The Association between Attachment Styles and

Physical Intimate Partner Violence Perpetration and

Victimization: A Meta-Analysis
CHELSEA M. SPENCER*
BROOKE M. KEILHOLTZ*
SANDRA M. STITH*

In this meta-analysis, we examine attachment styles—something commonly incorporated

into couples therapy—and their association with physical intimate partner violence (IPV)
perpetration and victimization among men and women. This meta-analysis incorporated
33 studies that looked at the association between four different attachment styles and IPV.
This study examined the strength of the correlation among different attachment styles and
IPV perpetration and victimization, examined gender differences in the strength of the
association among attachment styles and IPV, and compared the strength of the associa-
tion with IPV among different attachment styles. We found that anxious attachment, avoi-
dant attachment, and disorganized attachment styles were all significantly associated
with physical IPV perpetration and victimization. Secure attachment was significantly
negatively related to IPV perpetration and victimization. There was a significantly stron-
ger association between avoidant attachment and IPV victimization for women compared
to men. Clinical implications related to the importance of fostering secure attachments
when working with couples or individuals who have experienced IPV are addressed.

Keywords: Attachment; Intimate Partner Violence; Meta-Analysis

Fam Proc x:1–15, 2020

I ntimate partner violence (IPV) is a serious health issue that involves the physical, psy-
chological, or sexual harm by a current or former partner. The CDC’s National Intimate
Partner and Sexual Violence Survey found that nearly 1 in 5 adult women and 1 in 7 adult
men report experiencing severe physical violence from an intimate partner in their life-
time (Smith et al., 2017). The effects of IPV are not limited to victims and perpetrators,
but also to family and community systems. These effects can include both short-term and
long-term health, social, and economic consequences (Duvvury, Callan, Carney, &
Raghavendra, 2013; Wong & Mellor, 2014). Increasing awareness and understanding of
various variables associated with IPV can heighten our ability to promote and create
change on individual, familial, and societal levels.
Therapists and clinicians have a unique ability to target factors that may be related to
IPV perpetration in their work with individuals, couples, and families. In fact, research
has shown that between 36% and 58% of couples who seek couples counseling have experi-
enced physical IPV within their relationships (Jose & O’Leary, 2009). Of course, not all

*Kansas State University, Manhattan, KS.

Correspondence concerning this article should be addressed to Chelsea M. Spencer, Kansas State
University, Manhattan, KS. E-mail: cspencer@ksu.edu.

1
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doi: 10.1111/famp.12545
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couples who experience violence in their relationships are suitable candidates for couples
therapy. It has been strongly emphasized that when unidirectional violence that is used to
exert power and control over one’s partner is present within an intimate relationship, cou-
ples therapy is not the appropriate course of treatment (Stith et al., 2011). However,
research has identified that when couples experience bidirectional low levels of violence,
couples therapy can reduce or eliminate the violence between a couple who chooses to con-
tinue their relationship (Karakurt, Whiting, van Esch, Bolen, & Calabrese, 2016). In this
study, we examine attachment styles—something commonly incorporated into couples
therapy—and their relationship with physical IPV perpetration and victimization among
men and women.

Attachment Theory
Unique attachment styles were identified through Bowlby’s (1978) attachment the-
ory, which explores the natural tendency of infants to create and foster affectional
bonds with certain individuals, particularly caregivers. Bowlby believed that these
bonds influenced the creation of our internal working model, which provides us with
expectations of ourselves and others. Through this work, three attachment styles were
identified the following: secure, avoidant, and anxious (Bowlby, 1978). Hazan and Sha-
ver (1987) extended Bowlby’s attachment theory, which focused on attachment in
childhood, and began applying the concepts to attachment in adulthood, using the
same three attachment styles as Bowlby. Bartholomew and Horowitz (1991) continued
this work, expanding the number of attachment styles to four: secure, anxious, avoi-
dant, and disorganized. Anxious, avoidant, and disorganized are often lumped into the
label of insecure attachment, but each is associated with unique interpersonal issues
that lessen one’s ability to form and maintain close relationships (Bartholomew &
Horowitz, 1991).

Attachment Styles
Securely attached individuals are able to identify when they are emotionally dis-
tressed, and cope with this distress through seeking out closeness and relying on
others (Johnson & Whiffen, 1999; Mikulincer, Shaver, & Pereg, 2003). Secure attach-
ment allows for individuals to remain more flexible, increasing their ability to cope
with ambiguity and also remain open to new information and interpretations (Johnson
& Whiffen, 1999). Individuals with anxious attachment are easily triggered and strug-
gle to cope with their triggers (Johnson & Whiffen, 1999). Anxious attachment
increases an individual’s need for closeness and also increases fears about the relation-
ship and of being rejected. Those who are more anxiously attached are more aware of
their emotions but have difficulties identifying and managing their emotions (Stevens,
2014). Avoidant attachment typically is associated with an avoidance of interpersonal
closeness, a discomfort with emotional disclosure, and a desire for relational indepen-
dence (Bartholomew, 1990; Mikulincer, Shaver, & Pereg, 2003). Individuals with avoi-
dant attachment typically mask their emotions and are less aware of their emotional
state and are less reactive to their emotions, both positive and negative (Johnson &
Whiffen, 1999; Stevens, 2014). Disorganized attachment is characterized by experi-
ences of intense emotions and difficulty tracking one’s self and others (Beeney et al.,
2017). Individuals with disorganized attachment struggle to engage in a predictable
way because internal conflict experienced because of simultaneous fear of attachment
figures and need for attachment figures (Rholes, Paetzold, & Kohn, 2016).

