Accepted Manuscript

The association between attachment and psychopathic traits

Marion van der Zouwen, Machteld Hoeve, Anne M. Hendriks,

Jessica J. Asscher, Geert Jan J.M. Stams

PII: S1359-1789(18)30043-0
DOI: doi:10.1016/j.avb.2018.09.002
Reference: AVB 1234
To appear in: Aggression and Violent Behavior
Received date: 18 February 2018
Revised date: 15 August 2018
Accepted date: 14 September 2018

Please cite this article as: Marion van der Zouwen, Machteld Hoeve, Anne M. Hendriks,
Jessica J. Asscher, Geert Jan J.M. Stams , The association between attachment and
psychopathic traits. Avb (2018), doi:10.1016/j.avb.2018.09.002

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 ACCEPTED MANUSCRIPT
Running head: ATTACHMENT PSYCHOPATHIC TRAITS

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The association between attachment and psychopathic traits

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Marion van der Zouwen, Machteld Hoeve, Anne M. Hendriks, Jessica J. Asscher,

and Geert Jan J. M. Stams

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University of Amsterdam
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ATTACHMENT PSYCHOPATHIC TRAITS 2

Abstract

The purpose of this study was to examine the association between attachment and

psychopathic traits. A systematic search of relevant articles yielded 12 studies (11

independent samples), containing 133 effect sizes based on in total 1,876 participants. Results

from a three-level random-effects meta-analysis demonstrated a small-to-medium significant,

overall association of r = .18, indicating that insecure attachment was positively related to

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psychopathic traits. We also tested moderator effects; six significant moderators were found.

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First, the magnitude of the effect size depended on which psychopathic trait was investigated;

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the largest effect size was found for callous-unemotional traits (r = .23), and no effect was

found for antisocial behavior, narcissism and impulsivity. Second, parent- and caregiver
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reports on psychopathic traits resulted in stronger associations compared to self-reports and a

composite of multiple sources. Third and fourth, the association varied across attachment and
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psychopathic traits instruments. Fifth, if both attachment and psychopathic traits were

reported by the same informant, the association was stronger than when attachment and
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psychopathic traits were reported by different informants. Sixth, the association differed
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across sample setting, with the strongest association for a clinical setting followed by a
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secured setting and no association for both community or combined settings. No moderating
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effects were found for the attachment categories, attachment to whom and the informant of

attachment, publication year, and sample characteristics, such as gender, age, and sample size.
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We discuss the implications of our findings for future research and clinical practice.

Keywords: attachment to parents, psychopathic traits, multilevel meta-analysis

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ATTACHMENT PSYCHOPATHIC TRAITS 3

The Association between Attachment and Psychopathic traits

Nowadays, attachment theory and John Bowlby are inseparable (e.g., Craig, Gray, &

Snowden, 2013; MacDonald, Berlow, & Thomas, 2013; Mikulincer & Shaver, 2012; Savage,

2014). Development of attachment theory started during World War II, when he conducted

his first empirical study (Bowlby, 1944). In that study, Bowlby examined forty-four juvenile

thieves at the London Child Guidance Clinic. Through detailed examination, he was able to

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link their histories of maternal deprivation and separation to their symptoms. Fourteen of

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these thieves were described by Bowlby as affectionless, indicating that they lacked normal

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affection or warmth of feeling for anyone, shame or sense of responsibility. Bowlby

discovered that none of them had ever shown normal affection to anyone, and that they were
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unresponsive, solitary and undemonstrative. Many of their parents and foster parents

remembered that nothing they said or did to the children made any difference, because they
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responded neither to punishment nor to kindness. The children themselves all had a very

similar history of early separations from their (foster) mothers. Attachment theory was later
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conceived, among other factors, to explain the relation between lack of warm and continuous
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child care and an absence of concern for others (Bretherton, 1992).

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Almost at the same time, Hervey Cleckley was among the first to attempt to formalize a
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standard definition of psychopathy. Interestingly, unlike Bowlby he believed that

maltreatment and poor parenting were not causes of psychopathy, but Cleckley’s delineation
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of the psychopath was comparable to Bowlby’s description of the affectionless. In his book

“The Mask of Sanity”, Cleckley (1941; p. 24, 1988) described psychopathy as a disorder with

16 different characteristics, among which are “unresponsiveness in general interpersonal

relations”, and ”pathologic egocentricity and incapacity for love”. Despite the seemingly

opposite views of Bowlby and Cleckley about the role of a disruptive early environment in the
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ATTACHMENT PSYCHOPATHIC TRAITS 4

origins of both psychopathy and insecure attachment, decades ago both scholars assumed a

link between disturbed attachment relationships and psychopathy.

Attachment

Bowlby’s (1970) attachment-based theory is an environmental developmental theory.

This theory assumes that the etiology of psychopathy may be related to poor attachment

(Bailey & Shelton, 2014; Craig et al., 2013; Schimmenti et al., 2014). Attachment is a

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biologically-based developmental system that regulates proximity of the child to its

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caregiver(s) from infancy on. It serves to protect children from danger and to provide children

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with the opportunity to safely develop and explore their environment.

An influential taxonomy devised by Ainsworth (1978) distinguishes mutually exclusive

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attachment styles, based on observations of infant-caregiver behavior, the so called Strange

Situation Procedure (SSP). For instance, a consistently sensitive caregiver (sensitive to

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attachment behaviors of the child, e.g., crying) provides the child with a safe haven and a

secure base. In return, the child can explore the environment and seek comfort and contact
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with its caregiver in times of distress, a so-called secure attachment (Ainsworth, Blehar,
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Waters, & Wall, 1978). When caregivers are insensitive or inconsistently sensitive, they will
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not be perceived as a secure base and a safe haven. Their children are described as insecurely
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attached. Caregivers of anxious/resistant (C) attached children are thought to be unpredictable

in their response to their infant’s distress. They seem to be more attuned to their own needs
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than to their child‘s needs. Anxious/ resistant children seem unable to be comforted by their

caregiver in times of distress. On the contrary, avoidantly (A) attached children seem

indifferent or ignorant to their caregivers and do not seem to show any need of comfort. This

minimization of emotions seems to be a response to the consistent rejection by the parent. The

avoidant behavior allows the child to maintain sufficient proximity to the caregiver in times of

danger (Bartholomew & Horowitz, 1991).

