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Journal of Consulting and Clinical Psychology Copyright 1992 by the American Psychological Association, Inc.

1992, Vol. 60, No. 2,185-195 0022-006X/92/$3.00

Application of Attachment Theory to the Study of Sexual Abuse

Pamela C. Alexander
University of Maryland, College Park

Research on sexual abuse frequently fails to address the influence of the family as a risk factor for
the onset of all kinds of sexual abuse and as a mediator of its long-term effects. Attachment theory
provides a useful conceptual framework for understanding the familial antecedents and long-term
consequences of sexual abuse. Themes associated with insecure parent-child attachment (rejec-
tion, role reversal/parentification, and fear/unresolved trauma) are frequently found in the dy-
namics of families characterized by sexual abuse, and specific categories of sequelae are related to
probable attachment experiences. Implications for intervention and research on sexual abuse are
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
This document is copyrighted by the American Psychological Association or one of its allied publishers.

In spite of the wealth of clinical and research evidence that tion of abuse, and time elapsed since abuse). Peters (1988) simi-
childhood sexual abuse is associated with a variety of severe larly found that a family characteristic (maternal warmth)
long-term sequelae, there is no evidence of a specific diagnosis emerged as a stronger predictor of adjustment in adulthood
or constellation of symptoms unique to the experience of sex- than did abuse variables (duration and number of incidents).
ual abuse (Finkelhor, 1990). Moreover, the effects of sexual Harter et al. (1988) used path analysis to demonstrate that the
abuse are difficult to differentiate from the consequences of family variables of paternal dominance and familial isolation
emotional abuse and physical abuse (Briere & Runtz, 1990) and made significant independent contributions to the prediction
a dysfunctional family experience with which they often coexist of maladjustment among women with a history of sexual
(Alexander & Lupfer, 1987; Harter, Alexander, & Neimeyer, abuse. Using hierarchical multiple regression analysis, Edwards
1988). Therefore, any attempt to predict the onset of abuse and and Alexander (in press) found that parental conflict, paternal
its long-term effects must include a consideration of the family dominance, and sexual abuse (both intrafamilial and extrafa-
context that mediates the experience of the abuse. In this arti- milial) were all significantly related to psychological distress,
cle, I present a formulation of family dynamics and long-term dissatisfaction with current relationships, and lack of perceived
effects of sexual abuse within the framework of attachment social support. Finally, a body of literature has emerged sug-
theory. gesting that the severity of the long-term effects of sexual abuse
The justification for an approach to sexual abuse that takes appears to be mediated by the support received from the non-
into account the nature of the child's family relationships comes abusive parent (Conte & Schuerman, 1987b; Everson, Hunter,
from two distinct lines of research. First, certain family charac- Runyon, Edelsohn, & Coulter, 1989; Gold, 1986; Wyatt &
teristics are the most significant predictors for increased risk Mickey, 1987). Therefore, a failure to consider the relationship
for all kinds of child sexual abuse: specifically, absence of a context of sexual abuse ignores an important aspect of the long-
biological parent, maternal unavailability, marital conflict and term effects.
violence, the child's poor relationship with the parents, and the Attachment theory attempts to explain the development and
presence of a stepfather (Finkelhor & Baron, 1986; Paveza, potential distortion of intrapsychic processes such as emotion
1988). Although none of these authors would minimize the and cognition within the context of relationships and has been
individual pathology of the perpetrator, the predictive power of used extensively as a basis for understanding the antecedents
these family relationship factors across a wide array of clinical and consequences of physical abuse (e.g., Egeland, Jacobvitz, &
and community samples demands their further deliberation. Sroufe, 1988; Egeland & Sroufe, 1981). This article describes the
Second, many of the long-term effects of sexual abuse are value of attachment theory for the investigation of sexual abuse
associated with family variables above and beyond the effects and its long-term effects. To this end, I first briefly review the
of the abuse. Friedrich, Beilke, and Urquiza (1987), for exam- main tenets of attachment theory and recent research relating
ple, noted that family variables such as conflict and decreased attachment theory to the study of adult relationships and psy-
cohesion among family members accounted for more of the chological processes. I demonstrate how sexual abuse is fre-
variance of behavior problems among a sample of abused chil- quently preceded by insecure attachment and, as such, how its
dren than even abuse-specific variables (severity of abuse, dura- long-term effects are mediated by the history of attachment
during childhood. Finally, I discuss the clinical and research
implications of applying attachment theory to the study of sex-
I wish to thank Clara E. Hill, Pamela M. Cole, and Robert Brown for ual abuse.
their helpful comments on this article.
Correspondence concerning this article should be addressed to Attachment Theory
Pamela C. Alexander, Department of Psychology, University of According to Bowlby (1969/1982,1977), attachment is a bio-
Maryland, College Park, Maryland 20740. logically based bond with a caregiver. Because attachment be-

havior (assuring proximity with the caregiver) serves the sur- relatively stable over time (Bretherton, 1985; Main & Cassidy,
vival function of protection, it is universal and is most apparent 1988). Infant-mother attachment predicts social interactions
during periods of stress in early childhood, although it is actu- with new persons significantly more than infant-father attach-
ally evident throughout the life cycle (Ainsworth, 1989). Only ment. However, secure attachment with both parents predicts
by using the parent as a secure base is the child able to explore optimal outcome (Main & Weston, 1981). Secure attachment in
his or her environment effectively (Bowlby, 1988). infancy has been found to predict greater competence with
An important aspect of Bowlby's theory (1973) is his concept peers, ego resiliency, resourcefulness, empathy, and popularity
of the internal working model, a mental construction that among preschoolers (Sroufe, 1988). Avoidant attachment in in-
forms the basis of the personality. On the basis of early experi- fancy has been associated with emotional insulation, a lack of
ence with the attachment figure, the infant develops expecta- empathy, hostile or antisocial behavior, and attention-seeking
tions about (a) his or her own role in relationships (worthy and among preschoolers (Sroufe, 1988). Finally, resistant attach-
capable of getting others' attention vs. unworthy and incapable ment in infancy has been associated with later attention-seek-
of getting needed attention) and (b) others' roles in relationships ing, neediness, tenseness, impulsivity, frustration, passivity, and
(trustworthy, accessible, caring, and responsive vs. untrust- helplessness among preschoolers (Sroufe, 1988). In conclusion,
worthy, inaccessible, uncaring, and unresponsive). The develop- although attachment can and does change, there is enough evi-
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

