in stress-susceptible brain regions, hypothalamic-pituitary-adrenal response, and inflammatory marker levels (Nemeroff, 2016; Tarullo & Gunnar, 2006; Teicher et al., 2022). Given the high prevalence and profound impacts of childhood maltreatment, understanding the mechanisms underlying these adverse outcomes is essential (Jennissen et al., 2016).

The long-term impacts of childhood maltreatment on stress sensitivity and neurobiological functioning are deeply interconnected with the development of emotional and behavioral difficulties (Dadomo et al., 2022; Grecucci et al., 2023). Children who experience maltreatment face a heightened risk of developing reactive aggression and deficits in regulating emotions (Dvir et al., 2014). Moreover, adults with a history of childhood maltreatment tend to detect less positive emotions and be faster in recognizing negative ones (Bérubé et al., 2023) and show difficulties in many forms of emotion regulation (Heleniak et al., 2016; McLaughlin & Lambert, 2017). Emotion regulation is defined as the processes of monitoring, evaluating, and modifying emotional reactions, particularly their intensity and duration, to achieve specific goals (Gross, 2015; Morawetz et al., 2017, 2020). It involves six dimensions, such as emotional awareness, acceptance, and clarity, the ability to inhibit prepotent responses, engage regulation strategies, and activate goal-directed behavior (Cole et al., 2019). During childhood, responsive parenting and peer interactions play a crucial role in fostering emotion regulation skills. Consequently, experiencing abuse and neglect as a child can hinder the development of proper emotional and interpersonal abilities (Dadomo et al., 2022; Dvir et al., 2014; Grecucci et al., 2023). Emotion dysregulation - often a result of early adversity - is commonly conceptualized as a multidimensional construct that involves the disruption of one or more of the emotion regulation dimensions, leading to (1) a lack of awareness, understanding, and acceptance of emotions, (2) limited access to adaptive strategies for modulating the intensity and/or duration of emotional responses, (3) an unwillingness to experience emotional distress in the pursuit of desired goals, and (4) an inability to control behaviors while experiencing emotional distress (Gratz et al., 2009; Gratz & Roemer, 2004).

Emotion regulation plays a crucial role in how individuals evaluate and respond to stressful events, shaping their emotional reactions and expressions (Wang & Saudino, 2011). This developmental link between emotion regulation and stress is particularly important, as children's capacity to manage stress typically improves as they develop better emotional regulation skills (Wang & Saudino, 2011). Given the centrality of emotion regulation in effectively coping with stress, it is particularly concerning that difficulties in emotion regulation can exacerbate pre-existing vulnerabilities, such as impulsivity or behavioral inhibition, thereby contributing to more severe symptoms across various mental disorders (Beauchaine, 2015; Grecucci et al., 2022; Morawetz et al., 2024).

Thus, emotion dysregulation serves as a critical mechanism connecting childhood maltreatment to the long-term cognitive, psychological, and health consequences (Beauchaine, 2015; Sheppes et al., 2015; Strathearn et al., 2020). Understanding these connections is crucial for developing effective interventions aimed at mitigating the enduring effects of childhood maltreatment. However, while emotion dysregulation has been identified as a mediator between childhood maltreatment and psychopathologies (Jennissen et al., 2016), the broader relationship between various forms of childhood maltreatment, emotion regulation difficulties, and perceived stress remains underexplored. Gaining a deeper understanding of this mediation is critical for developing targeted interventions that address the complex interplay of factors contributing to the long-term effects of childhood maltreatment.

Interestingly, the impact of childhood maltreatment on psychological functioning (Gallo et al., 2018; Godinet et al., 2014) and on the development of psychopathology (Prachason et al., 2024) seems to be different among females and males. As previously mentioned, emotion regulation is a key mechanism that links childhood maltreatment to its long-term consequences (Kerig, 2020), and difficulties in this process are more common among females than males (Herd & Kim-Spoon, 2021; Vanhalst et al., 2018). In fact, the former tend to show a stronger inclination toward self-blame, ruminating, and catastrophizing following an adverse experience. Sex differences also emerge in perceiving stress and coping (Graves et al., 2021), as well as in the physiological stress responses (i.e., cortisol reactivity) (de Veld et al., 2012), with females showing higher levels of stress and stronger cortisol responses than males. Although studies on a variety of topics have highlighted the importance of sex-specific analyses (Glaesmer et al., 2011; Hong et al., 2018; Topitzes et al., 2012), mixed evidence persists, warranting further investigation (Prevoo et al., 2017).

