Frank W. Putnam’s research while affiliated with Microbiome Core Facility USA and other places

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Publications (216)


9. The Treatment of Multiple Personality: State of the Art
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December 2024

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2 Reads

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4 Citations

Frank W. Putnam



DISCRETE BEHAVIORAL STATES THEORY Discrete Behavioral States/States of Being

October 2024

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41 Reads

Discrete Behavioral States Theory (DBST) developed by Frank W. Putnam is a transtheoretical, translational rlieory of /11111c1oa1111s cious11eTshs.i s chapter focuses on DBST particularly as it relates to psychological trauma, dissociation and pomraumatic and dissociative disorders (DD). For a complete discussion of OBST see Putnam's book, Tlie Way We Are:H ow States of Nlind Ii,jfoence Our Ide11titicsP, ersonalitya, nd Pote11tialfoCr hange( 2016).1 OBST elucidates human experience and behavior across myriad normal and pathological domains. Discrete states of being (SoB) are so pervasive and ubiquitous as to be essentially invisible, unless they shift in dramatic, unexpected ways, and, even then, we usually do not conceptualize these changes in terms of behavioral states - although we use the word '·state" frequently. The "atheoretical" DSM-5 (American Psychiatric Association, 2013) uses the term "state/states·• over 100 times in describing psychiatric symptoms and disorders. DID diagnostic criteria are founded on the constructs of "identity state" and "personality state," in the DSM-IV-TR and DSM-5 (and DSM-111-R), respectively. The term "state" appears frequently in writings about the DD, especially dissociative identity disorder (DID). OBST is not a "perfect" theory. There are many areas that need to be refined, and it may not explain all aspects of human consciousness. However, the power ofDBST is based in substantial support from numerous domains of research, including human development, neurobiology, chronobiology, psychopathology, and many others - from subcellular to social systems.


Fig. 1. Path Diagram of First-Generation Clocks Results -FGDS Note: Standardized coefficients depicted. Bolded coefficients indicate a statistically significant (p < 0.05) association. Squares reflect measured variables and circles reflect latent variables.
Fig. 2. Path Diagram of First-Generation Clocks Results -BeCOME Note: Standardized coefficients depicted. Bolded coefficients indicate a statistically significant (p < 0.05) association. Squares reflect measured variables and circles reflect latent variables. "RT" = response time.
Fig. 3. Path Diagram of Second-Generation Clocks Results -FGDS Note: Standardized coefficients depicted. Bolded coefficients indicate a statistically significant (p < 0.05) association. Italicized coefficients indicate a near statistically significant (p < 0.10) association. Squares reflect measured variables and circles reflect latent variables. "RT" = response time.
Fig. 5. Path Diagram of DunedinPoAm Results -FGDS Note: Standardized coefficients depicted. Bolded coefficients indicate a statistically significant (p < 0.05) association. Italicized coefficients indicate a near statistically significant (p < 0.10) association. Squares reflect measured variables and circles reflect latent variables. "RT" = response time.
General pattern of results across cohorts.
Epigenetic age acceleration as a biomarker for impaired cognitive abilities in adulthood following early life adversity and psychiatric disorders
  • Article
  • Full-text available

October 2023

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43 Reads

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5 Citations

Neurobiology of Stress

John M. Felt

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Natan Yusupov

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Background Early life adversity and psychiatric disorders are associated with earlier declines in neurocognitive abilities during adulthood. These declines may be preceded by changes in biological aging, specifically epigenetic age acceleration, providing an opportunity to uncover genome-wide biomarkers that identify individuals most likely to benefit from early screening and prevention. Methods Five unique epigenetic age acceleration clocks derived from peripheral blood were examined in relation to latent variables of general and speeded cognitive abilities across two independent cohorts: 1) the Female Growth and Development Study (FGDS; n = 86), a 30-year prospective cohort study of substantiated child sexual abuse and non-abused controls, and 2) the Biological Classification of Mental Disorders study (BeCOME; n = 313), an adult community cohort established based on psychiatric disorders. Results A faster pace of biological aging (DunedinPoAm) was associated with lower general cognitive abilities in both cohorts and slower speeded abilities in the BeCOME cohort. Acceleration in the Horvath clock was significantly associated with slower speeded abilities in the BeCOME cohort but not the FGDS. Acceleration in the Hannum clock and the GrimAge clock were not significantly associated with either cognitive ability. Accelerated PhenoAge was associated with slower speeded abilities in the FGDS but not the BeCOME cohort. Conclusions The present results suggest that epigenetic age acceleration has the potential to serve as a biomarker for neurocognitive decline in adults with a history of early life adversity or psychiatric disorders. Estimates of epigenetic aging may identify adults at risk of cognitive decline that could benefit from early neurocognitive screening.

