The Moderating Role of Attachment on the Relationship Between History of Trauma and Intimate Partner Violence Victimization

Abstract

Exposure to trauma is a well-established predictor of intimate partner violence (IPV), although this relationship is not causal. The current study hypothesized that attachment-based anxiety moderated the relationship between trauma history and IPV revictimization in a sample of women who had reported IPV victimization 1 year earlier. Results confirmed the following hypotheses: When attachment-based anxiety was high, trauma history was positively associated with IPV victimization and use of violence. When attachment-based anxiety was low, trauma history was no longer positively associated with IPV victimization or use of violence. Secure attachments may protect female victims of IPV from the impact of trauma.

Keywords

trauma attachment IPV

Intimate partner violence (IPV) is a well-documented, persistent problem around the world. In the United States alone, nearly 25% of women are physically and/or sexually assaulted by a romantic partner at some point in their lifetime (Tjaden & Thoennes, 2000). Although both men and women use physical aggression against their partners, violence toward women tends to be more severe and more likely to result in physical injury (Archer, 2000; Yllö & Bograd, 1988). Indeed, 33% of female murder victims in 2003 were killed by an intimate partner (Rennison, 2003). IPV seldom occurs as a singular, isolated event; rather, it is a chronic, cyclical problem in which the majority of female victims are revictimized within 1 year of their previously reported incident (J. L. Miller & Krull, 1997; Walby & Allen, 2004). Despite the repetitive nature of IPV, most research has focused primarily on factors involved in single incidents of IPV and has not parsed out single versus multiple IPV events (Kuijpers, van der Knaap, & Winkel, 2012c). As a result, less is known about factors that contribute to women’s repeated experiences of IPV over time, sometimes by successive partners. The current study was designed to examine the relationship between factors (i.e., trauma history and attachment style) that have been shown to be associated with IPV victimization that may contribute to repeated victimization of women who have already experienced at least one recent IPV incident. Because victims have reported using physical force against their partners quite frequently (for a review, see Archer, 2000), which increases the likelihood of revictimization (Kuijpers, van der Knaap, & Winkel, 2012b), the extent to which these factors predict victim’s use of violence was also explored.

Exposure to trauma, particularly during childhood, has consistently been linked to IPV victimization (Linder & Collins, 2005; Renner & Slack, 2006; Tjaden & Thoennes, 2000; Whitfield, Anda, Dube, & Felitti, 2003) as well as women’s use of physical force against their partners (Ehrensaft et al., 2003; Dutton & White, 2012; Hare, Miga, & Allen, 2009; Linder & Collins, 2005; T. P. Sullivan, Meese, Swan, Mazure, & Snow, 2005; Swan, Gambone, Fields, Sullivan, & Snow, 2005; Swinford, DeMaris, Cernkovich, & Giordano, 2000; White & Widom, 2003; Whitfield et al., 2003). Social learning theory is often cited as an explanation for this association (e.g., Goldenson, Geffner, Foster, & Clipson, 2007; Hare et al., 2009; Mears, 2003; O’Leary, 1988; T. P. Sullivan et al., 2005). Children who witness or experience abusive behaviors by caretakers during their childhood learn that aggression is an acceptable means to resolve conflict (O’Leary, 1988). As a result, women who are exposed to violence as children learn to be aggressive in their own relationships, or to be more tolerant of aggression by their romantic partners. Furthermore, repeated exposure to violence and abuse can impede the development of self- and emotion regulation skills (Gilliom, Shaw, Beck, Schonberg, & Lukon, 2002; Kopp, 1989). Without self-regulating capacities, individuals are more likely to become physically aggressive when angered or upset. In addition, Downey and Feldman (1996) demonstrated that maltreated children often develop deficits in interpersonal functioning that increase the likelihood of rejection by peers and involvement in antisocial peer group. Romantic partners are then selected from these peer groups, leading to a pattern of involvement in contentious romantic relationships that may be more vulnerable to interpersonal violence.