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Attachment Styles and IPV
Attachment styles uniquely impact an individual’s ability to identify, process, regulate,
and cope with emotions (Johnson & Whiffen, 1999; Mikulincer, Shaver, & Pereg, 2003;
Stevens, 2014). An individual’s inability or struggle to emotionally regulate puts them at a
higher risk of being impulsively aggressive and violent (Davidson, Putman, & Larson,
2000). Research has identified an association between insecure attachment styles and IPV
perpetration among both men and women (Dutton & White, 2012; Godbout et al., 2009).
An association between an anxious attachment style and IPV victimization has also been
found (Henderson, Bartholomew, Trinke & Kwong, 2005).
Although insecure attachment styles have been found to be related to IPV, the underly-
ing causes of the IPV may differ as a result of different attachment styles. It has been the-
orized that when an individual has an avoidant attachment style, they may perpetrate
intimate partner violence as a means to deter their partners from getting too close with
them (Mayseless, 1991). It has also been theorized that an anxiously attached individual
may perpetrate IPV against their partner as a way to “pull” their partner back into the
relationship if they believe their partner is distancing themselves from the relationship
(Mayseless, 1991). Studies have shown that when couples are “mispaired” in their attach-
ment styles, such as having a male partner with avoidant attachment and a female part-
ner with anxious attachment, there is likely to be an increase in IPV perpetration by both
partners (Doumas, Pearson, Elgin & McKinley, 2008).
Due to the interrelationship between attachment styles and relational outcomes/re-
sponses/patterns, it is important to examine the association of various attachment styles
with IPV. Due to the ability of therapists to help clients alter attachment styles through
increasing awareness and understanding, attachment styles may serve as a point of inter-
vention for therapists working with couples who have experienced low levels of violence in
their relationship. Therapists who incorporate attachment styles into their work with cou-
ples may also prevent IPV from occurring through fostering more secure attachment
styles between partners.

Contribution of this Meta-Analysis

There are a number of inconsistencies found within individual studies focused on the
association among attachment styles and IPV perpetration and victimization. Some stud-
ies have found significant associations between avoidant attachment and IPV perpetration
(e.g., Henderson et al., 2005), while others have found that the association between avoi-
dant attachment and IPV perpetration was nonsignificant (e.g., Fournier, Brassard &
Shaver, 2011). Additionally, some studies have found a significant negative association
between secure attachment and IPV (e.g., Dutton, Saunders, Starzomski, & Bartholomew,
1994), while others found that secure attachment was not significantly related to physical
IPV perpetration or victimization (e.g., Henderson et al., 2005). Inconsistent results
regarding the association between attachment styles and physical IPV suggest a need to
synthesize the current literature to obtain a broader picture of these associations. Con-
ducting a meta-analysis provides an opportunity to “overcome limits of size or scope in
individual studies to obtain more reliable information” (Berman & Parker, 2002, pg. 1).
This is the first meta-analysis examining the association between attachments styles and
physical IPV perpetration and victimization.
There has also been a lack of research comparing potential gender differences in regard
to the association between different attachment styles and physical IPV perpetration or
victimization. There is a potential that the inconsistencies regarding the association
between attachment styles and physical IPV in the literature could be partially explained
by gender differences. Some studies have examined the association between IPV and

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attachment styles with samples of men and women combined, without examining the
direct association separately by gender (e.g., Lipps, 2002; Zimmerman, 2013). Other stud-
ies have focused exclusively on either men or women in their samples (e.g., Mauricio et al.,
2007; Rankin et al., 2000). Although there have been studies using dyadic data to explore
the association between attachment styles and IPV (e.g., Oka et al., 2014), only one study
has examined specific gender differences related to attachment styles and IPV perpetra-
tion (Sommer, Babcock, & Sharp, 2017). With only one study examining direct gender dif-
ferences, which only focused on perpetration, additional attention on potential gender
differences in the association between attachment styles and IPV perpetration and victim-
ization is warranted. This meta-analysis will utilize all available studies published on
attachment and physical IPV to see whether there are differences between men and
women in regard to how attachment styles are related to IPV perpetration and victimiza-
tion.

