While security in the parent-child relationship and about the marital relationship have been found to be important mechanisms linking family risk to maladjustment in children and adolescents, little is known about how individual differences in security processes about the larger family context may impact adolescent regulation and psychopathology. Pattern-based or person-oriented approaches provide unique advantages to understanding individual differences inherent in development. The present study sought to identify distinct patterns of adolescent regulatory processes important to relations between family risk and adolescents' mental health trajectories. Adolescents' emotional, behavioral, and physiological responses to family conflict were assessed in the context of mother-father-adolescent triads. Building on research on risky family environments, the present study explored how adolescents' regulatory patterns serve as precursor outcomes between family-wide risk and protective factors and adolescents' trajectories of problem behavior. Four patterns of regulatory processes were identified; the majority of adolescents displayed an adaptively regulated pattern consisting of low subjective and overt emotional distress. Under-controlled adolescents displayed high levels of subjective anger and high levels of overt anger and frustration and observable opposition and defiance. Over-controlled adolescents displayed higher levels of subjective distress, higher overt withdrawal, and lower cortisol reactivity. Lastly, a physiologically reactive pattern emerged such that these adolescents displayed higher cortisol reactivity in combination with low subjective and observable distress. Regulation patterns were associated with different profiles of family risk and protective factors, adolescent family-wide insecurity, and trajectories of mental health. Findings underscore the usefulness of examining higher-order organizations of regulation patterns exhibited in the family context and contributing to unique mental health outcomes during adolescence.