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Is Attachment Insecurity Putting Your Sexual Health at Risk?

According to a new study, insecure attachment may spur unhealthy sexual risks.

Though attachment theory has its critics, attachment style is thought by some to be one of the most significant factors affecting the way adults think about themselves and their relationships.

Your attachment style, according to attachment theory, begins to develop in the first few days of your life as you begin to learn what to expect from your caregivers (usually the mother). Will you be able to rely on them to care for you? In those crucial early bonding days, are your needs met for what psychologists call a “safe haven”? Alternatively, do you learn to fear that you will be abandoned and neglected?

As you progress through childhood and into adulthood, this sense of security or insecurity becomes the basis, according to attachment theory, for the way you interact with romantic partners. If you’re securely attached, you know your partner will be there for you, no matter what. If you’re insecurely attached, in contrast, you’ll be constantly on guard for signs of your partner’s loss of interest in you.

Given the centrality of sexuality in romantic relationships, it would make sense that your attachment style could influence the way in which you approach having sex with your partner. If you’re securely attached, you’ll feel comfortable about become intimate, not just emotionally but also physically. If you’re insecurely attached, however, being physically intimate can play into your biggest fears about abandonment.

According to a new meta-analysis (large-scale) study by University of Southern California’s Hye Min Kim and Lynn Carol Miller (2020), there is reason to expect that people with insecure attachment styles will express their fears of abandonment and neglect in the risky sexual behaviors of seeking multiple partners while, at the same time, being afraid to ask these partners to engage in protected sex.

The authors define attachment style as “mental models” that “involve the extent to which the self and others are respectively worthy of love and trust or not.” On this basis, the USC authors proposed that “In the context of sexual decision making, these individuals tend to believe one’s self as less worthy of love and value, putting others’ interests and needs before one’s own health concerns.” (p. 46). Previous research has explored the relationship between risky sexual behavior and attachment style, but Kim and Miller are the first to put this relationship to a stringent statistical test.

There is some previous research, in the words of the authors, showing that “anxiously attached individuals’ concerns about the relationship cause them to act in ways that are not in their own best interests, putting them at risk” (p. 47). However, this conclusion is challenged by other research suggesting that it’s the securely attached, comfortable with intimacy, who engage in risky sex in order to avoid jeopardizing that sense of closeness.

In part, the divergence in prior studies reflects variations in the nature of the samples according to, for example, age, HIV status, and race. There are also studies in which the sample characteristics are insufficiently reported. Adding to these sample variations is the fact that researchers continue to use different approaches to measuring attachment style. Some authors choose to use categorical types, and even these may differ from study to study, and others use the now more widely-accepted dimensional approach.

This dimensional approach proposes that people vary along the two fundamental factors of attachment anxiety (fear of abandonment) and avoidance (preferring to stay away from intimate relationships). By using dimensions instead of types, researchers are able to gain greater precision in examining relationships between attachment style and other qualities of an individual’s mental model of relationships. As you think about yourself, for example, would you regard yourself as simply “secure” or “insecure,” or does it make more sense to view yourself in relation to others as falling somewhere along a continuum?

The studies analyzed by the USC authors needed to meet stringent criteria of using a dimensional approach, defining attachment in terms of adult relationships, using quantitative measures, and including behavioral indicators of risky sex such as actual use of condoms rather than attitudes toward condom use. After screening a potential set of 329 articles, the authors immediately excluded 207 that were not completely relevant to the meta-analysis, and another 106 that were either qualitative in nature, did not use behavioral measures of risky sex, or failed another empirical criterion.

The resulting 16 studies (2 of which were unpublished) were therefore only about 5 percent of the published articles potentially relevant to the research question, but incorporated a large number of participants (7,233) and 14 sets of statistics representing the association between attachment and risky sex. The majority of samples were of college-age or even slightly younger, with 122 participants ranging from 19 to 66 years old (average age of 33).

Overall, Kim and Miller concluded that there is a positive association between attachment insecurity and engaging in risky sex, or sex with multiple partners and without a condom. However, the relationship was stronger for adults older than college-age adults, and for populations considered at risk (e.g. HIV-positive individuals), a finding the authors caution may reflect small sample sizes in the case of these additional factors.

Of the two attachment dimensions, anxious attachment was more strongly related to risky behavior, suggesting that people who go from partner to partner while also engaging in condomless sex, both fear rejection (should they ask for condom use) and seek validation in multiple sex partners. Although the avoidant may, similarly, engage in sex with multiple partners due to lack of interest in intimacy, there was no relationship between avoidant attachment and engaging in unprotected sex.

From these findings, the authors conclude that “In any case, under sexual circumstances, attachment anxiety and/or attachment avoidance could override one’s own decision-making pertaining to one’s goals for long-term health” (p. 53), due to poor “in-the-moment sexual behavior outcomes.” Moreover, the findings provide further empirical support for conceptualizing attachment style in continuous rather than categorical terms. Apart from this theoretical implication, the findings also suggest possible paths toward intervention to ensure that at-risk individuals learn to read their own internal danger signs when they’re about to make that poor “in the moment” decision.

To sum up, the USC study shows a new way to understand the role of attachment style in personal relationships. As you ponder your own romantic decisions, consider checking in on your own mental model to see whether fear of rejection is driving your choices. Fulfillment in relationships involves many factors, and being sexually healthy is one of the most important for your long-term benefit.


Kim, H. M., & Miller, L. C. (2020). Are insecure attachment styles related to risky sexual behavior? A meta-analysis. Health Psychology, 39(1), 46–57. doi:10.1037/hea0000821.supp (Supplemental).