The Current Study

In this study, we conducted a meta-analysis in order to examine attachment styles in
adulthood (secure, anxious, avoidant, and disorganized) and their association with physi-
cal IPV perpetration and victimization. First, we examined the strength, or magnitude, of
each attachment style and their association with IPV perpetration and victimization.
Next, we examined the strength of each attachment style and their association with IPV
perpetration and victimization separately for men and women. Next, we compared the
strength of the associations between attachment styles and IPV perpetration and victim-
ization between men and women. Lastly, we compared the strength of each attachment
style against one another to see whether there were significant differences in the strength
of the association between attachment styles and IPV for both men and women.

METHOD
Literature Search
Standard procedures for gathering studies to be included in a meta-analysis were fol-
lowed in this study (Borenstein, Hedges, Higgins, & Rothstein, 2009; Card, 2012; Hunter
& Schmidt, 2004). The literature search consisted of multiple searches in order to continu-
ally update the database of studies examining physical IPV perpetration and victimization
to be used in the meta-analysis. The first literature search included database searches
(ERIC, Sociological Abstracts, Medline, PsychLit, Social Sciences Abstracts, and Social
Sciences Citation Index) for published and unpublished studies conducted between 1980
and 2000. This search used keywords related to an intimate partner relationship (hus-
band, wife, spouse, intimate partner, and marital), violence (abuse, aggression, domestic
violence, batter, maltreatment, and violence), and correlates (correlate, factor, risk, pre-
dictor, and pathway). The second literature search utilized the same keywords as the first
round of screening using database searches (Proquest, Medline, Web of Science, and
PubMed) for studies conducted between 2000 and 2012. Lastly, the third literature search
utilized the same keywords as the prior two searches using database searches (Proquest,
Web of Science, and Medline) for studies conducted between 2013 and 2018.

Inclusion Criteria
Studies were included in the meta-analysis if they (a) examined physical IPV perpetra-
tion or victimization, (b) examined the relationship between adult attachment styles and
physical IPV perpetration or victimization, (c) provided statistical information that

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SPENCER, KEILHOLTZ, & STITH / 5
allowed for the calculation of one or more bivariate effect sizes, (d) examined adult inti-
mate relationships, including married, cohabitating or dating relationships, and same-sex
relationships, and (e) were written in English.
Through the three phases of the literature search, a total of 33,188 studies were identi-
fied for potential inclusion in the analysis. A total of 5,675 duplicates were removed, leav-
ing a total of 27,513 studies for examination. The first round of screening consisted of
examining the abstracts of articles and removing them from the second round of screening
if it was clear they did not meet the inclusion criteria. A total of 23,381 studies were
removed in the first round of screening, leaving a total of 4,132 studies included for the
second round of screening. In the second round of screening, which consisted of reviewing
the full article, 4,099 studies were removed based on the following criteria: 2,216 did not
examine physical IPV perpetration or victimization, 897 did not examine attachment
styles as correlates for physical IPV, 582 did not provide statistical information that
allowed for the calculation of at least one bivariate effect size, 272 did not examine adult
intimate relationships (e.g., we excluded adolescent samples or college dating samples), 72
examined special populations (e.g., institutionalized populations), and 27 were not written
in English. This left a total of 33 studies to be included in the analysis. In Table 1, we
include authors, date, sample size, country from which data were collected, percentage of
sample that is racial or ethnic minorities, whether or not the study examines individuals
in same-sex relationships, and whether the data were cross-sectional or longitudinal (in-
formation on the studies included in the analysis is available in Appendix S1).

Coding Procedures
Standard procedures for coding articles to be included in a meta-analysis were followed
in this study (Card, 2012; Hunter & Schmidt, 2004). Pertinent information from the stud-
ies was gathered using a 37-item code sheet. All studies included in the analysis were
coded by two separate coders with a 97.91% agreement rate. When discrepancies appeared
in the coding, research team members met with one of the lead researchers on the project
in order to come to collective consensus on the coding.

TABLE 1
Strength of Attachment Styles as Correlates with IPV for Men and Women

Attachment Style k Mean r 95% CI Classic Fail-Safe N

Perpetration
Anxious attachment 22 .16*** 0.12, 0.21 367
Avoidant attachment 24 .13*** 0.07, 0.19 266
Disorganized attachmenta 9 .11** 0.04, 0.18 29
Secure attachment 10 .11** 0.19, 0.08 62
Victimization
Anxious attachment 16 .21*** 0.15, 0.26 328
Avoidant attachment 15 .17*** 0.09, 0.25 199
Disorganized attachmenta 4 .16* 0.01, 0.31 1
Secure attachment 7 .20*** 0.30, 0.11 54

Note. CI = confidence interval; k = number of effect sizes; r = point estimate of effect size.
Boldface indicates statistically significant.
a
Indicates risk markers were not robust against possible publication bias.
*p < .05.
**p < .01.
***p < .001.

