Adverse Childhood Experiences and Insecure Attachment

Adverse Childhood Experiences (ACEs) refer to stressful or traumatic events that children face before reaching 18. These include various forms of abuse (physical, emotional, sexual), neglect (emotional, physical), and household challenges such as witnessing domestic violence, living with substance abusers, having an incarcerated relative, or experiencing family separation.

Studies have shown that individuals with a high number of ACEs are at an increased risk for negative outcomes in adulthood, including chronic diseases, mental illness, substance misuse, and reduced life potential. The more ACEs one has, the greater the risk for these outcomes.

A little girl sat on the floor with face in her hands while there is the shadow of her parents arguing on the wall
Snyder, K. S., Luchner, A. F., & Tantleff-Dunn, S. (2023). Adverse childhood experiences and insecure attachment: The indirect effects of dissociation and emotion regulation difficulties. Psychological Trauma: Theory, Research, Practice, and Policy. Advance online publication.

Key Points

  • The study examined how dissociation and emotion regulation difficulties indirectly impact the relationship between adverse childhood experiences (ACEs) and anxious and avoidant attachment patterns in adulthood.
  • ACEs predicted anxious attachment through dissociation and emotion regulation difficulties.
  • ACEs predicted avoidant attachment through dissociation but not through emotion regulation difficulties.
  • The results highlight the importance of dissociation and emotion regulation as factors influencing insecure attachment patterns in adulthood after ACEs.
  • Limitations include the use of self-report measures, a cross-sectional rather than longitudinal design, and a non-clinical sample.


Past research shows links between ACEs and later difficulties like dissociation, emotion regulation problems, and insecure attachment patterns (anxious and avoidant; Corcoran & McNulty, 2018).

However, few studies have examined the specific indirect roles of dissociation and emotion regulation together in explaining the relationship between ACEs and adult attachment insecurity, especially in non-clinical groups (Hébert et al., 2018; Poole et al., 2018).

This study aimed to address this gap by exploring whether dissociation and emotion regulation difficulties help explain how ACEs relate to anxious and avoidant attachment tendencies in adulthood.

Understanding these connections better informs intervention and prevention efforts targeting resilience after adversity.


  • Online questionnaire measuring key variables
  • Mediation analysis testing indirect effects
  • Variables: ACEs, dissociation, emotion regulation difficulties, adult attachment insecurity


  • 253 adults from an online participant pool
  • 18-77 years old (M = 33.05 years)
  • Mostly Caucasian (70%) and single (53.4%)
  • 45.5% reported current/past mental health treatment

Statistical Analysis

  • Pearson correlations
  • Hayes’ (2013) PROCESS macro for mediation models
  • Bootstrapping with 10,000 samples to test for indirect effects


  • In mediation modeling, dissociation and emotion regulation difficulties explained the link between greater ACEs and increased anxious adult attachment when controlling for mental health treatment.
  • Dissociation mediated the relationship between more adverse childhood experiences and higher avoidant attachment in adulthood, but emotion regulation difficulties did not show this significant mediating effect for avoidant attachment.
  • ACEs did not directly predict anxious nor avoidant attachment when accounting for the effects of the mediators, suggesting the attachment insecurities are shaped by the dissociation/regulation problems stemming from early adversity.


This study uniquely demonstrates how both dissociation and emotion dysregulation together help explain why adults exposed to adversity in childhood later struggle in close relationships, desiring extreme closeness due to anxieties or avoiding intimacy altogether.

Even small psychological disruptions after adversity can accumulate and manifest interpersonal.


  • Examined understudied explanatory roles of dissociation and emotion regulation together
  • Community sample extends literature beyond clinical groups
  • Highlighted adult attachment patterns as an outcome affected by childhood adversity


  • Self-report measures prone to bias
  • Cross-sectional design prohibits causal conclusions
  • Non-clinical sample limits clinical interpretation


The findings suggest clinicians should assess dissociation, emotion regulation capacities, and attachment styles when treating adults with childhood adversity histories.

Enhancing emotion regulation skills and resolving dissociative tendencies may mitigate later social challenges. Prevention efforts with children should prioritize cultivating healthy attachment relationships and building coping skills.


This study advances understanding of how early adversity disrupts developmental processes, identifying new explanatory mechanisms for lasting interpersonal effects.

The mediating roles of dissociation and emotional dysregulation in linking adverse experiences to adult attachment styles warrant further investigation, especially clinically.

Future Research

Continued research on resilience factors fostering secure attachment after adversity is vital. Though complex, making progress in mitigating the intergenerational effects of childhood adversity remains imperative.

