Abstract
Background and aim
The present study stems from the need to deepen knowledge regarding understanding the psychological mechanisms underlying Love Addiction (LA) and investigate the role of attachment style as a theoretical framework. We conducted a systematic review of the literature and a meta-analysis of the investigated topics to achieve this objective.
Method
Five databases (PsycINFO, PsycARTICLES, MEDLINE, Scopus, and Web of Science) systematically searched for studies that analyzed the relationship between LA and attachment dimensions, published in all years until September 23, 2024.
Results
Overall, we found 27 studies; of these, we included 15 in the meta-analysis, with 3,628 participants. The analyses were conducted using the test of heterogeneity, effect dispersion, and moderator analysis (gender, age, research continent, quality of the studies, and types of attachment instruments). A significant and positive relationship (r = 0.39, p < 0 .05) was observed between Love Addiction and anxious attachment, while a significant and negative relationship was found with avoidant attachment (r = −0.09, p < 0.05).
Conclusions
The systematic review and meta-analysis provide an important starting point for understanding and operationalizing the construct. The association with attachment styles allows postulating the relational nature of Love Addiction, differentiating it from other addictions. In addition, the association with anxious and avoidant attachment shows promise in understanding Love Addict subtypes.
Introduction
In the second half of the 1970s, researchers introduced the construct of Love Addiction (LA) into psychological literature (Peele & Brodsky, 1975). Over the years, several authors have contributed to understanding the construct under investigation, establishing different strands of research. While some authors suggest the introduction of LA within behavioral addictions (Costa, Ingrassia, Barberis, Griffiths, & Benedetto, 2021), other authors emphasize the emotional and relational facets of LA, differentiating it from other addictions (Cavalli, Ilarg, Tacchino, & Velotti, 2024; Redcay & McMahon, 2021).
Consequently, although this construct gained the attention of clinicians several decades ago, the scientific community has still not reached a consensus regarding the definition and operationalization of LA. Despite the ongoing debate, the literature recognizes some characteristics of Love Addiction, such as a form of obsessive love towards one or more partners; pervasive and unhealthy beliefs, feelings, and behaviors characterize it. The relationship becomes the over-riding priority, impacting other life areas such as hobbies, work, and friendships (Amor et al., 2022; Earp, Wudarczyk, Foddy, & Savulescu, 2017) and resulting in a lack of control that persists despite the negative consequences (Redcay & Simonetti, 2018; Reynaud, Karila, Blecha, & Benyamina, 2010; Sanches & John, 2018; Sussman, 2010).
One issue is the difficulty of defining a boundary between pathological and healthy love. For instance, Fisher, Xu, Aron, and Brown (2016) argued that love would be a natural addiction, given that the experience of love is associated with the activation of the reward system, a group of neural structures that are also activated in cocaine addiction and are responsible for positive emotions (Schultz, 2015). Nevertheless, researchers attempted to identify specific features that differentiate healthy from pathological love. One of the proposed criteria is the pervasiveness of the love addict's behaviors and feelings (Redcay & Simonetti, 2018). The addiction model proposed by Griffiths (2005) has also been considered a valuable perspective for understanding LA. This author identified six components that characterized addictions (salience, tolerance, mood modification, relapse, abstinence, and conflict), allowing us to understand better and identify several behavioral addictions, including LA (Costa et al., 2021). Since the inclusion of addictions not related to substances in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5; APA, 2013), there has been a burgeoning of proposals identifying new behavioral addictions, mainly associated with excessive involvement in a specific activity and the presence of the symptoms listed above (Billieux, Schimmenti, Khazaal, Maurage, & Heeren, 2015).
However, according to Billieux et al. (2015), care should be taken to avoid the risk of pathologizing every human experience in a reductive manner, which may lead to overlooking some central features of single disorders and psychological mechanisms involved in the onset and maintenance of the disorder. Following this perspective, to reach a definition of LA, it seems necessary to identify the psychopathological mechanisms that differentiate between healthy and pathological experiences of love. The debate surrounding the field of behavioral addiction and the possibility of identifying addictive behaviors in potential everyday behaviors provide interesting indications for the examination of Love Addiction. According to authors, the possibility of identifying a behavioral addiction would be advanced by the presence of large-scale epidemiological studies and high-quality studies, including neuroimaging evidence (Griffiths, 2022), as well as by considering functional impairment, clinical relevance, and theoretical embedding (Brand et al., 2020). Regarding this last point, as clearly emphasized by Bőthe, Koós, and Demetrovics (2022), there are many relevant implications of considering some conditions as addictions; these include an impact on research directions, assessment of comorbid conditions, and the development of clinical and policy interventions targeting problematic behavior. In their review, Brand et al. (2024), expand the findings of Bőthe et al. (2022), emphasizing the public health implications of undiagnosed and untreated behavioral addictions. Moreover, Brand and Potenza (2023) provided a helpful direction for investigation, recommending that researchers evaluate alternative models for explaining problematic behaviors. In other words, researchers should not limit themselves to examining these behaviors through the lens of addiction theory. However, they should also pay attention to the specificity of these behaviors, potentially adopting concurrent or complementary conceptualizations.
From this perspective, the conceptualization of LA within an addiction framework struggles to account fully for some specific aspects of this condition. Hence, it is important to develop a complementary model to the model proposed by Griffiths (2005) to understand the mechanisms underlying LA comprehensively. The first description of LA (Peele & Brodsky, 1975) emphasized its independence from other addictions. Indeed, a specific feature of LA, which is not primary in other behavioral addictions, is the role of psychological processes involved in relational functioning. The relationship with the beloved one is essential for love addicts. Sanches and John (2018) suggest that a central process involves gradually increasing dependency on the romantic partner until this person becomes necessary for the individual's well-being. The actual or imagined possibility of losing the significant other is associated with despair, depression, anxiety, and persistent attempts to restore the relationship (Sanches & John, 2018). The addiction model doesn't fully explain the core of the relationship in LA, highlighting the need for integration with other perspectives.
