Sanctuary for the Abused
Monday, November 22, 2004
Can pathological narcissism be induced by substance abuse or
biochemical imbalances in the brain?
The narcissist's moods change abruptly in the wake of a narcissistic injury. One can easily manipulate the moods of a narcissist by making a disparaging remark, by disagreeing with him, by criticising him, by doubting his grandiosity or fantastic claims, etc.
Such REACTIVE mood shifts have nothing to do with blood sugar levels, or with the presence or absence of any substance or chemical. It is possible to reduce the narcissist to a state of rage and depression AT ANY MOMENT, simply by employing the above "technique". He can be elated, even manic - and in a split second, following a narcissistic injury, depressed, sulking or raging.
The opposite is also true. The narcissist can be catapulted from the bleakest despair to utter mania (or at least to an increased and marked feeling of well-being) by being provided with the flimsiest Narcissistic Supply (attention, adulation, etc.).
These swings are totally correlated to external events (narcissistic injury or Narcissistic Supply) and not to cycles of hormones, enzymes, neurotransmitters, sugar, or other substances in the body.
It is conceivable, though, that a third, unrelated problem causes chemical imbalances in the brain, metabolic diseases such as diabetes, pathological
narcissism, and other mental health syndromes. There may be a common cause,
a hidden common denominator (perhaps a group of genes). (site owner's note: insulin issues such as diabetes & insulin resistance are KNOWN to cause depression, elation & mood swings but do NOT cause Narcissism or Narcissistic traits)Other disorders, like the Bipolar Disorder (mania-depression) are characterised by mood swings that are not brought about by external events (endogenous, not exogenous). But the narcissist's mood swings are strictly the results of external events (as he perceives and interprets them, of course).
Narcissists are absolutely insulated from their emotions. They are emotionally flat or numb.
The narcissist does not have pendular (cyclical) mood swings on a regular, almost predictable basis, from depression to euphoria (mania), as is the case in biochemically induced mental disorders.
Additionally, the narcissist goes through mega-cycles which last months or even years. These cannot, of course, be attributed to blood sugar levels or to Dopamine and Serotonin secretions in the brain.
NPD per se is not treated with medication. The underlying disorder is treated by one of the long-term psychodynamic or cognitive-behavioural therapies. Other PDs (NPD is usually comorbid - diagnosed with other PDs) are treated separately and according to their own characteristics.
But phenomena, which are often associated with NPD, such as depression or OCD (obsessive-compulsive disorder), are treated with medication. Rumour has it that SSRI's (such as Fluoxetine, known as Prozac) might have adverse effects if the primary disorder is NPD. They sometimes lead to the Serotonin syndrome, which includes agitation and exacerbates the rage attacks typical of a narcissist. The use of SSRI's is associated at times with delirium and the emergence of a manic phase and even with psychotic microepisodes. (site owner's note: while anti-depressants can help with the concurrent depression, it can also induce the Narcissistic person to 'feel good' and therefore make the narcissistic behavior worse or more compulsive. It's a tough balance.)
This is not the case with the heterocyclics, MAO and mood stabilisers, such as lithium. Blockers and inhibitors are regularly applied without discernible adverse side effects (as far as NPD is concerned).
Additionally, cognitive-behavioural therapies are often used to treat the attendant OCD and depression.
To summarise: Not enough is known about the biochemistry of NPD. There seems to be
some vague link to Serotonin but no one knows for sure. There isn't a reliable
non-intrusive method to measure brain and central nervous system Serotonin
levels anyhow, so it is mostly guesswork at this stage.
Thus, as of now, the typical and recommended treatment for pathological narcissism and the comorbid depression and OCD is talk therapy of one kind (psychodynamic) or another (cognitive-behavioural).
Antidepressants can be used moderately (with SSRI being currently under critical scrutiny).
Narcissistic Supply is exciting. When it is available, the narcissist feels elated, omnipotent, omniscient, handsome, sexy, adventurous, invincible, and irresistible. When it is missing, the narcissist first enters a manic phase of trying to replenish his supply and, if he fails, the narcissist shrivels, withdraws and is reduced to a zombie-like state of numbness.
Some people - and all narcissists - are addicted to excitement, to the adrenaline rush, to the danger inevitably and invariably involved. They are the adrenaline junkies. All narcissists are adrenaline junkies - but not all adrenaline junkies are narcissists.
Narcissistic Supply is the narcissist's particular sort of thrill. Deficient Narcissistic Supply is tantamount to the absence of excitement and thrills
in non-narcissistic adrenaline junkies. Originally, in early childhood, Narcissistic Supply is meant to help the narcissist regulate his volatile sense of self-worth and self-esteem. But Narcissistic Supply, regardless of its psychodynamic functions, also simply feels good. The narcissist grows addicted to the gratifying effects of
Narcissistic Supply. He reacts with anxiety when constant, reliable provision is absent or threatened.
Thus, Narcissistic Supply always comes with excitement, on the one hand and with anxiety on the other hand.
