•Three ACE classes emerged with differences in mental health symptoms.•Multiple ACEs subgroup reported higher somatization, anxiety, and overall symptoms.•Emotional abuse subgroup reported higher levels of anxiety and overall symptoms.•ACE exposure patterns distinguish between who may be at risk for different symptoms. It is well known that adverse childhood experiences (ACEs) are linked with mental health problems. Identifying different patterns of exposure to adverse childhood experiences can provide information regarding what types of adversity may place individuals at most risk for poor mental health. The aims of our study were to identify underlying patterns of 10 types of ACEs in a sample of young adults (i.e., 18–21 years) and to examine relations between the ACEs classes and mental health symptoms (i.e., somatization, depression, anxiety, overall psychological stress). We found that a three-class model fit the data best: low ACEs, high emotional abuse only, and high multiple ACEs. We found significant differences across classes for all mental health symptoms. The high multiple ACEs class had significantly higher mean somatization, anxiety, and overall psychological stress scores than both the high emotional abuse only and low ACEs classes, and the high emotional abuse only class had higher mean anxiety and overall psychological stress scores in comparison to the low ACEs class. In contrast, our results suggest that the low ACEs and high emotional abuse only classes had higher mean levels of depression symptoms than the high multiple ACEs class. Our findings highlight the importance of examining the unique effects of different patterns of exposure to ACEs on mental health to inform prevention and intervention efforts that mitigate the harmful effects of ACEs on mental health.