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
EMOTIONAL
 Development is at parallel
with cognition
 Importance of the
caretaker as he/she
provides the major stimulus
for both mental and
emotional growth
 Regular and predictable
interaction between
infants’ behavioral
repertoire and caretakers’
social responses
(Infancy)
SOCIAL
 At 3 weeks, Imitates facial
movements of adult
caretakers
 At 2 months, endogenous
smiling
 At 4 months, exogenous
smiling
***Study Table 2.3-1 and 2.3- 3 of
Kaplan, Landmarks of Normal
Behavioral Development and
Language Development
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.)
 Babies exposed to only one
caretaker are more likely
to have stranger anxiety
a theory to describe hw
young children acquire a
sense of identity
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
EMOTIONAL
 Exploratory excitement,
assertive pleasure,
pleasure in discovery and in
developing new behavior
(Toddler)
SOCIAL
 Has capacities for an
organized demonstration of
love (hugging, smiling,
kissing) and protest (crying,
banging, biting, kicking)
Developmental Landmarks
SEXUAL
DEVELOPMENT
 At 2 ½ years, gender
identity (the conviction of
being a boy or a girl)
becomes fixed
(Toddler)
SPHINCTER CONTROL
and SLEEP
 Toilet training is started
 At 2 ½ years old, control of
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
EMOTIONAL
 Can express complex
emotions (love,
unhappiness, jealousy,
envy) both preverbally and
verbally
 Anxiety is related to loss of
a person who was
loved/depended on and to
loss of
approval/acceptance
 Shame and humiliation are
evident
(Preschool)
SOCIAL
 Emerging capacity for
cooperation and sharing
 Aware of their bodies, of the
genitalia, and of differences
between the sexes
 Band-Aid Phase
 Conscience is established
 Rules as absolute
 Absolute
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