PSYCHIATRY

Human Development
Throughout the Life Cycle
(Chapter 2 – Kaplan and Sadock’s Synopsis of Psychiatry)
Why study the Life Cycle?
 To clarify people’s
behavior

 To understand the normal

stages of development

 To predict complications
and problems that can arise
Life-Cycle Theories
Sigmund Freud

Carl Gustav Jung

Harry Stack Sullivan

Erik Erikson

Jean Piaget

Daniel Levinson
Sigmund Freud
 Three Essays on the Theory
of Sexuality

 Childhood phases of dev’t

correspond to successive
shifts in the investment of
sexual energy in areas of
the body usually associated
with eroticism: mouth,
anus, genitalia
Sigmund Freud
Freud’s Developmental Stages
 Oral Phase - birth to 1 year
 Anal Phase - 1–3 years
 Phallic Phase - 3–5 years
 Latency Phase - 5/6 years to 11 years/puberty
 Genital Phase - 11 to adult

Successful resolution of these childhood phases was

essential to normal adult functioning
Adult experiences are of relatively little consequence
Carl Gustav Jung
 Viewed external factors as
an important role in
people’s growth and
adaptation

 Individuation as a process
of growth and expansion of
the personality

 Libido as psychic energy

not limited to sexuality or
aggression but includes
religious and spiritual urges
Harry Stack Sullivan
 Human development as
largely shaped by external
events, specifically social
interactions

 Need for interactions –

human as a social being
Erik Erikson
 Developmental potentials
occurred at all stages of
life and not only during
childhood
Erik Erikson’s 8 Stage Life Cycle
 1st 5 stages correlate with
Freud’s Psychosexual
Stages

 Additional 3 stages that

extended beyond youg
adulthood to old age

 Each stage is characterized

by a positive and negative
aspects; specific emotional
crises and is affected by
the interaction of the
person’s biology, culture
and society
Erik Erikson’s 8 Stage Life Cycle
 Epigenetic

 Ideal circumstance is crisis

at each stage must be
negotiated before a person
can move on to the next
phase
Jean Piaget
 Cognitive (Intellectual)
development

 Epigentic

 The sequence of the stages

is not automatic but
depends on both CNS
growth and life experiences
Jean Piaget
Daniel Levinson
 Personality development
throughout the course of
life

 Human life cycle is

composed of 4 major eras
 Childhood and Adolescence
 Early Adulthood
 Middle Adulthood
 Late Adulthood
 Longitudinal Studies of Human
Development
 Limitation of Freud, Jung
and Eriksons’ theories – not
based on controlled and
empirical research
CHANGE IS POSSIBLE
 Prospective longitudinal
THROUGHOUT A
studies
LIFETIME
 George Valliant
 Happy childhood = positive
traits in middle life
 Immaturity versus maturity
 Psychopathology versus
mental health
Neurobiology of Development
Physical maturation profoundly affects psychological
and emotional growth of children.
The environment also shape a child’s developing brain.

Arborization – growth of existing neurons which branch

out and establish contact with one another
Plasticity – intrinsic capacity of brain cells to grow and
branch in response to environmental stimuli
Concept of Normality
By Daniel Offer and Melvin Sabshin

Normality as Health

Normality as Utopia

Normality as Average

Normality as Process
Human Development
Prenatal Period

Infancy

Toddler Early Developmental

Stage
Preschool

Middle Years

Adolescence

Adulthood

Late Adulthood
Prenatal Period (embryo – right before birth)

Embryo vs Fetus

Damage at the fetal stage is usually more global in its

impact because rapidly growing organs are most
vulnerable.
Boys are more vulnerable to developmental damage
than girls
Prenatal Period
 By 16 to 20 weeks fetal  10th week cerebral cortex
movements are detected begins to develop
by the mother

 By 18th week - able to hear,

smell and taste

 17th week grasp reflex is

present

 25th week Moro (startle)

reflex

 28th week sucking reflex

Prenatal Period
Prenatal Disorders
 Amniocentesis
 Ultrasound
 X-rays
 Fetoscopy
 Fetal blood and skin sampling
 Chorionic Villus Sampling
 AFP screening

