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The Neurochemistry of Love and Attachment: The Neuroscience Of Narcissistic Personality Disorder - Part III

Posted Jun 23 2009 6:54pm

Oie_mans_brain            "Twas in another lifetime, one of toil and blood

           When blackness was a virtue and the road was full of mud

            I came in from the wilderness, a creature void of form

                                          "come in" she said    

                                                                                 "I'll give you shelter from the storm"

                                                                                                                                                (Dylan, 1974)

Daniel Alkon, MD, wrote in one of my all-time favorite books on the planet that "...memory's permanence maintains trauma's grip on our behavior" (Memory's Voice: Deciphering the Mind-Brain Code, 1994, p.1).  In studying memory and the brain as he has for decades, he (and countless others) long since came to the conclusion that early childhood psychological trauma can structurally and biochemically damage the brain and alter both the behavior and lifestyle of a portion of those that have been abused, and while a stunning concept no doubt, is certainly neither new nor at this juncture in our rather meager scientific development, controversial.  In Parts I and II of this thread, a (really basic) overview and clinical definition of Narcissistic Personality Disorder (NPD) was discussed, with emphasis on the neurobiological correlates of NPD.  In this final portion of the discussion, we shall see how sex addiction is related to NPD, and how both disorders are the tragic consequence of a neurochemically deprived brain that leaves in its wake, among other things, a complete inability to love and bond to another human being, AKA attachment. 

What makes these disorders all the more tragic, is that they are generally borne out of the very same pathology, passed down from one generation to another, like a virulent disease that both society and to a large extent, the treatment community, seem to want no part of.  With advances in both scientific methodology, etiology, and consilliance across fields, this is beginning, thank goodness, to change.  How exactly does one become immune to love and attachement in the first place?  Technically, the answer lies somewhere between the ventral tegmental and anterior cigulate cortex areas, and the neurohypophyseal peptides oxytocin and vasopressin.  And if you happen to be sexually addicted to boot, then what you are addicted to is not sex of course, but gobs and gobs of that luscious free-flowing dopaminergic candy, made readily available by the inability to suck up enough oxytocin and vasopressin to keep you "nailed down" and out of the proverbial pantry.  "Cooledge Effect" anyone?

From the very moment of birth, our mammalian brain (that would be yours) is busy orchestrating; receiving, processing, and sending crucial information throughout our central and peripheral nervous systems which in turn enable us to act on that information in specific ways.  This information is composed of an exquisite array of biochemical signals and messages that operate like a gigantic switchboard, knowing where to go and how to get certain information, what brain "station" to send the information to, in what "language" it should be read or translated, and ultimately, how to transcribe the messages once they are received and processed at the correct "facility".  This switchboard is of course our central nervous system (CNS), and the messengers are our neurotransmitters and specialized neuropeptides.  It is these hundreds o f neurotransmitters that allow us to think, perceive, and behave in the remarkable (and sometimes not so remarkable) ways in which we do.  They tell us what to think and feel, how and when to feel what, and how and when to behave.  Even more basic then that, they tell us when we are hungry and how much and when to eat, when we are tired, and when and how much we should sleep.  They regulate every aspect of who we are and how we perceive the world at any given moment.  They are a magnificently orchestrated cocktail of neurochemical slop that can quickly become our greatest enemy in the fight to self-regulate our own body, brain, and mind.  And when this happens, one's time and energy is spent on little else, but trying desperately to self-correct a nightmarish system that has somehow turned against itself and run completely amuck.  They have become prisoners of their own self - they know they're broken but they don't know why or how to fix it.

There is a clear, and many would suggest, causal connection between states of addiction and states of physiological dysregulation secondary to psychological trauma.  Posttraumatic states and disorders of arousal dysregulation can be defined in the simplest of terms as a dysregulation of the pleasure, pain, and fear centers of the brains reward circuitry.  What is addiction if not a continual biochemical cocktail that feeds the pleasure centers of the brain in order to squelch the tide of unremitting pain and unmitigated fear?  Both processes are fueled by the incessant out-of-control drive to seek that ever-higher dopaminergic rush, in a failed but panic-driven mixed-up effort to self-regulate with the dream of someday finding that neurochemical homeostatic comfort zone - which does not exist if you are arousal dysregulated.  This is the very struggle for the traumatized individual who desperately seeks shelter form the perfect storm of constatnt assault -  of biochemical dysregulation and emotional and behavioral toxicity, left as a legacy for having survived the initial onslaught of exposure to trauma that they never ever asked to have happen in the first place.

