Putnam, F. (1997) | References | Narcissus and the Child

What This Research Found

Frank Putnam's Dissociation in Children and Adolescents: A Developmental Perspective represents a paradigm shift in understanding dissociation—moving it from the margins of psychiatric curiosity to the centre of developmental psychopathology. Published by Guilford Press and cited over 3,000 times, this book established the scientific framework for understanding how trauma fragments the developing self.

The discrete behavioral states model explains dissociation's developmental origins. Putnam's most influential contribution is the discrete behavioral states (DBS) model, which grounds dissociation in normal infant development. Newborns organise experience into distinct psychophysiological states—the hungry state, the alert-playful state, the distressed state, the drowsy state. These states differ not just in behaviour but in physiology: heart rate, muscle tone, hormone levels, brain activity patterns all shift as infants move between states. Crucially, infants in one state have limited access to learning and memories from other states—state-dependent encoding is the norm in early development. Normal development involves the gradual integration of these discrete states into a unified sense of self that can access memories and learnings across contexts. This integration depends critically on consistent, attuned caregiving—the foundation of secure attachment. When caregivers respond predictably and sensitively to infant states, they help the infant develop smooth transitions between states and gradually link them into coherent self-experience.

Traumatic caregiving environments prevent normal state integration. Putnam documents extensively how abusive, neglectful, or chaotically unpredictable caregiving disrupts the integration process. When the caregiver is the source of terror—as occurs in narcissistic abuse, where the narcissistic parent alternates unpredictably between idealisation and devaluation, warmth and rage—the child cannot develop the secure base necessary for state integration. The child instead develops what Putnam calls "parallel tracks": separate state-dependent organisations of self that manage different contexts without integration. This pattern aligns closely with what Main and Hesse identified as disorganised attachment—the "fright without solution" that occurs when the attachment figure is simultaneously the source of fear. One track manages the dangerous parent; another operates in safer environments; still another holds overwhelming affect that cannot be processed. Without the consistent caregiving that weaves these tracks together, they remain separate—the developmental foundation of dissociative pathology. This explains why survivors of narcissistic abuse so often describe feeling like "different people" in different situations, why they struggle to maintain a coherent sense of identity, and why trauma memories feel separate from their ordinary self-experience.

Dissociation exists on a continuum from normal to pathological. Rather than viewing dissociative disorders as categorically distinct conditions, Putnam demonstrates that dissociative phenomena exist on a continuum. At the normal end are everyday experiences: highway hypnosis, absorption in a book or film, momentary forgetting of where you are or what you were doing. Further along are more clinically significant experiences: depersonalisation (feeling detached from your body or self), derealisation (feeling the world is unreal or dreamlike), amnesia for stressful events, identity confusion, and sudden state shifts. At the far end is Dissociative Identity Disorder (DID), characterised by the presence of distinct identity states and extensive amnesia. Putnam's epidemiological research demonstrated that moderate dissociative symptoms are remarkably common in trauma survivors—far more common than the dramatic presentations that dominate public imagination. This continuum model has profound clinical implications: it means that most trauma survivors, including those who experienced narcissistic abuse, likely have some degree of dissociative symptomatology that affects their treatment and recovery, even if they don't meet criteria for a dissociative disorder.

Childhood trauma has specific effects on identity development that differ from adult-onset trauma. Putnam's developmental perspective reveals why childhood trauma—including the chronic, relational trauma of growing up with a narcissistic parent—has such different effects from trauma that occurs in adulthood. When trauma occurs after identity has consolidated, it may shatter that identity, creating PTSD. When trauma occurs during identity formation, it shapes what identity can form in the first place. The child of a narcissistic parent doesn't develop a coherent identity that later fragments; they never develop coherent identity integration to begin with. This explains why Complex PTSD from developmental trauma presents so differently from classic PTSD: the problems with identity, affect regulation, and relationships that characterise C-PTSD reflect interrupted development, not disruption of established function. Putnam's research established that we cannot understand adult dissociative pathology without understanding developmental origins—and we cannot effectively treat it without addressing developmental deficits, not just processing discrete traumatic memories.

The research documents specific psychobiological alterations in dissociative states. Putnam's NIMH research included groundbreaking psychophysiological studies of dissociative identity disorder, documenting that different identity states showed measurably different physiological parameters: heart rate variability, galvanic skin response, EEG patterns, and even visual acuity and handedness could shift between states. This research demonstrated that dissociative states are not simply imaginative or performative—they have biological reality. While this research focused primarily on DID, it illuminated mechanisms relevant across the dissociative continuum. The finding that identity states have psychophysiological substrates supports treating dissociation as a real phenomenon with developmental origins, not as suggestion, fantasy, or malingering—a distinction that matters greatly for survivors whose experiences have been invalidated.