Another question related to the definition of LA concerns the discrimination of different subtypes. Whereas clinical descriptions of LA include several configurations, stressing the disorder's potential heterogeneity, existing criteria (Griffiths, 2005) fail to capture this variety. For example, the diagnosis of “love addicts” could be applied to individuals who quickly fall in love with a different partner as soon as the euphoric/passion phase of the relationship ends, but also to individuals unable to break up maladaptive relationships and individuals depending excessively on their partner (Briggie & Briggie, 2015; Peabody, 2005). Relying on the criterion of “salience” proposed in the addiction model, information about these different subtypes is not captured; instead, focusing on “salience” addresses the degree to which feelings, thoughts, and behaviors are oriented toward the partner (Costa et al., 2021; Griffiths, 2005). Indeed, such a focus fails to discriminate against the object of addiction in LA. While one individual might be addicted to a specific partner, another might be addicted to the feelings associated with romantic relationships, regardless of who the partner is. Therefore, an alternative perspective on LA must be able to explain the heterogeneity of this condition and identify its subtypes.
Lastly, another conceptual issue concerns the partial overlap of this condition with other psychopathological disorders, such as borderline personality disorder (BPD). Authors (Briggie & Briggie, 2015; Sanches & John, 2018) argued that the differential diagnosis of BPD is determined by whether the disorder is pervasive in all areas of the individual's life or only in the relational area. Other researchers have stated that love addicts experience fear of abandonment and act to prevent it, analogously to individuals who suffer from BPD (Briggie & Briggie, 2015; Sussman, 2010). From this point of view, conceptualizing LA exclusively within the addiction model may not account for potential shared processes underlying the overlap between LA and other disorders.
Overall, these conceptual issues stress the need for a complementary perspective to understand the LA construct.
Attachment framework, relationships, and psychopathology
Attachment theory is a helpful framework for the understanding of both romantic relationships and mental disorders, including addictions (Cataudella, Rogier, Beomonte Zobel, & Velotti, 2022; D'Arienzo et al., 2019; Estévez, Macía, Momeñe, & Etxaburu, 2022; Velotti, Castellano, Canevelli, & Bruno, 2014). Bowlby (1969) postulated a motivational system that regulates distance from significant others during stressful events. The theory states that beginning in early childhood and based on the history of interactions with caregiver/s, individuals develop strategies directed to regulating discomfort associated with the perception of threats. These experiences gradually become internalized into specific patterns, or mental representations about the self and others, through which individuals perceive the world (Bowlby, 1988).
Positive representations of self (as deserving of love and support) and others (as willing and able to provide support) reflect secure attachment. Attachment security is associated with resilience, confidence in one's ability to adapt and cope with stressful situations, adaptive emotion regulation strategies, and seeking support from others in distress (Mikulincer & Shaver, 2019). In contrast, negative representation of self (as unworthy of love) and/or a negative representation of others (unreliable or inconsistent) characterize insecurely attached. In this perspective, insecurity involves the lack of trust in one's ability to cope with adverse situations and/or in the availability of others to provide support in the case of distress (Gillath, Selcuk, & Shaver, 2008; Velotti, Castellano, & Zavattini, 2011). Specifically, unhealthy dependency and negative expectations regarding the availability of significant others characterize anxious attachment. In contrast, avoidant attachment involves distrust of others and an extreme sense of independence and self-reliance (Mikulincer & Shaver, 2019).
Extending Bowlby's (1980) and Ainsworth's (1978) contributions, which focused on attachments in childhood, Hazan and Shaver (1987) studied the processes involving the attachment system in romantic relationships. Anxiously attached partners experience fear of abandonment, excessive need for reassurance, and preoccupation about attachment figures' availability. They implement hyperactivating strategies to guarantee the partner's proximity (Barbaro, Pham, Shackelford, & Zeigler-Hill, 2016; Garofalo, Velotti, & Zavattini, 2016; Mikulincer, Shaver, & Pereg, 2003; Mikulincer & Shaver, 2013). Specifically, in romantic relationships, these strategies involve continuous attempts to monitor and control the partner and persistent demands for affection, approval, and reassurance (Feeney & Noller, 1990; Mende, Scott, Garvey, & Bolton, 2018). On the other hand, fear of intimacy, rejection by others, and the extreme need for self-sufficiency characterize avoidantly attached partners. Deactivation strategies are employed to ward off attachment needs (Coppola, Gangamma, Kawar, Patton, & Ramadoss, 2021; Mikulincer & Shaver, 2019); these strategies, may be expressed as reduced interest and commitment to the relationship, emotional distancing, and negative beliefs about the existence and duration of romantic love (Mende et al., 2018). Following the work of Hazan and Shaver (1987), Bartholomew and Horowitz (1991) proposed a four-category model of adult attachment, defined by the combinations of representation of self (positive or negative) and of others (positive or negative). The secure category includes positive representations of both self and others. The preoccupied category involves a negative representation of self and a positive representation of others; conversely, the dismissing category involves a positive representation of self and a negative representation of others. Finally, negative representations of self and others define the fearful category, analogous to disorganized attachment.
A considerable body of literature indicates that insecure attachment is associated with dysfunctional emotion regulation and interpersonal strategies (Castellano, 2014; Mikulincer & Shaver, 2013, 2019). These strategies have also been conceptualized as ways to deal with the activation of the attachment system. When stressors activate this system, secure individuals seek proximity to caring for others. In contrast, insecure individuals react to stress with hyperactivating or deactivating strategies of affective regulation (Main, 1990; Shaver & Mikulincer, 2014). Hyperactivating strategies include repeated and exaggerated attempts to ensure the closeness of the caregiver, whereas deactivating strategies involve denial and suppression of attachment needs to avoid distress due to the anticipation of rejection from significant others (Coppola et al., 2021; Mikulincer et al., 2003; Mikulincer & Shaver, 2019). Persistent implementation of hyperactivating and deactivating strategies increased vulnerability to psychopathology (Herstell et al., 2021; Mikulincer & Shaver, 2012; Schindler, 2019). Studies have highlighted the relationship between insecure attachment and depression (Conradi, Kamphuis, & de Jonge, 2018; Dagan, Facompré, & Bernard, 2018), anxiety (Huang et al., 2019; Manning, Dickson, Palmier-Claus, Cunliffe, & Tay-lor, 2017), suicide (Aaltonen et al., 2016; Zortea, Gray, & O’Connor, 2021) and eating disorders (Klein et al., 2022). Overall, many studies have revealed the utility of attachment dynamics in understanding relational functioning and psychopathology, highlighting the importance of considering the mutual interplay between these two areas (Johnson & Whiffen, 2003).