Adverse experiences in adulthood may also contribute to susceptibility to IPV. Herman (1997) argued that repeat exposure to potentially traumatic events throughout the life span, particularly when occurring in the context of a close relationship, can create marked impairments in an individual’s sense of self, self-control, affect regulation, and interpersonal functioning. Given these changes to self-awareness, impulsivity, and relationships, traumatized women may be more susceptible to repeat victimization. Although increased exposure to various traumas is related to increased risk of IPV (Whitfield et al., 2003), research to date has focused quite exclusively on adverse experiences in childhood. A number of studies have shown that symptoms of posttraumatic stress disorder (PTSD) in adulthood are linked to both use (Abel, 2001; Goldenson et al., 2007; Swan et al., 2005) and receipt of IPV in women (Kuijpers, van der Knaap, & Winkel, 2012a; Kuijpers et al., 2012b) without linking these symptoms to a specific trauma. Therefore, considering adverse experiences that occur throughout the life span may be important in understanding repeat IPV.

Current explanations for the link between traumatic experiences and IPV, such as social learning theory, are not deterministic in nature, as the majority of people who are exposed to adverse events do not report involvement in interpersonal violence (Ehrensaft et al., 2003). A number of potential mediators have been proposed, such as the development of maladaptive coping strategies (Downs, Smyth, & Miller, 1996; Gormley, 2005; Widom, 2000), engagement in antisocial behaviors (Maxfield & Widom, 1996), the development of a personality disorder (Downs et al., 1996; Weiler & Widom, 1996), and alcohol problems (Downs et al., 1996). Dutton and White (2012) propose a different viewpoint to account for these findings. They stipulate that attachment insecurity is responsible for the effects these variables have on the link between trauma history and IPV; in other words, women exposed to trauma develop insecure attachment styles, which in turn lead to a number of vulnerabilities—maladaptive coping, personality disorder symptoms, antisocial behavior, and alcohol use—that increase their susceptibility to IPV.

Attachment theory stipulates that we develop patterns of relating to others, or internal working models, based on the quality of our early relationships with caregivers (Bowlby, 1969). In adulthood, romantic attachment is based on two constructs of intimacy: anxiety and avoidance. Attachment-related anxiety refers to the extent to which individuals are fearful of being abandoned by their partners, and attachment-related avoidance refers to the extent to which individuals are fearful of intimacy and closeness with their partners. Adults with a “secure” attachment style are low in both anxiety and avoidance, and subsequently are more likely to be involved in healthy and stable romantic relationships (Hazan & Shaver, 1987). Anxious attachment, however, has been linked to a wide range of emotional and relational vulnerabilities in women, including repeat IPV victimization (Bond & Bond, 2004; Doumas, Pearson, Elgin, & McKinley, 2008; Henderson, Bartholomew, Trinke, & Kwong, 2005) and utilization of violence against partners (Godbout, Dutton, Lussier, & Sabourin, 2009; Goldenson et al., 2007; Henderson et al., 2005; Orcutt, Garcia, & Pickett, 2005). IPV may serve as a means to maintain a desired level of personal security within a relationship (Doumas et al., 2008). When a threat to the degree of attachment within the relationship is perceived, attachment-related anxiety is activated, which leads women to engage in behaviors intended to preserve the baseline attachment system (Bowlby, 1984). Individuals high in anxious attachment may initiate or tolerate violence to maintain a level of closeness, as the negative attention received through conflict may be preferable to perceived emotional distance or disengagement with the relationship (Gormley, 2005). Furthermore, relationships with high levels of anxious attachment tend to experience heightened interpersonal problems (Lawson & Malnar, 2011) and reduced affect regulation skills (Gormley, 2005) that contribute to intense interpersonal conflict and may result in violence.

To our knowledge, no study to date has evaluated the extent to which attachment-based anxiety moderates the impact of traumatic experiences on IPV victimization in women. A study conducted by Hare and colleagues (2009) examined the moderating role of attachment insecurity on the intergenerational transmission of aggression. They found that adolescents with secure attachment styles reported low levels of IPV perpetration, regardless of paternal aggression, whereas adolescents with aggressive fathers reported significantly higher IPV perpetration when attachment insecurity, a sum of attachment-based anxiety and avoidance, was also elevated. This study provides empirical support for the moderating role of attachment on specific traumatic exposure in childhood (i.e., living with fathers who were physically abusive toward their mothers) and use of violence in relationships; however, only adolescents were included, and only perpetrating behaviors were examined. Godbout et al. (2009) assessed the influence of insecure attachment on the link between exposure to parental violence and use of IPV using structural equation modeling. They found that childhood exposure to IPV affected men’s and women’s use of IPV both directly and indirectly, through attachment-based anxiety. Therefore, anxious attachment influences the link between IPV and specific traumatic experiences in childhood (i.e., witnessing or experiencing physical or psychological aggression by a parent), although its influence on the relationship between a wider range of adverse experiences and both use and receipt of IPV is unknown.