To build on this study, future research should utilize longitudinal designs tracking individuals over time to establish temporal sequencing between early adversity, mediating factors like dissociation and emotion dysregulation, and adult attachment outcomes.

Additionally, recruited samples should include wider demographic variability and specifically target clinical populations with confirmed trauma histories to determine generalizability of the mediation results.

Studies must move beyond self-reporting, incorporating clinician assessments, observational measures of functioning, and physiological indicators of stress systems.

Treatment outcome research could also examine whether directly intervening to improve emotion regulation abilities and resolve dissociative tendencies helps ameliorate insecure attachment patterns following childhood adversity.


Primary Paper

Snyder, K. S., Luchner, A. F., & Tantleff-Dunn, S. (2023). Adverse childhood experiences and insecure attachment: The indirect effects of dissociation and emotion regulation difficulties. Psychological Trauma: Theory, Research, Practice, and Policy. Advance online publication.

Other References

Corcoran, M., & McNulty, M. (2018). Examining the role of attachment in the relationship between childhood adversity, psychological distress and subjective well-being. Child Abuse & Neglect, 76, 297–309.

Hayes, A. F. (2013). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. Guilford Press.

Hébert, M., Langevin, R., & Oussaïd, E. (2018). Cumulative childhood trauma, emotion regulation, dissociation, and behavior problems in school-aged sexual abuse victims. Journal of Affective Disorders, 225, 1–20.

Poole, J. C., Dobson, K. S., & Pusch, D. (2018). Do adverse childhood experiences predict adult interpersonal difficulties? The role of emotion dysregulation. Child Abuse & Neglect, 80, 123–133.

Further Reading

  • Chapman, D. P., Whitfield, C. L., Felitti, V. J., Dube, S. R., Edwards, V. J., & Anda, R. F. (2004). Adverse childhood experiences and the risk of depressive disorders in adulthoodJournal of affective disorders82(2), 217-225.
  • Dube, S. R., Felitti, V. J., Dong, M., Chapman, D. P., Giles, W. H., & Anda, R. F. (2003). Childhood abuse, neglect, and household dysfunction and the risk of illicit drug use: the adverse childhood experiences studyPediatrics111(3), 564-572.
  • Ehrenthal, J. C., Levy, K. N., Scott, L. N., & Granger, D. A. (2018). Attachment-related regulatory processes moderate the impact of adverse childhood experiences on stress reaction in borderline personality disorder. Journal of Personality Disorders, 32(Suppl.), 93–114.
  • Felitti, V. J. (2009). Adverse childhood experiences and adult healthAcademic pediatrics9(3), 131-132.
  • Hamai, T. A., & Felitti, V. J. (2022). Adverse childhood experiences: Past, present, and future. Handbook of interpersonal violence and abuse across the lifespan: a project of the national partnership to end interpersonal violence across the lifespan (NPEIV), 97-120.
  • Kong, S. S., Kang, D. R., Oh, M. J., & Kim, N. H. (2018). Attachment insecurity as a mediator of the relationship between childhood trauma and adult dissociation. Journal of Trauma & Dissociation, 19(2), 214–231.
  • Lavi, I., Katz, L. F., Ozer, E. J., & Gross, J. J. (2019). Emotion reactivity and regulation in maltreated children: A meta-analysis. Child Development, 90(5), 1503–1524.
  • Murphy, A., Steele, M., Dube, S. R., Bate, J., Bonuck, K., Meissner, P., Goldman, H., & Steele, H. (2014). Adverse childhood experiences (ACEs) questionnaire and adult attachment interview (AAI): Implications for parent child relationships. Child Abuse & Neglect, 38(2),224–233.

Learning Check

  1. What role might a person’s support system outside the family play in mediating ACEs effects?
  2. Could attachment insecurity and emotion dysregulation have bidirectional impacts across development?
  3. Might the study variables function differently across unexamined cultural groups?
  4. What inferences can reasonably be made applying these non-clinical white sample findings to specialized clinical populations?
  5. How might self-report measurement limitations related to psychological constructs like dissociation impact interpretations?

Olivia Guy-Evans, MSc

BSc (Hons) Psychology, MSc Psychology of Education

Associate Editor for Simply Psychology

Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.

Saul Mcleod, PhD

Educator, Researcher

BSc (Hons) Psychology, MRes, PhD, University of Manchester

Saul Mcleod, Ph.D., is a qualified psychology teacher with over 18 years experience of working in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.