ment of this internal working model is so relationship-bound dence of predictive validity from longitudinal studies to sug-
This document is copyrighted by the American Psychological Association or one of its allied publishers.

that the child internalizes both sides of the experienced attach- gest that attachment patterns of infants are not spurious.
ment relationship and learns caregiving while receiving care Enough researchers have noted the difficulty of classifying
(Sroufe & Fleeson, 1986). certain children according to the three attachment patterns
Although the internal working model changes with the indi- just described (e.g., Crittenden, 1985,1988; Egeland & Sroufe,
vidual's experience, it does help to account for the relative stabil- 1981) that Main and Solomon (1986,1990) have identified crite-
ity of attachment relationships by emphasizing the role of the ria for an additional insecure attachment pattern called disor-
child's expectations in ongoing parent-child relationships ganized/disoriented. The disorganized child exhibits no single
(Sroufe, 1988). Furthermore, because the working model in- coherent strategy for dealing with the separation and reunion of
cludes affective as well as cognitive components (Bretherton, the attachment figure because the attachment figure is simulta-
1985), it "governs how incoming interpersonal information is neously the source of and the solution to the child's anxiety.
attended to and perceived, determines which affects are experi- Instead, when confronted with the parent's return, the disor-
enced, selects the memories that are evoked, and mediates be- ganized child displays a diverse array of behaviors including
havior with others in important relationships" (Zeanah & contradictory behavior patterns (e.g., strong initial proximity-
Zeanah, 1989, p. 182). Therefore, the internal working model is seeking followed by strong avoidance, approaching with head
both affected by and comes to affect the types of interpersonal averted), undirected expressions of fear or distress, stereotyp-
experiences that are encoded into the concept of self. ies, apprehension on the parent's return, and dazed or disor-
With the development of the strange situation paradigm, iented expressions. The parent of the disorganized child is pre-
Ainsworth, Blehar, Waters, and Wall (1978) provided the empir- sumed to be characterized by unresolved trauma such as loss or
ical basis for Bowlby's (1969/1982,1973) theory. Ainsworth dis- sexual abuse in childhood (Main & Cassidy, 1988) and thus may
covered that mother-child interactions in the first 3 months be inadvertently frightening or frightened in his or her behavior
predicted 12-month-olds' behavior in a laboratory setting dur- toward the child (Main & Hesse, 1990). The whole concept of
ing brief separations and reunions. Securely attached children the disorganized category, however, is the focus of current con-
(whose mothers were supportive and responsive to the infant's troversy among attachment researchers.
cries and needs during the first 3 months of life) either actively As the above discussion would suggest, insecure attachment
sought physical contact with the mother or at least greeted her (avoidance, resistance, and disorganization) has been found to
after a separation. Avoidantly attached children (whose mothers predominate in populations of children who have been physi-
were insensitive, expressed little emotion, and generally cally abused or neglected (Carlson, Cicchetti, Barnett, &
avoided physical contact with the infant) snubbed or avoided Braunwald, 1989; Egeland & Sroufe, 1981; Schneider-Rosen,
the mother on her return to the lab setting, showed little prefer- Braunwald, Carlson, & Cicchetti, 1985). There have been, how-
ence to her over a stranger, and also displayed episodes of spon- ever, no studies to date looking at attachment specifically in a
taneous aggression toward her at home. Resistant children sexually abused population.
(whose mothers were characterized by role reversal and incon-
sistent responding) showed a combination of contact-seeking Attachment in Adulthood
and angry tantrums toward the mother on her return. Main
and Weston (1982) described these attachment patterns as co- On the basis of Bowlby's idea of the internal working model,
herent strategies for achieving "felt security" and regulating dis- attachment to parents is presumed to continue into adulthood
tress (i.e., the secure child actively seeks comfort from the at- (Ainsworth, 1989). Furthermore, certain adult relationships
tachment figure and uses the caregiver as a secure base; the
avoidant child diverts attention from the attachment figure in 1
Although temperament has been found to affect the degree to
an apparent attempt to avoid the anxiety of potential rejection; which the child is emotionally sensitive to separation from the mother,
and the resistant child exhibits extreme dependence on the par- attachment determines the strategy used (and its effectiveness) to deal
ent in an attempt to gain the attachment figure's attention).1 with the negative affect associated with the separation (Fish & Belsky,
A child's attachment to a particular caregiver appears to be 1991).

