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The Association Between Childhood Sexual Abuse and Adult Attachment: A Meta-Analytic Review
Vanesa Pastor-Cerezo1, Alejandro Iborra Cuéllar1
1University of Alcalá, Alcalá de Henares, Spain.
Trauma, Violence & Abuse
|April 22, 2026
Summary
Childhood sexual abuse (CSA) is significantly linked to insecure adult attachment styles, specifically increased anxiety and avoidance. Factors like country of origin can influence the strength of this association.
Area of Science:
- Psychology
- Public Health
- Trauma Studies
Background:
- Childhood sexual abuse (CSA) is a significant adverse childhood experience.
- Attachment theory provides a framework for understanding interpersonal relationships in adulthood.
- Previous research suggests a link between CSA and insecure adult attachment, but synthesis is needed.
Purpose of the Study:
- To conduct a meta-analysis synthesizing evidence on the association between CSA and adult attachment.
- To examine the overall effect size for attachment anxiety and avoidance.
- To investigate potential moderators of this relationship.
Main Methods:
- Systematic review and meta-analysis of 30 studies adhering to PRISMA guidelines.
- Random-effects model used for data analysis.
- Publication bias and heterogeneity were assessed.
Main Results:
- A significant positive association was found between CSA and both adult attachment anxiety and avoidance.
- Substantial heterogeneity indicated variability in the association's strength.
- Country of origin moderated the association for avoidance, with effects seen in the US and Denmark.
Conclusions:
- CSA is robustly linked to insecure adult attachment (anxiety and avoidance).
- The relationship is modulated by factors such as country of origin.
- Interventions for CSA survivors should address attachment difficulties, and future research should consider methodological and cultural factors.
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