adult attachment - The Professional Counselor

The Impact of Intimate Partner Violence on Interpersonal and Intrapersonal Relationships: The Role of Childhood Attachment

Dec 5, 2024 | Volume 14 - Issue 3

Fei Shen, Ying Zhang, Xiafei Wang

Intimate partner violence (IPV) has consistently been shown to have deleterious effects on survivors’ interpersonal and intrapersonal relationships. Despite the negative outcomes of IPV, distress after IPV varies widely, and not all IPV survivors show a significant degree of distress. The present study examined the impact of IPV on adult attachment and self-esteem, as well as the moderating role of childhood attachment on the relationships between IPV, adult attachment, and self-esteem using path analysis. A total of 1,708 adult participants were included in this study. As hypothesized, we found that IPV survivors had significantly higher levels of anxious and avoidant adult attachment than participants without a history of IPV. Additionally, childhood attachment buffered the relationship between IPV and self-esteem. We did not find that childhood attachment moderated the relationship between IPV and adult attachment. These results provide insight on attachment-based interventions that can mitigate the negative effects of IPV on people’s perceptions of self.

Keywords: intimate partner violence, childhood attachment, adult attachment, self-esteem, moderation

More than 10 million adults experience intimate partner violence (IPV) victimization annually in the United States (Black et al., 2011); therefore, it undoubtedly remains a prominent public health concern. IPV victimization has been consistently associated with deleterious effects on survivors’ physical and mental health. It is well established that IPV survivors demonstrated increased risks for chronic pain, injury, insomnia, disabilities, post-traumatic stress disorder, depression, and suicidality (Burke et al., 2005; Gilbert et al., 2023; Matheson et al., 2015; McLaughlin et al., 2012). Historically, empirical studies on trauma and violence have focused on psychopathology and symptoms (McLaughlin et al., 2012; Sayed et al., 2015). However, there is limited research on exploring the link between IPV victimization and intrapersonal and interpersonal relationship outcomes. Attachment theory (Bowlby, 1969) not only provides a rich theoretical framework for conceptualizing an individual’s psychopathology, but also establishes a foundation for understanding the intrapersonal and relational sequelae of IPV (Levendosky et al., 2012; Sutton, 2019). IPV survivors often experience a violation of trust and a sense of betrayal in the aftermath and develop ineffective coping mechanisms (e.g., distancing themselves emotionally), which could potentially impact their new intimate relationships (St. Vil et al., 2021).

Despite the negative outcomes of IPV victimization, the levels of distress following such incidents can vary (Scott & Babcock, 2010). Although evidence has implicated numerous risk factors related to IPV victimization (e.g., childhood trauma, gender inequity; Jewkes et al., 2017; Meeker et al., 2020), limited effort has been put forth to recognize protective factors that contribute to IPV survivors’ coping and healing processes. Childhood attachment has been proposed as a potential protective factor for IPV survivors’ coping with traumatic experiences and a moderator for buffering the negative psychological outcomes of IPV (Pang & Thomas, 2020), which provides a meaningful foundation for us to further investigate childhood attachment as a moderator buffering relational outcomes. To our knowledge, no study to date has investigated the potential moderating role of childhood attachment security on the association between IPV, interpersonal outcomes (e.g., adult attachment), and intrapersonal outcomes (e.g., self-esteem) in a non-clinical sample. Understanding the moderating role of childhood attachment can potentially provide further directions toward protecting survivors from negative outcomes and creating interventions that foster healthier interpersonal relationships. In tackling the gaps in the literature, we aim to: (a) investigate the impact of IPV on adult attachment and self-esteem; and (b) examine the moderating role of childhood attachment on the relationships between IPV, adult attachment, and self-esteem.

Theoretical Framework—Attachment Theory
Attachment theory (Bowlby, 1969) offers an explanation of how the relationship between children and their primary caregiver(s) develops and how it impacts children’s subsequent developmental process. According to Bowlby (1973), children develop mental representations of themselves and others, known as internal working models, through their interactions with their primary caregiver(s). Children with secure attachment are more likely to form positive self-perceptions and relationships with others (Bowlby, 1969). In contrast, children who develop insecure attachment are more likely to struggle with coping with distress and form poor relationships with others, resulting from caregivers responding to their needs insensitively.

Although evidence suggests the continuity of attachment from childhood to adulthood (Bowlby, 1969), there are distinctions between these two variables based on individuals’ attachment needs, developmental stages, and characteristics of different relationships. As children grow into adolescents and emerging adults, they often continue to maintain connections with their primary caregivers while exploring new social roles outside of the family and forming close relationships with peers and romantic partners to develop adult attachment (Moretti & Peled, 2004). Secure adult attachment is generally characterized by flexibility, the ability to work independently and cooperatively with others, the ability to seek support from intimate partners, and the capacity to manage loss in a healthy manner (Brennan et al., 1998). Adult romantic relationships are thought to be underlined by two fundamental attachment-related dimensions: anxiety and avoidance. Adults with anxious attachment tend to experience worry and fear regarding abandonment or rejection by their partner, leading them to seek constant reassurance and validation from their partner. On the other hand, avoidant-attached individuals often feel uncomfortable with being close to their partner, which can lead them to withdraw from intimacy and emotional closeness in the relationship (Brennan et al., 1998). Thus, understanding the similarities and differences of attachment categories as well as dynamics of the attachment system is warranted (Lopez & Brennan, 2000).

Childhood Attachment, IPV Victimization, and Adult Attachment
Various researchers have extensively investigated the significant association between attachment developed with romantic partners and its involvement in IPV dynamics (Bradshaw & Garbarino, 2004; Duru et al., 2019; Levendosky et al., 2012). However, most studies explored the relationship between adult attachment and IPV perpetration (Gormley & Lopez, 2010; McClure & Parmenter, 2020). Specifically, individuals with insecure attachment present intense fear of abandonment or rejection and activate their aggressive behaviors to control their partners (Gormley & Lopez, 2010). Regarding IPV victimization circumstances, few studies have examined attachment security among IPV survivors. Specifically, simultaneously exploring attachment with primary caregivers in childhood and attachment with romantic partners in adulthood could capture the complexity of the impact of IPV victimization experiences on relational and emotional outcomes. Ponti and Tani (2019) investigated both childhood attachment and adult attachment among 60 women who experienced IPV and indicated that the attachment to the mother could influence IPV victimization both directly and indirectly through the mediation effect of adult attachment with romantic partners. In other words, attachment with the mother could serve as a protector for not entering a violent romantic relationship or healthily managing the aftermath of traumatic experiences.

Childhood attachment has been identified as a potential moderator that may contribute to the variations of the healing process among IPV survivors in a small but growing number of studies (e.g., Scott & Babcock, 2010). Pang and Thomas (2020) examined the moderating role of childhood attachment on the relationship between exposure to domestic violence in adolescence and psychological outcomes and adult life satisfaction with a sample of 351 adult college students. They found that childhood attachment moderated the relationship between IPV exposure and adult life satisfaction but not psychological outcomes. This study provides empirical support for the moderating role of childhood attachment on early IPV exposure and later adult psychological and relationship outcomes. Given the context in which IPV occurs in the intimate relationships, not addressing the association between childhood attachment and adult attachment together would not fully capture the complexity of the attachment process in the adult population. It is possible that the relationship between IPV victimization and adult attachment security would be attenuated in conditions of childhood attachment. Therefore, the moderation effect of childhood attachment in the context of IPV needs to be empirically substantiated.

