Elmeida Effendy

Psychiatric Department

Child is not a mini size measure

adult

 What s the difference between child and

adult ?

Elementary differences
Child :
have the character of egocentricly, everything
evaluated by the child pursuant to importance
of himself
sexual apparatus hadnt been formed finely;
event that had the sexual character will be
interpreted as something that have the
pregenital character
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 < 7 years old : not yet thinking pursuant to

causality; baby cant differentiate himself &

things coming from the outside
dont have the concept concerning time, childs

behaviour especially influenced by instinctual

motivation; if id is more dominant, child
determined by fulfilled immediately of his
satisfaction (fulfilled by demand of instinctual
motivation)

Differences between Child &

Adolescent Psychiatry and Adult
Psychiatry
1.Child not yet ready :
to express his suffered trouble or problem
to give good & directional information for
referring to his past
2. Child express his emotional difficulty

through his behaviour

difficulty in
giving food, sleep, urination/defecation ;
behaviour problem, emotional or somatic
symptoms
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 3.Childs personality s

influenced
by environmental factor; existence of the
change in environment or family will result
in child experienced a larger changes again
himself
4. Child express his feeling & fantasy
through games or by playing
5. If the obtained symptom come from
environment or family, the involved family
member better engaged
family
therapy or environmental manipulation
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 In facing child with psychiatric disorder we

must pay attention to :

1.Parent-child relationship; role of parents &

emotional atmosphere
influence in
forming personality, especially below 5-6 years
old
2.Child step by step performs the forming of
personality to adult personality by elements
since he was born & environmental situation
plays a part in growth & maturation of later

personality

 3. Child is not a white piece of paper/ tabula

rasa (Johns Locke concept), which quiescently

accept the character formulation processed by
his parents. Child give active contribution in
forming his character
4.Inharmonious relationship between his
parents
the child experience

mental disorders
* Child & adolescent psychiatry
psychiatry

family
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Child Development
Born with intrinsic factor :ability & potency

boundary

the nature experienced changes by

interaction with environmental factor

( representing extrinsic factor)
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 Intrinsic factor : hetero constitutional &

represent the matrix for the childs

development in the future
Extrinsic factor : influence the adjustment

& development of child

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Extrinsic factors that plays a role

Attitude & attention of the parents
Emotional atmosphere in the family
Norm & ethics in the family
Religious life in the family
Social economy level
Parents educational level

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Theories of Personality &

Psychopathology
Sigmund Freud
Topographical Model of the Mind
Structural Theory of the Mind
Psychosexual Development
Erik Erikson
Psychosocial Development
Jean Piaget
Psychocognitive Developmnet
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 Jerschildt
Psycho affective Development
Stella Chess
Psychomotor Development

Kohlberg
Moral Development

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Topographical Model of the Mind

Freud divided the mind into 3 regions:
1. The Conscious System
2. The Preconscious System
3. The Unconscious System

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 1. The Conscious System

Perceptions coming from the outside world or

from within the body or mind are brought into

awareness
Consciousness : a subjective phenomenon
whose content can be communicated only by
means language or behaviour

Conscious

attention cathexis
Preconscious
hypercathexis
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 2.The Preconscious System

Comprises: mental events, processes & contents
that can be brought into conscious awareness
by the act of focusing attention
Interfaces with unconscious & conscious
regions of the mind
To reach conscious awareness: contents of the
unconscious must become linked with words &
become preconscious
Serves
to maintain the repressive barrier
to censor unacceptable wishes & desires
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 3. The Unconscious System

Dynamic
Mental contents & processes are kept from

conscious awareness through the force of

censorship or repression
Closely related to instinctual drives
Limited to wishes seeking fulfillment
Characterized by primary process thinking,
which is principally aimed at facilitating
wish fulfillment & instinctual discharge
(pleasure principal)
Consists of id, ego, superego

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Preconscious

Unconscious

censors are over powered

Conscious

elements

can enter consciousness

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Structural Theory of the Mind