How This Research Is Used in the Book

Putnam's work provides essential framework for understanding the developmental effects of narcissistic parenting throughout Narcissus and the Child. The discrete behavioral states model illuminates how the chaos and unpredictability of narcissistic households prevents children from developing integrated identity.

In Chapter 4: What Causes Narcissism, the book draws on developmental psychopathology to explain how early relational trauma shapes personality formation:

"The narcissist's fragmented self-structure—oscillating between grandiose and depleted states, unable to maintain stable self-regard—reflects disrupted developmental integration that stems from intergenerational trauma. Putnam's research shows how infants naturally organise experience into discrete states that depend on consistent caregiving to integrate. When caregiving is itself chaotic, neglectful, or frightening, the child develops along parallel tracks that never fully merge. The narcissist's apparent multiplicity—the charming public persona, the rageful private self, the shameful hidden core—represents state-dependent self-organisations that were never integrated into coherent identity."

In Chapter 12: The Unseen Child, Putnam's work explains how children of narcissists develop fragmented self-experience:

"The child of a narcissist develops different selves for different contexts: the performing self that seeks parental approval, the hidden self that holds forbidden feelings, the numbed self that survives overwhelm. Without consistent, attuned caregiving to integrate these experiences, they remain separate—the developmental foundation of the dissociative symptoms so common in adult survivors. This isn't pathology in the pejorative sense; it's the predictable developmental consequence of growing up where the person who should have helped you build a unified self instead required you to fragment."

In Chapter 11: Neurological Contagion, the book uses Putnam's framework to explain dissociative responses to intimate partner abuse:

"Dissociation serves protective function: when escape is impossible and the threat is overwhelming, the mind separates from unbearable experience. Putnam documented how this protective mechanism, adaptive in the moment, creates long-term problems when experiences are not integrated. The partner of a narcissist who 'spaces out' during rages, who has gaps in memory for abusive incidents, who feels watching themselves from outside during degrading treatment, is employing survival mechanisms with developmental roots. The question is not why they dissociate—that's adaptive—but how to help them integrate what happened into coherent self-narrative once they're safe."

In Chapter 16: The Gaslit Self, Putnam's research illuminates how gaslighting exploits and exacerbates dissociative processes:

"Gaslighting is particularly devastating for survivors with existing dissociative tendencies—and childhood narcissistic abuse creates exactly those tendencies. The child who learned to doubt their perceptions, who had their reality systematically denied, who developed fragmented self-states to survive parental chaos, is exquisitely vulnerable to partners who continue the process. Dissociation already creates discontinuity in self-experience; gaslighting exploits and deepens that discontinuity. The survivor may genuinely not remember incidents the abuser denies—not because they didn't happen, but because they were encoded in dissociated states or because the gaslighting itself triggers protective dissociation that interferes with memory consolidation."

Why This Matters for Survivors

If you survived narcissistic abuse—whether from a parent, partner, or other significant figure—Putnam's research provides language for experiences that may have seemed unspeakable or shameful.

Your fragmentation began as survival. The different "selves" you experience—the functional adult who manages work, the terrified child who emerges when triggered, the numb observer who watches from a distance—didn't develop because something is wrong with you. They developed because your circumstances required it. The fight-flight-freeze response, when chronically activated by an inescapable threat like a narcissistic parent, creates state-dependent organisations of experience that serve protection. Putnam's research shows that dissociation is a normal developmental process that becomes problematic only when caregiving environments are abnormal. Your brain did exactly what brains do to survive: it organised experience in ways that allowed you to continue functioning under impossible conditions. The performing self that pleased the narcissist, the hidden self that held your true feelings, the shut-down self that endured unbearable moments—each emerged to serve survival functions. Understanding this can begin transforming shame into recognition: you're not fragmented because you're defective; you're fragmented because fragmentation kept you alive.

Your "foggy" or "missing" memories are not evidence of weakness. Survivors of narcissistic abuse often struggle with memory: gaps in childhood recollection, fuzzy recall of abusive incidents, difficulty constructing coherent narratives of what happened. Putnam's research explains why. Experiences encoded during highly dissociated states are not stored in ordinary autobiographical memory. They may be inaccessible from normal consciousness or may intrude as emotional flashbacks—overwhelming affect without narrative context. Additionally, the chronic stress of narcissistic environments impairs hippocampal function, disrupting memory consolidation. Your gaps aren't evidence that the abuse didn't happen or didn't matter. They're evidence that it was overwhelming enough to disrupt normal memory processing—which is itself evidence of how bad it was. What adverse childhood experiences research now documents at population scale, Putnam's work explained at the mechanistic level: chronic childhood adversity fundamentally alters how the brain processes and stores experience.

