Hostname: page-component-745bb68f8f-hvd4g Total loading time: 0 Render date: 2025-01-22T07:05:58.698Z Has data issue: false hasContentIssue false
  • English
  • Français

Early maternal separation and the trajectory of borderline personality disorder symptoms

Published online by Cambridge University Press:  07 July 2009

Thomas N. Crawford ,
Patricia R. Cohen ,
Henian Chen ,
Deidre M. Anglin  and
Miriam Ehrensaft
Thomas N. Crawford*
Affiliation:
New York State Psychiatric Institute
Patricia R. Cohen
Affiliation:
New York State Psychiatric Institute
Henian Chen
Affiliation:
New York State Psychiatric Institute
Deidre M. Anglin
Affiliation:
New York State Psychiatric Institute
Miriam Ehrensaft
Affiliation:
New York State Psychiatric Institute
*
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: [email protected]
Get access Rights & Permissions [Opens in a new window]

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.

Type
Regular Articles
Information
Development and Psychopathology , Volume 21 , Issue 3: Precursors and Diverse Pathways to Personality Disorder in Children and Adolescents: Part 1 , August 2009 , pp. 1013 - 1030
Copyright
Copyright © Cambridge University Press 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Agrawal, H. R., Gunderson, J., Holmes, B. M., & Lyons-Ruth, K. (2004). Attachment studies with borderline patients: A review. Harvard Review of Psychiatry, 12, 94–104.CrossRefGoogle ScholarPubMed
American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders (3rd ed.). Washington, DC: Author.Google Scholar
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.Google Scholar
Anglin, D. M., Cohen, P. R., & Chen, H. (2008). Duration of early maternal separation and prediction of schizotypal symptoms from early adolescence to midlife. Schizophrenia Research, 103, 143–150.Google Scholar
Bandelow, B., Krause, J., Wedekind, D., Broocks, A., Hajak, G., & Ruther, E. (2005). Early traumatic life events, parental attitudes, family history, and birth risk factors in patients with borderline personality disorder and healthy controls. Psychiatry Research, 134, 169–179.CrossRefGoogle ScholarPubMed
Barry, R. A., Kochanska, G., & Philibert, R. A. (2008). G × E interaction in the organization of attachment: Mothers' responsiveness as a moderator of children's genotypes. Journal of Child Psychology and Psychiatry, 49, 1313–1320.CrossRefGoogle Scholar
Bartholomew, K., Kwong, M. J., & Hart, S. D. (2001). Attachment. In Livesley, W. J. (Ed.), Handbook of personality disorders (pp. 196–230). New York: Guilford Press.Google Scholar
Bartholomew, K., & Shaver, P. R. (1998). Methods of assessing adult attachment: Do they converge? In Simpson, J. A. & Rholes, W. S. (Eds.), Attachment theory and close relationships (pp. 25–45). New York: Guilford Press.Google Scholar
Belsky, J. (2002). Developmental origins of attachment styles. Attachment and Human Development, 4, 166–170.Google Scholar
Berenson, K. R., Crawford, T. N., Cohen, P., & Brook, J. (2005). Implications of identification with parents and parents' acceptance for adolescent and young adult self-esteem. Self and Identity, 4, 289–301.Google Scholar
Bezirganian, S., Cohen, P., & Brook, J. (1993). The impact of mother–child interaction on the development of borderline personality disorder. American Journal of Psychiatry, 150, 1836–1842.Google ScholarPubMed
Bowlby, J. (1969). Attachment and loss: Vol. 1. Attachment. New York: Basic Books.Google Scholar
Bowlby, J. (1973). Attachment and loss: Vol. 2. Separation. New York: Basic Books.Google Scholar
Bowlby, J. (1980). Attachment and loss: Vol. 3. Loss, sadness, and depression. New York: Basic Books.Google Scholar
Bradley, S. J. (1979). The relationship of early maternal separation to borderline personality in children and adolescents: A pilot study. American Journal of Psychiatry, 136, 424–426.Google Scholar
Brennan, K. A., Clark, C. L., & Shaver, P. R. (1998). Self-report measurement of adult attachment: An integrative approach. In Simpson, J. A. & Rhodes, W. S. (Eds.), Attachment theory and close relationships (pp. 46–76). New York: Guildford Press.Google Scholar