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Receptive Language Abilities for Females Exposed to Early Life Adversity: Modification by Epigenetic Age Acceleration at Midlife in a 30-Year Prospective Cohort Study

October 2022

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12 Reads

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3 Citations

The Journals of Gerontology Series B Psychological Sciences and Social Sciences

Objectives: Deviations from normative trajectories of receptive language abilities following early life adversity (ELA) may indicate an elevated risk for advanced cognitive aging and related morbidities. Accelerated epigenetic aging at midlife may further identify those at greatest risk for advanced cognitive aging following ELA. We examined whether accelerations in epigenetic aging at midlife can identify those individuals who demonstrated the greatest change in receptive language abilities following ELA. Methods: Data were drawn from the Female Growth and Development Study (n = 86), a thirty-year prospective cohort study of females exposed to substantiated child sexual abuse (CSA), a severe ELA, and a non-CSA comparison condition. The Peabody Picture Vocabulary Test-Revised (PPVT-R) measured receptive language abilities on six occasions from childhood to mid-life. Interindividual differences in PPVT-R trajectories were examined in relation to CSA exposure and across five independent measures of epigenetic age acceleration derived from first (Horvath DNAmAge, Hannum DNAmAge) and second (GrimAge, PhenoAge, Dunedin Pace of Aging) generation epigenetic clocks. Results: Quadratic growth models revealed that PPVT-R scores were significantly lower at age 25 for females exposed to CSA. Specifically, CSA exposed females had lower intercepts when GrimAge was accelerated and a smaller quadratic trend when PhenoAge was accelerated. Discussion: ELA is associated with significant differences in development of receptive language abilities with the most pronounced differences observed for females with accelerated epigenetic ages at mid-life. These findings suggest that epigenetic age acceleration could serve as an indicator of differences in cognitive aging and portend to later adulthood cognitive functioning.


Discrete Behavioral States Theory

August 2022

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285 Reads

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5 Citations

Discrete Behavioral States Theory (DBST) developed by Frank W. Putnam is a transtheoretical, translational theory of human consciousness. This chapter focuses on DBST particularly as it relates to psychological trauma, dissociation and posttraumatic and dissociative disorders ( DD ). For a complete discussion of DBST see Putnam's book, The Way We Are: How States of Mind Influence Our Identities, Personality, and Potential for Change (2016).1 DBST elucidates human experience and behavior across myriad normal and pathological domains. Discrete states of being (SoB) are so pervasive and ubiquitous as to be essentially invisible, unless they shift in dramatic, unexpected ways, and, even then, we usually do not conceptualize these changes in terms of behavioral states - although we use the word "state" frequently. The "atheoretical" DSM-5 (American Psychiatric Association, 2013) uses the term "state/states" over 100 times in describing psychiatric symptoms and disorders. DID diagnostic criteria are founded on the constructs of "identity state" and "personality state," in the DSM-IV-TR and DSM-5 (and DSM-III-R), respectively. The term "state" appears frequently in writings about the DD, especially dissociative identity disorder (DID). DBST is not a "perfect" theory. There are many areas that need to be refined, and it may not explain all aspects of human consciousness. However, the power of DBST is based in substantial support from numerous domains of research, including human development, neurobiology, chronobiology, psychopathology, and many others - from subcellular to social systems.