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Statistical Approach and Analysis

This study used Comprehensive Meta-Analysis 3.0 software to enter and analyze the
data (Borenstein, Hedges, Higgins & Rothstein, 2014). This meta-analysis used a random-
effects approach to analyze the data as a means to account for real population differences
between studies by taking into account both within-study variance and between-study
variance (Borenstein, Hedges, Higgins & Rothenstein, 2010; Borenstein, Hedges, Higgins,
& Rothstein, 2011; Card, 2012). First, for each of the attachment styles, as long as data
were found in at least two studies (Cumming, 2012), we calculated an aggregate effect size
(Pearson’s r) for both IPV victimization and perpetration. For longitudinal studies, we col-
lected data from Wave 1 when available, although one study did pool waves 1–4 in their
bivariate analysis (La Flair, Bradshaw, Mendelson, & Campbell, 2015). A positive correla-
tion indicated that the attachment style was positively associated with IPV, and if there
was a negative correlation, it indicated that the attachment style was negatively related
to IPV. The magnitude of the association between each attachment style and IPV was
interpreted using Cohen’s (1992) criteria, where r < .01 is a trivial effect size, r = .10 is a
small effect size, r = .30 is a medium effect size, and r = .50 is a large effect size. In order
to account for potential publication bias, which refers to the notion that insignificant
results often go unpublished and thus cannot contribute to meta-analyses, we calculated
the classic fail-safe N for each attachment style as a correlate for IPV perpetration and vic-
timization. The classic fail-safe N provides the number of insignificant studies that would
be needed to pull the results from this meta-analysis above the threshold of p < .05, deem-
ing our results as insignificant (Rosenthal, 1979). In order to determine whether the
results in this study are robust against potential publication bias, the number of insignifi-
cant studies needed to make the results insignificant must be lower than the number of
effect sizes included in the analysis, multiplied by five and then adding 10 to that number
(Rosenthal, 1979).
In addition, we separated effect sizes for women and effect sizes for men. For men and
women separately, for each of the attachment styles, we calculated an aggregate effect size
(Pearson’s r) for both IPV victimization and perpetration. Next, we used gender as a cate-
gorical moderator and compared if there was significant variance, or differences, between
men and women in regard to the strength of the association between attachment styles
and IPV perpetration and victimization by calculating a Q-statistic, where a significant
result indicates significant difference, or heterogeneity, between the two groups. Due to
the lack of studies examining disorganized attachment for female perpetration or victim-
ization, we were only able to compare males and females regarding anxious, avoidant, and
secure attachment as correlates for IPV perpetration and victimization. Lastly, we com-
pared the strength of the attachment styles against one another as correlates for IPV per-
petration and victimization for both women and men by using attachment styles as the
moderating variable and calculating the Q-statistic. For women, we were able to compare
anxious, avoidant, and secure attachment styles as correlates for IPV perpetration and
victimization. For men, we were able to compare anxious, avoidant, disorganized, and
secure attachment as correlates for IPV perpetration and victimization.

RESULTS
When combining both males and females, we found that the strongest attachment style
as a correlate with IPV perpetration was anxious attachment (r = .16, p < .001; See
Table 1), followed by avoidant attachment (r = .13, p < .001) and disorganized attachment
(r = .11, p < .01). Secure attachment was a significantly negatively related to IPV perpe-
tration (r = .11, p < .01), meaning that there was a negative association between secure

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SPENCER, KEILHOLTZ, & STITH / 7
attachment and IPV perpetration. We also found that the strongest attachment style as a
correlate with IPV victimization was anxious attachment (r = .21, p < .001), followed by
avoidant attachment (r = .17, p < .001) and disorganized attachment (r = .16, p < .01).
Secure attachment was negatively related to IPV victimization (r = .20, p < .01). All
results were robust against potential publication bias with the exception of disorganized
attachment as a correlate for IPV perpetration and victimization. Therefore, these results
should be interpreted with caution.

Gender Comparisons
When looking at gender separately, we found that avoidant attachment was signifi-
cantly related to IPV perpetration for both men (r = .11, p < .01) and women (r = .23,
p < .001; see Table 2). Anxious attachment was significantly related to IPV perpetration
for both men (r = .13, p < .001) and women (r = .22, p < .001). Secure attachment was not
significantly related to IPV perpetration for women, but it was significantly negatively
related IPV perpetration for men (r = .13, p < .05). There were not enough studies to
examine the association between disorganized attachment and IPV perpetration for
women, but there was a significant association for men (r = .13, p < .01). We found that
anxious attachment was significantly associated with IPV victimization for both men
(r = .21, p < .001) and women (r = .23, p < .001). Avoidant attachment was significantly
associated with IPV victimization for women (r = .25, p < .001), but not for men. We did
not find enough effect sizes to examine the association between disorganized attachment
and IPV victimization for women, but found a significant association for men (r = .34,
p < .001). Lastly, secure attachment was found to be significantly negatively related to
IPV victimization for women (r = .18, p < .01) and (r = .25, p < .001).
Next, we compared the strength of attachment styles as correlates for IPV perpetration
and victimization between men and women. We found no significant differences between
men and women in the strength of anxious attachment (Qb = 1.73, p = .19; see Table 3),
avoidant attachment (Qb = 2.12, p = .15), or secure attachment (Qb = 0.43, p = .51) as cor-
relates for IPV perpetration. For IPV victimization, we did find that there was a signifi-
cantly stronger association among avoidant attachment and IPV victimization for women
compared to men (Qb = 9.25, p < .01). We did not find any significant differences in the
strength of the association among anxious attachment and IPV victimization (Qb = 1.73,
p = .19), or secure attachment and IPV victimization (Qb = 0.43, p = .51) when comparing
men and women.