Prenatal testing for women >35 yo or (+) FH of CD

Prenatal Counselling
Fetal Alcohol Syndrome
 Affects 1/3 of all infants born
to alcoholic women

 S/Sx:
 Pre natal growth retardation
 Microphthalmia, short
palpebral fissures, midface
hypoplasia, smooth or short
philtrum, thin upper lip
 Microcephaly, delayed dev’t,
hyperactivity, attention
deficits, learning disability,
intellectual deficits, seizures
Prenatal Period
 Smoking  Teratogenic medications
 Lower than average birth  Tetracycline, phenytoin,
weight progesterone-estrogens,
lithium etc...
 Severe radiation during
first 20 weeks
 Gross deformities
Infancy (birth to 15 months)

 Avg. NB weighs 3,400 g (7

½ lbs)

 Small fetus BW below 10th

percentile for gestational
age

 Premature infants 1000g –

2500 g

 Postmature - > 2 weeks

beyond expected date of
birth
Developmental Landmarks (Infancy)

REFLEXES SURVIVAL SYSTEMS

 Rooting  Breathing, sucking,
swallowing and circulatory
 Grasp and temperature
hemostasis are functional
 Plantar
at birth
 Knee  Sensory organs are
 Abdominal incompletely developed

 Moro Reflex
Developmental Landmarks (Infancy)

LANGUAGE COGNITVE
 Cries at birth  By the end of infancy,
previous primitive reflexes
 Vocalizes (guttural or transformed into voluntary
babbling sounds) by 8 actions
weeks
 Begins to interact with the
environment and
experience feedback from
their own bodies
Stages of Cognitive Development
by Piaget
Developmental Landmarks (Infancy)

EMOTIONAL SOCIAL
 Development is at parallel  At 3 weeks, Imitates facial
with cognition movements of adult
caretakers
 Importance of the
caretaker as he/she  At 2 months, endogenous
provides the major stimulus smiling
for both mental and
emotional growth  At 4 months, exogenous
smiling
 Regular and predictable
interaction between ***Study Table 2.3-1 and 2.3- 3 of
infants’ behavioral Kaplan, Landmarks of Normal
repertoire and caretakers’ Behavioral Development and
Language Development
social responses
Attachment
Infants show a rapidly increasing responsivity to the
external environment and an ability to form a special
relationship with significant primary caretakers
Harry Harlow
 Experimented on rhesus monkeys and effects of social
isolation

John Bowlby
 Attachment behavior develops during first year of life as
the maintenance of physical contact between the mother
and child when the child is hungry, frightened or distress
 Early separation had severe negative effect’s on children’s
emotional and intellectual development
Attachment
Mary Ainsworth
 Interaction between mother and baby during the
attachment period significantly influences the baby’s
current and future behavior
 Attachment serves to reduce anxiety and enables a child to
move from the attachment figure and to explore the
environment (secure base effect)
 Transitional object (term coined by Donald Winnicott) are
inanimate objects which serves a secure base for children
 Maternal sensitivity and responsiveness = secure
attachment
 Stranger Anxiety vs
Separation Anxiety
Stranger Anxiety Separation Anxiety
 Fear of strangers which  Occurs when separation
results from a baby’s from the person to whom
growing ability to the infant is attached
distinguish caretakers from
other people  Occurs between 10-18 mos.