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Some children behaved so inexplicably and contradictory during the SSP that the

observers were unable to classify the attachment pattern in one of the above categories.

Therefore, this kind of attachment is called disorganized (D) or disorientated attachment. It

has been hypothesized to be a result of frightening caregiver behaviors, such as maltreatment

(Cicchetti & Doyle, 2016; Guttmann-Steinmetz & Crowell, 2006). In addition to this four

categorical classification, Bartholomew and Horowitz (1991) developed a two dimensional

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(i.e., anxiety and avoidance) model, albeit still leading to the same four quadrants as

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mentioned above.

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The association between attachment difficulties and mental disorders in general is well

documented (Beeney et al., 2015; Cicchetti & Doyle, 2016; Bogaerts, Buschman, Kunst, &
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Winkel, 2010; Fearon, Bakermans- Kranenburg, Van IJzendoorn, Lapsey, & Roisman, 2010;

Mikulincer & Shaver, 2012; Timmerman & Emmelkamp, 2006). Meta-analyses confirm
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attachment insecurity to be related to internalizing disorders (Colonnesi et al., 2011; Groh,

Fearon, Van IJzendoorn, Bakermans-Kranenburg, & Roisman, 2016; MacDonald, Berlowb, &
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Thomas, 2013; Madigan, Atkinson, Laurin, & Benoit, 2013; Madigan, Brumariu, Villani,
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Atkinson, & Lyons-Ruth, 2016). Meta-analyses and reviews examining the relation between
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attachment and externalizing disorders show also an association (Fearon et al., 2010; Groh et
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al., 2017; Hoeve et al., 2012; Madigan et al., 2016; Savage, 2014; Schimmenti et al., 2014),

but not always as consistent as for internalizing disorders (Fearon & Belsky, 2011).
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Psychopathic traits

First of all, it is important to notice that there is a difference between psychopaths and

individuals with psychopathic traits. In the current study, psychopathic traits include

antisocial behavior, narcissism, impulsivity and callous-unemotional traits, based on the factor

analyses performed by Hare and colleagues (e.g., 2003). They concluded that the construct of

psychopathy consists of two main, partially independent, dimensions. One dimension includes
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the emotional and interpersonal traits, such as superficial charm (also called as narcissism),

lack of guilt and empathy, and affective deficits, the so-called callous-unemotional (CU)

traits. The other dimension captures impulsive and antisocial behavior (Dadds, Jambrak,

Pasalich, Hawes, & Brennan, 2011; Dadds & Salmon, 2003; Salekin, 2002). The concurrent

presence of both dimensions differentiates those with psychopathy from people suffering from

Antisocial Personality Disorder, which includes only the latter, and people with psychopathic

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traits but without antisocial behavior. Only individuals with psychopathic traits who also

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exhibit antisocial behavior are considered to be psychopaths (Blair, 2001; Farrington, 2005).

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Coid, Yang, Ullrich, Roberts and Hare (2009) found a prevalence of 29.2 % of people

exhibiting one or more psychopathic traits in a general population, whereas only 0.6% of their
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sample could be labeled as being a psychopath.

Furthermore, with regard to children and adolescents, the term psychopathy should
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always be substituted by “psychopathic traits”. Psychopathy implies a fixed and rigid

personality pattern, whereas children are still in the progress of character development (Kerig
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& Wenar, 2006). Therefore, in the present study, psychopathic traits comprise both overall
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psychopathy and the entire spectrum of these traits.

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Research on psychopathic traits has suggested a strong and robust link between
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juveniles exhibiting psychopathic traits and psychopathology, such as serious antisocial

behavior later in life (Asscher et al., 2011; Fite, Greening, & Stoppelbein, 2008; Fontaine,
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McCrory, Boivin,Moffitt, & Viding, 2011; Wilkinson, Waller, & Viding , 2016). This link

has stimulated a growing body of research examining causes and correlates of psychopathic

traits as early as possible in child development (e.g., Carlson. Oshri, & Kwon, 2015;

Christian, Meltzer, Thede, & Kosson, 2016).

Risk factors for psychopathic traits are diverse. Sometimes, the development of CU

traits is seen as a consequence of environmental risks, such as early maltreatment (Carlson et

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al., 2015; Daversa, 2010; Gao, Raine, Chan, Venables, & Mednick, 2010; Hicks et al., 2012;

Kimonis, Fanti, Isoma, & Donghue, 2013; Kolla et al., 2013), negative parental discipline

(Fontaine et al., 2011), low parental warmth (Bisby, Kimonis, & Goulter, 2017; Kimonis,

Cross, Howard, & Donoghue, 2012; Kroneman, Hipwell, Loeber, Koot, & Pardini, 2011),

parental indifference (Bailey & Shelton, 2014), insensitive parenting (Wagner, Mills-Koonce,

Willoughby, Zvara, & Cox, 2015), harsh parenting (Waller et al., 2012), emotional abuse

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(Schimmenti, Di Carlo, Passanisi, & Caretti, 2015), negative parenting (Waller, Gardner, &

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Hyde, 2013), or attachment difficulties (Fite et al., 2008; Frodi, Dernevik, Sepa, Philipson, &

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Bragesjö, 2001).

More in general, psychopathic traits are seen as a multicausal result of dispositional

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risks, such as genetics (Dadds, Moul, et al., 2014; Mann, Briley, Tucker-Drob, &Harden, 2015;

Tuvblad, Bezdjian, Raine, & Baker, 2014), because of the heritability of CU traits (Bezdjian,
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Raine, Baker, & Lynam,2011; Hicks et al., 2012; Larsson, Viding, & Plomin, 2008; Viding et

al., 2013) and maternal prenatal risks (Barker, Oliver, Viding, Salekin, & Maughan, 2011).
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Also neurological alterations of the amygdala and the surrounding structures (Beaver, Vaugh,
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DeLisi, Barnes, & Boutwell, 2012; Blair, Colledge, Murray, & Mitchell, 2001; Boccardi et
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al., 2011; Craig et al., 2009; Herpers, Scheepers, Bons, Buitelaar, & Rommelse, 2014), are
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mentioned as possible risk factors, for instance caused by early adverse parenting (Daversa,

2010), and leading to emotion recognition dysfunction, especially for the recognition of
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negative emotions of others (Bowen, Morgan, Moore, & Van Goozen, 2013). Subsequently,

the dispositional risks could explain the fact that the CU dimension of psychopathy has been

found to be fairly stable over time from infancy to adulthood (Andershed, 2010; Beaver et al.,

2012; Lynam et al., 2009 ). Furthermore, after early childhood, their effects persist regardless

of the quality of parenting (Beaver, Rowland, Schwartz, & Nedelec, 2011; Farrington, 2005;

Salekin & Lochman, 2008).