The sense that you don't know "who you really are" makes developmental sense. Many survivors of narcissistic abuse report fundamental confusion about their identity: not knowing what they want, what they feel, who they are separate from others' expectations. This isn't failure to develop personality; it's the predictable consequence of developing under conditions that prevented coherent self-integration. Putnam's discrete behavioral states model explains that unified identity isn't innate—it develops through consistent, attuned caregiving that helps link different states of experience. If your caregiver instead demanded you be whoever they needed you to be, if your different states received wildly inconsistent responses, if survival required compartmentalising your experience, you didn't receive what was needed for integration. The "core self" that others seem to have access to was not available to develop because the necessary developmental conditions were not provided.

Healing means building integration that was never completed, not recovering something that was lost. This distinction matters profoundly for recovery. You're not trying to get back to a pre-trauma self that was then fragmented—if your trauma was developmental, that unified self never fully formed. Instead, you're completing a developmental process that was interrupted. Putnam's framework suggests that healing involves gradually building connections between dissociated aspects of experience: developing awareness of state shifts, creating communication between "parts," slowly expanding the window of tolerance within which you can stay present. This is harder in adulthood than it would have been in childhood—neuroplasticity is reduced, patterns are entrenched—but the capacity for integration was never destroyed, only underdeveloped. Recovery is developmental completion, and it remains possible throughout the lifespan.

Clinical Implications

For psychiatrists, psychologists, and trauma-informed healthcare providers, Putnam's developmental framework transforms assessment and treatment of survivors who experienced narcissistic abuse.

Screen routinely for dissociative symptoms across the spectrum. Dissociation is underrecognised in clinical practice, partly because clinicians may only screen for dramatic symptoms like amnesia or identity alteration. Putnam's continuum model indicates that more subtle dissociative symptoms—depersonalisation, derealisation, emotional numbing, absorption, identity confusion—are clinically significant and far more common. Use screening tools like the Dissociative Experiences Scale as part of standard assessment for trauma survivors. Ask specifically about experiences of spacing out, feeling unreal, gaps in memory, feeling like a different person in different contexts, and watching oneself from outside. Normalise these experiences while assessing their severity and impact. Many patients won't spontaneously report dissociative symptoms because they've normalised them, assume everyone has them, or feel ashamed—direct, non-judgmental inquiry is necessary.

Assess dissociation as a developmental phenomenon, not just a symptom. Putnam's framework means asking not just "do you dissociate?" but "when did this begin, and how has it changed over your development?" Dissociative symptoms that began in childhood, particularly in the context of chronic relational trauma, represent developmental adaptation and likely require different treatment than acute dissociation in response to adult trauma. Assess the attachment history carefully—was there a primary caregiver who was both attachment figure and source of fear? This "fright without solution" that creates disorganised attachment is a primary pathway to developmental dissociation. Understanding the developmental trajectory helps treatment planning: developmental dissociation often requires longer treatment, more attention to the therapeutic relationship as a corrective experience, and work on building integrative capacity before trauma processing.

Recognise that dissociation affects treatment process, not just content. A patient who dissociates during sessions isn't simply having symptoms—they're demonstrating that standard treatment delivery may not be reaching them. Trauma processing work conducted while the patient is partially dissociated won't integrate. Insights gained in one self-state may not generalise to others. Progress that seems to occur in session may not persist because it was encoded in a state that isn't accessible in daily life. Putnam's work suggests attending carefully to state shifts during treatment, using grounding techniques to maintain presence, pacing work to stay within integrative capacity, and recognising that "resistance" may reflect dissociative processes rather than motivational factors. Treatment must work with the patient's actual level of integration, helping build integrative capacity alongside processing specific traumatic content.

Consider phase-oriented treatment for developmental dissociation. Putnam's research supports the phase-oriented approach to trauma treatment articulated by Pierre Janet and elaborated by Judith Herman: stabilisation and skill-building must precede trauma processing. For patients with significant developmental dissociation, the stabilisation phase may be lengthy. It involves developing affect regulation skills, establishing safety in the body, building the therapeutic alliance as a secure base, and increasing the patient's capacity to stay present during emotional activation. Rushing to trauma processing with a patient who cannot maintain integrative capacity risks destabilisation, retraumatisation, or encoding treatment work in dissociated states where it cannot be accessed. Putnam's developmental perspective helps explain why trauma processing that works well for adult-onset PTSD may be insufficient or even harmful for developmental trauma with significant dissociation.