with peers show the same characteristics of attachment (need Hazan and Shaver (1987) developed a self-report measure of
for access to the attachment figure, especially when stressed; attachment in an attempt to relate the adult's internal working
comfort and security in the company of the attachment figure; models of attachment to current romantic relationships. A dis-
and discomfort and anxiety on separation from the attachment criminant-function analysis of items describing the subjects'
figure) ascribed to parent-child attachments (Bowlby, 1980; attachment histories correctly classified 75% of the avoidant
Weiss, 1982). Research examining the continuity of attachment subjects, 90% of the anxious/ambivalent subjects, and 86% of
from childhood into adulthood is in progress. The longest lon- the secure subjects. Although Hazan and Shaver's measure of
gitudinal study extends from infancy to 6 years of age (Main & attachment derived findings consistent with the predictions of
Cassidy, 1988). However, a number of researchers have studied attachment theory, their construct of avoidance appeared to
attachment in adulthood retrospectively and inferred its conti- consist of active conscious avoidance, whereas the AAI con-
nuity from childhood by demonstrating its association with struct of avoidance resembled emotional detachment and com-
parenting behavior, styles of intimacy reminiscent of the child pulsive self-reliance (Bartholomew, 1990).
in the strange situation paradigm, and other patterns of behav- In an attempt to redress this discrepancy, Bartholomew and
ior and symptoms theoretically consistent with an attachment Horowitz (1991) developed a self-report instrument and a
perspective. structured interview in which subjects described family and
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Researchers have classified adults on the basis of their pre- close relationships. Their measures were based on the assump-
This document is copyrighted by the American Psychological Association or one of its allied publishers.

sumed attachment to their parents or significant others as se- tions that the secure subject has a positive view of self and
cure, avoidant (dismissing), preoccupied (anxious/ambivalent), others, the avoidant subject has a positive view of self and a
or fearful (unresolved). Secure adults (comparable to secure negative view of others, the preoccupied subject has a negative
children) have been described as coherent in their ability to view of self and positive view of others, and the fearful subject
reflect on their past (Main & Goldwyn, 1984), comfortable has a negative view of self and others (Bartholomew, 1990).
with a wide range of emotions (Haft & Slade, 1989), self-confi- Interrater reliabilities ranged from .74 to .95. Subjects' re-
dent and trusting (Feeney & Noller, 1990; Hazan & Shaver, sponses on measures of self-concept and interpersonal relation-
1987), and comfortable with closeness (Collins & Read, 1990). ships varied as expected as a function of attachment style
Avoidant (dismissing) adults (comparable to avoidant children) (Bartholomew & Horowitz, 1991).
have been described as idealizing and unable to recall their In conclusion, although each of these measures shows some
childhood (Main & Goldwyn, 1984), uncomfortable with inti- evidence of concurrent validity, there have been no attempts to
macy and lacking confidence (Collins & Read, 1990; Feeney & compare the results of the AAI with either of the self-report
Noller, 1990; Hazan & Shaver, 1987), and hostile and lonely measures described. Furthermore, the validation of these mea-
(Bartholomew & Horowitz, 1991; Kobak & Sceery, 1988). sures and the concept that adult attachment is built on child-
Preoccupied (anxious/ambivalent) adults (comparable to resis- hood attachment experiences ultimately depends on longer
tant children) have been described as confused and anxious term longitudinal studies that demonstrate their continuity
(Collins & Read, 1990; Kobak & Sceery, 1988), clinging, depen- with, and not just their analogy to, the construct of attachment
dent, and jealous (Brennan & Shaver, 1991; Feeney & Noller, in childhood. In the meantime, however, Bowlby's (1969/1982,
1990; Hazan & Shaver, 1987), and overly expressive (Bartholo- 1973,1980) theory, bolstered by findings from the child and
mew & Horowitz, 1991). Finally, fearful (unresolved) adults adult attachment literature, provides a useful construct for un-
(comparable to disorganized children) have been described as derstanding the diverse family dynamics and the variety of ef-
socially inhibited and unassertive, and they show a combina- fects of sexual abuse and therefore provides the basis for the
tion of avoidant and preoccupied traits (Bartholomew & Horo- following review.
witz, 1991).
Research on adult attachment has been conducted with sev-
Attachment Theory and Sexual Abuse
eral distinct paradigms. For example, the Adult Attachment
Inventory (AAI) interview was developed to study the relation- Applying attachment theory to the onset and outcome of
ship between caregiving (by a parent) and the inferred internal sexual abuse necessitates examining the interactions of the
working model of the parent with respect to his or her own whole family. This stance, that the whole family should be the
attachment history (George, Kaplan, & Main, cited in Haft & basic social unit of study, was actually advocated by Bowlby
Slade, 1989; Main & Goldwyn, 1984). The interview elicits the (Marvin & Stewart, 1990). Sroufe, Jacobvitz, Mangelsdorf,
adult's descriptions of his or her own attachment relationships, DeAngelo, and Ward (1985) stated it this way: "Viewing the
with emphasis on assessing whether specific memories of at- family as a system . . . implies interconnections among rela-
tachment relationships are accessible and are consistent with tionships; that is, one relationship has implications for other
the subject's overall characterization of childhood. Empirical relationships within the system" (p. 317).
studies have shown a strong correlation between parents' in- Abusiveness and rejection (whether sexual, physical, or emo-
ferred attachment style (as measured by the AAI) and the na- tional) can take many forms: active rejection, distance, and
ture of relationships with their own child (Benoit, Zeanah, & punishment; role reversal with an underlying rejection; or un-
Barton, 1989; Crowell & Feldman, 1988; Grossmann, Frem- predictability and alternate acceptance and rejection (Main &
mer-Bombik, Rudolph, & Grossmann, 1988; Main & Goldwyn, Goldwyn, 1984). Therefore, the following section describes dif-
1984). However, published specifications of the whole system ferent themes of insecure attachment that may be useful in
are still required to demonstrate its reliability, validity, and ease developing testable hypotheses about the wide array of family
of use. dynamics associated with the onset of sexual abuse. Finally, the

