# Situation: The nurse holds a mothers' class at a Rural Health Unit (RHU) on how infants and toddlers grow and develop. A mother asks what Freud taught about harsh or very early toilet training. According to Freud, fixation at that stage may later show in adulthood as which traits?

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> subject: Nursing Practice II — Maternal and Child Health Nursing

## 문제

Situation: The nurse holds a mothers' class at a Rural Health Unit (RHU) on how infants and toddlers grow and develop.

A mother asks what Freud taught about harsh or very early toilet training. According to Freud, fixation at that stage may later show in adulthood as which traits?

## 보기

1. Excessive orderliness and stubbornness **✔ 정답**
2. Difficulty with authority and gender roles
3. Shame and doubt about one's own abilities
4. Dependency, overeating, and smoking

**정답: 1**

## 해설

Toilet training belongs to Freud's anal stage (1 to 3 years). Fixation from harsh or conflict-filled training is linked to excessive orderliness, stubbornness, and stinginess, or the opposite, messiness. Shame and doubt is the negative outcome of Erikson's matching psychosocial stage, not a Freudian fixation; dependency and overeating come from oral fixation, and problems with authority and gender roles from the phallic stage.

## 심화 해설

Situation analysis

The question asks about Sigmund Freud’s psychosexual stage associated with toilet training and the adult traits that result from fixation at that stage. The mother in the RHU class is asking a developmental theory question, which is a common topic in maternal-child and psychiatric nursing content on licensure exams.

Core concept

Freud’s anal stage spans roughly 1 to 3 years of age. During this period, the child’s primary source of pleasure and conflict centers on bowel and bladder control. Toilet training becomes the key developmental task. The way caregivers handle this training—whether harsh, punitive, overly early, or excessively rigid—shapes how the child learns to manage impulses related to control, autonomy, and compliance.

Fixation at the anal stage occurs when toilet training is too strict, too early, or associated with excessive conflict and shame. The child may retain psychological energy tied to issues of control and orderliness. In adulthood, this fixation can manifest in two contrasting patterns. The first is the anal-retentive personality, characterized by excessive orderliness, stubbornness, rigidity, and stinginess. The second is the anal-expulsive pattern, which appears as messiness, disorganization, or defiance.

The correct answer, 1, describes the anal-retentive traits of excessive orderliness and stubbornness. These are the classic adult outcomes Freud associated with harsh or very early toilet training.

Why the other options are incorrect

| Option | Associated stage or theorist | Reason it does not fit |
| --- | --- | --- |
| 2 Difficulty with authority and gender roles | Freud’s phallic stage (3 to 6 years) | Conflicts in the phallic stage involve identification with the same-sex parent and resolution of the Oedipus or Electra complex, not toilet training. |
| 3 Shame and doubt about one’s own abilities | Erikson’s autonomy vs. shame and doubt stage (1 to 3 years) | This is a psychosocial outcome described by Erik Erikson, not a Freudian fixation. The age range overlaps with Freud’s anal stage, which is a common source of confusion on exams. |
| 4 Dependency, overeating, and smoking | Freud’s oral stage (birth to 1 year) | Fixation at the oral stage results from unmet or overindulged oral needs in infancy and leads to oral-dependent behaviors such as overeating, smoking, or excessive talking. |

Watch out! The age range for Freud’s anal stage and Erikson’s autonomy versus shame and doubt stage is the same—1 to 3 years—but the negative outcomes are different. Freud’s negative outcome is fixation leading to anal-retentive or anal-expulsive traits. Erikson’s negative outcome is shame and doubt. Licensure exams frequently test this distinction by placing Erikson’s outcome among the answer choices.

Clinical and theoretical context

Freud’s theory is a psychosexual developmental theory. It proposes that personality forms through a series of stages, each defined by a specific erogenous zone and a central conflict. Successful resolution allows the child to move to the next stage with healthy personality development. Unresolved conflict or excessive frustration at any stage leads to fixation, meaning psychic energy remains invested in that stage and influences adult behavior.