Conceptualizing love addiction as an attachment disorder
As noted above, the idea that the attachment framework is a valuable perspective for conceptualizing addiction is not new. Several studies investigated the role of insecure attachment in behavioral addictions such as internet addiction (Ceyhan, Boysan, & Kadak, 2019; D'Arienzo et al., 2019), gambling disorder (Di Trani, Renzi, Vari, Zavattini, & Solano, 2017; Keough, Penniston, Vilhena-Churchill, Michael Bagby, & Quilty, 2018; Pace, Schimmenti, Zappulla, & Di Maggio, 2013), smartphone addiction (Parent, Bond, & Shapka, 2021) and sex addiction (Kircaburun, Ünübol, Sayar, Carkci, & Griffiths, 2021; Kotera & Rhodes, 2019). Moreover, Flores (2004) defined addictive behavior as an attachment disorder, considering addiction as a “manifestation of unmet developmental needs” (Flores, 2004, p. 83). Attachment theory provides a well-established framework for understanding the romantic dynamics that are the core of LA. Indeed, researchers have highlighted an association between attachment security and satisfaction in romantic relationships (Conradi, Noordhof, & Kamphuis, 2021; Fitzpatrick & Lafontaine, 2017; Mikulincer & Shaver, 2016). A recent meta-analysis conducted by Candel and Turliuc (2019) supported an earlier review by Li and Chan (2012), highlighting a positive correlation between anxious attachment and high levels of conflict in romantic relationships and negative correlations between avoidant attachment and positive relationship indices, such as satisfaction, support, and connection.
Further, the attachment perspective may help to address the gap mentioned above related to the issue of identifying LA subtypes. The hyperactivating pattern that characterizes anxious attachment mirrors the description of a love-addicted craving for a romantic partner and the constant seeking of reassurance regarding the relationship. In contrast, the description of the “explorer” subtype (Fisher, 2017), which focuses on individuals who are addicted to romantic passion but fail to establish longer-lasting romantic relationships, fits with the description of the avoidant attachment style, which involves high levels of sensation-seeking and reported difficulty in maintaining romantic relationships over time (Fisher, 2017; Umemura, Lacinová, Kotrčová, & Fraley, 2017).
Lastly, attachment theory may offer valuable insights into the psychopathological processes underlying the co-occurrence of BPD and LA. Indeed, BPD is theorized to stem from insecure attachment, a notion supported by empirical support (Choi-Kain, Fitzmaurice, Zanarini, Laverdière, & Gunderson, 2009; Smith & South, 2020). Therefore, attachment insecurity might explain the frequent co-occurrence between LA and BPD.
In conclusion, the attachment framework is a promising perspective for conceptualizing LA and can be integrated with Griffiths' model (2005) to address several conceptual issues. These include neglect of the relational component involved in LA, the heterogeneity of LA, and the co-occurrence of LA with other psychiatric conditions.
The present study
Based on the gaps pointed out from previous literature and the promising framework of attachment theory, this study aims to offer a better understanding of the psychological and psychopathological mechanisms underlying LA, starting from a systematic review of the empirical literature. The goal is to identify and analyze all studies that have associated LA and attachment, assessing the scientific evidence supporting the assumption of attachment's key role in LA. Analysis of contributions that highlighted the link between attachment and LA is a first step in developing a complementary model to the addiction one (Griffiths, 2005), able to explain the core features of the construct, including its subtypes. Specifically, we developed the following hypotheses:
A significant and positive association will be found between LA and anxious attachment, reflecting the similarity between the classic subtype of LA and anxious attachment (e.g., fear of abandonment, continuous demand for reassurance, and need for approval (Briggie & Briggie, 2015; Mikulincer & Shaver, 2013);
A significant and negative association will be found between LA and avoidant attachment, considering that strong independence, emotional distancing, and difficulties in maintaining lasting romantic relationships characterize avoidant individuals, as noted in the “explorer” subtype of LA (Fisher, 2017; Mende et al., 2018; Mikulincer & Shaver, 2019; Umemura et al., 2017).
Method
A systematic search on LA was conducted following PRISMA guidelines (Moher, Liberati, Tetzlaff, Altman, & PRISMA Group, 2010). The entire study selection procedure is shown in the flowchart (Fig. 1). Of note is that the flowchart illustrates the process of a broader systematic search on the topic of LA. The study was registered on PROSPERO (CRD42022349824-08-12-2022).
Flow diagram of identification and selection of included studies
Citation: Journal of Behavioral Addictions 2025; 10.1556/2006.2025.00031
Eligibility criteria
We adopted selection criteria following the PICOS framework to provide a comprehensive overview of the existing literature on the construct of LA and attachment theory (Schardt, Adams, Owens, Keitz, & Fontelo, 2007). We included research that (1) assessed the relationship between LA and insecure attachment dimensions, providing the effect size (ES) data, or (2) that reported ES by comparing the severity of LA between individuals with insecure attachment. When data on the relationship between LA and attachment were lacking, the study's corresponding author was contacted to request additional information. No studies were excluded from the systematic review and meta-analysis due to sample characteristics, quantitative research design, or data (published and unpublished originals).
Search strategy
Systematic research was conducted in the following databases: PsycINFO, PsycARTICLES, MEDLINE, Web Of Science, and Scopus, including all years until September 23, 2024. The present study is part of a broader search on the construct of Love Addiction, so the keywords used in the search filter belong to the LA category (Appendix A). Subsequently, we selected articles that investigated attachment theory and LA. Moreover, to identify additional studies eligible for meta-analysis, the gray literature was searched (Conn, Valentine, Cooper, & Rantz, 2003), (1) interrogating the Google Scholar database (first 200 results), and (2) screening the reference lists of the articles included in the meta-analysis.
Study selection
Two researchers (blind for review) independently searched the systematic literature using the abovementioned databases. A total of 11,178 records were found with the initial search terms. After removing duplicates, 7,883 records were screened for eligibility based on title and abstracts, identifying 543 full-text articles. After further examination of the full-text, the researchers selected 27 studies that analyzed the relationship between LA and attachment. Figure 1 illustrates the entire process.