Comparing Attachment Styles as Correlates for IPV Perpetration and Victimization

When comparing the strengths of attachment styles as correlates for IPV perpetration
and victimization for women, we found that there were no significant differences between
the strength of anxious attachment and avoidant attachment as correlates for IPV perpe-
tration (Qb = 0.00, p = .99; see Table 3) or IPV victimization (Qb = 0.11, p = .74). We
found that anxious attachment was a significantly stronger correlate than secure attach-
ment for IPV perpetration (Qb = 8.40, p < .01) and IPV victimization (Qb = 34.75,
p < .001). We also found that avoidant attachment was a significantly stronger correlate
than secure attachment for both IPV perpetration (Qb = 10.39, p < .01) and IPV victimiza-
tion (Qb = 23.67, p < .001).
When comparing the strengths of attachment styles as correlates for IPV perpetration
and victimization for men, we found that anxious attachment (Qb = 16.62, p < .001; see
Table 4), avoidant attachment (Qb = 10.06, p < .01), and disorganized attachment
(Qb = 11.15, p < .01) were all significantly stronger correlates for IPV perpetration than
secure attachment. There were no significant differences in the strength between anxious

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TABLE 2
Comparing Strength of Attachment Styles as Correlates for IPV Between Men and Women

Attachment Style k Mean r 95% CI Qb p-Value

Perpetration
Anxious attachment
Women 6 .22*** 0.11, 0.32 1.73 .188
Men 14 .13*** 0.07, 0.20
Avoidant attachment
Women 6 .23** 0.09, 0.35 2.12 .146
Men 15 .11** 0.03, 0.19
Secure attachment
Women 2 .10 0.30, 0.11 0.43 .513
Men 7 .13* 0.24, 0.01
Disorganized attachment
Women — — — — —
Men 6 .13** 0.05, 0.21
Victimization
Anxious attachment
Women 10 .23*** 0.18, 0.29 0.17 .676
Men 4 .21*** 0.11, 0.31
Avoidant attachment
Women 9 .25*** 0.17, 0.32 9.25 .002
Men 4 .02 0.10, 0.15
Secure attachment
Women 3 .18** 0.31, 0.06 0.43 .513
Men 3 .25*** 0.37, 0.12
Disorganized attachment
Women — — — — —
Men 2 .34*** 0.15, 0.50

Note. CI = confidence interval; k = number of effect sizes; Qb = heterogeneity of between-group differ-

ences with k 1 degrees of freedom; r = point estimate of effect size.
Boldface indicates statistically significant.
*p < .05.
**p < .01.
***p < .001.

and avoidant attachment (Qb = 0.16, p = .69), anxious and disorganized attachment
(Qb = 0.01, p = .93), and avoidant and disorganized attachment (Qb = 0.12, p = .73) for
IPV perpetration for men.
For IPV victimization, we found that anxious attachment (Qb = 6.88, p < .01) and disor-
ganized attachment (Qb = 8.94, p < .01) were significantly stronger correlates for IPV vic-
timization compared to avoidant attachment. Anxious attachment (Qb = 43.59, p < .001),
avoidant attachment (Qb = 14.98, p = <.001), and disorganized attachment (Qb = 30.88,
p < .001) were significantly stronger correlates for IPV victimization compared to secure
attachment. There was no significant difference between anxious attachment and disorga-
nized attachment as correlates for IPV victimization for men (Qb = 1.53, p = .22).

DISCUSSION
This meta-analysis found that anxious attachment, avoidant attachment, and disorga-
nized attachment styles were all significantly associated with physical IPV perpetration
and victimization. Secure attachment was significantly negatively associated with physi-
cal IPV perpetration and victimization. Results related to disorganized attachment were
not robust against potential publication bias and should be interpreted with caution.

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TABLE 3
Comparing Strength of Attachment Styles as Risk Markers for IPV Perpetration and Victimization for Women

Risk Marker k Mean r 95% CI Qb p-Value

Perpetration
Anxious attachment 6 .22*** 0.11, 0.32 0.00 .988
Avoidant attachment 6 .23** 0.09, 0.35
Anxious attachment 6 .22*** 0.11, 0.32 8.40 .004
Secure attachment 2 .10 0.30, 0.11
Avoidant attachment 6 .23** 0.09, 0.35 10.39 .001
Secure attachment 2 .10 0.30, 0.11
Victimization
Anxious attachment 10 .23*** 0.18, 0.29 0.11 .740
Avoidant attachment 9 .25*** 0.17, 0.32
Anxious attachment 10 .23*** 0.18, 0.29 34.75 .000
Secure attachment 3 .18** 0.31, 0.06
Avoidant attachment 9 .25*** 0.17, 0.32 23.67 .000
Secure attachment 3 .18** 0.31, 0.06

Note. CI = confidence interval; k = number of effect sizes; Qb = heterogeneity of between-group differ-

ences with k 1 degrees of freedom; r = point estimate of effect size.
Boldface indicates statistically significant.
*p < .05.
**p < .01.
***p < .001.