 Occurs at 26-32 weeks (8  Margaret Mahler developed

mos.) a theory to describe hw
young children acquire a
 Babies exposed to only one sense of identity
caretaker are more likely
to have stranger anxiety
Stages of Separation-Individuation
by Mahler
Toddler (15 months – 2 ½ years)
 Marked by acceleration of
motor and intellectual
development

 Ability to walk, acquisition

of speech
Developmental Landmarks (Toddler)

LANGUAGE COGNITVE
 Vocalizations become  Begin to reason and to
distinct listen to explanations that
can help them tolerate
 Can name a few objects delay
and make needs known in 1
or 2 words  Create new behaviors from
old ones (originality0 and
engage in symbolic
activities
Developmental Landmarks (Toddler)

EMOTIONAL SOCIAL
 Exploratory excitement,  Has capacities for an
assertive pleasure, organized demonstration of
pleasure in discovery and in love (hugging, smiling,
developing new behavior kissing) and protest (crying,
banging, biting, kicking)
Developmental Landmarks (Toddler)
SEXUAL SPHINCTER CONTROL
DEVELOPMENT and SLEEP
 At 2 ½ years, gender  Toilet training is started
identity (the conviction of
being a boy or a girl)  At 2 ½ years old, control of
becomes fixed daytime urination achieved

 At 4 years, control of
nighttime urination and
bowel control is
accomplished
Parenting
In infancy, major responsibility is to meet the infants’
needs in a sensitive and consistent fashion
In the toddler stage, major responsibility is firmness
about boundaries of acceptable behavior and
encouragement of the child’s progressive emancipation
Other issue include the struggle for the exclusive
affection and attention of their parents
Preschool Period (2 ½ years – 6 years)
 Marked by physical and
emotional growth

 By 2-3 years of age,

children reach ½ their
adult height

 Mastered the primary task

of socialization
 Control bowel and urine
 Dress and feed themselves
 Control their tears and
temper outburst
Developmental Landmarks (Preschool)

LANGUAGE COGNITVE
 Language expands  Generally, still egocentric
thinking
 Use of sentences  Incapable of empathy

 Think intuitively and

prelogically
 Do not understand cause-
and-effect

 Begin to think symbolically

Developmental Landmarks (Preschool)

EMOTIONAL SOCIAL
 Can express complex  Emerging capacity for
emotions (love, cooperation and sharing
unhappiness, jealousy,
envy) both preverbally and  Aware of their bodies, of the
verbally genitalia, and of differences
between the sexes
 Anxiety is related to loss of
a person who was  Band-Aid Phase
loved/depended on and to
 Conscience is established
loss of
approval/acceptance  Rules as absolute
 Shame and humiliation are
 Absolute
evident
Retribution/Imminent Justice
Other Issues...
Sibling Rivalry
 Favoritism

Play
 Begin to distinguish reality from fantasy
 Pretend games, dramatic play are common
 Play behavior reflects their social development
 Growth can also be traced through their drawings

Imaginary Companions
 Usually appear during preschool, and in children with
above-average intelligence
 Disappear by age 12
Middle Years (6 years – 12 years)
 Enter elementary school

 Formal demands for

academic learning and
accomplishment become
major determinants of
further personality
development

 Psychosexual and
Psychosexual Moratorium
Developmental Landmarks (Middle Years)

LANGUAGE COGNITVE
 Can express complex ideas  Thinking is logical and
with relations among organized
several elements
 By age 9, ability to
concentrate is well
established

 Able to perform complex

motor tasks and activities
Developmental Landmarks (Middle Years)

EMOTIONAL SOCIAL
 Empathy and concern for  Peer interaction takes
others develop precedence

 Shyness or excitement with  Prefer to interact with the

the opposite sex same sex

 Identifies with the same sex

parent

 Chum Period
Other Issues...
Sex Role Development
 Sex roles are similar to their gender identity
 Independence, aggressiveness and physical play are
encouraged in boys while dependence, verbalization and
physical intimacy in girls
 Nowadays, society is more tolerant in its expectations of
the sexes, and roles become less rigid

Dreams and Sleep

 Somnambulism (sleepwalking)
Other Issues...
Birth Order by Frank Sulloway
 Firstborns
 Higher IQs
 Achievement oriented and most authoritarian
 Conservative and conformist
 Middle Children
 Usually receive the least attention in the home and may
develop strong peer relationships to compensate
 Youngest Children
 Receive too much attention and are spoiled
 Independent and rebellious with regards to family and cultural
norms
Other Issues...
Typing of Parenting