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The Association Between Attachment and Psychopathic traits

Although early theoretical literature on psychopathy holds a prominent position on

parent-child attachment, contemporary research on this theme is scarce. McCord and McCord

(1956) concluded that emotional deprivation, parental rejection, and lack of affection lead to

the development of a psychopathic personality in general and to the core affective deficits in

particular. Furthermore, Bowlby (1970) emphasized the importance of rejecting mothers and

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maternal deprivation for the development of psychopathic traits. Since then, several studies

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have documented an association between attachment and psychopathy and different potential

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explanations for this association have been put forward. For instance, delinquents high on

psychopathy report a childhood with separations, maltreatment, or abuse and are subsequently
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insecurely attached (Bailey & Shelton, 2014; Frodi et al., 2001; Schimmenti et al., 2014).

Their psychopathy is assumed to be caused by parent-driven attachment insecurity.

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Nevertheless, it could also be the other way around. Parent-child relationships, such as

attachment, develop as a result of complex interactions between parents and their children.
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CU traits are likely to impede these relationships with caregivers, so attachment difficulties
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could also be seen as child-driven (Larsson et al., 2008; Hawes, Dadds, Frost, & Hasking,
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2011). For example, researchers found that children with CU traits fail to attend to the eyes of
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attachment figures in general (Dadds, Allen, et al., 2014; Dadds et al., 2011), due to a

dysfunction in the neural systems necessary for emotional recognition (Blair, Peschardt,
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Budhani, Mitchell, & Pine, 2006; Bowen et al., 2013; Dawel, O’Kearney, McKone, &

Palermo, 2012), thus possibly impeding the attachment relationship.

Children with CU traits are seen as relatively fearless and insensitive to punishment

(Barker et al., 2011; Dadds & Salmon, 2003; Hawes, et al., 2011). Subsequently, these traits

pose a difficult parenting task: too gentle parenting will not be noted (Kochanska, 1995), and

increasing the amount of applied power will only promote resentment and anger, and external
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attributions for conduct problems (Dadds & Salmon, 2003; Kochanska, Barry, Stellern, &

O’Bleness, 2009). Both ways will not lead to internalization of rules nor stimulate conscience-

driven behavior and in all probability to the formation of an insecure attachment. Moreover,

children high on CU traits are found to be at increased risk for experiencing disruptions in

parent-child attachment (Pasalich, Dadds, Hawes, & Brennan, 2012). In line with these two

suppositions, Hawes and colleagues (2011) found a bidirectional effect for both CU traits and

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parenting. CU traits uniquely accounted for changes in inconsistent discipline, punishment,

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and parental involvement (e.g., also Larsson et al., 2008). Likewise, positive parenting,

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parental involvement and poor monitoring uniquely predicted change in CU traits.

Although scholars have suggested a link between attachment and psychopathy,

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primary studies on the relation between attachment difficulties and psychopathic traits have

resulted in inconsistent findings. For example, Fite and colleagues (2008) found a relation
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between attachment difficulties and CU and narcissistic traits. Some scholars have found

insecure attachment to be associated with only the affective factor of psychopathy (Catchpole,
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2009), or psychopathy in general (Mack, Hackney, & Pyle, 2011), whereas others concluded
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that they could not find any relation at all between attachment and psychopathy (Brennan &
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Shaver, 1998; Frodi et al., 2001; Holmqvist, 2008; Russell, 2004) or only for attachment to
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fathers, but not for attachment to mothers (Flight & Forth, 2007). Thus, the discussion about

the relation between attachment difficulties and psychopathic traits has not been resolved yet.
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The Present Meta-Analysis

Given the inconsistencies in findings regarding the attachment-psychopathic traits link,

a meta-analysis could shed light on this association and on potential explanations for the

variety in findings. However, apart from the literature reviews by Saltaris (2002), and Bailey

and Shelton (2014), a systematic review or meta-analysis that relates attachment specifically

to psychopathic traits has not been conducted yet. Several studies have found that the
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effectiveness of interventions is reduced for children with CU traits, when compared to

children with antisocial behavior, but without CU traits (e.g.,Wilkinson et al., 2016). It is thus

important to increase knowledge on important correlates of psychopathy, with the ultimate

aim to improve interventions that target both CU traits and antisocial behavior.

The main aim of the current meta-analysis was to examine the association between

psychopathic traits and attachment, and because the literature distinguishes between

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psychopathic traits and psychopathy, to shed light on this distinction and its clinical

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implications. A second aim was to examine moderators that might influence the relation

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between attachment and psychopathic traits. A meta-analysis is designed to reveal findings

upon which studies agree and eventually divest spurious findings (Dawel et al., 2012).
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Advantages of a meta-analysis are more reliable estimates of effect sizes and increased

statistical power. Because of the inconsistency in the literature about the role of attachment in
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the development of psychopathic traits and vice versa, we aim to disentangle patterns

underlying this association by performing moderator analyses.

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Method
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Sample of Studies
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We aimed to include all studies on the relation between attachment and psychopathic
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traits. The included studies were found in three consecutive steps. The only inclusion criterion

was that the study should describe an association between psychopathy or psychopathic traits
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and attachment to parents/caregivers. All sample types were included. The first step was to

search the database of Robert Hare. He has collected over 2000 studies that all focus on

psychopathy. The second step was a search through the computerized databases Web of

Science, PsycINFO, ERIC (Educational Resources Information Centre), Academic Search

Premier, and Google Scholar for articles, books, chapters, paper presentations, dissertations

and reviews. Combinations of the following key words were used: psychopathy, psychopathic
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traits, callous-unemotional and CU, cross-referenced with attachment. All found titles,

abstracts, and full-text articles were screened and excluded if they violated the inclusion

criterion. The literature search included all studies that were found until May, 2016. In the

third step, studies were located using the snowball method, that is, inspection of the reference

sections of the articles, the narrative reviews and book chapters. Finally, 15 studies met the

inclusion criterion that studies had to examine the association between attachment to

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parents/caregivers and psychopathy or psychopathy-alike disorders.