When examining gender differences, we did not find any significant differences between
men and women regarding attachment styles as correlates for IPV perpetration, but we
did find that there was a significantly stronger association among avoidant attachment
and IPV victimization for women compared to men.
Results from this meta-analysis may not be surprising to clinicians and therapists who
include an attachment framework when working with couples, or for therapists who spe-
cialize in working with situationally violent couples. It is important to highlight again that
when severe unidirectional violence, which is used to manipulate, intimidate, control, or
exert power over the other partner, is present in a relationship, these couples are never
suitable candidates for couples therapy (Stith et al., 2011). When looking at couples with
low levels of violence that is often bidirectional, the results of this study suggest that
attachment work within couples or individual therapy may be beneficial in preventing
IPV, reducing IPV or potentially eliminating IPV from the relationship. There is still some
controversy surrounding using attachment-based methods when working with couples
who have experienced violence in their relationship (Johnson, 2004). However, our find-
ings support the potential of including this framework when working with violent couples.
It has been established that relationship satisfaction is negatively related to IPV (e.g.,
Capaldi, Knoble, Shortt, & Kim, 2012; Stith et al., 2008) and that secure attachment is
positively related to relationship satisfaction (e.g., Hammond & Fletcher, 1991). Examin-
ing specific attachment styles and their relation to IPV for men and women can allow ther-
apists specific areas to target during treatment, as it has been advised to adjust treatment
according to an individual’s attachment style (Johnson & Whiffen, 1999). It is also possible
that working with couples to promote a secure attachment could also aid in improving cou-
ples’ overall relationship satisfaction.
We found that secure attachment was negatively related to IPV perpetration and vic-
timization, meaning that forming a secure attachment was related to a decrease in both
IPV perpetration and victimization. This highlights the importance of promoting a secure
attachment style when looking to create positive changes that have the potential to

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TABLE 4
Comparing Strength of Attachment Styles as Risk Markers for IPV Perpetration and Victimization for Men

Risk Marker k Mean r 95% CI Qb p-Value

Perpetration
Anxious attachment 14 .13*** 0.07, 0.20 0.16 .694
Avoidant attachment 15 .11** 0.03, 0.19
Anxious attachment 14 .13*** 0.07, 0.20 .007 .934
Disorganized attachment 6 .13** 0.05, 0.21
Anxious attachment 14 .13*** 0.07, 0.20 16.62 .000
Secure attachment 7 .13* 0.24, 0.01
Avoidant attachment 15 .11** 0.03, 0.19 0.12 .729
Disorganized attachment 6 .13** 0.05, 0.21
Avoidant attachment 15 .11** 0.03, 0.19 10.06 .002
Secure attachment 7 .13* 0.24, 0.01
Disorganized attachment 6 .13** 0.05, 0.21 11.15 .001
Secure attachment 7 .13* 0.24, 0.01
Victimization
Anxious attachment 4 .21*** 0.11, 0.31 6.88 .009
Avoidant attachment 4 .02 0.10, 0.15
Anxious attachment 4 .21*** 0.11, 0.31 1.53 .216
Disorganized attachment 2 .34*** 0.15, 0.50
Anxious attachment 4 .21*** 0.11, 0.31 43.59 .000
Secure attachment 3 .25*** 0.37, 0.12
Avoidant attachment 4 .02 0.10, 0.15 8.94 .003
Disorganized attachment 2 .34*** 0.15, 0.50
Avoidant attachment 4 .02 0.10, 0.15 14.98 .000
Secure attachment 3 .25*** 0.37, 0.12
Disorganized attachment 2 .34*** 0.15, 0.50 30.88 .000
Secure attachment 3 .25*** 0.37, 0.12

Note. CI = confidence interval; k = number of effect sizes; Qb = heterogeneity of between-group differ-

ences with k 1 degrees of freedom; r = point estimate of effect size.
Boldface indicates statistically significant.
*p < .05.
**p < .01.
***p < .001.

prevent or reduce IPV. Emotionally focused therapy (EFT; Johnson, 2012) is the model
that often comes to mind when therapists or clinicians decide to incorporate an attach-
ment perspective into their work with couples, families, or individuals. EFT aids couples
in decreasing reactivity caused by insecure attachment styles and promotes growth
toward a more secure attachment (Johnson, 2004, 2008). Several researchers have incor-
porated or proposed an attachment lens, or adaptation of EFT, when working with couples
who have experienced low levels of violence in their relationships (e.g., Schneider & Brim-
hall, 2014). However, reports of this work have been based mostly on case studies (e.g.,
Rouleau, Barabe, & Blow, 2019; Slootmaeckers & Migerode, 2019), or narratives high-
lighting how EFT could potentially be a good fit for situationally violent couples (Oka &
Whiting, 2011). There has not been quantitative research to examine the effectiveness of
EFT as a treatment modality when working with situationally violent couples, which war-
rant attention in future research. Due to the connection between how insecure attachment
styles may contribute to reactivity that may contribute to IPV perpetration, as well how
IPV victimization can have a negative impact on adult attachment, incorporating an
attachment lens in treatment may be highly beneficial in reducing or preventing low
levels of violence in the couple relationship. It is also important to note that attachment
work with individuals who have perpetrated IPV, or incorporating attachment