case is made that the diversity of interpersonal, affective, and also characterizes the unavailable mother, who, because of fac-
cognitive symptoms exhibited by abuse survivors is mediated tors within or beyond her control, is either physically absent
by the attachment experiences of the survivors. (because of excessive work demands or other responsibilities) or
psychologically unavailable (because of depression, illness, or
Attachment in the Sexually Abusive Family other debilities). A similar scenario might be seen in a steppar-
ent who has not chosen to take on the protective role of the
The assumption is made in this section that, whether or not attachment figure.
there is intergenerational transmission of abuse (Goodwin, Avoidance in any or all family members (i.e., the child and/or
McCarthy, & DiVasto, 1981; Ryan, 1989), sexual abuse is fre- the parent who is avoidant because of his or her own experi-
quently associated with the intergenerational transmission of ences of rejection in childhood) is one factor in the dynamics of
insecure attachment. Haft and Slade (1989) proposed a mecha- abuse. The avoidant individual attempts to deal with rejection
nism through which the parents' earlier attachment (working through self-deception, idealization of the parent, or active de-
model) affects their subsequent attachment to their own child. valuation of the importance of attachment (Main & Goldwyn,
Using the AAI, Haft and Slade found that mothers' attachment 1984). The abusive father, for example, who is uncomfortable
styles correlated highly with maternal attunement to the in- with his own impulses, may deny or minimize his own history
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

fant's affect. Secure mothers responded and correctly attuned to of rejection and abuse (Ryan, 1989) as well as the impact of his
This document is copyrighted by the American Psychological Association or one of its allied publishers.

both positive and negative expressions by their infants; preoc- abuse of his child. Similarly, to the extent that the mother (or the
cupied mothers randomly attuned to both positive and negative nonabusive father) has herself developed an avoidant pattern of
affective states and failed to attune to their baby's expression of attachment because of her own experience of rejection, she may
initiative during play; and avoidant (dismissing) mothers at- be less inclined to pursue information relevant to the abuse
tuned to their infant's expressions of mastery, autonomy, and (Gelinas, 1986). Parental distance and inaccessibility, espe-
separateness while failing to attune or misattuning to their in- cially among nonabusive fathers, have also been strongly impli-
fant's bids for comfort and reassurance. (This study did not cated in the occurrence of sibling incest (Smith & Israel, 1987).
assess the unresolved [fearful] category of the AAI.) Finally, the child who has developed an avoidant attachment
The authors concluded that the infant learns to view those pattern because of rejection may be even less able than most
affective experiences to which the mother misattuned as falling children to defend himself or herself or to seek help from others
outside the realm of shareable experience and to deny or dis- either inside or outside the home.
avow such feelings. To the extent, then, that defensiveness, de- Role reversal/parentification. A second important theme of-
nial, confusion, or inability to recall interferes with a parent's ten evident in sexually abusive families is role reversal and par-
ability to attune to the infant's needs and feelings accurately and entification (Gelinas, 1983), which has been associated primar-
empathically, a parent is more likely to repeat past patterns of ily with the resistant pattern of parent-child attachment
behavior. Furthermore, the relative comfort or discomfort of (George et al., cited in Haft & Slade, 1989). (Boszormenyi-Nagy
the mother with certain kinds of emotional states can influence and Spark, 1973, described parentification as the expectation
the infant's subsequent access to those same emotions at a very that one or more children will fulfill the parental role in the
early age. family system.) Empirical evidence for the prevalence of role
Whereas the previous study suggested that insecure attach- reversal in sexually abusive families was provided by Levang
ment in the parent precedes insecure attachment in the child, (1989), who analyzed the communication of incestuous fami-
the following analysis goes on to posit that insecure attachment lies, of families with daughters classified as oppositional, and of
in the parent precedes onset of abuse of the child. This is con- nonclinical families, using the Structural Analysis of Social Be-
sistent with the evidence on risk factors and with the opinion havior circumplex model. Daughters from the incest group ex-
that family dysfunction and relational imbalances precede the hibited significantly more parentlike behaviors toward their
onset of sexual abuse (Alexander, 1990; Gelinas, 1988). More- fathers than did daughters from either of the other two groups.
over, attachment theory offers precise predictions as to how Role reversal and the dissolution of generational boundaries
different types of insecure attachment are manifest in different (e.g., behaving as peers) have also been associated specifically
types of parent-child interactions in the sexually abusive fam- with the mother's history of father-daughter incest in a group
ily. The following discussion describes specific organizing of mother-son dyads who had been identified 42 months ear-
themes associated with the three insecure attachment catego- lier on the basis of their seductive interactions (Sroufe et al,
ries that have, in fact, been observed in physically and emotion- 1985).
ally abusive families (Zeanah & Zeanah, 1989). The process through which this parentification could contrib-
Rejection. The first theme described by Zeanah and Zeanah ute to the onset of sexual abuse was described by Cotroneo
(1989) is that of rejection, associated with avoidant attachment (1986). The experience of growing up as a parentified child can
in the child. The avoidant child feels unloved and unwanted, lead to a sense of entitlement in either an abuser, resulting in
and the avoidant (dismissing) parent actively turns away from expectations that one's child should meet one's own emotional
the child and is generally unavailable, both physically and psy- and sexual needs, or in a nonabusive parent, resulting in expec-
chologically. This pattern describes the authoritarian, in- tations to be nurtured by rather than to nurture the child. It is
cestuous father who is emotionally distant but also arbitrary in also possible that the adult who was parentified as a child is
his view that his spouse and children are his property and sub- continuing to meet the needs of his or her own parent, thus
ject to his needs (Herman, 1981). He may be physically abusive taking away the energy available for providing caregiving to the
as well as sexually abusive and neglectful. The rejection pattern child. The nonabusive parent of the parentified (resistant) child

