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My current setup (i7 4790S, GTX 760, 16GB RAM) should be able to handle this game at a constant 60fps without breaking a sweat. For some reason I'm nog even reaching mid 40's and it occasionally dips below 25fps, all on custom Epic settings (AA, MB & DOF turned off). For testing purposes, I lowered the resolution to 720p and got the same results. What gives?
I feel your pain. I've owned the game since its release on Steam and I have ALWAYS had performance issues with the game. It starts out so nice and butter smooth at the train station but as I get into the woods and the storm hits and well into the game the fps just plummets. Like you I can set all settings to low and it changes nothing. There are tons of queries like this in the Steam forums. I've tried myself looking for answers but I have yet to find any. The game truly needed more optimization plain and simple in my opinion. I really enjoy these kinds of games so its frustrating for me too, always having to stop mid game to attempt to tweak something here or there. Ethan Carter redux on the same engine runs so smooth for me.

I hope someone down the line with the know how will bring a mod or fix for the many people like us. I have a core i7 4790k 4@4Ghz, GTX 970 4GB and 16GB ram and the same thing happens to me. I've read some claiming to run it at 60fps but I don't see how and certainly haven't found an answer. Either they are fibbing, trolling or not understanding what 60 fps looks and feels like.