Childhood Attachment, IPV Victimization, and Self-Esteem
Self-esteem generally refers to a person’s overall evaluation and attitude toward themself (Rosenberg, 1965). Experiencing IPV was found to have detrimental effects on an individual’s self-esteem; IPV survivors often have lower levels of self-esteem than non-abused individuals (Childress, 2013; Karakurt et al., 2014; Tariq, 2013). Experiencing IPV (e.g., emotional and psychological abuse) can lead to feelings of worthlessness and hopelessness, making it difficult for survivors to maintain autonomy and make decisions that are in their best interest (Tariq, 2013). IPV survivors consistently reported feeling burdened with a sense of guilt, shame, and self-blame for being victimized (Lindgren & Renck, 2008). Unfortunately, this can contribute to a vicious cycle, as survivors who have low self-esteem are less likely to take steps to leave abusive relationships (Karakurt et al., 2014), which leads to further victimization (Eddleston et al., 1998). Understanding the link between IPV victimization and self-esteem is crucial, as rebuilding self-esteem can also help survivors develop stronger relationships with others, gain strength toward ending abusive relationships, reduce risks of mental health problems, and feel more empowered to seek help and support (Karakurt et al., 2022).

The development of the self can be seen to unfold in the context of attachment and the internalization of important others’ perceptions and expectations. Numerous studies have shed some light on the association between childhood attachment and self-esteem, suggesting that secure attachment with primary caregivers can serve as a key protective factor for developing higher levels of self-esteem (Shen et al., 2021; Wilkinson, 2004). In contrast, individuals who reported insecure attachment with their primary caregivers tended to demonstrate lower levels of self-esteem (Gamble & Roberts, 2005). However, interpersonal trauma such as IPV can produce long-term dysfunctions of self (Childress, 2013). Although no study has directly explored the moderating role of childhood attachment buffering the relationship between IPV and self-esteem, several studies have indicated that parental support serves as a moderator role in the relationship between interpersonal violence and self-esteem (Duru et al., 2019). Indeed, if a person had secure attachment experiences in childhood, they may have developed a positive sense of self-worth and the belief that they deserve love and respect, which could buffer the negative effects of IPV on their self-esteem. Considering the existing literature and theoretical explanations as a whole, it seems reasonable to postulate that childhood attachment might serve as a potential moderator of the association between IPV and self-esteem.

Taken together, the literature consistently supports the significance of exploring protective factors contributing to IPV survivors’ healing process, yet no study to date has investigated the potential moderating role of childhood attachment on the association between IPV, adult attachment, and self-esteem in a non-clinical diverse sample. In tackling these gaps, we pose two research questions (RQs):

RQ1: How is IPV associated with adult attachment and self-esteem?
RQ2: How does childhood attachment moderate the relationships between IPV, adult
attachment, and self-esteem?

We hypothesized that: 1) IPV victimization is significantly positively associated with adult attachment (i.e., anxious attachment, avoidant attachment) and negatively associated with self-esteem; 2) Childhood attachment moderates the relationship between IPV victimization and adult attachment (i.e., anxious attachment, avoidant attachment); and 3) Childhood attachment moderates the relationship between IPV victimization and self-esteem.

Method

Sampling Procedures
With approval from the university IRB, research recruitment information was posted on various social media platforms (e.g., Facebook, Craigslist, university announcement boards). Individuals who were 18 years of age or older and able to fill out the questionnaire in English were eligible for the study. Participants were directed to an online Qualtrics survey to voluntarily complete the informed consent and the measures listed in the following section. At the end of the survey, participants were prompted to enter their email addresses to win one of 10 $15 e-gift cards. Their email addresses were not included for data analysis.

Participants
Of the 2,373 voluntary adult participants who took the survey, 1,708 (71.76%) individuals were retained for the final analysis, including 507 (29.68%) participants who experienced IPV in adulthood and 1,191 (69.73%) participants without a history of IPV in adulthood. We eliminated participants who either did not consent to the study (n = 36, 1.51%), were younger than 18 years old (n = 33, 1.39%), or did not complete 95% of the survey questions (n = 596, 25.11%). We examined whether those who were excluded from the sample because of missing or invalid data differed from those who were retained. There was a significant difference in age between the included sample (M = 28.89, SD = 12.38) and excluded sample (M = 32.10, SD = 13.51); t (2,255) = −3.48, p = 0.001. Therefore, excluding participants with missing data was less likely to significantly impact our results. Table 1 shows that 76.23% of the participants were female. The age range of the sample was broad, from 18 to 89 years old, with an average age of 30.

Table 1
Demographic and Key Variables Information (N = 1,708)

Variables	N	Percent	Range	M(SD)
Childhood attachment	1,708	100%	1–5	3.34(0.92)
IPV status IPV Non-IPV	1,698 507 1,191	99.41% 29.68% 69.73%	0–1
Self-Esteem	1,704	99.77%	3–40	26.98(7.46)
Anxious Attachment	1,708	100%	1–7	4.11(1.26)
Avoidant Attachment	1,708	100%	1–7	3.71(1.16)
Control Variables
Gender Male Female	1,683 381 1,302	98.54% 22.31% 76.23%
Household Income Less than $5,000 $5,000–$9,999 $10,000–$14,999 $15,000–$19,999 $20,000–$24,999 $25,000–$29,999 $30,000–$39,999 $40,000–$49,999 $50,000–$74,999 $75,000–$99,999 $100,000–$149,999 $150,000 or more	1,514 183 96 119 83 98 78 128 141 239 143 139 67	88.64% 10.70% 5.60% 7.00% 4.90% 5.70% 4.60% 7.50% 8.30% 14.00% 8.40% 8.10% 3.90%

Measures
Childhood Attachment
The parental attachment subscale of the Inventory of Parent and Peer Attachment (Armsden & Greenberg, 1987) was used to measure childhood attachment. Participants rated their attachment to their parent(s) or caregiver(s) who had the most influence on them during their childhood. The subscale consists of 25 items divided into three dimensions, including 10 items on Trust (e.g., “My mother/father trusts my judgment”), nine items on Communication (e.g., “I can count on my mother/father when I need to get something off my chest”), and six items on Alienation (e.g., “I don’t get much attention from my mother/father”). Participants rated the items using a 5-point Likert scale ranging from 1 (almost never or never true) to 5 (almost always or always true). Responses were averaged, with a higher score reflecting more secure childhood attachment. This subscale has demonstrated relatively high internal consistency, with a Cronbach’s alpha of .93 (Armsden & Greenberg, 1987), and construct validity (Cherrier et al., 2023; Gomez & McLaren, 2007). In the present study, the Cronbach’s alpha coefficient for this subscale was .96.

Intimate Partner Violence
Participants’ experiences of IPV were assessed through the question “Have you ever experienced intimate partner violence (physical, sexual, or psychological harm) by a current or former partner or spouse since the age of 18?” Responses were coded as 1 = Yes, 0 = No.

