Can narcissism be the result of chemical or biochemical imbalances?
The narcissist's moods do change suddenly as a result of 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, which are cyclical. 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 blood sugar or biochemicals.
What is possible, though, is that a THIRD problem causes chemical imbalances, diabetes, narcissism and other syndromes. There may be a common cause, a hidden common denominator (perhaps a gene).
Other disorders, like bipolar (mania-depression) are characterised by mood swings NOT brought about by external events (endogenic, not exogenic). The narcissist's mood swings are only 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 mood swings, pendulum wise, on a regular, almost predictable basis, from depression to elation as in biochemically induced mental disorders.
Additionally, the narcissist goes through mega-cycles which last months or even years. The boring daily routine, carefully crafted, over years insulates the narcissist in a safe comfortable cocoon this aspect of everyday being groundhog day can not be dismissed. The narcissist finds comfort and safety in the most boring repetitive activities (OCD) 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. It is usually subjected to talk therapy. The underlying disorder is treated by long-term psychodynamic therapy. Other PDs (NPD rarely comes alone. It usually appears with other PDs) are treated separately and according to their own characteristics. Without treatment, the narcissist can become a malignant narcissist, this is when the narcissist starts taking sadistic pleasure in manipulating his/her victims.This level of narcissism has been classified since 1985 as non curable.
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. SSRIs do lead at times to delirium and a manic phase and even to 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).
Additional cognitive-behavioural therapies are often applied to treat OCD and sometimes 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 treatment is talk therapy (psychodynamic).
Cognitive-behavioural therapy for OCD and depression.
Antidepressants (with SSRI being currently under critical scrutiny).