Brennan, K. A., & Shaver, P. R. (1998). Attachment styles and personality disorders: Their connection to each other and parental divorce, parental death, and perception of parental caregiving. Journal of Personality, 66, 835–878.Google Scholar
Bretherton, I., & Munholland, K. A. (1999). Internal working models in attachment relationships: A construct revisited. In Cassidy, J. & Shaver, P. R. (Eds.), Handbook of attachment: Theory, research, and clinical applications (pp. 89–111). New York: Guilford Press.Google Scholar
Caspi, A., Sugden, K., Moffitt, T. E., Taylor, A., Craig, I. W., Harrington, H. L., et al. (2003). Influence of life stress on depression: Moderation by a polymorphism in the 5-HTT gene. Science, 301, 386–389.CrossRefGoogle ScholarPubMed
Charmandari, E., Kino, T., Souvatzoglou, E., & Chrousos, G. P. (2003). Pediatric stress: Hormonal mediators and human development. Hormone Research, 59, 161–179.Google Scholar
Chen, H., Cohen, P., Crawford, T. N., Kasen, S., Johnson, J. G., & Berenson, K. (2006). Relative impact of young adult personality disorders on subsequent quality of life: Findings of a community-based longitudinal study. Journal of Personality Disorders. 20, 510–523.Google Scholar
Chen, H., Cohen, P., Johnson, J. G., Kasen, S., Sneed, J. R., & Crawford, T. N. (2004). Adolescent personality disorders and conflict with romantic partners during the transition to adulthood. Journal of Personality Disorders, 18, 507–525.CrossRefGoogle ScholarPubMed
Chess, S., & Thomas, A. (1978). Temperamental individuality from childhood to adolescence. Annual Progress in Child Psychiatry and Child Development, 223–244.Google Scholar
Cicchetti, D., & Cohen, D. (Eds.). (2006a). Developmental psychopathology: Vol. 1. Theory and method (2nd ed.). New York: Wiley.Google Scholar
Cicchetti, D., & Cohen, D. (Eds.). (2006b). Developmental psychopathology: Vol. 3. Risk, disorder, and adaptation (2nd ed.). New York: Wiley.Google Scholar
Cicchetti, D., & Rogosch, F. A. (1996). Equifinality and multifinality in developmental psychopathology. Development and Psychopathology, 8, 597–600.CrossRefGoogle Scholar
Cohen, P. (1996). Childhood risks for young adult symptoms of personality disorder: Method and substance. Multivariate Behavioral Research, 31, 121–148.Google Scholar
Cohen, P. (2008). Child development and personality disorder. Psychiatric Clinics of North America, 31, 477–493.Google Scholar
Cohen, P., Chen, H., Gordon, K., Johnson, J., Brook, J., & Kasen, S. (2008). Socioeconomic background and the developmental course of schizotypal and borderline personality disorder symptoms. Development and Psychopathology, 20, 633–650.Google Scholar
Cohen, P., & Cohen, J. (1996). Life values and adolescent mental health. Mahwah, NJ: Erlbaum.Google Scholar
Cohen, P., & Crawford, T. N. (2005). Developmental issues. In Oldham, J. M., Skodol, A. E., & Bender, D. S. (Eds.), Textbook of personality disorders (pp. 171–185). Washington, DC: American Psychiatric Publishing.Google Scholar
Cohen, P., Crawford, T. N., Johnson, J. G., & Kasen, S. (2005). The Children in the Community Study of developmental course of personality disorder. Journal of Personality Disorders, 19, 466–486.Google Scholar
Crawford, T. N., Cohen, P., Johnson, J. G., Kasen, S., First, M. B., Gordon, K., et al. (2005). Self-reported personality disorder in the Children in the Community sample: Convergent and prospective validity in late adolescence and adulthood. Journal of Personality Disorders, 19, 30–52.CrossRefGoogle ScholarPubMed
Crawford, T. N., Cohen, P., Midlarsky, E., & Brook, J. S. (2001). Internalizing symptoms in adolescents: Gender differences in vulnerability to parental distress and discord. Journal of Research on Adolescence, 11, 85–119.Google Scholar
Crawford, T. N., Shaver, P. R., Cohen, P., Pilkonis, P. A., Gillath, O., & Kasen, S. (2006). Self-reported attachment, interpersonal aggression, and personality disorder in a prospective community sample of adolescents and adults. Journal of Personality Disorders, 20, 331–353.Google Scholar