Previous studies have examined stress responses as a risk factor for psychopathology, yet relatively little is known about how maltreatment relates to stress perception and regulation strategies that individuals acquire and use. To fill this gap, our study examines the effects of early traumatic experiences on stress in adulthood, with a focus on the mediating role of emotion dysregulation. Specifically, we investigated how difficulties in emotion regulation mediate the relationship between different traumatic experiences, such as abuse and neglect, and later perceived stress as defined by two dimensions: perceived helplessness and self-efficacy. We hypothesized that difficulties in regulating emotions would amplify the impact of early-life traumatic experiences on stress experienced throughout life. Through this study, we aim to provide a deeper understanding of the complex mechanisms linking childhood maltreatment to long-term stress.

This study aimed to examine how traumatic childhood experiences influence perceived stress in adulthood and whether this relationship is mediated by emotion dysregulation, controlling for variation in sex and age. Initial analyses of the contribution of demographic characteristics revealed sex and age differences in trauma exposure, emotion dysregulation, and stress. Females reported significantly more emotional and sexual abuse, greater emotion regulation difficulties (non-acceptance, impulse control, limited strategy access), and higher perceived helplessness than males. Age was positively associated with perceived self-efficacy and negatively related to impulse control difficulties and emotional clarity problems, suggesting greater regulatory capacity with age. These results allowed us to account for demographic influences when examining the mediating role of emotion dysregulation. The observed correlations further indicated that emotional abuse and neglect were consistently associated with greater emotion regulation difficulties and higher perceived stress, particularly high helplessness and low self-efficacy. These patterns supported our theoretical model and justified the use of structural equation modelling to examine potential mediating pathways and the overall structure of these relationships.

Following previous studies (Kim & Cicchetti, 2010; Zhang et al., 2022), emotion dysregulation partially mediated the relationship between childhood maltreatment and perceived stress, accounting for sex and age variation. In the path analysis, Emotional neglect emerged as a key predictor of emotion dysregulation that, in turn, increased perceived stress. Emotional abuse also predicted higher perceived stress both directly and indirectly, suggesting that the consequences of such traumatic experiences are both immediate and mediated by regulatory dysfunction. In contrast, Sexual abuse showed a strong contribution to the increased perceived stress later in life, regardless of emotion regulation abilities. More specifically, having limited access to emotion regulation strategies and difficulties in engaging in goal-directed behaviors, as well as less clarity and awareness of the emotional experiences, significantly amplified the long-term effect of emotional maltreatment on perceived stress, resulting in increased feelings of helplessness and reduced self-efficacy. Individuals can flexibly use emotion regulation strategies based on the situation, aligning them with changes in external circumstances and/or the individual's perceptions of them (Blanke et al., 2020; Elkjær et al., 2022). Emotion regulation flexibility can lead to more or less adaptive outcomes (e.g., the ability to achieve goals), influencing well-being (Aldao et al., 2015; Rammensee et al., 2023). According to the attachment theory, children living in abusive and neglectful environments experience insecure attachment (Greenman et al., 2024; Toof et al., 2020), which prevents them from learning appropriate strategies to manage emotions (Brenning & Braet, 2013) and cope with stress (Mikulincer & Shaver, 2019). Thus, our findings on the mediating role of emotion regulation difficulties may reflect a tendency for inflexible responses in individuals who experienced trauma in childhood. This inflexibility can intensify the negative impact of trauma over time, leading to greater perceived helplessness (i.e., difficulties in controlling circumstances) and reduced self-efficacy (i.e., ability to handle problems). In line with the learned helplessness model (Miller & Norman, 1979), organisms exposed to a situation where they experience unavoidable harmful stimuli (e.g., unavoidable shock) may fail to avoid such stimuli in the future when escape becomes possible (i.e., they learn “helplessness”). A revised approach proposed by Boddez and colleagues (2022) suggests that rather than learning passivity, organisms may learn controllability (Boddez et al., 2022; Duda & Joormann, 2022), meaning that prior experience with controllability could shape the perception of control later (Ly et al., 2019). Extending this mechanism would then result in a generalization of the sense of helplessness learned during unavoidable and uncontrollable maltreatment situations, reducing the perception of possible control over circumstances and increasing perceived stress (Duda & Joormann, 2022; Lieder & Goodman, 2013). Hence, there is evidence supporting integrated control beliefs, which are related to how children learn to cope with stress (Compas et al., 1991; Jenzer et al., 2019), and several studies highlighted that an altered perception of control may contribute to the development of affective disorders and the exacerbation of perceived stress (Gallagher et al., 2014; Ly et al., 2019; McEwen, 2000; Schweizer et al., 2020). This perspective can improve our understanding of the link between trauma, emotion regulation, and stress (Weems & Silverman, 2006) and is particularly relevant when considering the consequences of exaggerated and prolonged emotional reactions to stressful situations. Under such conditions, stress can contribute to the development of various types of psychopathology (Slavich, 2016b, 2016a), and the ability to cope effectively with stress can help prevent negative consequences for mental well-being (Dijkstra & Homan, 2016). For example, individuals who do not feel competent to avoid threatening situations (low self-efficacy) may experience anxiety (Weems & Silverman, 2006). Similarly, the perception of self as having an insufficient ability to cope with situations and not having control over social situations (high helplessness) is associated with higher degrees of social anxiety (Thomasson & Psouni, 2010). This also corroborates the findings of a recent study that investigated the dynamics of coping behavior and psychological distress across different phases of the COVID-19 pandemic within an adult general population sample and revealed that maladaptive coping strategies were consistently linked to increased psychological distress, whereas adaptive strategies were associated with decreased psychological distress (Schurr et al., 2024).