Attention and Memory in Depersonalization-Spectrum Dissociative Disorders: Impact of Selective-Divided Attentional Condition, Stimulus Emotionality, and Stress

May 2022

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111 Reads

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9 Citations

Journal of Trauma & Dissociation

We investigated cognition in depersonalization-spectrum dissociative disorders without comorbid posttraumatic stress disorder to explore evidence for emotionally avoidant information processing. Forty-eight participants with DSM-IV dissociative disorder (DD) (Depersonalization Disorder - 37, Dissociative Disorder NOS -11), 36 participants with Posttraumatic Stress Disorder (PTSD), and 56 healthy controls (HC) were administered the Weschler Adult Intelligence Scale-III (WAIS); the Weschler Memory Scale-III (WMS); and three Stroop tasks: the Standard Stroop, a selective-attention Emotional Stroop using neutral, dissociation, and trauma-related word categories, and a divided-attention Emotional Stroop using comparable words. Participants were also administered a paired-associates explicit and implicit memory test using emotionally neutral and negative words, before and after the Trier Social Stress Test. The DD and HC groups had comparable general intelligence and memory scores, though dissociation severity was inversely related to verbal comprehension and working memory. In the selective-attention condition, DD participants showed greater incidental recall across word categories with comparable interference. However in the divided-attention condition, DD participants significantly favored lesser attentional interference at the expense of remembering words. Across attentional conditions, DD participants had better recall for disorder-related than neutral words. Pre-stress, the DD group demonstrated better explicit memory for neutral versus negative words with reversal after stress, whereas the HC group demonstrated the opposite pattern; implicit memory did not differ. Cognition in the PTSD control group was generally dissimilar to the DD group. The findings in toto provide substantial evidence for emotionally avoidant information processing in DD, vulnerable to the impact of stress, at the level of both attention and memory.


Pathological Dissociation in The National Comorbidity Survey Replication (NCS-R): Prevalence, Morbidity, Comorbidity, and Childhood Maltreatment

April 2022

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65 Reads

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14 Citations

Journal of Trauma & Dissociation

Our aim was to examine U.S. national prevalence of pathological dissociation (PD) likely indicative of dissociative disorder, and associated morbidity, comorbidity, and childhood maltreatment. PD was assessed in 6,644 participants in the National Comorbidity Survey Replication, a nationally representative adult survey. Seven of the eight pathological dissociation taxon items were inquired about over the past month and scored on a 4-point scale. A conservative PD cutoff score was applied, with 100% specificity against healthy individuals and 84% sensitivity for Depersonalization Disorder which lies at the less severe end of the dissociative disorder spectrum; it yielded a national PD prevalence of 4.1%. The PD group had diminished physical and mental health, marked comorbidity with most major psychiatric disorders, and high likelihood of psychiatric hospitalization. Over half of PD members had attempted suicide, significantly more than individuals with lifetime major depression. Childhood maltreatment was quantified for physical abuse, witnessing domestic violence, physical neglect, emotional abuse, and emotional neglect. Total childhood trauma significantly positively predicted PD severity, as well as severity of all three pathological dissociative experiences (amnesia, depersonalization / derealization, identity alteration). Furthermore, each childhood trauma category significantly predicted PD severity uniquely and additively. Childhood maltreatment in the PD group was significantly greater than in lifetime major depression, except for similar emotional neglect, and was comparable to lifetime PTSD. The study reinforces the validity of prior PD findings across clinical and community samples, and highlights the need for increased attention toward diagnosing and treating these quite common and highly morbid disorders and their traumatic antecedents.


Cortisol Trajectories Measured Prospectively across Thirty Years of Female Development following Exposure to Childhood Sexual Abuse: Moderation by Epigenetic Age Acceleration at Midlife