Davies, P. T., & Cummings, E. M. (1994). Marital conflict and child adjustment: An emotional security hypothesis. Psychological Bulletin, 116, 387–411.Google Scholar
Derogatis, L. R., Lipman, R. S., Rickles, K., Uhlenhuth, E. H., & Covi, L. (1974). The Hopkins Symptom Checklist (HSCL). Behavioral Science, 19, 1–15.CrossRefGoogle ScholarPubMed
Fincham, F. D., & Osborne, L. N. (1993). Marital conflict and children: Retrospect and prospect. Clinical Psychology Review, 13, 75–88.Google Scholar
First, M. B., Gibbon, M., Spitzer, R. L., & Williams, J. B. W. (1997). Structured Clinical Interview for DSM-IV Axis II personality disorders (SCID-II). Arlington, VA: American Psychiatric Publishing.Google Scholar
Fonagy, P., Gergely, G., Jurist, E. L., & Target, M. (2002). Affect regulation, mentalization, and the development of the self. New York: Other Press.Google Scholar
Fox, N. A., Nichols, K. E., Henderson, H. A., Rubin, K., Schmidt, L., Hamer, D., et al. (2005). Evidence for a gene–environment interaction in predicting behavioral inhibition in middle childhood. Psychological Science, 16, 921–926.Google Scholar
Garner, B., Chanen, A. M., Phillips, L., Velakoulis, D., Wood, S. J., Jackson, H. J., et al. (2007). Pituitary volume in teenagers with first-presentation borderline personality disorder. Psychiatry Research, 156, 257–261.Google Scholar
George, C., Kaplan, N., & Main, M. (1985). The Berkeley Adult Attachment Interview. Unpublished manuscript, University of California, Berkeley.Google Scholar
Gross, R., Olfson, M., Gameroff, M., Shea, S., Feder, A., Fuentes, M., et al. (2002). Borderline personality disorder in primary care. Archives of Internal Medicine, 162, 53–60.Google Scholar
Heim, C., & Nemeroff, C. (2001). The role of childhood trauma in the neurobiology of mood and anxiety disorders: Preclinical and clinical studies. Biological Psychiatry, 49, 1023–1039.Google Scholar
Holmes, J. (2004). Disorganized attachment and borderline personality disorder: A clinical perspective. Attachment and Human Development, 6, 181–190.Google Scholar
Hyler, S. E., Rieder, R., Spitzer, R., & Williams, J. (1982). The Personality Diagnostic Questionnaire (PDQ). New York: New York State Psychiatric Institute.Google Scholar
Hyler, S. E., Skodol, A. E., Kellman, H. D., Oldham, J. M., & Rosnick, L. (1990). Validity of the Personality Diagnostic Questionnaire—Revised: Comparison with two structured interviews. American Journal of Psychiatry, 47, 1043–1048.Google Scholar
Jessor, R., Graves, T. D., Hanson, R. C., & Jessor, S. L. (1968). Society, personality, and deviant behavior: A study of a tri-ethnic community. New York: Holt, Rinehart & Wilson.Google Scholar
Johnson, J. G., Cohen, P., Kasen, S., Skodol, A., & Brook, J. (2000). Age-related change in personality disorder trait levels between early adolescence and adulthood: A community-based longitudinal investigation. Acta Psychiatrica Scandinavica, 102, 265–275.Google Scholar
Johnson, J. G., Cohen, P., Kasen, S., Ehrensaft, M. K., & Crawford, T. N. (2006). Associations of parental personality disorders and Axis I disorders with childrearing behavior. Psychiatry: Interpersonal and Biological Processes, 69, 336–350.Google Scholar
Kaufman, J., Yang, B., Douglas-Palumberi, H., Grasso, D., Lipschitz, D., Houshyar, S., et al. (2006). Brain-derived neurotrophic factor–5-HTTLPR gene interactions and environmental modifiers of depression in children. Biological Psychiatry, 59, 673–680.Google Scholar
Kaufman, J., Yang, B., Douglas-Palumberi, H., Houshyar, S., Lipschitz, D., Krystal, J. H., et al. (2004). Social supports and serotonin transporter gene moderate depression in maltreated children. Proceedings of the National Academy of Sciences of the United States of America, 101, 17316–17321.Google Scholar
Kavoussi, R. J., & Siever, L. J. (1992). Overlap between borderline and schizotypal personality disorders. Comprehensive Psychiatry, 33, 7–12.Google Scholar