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On closer inspection, three studies had to be excluded: One study measured teenage

mothers’ (insecure) attachment to their own caregivers and CU traits in their children

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(Phillips, 2004). Barb (2007) compared two groups of juveniles, with psychopathy and
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attachment both as independent discrete variables, but did not report the association between

these variables. Schimmenti and colleagues (2014) investigated the relation between
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attachment and psychopathy, but reported only qualitative data.

Finally, we included 12 studies, based on 11 independent datasets, both published and

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unpublished, between 2001 and 2015, which examined 133 associations between attachment
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and psychopathic traits. Both longitudinal (k = 3) as well as cross-sectional (k = 9) studies

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were included, as were all kinds of different sample types, such as community samples,
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incarcerated juvenile offenders, adult and child treatment groups, juveniles in group homes, et

cetera. In total, data of 1,876 participants were analyzed in the present study. Sample sizes
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ranged from 14 (Frodi et al., 2001) to 957 (Buck, 2015) participants, with an average of 170

participants per dataset. The age of the participants ranged from age 0-48 with a mean age of

8.9 years. Table 1 presents the included studies and their main characteristics.

Coding of the Study Outcomes and Characteristics

Potential moderators of the association between attachment and psychopathic traits were

grouped into publication characteristics, sample characteristics, study characteristics and

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assessment characteristics. Publication year and impact factor of the journal in which the

study was published were included as publication characteristics. As sample characteristics

gender (males, females, or both), percentage of boys, sample setting (incarcerated, clinical,

community sample), and age at the first measurement were coded.

Study characteristics for the associations between psychopathic traits and attachment

included all reported associations between psychopathic traits and attachment scores. For

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attachment we reported overall attachment, attachment coded as a ratio between avoidance

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and anxiety or coding in the categories A, B, C and D. Attachment measurements were coded

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as categorical (e.g., secure or insecure) or continuous (more or less insecure). With whom the

attachment relationship had been measured was categorized as follows: with father, mother,
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or parents /caregivers. For psychopathy we reported overall psychopathy, CU traits,

narcissistic traits, impulsivity, and antisocial behavior. Important to mention here is that only
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some of the studies that used the different versions of the Psychopathy Checklist (e.g., the

PCL: Youth Version (PCL:YV; Forth, Kosson, &Hare, 2003), or PCL-Screening Version
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(PCL-SV; Hart, Cox, Hare, 1997)) included antisocial behavior in the construct of overall
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psychopathy. For the other instruments, overall psychopathy was composed of the scores on
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CU, narcissism and impulsivity.

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Assessment characteristics were coded as follows. The seven different attachment

instruments were coded: IPPA (Inventory of Parent and Peer Attachment; Armsden &
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Greenberg, 1987), AAI (Adolescent Attachment Interview or Adult Attachment Interview;

George, Kaplan, & Main, 1985) or other. See Table 1 for more information about the

measures. The eight different psychopathy instruments were coded: PCL (all versions),

Antisocial Process Screening Device (APSD; Frick & Hare, 2001), or other. The assessment

methods for attachment were coded as self-reported, parent reported or reported by clinicians.

For psychopathic traits, some studies used different sources for the measurement, such as an
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integration of self-reports, official data and observations, coded as a composite, next to self-

reports and parent/caregiver reports. Finally, we coded whether the same informants were

used to gain information on psychopathic traits and attachment (same informant bias).

To capture the information regarding possible moderators, a coding scheme was

developed. Possible moderators were coded by the first author according to this coding

scheme. In total, 38 % of the articles were randomly selected to be double coded both by the

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second and the third author to check for interrater reliability. The average intraclass

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correlation measuring correspondence between the coders was .95 on the coded variables. The

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lowest intraclass correlations between the three raters were for the variables attachment coded

as categories (ABCD) or dimensional, gender and sample setting; their values were .79, .87,
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and .87 respectively.

Analyses
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Publication bias. To test for publication bias, an Egger’s test was performed to

inspect whether the effect sizes were distributed symmetrically (Egger, Davey-Smith,
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Schneider, & Minder, 1997). Next, a trim and fill analysis was performed to investigate
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whether adding effect sizes to the right or the left side of the distribution influenced the mean
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estimate (e.g., underestimation or overestimation) of the overall effect size (Duval &
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Tweedie, 2000a, 2000b). These analyses were performed with a two-level random-effects

model.
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Overall effect size. To correct for dependency because of multiple effect sizes derived

from the same studies, a three-level random effects model was used for the analyses, so there

were three levels of variance (Field, 2001). The first level of variance was the sampling

variance around the estimated population effect size. The second level of variance was

between effect sizes within studies. The third level of variance was across effect sizes

between studies (Van den Noortgate, López-López, Marín-Martínez, & Sánchez-Meca, 2012).
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We applied the procedure and R script described by Wibbelink and Assink (2015). Parameters

were estimated using a Restricted Maximum Likelihood method. The first step was to

calculate an overall estimate of the effect size. Of this overall estimate it was investigated

whether the variances at level 2 (within studies) and level 3 (between studies) significantly

deviated from zero by performing two log-likelihood ratio tests, to compare whether

constraining either the level 2 or level 3 variance deteriorated model fit compared to the

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unconstrained model. Next, it was established which percentage of the total variance was

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accounted for at each level. In addition, a check for possible outliers of the Fischer z scores of

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the effect sizes was conducted, but no outliers were found so just all raw data were used.

Moderator analyses. Univariate moderator analyses were performed to investigate

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which moderators significantly influenced the association between attachment and

psychopathic traits. Furthermore, the best fit and likelihood of all possible 63 models was
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examined by checking the corrected AIC’s (Akaike Information Criterion) and the Akaike

weight (Anderson, 2007). The Akaike weight for a particular model can be regarded as the
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probability that that model is the best model (Viechtbauer, 2016). Of the final model, it was
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investigated whether the variance at level 2 and 3 significantly deviated from zero. Next, it
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was again established how much of the total variance was found at each level. Finally, it was
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calculated how much more of the proportion of variance was explained by adding moderators,

using the formulas of Cheung (2014). All analyses were performed in R with the metafor and
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the glmulti package (Viechtbauer, 2010, 2016).