is either unlikely to attend to the abused child's emotional needs review of recent studies, Finkelhor (1990) concluded that as
or may be unable cognitively and emotionally to organize a many as one third of all children who are sexually abused re-
response to stop the abuser. For her part, although the resistant main symptom-free. The fact that they are more likely to have
child's typical neediness (Sroufe, 1988) may elicit the support of been abused for a shorter period of time without force or pene-
other protective adults, it could also make her more vulnerable tration by someone who is not a father figure and to have re-
to the manipulations of an abusive adult or older child outside ceived the full support of a well-functioning family suggests
the home (Troy & Sroufe, 1987). that the significant effects of abuse result more from the long-
Fear/unresolved trauma. A final theme of insecure attach- term relationships that preceded the abuse and that continued
ment frequently seen in abusive families is that of fear and after its termination than from the abuse itself.
unresolved trauma, associated with the disorganized attach-
ment pattern. The parent of the disorganized child may have Attachment as a Mediator in the Long-Term Effects
been sexually abused himself or herself or may have experi- of Sexual Abuse
enced a generalized fear of abandonment (Cotroneo, 1986; Lar-
son & Maddock, 1986). Disorganized attachment would also be Given that sexual abuse is not associated with a unique set of
expected in the chaotic, multiproblem incest family character- symptoms (Finkelhor, 1990) and that it invariably overlaps with
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

ized by substance abuse, physical abuse, and indiscriminate other types of abuse (Briere & Runtz, 1990), I contend that
This document is copyrighted by the American Psychological Association or one of its allied publishers.

sexual behavior. In fact, Latty-Mann and Davis (1988) and long-term effects of sexual abuse, although obviously related to
Brennan, Shaver, and Tobey (1991) have found evidence of high the specific nature of the abuse, are better understood accord-
rates of this attachment category in adult children of alcoholics. ing to a classification of the important attachment relationships
The perpetrator with a history of disorganized attachment concurrent with the abuse. Therefore, the actual relationship
may attempt to suppress or repress his own trauma or experi- context would be expected to determine the nature of long-
ence of abandonment through substance abuse or dissociation, term effects seen in the adult survivor of sexual abuse. In the
thus reducing his impulse control and fulfilling one of Finkel- following section, I briefly describe some of the most common
hor's four conditions for sexual abuse (Finkelhor, 1984). The types of symptoms exhibited by abuse survivors and relate
nonabusive parent with a disorganized attachment history may them to probable attachment experiences, providing hypothe-
be so disoriented at having to acknowledge the circumstances ses to test in future studies.
of an experience already too familiar or perhaps the potential Interpersonal problems. Interpersonal relationships would
breakup of the family that she may literally not see evidence of appear to be the arena in which many of the long-term conflicts
abuse and may not hear her daughter's bids for help (Hooper, related to sexual abuse are made manifest. In fact, the long-
1989). Finally, the disorganized child may find herself in the term effects of incest are best distinguished from symptoms
untenable situation of seeing her abuser as her only ally (Ge- reported by nonabused clients seeking outpatient therapy on
linas, 1988) or, as is frequently found in cases of sibling incest, the basis of their interpersonal component (Conte & Schuer-
her only security against her fears of family dissolution in the man, 1987a). The interpersonal problems may take many dif-
face of parental infidelity (Smith & Israel, 1987). In any case, a ferent forms.
lack of coping strategy (either passive or active), which is pur- The preoccupied individual (the resistant child grown up) is
portedly associated with disorganized attachment, has been characterized by an idealization of partners (or, often, of men
found to significantly increase the impact of child sexual abuse in general) associated with a negative perception of self (Bar-
(Conte & Schuerman, 1987b). tholomew, 1990; Briere, 1989; Herman, 1981). The unfortunate
In conclusion, a disturbance in attachment in any or all rele- consequence of the desperate or manic love style seen in the
vant family members is likely to be associated with diminished preoccupied individual (Feeney & Noller, 1990) is subsequent
capacity to meet one's needs in appropriate ways, to monitor disappointment or even revictimization (Russell, 1986). Troy
oneself or others, and to seek help to stop the abuse. Thus, and Sroufe (1987) similarly noted that preschoolers identified
insecure attachment may either help set the stage for sexually in infancy as resistant (predecessors to preoccupied adults)
abusive behavior or may interfere with its termination. were more likely to be targeted for victimization by other chil-
Up to this point, the assumption has been made that insecure dren. Another version of the preoccupied individual frequently
attachment frequently precedes the abuse and either precludes seen in sexual abuse survivors is the compulsive caregiver
impulse control in the abuser, interferes with protectiveness (Courtois, 1988), who may ironically be viewed by others as
and responsivity of the nonabusive parent(s), or increases the manipulative and controlling (Bartholomew, 1990) while view-
vulnerability of the child to abuse both inside and outside the ing herself as excessively vulnerable and overly reliant on others.
home. It is possible, of course, that the abuse itself (and the The avoidant (dismissing) individual would be more likely to
betrayal of trust that it represents) as well as responses of signifi- experience a sense of social isolation and estrangement from
cant others to the disclosure of abuse may cause a sudden ero- others (Briere, 1989; Harter et al., 1988; Kobak & Sceery, 1988).
sion of trust in a previously securely attached child. Such a This experience of simultaneous dependency and lack of trust
scenario would seem to be more likely in the case of extrafa- so common in sexual abuse survivors (Wooley & Vigilanti,
milial abuse (i.e., how would an attachment figure who was 1984) is also observable in someone who has adopted an avoid-
responsive to the needs of a child ever sexually abuse in the first ant style of attachment (Bartholomew & Horowitz, 1991).
place?), although a child might be securely attached to the non- Avoidance may even be manifest in a strategy of compulsive
abusive parent and not to the abuser. Moreover, not all sexually sexuality in which the anxiety associated with close emotional
abused children are adversely aifected in a significant way; in a relationships is avoided without necessitating that the individ-

