Stages of Personality Development

Freud’s Psychosexual Development
0 – 18 mo	Oral	Oral gratification
18 mo – 3 yr	Anal	Independence and control (voluntary sphincter control)
3 – 6 yr	Phallic	Genital focus
6 – 12 yr	Latency	Repressed sexuality; channeled sexual drives (sports)
13 – 20 yr	Genital	Puberty with sexual interest in opposite sex

Sullivan’s Interpersonal Theory
0 – 18 mo	Infancy	Anxiety reduction via oral gratification
18 mo – 6 yr	Childhood	Delay in gratification
6 – 9 yr	Juvenile	Satisfying peer relationships
9 – 12 yr	Preadolescence	Satisfying same-sex relationships
12 – 14 yr	Early adolescence	Satisfying opposite-sex relationships
14 – 21 yr	Late adolescence	Lasting intimate opposite sex relationship

Erikson’s Psychosocial Theory
0 – 18 mo	Trust vs. mistrust	Basic trust in mother figure & generalizes
18 mo – 3 yr	Autonomy vs. shame/doubt	Self-control/independence
3 – 6 yr	Initiative vs. guilt	Initiate and direct own activities
6 – 12 yr	Industry vs. inferiority	Self-confidence through successful performance and recognition
12 – 20 yr	Identity vs. role confusion	Task integration from previous stages; secure sense of self
20 – 30 yr	Intimacy vs. isolation	Form a lasting relationship or commitment
30 – 65 yr	Generativity vs. stagnation	Achieve life’s goals; consider future generations
65 yr - death	Ego integrity vs. despair	Life review with meaning from both positives and negatives; positive selfworth

  

Mahler’s Theory of Object Relations
0 – 1 mo	1. Normal autism	Basic needs fulfillment (for survival)
1 mo – 5 mo	2. Symbiosis 3. Separation – individuation	Awareness of external fulfillment source
5 mo – 10 mo	– Differentiation	Commencement of separateness from mother figure
10 mo – 16 mo	– Practicing	Locomotor independence; awareness of separateness of self
16 mo – 24 mo	– Rapprochement	Acute separateness awareness; seeks emotional refueling from mother figure
24 mo – 36 mo	– Consolidation	Established sense of separateness; internalizes sustained image of loved person/object when out of sight; separation anxiety resolution

  

Pepleu’s Interpersonal Theory
Infant	Depending on others	Learning ways to communicate with primary caregiver for meeting comfort needs
Toddler	Delaying satisfaction	Some delay in self-gratification to please others
Early Childhood	Self-identification	Acquisition of appropriate roles and behaviors through perception of others’ expectations of self
Late Childhood	Participation skills	Competition, compromise, cooperation skills acquisition; sense of one’s place in the world

Mental Health and Mental Illness: Basics - 2

Theories of Personality Development

Psychoanalytic Theory

Sigmund Freud, who introduced us to the Oedipus complex, hysteria, free association, and dream interpretation, is considered the “Father of Psychiatry.” He was concerned with both the dynamics and structure of the psyche. He divided the personality into three parts:

• Id – The id developed out of Freud’s concept of the pleasure principle. The id comprises primitive, instinctual drives (hunger, sex, aggression). The id says, “I want.”
• Ego – It is the ego, or rational mind, that is called upon to control the instinctual impulses of the self-indulgent id. The ego says, “I think/I evaluate.”
• Superego – The superego is the conscience of the psyche and monitors the ego. The superego says “I should/I ought.” (Hunt 1994) 

Topographic Model of the Mind

Freud’s topographic model deals with levels of awareness and is divided into three categories:

• Unconscious mind – All mental content and memories outside of conscious awareness; becomes conscious through the preconscious mind.
• Preconscious mind – Not within the conscious mind but can more easily be brought to conscious awareness (repressive function of instinctual desires or undesirable memories). Reaches consciousness through word linkage.
• Conscious mind – All content and memories immediately available and within conscious awareness. Of lesser importance to psychoanalysts.

Mental Health and Mental Illness: Basics - 1

General Adaptation Syndrome (Stress-Adaptation Syndrome)

Hans Selye (1976) divided his stress syndrome into three stages and, in doing so, pointed out the seriousness of prolonged stress on the body and the need for identification and intervention.

• Alarm stage – This is the immediate physiological (fight or flight) response to a threat or perceived threat.
• Resistance – If the stress continues, the body adapts to the levels of stress and attempts to return to homeostasis.
• Exhaustion – With prolonged exposure and adaptation, the body eventually becomes depleted. There are no more reserves to draw upon, and serious illness may now develop (e.g., hypertension, mental disorders, cancer). Selye teaches us that without intervention, even death is a possibility at this stage.