Data extraction process and management
Data extraction and coding were carried out according to the following protocol: (1) research characteristics (authors, year, continent of research, publication status, quality assessment); (2) sample characteristics (size, gender, average age, sample status); (3) characteristics of the methodology (cross-sectional or longitudinal; instruments used to assess LA and attachment); (4) main results (statistical index, value, and effect size). Moreover, the study examined moderator variables that might explain the relationship between LA and insecure attachment dimensions. Specifically, gender, age, continent, study quality, and attachment instrument were analyzed as moderators. All were tested if there were at least 10 studies to ensure sufficient power for the analyses (Higgins et al., 2019). Regarding categorical moderators, the reference category was selected according to the most frequent value in the dataset. As a result, the following moderators were examined in the meta-analysis:
Gender, coded as the percentage of males in the sample;
Age, coded in years;
Continents, coded in two categories: 1 = Europe and 2 = Not Europe;
The methodological quality of the studies; see below;
The type of instrument used to measure attachment is coded in two categories: 1 = RQ and 2 = others.
Assessment of methodological quality
Considering that the research included in the meta-analysis adopted a cross-sectional research design, we used the Newcastle-Ottawa scale (Wells et al., 2000) to assess the quality of the studies. Three dimensions were assessed for each study: selection (representativeness of the sample, sample size, non-respondents, ascertainment of the exposure), comparability, and outcome (assessment of the outcome and statistical test). Two authors (blind for review) made independent quality ratings. When disagreements emerged, a third author (blind for review) was consulted.
Statistical analyses
Meta-analysis was performed using the software Comprehensive Meta-Analysis (version 3). The ESs were computed as Person's r. In studies in which effect size was reported as the difference between two groups, the statistical index was transformed into Pearson's r coefficient. According to Gignac and Szodorai's (2016) standards, ESs were read as small (0.15), medium (0.25) or large (0.35). Lastly, the correlations were transformed into Fisher's Z coefficients to test prediction intervals.
Statistical treatment of interdependency of observations
A frequent concern that has emerged among meta-analytic researchers is related to the impact of interdependency between observations on the estimation of effect sizes. Because some of the extracted data used in this meta-analysis were collected from the same sample of participants, a three-level meta-analysis approach was adopted (Cheung, 2015). This approach allows us to estimate a meta-analytic model that considers the clustering role of the variable that creates dependency among observations and to compare its fit to a two-level model. Results of the variance analysis comparing the goodness of fit of these two models provide indications of a better statistical approach, with a statistically significant result suggesting the need to account for the clustering variable in estimating effect sizes. These preliminary operations were performed with the metafor package of the Rstudio software for Mac (Viechtbauer, 2015).
Computation of ESs
A random-effects model was adopted to calculate the effect size. This choice is most appropriate when the sample is significantly heterogeneous, allowing the possibility of making unconditional inferences about the population (In Cooper, Hedges, & Valentine, 1994).
Publication bias
The publication bias was tested using the linear regression method of Egger, Smith, Schneider, and Minder (1997) and the “trim and fill” method of Duval and Tweedie (2000) to check the overestimation of the mean effect size. This method provides an estimate of missing studies, identifying and correcting the funnel plot asymmetry caused by publication bias (Duval, 2005).
Results
27 articles that investigated the relationship between LA and insecure attachment were examined (see Table 1). These studies were published over a period from 1990 to 2024. Twenty studies analyzed the association between LA and the anxiety and avoidance dimensions of attachment. Of these, nine investigated the relationship between fearful attachment and LA, and only two between LA and disorganization. Six examined the relationship between LA and insecure attachment-related dimensions: being goal-oriented outside the romantic relationship (“Relationships as secondary”) and feeling discomfort in depending on the other (“Discomfort with Closeness”) typical of avoidant attachment and being oriented to other's judgments (“Need for Approval”) and toward relationship (“Preoccupation with Relationships”) distinctive of anxious attachment. Lastly, only one contribution focused on LA and attachment insecurity without distinguishing between types of insecurity. Most of the studies (77%) were conducted on community populations, one (7.4%) on a mixed sample (including both clinical and community individuals), one (4.3%) on a clinical sample, and the remaining three (11%) compared men who committed intimate partner violence (IPV) and men who did not. A meta-analysis assessed the relationship between LA and insecure attachment styles. Studies providing observations insufficient to perform meta-analyses were included in the systematic review. The results obtained from the systematic review are shown first, followed by the meta-analytic results (see Table 1). Overall, 21 contributions were included in the qualitative synthesis.