The present study sought to investigate the extent to which attachment-based anxiety moderated the impact of traumatic experiences on repeat IPV in a sample of women who reported a previous incident of IPV victimization to the police. We were particularly interested in the role of anxious attachment in IPV, rather than avoidant attachment, as women with high levels of anxious attachment may be more likely to engage in conflict, whereas women with high levels of avoidant attachment may be more likely to disengage with their partners to avoid conflict and its implications for intimacy. This notion has some empirical support, as anxious attachment has been found to be a more salient predictor of IPV than avoidant attachment (Bond & Bond, 2004; Doumas et al., 2008; Henderson et al., 2005), although that finding is not consistent in all studies (Kuijpers et al., 2012b; Wolfe, Wekerle, Reitzel-Jaffe, & Lefebvre, 1998). We hypothesized that anxious attachment would moderate the relationship between traumatic experiences and both victimization and violence utilization for women with a previous history of IPV victimization. More specifically, when high levels of anxious attachment were reported, women who reported frequent past traumas would report the most IPV revictimization and the most frequent use of physical force against their partners. When low levels of anxious attachment were reported, women would report comparable levels of IPV revictimization and use of violence regardless of their trauma histories. Because PTSD symptoms have been identified as risk factors for both IPV revictimization (Kuijpers et al., 2012a, 2012b) and use of violence against partners (Abel, 2001; Goldenson et al., 2007; Swan et al., 2005), analyses controlled for the role of PTSD symptoms.

Method

Participants

Participants in this study were 93 women who participated in a longitudinal study of a police-advocacy program following an incident of IPV reported to the police (Stover, Berkman, Desai, & Marans, 2010). The original sample of 107 women was recruited between November 2004 and October 2005 in the city of New Haven, Connecticut. Police reports were screened for the following criteria: (a) an altercation between a male and female intimate partner; (b) arrest of the male perpetrator was made or an arrest warrant was pending; (c) female victim aged 18 or older; and (d) female victim had at least one child under 18 years of age. Cases resulting in a dual arrest or arrest of the female partner or with non-English- or Spanish-speaking victims were excluded. Participants were recruited by phone using methods described by C. M. Sullivan and Cain (2004) for safely contacting victims of IPV. At the time of each office visit, research assistants assessed victim safety using the Danger Assessment Scale (Campbell, Webster, & Glass, 2009). Women were provided with contact information for local domestic violence services and put in touch with police, mental health providers, or domestic violence advocates as needed. For a full description of study procedures in the original study, see Stover et al. (2010). The study procedures were approved by the Yale University School of Medicine Human Subjects Committee.

Of the 107 original participants, 10% did not complete the 12-month follow-up interview, and 3 (2.8%) did not respond to questions that were necessary for data analysis. The final number of participants for this secondary analysis study was 93. Analyses were conducted to determine whether the participants who dropped out of the study prior to the 12-month follow-up differed significantly from those who completed the study. No significant differences were found.

Demographic information is presented in Table 1. The women who participated in the study were primarily low-income with limited education, and most were unemployed. Ethnically, the sample was 55.9% African American, 25.8% Hispanic, and 14% Caucasian. The mean age of the participants was 30. Women had a median of 2 children with a mean age of 9.2. Women had participated in an average of 3 hr of child, family, or adult mental health treatment in the 12 months since their police-reported IPV experience at baseline (M = 11.3, range = 0-88, SD = 17.5). Their assailants were incarcerated for an average of 53.5 days for the IPV incident that prompted participation in the study (range = 0-365, SD = 108.7). Thirty-two percent of women reported still being in a relationship with their perpetrator, 23% reported being in a new relationship, and 44% were not in a relationship at the time of the interview.

Table 1.

Frequency Distribution of Demographic Characteristics.