ual cut off contact with others completely (Brennan & Shaver, well as to resort to its use for sensation-seeking (Brennan &
1991). Shaver, 1991).
An attachment perspective would also predict that, because The avoidant (dismissing) adult is characterized by an ab-
of their own experience of insecure attachment, survivors may sence of memories and an idealization of the parents and of the
experience anxieties and distortions in their relationships with past (Main & Goldwyn, 1984). The parent who has selectively
their children. Evidence suggests that women who were sex- misattuned to or ignored the child's needs for nurturance and
ually abused as children are more likely to have daughters who dependence while encouraging the child to be independent
become sexually abused (Goodwin et al., 1981). To the extent, (Haft & Slade, 1989) has effectively erased those kinds of feel-
however, that this intergenerational transmission of abuse is ings from the child's awareness. As a result, the avoidant adult is
not universal, it is likely that it is mediated in part by the par- debilitated in expressing or acknowledging emotions and rely-
ent-child attachment (Egeland et al., 1988; Main & Goldwyn, ing on others. However, even though the avoidant individual is
1984). Evidence of this mechanism was provided by Cole and likely to deny fears and subjective distress (Kobak & Sceery,
Woolger (1989), who compared the child rearing attitudes of a 1988), she is still likely to exhibit covert evidence of her fears
group of mothers who had been sexually abused by their fathers (Mikulincer, Florian, & Tolmacz, 1990). She is also more likely
with the attitudes of another group of mothers who had been to use alcohol expressly for the purpose of reducing this nega-
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

sexually abused as children by nonrelatives. Mothers who were tive affect (Brennan & Shaver, 1991).
This document is copyrighted by the American Psychological Association or one of its allied publishers.

survivors of incest were significantly more likely to endorse the Finally, the fearful adult (the disorganized child grown up)
child rearing strategy of extreme autonomy promotion (e.g., would be expected to exhibit the most severe disorders of affect
"The earlier a child is weaned from its emotional ties to its regulation, including PTSD and dissociation. In describing the
parents the better it will handle its own problems") than were dynamics of PTSD, Roth and Lebowitz (1988) noted that both
mothers who were survivors of extrafamilial abuse. Of even approach and avoidance of a stressful event are necessary for
greater interest, the autonomy promotion was particularly the eventual integration of the event into an individual's self-
likely to occur when mothers perceived their own mothers as schema. Although approach strategies (such as displayed by the
negatively controlling or uninvolved. In a subsequent study, preoccupied individual) are obviously essential for acknowledg-
Cole, Woolger, Power, and Smith (in press) found that incest ing the event, too great a reliance on approach can result in a
survivors, when compared with a group of adult children of rapid and dysfunctional escalation of negative affect (Silver,
alcoholics and a nonrisk group, reported significantly more par- Boon, & Stones, 1983). On the other hand, although avoidance
enting difficulties that seemed to be mediated by problems in keeps the individual from becoming overwhelmed, it also pre-
emotion regulation and by the poor quality of their parental cludes access to information and experience necessary to inte-
partnership. grate the event and to prevent its recurrence. Posttraumatic
In conclusion, attachment history appears to exert a direct stress symptoms occur when the individual is faced with an
influence on subsequent intimate relationships, both with a event for which neither coping strategy is effective (Roth &
partner and with one's own children. Furthermore, frustrations Cohen, 1986), especially one involving the schema of self. Con-
with children are either compounded by the existence of a trou- sequently, when there is a breakdown of either an approach
bled partnership or mitigated if there has been another inter- strategy or an avoidance strategy, the individual is effectively
vening attachment relationship (such as with a supportive left with neither.
partner or a therapist) to clarify and counteract the effects of an The conflict described by the PTSD conceptualization and
insecure attachment in childhood (Egeland et al., 1988). the resultant lack of strategy to deal with affect is remarkably
Affect regulation. Another general category of long-term similar to the conflicted behavior and the apparent lack of
problems experienced by women sexually abused as children is strategy displayed by the disorganized child attempting to deal
difficulty in regulating affect, as evidenced by depression and with a parent who is both the source of and the solution to the
anxiety (Browne & Finkelhor, 1986), substance abuse (Browne felt anxiety (Main & Solomon, 1986). The literature on attach-
& Finkelhor, 1986), posttraumatic stress disorder (Briere & ment has suggested that the fearful adult (the disorganized
Runtz, 1987; Roth & Lebowitz, 1988), and dissociation (Briere child grown up) experiences both the overt distress, low self-es-
& Runtz, 1987; Putnam, 1985). Regulation of affect is directly teem, and dependency typically seen in the preoccupied adult
applicable to attachment in that the strategy used by the adult and conscious attempts at avoidance (whether through sub-
presumably generalized from the strategy used initially by the stance abuse or withdrawal from relationships; Bartholomew &
infant to deal with anxiety surrounding attachment. Horowitz, 1991). It would therefore be expected that the sexual
For example, the preoccupied individual (the resistant child abuse survivor who has developed a disorganized attachment
grown up) tends to potentiate negative affect through her hy- pattern as a result of finding herself in an untenable conflict
pervigilance on the attachment figure (Kobak & Sceery, 1988). would be most likely to exhibit the long-term symptoms typi-
Consequently, not only has she ready access to negative and cally associated with PTSD.
confused affects and memories stemming from attachment The process of dissociation can also be seen to derive from
conflicts in childhood but her strategy for dealing with these the early attachment experiences of the disorganized child. Ac-
conflicts is to focus attention on them. As a result, the preoccu- cording to Bretherton (1985), the extreme of dissociation is
pied adult is more likely to be plagued by depression and anxi- especially likely when the child cannot cope with the parent as
ety (Kobak & Sceery, 1988). Evidence also suggests that she is rejecting or when the parent attempts to persuade the child that
more likely to use alcohol to quell this anxiety and tension as the apparent rejection is actually something else. Because the