Studies (N = 27) investigating the relationship between love addiction and attachment dimensions included in the systematic review and meta-analysis
| Author (year) | Design | Sample | Love addiction measure | Attachment measure | Quality assessment | r | ||
| N | Age | % males | ||||||
| Anxiety | ||||||||
| *Ahmadi, Davoudi, Ghazaei, Mardani, and Seifi (2013) | Cross-sectional | 290 | – | 59.6 | PSL | AAI | 6 | 0.26 |
| *Alonso-Arbiol et al. (2002) | Cross-sectional | 602 | 20.6 | 51.6 | IDI emotional reliance on another person subscale | ECR | 6 | 0.64 |
| *Alonso-Arbiol et al. (2002) | Cross-sectional | 602 | 20.6 | 51.6 | IDI emotional reliance on another person subscale | RQ | 6 | 0.40 |
| *Cavalli et al. (2024) | Cross-sectional | 72 | 30.36 (9.72) | 30.6 | LAI | ECR-SF | 7 | 0.62 |
| **Feeney and Noller (1990) | Cross-sectional | 374 | – | 43.3 | 13 item from criteria of Peele and Brodsky (1975) and items adapted from Cowan and Kinder (1985) | AAQ | 5 | – |
| *Gerstner et al. (2019) | Cross-sectional | 500 | – | 40 | Adaption of Escala de adicción al amor | CaMir | 8 | 0.36 |
| *Gori, Russo, and Topino (2023) | Cross-sectional | 300 | 37.83 (12.93) | 20 | LAI | RQ | 7 | 0.20 |
| **Holtzworth-Munroe et al. (1997) | Cross-sectional | 33 | – | 100 | SSDS SF | RQ | 7 | – |
| *Honari and Saremi (2015) | Cross-sectional | 306 | 28.7 (4.30) | 0 | LAS | AAQ | 6 | 0.25 |
| *Mangialavori and Cacioppo (2022) | Cross-sectional | 291 | 31.8 | 0 | LAS mania subscale | RQ | 6 | 0.32 |
| *Mangialavori and Cacioppo (2022) | Cross-sectional | 104 | 32.8 | 100 | LAS mania subscale | RQ | 6 | 0.47 |
| *Momeñe and Estévez (2018) | Cross-sectional | 269 | 28.34 (10.15) | 23 | IRIDS-100 | CaMir | 5 | 0.40 |
| *Ramos Mejìa (2016) | Cross-sectional | 157 | 29.23 (6.45) | 28.7 | CDE | Tipos de apego romanticos | 4 | 0.22 |
| *Retana Franco and Sánchez Aragón (2008) | Cross-sectional | 176 | 29.15 | 50 | Escala de adicción al amor | RQ | 5 | 0.20 |
| **Rocha et al. (2019) | Cross-sectional | 500 | 23.75 | 34.20 | CDE | IPPA-M | 5 | – |
| *Salani et al., (2022) | Cross-sectional | 344 | 40.85 | 0 | – | RQ | 6 | 0.35 |
| **Stravogiannis et al. (2018) | Cross-sectional | 65 | 39.49 | – | LAS | AAQ | 8 | – |
| **Valle and Moral (2017) | Cross-sectional | 382 | 24.5 (1.97) | 45 | IRIDS-100 | Cuestionario de apego adulto | 7 | – |
| *Wigman et al. (2008) | Cross-sectional | 177 | 22 (7.39) | 28.2 | IDI | RQ | 7 | 0.41 |
| *Yárnoz-Yaben (2010) | Cross-sectional | 40 | 45.5 (10.1) | 45 | IDI | RQ | 6 | 0.66 |
| Avoidance | ||||||||
| *Ahmadi et al. (2013) | Cross-sectional | 290 | – | 59.6 | PLS | AAI | 6 | 0.04 |
| *Alonso-Arbiol et al. (2002) | Cross-sectional | 602 | 20.6 | 51.6 | IDI emotional reliance on another person subscale | ECR | 6 | −0.02 |
| *Alonso-Arbiol et al. (2002) | Cross-sectional | 602 | 20.6 | 51.6 | IDI emotional reliance on another person subscale | RQ | 6 | −0.22 |
| *Cavalli et al. (2024) | Cross-sectional | 72 | 30.36 (9.72) | 30.6 | LAI | ECR-SF | 7 | 0.09 |
| **Feeney and Noller (1990) | Cross-sectional | 374 | – | 43.3 | 13 item from criteria of Peele and Brodsky (1975) | AAQ | 5 | – |
| *Gerstner et al. (2019) | Cross-sectional | 500 | – | 40 | Adaption of Escala de adicción al amor | CaMir | 8 | 0.24 |
| *Gori et al. (2023) | Cross-sectional | 300 | 37.83 (12.93) | 20 | LAI | RQ | 7 | −0.10 |
| **Holtzworth-Munroe et al. (1997) | Cross-sectional | 33 | – | 100 | SSDS SF | RQ | 7 | – |
| *Honari and Saremi (2015) | Cross-sectional | 306 | 28.7 (4.30) | 0 | LAS | AAQ | 6 | 0.12 |
| *Mangialavori and Cacioppo (2022) | Cross-sectional | 291 | 31.8 | 0 | LAS mania subscale | RQ | 6 | −0.09 |
| *Mangialavori and Cacioppo (2022) | Cross-sectional | 104 | 32.8 | 100 | LAS mania subscale | RQ | 6 | −0.03 |
| *Momeñe and Estévez (2018) | Cross-sectional | 269 | 28.34 (10.15) | 23 | IRIDS-100 | CaMir | 5 | 0.31 |
| *Retana Franco and Sánchez Aragón (2008) | Cross-sectional | 176 | 29.15 | 50 | Escala de adicción al amor | RQ | 5 | 0.18 |
| **Rocha et al. (2019) | Cross-sectional | 500 | 23.75 | 34.20 | CDE | IPPA-M | 5 | – |
| *Salani et al. (2022) | Cross-sectional | 344 | 40.85 | 0 | – | RQ | 6 | 0.15 |
| **Stravogiannis et al. (2018) | Cross-sectional | 65 | 39.49 | – | LAS | AAQ | 8 | – |
| **Valle and Moral (2017) | Cross-sectional | 382 | 24.5 (1.97) | 45 | IRIDS-100 | Cuestionario de apego adulto | 7 | – |
| *Wigman et al. (2008) | Cross-sectional | 177 | 22 (7.39) | 28.2 | IDI | RQ | 7 | −0.27 |
| *Yárnoz-Yaben (2010) | Cross-sectional | 40 | 45.5 (10.1) | 45 | IDI | RQ | 6 | −0.23 |
| Fearful | ||||||||
| **Alonso-Arbiol et al. (2002) | Cross-sectional | 602 | 20.6 | 51.6 | IDI emotional reliance on another person subscale | RQ | 6 | 0.22 |
| **Gori et al. (2023) | Cross-sectional | 300 | 37.83 (12.93) | 20 | LAI | RQ | 7 | 0.25 |
| **Holtzworth-Munroe et al. (1997) | Cross-sectional | 33 | – | 100 | SSDS SF | RQ | 7 | – |
| **Mangialavori and Cacioppo (2022) | Cross-sectional | 291 | 31.8 | 0 | LAS mania subscale | RQ | 6 | 0.31 |
| **Mangialavori and Cacioppo (2022) | Cross-sectional | 104 | 32.8 | 100 | LAS mania subscale | RQ | 6 | 0.36 |
| **Salani et al. (2022) | Cross-sectional | 344 | 40.85 | 0 | – | RQ | 6 | 0.19 |
| **Valle and Moral (2017) | Cross-sectional | 382 | 24.5 (1.97) | 45 | IRIDS-100 | Cuestionario de apego adulto | 7 | – |
| **Wigman et al. (2008) | Cross-sectional | 177 | 22 (7.39) | 28.2 | IDI | RQ | 7 | 0.26 |
| **Yárnoz-Yaben (2010) | Cross-sectional | 40 | 45.5 (10.1) | 45 | IDI | RQ | 6 | 0.54 |
| Disorganized | ||||||||