Adult Attachment
Adult attachment was measured using the Experience in Close Relationships Scale (ECR; Brennan et al., 1998). The ECR consists of 36 items with 18 items assessing each of the two dimensions: anxious attachment (e.g., “I worry about being abandoned”) and avoidant attachment (e.g., “I try to avoid getting too close to my partner/friends”). To reduce confounding factors with childhood attachment with their parent(s) or primary caregiver(s), we only assessed adult attachment with close friends and/or romantic partners. Responses were rated on a 7-point Likert scale ranging from 1 (strongly disagree) to 7 (strongly agree). Two scores were computed by averaging items on each subscale, with a higher score reflecting a higher level of anxious or avoidant attachment. Two subscales demonstrated high construct validity in various studies (Gormley & Lopez, 2010; Ponti & Tani, 2019) and a relatively high consistency for anxiety (α = .91) and avoidance (α = .94; Brennan et al., 1998). Cronbach’s alpha coefficients for the present study were .93 for anxiety and .92 for avoidance.

Self-Esteem
The Rosenberg Self-Esteem Scale (RSES; Rosenberg, 1965) is a 10-item self-report measure of overall feelings of self-worth or self-acceptance (e.g., “I am satisfied with myself”). All items were coded using a 4-point Likert scale ranging from 1 (strongly disagree) to 4 (strongly agree). Items were summed, with a higher score indicating a higher level of self-esteem. RSES has been frequently used in various studies, demonstrating high reliability and validity (Brennan & Morris, 1997; Rosenberg, 1979). The Cronbach’s alpha for the present study was .89.

Control Variables
To make more accurate estimates, we included control variables that are potentially associated with IPV exposures, such as gender and household income. Gender was dummy coded as 1 = Male, 2 = Female.

Data Analysis
We used SPSS 27 for data preparation and Mplus 8 for data analysis. Missing data were treated with the full information maximum likelihood in Mplus as recommended (Acock, 2005). We examined all the bivariate relationships between all the variables within our study including IPV, childhood attachment, adult attachment (anxious and avoidant attachment), self-esteem, and control variables (i.e., gender and household income). We conducted path analysis to examine the moderating role of childhood attachment between IPV, self-esteem, and adult attachment (see Figure 1). We computed an interaction term by multiplying the predictor (IPV) and the moderator (childhood attachment). A moderation relationship is identified if the interaction item significantly predicts the dependent variables (Baron & Kenny, 1986). The goodness of model fit was evaluated by recommended indices with a non-significant chi-square value, RMSEA < .08, CFI > .90, TLI > .90, and SRMR < .05 (Hooper et al., 2008).

Figure 1
Path Analysis: Moderating Effect of Childhood Attachment on the Relationship Between IPV, Self-Esteem, and Adult Attachment

Results

Descriptive statistics and bivariate correlations of the study variables are demonstrated in Tables 1 and 2. Our model demonstrated good fit to the data, with χ²(4) = 41.90, p = .001, RMSEA = .07, 90% CI [.05, .08], CFI = .99, TLI = .99, SRMR = .02.

The standardized coefficients of the path model revealed that IPV survivors tended to have higher levels of anxious adult attachment (b = .67, p < .001) and avoidant adult attachment (b = .62, p < .001), and lower levels of self-esteem (b = −.29, p < .001) compared with participants without a history of IPV (see Table 3). Individuals with more secure childhood attachment tended to have lower levels of anxious adult attachment (b = −.38, p < .001) and avoidant adult attachment (b = −.31, p < .001), and higher levels of self-esteem (b = .22, p < .001). We found that childhood attachment buffered the relationship between IPV and self-esteem (b = .12, p < .001). Specifically, IPV survivors with more secure childhood attachment demonstrated higher levels of self-esteem. Although the moderation effect was statistically significant, the magnitude of the effect was small. Moreover, IPV survivors with more secure childhood attachment did not demonstrate significant differences on anxious or avoidant adult attachment compared to participants without a history of IPV.

Table 2
Bivariate Correlation Matrix of Variables

	1	2	3	4	5	6	7
1. Anxious Adult Attachment	–
2. Avoidant Adult Attachment	.40***	–
3. Self-Esteem	−.18***	−.15***	–
4. Childhood Attachment	−.45***	−.47***	.18***	–
5. IPV	.26***	.54***	−.17***	−.31***	–
6. Gender	−.10***	−.06**	.14***	−.01	−.08***	–
7. Household Income	.03	.08***	−.05*	−.08**	−.06*	−.01	–

*p < .05 (two-tailed). **p < .01. ***p < .001.

Table 3
Unstandardized and Standardized Path Coefficients (Standard Errors) for Path Analysis

Parameter Estimates		Anxious Adult Attachment	Avoidant Adult Attachment	Self-esteem
Childhood Attachment	Unstandardized	−.37(.01)***	−.33(.02)***	.26(.04)***
	Standardized	−.38(.01)***	−.31(.02)***	.22(.03)***
IPV	Unstandardized	.61(.01)***	.62(.02)***	−.33(.04)***
	Standardized	.67(.01)***	.62(.02)***	−.29(.03)***
IPV*Childhood Attachment Interaction	Unstandardized	.00(.00)	.01(.01)	.10(.02)***
IPV*Childhood Attachment Interaction	Standardized	.01(.01)	.01(.01)	.12(.02)***
Control Variables
Gender	Unstandardized	−.03(.01)**	−.08(.03)**	.18(.06)**
	Standardized	−.02(.01)**	−.04(.01)**	.07(.02)**
Household Income	Unstandardized	.01(.00)***	.01(.00)***	−.02(.01)**
	Standardized	.02(.01)***	.04(.01)***	−.06(.02)**

*p < .05 (two-tailed). **p < .01. ***p < .001.

Female participants tended to have lower levels of anxious (b = −.02, p < .01) or avoidant adult attachment (b = −.04, p < .01), and higher levels of self-esteem (b = .07, p < .01). Individuals with higher household income reported higher levels of anxious adult attachment (b = .02, p < .001), avoidant adult attachment (b = .04, p < .001), and lower levels of self-esteem (b = −.06, p < .01).

Discussion

Although most existing literature predominantly focuses on revealing how the attachment style of the IPV perpetrators may influence their behavior (Velotti et al., 2018), our study contributes to the field by exploring the potential association between IPV victimization and adult attachment. Using a non-clinical sample, this study identified a positive association between IPV victimization and adult insecure attachment, including both anxious and avoidant dimensions. Meanwhile, a negative association was observed between IPV victimization and self-esteem. These findings concur with the tenets of attachment theory, which posits that individuals who experienced IPV would have a sense of betrayal of trust within intimate relationships. Rather than serving a secure attachment base in intimate adult relationships, IPV experience altered internal models of self as a victim and the other as perpetrator if the individuals stay in the abusive relationships for long enough (Levendosky et al., 2012). IPV survivors may adopt maladaptive coping strategies to mitigate the distress stemming from such intimate relationships. Consequently, these individuals might manifest anxious or avoidant attachment (Levendosky et al., 2012). At the same time, our results indicating reduced self-esteem among IPV victims resonates with previous studies, underscoring the detrimental effects of IPV on self-esteem (Childress, 2013; Karakurt et al., 2014). Enduring undeserved maltreatment from partners can persistently undermine an individual’s sense of self-efficacy and competency (Tariq, 2013).

Our findings do not identify childhood attachment as a significant moderating factor between IPV victimization and insecure attachment in adulthood. There is currently no study to compare with this finding, as the present study is the first to investigate the moderating role of childhood attachment on the relationship between adult IPV victimization and adult attachment.