Variable	n	%
Ethnicity
Caucasian	13	14.0
African American	52	55.9
Hispanic/Latina	24	25.8
Other	4	4.3
Employment
Unemployed	40	43.0
Employed part-time	25	26.9
Employed full-time	22	23.7
Student	6	6.5
Government assistance
Receiving assistance	68	73.1
Not receiving assistance	25	26.9
Education
Eighth grade	2	2.2
Some high school	19	20.4
High school degree	34	36.6
Some college	21	22.6
Associate degree	9	9.7
Bachelor’s degree	3	3.2
Graduate degree	3	3.2
Trade school	2	3.2
Current relationship status
In a relationship	44	47.3
Not in a relationship	49	52.7
Current relationship to perpetrator of index event
In a relationship	30	32.3
Not in a relationship	63	67.7

Procedure

A domestic incident was reported to the New Haven, CT Department of Police Services via a 911 emergency call. Police responded to the scene of the incident and completed a report based on an arrest. Cases were assigned for follow-up visits with police officer–advocate teams. Potential participants who met inclusion criteria based on police report screening were called by the research assistant between 10 days and 3 weeks after the incident of IPV to ask whether they would like to participate in a research study examining women’s experiences of IPV and the impact of police and other services. Baseline interviews were scheduled within 6 weeks of the domestic incident that qualified them for the study, and follow-up interviews took place at 6 and 12 months later. Interviews were scheduled either at the research study offices or in the women’s homes and took approximately 1.5-2 hr to complete. Women were interviewed using a series of questionnaires. They were paid for their participation in each interview. The Yale University Institutional Review Board approved this study.

Interview Measures

This research study utilized data from the 12-month follow-up interview. For a description of all measures used in this study, see Stover and colleagues (2010). Participants were asked a series of demographic questions and were administered standardized questionnaires.

IPV revictimization/use of violence

The Physical Assault scale of the Conflict Tactics Scale–2 (CTS2; Straus, Hamby, Boney-McCoy, & Sugarman, 1996) was used to measure the level of conflict and abuse between partners and violence-related injury. The CTS2 has been used in hundreds of studies, and has repeatedly demonstrated good internal consistency and validity (Straus et al., 1996). Because participants had already experienced at least one IPV incident to be included in this study, responses to the CTS2 were indicative of the frequency of repeated IPV 12 months after the initial incident that qualified them for the study. If women reported involvement with a new and different partner than the one involved in the police-reported incident that qualified them for the study, data were collected for their experiences of violence from their former partner and the new partner to provide an estimate of total IPV experienced.

Traumatic experiences

Victim trauma history was determined by the Traumatic Events Screening Inventory (TESI; Ford et al., 2000), which assesses a variety of stressors over the course of the lifetime (e.g., sexual abuse, physical abuse, community violence, accidents). The TESI has demonstrated good internal consistency and reliability with adult women (Ford & Fornier, 2007). The total numbers of previous traumas are tallied to create a trauma history total score.

Attachment

The Experiences in Close Relationships–Revised (ECR-R; Fraley, Waller, & Brennan, 2000) measures how an individual generally feels in romantically close adult relationships. The participant is asked not to respond about their feelings and experiences with their current or most recent partner, but how they feel and respond in general in romantic relationships. Participants respond to each item on a 7-point Likert-type scale. Items are consistent with anxious attachment (e.g., I am afraid I will lose my partner’s love; I worry that romantic partners will not care about me as much as I care about them) or avoidant attachment behaviors (e.g., I get uncomfortable when a romantic partner wants to be very close; I prefer not to show a partner how I feel deep down) and generate Anxious and Avoidant Total Scores. The ECR-R has excellent test–retest reliability and predictive validity (Sibley, Fischer, & Liu, 2005) and good internal consistency, and studies have supported the anxious and avoidant factors of the measure (Fairchild & Finney, 2006; Sibley & Liu, 2004). It has been used in multiple studies of IPV (Dye & Davis, 2003; Fairchild & Finney, 2006; Goldenson et al., 2007) with IPV perpetrators and victims showing greater attachment insecurity on both factors.

PTSD symptoms

The Posttraumatic Checklist–Civilian Version (PCL-C; Blanchard, Jones-Alexander, Buckley, & Forneris, 1996) was utilized to assess symptoms of PTSD. Participants rate the extent to which they have experienced 17 potential symptoms of PTSD in the last month on a Likert-type scale ranging from 0 (not at all) to 5 (extremely). Responses were summed into a single composite score for total PTSD symptoms. Test–retest reliability ranges from .66 for 2 weeks to .93 for 2-3 days, and several studies have supported its convergent, discriminant, and predictive validity in both community and clinical samples (Wilkins, Lang, & Norman, 2011).