discrepancy is out of the child's (and perhaps even the parent's) styles, intrapsychic processes, and symptoms that have been
awareness, the conflict is irresolvable. This conflict is, in fact, observed in women with a history of sexual abuse. Linking
one of the two main predisposing factors for multiple personal- these sequelae with specific histories of parent-child attach-
ity disorder (MPD), dissociation at its extreme (Braun & Sachs, ment should prove to be helpful to therapists in identifying the
1987). MPD is associated with exposure to severe, overwhelm- psychological conflicts underlying presenting complaints of
ing trauma that includes an element of unpredictability and clients. However, the relevance and utility of this framework to
alternation between abuse and love. For example, an abusive the field of sexual abuse ultimately needs to be demonstrated
parent might say "I love you" to the child and then immediately through well-designed tests of these hypothesized relation-
proceed to burn the child with a cigarette (Braun & Sachs, ships.
1987). Through the process of dissociation, or defensive exclu-
sion of information, the child thus attempts to defend against
Clinical Implications
severe trauma or loss (Bowlby, 1980).
In conclusion, because of its focus on the development of With its focus on the relational context of abuse, attachment
intrapsychic strategies for dealing with attachment-related anxi- theory is very pertinent to a discussion of therapy with the
eties, attachment theory is able to provide predictions about the abuse survivor. For example, in her work with incestuous fami-
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

specific sequelae of affective disturbances associated with dif- lies, Gelinas (1988) has contended that cessation of the abuse
This document is copyrighted by the American Psychological Association or one of its allied publishers.

ferent types of insecure attachment in abuse survivors. does not automatically change the relational imbalances within
Disturbance of self. One final category of symptoms ob- the family. Attachment theory would extend this argument to
served in survivors of sexual abuse is a disturbance of sense of the adult survivor in that cessation of the abuse (and a singular
self. The most common form this takes is a chronic negative focus on the abuse in therapy) does not automatically change
self-esteem and sense of incapacity to affect the world (Alex- the survivor's internal working models of relationships. It is not
ander & Lupfer, 1987; Finkelhor, 1990). It may also take the unusual, for example, for women who have conscious inten-
form of a general confusion regarding one's own feelings and tions of not repeating the errors of their parents to continue to
wishes, as poignantly described through Herman's (1981) exam- behave unwittingly in role reversing or ineffective ways with
ple of the incest survivor who was raped by a man she met at a their own children, thereby increasing the child's risk for subse-
bar and subsequently married him a week later. quent abuse (Alexander, 1990; Cole et al., in press). Therefore,
According to Bowlby (1973), the internal working model of any model of therapy that fails to address explicitly the attach-
the self develops as a result of the experience of caretaking ment relationships preceding and surrounding the experience
received by the infant. Therefore, a neglect of one's needs (as is of the abuse may neither promote recovery nor protect against
inherently experienced by the sexually abused child) or an ac- other kinds of abuse in the future.
tive rejection by the parent will necessarily result in a sense of Internal working models are not simply determined by past
self as unworthy, undeserving, and even bad. Subjective aware- relationships but also function in a reciprocal process with
ness of this lack of acceptance is evident in the negative self-es- current relationships (Kobak & Hazan, 1991). Therefore, a
teem typically displayed by preoccupied and fearful adults focus on current relationships offers a concrete opportunity to
(Bartholomew & Horowitz, 1991). On the other hand, because modify implicit expectations about relationships (and about
the avoidant child is able to develop a strategy for deactivating self). Conversely, a therapist's failure to make use of these
the attachment system (whether through displacement or current relationships can allow them to effectively sabotage any
blunted affect), the perception of self is not as affected (Bar- changes that might have begun in therapy.
tholomew, 1990; Bartholomew & Horowitz, 1991; Kobak & Among these important attachments is, of course, the
Sceery, 1988). Therefore, with respect to the experience of sex- marriage of the abuse survivor, which routinely should be ex-
ual abuse, it is expected that the problems of self-identity de- plored in therapy (especially given the evidence of marital con-
scribed above would be more likely to appear in women who flict and revictimization among survivors; Briere, 1989; Rus-
have developed a preoccupied or fearful attachment style. sell, 1986). In fact, some professionals have advocated integrat-
One of the more severe disturbances of self-concept, border- ing marital and individual therapy even when the presenting
line personality disorder, is increasingly found to be preceded complaint is limited to the resolution of sexual abuse (Barrett &
by a history of sexual abuse (Briere & Runtz, 1987). The con- Stone-Fish, 1991; Johnson, 1989). Cole's work on parenting by
stellation of symptoms associated with it include problems of the adult survivor similarly has pointed to the urgency of actu-
affect regulation (e.g., unstable affect, intense affective reactiv- ally observing and exploring the survivor's relationship with her
ity), impulse control (self-destructive behaviors such as sub- children (Cole et al., in press). Finally, Schatzow and Herman
stance abuse, promiscuity, and risk-taking), reality testing (1989) have described the healing process of renegotiating a
(idiosyncratic and disorganized thinking), and interpersonal relationship with the family of origin, particularly with the
relationships (intense emotional involvement with swings be- mother. In conclusion, the goals of focusing on these current
tween symbiotic closeness and rage or despairing withdrawal; attachments are to intervene in important relationships and
Herman & van der Kolk, 1987). These same symptoms would also to alter the survivor's working model of relationships.
be descriptive of an individual with a history of a resistant or A final important clinical implication of attachment theory
disorganized attachment (i.e., a preoccupied or fearful adult). for childhood sexual abuse centers around prevention. This ar-
In conclusion, attachment theory provides a useful concep- ticle has argued that sexual abuse often develops out of the
tual framework for organizing the diversity of relationship context of an insecure parent-child attachment. The obvious