Although previous research implied that childhood attachment can mitigate the adverse effects of IPV on psychological health and adult life satisfaction (Pang & Thomas, 2020), those studies assessed IPV experiences during an individual’s childhood. Nevertheless, we speculate that IPV targets an individual’s sense of security, which is predominantly influenced by adult romantic relationships (Dutton & White, 2012). This IPV-related sense of security distinguishes itself from childhood attachment, which primarily arises from interactions between parents and children. For instance, the fear associated with intimate relationships and feelings of betrayal, as a result of sustained physical and emotional abuse from an intimate partner, may not be readily alleviated by the sense of security instilled by one’s primary caregivers during childhood. Survivors who were abused by their partner may attempt to manage their distress by deactivating their attachment system, which would reflect more insecure working models of self and others, less self-confidence, and lack of trust in others (Kobayashi et al., 2021).

Conversely, our research determined that childhood attachment acts as a moderator between IPV victimization and self-esteem, aligning with previous studies showing parental support as a vital protective mechanism for the self-esteem of individuals subjected to interpersonal violence (Duru et al., 2019). As posited by attachment theory, secure childhood attachment fosters a robust self-concept, equipping individuals with the belief that they are valuable and deserving of love (Bowlby, 1969). This foundational belief may serve as an effective counterbalance, attenuating the damage to self-esteem precipitated by IPV. We acknowledge that although the moderating effect of childhood attachment on the relationship between IPV victimization and self-esteem was statistically significant, the magnitude standardized coefficients were fairly low. One possible explanation could be that when transitioning to adulthood, individuals expand their social relationships with their peers, romantic partners, and offspring, which may increasingly take on their attachment organizations (Allen et al., 2018; Guarnieri et al., 2015). Future studies could further explore the level of effectiveness of childhood attachment mitigating the negative impact of IPV experience on interpersonal and intrapersonal outcomes in adulthood.

Limitations and Future Directions
Although the present study adds important contributions to the literature on IPV victimization and attachment, several limitations must be acknowledged. First, the dichotomous question of IPV could not fully capture all of the complexity of IPV victimization experiences. Future research should consider other factors related to IPV, including severity of the violence, types of IPV, age of onset, frequency, and duration. Second, retrospective reporting of childhood attachment with the primary caregiver(s) may lead to bias, or distortion in the recall of traumatic events from family of origin. However, previous studies have shown that retrospective reports only have a small amount of bias and that it is not strong enough to invalidate the results for adverse childhood experiences (Hardt & Rutter, 2004).

A growing body of literature has identified adult attachment as a risk factor of IPV (Doumas et al., 2008); here, we were not able to determine the causal relationship between adult attachment and IPV. We did conduct a path analysis using childhood attachment and adult attachment to predict IPV and self-esteem, but the model did not demonstrate a good fit. It is possible that attachment and IPV do not have a simple causal relationship; other childhood trauma experiences may contribute to the complexity of the IPV (Li et al., 2019).

Finally, not knowing the types of attachment in childhood limited our exploration regarding the changes of attachment styles from childhood to adulthood. The cross-sectional design of assessing childhood attachment and adult attachment concurrently did not provide sufficient evidence to determine the cause and effect. Bowlby (1969) believed that there is a continuity between childhood attachment and adult attachment over the life course. An individual’s security in adult relationships may be a partial reflection of their experiences with primary caregivers in early childhood (Ammaniti et al., 2000). However, one of the common misconceptions about attachment theory is that attachment is always stable from infancy to adulthood (Hazan & Shaver, 1994). It is possible that adults’ attachment patterns would change if their relational experiences were disturbed by relational trauma such as IPV (West & George, 1999) or childhood trauma (Shen & Soloski, 2024), which partially explains that childhood attachment is not a significant moderator between IPV and adult attachment from our findings. Future research could conduct longitudinal studies to examine the changes of attachment and how childhood trauma and IPV influences attachment over time.

Implications
The findings of the present study provide insights that may inform clinical interventions for adult survivors who have experienced IPV to rebuild trusting interpersonal relationships and relationships with self. First, IPV experiences were significantly associated with anxious and avoidant adult attachment. During a traumatic experience, such as IPV, the attachment security system is activated, and survivors are in a surviving mode and tend to seek protection. Unfortunately, IPV involves power, control, and betrayal within an intimate relationship, which may damage internal working models of self and others if they stay for long enough (Levendosky et al., 2012). Thus, clinical interventions could focus on altering survivors’ negative internal working models to increase security within non-abusive close relationships. Close friends and family members could remain as a secure base for IPV survivors while they rebuild their personal and social lives that IPV have damaged. Additionally, therapeutic relationships could potentially serve as a secure base for survivors to explore their attachment behaviors. Survivors with avoidant attachment demonstrate deactivation attachment behaviors (Brenner et al., 2021), such as minimizing the impact of their trauma experiences, having a tendency to perceive and present themselves as strong, or avoiding discussing their trauma experiences to avoid the possible pain (Muller, 2009). Therefore, clinicians need to hold a safe space to challenge survivors with avoidant attachment to reactivate their attachment systems, such as by validating their avoidance and ambivalence or facilitating conversations to turn toward trauma-related experiences and emotions instead of turning away. Survivors with anxious attachment, on the other hand, demonstrate hyperactivation attachment behaviors, including fear of rejection and abandonment, hypersensitivity to and preoccupation with relationships and intimacy, utilization of negative emotional regulation strategies, as well as difficulties with leaving abusive relationships (Kural & Kovacs, 2022; Velotti et al., 2018). Clinicians could teach anxious-attached survivors some effective coping strategies, including self-regulation skills, creating boundaries, establishing safety plans, maintaining relationships with others, and increasing self-compassion (Rizo et al., 2017), which may help them to perceive themselves as worthy, lovable, and less dependent on others.

Furthermore, group counseling is a powerful way to learn about trusting oneself and others and to improve interpersonal relationship skills. Clients’ attachment patterns will be activated through interactions with the group members and the facilitators. Clients with anxious attachment tend to react to group members’ rejections, while clients with avoidant attachment tend to demonstrate withdrawal behaviors (e.g., disengagement; Zorzella et al., 2014). Therefore, when working with these clients, clinicians should stimulate the change of internal working models by using the group as a secure base to foster corrective emotional exchanges that challenge group members’ maladaptive beliefs about themselves and others (Marmarosh et al., 2013).

One of the important findings of the current study is that childhood attachment with the primary caregiver(s) buffered the relationship between IPV and self-esteem. From a clinical point of view, the result may bring hope for adult survivors of interpersonal violence regarding their healing process; primary caregivers could still serve as a secure base to offer a crucial opportunity to strengthen the internal working models that would positively affect later adjustment. Counselors could assess survivors’ attachment with their primary caregivers and give them autonomy to determine if it is beneficial to get their non-abusive primary caregivers involved in the treatment to provide support. Although the moderation result from the present study was statistically significant, the magnitude of moderating effect was small. During adulthood, individuals expand their relationship networks with their peers (e.g., friends) and romantic partners, as these relationships become more central in their daily life (Guarnieri et al., 2015). Therefore, the effectiveness of childhood attachment mitigating the adverse effect of IPV in adulthood clinically needs to be further investigated.

Conclusion
The present study empirically examines the moderation role of childhood attachment on the association between IPV, adult attachment, and self-esteem. Specifically, we found that childhood attachment was a significant moderator buffering the relationship between the experience of IPV and self-esteem. A theoretical and empirical understanding of the role of attachment in the context of IPV has implications for researchers and clinicians working with survivors and their families.

