Narcissists, Medication, and Chemical Imbalances
Frequently Asked Question # 70
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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 are not provoked by the fluctuations in the narcissist's body chemistry (for instance, his blood sugar levels), or with the presence or absence of any substance or chemical in his brain. 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).
Certain medical conditions can activate the narcissistic defense mechanism. Chronic ailments are likely to lead to the emergence of narcissistic traits or a narcissistic personality style. Traumas (such as brain injuries) have been known to induce states of mind akin to full-blown personality disorders.
Such "narcissism", though, is reversible and tends to be ameliorated or disappear altogether when the underlying medical problem does.
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.
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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.
The Narcissistic Personality Disorder (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 Personality Disorders (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.
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.
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).
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