4 types according to Michael Rutter

1. Authoritarian - rigid and have strict rules
- leads to depressed children
2. Permissive - indulgent, no limit setting
- leads to poor impulse control
3. Indifferent - neglectful and lack of involvement
- aggressive behavior
4. Reciprocal - shared decision making with behavior
directed in a rational manner
- self reliant children
Adolescence (11/12 years – 20 years)
 Characterized by profound
biological, psychological
and social developmental
changes

 Rapid acceleration of
skeletal growth and
beginnings of physical
sexual development

 Consolidation of
personality formation
Puberty
Puberty is a physical process of change characterized by
the development of secondary sexual characteristics
(versus adolescence is psychological process of change)
Onset is triggered by the maturation of the HPAG axis
marked by secretion of sex steroids which produces the
manifestations of the primary and secondary sex
characteristics
Girls enter puberty 12 to 18 months earlier than boys
with an average of 11 years (range of 11-13) and 13
years for boys (range of 10-14)
Pubertal Stages

*** Study Table 2.4-1 of Kaplan Pubertal Stages

Psychosexual Development
Sex drive highest during adolescent

Masturbation, sexual behavior and experimentation are

common
Intellectualism and ascetism, 2 defense mechanisms
commonly used to deal with sexual drives
Hero worship, crushes and idealization of movie and
music stars are characteristic of this stage
Intellectualism and ascetism
Cognitive and Personality
Development
Thinking becomes abstract, conceptual and future
oriented
Major task is to achieve a secure sense of identity

Identity diffusion is a failure to develop a cohesive self

or self-awareness
Characterized by negativism
Development of Morals
Morality is defined as a conformity to shared standards,
rights, and duties
When two socially accepted standards conflict, a person
learns to make judgements based on an indivdualized
sense of conscience
Lawrence Kohlberg integrated Jean Piaget’s concepts
and described 3 major levels of morality
Kohlber’s Stages of
Moral Development
Other Issues...
Choice of Occupation

Risk-Taking Behavior
 Alcohol, tobacco, and other substance use
 Promiscuous sexual activity
 Accident-prone behavior

Pregnancy

Violence
Adulthood (20 years above)

 Longest phase of human

life

 Person is fully developed

and mature

 Period of peak potential for

personal fulfillment

 3 main parts:
 Young/Early (20-40 y.o.)
 Middle (40-65 y.o.)
 Late
Early Adulthood (20 years – 40 years)

Peak of biological development

Assumption of major social roles and the evolution of an

adult self and life structure
Explores options for occupation, marriage or alternative
rrelationships
Primary goal is to become autonomous and less
dependent on people and institutions
Middle Adulthood (40 years to 65 years)

Noon of life

Reviews the past, how life has gone and deciding what
the future will be like
Experiences the gap between early aspirations to
current achievements
Late Adulthood (65 years and above)

 Senescence or aging
process is characterized by
a gradual decline in the
functioning of all the
body’s systems

 Longevity

*** Study Table 2.6-1 Biological Changes Associated with Aging

Other Issues...
Social Activity

Ageism

Retirement

Sexual Activity

Psychiatric problems
 LOSS – predominant theme that characterizes the
emotional experiences of old people
Thanatology:
Death and Bereavement
 Thanatology is the study of
the experience of dying
and bereavement.

 Reactions to death may

depend if it’s a timely or
untimely death

 Elisabeth Kübler-Ross
enumerated 5 Stages of
reactions to impending
death
Grief, Mourning, and Bereavement
Terms that apply to psychological reactions to those
who survive a significant loss
Grief
 Subjective feeling precipitated by the death of a loved one

Mourning
 Process by which grief is resolved; it is the societal
expression of post-bereavement behavior and practices

Bereavement
 State of being deprived of someone by death
Grief
Normal Grief versus Pathological Grief

Grief Period

Childhood Grief Period

Anticipatory Grief