Lenzenweger, M., Loranger, A., Korfine, L., & Neff, C. (1997). Detecting personality disorders in a nonclinical population: Application of a 2-stage for case identification. Archives of General Psychiatry, 54, 345–351.Google Scholar
Levy, K. N. (2005). The implications of attachment theory and research for understanding borderline personality disorder. Development and Psychopathology, 17, 959–986.CrossRefGoogle ScholarPubMed
Lieb, K., Rexhausen, J. E., Kahl, K. G., Schweiger, U., Philipsen, A., Hellhammer, D. H., et al. (2004). Increased diurnal salivary cortisol in women with borderline personality disorder. Journal of Psychiatric Research, 38, 559–565.CrossRefGoogle ScholarPubMed
Links, P. S., Steiner, M., Offord, D. R., & Eppel, A. B. (1988). Characteristics of borderline personality disorder: A Canadian study. Canadian Journal of Psychiatry, 33, 336–340.Google Scholar
Maughan, B., Pickles, A., & Quinton, D. (1995). Parental hostility, childhood behavior and adult social functioning. In McCord, J. (Ed.), Coercion and punishment in long term perspectives (pp. 34–58). New York: Cambridge University Press.Google Scholar
Maughan, B., & Rutter, M. (1997). Retrospective reporting of childhood adversity: Issues in assessing long-term recall. Journal of Personality Disorders, 11, 19–33.Google Scholar
McGlashan, T. (1986). The Chestnut Lodge Follow-Up Study, Part III: Long-term outcome of borderline personalities. Archives of General Psychiatry, 42, 20–30.CrossRefGoogle Scholar
Mikulincer, M., & Shaver, P. R. (2007). Attachment in adulthood: Structure, dynamics, and change. New York: Guilford Press.Google Scholar
Modestin, J., Ern, T., & Oberson, B. (1998). A comparison of self-report and interview diagnoses of DSM-III-R personality disorders. European Journal of Personality, 12, 445–455.Google Scholar
Moss, E., Cyr, C., Bureau, J.-F., Tarabulsy, G. M., & Dubois-Comtois, K. (2005). Stability of attachment during the preschool period. Developmental Psychology, 41, 773–783.Google Scholar
Paris, J., Brown, R., & Nowlis, D. (1987). Long-term follow-up of borderline patients in a general hospital. Comprehensive Psychiatry, 28, 530–535.Google Scholar
Paris, J., Zweig–Frank, H., & Guzder, J. (1994). Psychological risk factors for borderline personality disorder in female patients. Comprehensive Psychiatry, 35, 301–305.Google Scholar
Reich, B., & Zanarini, M. C. (2001). Developmental aspects of borderline personality disorder. Harvard Review of Psychiatry, 9, 294–301.Google Scholar
Robins, L. N., Schoenberg, S. P., Holmes, S. J., Ratcliff, K. S., Benham, A., & Works, J. (1985). Early home environment and retrospective recall: A test for concordance between siblings with and without psychiatric disorders. American Journal of Orthopsychiatry, 55, 27–41.Google Scholar
Rothbart, M. K., Ahadi, S. A., Hershey, K. L., & Fisher, P. (2001). Investigations of temperament at three to seven years: The Children's Behavior Questionnaire. Child Development, 72, 1394–1408.Google Scholar
Rutter, M., & Sroufe, L. A. (2000). Developmental psychopathology: Concepts and challenges. Development and Psychopathology, 12, 265–296.Google Scholar
Salzman, J. P., Salzman, C., & Wolfson, A. N. (1997). Relationship of childhood abuse and maternal attachment to the development of borderline personality disorder. In Zanarini, M. C. (Ed.), Role of sexual abuse in the etiology of borderline personality disorder (pp. 71–91). Washington, DC: American Psychiatric Press.Google Scholar
Sanislow, C. A., Morey, L. C., Grilo, C. M., Gunderson, J. G., Shea, M. T., Skodol, A. E., et al. (2002). Confirmatory factor analysis of DSM-IV borderline, schizotypal, avoidant and obsessive–compulsive personality disorders: Findings from the Collaborative Longitudinal Personality Disorders Study. Acta Psychiatrica Scandinavica, 105, 28–36.Google Scholar
Schaefer, E. (1965). Children's reports of parental behavior: An inventory. Child Development, 36, 413–424.Google Scholar