Address the relational and identity dimensions, not just trauma memories. Standard trauma-focused treatments like Prolonged Exposure or CPT were developed primarily for adult-onset PTSD and focus on processing discrete traumatic memories. Putnam's research suggests that developmental dissociation requires additional treatment elements: building coherent identity, developing the capacity for secure attachment, learning to identify and communicate internal states, and integrating dissociated aspects of experience. The therapeutic relationship becomes not just a container for trauma processing but a corrective developmental experience—providing the consistent, attuned responsiveness that was missing in childhood and that is necessary for state integration to proceed. Treatment models that address these dimensions—such as complex trauma treatments, parts-based approaches, and attachment-focused therapies—may be more appropriate than memory-focused approaches alone.

Broader Implications

Putnam's research extends beyond clinical treatment to illuminate patterns across families, institutions, and social systems.

The Intergenerational Transmission of Dissociative Adaptation

Narcissistic parents typically have their own unintegrated selves—dissociative adaptations to their own developmental trauma that were never resolved. Putnam's framework explains the mechanism of intergenerational transmission: the parent whose states are poorly integrated cannot provide the consistent, attuned caregiving necessary for their child's integration. The parent's sudden state shifts—from warm to rageful, from present to dissociatively absent, from attentive to terrifyingly unpredictable—create exactly the conditions that prevent the child's state integration. The parent may not even remember their abusive episodes because they occurred in dissociated states. The child develops their own dissociative adaptations to survive the parent's dissociation, perpetuating the pattern. Intervention at any generation—helping parents integrate their own states, providing children with alternative attachment figures, early therapeutic intervention—can potentially interrupt this transmission.

Relationship Patterns and Partner Selection

Adults with developmental dissociation often recreate familiar relational dynamics without conscious awareness—a pattern that contributes to trauma bonding in adult relationships. Putnam's state-dependent encoding research helps explain why: what was learned in one state may be inaccessible when making decisions in another state. The dissociated adult may have cognitive understanding that narcissistic partners are harmful while simultaneously being drawn to them through implicit, state-dependent learning that equates intensity with connection, unpredictability with love, or trauma bonding neurochemistry with genuine attachment. Additionally, people with significant dissociation may literally become "different people" in different relational contexts—the self that chooses partners may be different from the self that experiences the relationship's consequences. Recovery involves bringing these different state-perspectives into dialogue, allowing the wary part's knowledge to inform the longing part's choices.

Workplace and Professional Functioning

Dissociation affects professional functioning in ways that may be invisible to others and confusing to the survivor. State-dependent encoding means skills and knowledge may be accessible in some contexts but not others—the competent professional who becomes unable to function when triggered by an authority figure. State shifts may create inconsistency that appears motivational or characterological rather than dissociative. Dissociative gaps may cause genuine memory failures that appear as unreliability or dishonesty. The exhaustion of maintaining fragmented functioning may create fatigue and reduced capacity that mimics burnout or depression. Workplaces that understand dissociation can support affected employees through predictability, clear expectations, reduced triggers, and appropriate accommodations—rather than disciplining symptoms that are actually survival adaptations.

Educational Settings and Child Development

Schools interact with children during critical windows for developmental integration. Teachers and school staff may be among the first to notice dissociative symptoms: the child who spaces out and doesn't respond to their name, dramatic behavioural inconsistencies, gaps in memory for classroom events, or the child who seems like different people on different days. Putnam's research suggests that schools can play a protective role, potentially providing the consistent, predictable, attuned adult relationships that may partially compensate for chaotic home environments. Trauma-informed educational practices—recognising that behavioural inconsistency may reflect dissociation rather than defiance, providing predictable routines that reduce dissociative need, responding to triggered children with regulation support rather than punishment—can support children whose home environments prevent integration.

Legal and Forensic Considerations

Putnam's research has significant implications for legal contexts involving trauma survivors. Dissociative amnesia is genuine—survivors may truly not remember abusive incidents, complicating both reporting and testimony. State-dependent memory means that what was encoded in traumatic states may be inaccessible in the calm context of a courtroom. Triggered dissociation during legal proceedings may affect a survivor's capacity to testify coherently. The chronic hypervigilance that survivors carry may be misread as deceptiveness or instability. At the same time, Putnam's rigorous research provides scientific foundation for the reality of dissociative phenomena, countering claims that dissociation is fabricated or suggested. Legal professionals working with trauma survivors benefit from understanding that memory gaps, inconsistent recall, and apparent state shifts during testimony reflect genuine dissociative processes, not deception.