The anal stage is specifically about the conflict between the child’s desire for autonomy over bodily functions and the external demands of toilet training. Harsh, punitive, or prematurely imposed toilet training can create a lasting association between control and anxiety. The child may cope by over-controlling—becoming excessively neat, orderly, and obstinate—or by rebelling—becoming messy and disorganized. These patterns are not diagnostic categories but rather descriptive personality tendencies within Freudian theory.

The provided research literature supports the continued relevance of anal-stage concepts in clinical thinking. One study examined the relationship between functional constipation and anal-retentive behavior features, noting that defecation is learned during the childhood anal period and that problems in that period may affect both character and defecation function [1]. This reinforces the idea that early toilet training experiences can have lasting physiological and psychological correlates. Broader reviews of personality theories also describe Freud’s framework as foundational for understanding how early experiences shape relatively stable patterns of thinking, feeling, and behaving .

Key point! For nursing licensure exams, associate the following pairs: oral stage with dependency and oral habits; anal stage with orderliness, stubbornness, or messiness; phallic stage with gender identity and authority conflicts; latency stage with social skill development; and genital stage with mature intimacy.

Nursing application

When teaching a mothers’ class at an RHU, the nurse can use this Freudian concept to guide practical advice on toilet training. The theory suggests that toilet training should be developmentally appropriate, patient, and non-punitive. The child should show readiness signs—such as staying dry for longer periods, showing interest in the toilet, and being able to follow simple instructions—before training begins. Forcing toilet training too early or responding with harsh punishment can create anxiety and power struggles that may influence the child’s developing sense of control.

This aligns with the broader nursing goal of promoting healthy parent-child interaction during developmental transitions. While Freud’s theory is not used to diagnose adult personality disorders in clinical nursing practice, it provides a framework for understanding how early caregiving patterns can shape long-term behavioral tendencies. The nurse can use this understanding to educate parents about realistic expectations and positive reinforcement during toilet training.

The distinction between Freud’s anal fixation and Erikson’s shame and doubt is especially important in maternal-child nursing. Both theorists describe the same developmental window, but Freud focuses on psychosexual conflict and personality traits, while Erikson focuses on psychosocial crisis and self-concept. A mother who asks specifically about “Freud” is asking about fixation and adult personality traits, not about the child’s immediate emotional state.References (research sources)

- [1]Relationship between functional constipation and anal-retentive behavior features.Research articleYılmaz TU, Taş Hİ, Uçar E, Cerit C, Çelebi A, Güler SA, Utkan Z. (2019) · DOI: 10.5578/turkjsurg.4035

## 임상 시나리오

Toilet Training and Anal-Stage FixationFreud's Anal Stage in Adult Personality
Freud's anal stage spans 1 to 3 years. The key developmental task is toilet training, which centers on bowel and bladder control.

Harsh, punitive, or very early toilet training can lead to fixation. In adulthood, this may appear as the anal-retentive personality: excessive orderliness, stubbornness, rigidity, and stinginess.

The opposite pattern, anal-expulsive, may present as messiness, disorganization, or defiance.

CautionDo not confuse Freud's anal-stage fixation with Erikson's negative outcome of shame and doubt in the autonomy versus shame and doubt stage. Oral fixation produces dependency and overeating, while phallic-stage issues involve authority and gender roles.

## 핵심 개념

- **Anal stage** — Freud's psychosexual stage from about 1 to 3 years, when pleasure and conflict center on bowel and bladder control and toilet training.
- **Anal-retentive personality** — Adult pattern linked to harsh or overly early toilet training, characterized by excessive orderliness, stubbornness, rigidity, and stinginess.
- **Anal-expulsive pattern** — Opposite adult outcome of anal-stage fixation, appearing as messiness, disorganization, or defiance.
- **Fixation** — In Freudian theory, persistent psychological energy tied to an earlier psychosexual stage due to unresolved conflict.
- **Erikson's autonomy versus shame and doubt** — Psychosocial stage corresponding to toddlerhood, whose negative outcome is shame and doubt, not a Freudian fixation trait.

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