necessary response is a societal one: greater support for fami- is needed to demonstrate the relative stability of attachment
lies. This could include maternity and paternity leave policies, style, with consideration being given to intervening experiences
improved options for day care and for flexible work schedules, (such as psychotherapy or the establishment of a uniquely sup-
parent education for teenage parents, and the routine use of portive relationship) that would be expected to change one's
mediation in divorce proceedings and custody disputes (i.e., internal working model of attachment.
anything that would facilitate secure parent-child attachment). Research on attachment is also not exempt from the biases in
However, support for parents should not be construed to sampling procedures plaguing other research on sexual abuse
mean support just for mothers. It is true that evidence on risk (Beutler & Hill, 1992; Briere, 1992). For example, studies of
factors (Finkelhor & Baron, 1986), on maternal support follow- adult survivors are subject not only to memories of abuse but
ing disclosure (e.g., Everson et al., 1989), and on the relative also to memories of attachment relationships in general. Al-
impact of mother-child attachment over father-child attach- though procedures such as the A Al assess the process as well as
ment in predicting subsequent child behavior (Main & Weston, content of the memories in their determination of adult attach-
1981) certainly justifies an emphasis on the mother. Unfortu- ment categories, the mere willingness to participate in an inter-
nately, these findings often become a convenient vehicle for view about personal relationships is likely to bias the composi-
blaming the mother, when the mother's relative influence may tion of the group interviewed. A self-report measure is less
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

actually reflect the lack of a father-child attachment and the intrusive and less likely to systematically restrict the participa-
This document is copyrighted by the American Psychological Association or one of its allied publishers.

reduced emphasis placed on that relationship by our society. tion of certain types of individuals. Nonetheless, research such
Therefore, an emphasis on prevention should also include a as that conducted by Wyatt and Peters (1986) needs to deter-
focus on establishing father-child attachment and holding the mine how different procedures affect rates of subject participa-
father responsible for the security of the child before abuse (by tion and their responses.
him or anyone else) even becomes a possibility. Placing equal As consensus develops about how adult attachment is best
responsibility for the care of the child on both parents and then assessed, this normative construct can be applied more readily
providing support to facilitate the attachment relationship with to problem populations, including adults sexually abused as
both parents is the best and most efficient way to assure the children. Multimethod assessments are essential for the valida-
child's well-being and to protect the child from abuse (Finkel- tion of attachment measures, for testing specific hypotheses,
hor, 1984). Attachment theory is particularly well-suited to ad- and for assessing the strengths and weaknesses of different pro-
dress this issue of prevention. cedures. Whereas the A Al evolved out of a tradition of develop-
mental psychology, the self-report measures designed by Hazan
and Shaver (1987) and Bartholomew and Horowitz (1991) were
Research Implications
derived from social psychological studies of normal adults in
Although attachment theory theoretically would appear to romantic relationships. Other current work on attachment has
be congruent with the study of sexual abuse, both research on been based on clinical practice with adult psychiatric popula-
attachment in children and adults and research on the family tions (Pilkonis, 1988; West & Sheldon, 1988; West, Sheldon, &
dynamics and long-term effects of sexual abuse are still in their Reiffer, 1987) and includes prototype methodology. Thus, re-
early stages. Therefore, a number of caveats and questions must search on attachment represents a unique opportunity to bring
be addressed with regard to the merging of these two research together these diverse theoretical perspectives and methodolo-
areas. gies in the study of a particular clinical population. However,
Inferences about attachment in adults sexually abused as this advantage will be realized only to the extent that multi-
children require, as their base, a better understanding of method assessments are actually used.
current patterns of parent-child attachment in sexually abusive
families. The extensive research that has been conducted on Conclusion
attachment in physically abusive families (using populations at
risk or recently identified abused children) is relevant to the In conclusion, it has been proposed that attachment theory is
study of sexual abuse, but research of this type should include a useful conceptual framework for explaining the relational an-
assessment of all relevant parental figures in families of differ- tecedents and consequences of sexual abuse. Research is obvi-
ent compositions as well as assessments of family interactions. ously needed to test the hypotheses that certain family and
Longitudinal follow-ups of these children and families could parent-child relationships are associated with distinct patterns
evaluate the stability of attachment processes, and both concur- of abuse and that parent-child attachment can account for
rent and prospective assessments of adults sexually abused as some of the substantial diversity of effects seen in abuse survi-
children could suggest how patterns of family interactions and vors. Attachment theory may also prove useful in predicting
attachment are affected by a history of sexual abuse. the developmental course of symptom formation (cf. Cole &
Present research on adult attachment is limited by the fact Putnam, 1992), given the evidence that memories of abuse are
that causality between experiences in childhood and the presen- often triggered by crises around attachment issues (such as
tation of a particular attachment style in adulthood has not marriage or the birth of a child; Bartholomew & Horowitz,
been firmly established. All current research in adult attach- 1991; Gelinas, 1983). To the extent that these predictions are
ment is correlational, with the very real possibility that the demonstrated empirically, an attachment perspective should
adoption of a given attachment style in adulthood reshapes prove useful in the development of a comprehensive and
memories of childhood (Mikulincer et al., 1990). Therefore, theory-based program of intervention for both children and
/ongitudinal research with abused and nonabused populations adults.

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