Conflict of Interest and Funding Disclosure
The authors reported no conflict of interest
or funding contributions for the development
of this manuscript.

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Fei Shen, PhD, LMFT, is an assistant professor at Kean University. Ying Zhang, PhD, is an assistant professor at Clarkson University. Xiafei Wang, PhD, is an assistant professor at Syracuse University. Correspondence may be addressed to Fei Shen, 1000 Morris Ave., Union, NJ 07083, fshen@kean.edu.

Attachment, Self-Esteem, and Psychological Distress: A Multiple-Mediator Model

Apr 1, 2021 | Volume 11 - Issue 2

Fei Shen, Yanhong Liu, Mansi Brat

The present study examined the relationships between childhood attachment, adult attachment, self-esteem, and psychological distress; specifically, it investigated the multiple mediating roles of self-esteem and adult attachment on the association between childhood attachment and psychological distress. Using 1,708 adult participants, a multiple-mediator model analysis following bootstrapping procedures was conducted in order to investigate the mechanisms among childhood and adult attachment, self-esteem, and psychological distress. As hypothesized, childhood attachment was significantly associated with self-esteem, adult attachment, and psychological distress. Self-esteem was found to be a significant mediator for the relationship between childhood attachment and adult attachment. In addition, adult attachment significantly mediated the relationship between self-esteem and psychological distress. The results provide insight on counseling interventions to increase adults’ self-esteem and attachment security, with efforts to decrease the negative impact of insecure childhood attachment on later psychological distress.

Keywords: childhood attachment, adult attachment, self-esteem, psychological distress, mediator

Attachment has been widely documented across disciplines, following Bowlby’s (1973) foundational work known as attachment theory. Attachment, in the context of child–parent interactions, is defined as a child’s behavioral tendency to use the primary caregiver as the secure base when exploring their surroundings (Bowlby, 1969; Sroufe & Waters, 1977). Research has shed light on the significance of childhood attachment in predicting individuals’ intrapersonal qualities such as self-esteem and emotion regulation during adulthood (Brennan & Morris, 1997), interpersonal orientations examined through attachment variation and adaptation across different developmental stages (Sroufe, 2005), and overall psychological well-being (Cassidy & Shaver, 2010; Wright et al., 2014).

Given its clinical significance, attachment has gained increased interest across disciplines. For example, childhood attachment was found to significantly predict coping and life satisfaction in young adulthood (Wright et al., 2017). Relatedly, a 30-year longitudinal study reinforces the vital role of childhood attachment in predicting individuals’ development of “the self and personality” (Sroufe, 2005, p. 352). Sroufe’s (2005) study reinforced the vital role of attachment across the life span. As an outcome variable, attachment is asserted to be associated with empathy (Ruckstaetter et al., 2017) and parenting practice in the adoptive population (Liu & Hazler, 2017). Considering the interplay between individuals’ relationship evolvement and their living contexts (Bowlby, 1973; Sroufe, 2005), attachment is examined at different stages generally labelled as childhood attachment and adult attachment, with the former focusing on the infant/child–parent relationship and the latter on adults’ generalized relationships with intimate others (e.g., romantic partners, close friends). Because of the abstract nature of attachment, it is commonly measured in the form of childhood attachment styles (Ainsworth et al., 1978) or adult attachment orientations (Turan et al., 2016).

Conceptual Framework
The present study is grounded in attachment theory, which is centered around a child’s ability to utilize their primary caregiver as the secure base when exploring surroundings, involving an appropriate balance between physical proximity, curiosity, and wariness (Bowlby, 1973; Sroufe & Waters, 1977). A core theoretical underpinning of attachment theory is the internal working model capturing a child’s self-concept and expectations of others (Bretherton, 1996). Internal working models of self and other are complementary. Namely, a child with strong internal working models is characterized with a perception of self as being worthy and deserving of love and a perception of others as being responsive, reliable, and nurturing (Bowlby, 1973; Sroufe, 2005).

In the context of attachment theory, childhood attachment is considered an outcome of consistent child–caregiver interactions and serves as the foundation for individuals’ later personality development (Bowbly, 1973; Sroufe, 2005). In line with child–caregiver interactions, Ainsworth et al. (1978) came up with three attachment styles based upon Bowlby’s seminal work, including secure, anxious-ambivalent, and anxious-avoidant attachment, following sequential phases of laboratory observations. Attachment theory was subsequently extended beyond the child–parent relationship to include later relationships in adulthood, given the parallels between these relationships (Cassidy & Shaver, 2010). Likewise, four distinct adult attachment styles (i.e., secure, dismissing, preoccupied, and fearful) are referred to based on the two-dimensional models of self and other (Konrath et al., 2014). Adult attachment styles are commonly examined under two orientations: attachment avoidance and attachment anxiety (Turan et al., 2016). Individuals showing low avoidance and low anxiety are considered securely attached, whereas those with high levels of anxiety and avoidance tend to be insecurely attached. Although childhood attachment and adult attachment are broadly considered distinct concepts in the literature, they share a spectrum of behaviors spanning from secure to insecure attachment. The levels of avoidance and anxiety involved in these behaviors are used as parameters to differentiate securely attached individuals from those who are insecurely attached.

Childhood Attachment, Self-Esteem, and Adult Attachment
Despite the conceptual overlaps, childhood attachment to caregivers and adult attachment to intimate others are commonly investigated as two distinct variables associated with individuals’ needs and features of different relationships. Childhood attachment captures a child’s distinct relationship with the primary caregiver (e.g., the mother figure) as well as their ability to differentiate the primary caregiver from other adults (Bowlby, 1969, 1973), whereas adult attachment may involve an individual’s multiple relationships (with parents, a romantic partner, or close friends). Noting the general stability of attachment from childhood to adulthood (Fraley, 2002), previous conceptual work stresses the importance of contexts in individuals’ attachment evolvement, highlighting that “patterns of adaptation” and “new experiences” reinforce each other in a reciprocal way (Sroufe, 2005, p. 349). For instance, an individual may develop secure attachment in adulthood because of healthy interpersonal experiences likely facilitated by trust, support, and nurturing received from significant others or their relationships, despite showing insecure attachment patterns in early childhood. A dynamic view of attachment development is thus warranted.

From a dynamic lens, researchers have generated evidence for the association between childhood attachment and adult attachment (Pascuzzo et al., 2013; Styron & Janoff-Bulman, 1997). For example, in a study of 879 college students (Styron & Janoff-Bulman, 1997), participants’ perception of their childhood attachment to both mother and father significantly predicted 7.9% of the variance in their adult attachment scores. Similarly, Pascuzzo et al. (2013) followed 56 adolescents at age 14 through age 22 and found that attachment insecurity to both parents and peers during adolescence was significantly associated with anxious romantic attachment in adulthood as measured by the Experience in Close Relationships Scale (ECR; Brennan et al., 1998). Studies that rely on retrospective data to assess childhood attachment (e.g., Styron & Janoff-Bulman, 1997) may be limited in validity because of time elapsed and potential compounding variables.

Childhood attachment is well recognized as the foundation for the growth of self-reliance and emotional regulation (Bowlby, 1973). Aligning with self-reliance, self-esteem appears to be frequently studied primarily through self-liking and self-competence (Brennan & Morris, 1997). Brennan and Morris (1997) defined self-liking as general self-evaluation based on perceived positive regard from others, and self-competence as concrete self-evaluation based on personal abilities and attributes. Previous research has suggested that secure attachment (to parents and peers) is significantly associated with higher levels of self-esteem (e.g., Wilkinson, 2004). In contrast, individuals who reported insecure attachment tended to endorse low self-esteem (Gamble & Roberts, 2005).