| **Gerstner et al. (2019) | Cross-sectional | 500 | – | 40 | Adaption of Escala de adicción al amor | CaMir | 8 | 0.30 |
| **Momeñe and Estévez (2018) | Cross-sectional | 269 | 28.34 (10.15) | 23 | IRIDS-100 | CaMir | 5 | 0.32 |
| Insecure Attachment | ||||||||
| **Barbarias-García et al. (2024) | Cross-sectional | 712 | 21.27 (3.34) | 18.51 | DEN | CaMir-R | 6 | – |
| **Buck et al. (2012) | Cross-sectional | 134 | 37.3 | 100 | SSDS | RQ | 7 | – |
| **Cavalli et al. (2022) | Cross-sectional | 307 | 29.51 (11.75) | 34 | LAI | ASQ | – | – |
| **Dineen and Dinc (2024) | Cross-sectional | 249 | 39.51 (13.87) | 29 | LAI-SF | R-AAS-SF | 8 | – |
| **Estévez et al. (2018) | Cross-sectional | 1,533 | 15.76 (1.25) | 53.9 | DEN | CaMir-R | 7 | – |
| **Rogier, Di Marzio, Presicci, Cavalli, and Velotti (2024) | Cross-sectional | 307 | 29.51 (11.75) | 33 | LAI | ASQ | 7 | – |
| **Holtzworth-Munroe et al. (1997) | Cross-sectional | 119 | 31.76 (7.11) | 100 | SSDS SF | AAS | 7 | – |
Note. *Included only in the meta-analysis; **included only in the systematic review; PSL: Passionate Love Scale; AAI: Adult Attachment Inventory; IDI: Interpersonal Dependency Inventory; LAI: Love Addiction Inventory; ECR: Experiences in Close Relationships; RQ: Relationships Questionnaire; ECR-SF: Experiences in Close Relationships Short-Form; AAQ: Adult Attachment Questionnaire; CaMir: CArtes- Modèles Individuels de Relations; SSDS SF: Spouse-Specific Dependency Scale Short-Form; LAS: Love Attitudes Scales; IRIDS-100: Inventario de Relaciones Interpersonales y Dependencias Sentimentales; CDE: Cuestionario de Dependencia Emocional; IPPA-M: Inventario de Apego con Padres y Pares-Modificado; SSDS: Spouse Specific Dependency Scale; ASQ: Attachment Style Questionnaire; DEN: Emotional dependency in Dating; R-AAS-SF: Revides Adult Attachment Scale Short-Form; CaMir-R: CArtes- Modèles Individuels de Relations-Revised; AAS: Adult Attachment Scale.
Systematic review of studies not included in meta-analyses
Love addiction and anxious attachment
As shown in Table 1, five studies examined the relationship between LA and the anxiety dimension. Stravogiannis et al. (2018) found that 57.6% of individuals with pathological love had anxious attachment. In a study conducted on IPV perpetrators and nonviolent men, Holtzworth-Munroe, Stuart, and Hutchinson (1997) observed a positive association between spouse dependency and preoccupied attachment. Three studies were conducted on community samples. Rocha, Umbarila, Meza, and Riveros (2019) observed that individuals with preoccupied attachments had higher levels of separation anxiety than individuals with secure and avoidant attachments. Feeney and Noller (1990) found that individuals with ambivalent attachment had higher scores than secure and avoidant individuals on 'Reliance on partner' and 'Unfulfilled hopes' (i.e., two components of their measure of LA). Lastly, Valle and Moral (2017) found that anxious individuals had higher levels of emotional dependence than individuals with avoidant and secure attachment but lower levels than individuals with fearful attachment.
Love addiction and avoidant attachment
Five studies analyzed the relationship between LA and avoidant attachment. Stravogiannis et al. (2018) found that 9.1% of pathological lovers had an avoidant attachment. Among IPV perpetrators and nonviolent men, Holtzworth-Munroe et al. (1997) found that a narrow focus on the partner was negatively associated with dismissing attachment. Feeney and Noller (1990) observed that avoidant individuals had lower scores on 'Reliance on a partner' than ambivalent and secure individuals and higher scores on 'Unfulfilled hopes' than secure individuals. Moreover, Rocha et al. (2019) observed that individuals with avoidant attachment scored lower on most subscales of emotional dependence (separation anxiety, fear of loneliness, borderline expression, and couple's affective expression) than individuals with preoccupied and secure attachment. Similarly, Valle and Moral (2017) observed that individuals with avoidant attachment had lower levels of emotional dependence than preoccupied and fearful individuals.
Love addiction and fearful attachment
Overall, nine studies focused on the relationship between LA and fearful attachment. Specifically, Valle and Moral (2017) observed that individuals with fearful attachments showed higher levels of emotional dependency than other attachment styles. Alonso-Arbiol, Shaver, and Yárnoz (2002) and Yárnoz-Yaben (2010) also found a positive association between fearful attachment and emotional dependency. Similarly, Wigman, Graham-Kevan, and Archer (2008) observed a positive correlation with emotional reliance, while Gori et al. (2023) showed a positive association with LA. Mangialavori and Cacioppo (2022) highlighted a positive association between mania and fearful attachment in female and male samples. Only one study, that of Holtzworth-Munroe et al. (1997), did not find a significant association between spouse dependency and fearful attachment. Of the nine studies included, only one was conducted on a mixed sample, including love addicts and a community sample. Salani et al. (2022) found that the clinical group reported higher levels of fearful attachment than the control group.
Love addiction and disorganized attachment
Only two contributions investigated the relationship between LA and disorganized attachment. Both (Gerstner, Font Roig, Núñez, & Pelegrin, 2019; Momeñe & Estévez, 2018) were conducted in community samples and showed a positive association between LA and disorganization.