Data analyses

We first conducted preliminary analyses to assess the relationship of potential covariates with IPV revictimization and use of violence using bivariate correlations for continuous variables and univariate ANOVAs for categorical variables. Potential covariates included age, employment status, receipt of government assistance (to assess socioeconomic status), alcohol use, relationship status, relationship to perpetrator of the index event, length of perpetrator’s incarceration following index event, frequency of IPV in the year prior to the study (measured by the CTS2 collected at baseline in the original study), and treatment received during the previous 12 months since the index IPV event. Next, we tested our hypotheses using hierarchical regression to determine the main effects of anxious attachment and trauma history on IPV revictimization, and their interaction effect on IPV revictimization. Covariates were entered in the first step of the regression model followed by standardized variables for trauma history and anxious attachment style at the second step. The interaction of trauma history and standardized anxious attachment was added at step three. This interaction, if significant, represents the extent to which anxious attachment moderates the relationship between trauma history and IPV revictimization. Because the sample size is less than 100, adjusted R² was used to evaluate the degree of variability and association between study variables (Garson, 2013). This same model was repeated with women’s self-reported use of physical violence as the dependent variable.

Results

Of the 93 participants, 22.6% (n = 21) reported at least one new incident of physical violence in their relationship during the follow-up period. Of these participants, 81.0% (n = 19) reported both using and receiving IPV, 9.5% (n = 2) reported using violence only, and 9.5% (n = 2) reported being the victim of violence only. Preliminary analyses demonstrated that employment and length of incarceration were significantly associated with IPV victimization and/or use of violence (see Table 2). Length of incarceration had a significant positive correlation with IPV revictimization. Unemployed women (M = 6.39, SD = 14.42) reported significantly higher levels of violence against their partners than employed women (M = 1.34, SD = 4.23). Of the 93 participants, 14 (15.1%) reported that they did not know the length of time their perpetrator had been incarcerated. Length of incarceration was not a significant predictor of either victimization (β = .185, p = ns) or use of violence (β = .121, p = ns) in a preliminary model, and its inclusion substantially reduced power of the analyses by reducing the number of participants. Because its removal did not alter the findings, it was not included in the final models presented here to maintain adequate power. Therefore, employment and PTSD symptoms were the only covariates entered at Step 1.

Table 2.

Correlational and ANOVA Analyses for Potential Covariates.

Potential covariate	IPV receipt	IPV use	n
	R
Age	−.066	−.121	93
Alcohol use	.049	.041	84
Mental health treatment	−.027	−.050	85
IPV victimization in year prior to study	.117	−.004	93
IPV use in year prior to study	.144	.030	93
Length of perpetrator’s incarceration	.286*	.043	79
	F
Employment	0.895	5.303*	93
Receiving government assistance	0.355	0.038	93
Currently in relationship	0.144	0.774	93
Currently in relationship with perpetrator	0.088	1.283	93

Note. IPV = intimate partner violence.

p ≤ .05.

Descriptive statistics and correlations for the study variables are displayed in Table 3. Five of the study variables had significant positive inter-correlations: anxious attachment, traumatic experiences, IPV revictimization, use of IPV, and PTSD symptoms. In addition, unemployed women were significantly more likely to report PTSD symptoms and using violence than employed women.

Table 3.

Means, Standard Deviations, and Correlations for Study Variables.

	M	SD	Range	1.	2.	3.	4.	5.
1. Employment				—	—	—	—	—
2. PTSD symptoms	28.0	14.1	17-85	−.282**	—	—	—	—
3. Traumatic experiences	6.1	3.6	0-16	−.126	.49^††	—	—	—
4. Anxious attachment	2.8	1.5	1-7.5	−.053	.49^††	.36***	—	—
5. Victim of IPV	3.8	13.3	0-99	−.129	.38***	.32**	.32**	—
6. Use of IPV	3.7	10.7	0-60	−.219	.40**	.31**	.22*	.64^†††

Note. PTSD = posttraumatic stress disorder; IPV = intimate partner violence.

p ≤ .05. **p ≤ .01. ***p ≤ .001. ^††p ≤ .000001. ^†††p ≤ .0000000001.

IPV Revictimization

Hierarchical regression results for IPV revictimization are presented in Table 4. The combination of covariates accounted for a significant amount of variance in IPV revictimization. PTSD symptoms were the only significant unique contributor to IPV revictimization at the first step. The addition of traumatic experiences and anxious attachment to the model accounted for a small (2.4%) and nonsignificant increase in the proportion of variance explained, as neither anxious attachment nor traumatic experiences significantly predicted IPV revictimization; however, the inclusion of these main effects neutralized the impact of PTSD symptoms on IPV revictimization.

Table 4.

Hierarchical Regression Analysis of Participants’ Repeat Victimization at 12 Months.

