Definition/Introduction

Erikson’s Stages of Psychosocial Development is a theory introduced in the 1950s by the psychologist and psychoanalyst Erik Erikson. It built upon Freud’s theory of psychosexual development by drawing parallels in childhood stages while expanding it to include the influence of social dynamics as well as the extension of psychosocial development into adulthood.[1] It posits eight sequential stages of individual human development influenced by biological, psychological, and social factors throughout the lifespan. This bio-psychosocial approach has influenced several fields of study, including gerontology, personality development, identity formation, life cycle development, and more.[2][3]

Issues of Concern

Function

Stages arise as individuals grow and face new decisions and turning points during childhood, adolescence, and adulthood. Each stage is defined by two opposing psychological tendencies – one positive/syntactic and negative/dystonic. From this develops an ego virtue/strength or maldevelopment, respectively. If the virtue is adopted, it can help to resolve the current decision or conflict. It will also help subsequent stages of development and contribute to a stable foundation for core belief systems in relating to the self and the outer world.[3] The opposite is true with the adoption of the maldeveloped quality.

As an example, the ego identity crystallizes in stage 5, during adolescence. The two opposing qualities are ego identity and confusion/diffusion. Those who develop ego identity yield the virtue of fidelity, while the inability to do so – ego confusion – creates a quality of repudiation. With a stronger sense of ego identity, the interaction with the outer and inner world is of rejecting incongruent evaluations of self and a decreased level of anxiety, respectively.[4]

While adopting the syntonic attribute is clearly beneficial in this example, doing so should be done within reason. Extreme ego identity can become fanaticism, which can create unhealthy interactions with the self and others. One must navigate the two opposing values in each stage to find a balance, instead of only striving for the positive quality. Straying too far towards the positive tendency can be maladaptive, while leaning too far toward the negative can be malignant.[3]

Components 

Some scholars have attempted to confine stages to specific ages, but Erikson did not initially define this. Instead, there are periods within childhood, adolescence, and adulthood. Each stage provides an example in which the positive attribute may be furthered.

Stages of Childhood

Stage 1 – Infancy period: Trust vs. Mistrust

• Virtue: Hope, Maldevelopment: Withdrawal
• Concomitant Freudian stage: oral stage
• Example: Secure environment provided by the caregiver, with regular access to affection and food

Stage 2 – Early Childhood period: Autonomy vs. Shame, doubt

• Virtue: Will, Maldevelopment: Compulsion
• Concomitant Freudian stage: anal stage
• Example: Caregiver promotes self-sufficiency while maintaining a secure environment

Stage 3 – Play Age period: Initiative vs. Guilt

• Virtue: Purpose, Maldevelopment: Inhibition
• Concomitant Freudian stage: genital stage
• Example: Caregiver encourages, supports, and guides the child’s own initiatives and interests

Stage 4 – School Age period: Industry vs. Inferiority

• Virtue: Competence, Maldevelopment: Inertia (passivity)
• Concomitant Freudian stage: latency stage
• Example: Reasonable expectations set in school and at home, with praise for their accomplishments

Stage of Adolescence

Stage 5 – Adolescence period: Identity vs. Identity confusion

• Virtue: Fidelity, Maldevelopment: Repudiation
• Example: Individual weighs out their previous experiences, societal expectations, and their aspirations in establishing values and ‘finding themselves.’

Stages of Adulthood 

Stage 6 – Young Adulthood period: Intimacy vs. Isolation

• Virtue: Love, Maldevelopment: Distantiation
• Example: Individual forms close friendships or long-term partnership

Stage 7 – Adulthood period: Generativity vs. Stagnation/Self-absorption

• Virtue: Care, Maldevelopment: Rejectivity
• Example: Engagement with the next generation through parenting, coaching, or teaching

Stage 8 – Old Age period: Integrity vs. Despair

• Virtue: Wisdom, Maldevelopment: Disdain  
• Example: Contemplation and acknowledgment of personal life accomplishments

A ninth stage was added by Erik Erikson’s wife, Joan Erikson. It considers new challenges experienced with continued aging and incorporates aspects from all previous eight stages of psychosocial development.

The sequential layout of Erikson’s Stages of Psychosocial Development might initially suggest that stage outcomes become fixed once the next stage is engaged. While there is a fixed sequence, resolution can be a life-long process, re-activated at various times depending on life events that affect the ego strength or maldeveloped belief pattern.[5] Resolution is not required to move on to the next stage. Additionally, with advancement to a new stage, preceding stages are questioned and must be reintegrated.[6] This is why his theory is sometimes referred to as an ‘epigenetic principle.’ Additional research suggests that the latter four stages are, to an extent, a repetition of previous stages.[7] As an example, the stage of intimacy can be considered a combination of autonomy and trust. Thus, the developmental stages and formation of identity is an ever-evolving process, as opposed to a rigid concrete system.

Clinical Significance

Several clinical tools and further research have emanated from and have undergone significant influence by Erikson’s Stages of Development:

1. Studying Erikson’s stages serve as a basis of treatment for different recovery stages of mental illness.[8] For example, the initial stage of trust vs. mistrust parallels the mental illness recovery stage concerning the acceptance of the mental illness and trusting the idea of recovery.
2. The Erikson Psychosocial Stage Inventory (EPSI) was based on Erikson’s stages, and the modified version following it (MEPSI) is a reliable tool used to assess psychosocial development.[9][10]
3. A model of psychodynamic psychotherapy is based on the concept and staging of Erikson’s theory.[3]

Nursing, Allied Health, and Interprofessional Team Interventions

Erikson's Stages of Psychosocial Development can be utilized by mental health providers when treating patients who are facing periods of adjustment or turning points in life. When taken in the appropriate context to social and cultural factors, it can be a means for the patient to augment awareness and understanding of themselves. While many stages focus on periods early in life, it can serve as a conceptual and possibly actionable guide for those later in life as well.[11] This area continues to be an active focus of research, as Erickson's developmental maturity in mid-life is studied alongside global cognitive and executive function, as well as emotional health.[12]

This research was supported (in whole or part) by HCA Healthcare and/or an HCA Healthcare affiliated entity. The views expressed in this publication represent those of the author(s) and do not necessarily represent the official views of HCA Healthcare or any of its affiliated entities.