Love addiction and insecure attachment
Seven studies explored the relationship between LA and other insecure attachment dimensions. The first study, conducted on a sample of IPV perpetrators and nonviolent men (Buck, Leenaars, Emmelkamp, & Van Marle, 2012), highlighted that insecurely attached batterers scored higher on dependency on partners than securely attached men. Barbarias-García et al. (2024) and Estévez et al. (2018) observed a negative correlation between emotional dependency and security. Further, the authors (2018) found a positive association between emotional dependency and dimensions related to more general childhood insecurity, such as being fearful and overprotected and having a lack of parental limits during childhood. Cavalli, Rogier, and Velotti (2022) noted a positive relationship between LA and anxious dimensions, such as needing approval and preoccupation with relationships. Rogier et al. (2024) partially confirmed these findings, discovering a positive association between LA and preoccupation with relationships. Furthermore, in the same study (2024), a positive relationship was observed between LA and the perception of the relationship as secondary, associated with an avoidant style. Further, Holtzworth-Munroe et al. (1997) observed that spouse dependency was associated with dimensions of insecurity, including anxiety over abandonment, avoidance of dependency, and discomfort with closeness. Similarly, Dineen and Dinc (2024) observed that participants with higher LA were more anxiously attached than those with lower LA.
Meta-analysis results
Overall, 15 studies employing 14 independent samples were included in the meta-analysis (N = 3,628). One of these (Alonso-Arbiol et al., 2002) was considered twice, as the authors used two different instruments to assess attachment. Table 1 report data extracted and coded.
Love addiction and anxious attachment
Overall, 15 contributions were included in the meta-analysis to investigate the relationship between LA and attachment anxiety. Because the fit of the two-level model was shown to not differ statistically from the three-level model (p > 0.05), the more parsimonious two-level one was selected. Regarding the anxiety dimension, a large and significant ES was observed [r = 0.38, p < 0.0001 (see Table 2 and Fig. 2a)]. The funnel plot did not highlight publication bias [Egger's test = 0.36 p > 0.05 (see Appendix B)]. However, Duval and Tweedie's trim-and-fill method identified that one study should be trimmed and filled. The resulting adjusted ES was still significant [r = 0.39, p < 0.05], confirming the first hypothesis. The effect sizes varied across studies [Q(14) = 127.88, p < 0.0001]. The prediction interval was tested to understand the trend of the effect in different populations. As shown in Fig. 3, the mean effect size was z = 0.39 [0.30; 0.46], but the actual effect size of all comparable populations fell in the interval 0.02 to 0.66. Based on these data, several possible moderators were tested. Only the continent of research was significant (p < 0.05), while the other moderators were nonsignificant: gender (p = 0.144), age (p = 0.692), quality of studies (p = 0.300), and type of attachment instrument (p = 0.449).
Overall results for the association between love addiction, anxiety and avoidance
| K | N | r | 95 CI | z | p | |
| Anxiety | 15 | 3,628 | 0.38 | [0.30; 0.46] | 8.34 | 0.0001 |
| Avoidance | 14 | 3,471 | −0.01 | [−0.10; 0.07] | −0.28 | 0.776 |
Forest plots of studies included in meta-analysis
Citation: Journal of Behavioral Addictions 2025; 10.1556/2006.2025.00031
Prediction interval of true effect size
Citation: Journal of Behavioral Addictions 2025; 10.1556/2006.2025.00031
Love addiction and avoidant attachment
We included 14 contributions investigating the relationship between LA and attachment avoidance. According to the analysis of variance performed on goodness of fit values, the three-level model was not statistically better than the two-level model (p > 0.05), suggesting that the two-level model was more appropriate. No significant ES was found for the avoidance dimension [r = −0.01, p = 0.776 (see Table 2 and Fig. 2b)]. To check the presence of publication bias, Egger's test was conducted [Egger's test = 2.67, p < 0.05 (see Appendix B)]. Duval and Tweedie's trim-and-fill method identified that four studies should be trimmed and filled. The adjusted ES became significant [r = −0.09, p < 0.05], confirming the second hypothesis. We tested whether the effect size varied across studies [Q(13) = 102.88, p < 0.0001]. None of the tested moderators were significant: gender (p = 0.558), age (p = 0.061), continent of research (p = 0.750), quality of studies (p = 0.980), and types of attachment instrument (p = 0.136).
Discussion
Given the issue in operationalizing the construct of LA, as previously discussed, the main goal of the present study was to address the identified gaps by adopting attachment theory as the theoretical framework. This approach offered an alternative perspective to the transdiagnostic model of behavioral addictions (Griffiths, 2005).
Overall, the systematic review examined 21 studies. Most studies were conducted in the last six years, reflecting the increasing interest in LA. Nine studies analyzed fearful attachment, and two studies analyzed disorganized attachment. However, the number of studies using these attachment measures did not allow for a meta-analysis. The remaining studies explored associations between attachment insecurity and LA. Significant and positive relationships between different dimensions related to LA and anxious, fearful, and disorganized attachment were observed, whereas, in some studies, the dimensions connected to attachment avoidance were negatively associated with LA. Regarding the evaluation of LA, significant variability in instrument choice was observed, reflecting the limitations observed in the meta-analysis, as mentioned below.
Meta-analysis confirmed the key association observed in the systematic review, highlighting a significant and large effect size in the relation between LA and the anxiety dimension of attachment. Indeed, hyperactivation strategies, primarily associated with the anxious style, share several clinical features of LA (Briggie & Briggie, 2015; Mikulincer & Shaver, 2013). Specifically, similarly to anxious individuals, love addicts experience high anxiety over abandonment and rejection and persistently attempt to maintain closeness to the other. In romantic relationships, anxious individuals focus on avoiding abandonment (genuine or imagined), may become clingy, controlling, and coercive, and require frequent reassurance, like love addicts (Briggie & Briggie, 2015). Moreover, these characteristics are also found in the clinical configurations of BPD (APA, 2022; Sussman, 2010). These findings may explain the observed overlap of LA and BPD, pointing to anxious attachment as a plausible shared etiology.