Variable and statistic	Standardized βs
Variable and statistic	Step 1	Step 2	Step 3
Step 1: Control variables
PTSD symptoms	.369***	.212	.113
Employment	−.037	−.052	−.039
Step 2: Main effects
Anxious attachment		.152	.109
Traumatic experiences		.160	.122
Step 3: Interaction effect
Anxious Attachment × Traumatic Experiences			.482^††
N	93	93	93
F	7.475***	4.969***	11.202^††
Df	2	4	5
R ²	.145	.188	.397
Adjusted R²	.126	.150	.362
Change in adjusted R²		.024	.212^††

Note. PTSD = posttraumatic stress disorder.

***

p ≤ .001. ^††p ≤ .000001.

The addition of the interaction term for anxious attachment and traumatic experiences at the last step accounted for a substantial (21.2%) and significant increase in the proportion of variance explained. The interaction variable was significantly associated with IPV revictimization. When anxious attachment was low, trauma history was negatively associated with revictimization. When anxious attachment was high, trauma history was positively associated with revictimization (see Figure 1).

Figure 1.

The moderating role of attachment-based anxiety in the relationship between traumatic experiences and IPV revictimization at 12 months.

Women’s Use of Violence

To assess the extent to which anxious attachment moderated the effects of traumatic experiences on use of violence toward intimate partners by female victims of IPV, the aforementioned analysis was repeated using victims’ report of their own use of violence as the dependent variable (see Table 5). At the first step, the covariates PTSD symptoms and employment accounted for a significant amount of variance in use of violence. Again, PTSD symptoms had a significant positive association with use of violence. The addition of trauma history and anxious attachment to the model accounted for a slight (0.10%) decrease in the proportion of variance explained. Neither variable was significantly associated with use of violence, although PTSD continued to display a significant positive association.

Table 5.

Hierarchical Regression Analysis of Participants’ Use of IPV at 12 Months.

Variable and statistic	Standardized βs
Variable and statistic	Step 1	Step 2	Step 3
Step 1: Control variables
PTSD symptoms	.366***	.281*	.240
Employment	−.133	−.136	−.131
Step 2: Main effects
Anxious attachment		.026	.008
Traumatic experiences		.146	.130
Step 3: Interaction effect
Anxious Attachment × Traumatic Experiences			.201*
N	93	93	93
F	9.559***	5.240**	5.148***
Df	2	4	5
R ²	.422	.443	.482
Adjusted R²	.160	.159	.187
Change in adjusted R²		−.001	.028*

Note. IPV = intimate partner violence; PTSD = posttraumatic stress disorder.

p ≤ .05. **p ≤ .001. ***p ≤ .0001.

The addition of the interaction term for anxious attachment and trauma history accounted for a small (2.8%) but significant increase in the proportion of variance explained in women’s use of violence. The interaction variable was significantly associated with use of violence, and its inclusion neutralized the impact of PTSD symptoms. As seen in Figure 2, when anxious attachment was low, participants reported similar levels of violence, regardless of trauma history. When anxious attachment was high, trauma history and use of violence were positively associated.

Figure 2.

The moderating role of attachment-based anxiety in the relationship between traumatic experiences and victims’ use of violence at 12 months.

Discussion

Results demonstrated that anxious attachment moderated the relationship between traumatic experiences and repeat IPV victimization, as well as between traumatic experiences and women’s use of violence. Women who were exposed to multiple past traumas reported being revictimized and using violence in romantic relationships most frequently when they also endorsed high levels of attachment-based anxiety. When attachment-based anxiety was low, trauma history was negatively associated with repeat victimization, and was not associated with use of violence. Despite the strong link between trauma and IPV in the literature (e.g., Dutton & White, 2012; Ehrensaft et al., 2003; Hare et al., 2009; Linder & Collins, 2005; Renner & Slack, 2006; T. P. Sullivan et al., 2005; Swan et al., 2005; Swinford et al., 2000; Tjaden & Thoennes, 2000; White & Widom, 2003; Whitfield et al., 2003), to our knowledge, no previous study examined the modifying effect of attachment on this relationship in adults. The present study postulates that attachment-based anxiety may explain why many women who are exposed to trauma and violence in their lives do not experience repeated, ongoing IPV, as secure attachment may serve as a buffer against the negative implications of adverse life events (Bowlby, 1969).

