Freud's Developmental Theory

Issues of Concern

The primary tenet of Freudian psychosocial development revolves around the causal relationship between sexual conflict and the subsequent precipitant psychoneurosis. This principle has incited controversy since its inception. Opponents of Freud have argued that neuroses can develop independently without the need for a psychosexual impetus.[2] 

Experimenter bias is another common critique of Freud. Friedman and Downey, in their paper Biology and the Oedipus Complex, explore the likelihood that the Oedipal Complex is just mistaken evolutionary-based play behavior that manifests through competition.[3] Despite these areas of concern, psychoanalysis remains influential in contemporary mental health care.

Clinical Significance

Psychosexual Development Stages

Each of the 5 stages of Freudian psychosexual development theory is associated with a corresponding age range, erogenous body part, and clinical consequence of fixation.

Stage I: 0-1 year, oral, mouth

Oral desire is the center of pleasure for the newborn baby. The earliest attachment of a baby is to the one that provides gratification to his oral needs, usually his mother. If the optimal amount of stimulation is unavailable, libidinal energy fixates on the oral mode of gratification, resulting in subsequent latent aggressive or passive tendencies. 

Stage II: 1-3 years old, anal, bowel, and bladder

Toilet training is an especially sensitive task during this period. The parents' desire for adequate performance shifts the libidinal energy from the oral to the anal area. The child faces increased chances of being reprimanded, feeling inadequate, and an increased ability to perceive a negative evaluation from a caretaker if he fails to perform appropriately. Fixation at this stage can manifest in anal retentiveness (incessant orderliness) or anal expulsiveness (whimsical disorganization).

Stage III: 3-6 years old, phallic, genitalia

This is perhaps the most controversial stage of Freud's psychosexual development. This is the stage in which the child begins to experience pleasure associated with their genitalia. In this period of primitive sexual development, the child can establish the roots of fixation with the opposite sex parent, the Oedipus complex. 

Stage IV: 6 - 12 years old, latency, dormant sexual feelings

During this time, the libido is relatively repressed or sublimated. Freud did not identify any erogenous zone for this stage. The child begins to act on their impulses indirectly by focusing on school, sports, and building relationships. Dysfunction at this stage results in the child's inability to form healthy relationships as an adult.

Stage V: 13-18 years old, genital, mature sexual feelings

The child's ego becomes fully developed during this stage, and they are subsequently seeking independence. Their ability to create meaningful and lasting relationships is concrete, and their sexual desires and activities are healthy and consensual. If a child or young adult experiences dysfunction during this period, they are unable to develop meaningful healthy relationships.[2]

Structural Theory

One must address his structural theory of mind to explicate Freud's developmental theories. The latter suggests that the psyche (personality) encompasses three psychic structures: the id, ego, and superego. 

The id 

The id is the instinctual aspect of the psyche, consisting of sexual and aggressive drives. It is essentially the individual's biological, instinctual, unconscious drive as it is involved in gratification. A newborn's behavior is driven purely by innate instincts (id). As the child matures, the ego differentiates from the id.

The ego

The ego is the decision-making aspect of personality. In contradiction to the id, which operates by the pleasure principle and immediate gratification, the ego operates by the reality principle, seeking satisfaction via practical strategies. The ego mediates the interaction between the id and the "real" world. It is rational by nature, whereas the id is irrational.[4][5] 

The superego

The last psychic structure to develop is the superego, which incorporates the morals and values of society. This construct develops during the phallic stage and is analogous to one's moral compass.[4][6] These structures can help explain pathologic behavior and sources of anxiety. 

Freud's developmental theories form the basis for psychoanalysis and subsequent derivatives that make up contemporary psychotherapy.[7][8][9]

Nursing, Allied Health, and Interprofessional Team Interventions

One example of how dysfunction in Freud's psychosexual development can influence patient care is discussed in a 2008 paper that investigates the change of shift handover ritual between psychiatric nurses. The handover from one nursing shift to another fits all the criteria as a ritual as defined by psychoanalytic theory. This ritual is influenced by the nurse's anxieties and their resultant perception of the patient. It is suggested that the handover acts as a ritual through which the nurses can keep their anxieties manageable and continue caring for the patient.[10]