Bartholomew, K., & Horowitz, L. (1991) | References

What This Research Found

Kim Bartholomew and Leonard Horowitz's 1991 paper fundamentally reshaped how researchers and clinicians understand adult attachment. Published in the Journal of Personality and Social Psychology and cited over 5,000 times, this work established the four-category model of adult attachment that remains dominant in relationship psychology today.

The two-dimensional framework: Bartholomew and Horowitz proposed that adult attachment can be understood through two underlying dimensions. The self-model dimension reflects how positively or negatively you view yourself—whether you feel worthy of love and attention. The other-model dimension reflects how positively or negatively you view others—whether you expect them to be available, responsive, and trustworthy. These dimensions can also be understood as anxiety (self-model) and avoidance (other-model).

The four attachment styles: By crossing these two dimensions, the researchers identified four prototypic attachment patterns:

Secure attachment (positive self, positive other): These individuals feel worthy of love and expect others to be responsive. They are comfortable with intimacy and autonomy, can depend on others without losing themselves, and maintain balanced, stable relationships.
Preoccupied attachment (negative self, positive other): These individuals doubt their own worth but view others positively—leading to desperate pursuit of approval and validation. They experience intense anxiety about abandonment, become preoccupied with relationships, and often appear "needy" or "clingy." Their sense of self depends heavily on others' acceptance.
Dismissing-avoidant attachment (positive self, negative other): These individuals maintain positive self-regard by devaluing the importance of close relationships. They appear self-sufficient, minimize attachment needs, and may seem emotionally distant. They protect themselves by convincing themselves they don't need others—a pattern that can shade into covert narcissism in its more extreme forms.
Fearful-avoidant attachment (negative self, negative other): These individuals experience the most conflicted attachment pattern. They want intimacy but fear it; they doubt their own worth while also distrusting others. This creates approach-avoidance cycles and often produces the most pervasive relationship difficulties, including vulnerability to trauma bonding.

The key innovation: Before this research, adult attachment was typically measured using Hazan and Shaver's three-category system adapted from infant research. Bartholomew and Horowitz's crucial insight was recognising that "avoidant" attachment actually encompasses two distinct patterns with very different dynamics. Dismissing individuals avoid closeness while maintaining self-esteem; fearful individuals avoid closeness because they expect rejection and believe they don't deserve love. This distinction has profound clinical implications—these two groups need very different therapeutic approaches.

Interpersonal problems map onto attachment styles: The research demonstrated that each attachment style predicts specific patterns of interpersonal difficulties. Secure individuals showed the fewest problems. Preoccupied individuals reported problems with being too dependent, too caring, and too self-sacrificing. Dismissing individuals had problems with being cold, competitive, and introverted. Fearful individuals showed the most pervasive difficulties across multiple domains—problems with both closeness and distance, intimacy and isolation.

Consistency across relationships: Study 2 extended these findings to examine attachment in both family and peer contexts. The results showed that attachment patterns operate similarly across different relationship types, and that family and peer attachment are correlated—your attachment to your family of origin predicts your attachment patterns in friendships and romantic relationships.

How This Research Is Used in the Book

Bartholomew and Horowitz's four-category model provides essential framework throughout Narcissus and the Child for understanding how narcissistic parenting shapes children's relationship patterns. In the Glossary entry on Attachment, the book explicitly presents the four-category model:

"The four attachment styles are secure (trusts others, feels worthy of love), anxious/preoccupied (craves closeness but fears abandonment), avoidant/dismissive (suppresses attachment needs, values independence), and disorganised/fearful (wants closeness but fears it, creating chaotic relationship patterns)."

In Chapter 11: Neurological Contagion, Bartholomew's framework helps explain how narcissistic relationships modify attachment styles. The chapter discusses how prolonged exposure to narcissistic abuse can shift a person from secure attachment to insecure patterns:

"A person who entered the relationship with secure attachment may emerge with anxious attachment—hyperactivated attachment circuitry that monitors and cannot tolerate separation. Or they may emerge with avoidant attachment—deactivated circuitry that suppresses attachment needs to avoid further pain."

The book draws on Bartholomew's model to explain the fearful-avoidant pattern so common among children of narcissists—wanting intimacy desperately while being terrified of it, having learned that reaching for connection brings pain yet still needing that connection for survival.