To analyze the trend of the effect in different populations, we tested the prediction intervals concerning anxious attachment. Regarding the effect size variability, we checked several moderators, and only the continent of research was significant. Specifically, we observed a positive association between anxiety and LA in European countries only. Although there is no data on the prevalence of LA in different countries, it is possible to speculate on cultural influences on the perception of dependency and attachment style (Smith & Klases, 2016). Shaver, Mikulincer, Alonso-Arbiol, and Lavy (2010) and Frías, Shaver, and Díaz-Loving (2014) highlight avoidance as a strategy mainly adopted in individualistic cultures that promote independence and autonomy. However, Bretaña, Alonso-Arbiol, Lavy, and Zhang (2019) reported higher levels of avoidance in collectivist cultures. Regarding the relationship between love styles and attachment styles across cultures, as noted by Smith and Klases (2016), most of the research that highlights the association between mania and attachment anxiety has been conducted in the West. Other variables, such as the clinical status of the population, maybe more helpful in understanding this variance. However, the few studies conducted on the clinical population made it impossible to examine their moderating role in this meta-analysis.
A significant negative effect was observed regarding the relationship between avoidant attachment and LA. Although the ES was not found to be particularly large, it represents a valuable starting point for understanding the relationship between LA and avoidant attachment. The current difficulty could influence the data in operationalizing the construct of LA and the consequent discrimination of love addict subtypes. Several authors proposed a subgroup of love addicts characterized by rapid relationship breakdowns and the seeking of new partners at the end of the initial euphoric phase of relationships (Briggie & Briggie, 2015; Peabody, 2005; Reynaud et al., 2010). Avoidant attachment could be particularly useful in understanding psychological mechanisms underlying this subtype of LA. Individuals with avoidant attachment are inclined to devalue dependence on the other, preferring to maintain self-sufficiency (Coppola et al., 2021; Mikulincer & Shaver, 2019). Although these strategies are implemented to avoid rejection and maintain a sense of internal security, they differ substantially from the characteristics highlighted in the current description of LA, which overlap with anxious attachment (Mende, 2018; Mikulincer & Shaver, 2019).
The limited operationalization of LA might be reflected in the variety of instruments used to assess LA. For example, Feeney and Noller (1990), through factor analysis, identified two dimensions of LA, while Mangialavori and Cacioppo (2022) and Stravogiannis et al. (2018) used the “Mania” subscale of the Love Attitude Scale as an index of LA. This consideration may reflect the multidimensional nature of this construct, highlighting the need to determine the complex nature of LA, including its subtypes. Hence, some dimensions that could better describe the “explorer subtype” of love addict (Fisher, 2017) may not yet be represented by existing tools; consequently, this could result in an underestimation of the actual association between avoidance and LA. This aspect appears particularly relevant considering the association between fearful and disorganized attachment and LA, as seen in the systematic review. In Bartholomew and Horowitz's conceptualization of attachment styles (1991), fearful attachment partially overlaps with the avoidant style proposed by Hazan and Shaver (1987), involving the implementation of avoidant strategies out of a fear of rejection (Bartholomew & Horowitz, 1991). Considering the role of fearful attachment in addictions (Demircioğlu & Göncü Köse, 2021; Schindler, 2019) and BPD (Hashworth, Reis, & Grenyer, 2021), it seems important to further investigate the relationship of these disorders with LA.
Conclusions, limitations, and future directions
The systematic review and meta-analysis identified a substantial overlap between attachment anxiety and LA. Moreover, a weaker negative association between attachment avoidance and LA was discovered, supporting the validity of the proposed framework. The data also provide an important summary of the current literature and a helpful starting point for future research. Indeed, the role of the attachment framework allows for highlighting the relational nature of LA, enabling further differentiation from other behavioral addictions. Moreover, the association with anxious and avoidant attachment shows promise in understanding Love Addict subtypes. It also provides an important aspect to be investigated and considered in the therapeutic formulation of work with love addict patients.
However, this work is not without limitations. The main limitation concerns the different instruments used to assess LA. This highlights the importance of working towards consensus regarding the operationalization of the LA construct. Another limitation concerns the exclusion of the fearful attachment style from the meta-analysis; this decision was determined by the limited number of studies in the literature (N = 9). A final limitation is related to the populations investigated. Most of the research was conducted on community samples, with only a tiny percentage recruiting clinical samples. These data did not allow us to investigate the possible role of clinical status as a moderator that may influence the relationship between attachment and LA.
Overall, several aspects of LA still need to be explored. Future research could address the highlighted limitations, analyze the relationship between LA and fearful attachment, and formulate an ad-hoc hypothesis. Lastly, an important issue concerns the development of a multidimensional tool for assessing all the facets of LA.
Funding sources
The authors received no financial support for the research, authorship, and/or publication of this article.
Authors' contribution
RGC contributed to the study design, methodology, interpretation, and writing of the manuscript. GR and JF contributed of the reviewing of the manuscript. PV contributed to the study concept, design, reviewing of the manuscript and study supervision.
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
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Appendix A. Search terms
| Concept | Construct | Term (linked with “OR”) |
| Love Addiction | A. Love addiction | Love Addict* |
| Pathological Love | ||
| Obsessive Love | ||
| Compulsive Love | ||
| Excessive Love | ||
| Problematic* Love | ||
| Relationship Addict* | ||
| Obsessive Relationship | ||
| Compulsive Relationship | ||
| Romantic Addict* | ||
| Pathological Romantic | ||
| Obsessive Romantic | ||
| Compulsive Romantic | ||
| Excessive Romantic | ||
| Problematic* Romantic | ||
| Passion Addict* | ||
| Pathological Passion | ||
| Obsessive Passion | ||
| Compulsive Passion | ||
| Excessive Passion | ||
| Problematic* Passion | ||
| Interpersonal Addict* | ||
| Obsessive Interpersonal | ||
| Compulsive Interpersonal | ||
| Love Addiction Inventory | ||
| Passionate Love Scale | ||
| Codepedency | ||
| Intima* Addict* | ||
| Pathological Intima* | ||
| Obsessive Partner | ||
| Compulsive Partner | ||
| Dependent Partner | ||
| Affective Dependenc* | ||
| Affective Addict* | ||
| Emotional Dependenc* | ||
| Co-Dependency | ||
| Interpersonal Dependenc* | ||
| Addict* to Romantic Relationship | ||
| Addict* to Relationship | ||
| Addict* To Love | ||
| Addict* To Partner | ||
| Addict* To Intima* | ||
| Addict* To Passion | ||
| Love Dependenc* | ||
| Relationship Dependenc* | ||
| Pathological Affect* |
Appendix B. Funnel plots of studies included in meta-analysis