November 2021

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45 Reads

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16 Citations

Psychoneuroendocrinology

Lasting changes in the hypothalamic-pituitary-adrenal (HPA) axis are a potential indication of the biological embedding of early life adversity, yet, prospective and repeatedly collected data are needed to confirm this relation. Likewise, integrating information from multiple biological systems, such as the HPA axis and the epigenome, has the potential to identify individuals with enhanced embedding of early life adversity. The current study reports results from the Female Growth and Development Study, a 30-year prospective cohort study of childhood sexual abuse (CSA). Females exposed to substantiated CSA and a demographically-similar comparison condition were enrolled and resting state cortisol concentrations were sampled on seven subsequent occasions across childhood, adolescence, and adulthood. Differences in participants’ cortisol trajectories were examined in relation to prior CSA exposure and DNA methylation-derived epigenetic age acceleration at midlife. Bilinear spline growth models revealed a trajectory where cortisol secretion increased until approximately age twenty and then declined into mid-life, consistent with normative trends. However, cortisol concentrations peaked at a lower level and transitioned to the decline phase at an earlier age for females in the CSA condition with increased epigenetic age acceleration. Robustness tests across three independent measures of epigenetic age acceleration demonstrated similar results for lower peak cortisol levels and earlier ages at transition. Results suggest that CSA is associated with significant changes in HPA-axis activity over extended periods of time with these changes most pronounced in females with accelerated epigenetic aging in mid-life. Implications for biological embedding models of early life adversity and adulthood health are discussed.


Citations (89)


... Several scales measuring dissociation, such as the Dissociative Experience Scale (DES) ofBemstein and Putnam (1986), the Structured Clinical Interview for Dissociative Disorders (SCID-D) of Steinberg, Howland, and Cicchetti (1986), and the Perceptual Alteration Scale (PAS) of Sanders (1986) are being developed and used to screen for dissociative symptoms and disorders and will help in suspecting the hidden forms of this condition. Kluft (1985b) has observed that only about 6% of MPD patients present overtly. ...

Reference:

Dissociation : Vol. 1, No. 2, p. 027-033 : Diagnosis Of Covert And Subtle Forms Of Multiple Personality Disorder Through Dissociative Signs
9. The Treatment of Multiple Personality: State of the Art
  • Citing Chapter
  • December 2024

... Na história mais recente do TDI, tem havidoum reconhecimento crescente da complexidade do transtorno e da insuficiência de critérios e abordagens sustentados predominantemente na identificação de personalidades distintas no interior do indivíduo. Ao contrário do que popularmente se concebe, os pesquisadores defendem hoje não ser tão simples, e muitos menos útil, distinguir marcadamente uma personalidade da outra, considerando-se 1) as muitas nuances do processo de alteração / troca de identidades, 2) a tendência apressada e entusiasta de alguns terapeutas em interpretar certos comportamentos como indícios necessários da presença de uma segunda personalidade, sugestionando, assim, seus pacientes, 3) bem como a elevada susceptibilidade hipnótica de pacientes com TDI (PUTNAM; CARLSON, 2005). ...

Chapter 2. Hypnosis, Dissociation, and Trauma: Myths, Metaphors, and Mechanisms
  • Citing Chapter
  • December 2024

... Alémdisso, observa-se que indivíduos expostos a ambientes cotidianos atribulados e instáveis durante suas infâncias tendem a apresentar mudanças em mecanismos fisiológicos e neuropatológicos e, assim, alteram suas idades epigenéticas. Com isso, tem-se um cenário de divergência entre a idade biológica e a idade epigenética destes indivíduos, que, devido a esse contexto, tendem a apresentar deficits em suas expressões cognitivas durante a vida adulta(FELT et al., 2023).Tambémé válido ressaltar que estudos constataram que, a partir das análises de dados coletados por Enlow et al, Strathearn et al e Richards e Wadsworth, indivíduos expostos a experiencias traumáticas entre 0 e 24 meses de vida, apresentaram deficits no desempenho cognitivo entre as idades de 24 a 96 meses, que maus-tratos nos primeiros anos de vida apresentam reflexos no desempenho intelectual individual e que crianças que passaram por eventos traumáticos como a morte de um dos genitores ou o divórcio dos pais tendem a apresentar uma menor performance intelectual entre os 8 e 15 anos de idade (OH et al., 2018). As modificações nas histonas, proteínas que ajudam a estruturar o DNA, também desempenham um papel crucial na regulação dos genes. ...

Epigenetic age acceleration as a biomarker for impaired cognitive abilities in adulthood following early life adversity and psychiatric disorders

Neurobiology of Stress

... These discrepant findings may be due to differences in how these samples were recruited. The FGDS cohort was 6-16 years of age at the time of enrollment and were between the ages of 29 and 45 when the neurocognitive battery and epigenetic age acceleration estimates were collected (Trickett et al., 2011;Felt et al., 2022). Patients from the BeCOME cohort were recruited to evaluate psychiatric diagnoses, excluded if they had any evidence of physical impairment, neurocognitive degeneration, or substance abuse, and all were between the age of 18 and 65 43 . ...