In Chapter 12: The Unseen Child, the four-category model illuminates intergenerational transmission. The narcissistic parent's own attachment insecurity—often dismissing-avoidant, with its characteristic emotional unavailability and devaluation of intimacy—shapes the child's developing attachment system:

"The parent's attachment style shapes how they interact with their infant, which literally sculpts the infant's developing brain. The narcissistic parent's emotional unavailability creates disorganised attachment patterns in the child's neural networks—patterns that become templates for all future relationships."

Why This Matters for Survivors

If you were raised by a narcissistic parent, Bartholomew and Horowitz's research provides a precise map of how your early experiences shaped your relationship patterns—and why those patterns, while painful, made adaptive sense.

Your attachment style was an adaptation, not a defect. Children develop attachment patterns that are functional responses to their caregiving environment. If your narcissistic parent was emotionally unavailable, you may have learned to suppress your attachment needs (dismissing pattern) because expressing them brought rejection or criticism. If your parent was inconsistent—sometimes attentive, sometimes cold—you may have developed hypervigilant monitoring of their moods and desperate attempts to maintain connection (preoccupied pattern). If your parent was simultaneously the source of comfort and the source of fear, you may have developed the approach-avoidance of fearful attachment. These weren't mistakes; they were the best available strategies for the environment you faced.

The fearful-avoidant pattern is especially common among survivors. Bartholomew's research illuminates why many children of narcissists develop this most painful attachment style. Your narcissistic parent taught you that intimacy is both necessary and dangerous. You needed their love to survive, but reaching for it often brought pain—criticism, rejection, conditional acceptance, or unpredictable responses. Your nervous system encoded both lessons: "I desperately need closeness" and "closeness brings pain." The result is the push-pull dynamic of fearful attachment: wanting love while being terrified of it.

Your self-model may carry their distortion. Bartholomew's framework distinguishes between your view of yourself and your view of others. Children of narcissistic parents often develop negative self-models—believing they are fundamentally unworthy of love—because they internalised their parent's treatment. When your parent treated you as an extension of themselves, devalued your independent thoughts and feelings, or made love conditional on meeting their needs, you learned that your authentic self wasn't acceptable. This isn't the truth about you; it's the imprint of their pathology on your developing psyche.

Understanding your pattern is the first step toward changing it. The power of Bartholomew's model is that it identifies specific dimensions—self-model and other-model—that can be targeted in healing. If you have a negative self-model, therapeutic work on self-worth and self-compassion becomes essential. If you have a negative other-model, gradually learning to trust through consistent, safe relationships is the path forward. The four-category model isn't a life sentence; it's a diagnostic tool that points toward what needs to heal.

Clinical Implications

For psychiatrists, psychologists, and trauma-informed clinicians, Bartholomew and Horowitz's research has direct implications for assessment and treatment of survivors of narcissistic abuse.

Assessment should identify the specific attachment pattern. Bartholomew's model suggests that treatment needs differ based on attachment style. Preoccupied patients need help developing a more stable sense of self that doesn't depend on others' validation—reducing the hyperactivation of their attachment system. Dismissing patients need help reconnecting with suppressed attachment needs and learning to value intimacy. Fearful patients need work on both dimensions—building self-worth while gradually learning to trust. The Relationship Questionnaire (RQ) and Experiences in Close Relationships (ECR) scale can help assess patterns, but clinical observation of how the patient relates in therapy often provides the richest data.

The therapeutic relationship must be calibrated to attachment style. Preoccupied patients may quickly become intensely attached to the therapist, requiring careful boundaries while maintaining warmth. They may seek excessive reassurance, become distressed by separations (vacations, cancelled sessions), or attempt to extend the relationship beyond professional bounds—patterns resembling codependency. Dismissing patients may minimise the importance of therapy, avoid emotional material, and seem uninvested—this is protective avoidance, not resistance to be confronted. Fearful patients may oscillate unpredictably between engagement and withdrawal, testing whether the therapist can tolerate their ambivalence. Each pattern requires different therapeutic positioning.

Earned security is the goal, not just insight. Bartholomew's framework suggests that attachment patterns exist on continuous dimensions that can shift. The goal of therapy isn't just understanding your attachment style intellectually—it's having corrective relational experiences that gradually update your internal working models. This requires a therapeutic relationship that provides what was missing: consistent availability, emotional attunement, repair of inevitable ruptures, and tolerance of the patient's attachment patterns without abandonment or retaliation. The therapist becomes a secure base from which the patient can explore their patterns and experiment with new ways of relating.