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SPENCER, KEILHOLTZ, & STITH / 11
interventions when working with victims of IPV to promote future secure attachments,
may be other possible strategies to reduce future violence or heal from experiencing vio-
lence.
We also found that anxious attachment was one of the strongest correlates for both IPV
victimization and perpetration for both men and women, and had a significantly stronger
association with IPV than secure attachment. Anxious attachment has been identified as
a possible catalyst to perpetrating violence by fueling one partner’s need to “pull” their
partner back into the relationship, even if they have to resort to violence to do so (Mayse-
less, 1991). It has also been identified that it is possible that after IPV victimization, which
can be viewed as a betrayal of trust, an individual’s need to feel safe and secure in their
relationship may increase, which can contribute to anxious attachment, or a negative
interaction cycle that includes anxious attachment (Rouleau, Barabe & Blow, 2019; Sch-
neider & Brimhall, 2014). It has been found that women who were victims of IPV reported
higher levels of anxious attachment compared to controls, further suggesting anxious
attachment might be an outcome related to IPV victimization (Craparo, Gori, Petruccelli,
Cannella & Simonelli, 2014). It has also been found that borderline and antisocial person-
ality dimensions mediate the association between anxious attachment and IPV victimiza-
tion among women (McKeown, 2014). The association between anxious attachment and
IPV, including both perpetration and victimization (whether the attachment style con-
tributes to the negative interactions that may escalate into violence, or as an outcome of
violence), suggests that attachment-based treatment may be beneficial for couples who
have experienced IPV and wish to stay together, individuals who have perpetrated IPV
and wish to change future behaviors, or individuals who have been victims of IPV and
wish to have healthy future relationships.
We found that avoidant attachment was a significantly associated with IPV perpetra-
tion for men and women, and IPV victimization for women. In regard to IPV perpetration,
an individual with an avoidant attachment style may use violence against their partners
to meet their goal of preventing their partner from getting too close, or too intimate with
them (Mayseless, 1991). There are additional factors that can mediate the association
between attachment styles and IPV perpetration, such as interpersonal problems (Lawson
& Malnar, 2011), that may also need to be addressed in a therapeutic setting. Women who
have been victims of IPV were more likely to report avoidant attachment styles compared
to women who have not been victims of IPV, and it has been found that women with avoi-
dant attachment styles were more likely to experience revictimization from partners (Cra-
paro et al., 2014). This may suggest that when a partner withdraws from the relationship,
if the other partner does not have the ability to self-regulate, they may in turn use violence
against their withdrawing partner. The association between avoidant attachment and
IPV, including both perpetration and victimization, suggests that attachment-based treat-
ment with the goal of creating a more secure attachment may be a beneficial modality of
preventing future violence.
It is also important to explore the significant gender difference that we found in our
analyses, which were that avoidant attachment was a significantly stronger correlate for
female IPV victimization than it was male IPV victimization. This finding was related to
the fact that avoidant attachment was not a significant correlate for male IPV victimiza-
tion, but it was a significant correlate for female IPV victimization. Previous scholars have
emphasized the importance of integrating a feminist/critical perspective on gender when
implementing EFT (Vatcher & Bogo, 2001). When hypothesizing why avoidant attach-
ment may be a stronger correlate for female victimization than male victimization, it may
be due to power differentials within heterosexual relationships. When working with
heterosexual couples, it is critical to address/examine power imbalances related to gender,
as they are often unnoticed or unaddressed, but can have “many destructive consequences,