Results

Overall Effect Size

The mean estimate of the overall effect size of the association between attachment and

psychopathic traits was .18 and significantly deviated from zero, SEz = .06, t(132) = 3.04, p <

.001, 95% CI = .06 - .31. This estimate indicated that there was a small-to-medium but
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ATTACHMENT PSYCHOPATHIC TRAITS 15

significant association. There was a significant amount of heterogeneity in the effect sizes not

accounted for by the model, Q(132) = 861.55, p < .001. The variance at level 2, or the

variance between effect sizes within studies, was .02. Setting this variance to zero

significantly improved model fit compared to the unconstrained model, χ2(1) = 216.57, p <

.001, indicating a significant amount of variance at level 2. The variance at level 3, or the

variance between effect sizes, was .03. Setting this variance to zero also significantly

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improved model fit compared to the unconstrained model, χ2(1) = 75.06, p < .001, indicating a

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significant amount of variance at level 3. Of the total variance, 19.98% was at level 1, 36.58%

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was at level 2, and 43.43% was at level 3. Because the residual heterogeneity was significant,

moderator analyses were performed to investigate which moderator significantly influenced

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the strength of the association between attachment and psychopathic traits.

Publication Bias
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The Egger’s test revealed that the distribution of the effect sizes was asymmetrical, z = -

3.67, p = .000. Performing a trim and fill analysis led to adding effect sizes on the right side
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of the distribution. The effect size after the trim and fill analysis (z = 0.22) was further away
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from zero than the effect size before the trim and fill analysis (z = 0.14), thereby posing no
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threat for possible overestimation. Figure 1 displays the original funnel plot of the effect sizes,
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whereas Figure 2 displays the funnel plot after the trim and fill procedure, therefore

visualizing how the distribution of the effect sizes would be if it was symmetrical.
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Moderator Analysis

The QM statistics for whether a moderator was significant and the QE statistics for the

residual heterogeneity of the discrete moderators are displayed in Table 2. The following

moderators were not significant: year of publication, impact factor, gender, percentage of

boys, age, sample size, attachment categories, attachment scale, attachment to whom and

attachment reported by whom. The moderators which psychopathic trait, psychopathic traits
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reported by whom, attachment instrument, psychopathy instrument, sample setting and same

informant bias were significant. Coefficients for the significant univariate moderators are

displayed in Table 3.

The Final Model

Due to the fact that we found six significant moderators, with 63 possible combinations,

we used an information-theoretic approach to select the best fitting model (Anderson, 2007).

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The “best” model (the model with the lowest AICc, -124.49, and the highest Akaike weight,

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0.87) turned out to be a multivariate model, including all six significant univariate moderators

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(sample setting, psychopathic traits, attachment instrument, psychopathy instruments,

psychopathy reported by whom and informer bias). Effects of all moderators remained
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significant, QM (14) = 9.15, p <.001. A significant amount of residual heterogeneity remained

not accounted for by the model, QE(118)= 201.69, p <.001. Level-2 variance of the final
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model was .01. Setting this variance to zero significantly deteriorated model fit, χ2(16) =

43.52, p < .001, indicating that the level-2 variance significantly deviated from zero. Level-3
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variance was .01. Setting this variance to zero did not deteriorate model fit, χ2(16) =.89, p =
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.346, indicating that the variance did not deviate from zero. Of the total variance, 42.59% was
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at level 1, 23.89% was at level 2, and 33.52% was at level 3. Compared to the model without
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the moderators, at level 1 there was an increase of 22.60% in variance explained by the final

model. However, a decrease of 12.69% in variance at level 2, and a decrease of 9.91% in

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variance were explained by the final model. According to Cheung (2014), these negative

values should be truncated to zero, indicating that adding the moderators did not explain more

of the variance between studies or between effect sizes.

Discussion

The purpose of the present meta-analysis was to investigate the strength of the

association between attachment and psychopathic traits. In addition, we tested whether

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moderators influenced the strength of this association. The present study is, to our knowledge,

the first secondary analysis to focus on the association between these constructs. On the basis

of theoretical models (e.g., Farrington, 2005; Saltaris, 2002), we expected that psychopathy

would be associated with attachment. However, on the basis of the literature no prior

hypotheses could be formulated regarding the association between specific psychopathic traits

and attachment categories and the effects of potential moderators. Therefore, the current study

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was mainly explorative.

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Overall, we found a significant association between attachment and psychopathic traits

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of .18, meaning that psychopathy in general and attachment are weakly related to each other,

following the criteria of Cohen (1992) about the interpretation of the magnitude of effect
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sizes. However, examining the different categories of psychopathic traits, significant

differences in the attachment-psychopathic traits link were found; the strongest link was
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found for CU traits, followed by psychopathy in general, while nonsignificant links were

found for narcissism, antisocial behavior, and impulsivity. This suggests that those with CU
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traits in particular were more likely to have insecure attachments. This finding is in line with
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prior research, in which CU traits were seen as the most impeding psychopathic trait for
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interpersonal relationships in general (Larsson et al., 2008; O’Connor et al., 2016). Moreover,
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the heritability of CU traits is strong (Bedzjian et al., 2011; Larsson et al., 2008), meaning that

children with CU traits are more likely to have parents with CU traits, thus the forming of a
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secure attachment may be impeded by both parents and offspring (Dadds, Allen et al., 2014).

Further, we found that the attachment-psychopathic traits association was dependent on

the setting. Moderate to large associations were found in clinical and secure setting, but no

significant effects sizes were found when a study did combine two different settings, such as a

forensic and a mental health clinic (e.g., Catchpole, 2009; Frodi et al., 2001). Also, for the

community samples we did not find any significant effect. An explanation may be that
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psychopathy (e.g, Coid, et al., 2009) and CU traits (e.g., Rowe, Maughan, Moran, Ford,

Briskman, & Goodman, 2010) are relatively rare in general population samples. Samples in

clinical or justice settings may therefore be more suitable to investigate psychopathy or

psychopathic traits in relation to important correlates, such as attachment (in)security.

