28 - Puberty trends

Puberty trends:

© SPMM Course 11. Adaptations in adolescence & adult life Adolescence is the period between childhood and adulthood and is described in many of the developmental models (Piaget – formal operational, Freud - genital stage, Erikson – identity vs. role confusion). Conflict with parents is common during this time due to developing a sense of self and autonomy. This could be attributed to a second separation-individuation phase. Anna Freud described affective instability as the oscillation between behavioural and affective excess and scarcity during adolescence induced by endocrine changes, sexual maturity and instability of ego defenses. Erikson described adolescent turmoil as a temporary maladaptive state that was due to identity diffusion. According to him all adolescents passed through this state. But later studies (Offer & Offer 1975) showed that while upheaval and turmoil are common in adolescence, they might not occur in all adolescents. Nearly 23% showed continuous linear development during adolescence, while 35% were late bloomers who were less introspective and had some frictions with their families. Around 21% had recurrent conflicts with their parents and chose less competitive careers. Marcia’s theory on adolescence: A mature self-identity is possible only if an individual experiences several crises, finally arriving at a stage of commitment. Successful maturation during adolescence depends on both the degree of crises faced and commitment achieved, with different levels of maturation as shown in the table below.

Degree of crises Degree of commitment

HIGH LOW HIGH Identity achievement Foreclosure LOW Moratorium Role confusion  Identity achievement: Most mature achievement – most desirable.  Foreclosure: Avoids anxieties by prematurely committing to safe and conventional parental and societal goals and beliefs.  Moratorium: Experiences height of crises but postpones decisions until alternative identities are tried.  Role confusion: a unresolved state of adolescence

Puberty trends:

© SPMM Course  In the UK the average age of onset of puberty in males is 11.2 years; for females it is 11 years. Menarche on average is at 12.5 years for females.  There is a general trend for falling in menarcheal age globally over last 50 years. Compared to US and other European countries this falling trend is smaller in UK (by about 6 months in 30 years).  Social stress is also a puberty accelerator, with familial disruption and father absenteeism, being one of the most effective stressors.  Precocious puberty is suspected in boys before age 9, and girls before age 8.

As children develop through adolescence into adulthood, they hold increasingly complex orientations to the self and to the interpersonal world. Jane Loevinger described 9 stages of ego and personal identity development involving childhood, adolescence and adulthood.

1. Presocial – the baby is unable to differentiate itself from the world
2. Impulsive – the child is concerned with bodily impulses
3. Self-protective – the child has a notion of blame but externalises to the situation or other people
4. Conformist – around school age, they conform to socially approved codes/the norm
5. Self-Aware – (conscientious-conformist) transitional stage – increased self-awareness and self-criticism; deepened interest in interpersonal relations
6. Conscientious – internalisation of rules is complete; goals/ideals are acknowledged, and there is a new responsibility – feel guilt for hurting others rather than rule-breaking
7. Individualistic – respect for individuality and interpersonal ties
8. Autonomous – ‘synthesizers’ – able to conceptually integrate ideas
9. Integrated – rarely attained stage “learning is understood as unavoidable…the unattainable is renounced.” Pairing occurs often within the same cultural and socioeconomic background (homogamous mate selection). Equity theory suggests that individuals consider the cost-benefit ratio for each person in a relationship; reinforcement theory suggests that individuals chose their partners on the basis of reinforcement of attraction with rewards. The midlife transition occurs around age 40 to 45. The term ‘Midlife Crisis’ was coined by Elliot Jacques who distinguished it as a critical phase in development as the transition between the forties and early sixties, and is often associated with coming to realise mortality, unrealized goals, menopause or children leaving home. Downshifting refers to voluntary opting out of a

© SPMM Course pressurized career and giving up well-paid job for more fulfilling life (anti-urbanism). Empty nest distress refers to the feeling of loneliness when children leave home. Bereavement is usually used to describe loss if a person, but can be loss of anything e.g. marriage, employment, and refers to being in a state of mourning (a process influenced by culture and society in which grief is resolved). The classic work on stages of grief came from Erich Lindemann, who studied 101 bereaved people and published in 1944; an article titled “Symptomology and Management of Acute Grief”. In this article he described a set pattern of reaction to a loss event (grief): After an unexpected death, there is the initial shock that lasts 10-14 days. After the initial shock comes a period of intense sadness, and the grieving person may withdraw from social contact. Next comes anger, as the grieving person seems to ‘protest’; the unexpected death. Finally, within a year or so, the grief is resolved, and the person returns to normal. These stages were further refined by Parkes. 5 stages of bereavement (Parkes)

1. Alarm
2. Numbness
3. Pining for the deceased (illusions or hallucinations of the deceased can occur)
4. Depression
5. Reorganisation (recovery) Physiological events such as pregnancy and childbirth could also be stressful in adult life. The psychological stress during pregnancy can have physiological implications on the growing fetus. Release of corticotrophin releasing hormone (CRH) from the placenta increases with stress, and with this an increased risk of intrauterine infection, preterm labour and low birth weight is seen. Pre-term infants are susceptible to complications later such as developmental delay and increased rate of mortality. Babies subject to stress in utero can have the difficult temperament and are irritable. There is additional data to suggest that stress in utero can result in increased risk of chronic health issues in adulthood e.g. hypertension and diabetes. Psychological symptoms following childbirth include intrusive thoughts, avoidance, anxiety, depression, social dysfunction and somatisation. Significant psychological distress is noted in 37% of mothers and 13% of fathers. Factors predicting acute maternal psychological distress included being a single parent, multiparity and previous traumatic birth. At six week and six months, psychological distress symptoms fell to that of general population level indicating that in most people, this is a short-term distress.