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Psychosexual stages of development among persons with disabilities.

Poster · April 2016

DOI: 10.13140/RG.2.2.21232.87047

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Freud’s Psychosexual
Stages of Development
The Impact Psycho-sexual
Oral (0-2) — Sexual gratification
experienced through mouth. Since mouth is
Freud’s model suggests that sexual
instincts often conflicts with social Stages of
expectations, therefore, each of the
important for physical survival (eating &
drinking), it becomes the source of pleasure
psychosexual stages is associated with
certain defense mechanisms (Smart,
Development
& pain. 2012).

among People
Anal (2+) - Focus on anus as the most Even higher among people with
sexualized part of body, concept of control
and creativity; becoming aware of and
disabilities, where sexuality is often
considered a taboo (Williams, 2014). As
with Disabilities.
satisfying the demands of society & culture. such, higher level of defense
Raghav Suri, M.A., Psy.M.
mechanisms and intra-psychic conflict

Phallic (3+) - Heightened genital sensitivity

and self-stimulation. Competing internal The intra-psychic conflict often manifests
struggles of needing sexual satisfaction, but in the form of shame, isolation and
understanding that it’s not socially limited understanding of their own Sexuality is a crucial part of human
acceptable. Internalizing parents’ values and sexuality and sexual development - leads existence and development.
morals. to:
Human sexuality encompasses the sexual
knowledge, beliefs, attitudes, values and
Latent (7 to puberty) - Ego matures and Understanding of intimacy and behaviors of individuals.
suppresses the desire for sexual stimulation. sexuality primarily from an able-bodied The most commonly referenced model of
Focus on developing social, emotional and perspective.
psychosexual development is Sigmund
Freud’s 5-phase model. However, the model
cognitive aspects of relating.
Greater likelihood of being sexually was based on able-bodied perspective and
abused and assaulted.
does not take congenital or acquired
Genital (Puberty+) - Goal of sexual maturity,
disabilities into account.
to develop sexual relationships, shift of
Lower self-confidence, which in turn is This poster focuses on integration of Frued’s
focus from the family of origin to other
likely to increase psychologically- model of psychosexual development and
relationships; attempts at developing and the disability identity development model,
based sexual difficulties and reduced
maintaining long-term sexual partner(s). based on the current literature and
sexual satisfaction.

research. Additionally,

 Higher chances of coming in contact
with sexually-transited infections (STIs) The aim of the presentation is:
due to limited safe-sex practices.
to take the first steps in
Freud suggests that Fixations can understanding psycho-sexual
Can lead to a feeling of “yet another development from a perspective
lead to difficulties in forming loving, that embodies all levels and
failure” based on individual’s stage of
sexual relationships with others. disability identity development. aspects of abilities/disabilities.
Limitations of the model Other suggested implications

Based on “able-bodied’ perspective. Does not take (Medical/Sin perspective)

congenital or early acquired disabilities into consideration.

Adapted from Stebnicki & Marini (2012)

The sequential stages of development model has limited
applicability to many types of disabilities (Heller & Harris, Requirements of mourning - Grieving the loss of a body part or functioning

2012).

Widely disregard by the field and empirical studies.

The theory is criticized for being ‘sexist’ and culturally

biased.
Attempts of denial or rejection of “suffering” by a person with disability is met
with negative attitudes due to differing world views (and need to protect the
Limits the role of psychosocial factors in sexual
self).

development.

The model aligns closely with biomedical view of disability The importance of sight in Freud’s model (desire to be looked at and to look at
rather than the sociopolitical model (Smart, 2012).
others during early psychosexual stages) can be understood in terms of

Secure attachment.**

Application of the theory:

Attention to sexual development of the child.**

The use of defense mechanisms, such as denial or alteration

of stressful realities, such as disability (Livneh & Cook, 2005).
Unresolved conflict can result in approach/fascination-avoidance/repulsion
Denial of disability, denial of implications, or denial of conflict.

permanence? (Smart, 2012)

Generalization of one perceived characteristic (physical disability) to an unrelated

Difference between congenital and acquired disabilities?

characteristic (sexual functioning)

Significance of individual’s body image - impact on self-

concept and personal identity
Establishing a perspective of altered abilities instead of dis-ability.**

Observation and internalization of an ideal body image

starts during early stages of development.
Aesthetic-sexual aversion - discomfort experienced by able-bodied individuals
Personality and sexual differences in abilities become when come in contact with PWDs due to internalized aesthetic standards as well
prominent during the adolescent years.
as fear of social ostracism.

Importance of early stages of development

Discrimination and oppression

Sensitive periods in adjustment and development

Internalization by PWDs based on their individual disability identity
Need for secure attachment.
development stage.

Need for education and modeling.