Consider the link between attachment and personality pathology. Bartholomew's dismissing-avoidant pattern—with its positive self-model achieved through devaluing others—shares features with narcissistic personality disorder. Research suggests that grandiose narcissism may represent an extreme form of dismissing attachment. Fearful-avoidant attachment, meanwhile, is strongly associated with borderline personality features. Understanding attachment patterns helps clinicians see personality disorders not as mysterious pathology but as extreme versions of recognisable attachment strategies developed in response to early relational trauma.

Pharmacological considerations are secondary but relevant. While attachment patterns are primarily relational, pharmacology may facilitate therapeutic work. For preoccupied patients with intense attachment anxiety, SSRIs or SNRIs may reduce baseline anxiety enough to tolerate the work of developing more stable self-regard. For fearful patients with complex PTSD features, addressing trauma-related symptoms may create conditions more conducive to attachment work. Medication cannot change attachment style directly, but it can create a neurobiological environment where relational learning becomes more possible.

Broader Implications

Bartholomew and Horowitz's research extends far beyond individual therapy to illuminate patterns across relationships, families, and society.

The Intergenerational Transmission of Attachment Patterns

Attachment patterns transmit across generations primarily through caregiving behaviour, creating patterns of intergenerational trauma. A parent with dismissing attachment may be emotionally unavailable to their children, producing anxious or fearful attachment in the next generation. A parent with preoccupied attachment may be inconsistently available—intensely present when their own attachment anxiety is activated, absent when it's not—producing similar inconsistency in their children's internal working models. Narcissistic parents, often operating from dismissing attachment with suppressed but powerful attachment needs, create particularly damaging conditions: the child experiences a parent who is simultaneously unavailable and demanding, who requires the child to meet the parent's attachment needs while dismissing the child's. Understanding this transmission mechanism suggests intervention points: treating parental attachment issues, providing parent-child therapy, and ensuring children have access to at least one secure attachment figure who can buffer against parental insecurity.

Relationship Patterns in Adulthood

Bartholomew's model explains why certain relationship dynamics repeat across survivors' lives. The preoccupied individual, hungry for validation, may be particularly vulnerable to the initial idealisation phase of narcissistic relationships—the love-bombing feels like the unconditional acceptance they've always craved. The fearful individual, expecting both connection and pain, may find the push-pull dynamic of narcissistic relationships paradoxically familiar. The dismissing individual may be drawn to narcissistic partners who don't demand emotional intimacy, or may themselves develop narcissistic patterns as an extreme form of their avoidant strategy. Understanding these dynamics helps survivors recognise why they're attracted to certain partners and consciously choose differently.

Workplace and Organisational Dynamics

Attachment patterns don't disappear at the office door. Preoccupied individuals may become excessively anxious about supervisors' approval, reading rejection into neutral feedback and becoming distressed by normal professional distance. Dismissing individuals may struggle with collaborative work, mentorship, and any role requiring emotional attunement to others. Fearful individuals may have difficulty in hierarchical relationships that trigger early experiences of unpredictable authority figures, potentially experiencing dissociation or freeze responses when attachment patterns are activated. Organisations benefit from understanding that some employees' seemingly excessive reactions to feedback, change, or authority reflect attachment patterns shaped long before they joined the company. Trauma-informed management practices can prevent inadvertently triggering attachment wounds.

Romantic Partner Selection and Mismatch

Bartholomew's model illuminates why certain pairings are particularly problematic. The preoccupied-dismissing pairing is notoriously unstable: the preoccupied partner's pursuit triggers the dismissing partner's withdrawal, which intensifies the preoccupied partner's anxiety in a escalating cycle. Narcissists (often dismissing) paired with partners who become preoccupied create textbook trauma bonds—the inconsistent availability perfectly conditions anxious attachment. Understanding these dynamics helps survivors recognise destructive patterns and consciously seek partners whose attachment styles are compatible with developing security.

Legal and Custody Considerations

Family courts making custody decisions increasingly recognise that parental attachment patterns affect children's wellbeing. A parent with dismissing attachment may provide material care while failing to meet the child's emotional needs, a pattern that can amount to emotional neglect within coercive control dynamics. A parent with preoccupied attachment may burden the child with the parent's emotional needs rather than attending to the child's. Bartholomew's framework provides a conceptual tool for understanding why some parents struggle with emotional availability even without overt abuse. Custody evaluations that assess parental attachment patterns—not just behaviour during evaluation sessions—can better predict the relational environment children will experience.