The link between trauma and anxious attachment has strong theoretical support. Traumatic experiences have a profound impact on the development of insecure attachment styles (Bowlby, 1969, 1984). In childhood, exposure to trauma reduces the predictability of one’s environment and the people in it, leading one to feel less able to rely on others for comfort, support, and basic needs. A securely attached child is more likely to trust that she is worthy of help and that others will be available for support, whereas an insecurely attached child may lack the emotional support or the inner resources required to ask for it (Belsky & Fearon, 2002; Toth & Cicchetti, 1996). Trauma continues to impede healthy attachments in adulthood, as traumatic experiences may lead one to feel helpless and unsafe in what is perceived to be an unpredictable and harmful world (Foa, Cascardi, Zoellner, & Feeny, 2000). Adult survivors of trauma tend to report trusting others less than those without histories of trauma (W. R. Miller, Williams, & Bernstein, 1982; Resick, 1983). Adult survivors of trauma have also reported increased fear of intimacy, fear of abandonment, and other attachment-related anxiety (Thelen, Sherman, & Borst, 1998). Cumulative exposure to such experiences increases the likelihood that one will feel insecure and mistrustful in adult relationships (Herman, 1997).

It is important to note that a secure attachment style does not invariably signal a life free of maltreatment or other adverse experiences, as trauma does not cause insecure attachment. Attachment style is based on one’s ability to evaluate interpersonal experiences in a balanced, coherent, and objective manner. It is indicative of cognitive and emotion regulation capacities that allow one to step back and label destructive relational experiences as just that—destructive (Godbout et al., 2009). Anxiously attached individuals, therefore, have difficulties evaluating past experiences rationally, and may be more likely to perceive maladaptive interpersonal strategies such as violence as constructive in maintaining intimacy. Thus, in the present study, women with less attachment anxiety, who would be more equipped to effectively evaluate problematic behaviors in their relationships, were less likely to be revictimized by their partners or to use violence against their partners, even when they experienced substantial levels of trauma in the past. Indeed, the more these women were exposed to adverse events in the past, the less likely they were to stay involved in violent relationships, as they may have been better able to accurately perceive and subsequently avoid relational violence than women whose perceptions were obfuscated by attachment-based anxiety.

Given the high correlation between exposure to traumas and attachment-based anxiety, it is not surprising that studies of IPV consistently demonstrate the predictive power of past traumatic experiences without accounting for attachment style. Hare and colleagues (2009) did account for the moderating role of attachment on this relationship using their sample of adolescents. Consistent with our findings, when attachment insecurity was high, adolescents who were exposed to paternal violence were more likely to report using violence toward their romantic partners. When attachment insecurity was low, however, exposure to paternal violence did not predict IPV. They concluded that possessing a balanced, coherent, and objective view on past experiences, even those that are negative, is advantageous in that it reduces the likelihood of significant discord in current relationships. The present study demonstrated that this modifying effect continues to be present when examining a wider range of traumatic experiences and repeat IPV incidents in adulthood.

Godbout et al. (2009) also assessed the inter-relationships between trauma (defined as exposure to violence during childhood), IPV, and attachment style in a nonclinical sample of married or cohabitating couples. They found that exposure to parental violence both directly predicted IPV and indirectly predicted it through attachment anxiety. The present study found similar inter-correlations between variables, as both anxious attachment and traumatic experiences were positively correlated with each other and with IPV experiences. Our findings, however, suggest that this positive relationship between trauma and IPV does not apply to women with healthier levels of attachment-based anxiety. Conceptualizing attachment as a mediator does not capture the subset of women who, despite multiple adverse experiences, are not anxious in their relationships.

The present study suggests that considering attachment style is important in the identification and treatment of women who are at risk of IPV revictimization. Given the protective role of low levels of attachment-based anxiety, fostering the development of the ability to effectively appraise and process past interpersonal experiences may help prevent future violence. Although symptom reduction may reduce the likelihood of revictimization (Iverson et al., 2011), PTSD symptoms are only one factor contributing to the cyclical nature of IPV; therefore, a successful treatment should also aim to improve victims’ abilities to effectively identify, evaluate, and respond to dysfunctional relationships (i.e., reduce attachment-based anxiety). Cognitive Processing Therapy (CPT; Resick & Schnicke, 1993) has been adapted for IPV (Iverson et al., 2011) and has components that address affect regulation and cognitive processing of past IPV, but does not emphasize the development and appraisal of healthy current relationships. Healing Trauma (Covington, 2010), a five-session gender-specific treatment for female victims of IPV, includes one session aimed at increasing awareness about healthy relationships; however, its efficacy has not been evaluated to date, and the brief nature likely does not address the longstanding nature of attachment insecurity. Treatments that emphasize improved relational awareness and functioning, such as Interpersonal Therapy (IPT; Markowitz, 1998), may be a good starting point for the development of treatments for repeat IPV. Furthermore, when assessing for risk of violence or victimization, trauma history, anxious attachment style, and PTSD should all be taken into account.