Understanding how altered abilities manifest differently in An attitude of openness is crucial for adolescents and adults to verbalize their
sexual performances (changing the able-bodied sexual thinking, beliefs and appropriate expressions.

perspective of sexuality). ** Suggestions of the presenter (R. Suri)

 Psychosexual development and functioning among The Recognition Model: A
individuals with Chronic medical illness new sexual health model
for disability
Lock’s Phases of Psychosexual Development (2011) Couldlrick, Sadlo & Cross (2010)
Suggests 3 Phases of psycho-sexual development among adolescents with chronic medical illness,
aligning with the 3 stages of adolescence. • Model is presented for the Health and
Early Phase (11-13 years) social care professionals working with
Most significant sexual issues concerned with the changing body (puberty): Attractiveness, body size, and disabled people.

maturational rate; impacts self-esteem and body image.

Different impact based on gender and disability in most cultures.

• Based on increasingly recognition of the
Chronic medical illness and disabilities can impact the nature of pubertal development, timing, and importance of holistic practice that
developmental rate. Most importantly, it can impact the attention to sexual development of the encompasses the sexual health needs of
adolescent.** service users. Developed on evidence
Education: Clinicians and care-givers should closely work to address anxieties associated with this stage.

from an extensive research.

Therapy: To process behavioral limitations of their sexual lives, sexual dilemmas and pubertal issues.

• At its core is the recognition of disabled

Middle Phase (14-16 years)
Sexual issues as they relate to relationships. Includes dating, competence, attention to sexual orientation people as having sexual desires and
and exploratory sexual experiences.
needs like anyone else.

Often associated with guilt due to separation from family and changing relational dynamics. This can impact
PWDs in a number of ways, depending on their disabilities and perceived sense of independence.
• It takes a team approach to protect and
Impediments to peer relationships may lead to sexual problems. For PWDs, it can further strengthen the support the sexual health of service
“limited sexual abilities” self-concept.
users.

Allowing the sexual socialization to take place.

Support in the process of moving away from the family of origin to explore the social world of peers.
• It draws on existing skills within the
Clinicians should focus on tracking and educating regarding the adolescent’s psychosexual development. team, and depends on every team
member, regardless of role.

Late Phase (17-19 years)

Involves deeper interpersonal intimacy - increasing need for emotional and sexual intimacy, fewer needs • Emphasizes on positively responding to
for a familial base.
direct or indirect questions asked by the
For PWDs, there can be concern around decreased life-span, fertility, anxiety about dependency on
service user, thereby affirming the
partner(s), and potential for genetic transmission of disability/disorder to their offsprings.

Therapy: To process the guilt, concerns and fears of being emotionally intimate with another person.
relevance and priority he or she may
The clinicians should expect that these issues will complicate sexual relationships and behaviors.
attach to sexual expression

Special attention should be paid to cultural differences.

 Psychosexual Psychosexual Psychosexual
development and development and development and
functioning functioning functioning
Among individuals with Learning Among individuals with Prader-Will Within neurological rehabilitation
Disability (LD) Syndrome (PWS) settings
• Incidents of sexual offending is 4-6 Greenswag (1988) emphasizes the Glass (2009) states that cultural and
times higher among individuals with discussion of sexual desires and need social taboos limits the opportunities
learning disabilities (Barron et al., 2002).
for expression among cognitively for expression of sexual needs, despite
impaired and sexually immature the availability of physical therapy for
• Higher risk of recurrence (Barron et al.,
adolescents/adults with PWS.
functional loss.

2002).

Among individuals with Congenital Suggests an adoption of supportive

• Due to lack of sexual knowledge; limited
Physical Disabilities therapies with a focus on functional
to no sexual education (Galea et al., abilities for individuals recovering from
2004; Boucher, 2014).
• Brown (2009) suggests that fostering spinal injury, multiple sclerosis, lower
Emphasizing the role of psychosocial self-esteem and a positive sexual motor neurone difficulties and spina
identity
bifida.

factors in psychosexual development

among people with disabilities.**
Likely to reduce the sexual hesitation
and limitations

Emphasis of education and Family, peers, educators and health Specific Aspects of PWD’s
modeling.**
care providers play a crucial role in the Psychosexual Development
process.
(Strax,1991)
Clinical assessments should take
environmental and psychosocial factors Among individuals with “Reasons for a prolonged adolescence
into consideration (Boucher, 2014).
among PWD:
Developmental Disabilities
Person’s own interpretation of sexuality The disabled individual has been
• Weller (2013): Often treated in a child-
must be fostered through education, overprotected and sheltered.

like manner; may impact self-

exposure, modeling and openness from
perception. Studied 26 adults
Individuals experience with peers is
an early age.**
• 73% identified as adults

limited.

• 27% self-identified as children

** Suggestions of the presenter (R. Suri)
Dearth of appropriate role models.”
 References

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