Receptive Language Abilities for Females Exposed to Early Life Adversity: Modification by Epigenetic Age Acceleration at Midlife in a 30-Year Prospective Cohort Study
  • Citing Article
  • October 2022

The Journals of Gerontology Series B Psychological Sciences and Social Sciences

... Consistent with treatment guidelines (Bisson et al., 2019;ISSTD, 2011) and expert recommendations (Brand et al., 2012), patients were educated about and encouraged to make use of grounding skills, containment of intrusive traumatic material, enhanced awareness of and ability to safely experience emotions, and healthy self-care. For individuals who experienced dissociated self-states (i.e., two or more psychobiological identity states of subjective consciousness with the capacity for ideation, agency, and action; for more, see Kluft, 1988;Loewenstein & Putnam, 2023), work also focused on fostering internal communication and cooperation among self-states (Brand et al., 2012). All staff contributed to a therapeutic milieu that supported the adaptive application of symptom management skills. ...

Discrete Behavioral States Theory
  • Citing Chapter
  • August 2022

... Such characteristics fundamentally challenge our understanding of human consciousness. DPRD significantly affects cognitive and emotional functioning [4][5][6], thereby heavily burdening affected individuals. The elusive pathogenesis of DPRD has hindered the development of effective treatments, underscoring the urgent need for comprehensive investigations into its neural mechanisms. ...

Attention and Memory in Depersonalization-Spectrum Dissociative Disorders: Impact of Selective-Divided Attentional Condition, Stimulus Emotionality, and Stress
  • Citing Article
  • May 2022

Journal of Trauma & Dissociation

... DID is more prevalent than many people realise, especially in psychotherapy clients. The one-year prevalence rate of DID in the US was 1.5% (Simeon and Putnam 2022). By contrast, schizophrenia is thought to impact 0.3%-0.7% of the population (American Psychiatric Association [APA] 2022). ...

Pathological Dissociation in The National Comorbidity Survey Replication (NCS-R): Prevalence, Morbidity, Comorbidity, and Childhood Maltreatment
  • Citing Article
  • April 2022

Journal of Trauma & Dissociation

... Our findings are consistent with prior results observing EAA later in life in those with higher cumulative ACE exposure. 26, [66][67][68][69][70] Differences in the association between ACEs and epigenetic aging during pregnancy were not affected by either the inclusion or omission of cell type. Given no differences by cell-type composition in our models, changes in epigenetic aging may be capturing the aging of tissues and organs rather than the gradual changes in immune cell composition that occur concurrently with the aging process. ...

Cortisol Trajectories Measured Prospectively across Thirty Years of Female Development following Exposure to Childhood Sexual Abuse: Moderation by Epigenetic Age Acceleration at Midlife
  • Citing Article
  • November 2021

Psychoneuroendocrinology

... The ACE-obesity association is hypothesized to arise from a diverse range of pathways that connect the lifespan effects of childhood ACEs to elevation in body adiposity across the lifespan. For example, ACE-associated stress may lead to hypothalamic pituitary access dysregulation, changes in insulin and hunger hormone levels, cytokine activation, and immunometabolic derangements that increase obesity risk [40][41][42][43]. Childhood trauma has been linked both directly and indirectly to obesity via elevated levels of C-reactive protein, which leads to inflammation. ...

Hypothalamic-pituitary-adrenal axis attenuation and obesity risk in sexually abused females
  • Citing Article
  • May 2021

Psychoneuroendocrinology

... Yet, in the study of Salokangas et al. [9], females (71.8%) had been in the majority; and in both our and Salokangas' study, sexual abuse was equally rare and weakly related to female sex. Thus, for the reported dose-response relationship between multiple forms of CAT and mental disorder [57] and its description as the most synergistically reactive CAT domain [58], sexual abuse may mainly add to the overall burden of CAT in those most likely afflicted also by other forms of CAT. ...

All Adverse Childhood Experiences Are Not Equal: The Contribution of Synergy to Adverse Childhood Experience Scores

American Psychologist