In addition to evaluating the moderating role of attachment, the present study differed from the literature on IPV in women in a number of ways. First, it utilized a sample of inner city adult women who had already experienced at least one incident of IPV during which their partners were arrested. Because all participants were subjected to IPV 1 year earlier, the present study was able to investigate the factors involved in revictimization, as well as using violence against partners after previously being victimized by violence, which are important aspects of the cyclical nature of IPV.

The present study is also unique in that it controlled for PTSD while demonstrating factors associated with IPV. Posttraumatic symptoms have been linked to IPV victimization (Abel, 2001; Babcock, Green, & Robie, 2004; Kuijpers et al., 2012a) as well as use of IPV (Goldenson, Spidel, Greaves, & Dutton, 2009; Swan et al., 2005). In our study, PTSD was a strong predictor of both IPV victimization and utilization, and its inclusion weakened the impact of traumatic experiences and anxious attachment; without PTSD, traumatic experiences significantly predicted both IPV victimization and use of violence. The significance of the interaction term even when controlling for PTSD demonstrates the robust nature of the moderating effect of attachment-based anxiety in this sample.

The present study measured trauma history more broadly than past research, as previous studies exclusively focused on childhood experiences of specific traumas, such as witnessing parental IPV. The importance of childhood exposure to violence, however, does not exclude or prevent the impact of exposure to violence in adulthood. Adult victims of rape, for example, are susceptible to substantial difficulties in self-regulation and interpersonal functioning that can last for decades after the rape (Kilpatrick, Saunders, Veronen, Best, & Von, 1987). Furthermore, many studies that demonstrated the link between PTSD and IPV (i.e., Abel, 2001; Goldenson et al., 2007; Kuijpers et al., 2012a; Swan et al., 2005) did not assess the traumatic experiences that led to these symptoms; therefore, it is likely that adult experiences of trauma at least partially contributed to the symptoms reported.

With these aforementioned strengths, there are important limitations to the present study. Repeat violence and all other study variables were measured by self-report and may be an under-representation of actual violence experienced; multiple informants or use of arrest records would strengthen the findings. The lack of consistent data on length of incarceration of the perpetrator limited our ability to include that variable in our models. Future studies should further examine this variable in conjunction with the variables explored here. Furthermore, a larger sample size that includes greater variability in severity of IPV and socioeconomic status as well as women who are not mothers would provide additional validity to these findings for the broad sample of women who experience IPV.

Conclusion

The present study was the first to our knowledge to demonstrate how attachment-based anxiety moderates the impact of trauma history on IPV revictimization. Greater experiences of different kinds of traumas are predictive of revictimization and violence utilization for women who have significant attachment-based anxiety, but not for women who are more secure in their romantic relationships. Results suggest that the evaluation of past traumatic experiences, anxious attachment style, and PTSD symptoms is very important for assessing risk of continued IPV victimization.

Footnotes

Acknowledgements

The authors thank Dina Filguera-G’omez, Paula Schaeffer, Billie Ann Starks, and Sarah Beckwith for their work making this study possible.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Funding for this research was provided by the Substance Abuse and Mental Health Administration as part of the National Child Traumatic Stress Network and the Ethel F. Donaghue Women’s Health Research at Yale.

Author Biographies

Linda Sapanski Smith is a licensed clinical psychologist in private practice on Long Island, New York. An early career psychologist, her clinical and empirical experience to date has primarily focused on children and families affected by trauma. This research was completed during her postdoctoral fellowship at Yale University Child Study Center in their Trauma and Children track.

Carla Smith Stover is a licensed clinical psychologist and an assistant professor in the Department of Mental Health Law and Policy at the University of South Florida. She also holds a clinical faculty appointment at Yale University Child Study Center. She has extensive clinical experience with families affected by trauma and domestic violence. She has provided trainings in best practices and intervention for domestic violence and trauma nationally. She has been the principal investigator on multiple studies examining the efficacy of outreach and intervention efforts for families affected by domestic violence and other traumas.

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