It is worth noting that, in our sample, women reported a higher frequency of early-life maltreatments (both emotional and physical) and showed more compromised emotion regulation abilities (nonacceptance of emotional responses). Cutler and Nolen-Hoeksema (1991) first proposed sex differences in the effects of childhood trauma, arguing that females are more inclined to blame themselves for stressful life events (e.g., maltreatment), making them more vulnerable to low self-esteem and mental health problems. Furthermore, while abuse is likely to impact both sexes negatively, the symptoms of the trauma may differ (e.g., internalized disorders in females and externalized disorders in males) (Hanson et al., 2008). These results highlight the importance of considering sex when studying affective variability in the effects of early-life trauma (Prevoo et al., 2017).

A noticeable finding of this study is the stronger and more consistent effect of emotional trauma, both abuse and neglect, compared to physical trauma. This aligns with a growing body of evidence indicating that emotional maltreatment may be as harmful, or even more so, than physical forms of abuse (Dye, 2020; Spinazzola et al., 2014). First, emotional trauma directly disrupts the development of core self-regulatory capacities (Warmingham et al., 2023). Emotionally neglectful environments fail to model and validate emotional experiences, impeding the child’s ability to recognize, understand, and manage emotions (Eilert & Buchheim, 2023). Also, emotional abuse, through denigration, hostility, or rejection, may actively distort a child’s self-concept and emotional security (Baugh et al., 2019). Second, physical abuse typically occurs in episodes and receives external support, while emotional trauma usually manifests chronically and subtly, making it more challenging to detect and report. This often results in deeper effects on self-regulation and stress appraisal systems (Osborne et al., 2022).

Our findings that specific emotion regulation difficulties, such as limited access to adaptive strategies, difficulty engaging in goal-directed behavior, and reduced emotional clarity and awareness, mediate the impact of emotional abuse and neglect on perceived stress align closely with the Research Domain Criteria (RDoC) project (Cuthbert & Insel, 2013; Fernandez et al., 2016). Within the RDoC framework, emotion regulation processes are situated at the intersection of the negative valence systems (e.g., heightened threat sensitivity in maltreated individuals) and cognitive control systems (e.g., goal-directed behavior under emotional strain). The mediators identified in our models map directly onto these domains, suggesting that early maltreatment may disrupt processes central to both affective and cognitive control. This reinforces the value of RDoC as a lens for understanding how emotion regulation operates as a transdiagnostic mechanism linking adversity to stress-related psychopathology (Aldao, 2016; Fernandez et al., 2016; Morawetz et al., 2024).

These findings highlight the crucial role of emotion regulation in connecting early traumatic experiences with stress perception in adulthood. They support a model suggesting that emotionally abusive or neglectful environments impair regulatory processes, which then increase vulnerability to stress. Importantly, the specific emotion regulation pathways identified present promising opportunities for intervention. Therapeutic strategies that focus on improving clarity and awareness, encouraging goal-directed coping, and increasing access to effective emotion regulation techniques may be particularly beneficial for adults who have experienced childhood maltreatment. Additionally, longitudinal studies are needed to gain deeper insights into the causal relationship between childhood trauma, emotion regulation, and adult stress outcomes, paving the way for more effective early interventions.