Definition/Introduction

Freud's developmental theory on psychosexual development was among the first attempts to bring psychology under the same scientific structure and methodology of medicine. This unification was accomplished by first defining normative human sexual development. Freud organized psychosexual maturation into 5 distinct phases. Each stage symbolizes the concentration of the libido or instincts on a different area of the body (i.e., erogenous zones). In order to mature into a well-functioning adult, one must progress sequentially through each of the aforementioned psychosexual stages. When libidinal drives are repressed or unable to be appropriately discharged, the child is left wanting and unsatisfied. Freud identified this dissatisfaction as fixation. Fixation at any stage would produce anxiety, persisting into adulthood as neurosis. This dynamic formed the foundational bedrock for Freud's psychoanalytic sexual drive theory.[1] 

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 to Freud have argued that neuroses can develop independently without the need of 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

Each of the five 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 not available, 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 to be reprimanded, to feel 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 now begins to act on their impulses indirectly by focusing on activities such as 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 their independence. Their ability to create meaningful and lasting relationships is concrete, and their sexual desires and activity are healthy and consensual. If a child or young adult experiences dysfunction during this period, they will be unable to develop meaningful healthy relationships.[2]

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

The id is the instinctual aspect of the psyche, consisting of the sexual and aggressive drives. It is essentially the biological, instinctual, unconscious drive of the individual 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 is the decision-making aspect of personality. In contradiction to the id, which operates by way of the pleasure principle and immediate gratification, the ego operates by way of the reality principle, seeking satisfaction via practical strategies. The ego ultimately mediates the interaction between the id and the "real" world. It is rational by nature, whereas the id is irrational.[4][5] 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 with the ongoing practice of caring for the patient.[10] [Level 5]