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including depression and anxiety, invalidation of identity, and limited emotional attune-
ment and vulnerability” (Knudson-Martin, 2013, p. 9). Men are more likely to have avoi-
dant attachment styles than women (Del Giudice, 2011), which adhere to historical
gender roles where men avoid vulnerability and may distance themselves/withdraw from
the relationship. Since gender power differences tend to be accepted among heterosexual
couples (Knudson-Martin, 2013), it may be that when men display avoiding behaviors,
due to gendered power dynamics within these relationships, their avoidant behavior is
accepted and does not escalate into violence within the relationship. On the other hand,
when a woman displays avoiding behaviors/an avoidant attachment style (which does not
adhere to the traditional gender role that suggests that women must be available, caring,
and nurturing), her lack of power may not allow her avoidant behaviors to be accepted,
potentially leading her partner to escalate with anger and/or violence.
Lastly, we found that disorganized attachment was significantly related to IPV perpe-
tration and victimization when looking at both men and women combined. Since disorga-
nized attachment is characterized by high attachment-related anxiety and high
attachment-related avoidance (Brennan & Shaver, 1995), it may be that individuals with
disorganized attachment styles are experiencing negative interactions similar to both
those with anxious attachment styles and avoidant attachment styles. Similar levels of
reactivity that may be found in anxious attachment, and similar patterns of withdrawing
behavior found in avoidant attachment may be present in the intimate relationship when
a partner has a disorganized attachment style. Again, the links between disorganized
attachment and IPV perpetration and victimization highlight the importance of develop-
ing and creating secure attachment styles among couples and individuals as a means to
prevent or reduce future IPV.
When examining the strength of the association between attachment styles and physical
IPV perpetration and victimization, it is important to put this into context related to other
factors that could be examined or addressed in therapy. A recent meta-analysis examined
mental health factors as correlates for IPV perpetration and victimization (Spencer et al.,
2019). Results from the current study suggest that attachment styles are comparable in
strength, or magnitude, in their association with IPV to other mental health disorders and
symptoms, such as depression, anxiety, and post-traumatic stress disorder (PTSD). For
example, the current study found that for women, the correlation between anxious attach-
ment and IPV perpetration was r = .22, which was a slightly weaker association than
depression (r = .26), but stronger than anxiety (r = .13) and PTSD (r = .17; Spencer et al.,
2019). There is still some debate or controversy in utilizing attachment-based work, or EFT,
with couples who have experienced violence in their relationship (Johnson, 2004), yet incor-
porating mental health treatment has been less debated in working with IPV. Our results
suggest that using attachment-based work when treating couples who wish to stay together
after violence in their relationship warrants attention.

Limitations & Future Research

One limitation of this meta-analysis, which is true of all meta-analyses, is the potential
that there were studies missed to be included in the study. We only were able to include
33 studies in this meta-analysis. Due to the nature of studies included in the meta-analy-
sis, we were only able to examine attachment styles of either the perpetrator or victim as
correlates for IPV. Doumas, Pearson, Elgin, and McKinley (2008) examined how attach-
ment “mispairings” (e.g., a male with an avoidant attachment and their female partner
with an anxious attachment style) impacted levels of violence within the relationship.
Continued focus on how attachment pairings/mispairings increase or decrease risk for
IPV in the couple relationship would be greatly beneficial for expanding our knowledge of

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SPENCER, KEILHOLTZ, & STITH / 13
how attachment styles relate to IPV. Additionally, this study did not examine dyadic data,
as most of the studies included did not incorporate dyadic data. Future research examin-
ing dyadic data would provide additional information about the potential of attachment
pairings/mispairings and IPV perpetration and victimization. Additionally, although this
manuscript examined physical IPV specifically, future research may also benefit from
examining the association between attachment styles and emotional IPV.
Although the studies included in this meta-analysis all examined adult attachment (as
opposed to attachment to caregivers in childhood), they still used a variety of measure-
ments to determine attachment styles, some of which have been criticized for a lack of
measurement precision or poor test–retest reliability (Fraley, Waller, & Brennan, 2000).
Another limitation of this study is that the data are cross-sectional, meaning although we
have found a link between attachment styles and IPV perpetration and victimization, it
would be impossible to truly know whether the attachment styles created negative rela-
tionship patterns that escalated into the use of violence, or whether experiencing violence
in the relationship caused attachment injuries that contributed to insecure attachment
styles based on the results of this study. Lastly, with the lack of clinical research on the
effectiveness of treatment for couples and individuals who have perpetrated or have been
victims of IPV using an attachment-based practice, future research on this topic would
greatly benefit the field of couple and family therapy.

CONCLUSION
The results from this meta-analysis suggest the importance of clinicians incorporating
attachment-based practices when working with couples or individuals who have experi-
enced IPV. This meta-analysis found that anxious attachment, avoidant attachment, and
disorganized attachment styles were all significant correlates for physical IPV perpetra-
tion and victimization. Secure attachment was significantly negatively related to physical
IPV perpetration and victimization. Working toward promoting secure attachment among
couples who have experienced low levels of violence and wish to stay together, individuals
who have perpetrated violence but wish to change their behaviors, and individuals who
have been victims of IPV and want to heal the attachment injuries they have as a result of
the violence may be beneficial in preventing or reducing future violence. We did find that
avoidant attachment was a significantly stronger correlate for IPV victimization for
women compared to men. This may highlight the importance of incorporating a critical
gender perspective when using attachment-based frameworks, such as EFT, with couples.
Overall, the results of this meta-analysis found that insecure attachment styles are signif-
icantly associated with IPV perpetration and victimization, and secure attachment styles
are negatively related to physical IPV perpetration and victimization.

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SUPPORTING INFORMATION
Additional Supporting Information may be found in the online version of this article:
Table S1. Study Characteristics.
Appendix S1. Studies Included in the Meta-Analysis.

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