CLINICAL PEARL: Identification and treatment of chronic, post-traumatic stress disorder (PTSD) and unresolved grief, including multiple (compounding) losses, are critical in an attempt to prevent serious illness and improve quality of life.

Fight-or-Flight Response

In the fight-or-flight response, if a person is presented with a stressful situation (danger), a physiological response (sympathetic nervous system) activates the adrenal glands and cardiovascular system, allowing a person to rapidly adjust to the need to fight or flee a situation.

• Such physiological response is beneficial in the short term: for instance, in an emergency situation.
• However, with ongoing, chronic psychological stressors, a personcontinues to experience the same physiological response as if there were a real danger, which eventually physically and emotionally depletes the body.

Diathesis-Stress Model

The diathesis-stress model views behavior as the result of genetic and biological factors. A genetic predisposition results in a mental disorder (e.g., mood disorder or schizophrenia) when precipitated by environmental factors.

Posttraumatic Stress Disorder

Posttraumatic Stress Disorder (PSD) is defined as an experiencing of a traumatic event in either daytime reveries or dreams. Natural and / or mad-mad disaster are usually the stress experiences.

Symptoms:
The symptoms of Posttraumatic Stress Disorder are likely same as anxiety, depression and organic mental disorder. Assess the following symptoms when caring of posttraumatic stress disorder patients:

• Substance abuse
• Headache
• Memory (attention deficit)
• Pain

Beside of symptoms I mentioned above, psychosocial and cultural of the client should be assess too.

• Feeling of detachment and guilt
• Inability to feel emotions
• Impulsive behavior
• Anxiety of depression
• Nightmares
• Emotional lability
• Acting out, reliving traumatic experience

Planning:

• Safe and effective care environment
• Physiological integrity (to reduce or eliminate physiological symptoms of stress)
• Psychosocial integrity

Implementation:
There are four stages of implementation regarding Posttraumatic Stress Disorder patients:

1. Recovery: to assist patient to realize that he/she is safe
2. Avoidance: to provide support while patient attempts to suppress thought of traumatic experiences
3. Adjustment: to assist patient to alter environment if needed.

Abnormal Motor Behaviors

Abnormal motor behaviors are activities displayed by the mentally ill patient and occur as a result of a psychiatric disorder.

There are types of abnormal motor behaviors as I mention here:

Akathisia

• Displaying motor restlessness and muscular quivering
• Patient is unable to sit or lie quietly

Echolalia
Repeating the speech of another person

Echopraxia
Repeating movement of another person

Parkinson-like Symptoms
Making masklike faces, drolling, and having shuffling gait, tremors, and muscular rigidity

Waxy Flexibility
Having one’s arm or legs place in a certain position and holding that same position for hours

Dyskinesia
Impairment of the power of voluntary movement

Abuse and Neglect: Shaken Baby Syndrome

Shaken baby syndrome (SBS) is a form of physical abuse that mostly caused by rigorous shaking. There are three risk factors of shaken baby syndrome: gender, financial stress, and mental-health problems.


Sign and Symptoms:

• Poor feeding
• Bulging fontanels
• Lethargy
• Seizures
• Apnea
• Retinal detachment

Nursing Interventions:
Assure and teach parent about age-appropriate play of the infants that will not cause injuries

Abuse and Neglect: Child Abuse

Signs of Physical Child Abuse:

• Unexplained bruise or welts
• Unexplained burns
• Unexplained fractures (multiple or in various stages of healing)
• Unexplained lacerations or abrasions (mouth, eyes, and external genitalia)
• Expresses fear of going home
• Appears frightened of parents
• Reports of being injured by parents
• Exhibits extreme aggressiveness or withdrawal
• Acts wary of contact with adults
• Becomes apprehensive when other children cry

Signs of Physical Child Neglect:

• Inappropriate dress
• Always hungry
• Poor hygiene
• Uncared for medical or physical problems
• Begging or stealing food
• Abandonment
• Early arrival and late departure from school
• Fatigue
• Listlessness
• Reports lack of a caretaker
• Delinquency

Why the parent becomes an abusive parent? Here are the risk factors that parent become an abuser:

1. Under significant stress
2. Abused as a child
3. Deficient in social and financial resources
4. Lack of impulse control
5. Uses inappropriate coping skills
6. Anger and hostility
7. Ambivalent toward parenthood
8. Mental illness
9. Marital problems
10. Lack of knowledge regarding children development
11. Substance abuser

Nursing Interventions:

• Assess the patient, family, and significant others about the signs of an impending crisis and effective problem solving techniques to manage crisis
• Assess the patient, family, and significant others about the signs of abuse and neglect, and to access help immediately if abuse or neglect are suspected
• Assess caregivers about coping strategies to prevent abuse and neglect