Public Health and Prevention Approaches

Viewing dissociation through Putnam's developmental lens reframes it as a preventable consequence of early adversity rather than an inevitable individual pathology. Public health approaches that support families, reduce childhood adversity, and provide early intervention can potentially prevent the developmental disruption that leads to dissociative adaptations. Putnam's subsequent work on child abuse prevention and the public health approach to childhood adversity builds directly on his dissociation research: if we know that certain caregiving environments prevent state integration, we can work to ensure fewer children grow up in those environments. The societal cost of failing to address childhood adversity is measured not just in dissociative disorders but in the full range of developmental consequences Putnam and others have documented.

Limitations and Considerations

Putnam's influential work has limitations that warrant acknowledgment for responsible clinical and scholarly application.

The discrete behavioral states model, while influential, remains a theoretical framework. Putnam's DBS model provides a compelling developmental explanation for dissociation, but direct empirical testing of its core claims is challenging. We cannot directly observe infant state integration, and much evidence comes from retrospective reconstruction or inference from adult pathology. The model is consistent with infant research on state organisation and attachment research on integration, but alternative theoretical accounts of dissociation exist. Clinicians should hold the model as a useful framework rather than established fact.

Research populations may not generalise fully. Putnam's psychophysiological research focused primarily on patients with severe dissociative identity disorder—a relatively rare and extreme presentation. While his theoretical framework addresses the full dissociative continuum, the empirical findings from DID populations may not fully apply to more common, moderate dissociative presentations. Additionally, research populations were primarily Western and female; dissociative presentations may vary across cultures and genders in ways not fully captured.

The relationship between dissociation and other trauma responses remains complex. Putnam's work focuses specifically on dissociation, but trauma produces a range of responses including hyperarousal, avoidance, and various symptom presentations that may coexist with or present as alternatives to dissociation. Why some trauma survivors develop primarily dissociative responses while others develop different presentations is not fully explained by the developmental model. Genetic factors, specific trauma characteristics, and protective factors likely all play roles that remain incompletely understood.

Assessment tools have limitations. The Dissociative Experiences Scale and other measures Putnam helped develop have been valuable for research and screening but are self-report measures with known limitations: they may miss dissociation in patients who don't recognise their experiences as dissociative, and they may capture normative experiences in some populations. Clinical assessment should supplement standardised measures with careful interview.

Historical Context

Dissociation in Children and Adolescents appeared in 1997, a pivotal moment in the evolving understanding of dissociative phenomena. The preceding decades had seen both increased recognition of dissociative disorders and fierce controversy that threatened to delegitimise the entire field.

The 1980s saw dissociative identity disorder (then called multiple personality disorder) gain diagnostic recognition in DSM-III and increasing clinical attention. Clinicians reported treating patients who manifested distinct identity states with different names, ages, genders, and even physiological characteristics. However, this period also saw the "memory wars"—contentious disputes over recovered memories of childhood abuse, suggestibility, and false memories. Critics argued that DID was an iatrogenic phenomenon created by suggestive therapy techniques, while proponents argued that sceptics were dismissing genuine trauma survivors. The debate became polarised and acrimonious, with casualties including patients caught between competing claims, therapists accused of malpractice, and families torn apart by disputed allegations.

Putnam's work provided a scientifically grounded path through this minefield. Rather than debating whether DID was "real," he situated dissociation within normal developmental processes and demonstrated empirically how these processes could be disrupted by trauma. His research at NIMH provided objective psychophysiological data documenting that identity states had measurable biological correlates—they were not merely imaginative or performative. His developmental framework explained how dissociation could arise without requiring acceptance of controversial claims about recovered memories. By anchoring dissociation in established developmental science rather than contested clinical claims, Putnam helped establish it as a legitimate field of scientific inquiry.

The book synthesised Putnam's extensive research program, including epidemiological studies documenting the prevalence of childhood maltreatment, longitudinal studies tracking its developmental effects, psychophysiological studies of dissociative states, and clinical research on assessment and treatment. It provided the first comprehensive developmental framework for understanding dissociation, transforming how clinicians and researchers conceptualised these phenomena.

Dissociation in Children and Adolescents has been cited over 3,000 times and remains a foundational text in trauma and dissociation studies. Putnam's discrete behavioral states model has influenced subsequent theoretical developments including structural dissociation theory (van der Hart, Nijenhuis, and Steele) and clinical approaches including parts-based trauma therapies. His work established that we cannot understand adult dissociative pathology without understanding its developmental origins—a principle now fundamental to developmental psychopathology approaches to trauma.

Dissociation in Children and Adolescents: A Developmental Perspective

APA Citation