Furthermore, we found various significant differences in effect sizes related to the

method of measurement of either psychopathic traits or attachment. Regarding the attachment

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instrument, a medium effect size was found when the scores on the IPPA were reported, and

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no effect was found for any other attachment instrument. Possibly, this could be due to the

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fact that the IPPA measures the overall strength of attachment compared to for instance the

AAI, which focuses more specifically on the different attachment categories. Moreover, the
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IPPA and the BSQ (Behavioral Systems Questionnaire) were the only questionnaires

compared to the interviews and observations used for the other attachment assessments.
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Likewise, for the psychopathy instruments, a medium to large effect size was found for

the APSD, and nonsignificant effect sizes were found for the other instruments. The APSD
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was an adaptation of the PCL- which was based on the PCL-R for adults (Patrick, 2005,
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p.396), and aimed to be more sensitive to the developmental stage of children and
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adolescents, but in contrast to PCL-versions, the APSD captured only the CU, narcissistic and
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impulsive traits, and not antisocial behavior. This could be in line with the finding that the

only significant effect size was found for CU traits, and not for narcissistic, impulsive or
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antisocial traits. The fact that most of the parent-reported instruments included only CU traits,

might explain that the only significant effect size found across informants was for parent-

reported psychopathic traits (i.e., not self-reports and composites of different sources), might

also be in line with the largest effect size found for CU. Finally, stronger associations between

insecure attachment and psychopathic traits were found for studies relying on the same

informant reporting on both attachment and psychopathic traits than for studies using data
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from different informants. At least partly this may be explained by common method variance

(see e.g., Podsakoff, MacKenzie, Lee, & Podsakoff, 2003).

We did not find any differences between attachment categories, suggesting that the

associations between psychopathic traits and secure attachment on the one hand, and the

various types of insecure attachment, including avoidant, anxious/resistant, and disorganized

attachment on the other hand, are similar. Nevertheless, because of the low number of studies

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that met our inclusion criteria, these results need to be interpreted with caution. Furthermore,

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the association between attachment and psychopathic traits was also independent of

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participant characteristics, as this association was similar across gender and age groups. This

former finding is in line with the literature (e.g., Blanchard & Lyons, 2016), and the latter
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finding could be ascribed to the high genetic component of CU traits, and thus a small

contribution of environmental exposure to individual differences (e.g., Larsson et al., 2008).

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Likewise, we did not find differences between to whom the attachment was reported,

suggesting that attachment to mothers as well as to fathers seems to be about equally

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associated with psychopathic traits. This particular finding may possibly be explained by the
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fact that only six of the twelve included studies reported separate father and mother scores on
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attachment. A moderating effect may be expected, because research did show differences
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between mothers and fathers for the association between CU traits in boys and impaired eye

contact with their attachment figures. This impairment in eye contact was associated with
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psychopathic traits in their fathers, whereas the mothers did not show any impairments, and

the quality of their attachment-behaviors was independent of the level of eye contact of their

sons (Dadds et al., 2011; Dadds, Allen et al., 2014). Subsequently, attachment with mothers

would be less impeded and therefore would show a weaker correlation with psychopathic

traits. Nevertheless, the lack of an effect of this moderator could be due to the number of

studies, and therefore should be interpreted with caution and needs further investigation.
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Strengths, Limitations and Recommendations

Although an abundance of theoretical studies seem to consider the association between

attachment and psychopathy as self-evident, even without any exclusion criteria, we did find

only 12 studies based on empirical findings that met our criteria for the current meta-analysis.

To our knowledge, the current study is the first to investigate this relation at a meta-analytic

level. Due to the correlational nature of this study, we cannot make statements about a causal

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relation between attachment and psychopathy. Given the limitations of the present study,

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which is based on only 12 studies, more research on the role of attachment in the development

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of psychopathy and the different traits in particular, but also on the role of psychopathic traits

in the development of attachment insecurity is recommended. Furthermore, although the

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moderators did not increase the explained variance in the strength of the association between

attachment and psychopathic traits, with the significant moderators explaining a unique
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proportion of the variance of effect sizes, the present study yielded implications for future

research on this topic.

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Despite these limitations, a strength is that this study has found evidence for the
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association between attachment and psychopathy, and more particular the association between
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attachment and CU traits. Therefore, it is recommended to prospectively and longitudinally

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study the association between attachment and the different psychopathic traits, with the aim to

obtain a more refined picture of the options and (im)possibilities of intervention and treatment
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methods. However, it should be emphasized that the changeability of psychopathic traits

seems to be highly dependent on age, therefore stressing the importance of early interventions

(Högström, Enebrink, & Ghaderi, 2013; Hyde et al., 2013; Ribeiro da Silva, Rijo, & Salekin,

2013; Savage, 2014, Waller Gardner, & Hyde, 2013) and the need for interventions to be

tailored specifically for youth high on CU traits, regardless of any comorbid behavioral
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difficulties (Högström et al., 2013; Hyde et al., 2013; Manders, Deković, Asscher, Van der

Laan, & Prins, 2013; McDonald, Dodson, Rosenfield, & Jouriles, 2011).

Future perspectives Two attachment related lines of research may be relevant when

implementing the findings of the current meta-analysis into interventions. First, the findings

of research showing that attention to fearful faces predicts attachment security (Peltola,

Forssman, Puura, Van IJzendoorn, & Leppänen, 2015), linked with the finding that CU traits

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are seen as a consequence of the inability to recognize fearful faces (e.g., Dadds et al., 2006),

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as a result of an impairment in attention to the eye region (Dadds et al., 2011), resulted in

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Emotion Recognition Training (ERT). For children with high levels of CU traits, ERT and not

TAU produced significant improvements in conduct problems and affective empathy. So ERT
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could be used as an intervention for children with high CU-traits, although the change

associated with ERT seemed not to occur through improvements in emotion recognition, but
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by increasing overall attention to socially relevant cues (Dadds, Cauchi, Wimalaweera,

Hawes, & Brennan, 2012).

