Professionals working in high-risk occupations, such as firefighters and emergency medical personnel, are repeatedly exposed to potentially traumatic events that may affect both psychological functioning and decision-making under pressure. However, psychological responses to occupational stress are heterogeneous, and their implications for performance remain insufficiently understood. The present study adopted a person-centered approach to examine latent profiles of psychopathological symptoms and their associations with emotional, social, and behavioral functioning in a virtual reality (VR) emergency simulation. A sample of 395 Portuguese firefighters completed the Brief Symptom Inventory (BSI), measures of emotion regulation difficulties, posttraumatic stress symptoms, and perceived social support, and performed a VR-based medical emergency task assessing decision-making accuracy under stress. Latent profile analysis identified four distinct symptom profiles: Low Psychological Distress, Moderate Internalizing Distress, High Global Psychological Distress, and Mixed / Interpersonal Distress. Profiles differed significantly in emotion regulation difficulties, posttraumatic stress symptoms, perceived social support, and VR task performance. Notably, individuals characterized by a Mixed / Interpersonal Distress profile, marked by elevated interpersonal sensitivity, hostility, and paranoid ideation, committed significantly more decision-making errors in the VR simulation than those in the Low Psychological Distress profile. In contrast, high global psychological distress was not uniformly associated with poorer performance. These findings suggest that decision-making under stress in emergency contexts is shaped less by generalized psychopathology and more by specific interpersonal and affective symptom configurations. The study underscores the value of person-centered approaches and immersive VR methodologies for identifying psychologically meaningful risk patterns, with important implications for assessment, training, and targeted intervention in emergency service professions.