When unable to secure "normal" Narcissistic Supply - adulation, recognition, fame, celebrity, notoriety, infamy, affirmation, or mere attention - the narcissist resorts to "abnormal" Narcissistic Supply. He tries to obtain his drug - the thrills, the good feeling that comes with Narcissistic Supply - by behaving recklessly, by succumbing to substance abuse, or by living dangerously.
Such narcissists - faced with a chronic state of deficient Narcissistic Supply - become criminals, or race drivers, or gamblers, or soldiers, or investigative journalists. They defy authority. They avoid safety, routine and boredom - no safe sex, no financial prudence, no stable marriage or career. They become peripatetic, change jobs, or lovers, or vocations, or avocations, or residences, or friendships often.
But sometimes even these extreme and demonstrative steps are not enough. When confronted with a boring, routine existence - with a chronic and permanent inability to secure Narcissistic Supply and excitement - these people compensate by inventing thrills where there are none. (site owner's note: sex addiction fits into this criteria)
They become paranoid, full of delusional persecutory notions and ideas of reference. Or they develop phobias - fear of flying, of heights, of enclosed or open spaces, of cats or spiders. Fear is a good substitute to the excitement they so crave and that eludes them.
Anxiety leads to the frenetic search for Narcissistic Supply. Obtaining the supply causes a general - albeit transient - sense of wellbeing, relief and release as the anxiety is alleviated. This cycle is addictive.
But what generates the anxiety in the first place? Are people born adrenaline junkies or do they become ones?
No one knows for sure. It may be genetically determined. We may discover one day that adrenaline junkies, conditioned by defective genes, develop special neural and biochemical paths, an unusual sensitivity to adrenaline. Or, it may indeed be the sad outcome of abuse and trauma during the formative years. The brain is plastic and easily influenced by recurrent bouts of capricious and malicious treatment.
Pathological narcissism is an addiction to Narcissistic Supply, the narcissist's drug of choice. It is, therefore, not surprising that other addictive and reckless behaviours - workaholism, alcoholism, drug abuse, pathological gambling, compulsory shopping, or reckless driving - piggyback on this primary dependence.
The narcissist - like other types of addicts - derives pleasure from these exploits. But they also sustain and enhance his grandiose fantasies as "unique", "superior", "entitled", and "chosen". They place him above the laws and pressures of the mundane and away from the humiliating and sobering demands of reality. They render him the centre of attention - but also place him in "splendid isolation" from the madding and inferior crowd.
Such compulsory and wild pursuits provide a psychological exoskeleton. They are a substitute to quotidian existence. They afford the narcissist with an agenda, with timetables, goals, and faux achievements. The narcissist - the adrenaline junkie - feels that he is in control, alert, excited, and vital. He does not regard his condition as dependence. The narcissist firmly believes that he is in charge of his addiction, that he can quit at will and on short notice.
The narcissist denies his cravings for fear of "losing face" and subverting the flawless, perfect, immaculate, and omnipotent image he projects. When caught red handed, the narcissist underestimates, rationalises, or intellectualises his addictive and reckless behaviours - converting them into an integral part of his grandiose and fantastic False Self.
Thus, a drug abusing narcissist may claim to be conducting first hand research for the benefit of humanity - or that his substance abuse results in enhanced creativity and productivity. The dependence of some narcissists becomes a way of life: busy corporate executives, race car drivers, or professional gamblers come to mind.
The narcissist's addictive behaviours take his mind off his inherent limitations, inevitable failures, painful and much-feared rejections, and the Grandiosity Gap - the abyss between the image he projects (the False Self) and the injurious truth. They relieve his anxiety and resolve the tension between his unrealistic expectations and inflated self-image - and his incommensurate achievements, position, status, recognition,intelligence, wealth, and physique.
Thus, there is no point in treating the dependence and recklessness of the
narcissist without first treating the underlying personality disorder. The narcissist's addictions serve deeply ingrained emotional needs. They intermesh seamlessly with the pathological structure of his disorganised personality, with his character faults, and primitive defence mechanisms.
Techniques such as "12 steps" may prove more efficacious in treating the narcissist's grandiosity, rigidity, sense of entitlement, exploitativeness,
and lack of empathy. This is because - as opposed to traditional treatment
modalities - the emphasis is on tackling the narcissist's psychological makeup, rather than on behaviour modification.
The narcissist's overwhelming need to feel omnipotent and superior can be co-opted in the therapeutic process. Overcoming an addictive behaviour can be - truthfully - presented by the therapist as a rare and impressive feat, worthy of the narcissist's unique mettle.
Narcissists fall for these transparent pitches surprisingly often. But this approach can backfire. Should the narcissist relapse - an almost certain occurrence - he will feel ashamed to admit his fallibility, need for emotional sustenance, and impotence. He is likely to avoid treatment altogether and convince himself that now, having succeeded once to get rid of his addiction, he is self-sufficient and omniscient.