These results provide theoretical and empirical evidence for links between childhood attachment and adult attachment, but these links are likely to be indirect and mediated by other relevant variables from developmental perspectives. To our knowledge, no study has investigated the effect of self-esteem on the relationship between childhood attachment and adult attachment. The theoretical framework of attachment theory indicates that childhood attachment can have not only direct effects on adult attachment, but also indirect effects on adult attachment via self-esteem. In order to develop effective interventions tackling issues with adult attachment, it is important to examine potential mediators (e.g., self-esteem) between childhood attachment and adult attachment. To address this gap, the present study tests this hypothesized mediation function of self-esteem with a nonclinical sample of adults.

Self-Esteem, Attachment, and Psychological Distress
The extant literature comprises prolific information on the relationship between attachment and psychological well-being (Gnilka et al., 2013; Karreman & Vingerhoets, 2012; M. E. Kenny & Sirin, 2006; Turan et al., 2016; Wright et al., 2014). Existing evidence focuses on the relationship between adult attachment orientations and individuals’ psychological well-being (e.g., Karreman & Vingerhoets, 2012; Lynch, 2013; Roberts et al., 1996; Sowislo & Orth, 2013). Nevertheless, previous research has shed some light on the role of early childhood attachment in predicting psychological distresses in adulthood, including depression and anxiety (Bureau et al., 2009; Lecompte et al., 2014; Styron & Janoff-Bulman, 1997). Lecompte and colleagues (2014) conducted a longitudinal study of a sample of preschoolers (N = 68) with data collected at 4 years and again at 11–12 years; results of the study suggested that children with disorganized attachment at the baseline scored higher in both anxiety and depressive symptoms compared to those classified as securely attached.

Likewise, the effect of self-esteem on psychological distress is well established. A meta-analysis on 80 longitudinal studies published between 1994 and 2010 yielded consistent evidence supporting the relationship between low self-esteem and depressive symptoms (Sowislo & Orth, 2013). More recently, Masselink et al. (2018) examined data collected at four different points of participants’ development from early adolescence to young adulthood, which demonstrated that low self-esteem constitutes a persistent risk factor for participants’ depressive symptoms across developmental stages. Moreover, self-esteem scores in early adolescence significantly predicted the participants’ depressive symptoms at later stages, specifically during late adolescence and young adulthood.

Research has also supported the association between self-esteem, adult attachment, and psychological distress. Lopez and Gormley (2002) followed 207 college students from the beginning to the end of their freshman year and identified adjustment outcomes in association with the participants’ attachment styles and changes of their attachment styles measured by the ECR (e.g., secure-to-insecure attachment, insecure-to-secure attachment). The authors found that participants who remained securely attached scored higher in self-confidence and lower in both psychological distress and reactive coping compared to those who reported consistent insecure attachment. Moreover, participants who maintained secure attachment presented better outcomes in self-confidence and psychological well-being than the comparative group with secure-to-insecure or insecure-to-secure attachment changes (Lopez & Gormley, 2002). Adult attachment (measured by the ECR) was also found to be a mediator for the effects of traumatic events on post-traumatic symptomatology among a sample of female college students (Sandberg et al., 2010). In addition, Roberts et al. (1996) suggested attachment insecurity contributed to negative beliefs about oneself, which in turn activated cognitive structures of psychological distress, such as depression and anxiety, with a sample of 152 undergraduate students.

Taken together, the literature provides consistent support for the significant relationships between childhood attachment and various outcome variables in later adulthood, including adult attachment, self-esteem, and psychological distress. It further reveals a two-fold gap: (a) the variables tended to be investigated separately in previous studies, yet the mechanisms among these variables remained underexplored; and (b) little is known about the role of self-esteem and adult attachment in the association between childhood attachment and psychological distress. Disentangling the mechanisms, including potential mediating roles, involved in the variables will enrich the current knowledge based on attachment and can facilitate counseling interventions surrounding the effects of childhood attachment. In tackling the gap, three hypotheses were posed:

1. Childhood attachment is significantly associated with adult attachment, self-esteem, and psychological distress.
2. Self-esteem mediates the relationship between perceived childhood attachment and adult attachment.
3. Adult attachment mediates the relationship between self-esteem and
psychological distress.

Method

Participants
Of the 2,373 voluntary adult participants who took the survey, 1,708 (72%) completed 95% of all the questions and were retained for final analysis. Among the participants, 76.2% (n = 1,302) were female, 22.3% (n = 381) were male, and 1.3% (n = 25) chose not to specify their gender. The mean age of the participants was 29.89, ranging from 18 to 89 years old (SD = 12.44). A total of 66.3% (n = 1,133) of participants described themselves as White/European American, 8.7% (n = 148) as African American, 10.2% (n = 175) as Asian/Pacific Islander, 2.6% (n = 44) as American Indian/Native American, 7.3% (n = 124) as biracial or multiracial, 3.6% (n = 61) as other race, and 1.3% (n = 23) did not specify.

Sampling Procedures
The study was approved by the university’s IRB. We posted the recruitment information on various websites (e.g., Facebook, discussion board, university announcement board, Craigslist) in order to recruit a diverse pool of participants. Individuals who were 18 years old or above and were able to fill out the questionnaire in English were eligible for participating in this project. Participants were directed to an online Qualtrics survey consisting of the measures discussed in the following section. An informed consent form was included at the beginning of the survey outlining the confidentiality, voluntary participation, and anonymity of the study. Participants were prompted to enter their email addresses to win one of ten $15 e-gift cards. Participants’ email addresses were not included in the survey questions and data analysis.

Measures
Psychological Distress
Psychological distress was measured using the 10-item Kessler Psychological Distress Scale (K10; Kessler et al., 2003). Participants were asked about their emotional states in the past four weeks (e.g., “How often did you feel nervous?”). Responses were rated on a 5-point scale ranging from 0 (None of the time) to 4 (All of the time). Scores were averaged, with a higher score indicating a higher level of psychological distress. Previous studies using K10 have provided evidence of validity (Andrews & Slade, 2001). The internal consistency for K10 has been well established with a Cronbach’s alpha coefficient ranging from .88 (Easton et al., 2017) to .94 (Donker et al., 2010). In this study, the Cronbach’s alpha coefficient was .94.

Childhood Attachment
Childhood attachment was measured using the Parental Attachment subscale of the Inventory of Parent and Peer Attachment (IPPA; Armsden & Greenberg, 1987). Previous research has demonstrated evidence that this measure has great convergent and concurrent validity (M. E. Kenny & Sirin, 2006). The IPPA has been used to recall childhood attachment in adult populations (Aspelmeier et al., 2007; Cummings-Robeau et al., 2009). This 25-item subscale directs participants to recall their attachment to the parent(s) or caregiver(s) who had the most influence on them during childhood. The subscale consists of three dimensions, including 10 items on trust, nine items on communication, and six items on alienation. Some sample items are: “My parent(s)/primary caregiver(s) accepts me as I am” for trust, “I tell my parent(s)/primary caregiver(s) about my problems and troubles)” for communication, and “I do not get much attention from my parent(s)/primary caregiver(s)” for alienation. Participants rated the items using a 5-point Likert scale ranging from 1 (Almost never or never true) to 5 (Almost always or always true). Items were averaged to form the subscale, with a higher score reflecting more secure childhood attachment. The subscale has demonstrated high internal consistency with a Cronbach’s alpha of .93 (Armsden & Greenberg, 1987). In the present study, Cronbach’s alpha for the subscale was .96.