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The second recommended line of inquiry based on the found association between CU
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traits and attachment is more pharmacogenetically orientated. Oxytocin, a hormone known for
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its role in bonding between parents and their offspring (Buchheim et al., 2009; Liu, McErlean,
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& Dadds, 2012; Strathearn, 2011; Strathearn, Fonagy, Amico, & Montague, 2009; Swain et

al., 2014), might also be involved in the development of psychopathy. Variations in oxytocin
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receptors and/or oxytocin blood levels were found to be associated with CU-traits (Beitchman

et al, 2012; Dadds, Moul, et al., 2014). Furthermore, administration of oxytocin to adults

(Guastella, Mitchell, & Dadds, 2008), fathers (Weisman, Zagoory-Sharon, & Feldman, 2014)

or children (Guastella et al., 2010) showed to increase not only their focus on the eye region

of the face and therefore their emotion recognition (Guastella et al., 2010), but also the quality

of the parent-child social behaviors such as positive affect (Weisman et al., 2014). So both
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interventions (attention to the eye region/emotion recognition and the administration of

oxytocin) seem to have in common that they both target not only the CU-trait but also

ameliorate insecure attachment, and therefore should be thoroughly investigated.

In addition, from a prevention perspective, it is of utmost importance to further

examine the associations between CU traits and different attachment categories, given the

possible protective function of secure attachment in the development of psychopathic traits.

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For example, secure attachment priming resulted in more attachment security and less

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psychopathy (Allen, 2015). Additionally, research findings indicate that formation of a more

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secure attachment, although complicated by the insensitivity of the child, could serve as a

protective factor for a child with callous-unemotional traits (Kochanska, 1995; Nakash-
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Eisikovits et al., 2002). Albeit the association between attachment and psychopathic traits in

particular turned out to be weak, more investigation in the correlations between psychopathic
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traits and other constructs concerning parental behavior, such as parental bonding (Blanchard

& Lyons, 2016; Craig et al., 2013), positive parenting (Hawes et al., 2011) or parental warmth
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(Bisby et al., 2017; Kimonis et al., 2013) is highly recommended in general, and more
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specifically for treatment possibilities, given the devastating effects psychopathic traits can
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have on both individuals with psychopathic traits themselves, but also their environment.
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Conclusion
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Although this study provides insight into the strength of the association between

attachment and psychopathic traits, it does not –nor did it intend to– provide insight in what

comes first, attachment difficulties or psychopathic traits. So, the apparent paradox between

Bowlby (1944), who stated that psychopathy should be seen as a result of a bad early

environment, and Cleckley (1941), who thought that bad parenting could not be the regular

cause, still exists. However, this study has demonstrated that there is an association between

attachment and psychopathic traits. It might be that both Cleckley and Bowlby were right
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about the nascence of psychopathy and that it only depends on where the starting point for

any assessment is put. Nonetheless, children with neurological alterations due to genetic

factors and/or early childhood experiences do form a specific parenting challenge, and are

therefore at a greater risk for a distorted relationship with their caregivers. It is therefore

recommendable to treat psychopathic traits by improving attachment with parents, especially

in younger children.

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Tables

Table 1 Overview of included studies (k =12)

Authors N % male mean Instrument Instrument Sample type (setting)
age attachment (informant
(to whom) psychopathy)
Asscher et 243 72 16.0 IPPA: Self-report APSD (Self- Serious juvenile
al., 2010 and parent reported or parent/ delinquents (boys and
reported caregivers girls sample) in MST-

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(parentsa) reported) group (clinical)
Buck, 2015 957 unknown 15,0 BSQ: Self-report: Combination YPTI Adolescents from the
secure attachment & WAI (Self- NICHD Study of Early

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(parents) report ) Child Care and Youth

SC
Development
(community)
Catchpole, 109 50 15.4 AAI: Semi- PCL:YV ( Semi- Adolescents (boys and
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2009 structured structured girls sample) for
interview: interview and a assessment of severe
adolescent review of collateral behavioral problems in
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version (primary information) forensic and mental health

b
caregiver ) clinic (combination)
Flight & 42 100 17.1 IPPA: Self-report PCL:YV (Semi- Incarcerated adolescents
D

Forth, 2007 (mother, fathera ) structured serving dispositions for

violent offences
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interview and a
review of files) (incarcerated).
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Frodi et al., 14 100 34.0 AAI: Semi- PCL:SV ( trained Incarcerated, 10 violent
2001 structured assessor, structured index offence, 4 drug-
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interview interview and files) related Swedish forensic

b
(parents ) psychiatry unit or at a
medium security prison
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(combination)
Isaak, 2012 110 58 15.4 CAPAI: PCL-YV High risk adolescents (boy
Interview (integration of & girl sample) in forensic
c
(mother ) self-reports, and mental health setting

collateral sources (combination). Same

and direct sample set as described by

observation) Catchpole, 2009.

Kochanska 100 50 5.5 SSP Observation, ICU (parent Two-parent families of

b
et al., 2009 (mother, father ) ratings) normally developing
infants (community)
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Kosson eal., 114 100 14.5 IPPA: Self-report PCL:YV; Adjudicated delinquent
2009 (parentsa) (Composite of self- adolescents
report, observation supervised by court
and collateral counselors/ in short-term
sources) detention centre
(combination)
Mazzarello, 42 0 23.4 AAP: analysis of APSD –CU (Self- Adolescent mothers at
2007 narratives report) Montreal children’s

(parentsb) Hospital (community)

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Pasalich et 55 100 6.3 MCAST: Story SDQ & APSD Boys referred to
al. 2012 stem completion pooled ( Mother, university psychology

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task (motherb) father and teacher clinic for assessment and
report) treatment of conduct

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problems (clinical)
Smith, 2011 60 50 15.7 IPPA Self-report ICU (Self-report) High-risk young offenders
a
(father, mother ) serving custodial services
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in a Secure Training
Centre (incarcerated)
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Willoughby 149 50 3.0 SSP: Caregiver, ASEBA Children with

b
et al., 2014 parent (mother ) (caregivers) disorganized attachment
(community)
Note: = overall strength of attachment, = categorical measure of attachment, c
a b
D

=dimensional measure of attachment, IPPA = Inventory of Parent and Peer Attachment, BSQ
E

= Behavioral Systems Questionnaire, AAI = Adolescent Attachment Interview (Catchpole,

