The Association Between Childhood Sexual Abuse and Adult Attachment: A Meta-Analytic Review

This meta-analysis synthesized evidence on the association between childhood sexual abuse (CSA) and adult attachment. It examined the overall effect size of this relationship, focusing on attachment anxiety and avoidance, and investigated methodological and contextual moderators. Following PRISMA guidelines, a systematic review and meta-analysis of 30 studies was conducted. Data were analyzed using a random-effects model, with assessments of publication bias and heterogeneity. Results revealed a significant positive association between CSA and both adult attachment anxiety and avoidance. Substantial heterogeneity indicated variability in this association's strength. Moderation analyses showed no significant effects for anxiety; however, for avoidance, country of origin moderated the association (with positive effects observed in the United States and Denmark). Additionally, trends toward significance were noted when the Experiences in Close Relationships was used and when CSA was measured dichotomously. In conclusion, CSA is significantly linked to insecure adult attachment, a relationship modulated by various factors. These findings highlight the need to address attachment difficulties in interventions for CSA survivors and to consider methodological and cultural factors in future research.