Adult Attachment
Adult attachment was measured using the ECR (Brennan et al., 1998). The ECR consists of 36 items with 18 items assessing each of the two orientations: attachment anxiety and attachment avoidance. In order to avoid confounding factors, we only assessed adult attachment with close friends or romantic partners, as relationships with parents can confound the childhood attachment outcomes. Responses were rated on a 7-point Likert scale ranging from 1 (Strongly disagree) to 7 (Strongly agree). Two scores were averaged, with a higher score reflecting a higher level of attachment anxiety or avoidance. In terms of validity, the ECR subscales have been found to be positively associated with psychological distress and intention to seek counseling, and negatively associated with social support (Vogel & Wei, 2005). The ECR has a high internal consistency for both the anxiety (α = .91) and avoidance (α = .94) dimensions (Brennan et al., 1998). For this study, Cronbach’s alphas for attachment anxiety and attachment avoidance were .93 and .92, respectively.

Self-Esteem
Rosenberg’s Self-Esteem Scale (RSES; Rosenberg, 1965) is a 10-item scale designed to assess an adult’s self-esteem. The scale assesses both self-competency (e.g., “I feel that I have a number of good qualities”) and self-liking (e.g., “I certainly feel useless at times”). Responses were coded using a 4-point Likert scale ranging from 1 (Strongly disagree) to 4 (Strongly agree). Negatively worded statements were reverse-coded. Scores were averaged, with a higher score reflecting a higher level of self-esteem. RSES has been frequently used in various studies with high reliability and validity (Brennan & Morris, 1997; Chen et al., 2017). In this study, the Cronbach’s alpha coefficient was .89.

Data Analysis
Descriptive statistics were computed using SPSS version 23 followed by a multiple-mediator model analysis using Mplus version 7.4 (Muthén & Muthén, 2012). Missing data were treated with the full information maximum likelihood estimation in Mplus, which was one of the most pragmatic approaches in producing unbiased parameter estimates (Acock, 2005). The multiple-mediator model includes childhood attachment as the predictor, self-esteem and adult attachment anxiety and avoidance as mediators, and psychological distress as the outcome variable (see Figure 1). The mediation analysis was conducted using bootstrapping procedures (J = 2,000), which was a resampling method to construct a confidence interval for the indirect effect (Preacher & Hayes, 2008). Several model fit indices based on Kline’s (2010) guidelines were employed, including the ratio of chi-square to degree of freedom (χ2/df), root-mean-square error of approximation (RMSEA), Tucker-Lewis index (TLI), comparative fit index (CFI), and standardized root-mean-square residual (SRMR). Indicators of good model fit are a nonsignificant chi-square value, a CFI and TLI of .90 or greater, RMSEA of .08 or less, and an SRMR of .05 or less (Hooper et al., 2008).

Figure 1

Multiple-Mediator Model: Self-Esteem, Anxious Adult Attachment, and Avoidant Adult Attachment as Multiple Mediators Between Childhood Attachment and Psychological Distress

Results

Descriptive Statistics and Correlations
The descriptive statistics of each variable are reported in Table 1.

Table 1

Descriptive Statistics for Variables (N = 1,708)

Pearson’s correlations between variables were computed. All bivariate statistics are presented in Table 2 and provided full support for our Hypothesis 1. For instance, childhood attachment was positively associated with self-esteem (r = .38, p < .001) and negatively correlated with adult attachment anxiety (r = -.26, p < .001) and avoidance (r = -.45, p < .001), as well as with psychological distress (r = -.35, p < .001). Significant negative correlations were found between self-esteem and adult attachment anxiety (r = -.49, p < .001) and avoidance (r = -.46, p < .001), and between self-esteem and psychological distress (r = -.63, p < .001). Both adult attachment anxiety (r = .57, p < .001) and avoidance (r = .42, p < .001) were positively associated with psychological distress. Significant correlation was found between adult attachment anxiety and avoidance (r = .31, p < .001).

Table 2

Correlation Matrix of Variables (N = 1,708)

*p < .05. **p < .01. ***p < .001 (two-tailed).

The Multiple-Mediator Model
The multiple-mediator model involving self-esteem and adult attachment as mediators, with bootstrapping procedures, yielded satisfactory fit indices: χ²(1) = 12.24, p < .001, CFI = 1.00, TLI = 0.96, SRMR = .01. However, the index of RMSEA = .08, 90% CI [0.05, 0.12] indicated a mediocre fit, with the upper value of 90% CI larger than the suggested cutoff score of 0.08. D. A. Kenny et al. (2015) suggested that the models with small degrees of freedom had the average width of the 90% CI above 0.10, unless the sample size was extremely large. The nonsignificant χ² value was interpreted as a good fit index.

The present study further revealed that secure childhood attachment was associated with high self-esteem (β = .25, p < .001) and low levels of anxiety (β = -.12, p < .001) and avoidance (β = -.41, p < .001) of adult attachment. Meanwhile, high self-esteem was associated with low anxiety (β = -.95, p < .001) and low avoidance (β = -.64, p < .001) of adult attachment. In addition, high self-esteem (β = -.68, p < .001) and low adult attachment anxiety (β = .26, p < .001) and avoidance (β = .11, p < .001) were significantly associated with low psychological distress. The results supported both Hypotheses 2 and 3 in that self-esteem mediated the relationship between childhood attachment and adult attachment, and adult attachment mediated the relationship between self-esteem and psychological distress.

The mediating role of self-esteem was examined using bootstrapping procedures. Results demonstrated that self-esteem significantly mediated the association between childhood attachment and adult attachment anxiety (b = -.24, 95% CI [-0.27, -0.21]) and avoidance (b = -.16, 95% CI [-0.19, -0.14]).

The present study further supported the mediating role of adult attachment (i.e., anxiety and avoidance). The association between self-esteem and psychological distress was significantly mediated by both adult attachment anxiety (b = -.24, 95% CI [-0.29, -0.21]) and avoidance (b = -.07, 95% CI [-0.10, -0.05]). Mediation effects are denoted in Table 3.

Table 3

Mediation Analysis With Bootstrapping: Unstandardized and Standardized Estimates and Confidence Intervals for Mediation Effects

Note. Bootstrap J = 2,000, CI = confidence interval; IV = independent variable; DV = dependent variable; CA = Childhood Attachment; SE = Self-Esteem; AnA = Anxious Adult Attachment; AvA = Avoidant Adult Attachment; PD = Psychological Distress. Direct effect of path direction, IV® Mediator, Mediator ® DV, IV ® DV. Statistical significance was evaluated based on whether 95% bias corrected bootstrap CIs include zero or not. If zero was included in the CI, then it was not a significant indirect effect. Model fit: χ²(1) = 12.24, p < .001, CFI = 1.00, TLI = 0.96, SRMR = .01, RMSEA = .08 (90% CI [0.05, 0.12]).