PT

2009) or Adult Attachment Interview (Frodi et al., 2001), CAPAI= Comprehensive

Adolescent-Parent Attachment Inventory, SSP = Strange Situation Procedure (Kochanska et
CE

al., 2009) or Strange Situation Paradigm (Willoughby et al., 2014), AAP = Adult Attachment
Projective, MCAST = Manchester Child Attachment Story Task, APSD = Antisocial Process
AC

Screening Device, YPTI= Youth Psychopathic Traits Inventory, WAI= Weinberger

Adjustment Inventory, PCL:YV = Psychopathy Checklist: Youth Version, PCL: SV =
Psychopathy Checklist: Screening version, ICU =Inventory of Callous-Unemotional Traits,
SDQ = Strengths and Difficulties Questionnaire, ASEBA = Achenbach System
of Empirically Based Assessment.
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Table 2 The QM statistics for whether a moderator was significant and the QE statistics for the

residual heterogeneity of the moderators.

QM (df) p QE (df) p

Publication characteristics

Year of publication 3.57 (1) .062 264.69 (99) < .001

Impact factor 0.05 (1) .822 168.49 (20) < .001

PT
Sample characteristics

RI
Gender 0.54 (2) .586 771.98 (130) < .001

SC
Percentage boys 0.05 (1) .816 645.38 (129) < .001

Age 0.68 (1) .410 826.24 (131) < .001

NU
Sample setting 5.36 (3) .002 462.56 (129) < .001

Study characteristics
MA

Attachment categories 0.94 (6) .468 675.26 (126) < .001

Attachment to whom 1.68 (2) .190 811.69 (130) < .001

D

Psychopathic traits 2.46 (4) .049 769.10 (128) < .001

E

Assessment characteristics
PT

Attachment scale 0.29 (1) .593 744.39 (131) < .001

CE

Attachment instrument 3.74 (2) .026 477.12 (130) < .001

Psychopathy instrument 5.96(2) .003 472.35 (130) < .001

AC

Attachment reported by whom 1.63 (1) .201 692.92(131) < .001

Psychopathic traits reported by whom 28.04(2) < .001 645.80 (130) < .001

Informant bias 5.01 (1) .027 859.46 (131) < .001

Sample size 1.66 (1) .200 817.83 (131) < .001

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Table 3 Coefficients for the univariate moderator analyses

Psychopathic traits.

#studies #ES ESz SE t 95% CI p ρ

Overall 6 28 .17 .07 2.41 0.031 0.311 .017 .17

psychopathy

CU 10 38 .23 .06 3.57 0.102 0.356 < .001 .23

PT
Narcissism 4 26 .08 .07 1.17 -0.059 0.230 .245 .08

RI
Impulsivity 5 27 .11 .07 1.60 -0.027 0.255 .113 .11

SC
Antisocial 2 14 .14 .08 1.62 -0.027 0.255 .106 .13
NU
Psychopathic traits reported by whom.

#studies #ES ESz SE t 95% CI p ρ

MA

Self-reported 4 21 .07 .11 .58 -0.160 0.291 .566 .07

Parents/caregivers 3 23 .44 .12 3.79 0.209 0.665 <.001 .41

D

Composite 6 89 .14 .13 1.05 -0.121 0.395 .296 .14

E
PT

Psychopathy instruments.
CE

#studies #ES ESz SE t 95% CI p ρ

PCL* 5 88 .09 .07 1.39 -0.039 - 0.222 .168 .09

AC

APSD 2 33 .45 .09 5.06 0.273 - 0.624 <.001 .42

Other 5 12 .11 .07 1.65 -0.023 - 0.248 .102 .11

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ATTACHMENT PSYCHOPATHIC TRAITS 46

Table 3 Coefficients for the univariate moderator analyses (continuation)

Attachment instruments.

#studies #ES ESz SE t 95% CI p ρ

IPPA 4 45 .32 .07 4.52 0.177 - 0.454 < .001 .31

AAI 2 61 .11 .07 1.51 -0.034 - 0.252 .113 .11

PT
Other 6 27 .06 .06 0.97 -0.064 - 0.187 .333 .06

RI
SC
Sample setting

#studies #ES ESz SE t 95% CI p ρ

NU
Community 3 10 .09 .07 1.35 -0.044 - 0.231 .180 .09

Clinical 3 33 .40 .07 5.56 0.258 - 0.543 < .001 .38

MA

Incarcerated 3 12 .23 .08 2.78 0.066 - 0.391 .006 .22

Combination 3 78 .03 .07 0.48 -0.101 - 0.165 .632 .00

E D
PT

Informant bias

#studies #ES ESz SE t 95% CI p ρ

CE

Same informant 6 91 .23 .07 3.44 0.097 - 0.359 < .001 .22

Different 7 42 .14 .07 2.09 0.007 - 0.271 .039 .14

AC

informant
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ATTACHMENT PSYCHOPATHIC TRAITS 47

Figure 1.

Funnel plot with Fisher’s z transformed correlations. On the y-axis are the standard

errors of the studies, with smaller standard errors representing larger sample sizes. On the x-

axis are the associations between attachment and psychopathy.

PT
RI
SC
NU
MA
E D
PT
CE
AC
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ATTACHMENT PSYCHOPATHIC TRAITS 48

Figure 2

Funnel plot of the effect sizes. On the y-axis are the inverses of the standard errors, on the x-

axis the observed effect sizes.

PT
RI
SC
NU
MA
E D
PT
CE
AC

Figure 2 displays the funnel plot after the trim and fill analysis. It visualizes how the

distribution of the effect sizes would be if it was symmetrical. The black dots represent the

effect sizes, the white dots represent the imputed effect sizes. As is visible in Figure 2, all the

imputed effect sizes are on the right side of the distribution.

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ATTACHMENT PSYCHOPATHIC TRAITS 49

Highlights: The association between attachment and psychopathic traits

(AVB_2018_37)

 As a whole, psychopathic traits were positively related to insecure attachment

 Of these traits, only callous-unemotional traits showed a relation with

attachment

PT
 Only in clinical and secured settings this relation was present

 Solely parent- and caregiver reports on psychopathic traits showed this

RI
relation

SC
NU
MA
E D
PT
CE
AC