Public Health and Prevention

Bartholomew's research, combined with other attachment work, suggests that promoting secure attachment could be one of the highest-return public health investments. Programs that help parents understand and modify their attachment patterns, that support parent-child attunement, and that ensure children have access to at least one secure attachment figure—providing protective factors—could prevent the downstream consequences of insecure attachment: relationship difficulties, mental health problems, adverse childhood experiences, and transmission to the next generation. The return on investment, measured in reduced therapy costs, relationship dysfunction, and intergenerational trauma transmission, would likely be substantial.

Limitations and Considerations

Bartholomew and Horowitz's influential work has important limitations that inform how we apply it.

Categories versus dimensions. The four-category model, while clinically useful, may oversimplify continuous variation. Bartholomew herself noted that attachment exists on two continuous dimensions, with the four categories representing prototypes rather than discrete types. Many individuals fall between categories or shift between them depending on relationship context. Clinicians should use the categories as heuristics while recognising that individual presentations are more varied.

Self-report limitations. The research relied substantially on self-report measures, which may not capture attachment patterns accurately. Dismissing individuals, by definition, minimise attachment concerns and may report being more secure than their behaviour suggests. The Adult Attachment Interview (AAI), which assesses attachment through narrative analysis rather than self-report, often identifies insecurity that self-report misses. Clinical assessment should complement self-report with observation of actual relational behaviour.

Cultural considerations. The research was conducted primarily with Western, predominantly white, middle-class samples. Attachment theory makes universal claims about human nature, but how attachment is expressed and what constitutes "secure" relating may vary across cultures. Parenting practices normative in one culture might be classified as avoidant or intrusive by researchers trained in another. Cross-cultural research continues to explore how the model applies across different cultural contexts.

The stability question. How stable are attachment patterns over time? Research suggests moderate stability with meaningful change possible, but the conditions under which attachment shifts—and how much therapeutic intervention can facilitate that shift—remain active areas of investigation. Clinicians should neither treat attachment as fixed destiny nor assume it changes easily.

Overlap with other constructs. The attachment dimensions overlap with other personality constructs—particularly neuroticism (related to anxiety/self-model) and introversion-extraversion (related to avoidance/other-model). This raises questions about whether attachment represents a distinct system or is simply personality by another name. Most researchers maintain that attachment captures something specific about close relationship functioning, but the boundaries with general personality remain debated.

Historical Context

Bartholomew and Horowitz's 1991 paper appeared at a pivotal moment in attachment research. John Bowlby had established attachment theory in his three-volume Attachment and Loss series (1969-1980), proposing that attachment is a biologically-based behavioural system shaping development across the lifespan. Mary Ainsworth's Strange Situation research in the 1970s identified three infant attachment patterns: secure, avoidant, and anxious-resistant.

The challenge was extending these concepts to adults. Cindy Hazan and Phillip Shaver published their influential 1987 paper adapting Ainsworth's three categories for adult romantic attachment. But researchers noted problems: the "avoidant" category seemed to contain heterogeneous individuals with different underlying dynamics.

Bartholomew, completing her PhD at Stanford under Horowitz's mentorship, recognised that avoidant attachment actually encompassed two distinct patterns. The dismissing type maintains positive self-regard by devaluing intimacy—they appear self-sufficient and genuinely seem unbothered by relationship distance. The fearful type wants intimacy but fears it—they have negative views of both self and others, leading to anxious approach-avoidance rather than the calm distance of dismissing individuals.

This insight drew on earlier theoretical work. Bowlby had proposed that attachment involves internal working models of both self and others. Main and colleagues, developing the Adult Attachment Interview, identified "dismissing" adults who maintained attachment avoidance while speaking positively of parents, and "preoccupied" adults who were enmeshed in attachment concerns. Bartholomew's innovation was crossing the self-model and other-model dimensions to generate four categories that captured these clinical distinctions.

The 1991 paper validated this model through systematic research—developing interview measures, examining interpersonal problems associated with each style, and demonstrating consistency across family and peer relationships. The work was immediately influential, cited over 5,000 times and becoming the standard framework for adult attachment research. Subsequent researchers have refined and extended the model, developing improved self-report measures like the Experiences in Close Relationships scale, but Bartholomew's fundamental insight—that attachment involves separate evaluations of self and other—remains central to how the field conceptualises adult attachment.

Attachment Styles Among Young Adults: A Test of a Four-Category Model

APA Citation