CONSCIOUS

Id

SUPEREGO
CONSCIOUS

EGO
UNCONSCIOUS

UNCONSCIOUS

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Structural Theory of the Mind

ID

SUPEREGO
EGO

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 1.Id
reservoir of unorganized instinctual

drives
primary process thinking
pleasure principal

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 2. Ego
spans all 3 topographical dimensions
of conscious, preconscious &
unconscious
Executive organ of the psyche &
controls motility, perception, contact
with reality
Reality principle
secondary
process thinking
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 3. Superego
Moral conscience: ideals & values internalized
from parents
Children internalized parental values &
standards at 5-6 years old
Ego ideal : what a person should do &
shouldnt do
Through out the latency period , children
continue to build on early identifications
through air contact with admired figures,
formation of moral standards, aspirations &
ideals
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Stages of Psychosexual
Development
Oral stage : birth- 18 months
Anal stage : 18-36 months
Urethral stage
Phallic stage : 3-5 years
Latency stage : 5-6 years-11-13 years
Genital stage : 11-13 years-reaches young

adulthood
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 Oral stage : birth:-18 months

Centers on the mouth, lips, tongue
Oral sensations : thirst, hunger, pleasurable

tactile stimulations evoked by the nipple or

its substitute
Oral triad : eat, sleep, relaxation
Oral drives :
Libidinal (oral erotism) >> early part s of
oral phase
Aggressive (oral sadism): biting, chewing,
spitting, crying, destroying
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 Objectives
to establish
a trusting dependence on nursing & sustaining

objects
comfortable expression & gratification of oral
libidinal needs without excessive conflict or
ambivalence from oral sadistic wishes
Pathological traits : excessive optimism, narcissism,
pessimism, dependent, envy & jealousy
Character traits: capacities to
give & receive from others without dependence,
envy
rely on others with a sense of self-reliance & self
trust
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Anal Stage: 18-36 months

Maturation of neuromuscular control over sphincter
More voluntary control over retention or expulsion of

feces
Toilet training
Anal erotism : sexual pleasure in anal functioning:
retaining the precious feces & presenting them as a
precious gift to the parent
Ambivalence
Anal sadism : feces : powerful & destructive weapons

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 Objective : striving for independence & separation

from the dependence on & control by the parent

Pathological traits : orderliness ,obstinacy,

willfulness, stubbornness, frugality, messiness,

defiance, rage, sadomasochistic tendency
Character traits: personal autonomy, capacity for

independence & personal initiative without guilt,

self-determining without shame or self doubt, lack
ambivalence ,willing cooperation without
excessive willfulness or self diminution or defeat
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Urethral Stage

Transitional stage between anal & phallic

stage
Urethral erotism : pleasure in urination &
retention
Pathological trait s : competitiveness,
ambition, development of penis envy
Character traits : budding gender identity &
subsequent identifications

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Phallic stage : 3-5 years

Primary focus of sexual interests, stimulation &

excitement in genital area

Penis : female
evidence of castration
Genital masturbation
Oedipal wishes
Objectives: to focus erotic interest in genital area
& genital functioning, identification

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 Character traits:
foundations for an emerging sense of sexual
identity, sense of curiosity without
embarrassment, initiative without guilt
Regulation of drive impulses & direction to
constructive end
Internal source of regulation is superego; based
on identifications derived primarily from
parental figures

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Latency Stage : 5-6 years-11-13

years
Relative quiescence or inactivity of sexual

drive
Primarily homosexual affiliations for boys
& girls
Sublimation of libidinal & agressive
energies into learning, play activities,
exploring environment
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 Objectives:
further integration of oedipal identification
consolidation of sex-role identity & sex roles
mastery skills
Character traits
Essential basis for a mature adult life of

satisfaction in work & love

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Genital stage : 11-13years-reaches

young adulthood
Physiological maturation of systems of

genital functioning & attendant hormonal

systems
intensification of drives,
particularly libidinal drive

Regression in personality organization;

reopens conflicts of previous stages of

psychosexual development

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