Shaver, P. R., & Mikulincer, M. (2002). Attachment-related psychodynamics. Attachment and Human Development, 4, 133–161.CrossRefGoogle ScholarPubMed
Shaver, P. R., & Mikulincer, M. (2004). What do self-report attachment measures assess? In Rholes, W. S. & Simpson, J. A. (Eds.), Adult attachment: Theory, research, and clinical implications (pp. 17–54). New York: Guilford Press.Google Scholar
Shea, M. T., Stout, R., Gunderson, J., Morey, L. C., Grilo, C. M., McGlashan, T., et al. (2002). Short-term diagnostic stability of schizotypal, borderline, avoidant, and obsessive–compulsive personality disorders. American Journal of Psychiatry, 159, 2036–2041.Google Scholar
Siever, L. J., & Davis, K. L. (1991). A psychobiological perspective on the personality disorders. American Journal of Psychiatry, 148, 1647–1658.Google Scholar
Smith, S. M., & Vale, W. W. (2006). The role of the hypothalamic–pituitary–adrenal axis in neuroendocrine responses to stress. Dialogues in Clinical Neuroscience, 8, 383–395.Google Scholar
Skodol, A. E., & Bender, D. S. (2003). Why are women diagnosed borderline more than men? Psychiatric Quarterly, 74, 349–360.Google Scholar
Skodol, A. E., Gunderson, J. G., Livesley, W. J., Pfohl, B., Siever, L. J., & Widiger, T. A. (2002). The borderline diagnosis from the perspectives of psychopathology, comorbidity, personality structure, biology, genetics, and course. Biological Psychiatry, 51, 936–950.CrossRefGoogle Scholar
Soloff, P. H., & Millward, J. W. (1983). Developmental histories of borderline patients. Comprehensive Psychiatry, 24, 574–588.Google Scholar
Solomon, J., & George, C. (1999). Attachment disorganization. New York: Guilford Press.Google Scholar
Stalker, C. A., & Davies, F. (1995). Attachment organization and adaptation in sexually-abused women. Canadian Journal of Psychiatry, 40, 234–240.Google Scholar
Stone, M. H., Hurt, S. W., & Stone, D. K. (1987). The P.I.-500: Long-term follow-up of borderline inpatients meeting DSM-III criteria: I. Global outcome. Journal of Personality Disorders, 1, 291–298.Google Scholar
Suomi, S. J. (2006). Risk, resilience, and Gene × Environment interactions in rhesus monkeys. Annals of the New York Academy of Sciences, 1094, 52–62.Google Scholar
Tarullo, A. R., & Gunnar, M. R. (2006). Child maltreatment and the developing HPA axis. Hormones and Behavior, 50, 632–639.Google Scholar
Thomas, A., & Chess, S. (1977). Temperament and development. Oxford: Brunner/Mazel.Google Scholar
Thomas, A., Chess, S., & Birch, H. G. (1970). The origin of personality. Scientific American, 223, 102–109.Google Scholar
Thomas, A., Chess, S., & Korn, S. J. (1982). The reality of difficult temperament. Merrill–Palmer Quarterly, 28, 1–20.Google Scholar
Torgersen, S., Kringlen, E., & Cramer, V. (2001). The prevalence of personality disorders in a community sample. Archives of General Psychiatry, 58, 590–596.Google Scholar
Van Voorhees, E., & Scarpa, A. (2004). The effects of child maltreatment on the hypothalamic–pituitary–adrenal axis. Trauma Violence and Abuse, 5, 333–352.Google Scholar
Waters, E., Merrick, S., Treboux, D., Crowell, J., & Albersheim, L. (2000). Attachment security in infancy and early adulthood: A twenty-year longitudinal study. Child Development, 71, 684–689.Google Scholar
Weinfeld, N. S., Sroufe, L. A., & Egeland, B. (2000). Attachment from infancy to early adulthood in a high-risk sample: Continuity, discontinuity, and their correlates. Child Development, 71, 695–702.CrossRefGoogle Scholar
Winograd, G., Cohen, P., & Chen, H. (2008). Adolescent borderline symptoms in the community: Prognosis for functioning over 20 years. Journal of Child Psychology and Psychiatry, 49, 933–941.Google Scholar
Zanarini, M. C., Yong, L., Frankenburg, F. R., Hennen, J., Reich, D. B., Marino, M. F., & Vujanovic, A. A. (2002). Severity of reported childhood sexual abuse and its relationship to severity of borderline psychopathology and psychosocial impairment among borderline inpatients. Journal of Nervous and Mental Disease, 190, 381–387.Google Scholar