Early maternal separation and the trajectory of borderline personality disorder symptoms THOMAS N. CRAWFORD, PATRICIA R. COHEN, HENIAN CHEN, DEIDRE M. ANGLIN, AND MIRIAM EHRENSAFT New York State Psychiatric Institute Abstract Extended maternal separations before age 5 were evaluated as a predictor of long-term risk for offspring borderline personality disorder (BPD) symptoms in longitudinal data from a large random community sample. Early separations from mother predicted elevations in BPD symptoms assessed repeatedly from early adolescence to middle adulthood. Early separations also predicted a slower than normal rate of decline in symptoms with age. Other theoretically grounded risks were examined and shown to predict elevated BPD symptoms over the developmental trajectory. Long-term effects of early separations were largely independent of childhood temperament, child abuse, maternal problems, and parenting risks. These data provide the first prospectively collected data on the developmental course of BPD symptoms and suggest a series of environmental and other influences on these very disabling problems. Borderline personality disorder (BPD) is a seri- ous psychiatric disturbance characterized by emo- tional lability, poor impulse control, and angry outbursts. In addition to core disturbances in affect regulation, BPD also manifests in chaotic interpersonal relationships, unstable identity, suicide attempts, self-mutilation, and other self- destructive behaviors (Skodol et al., 2002). The prevalence of BPD is 1–2% in the community, 10% in outpatient psychiatric clinics, and 20% in inpatient psychiatric settings (Gross et al., 2002; Lenzenweger, Loranger, Korfine, & Neff, 1997; Torgersen, Kringlen, & Cramer, 2001). Al- though women present with BPD more often than men in clinical settings (Skodol & Bender, 2003), gender differences in prevalence have not been observed in population-based epidemiological research (Torgersen et al., 2001; Winograd, Co- hen, & Chen, 2008). Approximately 3% to 10% of patients with BPD commit suicide (McGlas- han, 1986; Paris, Brown, & Nowlis, 1987; Stone, Hurt, & Stone, 1987), thus making it a serious concern for the public health. Despite widespread interest in BPD, relatively little empirical research has investigated its course and developmental origins in prospective data first gathered in childhood (Cohen, 2008). Longitudinal data from a community sample show that average symptom levels are highest in early adolescence and then decline over time (Co- hen et al., 2008; Johnson, Cohen, Kasen, Skodol, & Brook, 2000), probably because of maturation and socialization effects. Symptom levels in adult patients in clinical settings also tend to decline over time (Shea et al., 2002). Given parallel find- ings in community and clinical data, it is impor- tant to identify childhood risks that lead to early elevations in BPD symptoms but also to clarify developmental processes that delay or otherwise interfere with their usual developmental decline. The limited data on etiology show that BPD is associated with childhood histories of abuse, Address correspondence and reprint requests to: Thomas N. Crawford, Children in the Community Study, New York State Psychiatric Institute, 100 Haven Avenue, Suite 31F, New York, NY 10032; E-mail: crawfor@pi.cpmc. columbia.edu This research was supported by NIMH Grants MH-49191 and MH-36971 and by National Institute on Drug Abuse Grant DA-03188. Development and Psychopathology 21 (2009), 1013–1030 Copyright # 2009 Cambridge University Press Printed in the United States of America doi:10.1017/S0954579409000546 1013