The connection between early life adversity and later violent behavior has gained new clarity through evidence revealing how childhood experiences fundamentally reshape emotional regulation systems. This understanding could transform approaches to preventing aggressive outcomes in vulnerable populations. Analysis of 28 studies examining violence patterns in borderline personality disorder reveals that childhood trauma and dysfunctional family environments emerge as the strongest predictors of adult aggressive and suicidal behaviors, with odds ratios ranging from 3.9 to 5.8. The research demonstrates that emotional dysregulation and impulsivity drive violent behaviors with effect sizes between 0.25 and 0.52, while psychiatric comorbidities including bipolar disorder and substance use disorders amplify aggression risk by 2.1 to 3.2 times. Gender differences prove particularly striking, with women comprising 75% of borderline diagnoses yet directing aggression primarily inward through self-harm and suicide attempts, while men more frequently express outward-directed violence. These findings illuminate a critical gap in current mental health interventions, which often address symptoms rather than underlying trauma-driven dysregulation. The systematic review methodology strengthens confidence in these patterns, though the observational nature of included studies limits causal interpretations. For healthcare practitioners, these results suggest that early trauma screening and targeted emotional regulation therapies may prove more effective than traditional symptom-focused treatments. The research also highlights the need for gender-specific intervention strategies, given the markedly different expression patterns of aggression between men and women with borderline personality disorder.