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Models of mental health emphasize the fundamental role of emotion regulation (ER). Still, it is unknown whether ER impairment varies in severity and type between different disorders. To systematically investigate this question, we searched multiple databases via EBSCOhost for studies comparing adults with mental disorders to nonclinical controls on self-reported ER. We calculated standardized mean differences (SMD) and conducted multilevel meta-analyses to account for nested data. We included 619 studies (1998-2025) that assessed selected ER questionnaires in 41,590 clinical participants and 36,787 controls. Compared with controls, clinical participants overall reported pronounced difficulties in ER (large SMD = 1.70) and different ER strategy use (moderate to large SMDs: less frequent acceptance = -0.85, problem-solving = -0.63, and reappraisal = -0.63; more frequent avoidance = 1.00, rumination = 1.51, and suppression = 0.73). Difficulties in ER, decreased use of reappraisal, and increased use of rumination and suppression were evident in almost all mental disorders, emphasizing the transdiagnostic relevance of these facets. In addition, there were specific profiles for disorders with particularly pronounced effect sizes (e.g., difficulties in ER and acceptance in personality disorders; rumination and reappraisal in depressive disorders). An additional review of 25 ecologically momentary assessment studies of ER in daily life aligned with the main findings. Future research is needed to examine further disorders and the temporal relationship between psychopathology and ER. Nonetheless, there is substantial evidence to assume both universality of ER impairments across disorders and disorder-specific pronunciations. This speaks for using transdiagnostic interventions aimed at improving ER but also points to the need of additional, more targeted interventions for some disorders. (PsycInfo Database Record (c) 2026 APA, all rights reserved).