This study examined the mediating role of the six Difficulties with Emotion Regulation Scale (DERS) subscales in the relation between adverse childhood experiences (ACEs) and adult psychological distress in a clinical sample of adults receiving psychological treatment at a community-based mental health clinic. In the first part of the study, we found (a) a direct association between childhood adversity and adult psychological distress and (b) the DERS total score mediated this relation. In addition, the DERS subscales differentially mediated this relation. Specifically, the Nonacceptance of Emotional Responses, Impulse Control Difficulties, and Lack of Access to Emotion Regulation Strategies significantly affected psychological distress in adulthood. In the second part of the study, the moderating role of the level of exposure to ACEs in the abovementioned relation was analyzed. For individuals with low ACE scores, the relation between ACEs and adult psychological distress was mediated by four of the six DERS subscales (Nonacceptance of Emotional Responses, Difficulty Engaging in Goal-Directed Behavior, Impulse Control Difficulties, and Limited Access to Emotion Regulation Strategies). For individuals with high ACE scores, none of the DERS subscales significantly moderated the relation between ACEs and psychological distress. These findings suggest that how each dimension of emotional regulation contributes to distress among a marginalized urban population is a function of the level of trauma exposure. These data offer an important guidepost for clarifying impeding regulatory difficulties to target for future intervention work. (PsycINFO Database Record (c) 2019 APA, all rights reserved)