Discussion

The present study highlights the significance of childhood attachment and its associations with self-esteem and psychological distress in adulthood. Participants who reported secure childhood attachment scored higher on self-esteem and lower on psychological distress. Secure childhood attachment was also found to be associated with low adult attachment anxiety and avoidance. Our study builds upon previous research (e.g., Sroufe, 2005) to capture the complexity of key variables related to attachment and its evolvement from childhood to adulthood. The results shed further light on the mechanisms among childhood attachment, self-esteem, adult attachment, and psychological distress. Self-esteem was found to be a significant mediator between childhood attachment and adult attachment; meanwhile, adult attachment was found to be a mediator between self-esteem and psychological distress.

The findings support Hypothesis 1 in that individuals with more secure childhood attachment reported higher levels of self-esteem, lower levels of adult attachment anxiety and avoidance, and less psychological distress. The results echo attachment theory (Bowlby, 1973), positing childhood attachment as a predictor of later adjustment as well as self-esteem, indicating that the quality of attachment appears to be intimately related to how to cope with stress and how to perceive oneself (Wilkinson, 2004). The results are also consistent with previous research that highlighted secure childhood attachment as a protective factor against anxiety, depression, and later emotional and relational distress (e.g., Karreman & Vingerhoets, 2012).

Results also lend support to Hypothesis 2 in that self-esteem mediated the relationship between childhood attachment and adult attachment. Self-esteem as a mediator echoed previous research that indicated the influence of childhood attachment on one’s self-esteem may be mitigated by expanded social networks in adulthood (Steiger et al., 2014). For instance, it is likely that improving self-esteem through peer connections (e.g., friendship; romantic relationships) may contribute to individuals’ adaptation to close relationships and enhance attachment security in adulthood, despite their insecure attachment with primary caregivers in childhood (Fraley, 2002; Sroufe, 2005).

Congruent with Hypothesis 3, adult attachment was a mediator for the relationship between self-esteem and psychological distress. Previous research provided evidence that low self-esteem increases the risk of developing psychological distress such as depressive and anxious symptoms (Li et al., 2014); nevertheless, individuals may experience less psychological impact with secure attachment manifested through their close relationships. Little is known about the relationship between insecure adult attachment (i.e., anxious and avoidant attachment) and psychological distress, and the mediating role of adult attachment has rarely been addressed. In a sample of 154 women in a community context, Bifulco et al. (2006) found that fearful and angry-dismissive attachment partially mediated the relationship between childhood adversity and depression or anxiety. The present study extends the Bifulco et al. study to include a larger, gender-inclusive, and racially diverse population that captures a wider age range. Further, using continuous measurements, the present study counteracts the limitations of dichotomous measures used in Bifulco et al.’s study, thus reflecting the spectrum and complexity of attachment.

Implications for Counseling Practice
The present study sheds light on interventions for clients’ psychological distress. The results corroborated positive associations between psychological distress and insecure childhood attachment and attachment anxiety and avoidance during adulthood. Although adults can no longer change their childhood experiences, including their attachment-related adversities, interventions that target improving adult attachment may still mitigate the negative effect of childhood attachment on psychological distress later during adulthood. Considering the reciprocal influence noted between self-esteem and adult attachment (Foster et al., 2007), counseling strategies encompassing both self-esteem and adult attachment are thus desirable.

Specifically, counselors could conceptualize self-esteem in a relational context in which they may incorporate clients’ support systems (e.g., partner, close friends, parents) into the treatment. A key treatment goal may be utilizing close relationships to boost self-esteem. On the contrary, counselors may engage clients with low self-esteem in communicating their attachment needs while involving significant others (e.g., partners) to enact positive responses, such as attentive listening and validation of mutual needs. Counselors are encouraged to assess how childhood attachment experiences may have influenced the client’s adult attachment, as insecure attachment may lead to challenges with perceived trustworthiness of self and others, which could hinder growth in the interpersonal relationships. Clients may further benefit from reflecting over specific attachment behaviors and interactional patterns within close relationships (e.g., how they manage proximity to an attachment figure when they experience distress) in order to restructure and enhance their attachment security internally and externally (Cassidy et al., 2013).

The finding of self-esteem as a significant mediator supports the proposition that self-esteem is responsive to life events and that these can influence one’s perception and evaluation of self. Previous research indicated that individuals with low self-esteem may be easily triggered by stressful life events and consequently respond irrationally and negatively (Taylor & Montgomery, 2007). Counselors may consider adapting Fennell’s (1997) Cognitive Behavioral Therapy model comprising early experience, bottom line, and rules for living to help clients enhance self-esteem. Fennell’s model suggests that clients’ early experiences (e.g., childhood attachment, traumatic experience, cultural context) may have an influence on the development of a fundamental bottom line about themselves (e.g., “I am not good enough,” “I am worthless”). Counselors may further assist clients with mapping out the rules for living (e.g., dysfunctional assumptions) related to distorted thoughts on what they should do in order to cultivate their core beliefs (as being loved or accepted or vice versa). For example, if clients have formed insecure attachment during childhood (early experience), they may develop a bottom line that “I am not good enough.” In making efforts to feel accepted in the family, they may have the rules for living that “I have to receive all As in all my classes.” If clients fail to achieve the rules for living, they likely would develop anxious and depressive symptoms, which may activate the confirmation of the bottom line. To counteract the negative patterns, counselors may work with clients to process the impact of early experience (e.g., early insecure attachment) on their bottom line and revise the rules of living to develop healthier coping strategies. When clients develop alternative rules of living, counselors may further help them to re-evaluate the bottom line and enhance self-acceptance.

Limitations and Future Research Directions
Although the results supported all three hypotheses, the present study was subject to a few limitations. First, the self-report measures may have been subject to biases, especially for the memory of childhood attachment. Another limitation pertains to a retrospective assessment of perceptions of childhood attachment that may be changed over time because of life experiences (e.g., death, parental divorce). Relatedly, the cross-sectional study could not capture the changes over a period of time. Not knowing the types of childhood attachment (i.e., anxious attachment, avoidant attachment) presented as another limitation for researchers’ understanding of the variations of attachment and how each type might impact long-term outcomes. In the future, researchers may consider longitudinal studies to explore the variations and changes in attachment over the life span and examine what other mechanisms contribute to the changes to protect against the negative impact. Future research may also incorporate other-report data filled out by significant others (e.g., parents, romantic partners) to minimize social desirability and provide multiple perspectives.

Conclusion

Attachment theory provides a strong theoretical framework in understanding individuals’ psychological well-being over the life span (DeKlyen & Greenberg, 2008). Informed by attachment theory, the present study investigated the mediating roles of self-esteem and adult attachment (measured through the levels of anxiety and avoidance) on the relations between childhood attachment and psychological distress, and between self-esteem and psychological distress, respectively. The multiple-mediator analysis with bootstrapping supports both self-esteem and adult attachment as significant mediators. Our results also support the associations between childhood attachment with self-esteem, adult attachment, and psychological distress. The study contributes to the gap pertaining to adult attachment and provides practical implications for counselors working in various settings in their work with clients surrounding attachment security, self-esteem, and psychological well-being.

Conflict of Interest and Funding Disclosure
The authors reported no conflict of interest
or funding contributions for the development
of this manuscript.

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Fei Shen, PhD, is a staff therapist at Syracuse University. Yanhong Liu, PhD, NCC, is an assistant professor at Syracuse University. Mansi Brat, PhD, LPC, is a staff therapist at Syracuse University. Correspondence may be addressed to Fei Shen, 150 Sims Drive, Syracuse, NY 13210, fshen02@syr.edu.

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