Candace Pert appropriately dubbed the endogenous neuroamine, phenylethylamine (PEA), the "love molecule" (check out her 1997 book Molecules of Emotion: The Science Behind Mind-Body Medicine).  She's the one that also says "god is a neuropeptide", but we'll just have to save that juicy little morsal for another issue - if not another blog - altogether.   PEA, in addition to dopamine (DA), oxytocin (OT), and arginine vasopressin (AVP), are all neuropeptides (remember?  neuropeptides are the highly specialized neurotransmitters - brain messengers -  that talk to one another)  that are implicated in the feeling states related to sexual arousal and the "thrill" of falling in love.  You might think PEA sounds familiar if you tend to consume dark chocolate.  PEA  stimulates the CNS, producing  the rapid heart rate, flush, and "rush" of being in love.  Makes sense considering that it's an amphetamine!.  More importantly however, PEA releases DA, which we know to be the culprit behind sexual arousal, of which DA, post coitus, then stimulates the release of OT, also known as the "cuddle chemical", and AVP.  OT is secreted by DA in the anterior pituitary gland sending a wash of calmness over the body, and increasing the bodies sensitivity to touch.  More touching increases more OT, which then continues the cycle (see the post in this blog on "Prairie Voles").  OT is the neurochemical tie that binds.  This little cycle of neurochemistry is an extraordinarily important component of mammalian (again, that would be you)  bonding, trust, attachment, and love.  BUT...

When only PEA and more importantly, only DA are released  without the ensuing OT "cuddle chemical", there is simply sex without bonding, attachment, and love.  It is as if the system is all jacked up and in desperate addictive need of another "hit", as soon as possible.  There is no time to hang out and snuggle.  Uh-uh.  You are big-time DA  jonesing for another DA fix, and the very  thought  of hanging out and smelling the roses for an extended 'spoon' session with your significant other, is simply out of the damn question!  Further, when only DA is released and the release of OT is inhibited, then DA is continually released in the absence of OT.  If OT is attenuated or inhibited altogether, then the brain builds an actual tolerance to DA, and more and more DA is needed and sought, making OT a veritable thing of the past, and DA the drug-addicts drug-of-choice.  No OT - no attachment or love.  Period.  Only the ever-increased pursuit of sex with multiple partners (or at the very least, lots of "you" all by your lonesome) since DA seeks out novelty (and seeks to avoid anything like love and attachment that might get in its way)  and without OT, there is literally, no tie to bind!  This becomes the psychological equivalent of the Coolidge Effect personified.  It may also explain much of the addictive aspect and impairment in intimate bonding and attachment that many, if not all, sex addicts struggle with. 

Sex addiction is an addiction to shame.  They are ashamed of who they are and who they are not, of what they do, and of being seemingly incapable of controlling their own desires.  They are ashamed of having something that society perceives as deviant and in the same column as pedophilia.   Shame produces a rush of neurochemicals that  fuels the release of DA like little else.  Sex addicts act out.  Acting out causes severe shame (sex addicts are not sociopaths or antisocial, and feel tremendous amounts of guilt and shame on a continually spiraling basis).   They also sometimes act "in" as a way of preventing themselves from acting "out".  Either way, if they are sexual in inappropriate addictive ways, they are not sober (see the 1st article in this blog).  The prime consideration for sex addicts, just as it is for drug addicts, is to stop acting out.  But WHY do sex addicts act out?  Because of sex?  No.  Just like alcoholics and drug addicts,  acting out (take drugs) is a way to medicate or anesthetize their pain.  What are sex addicts anesthetizing?  LOVE and ATTACHMENT!  Because all sex addicts by definition also carry a NPD, they are attachment disordered.  Sex addiction comes about in the massive majority of all cases, secondary to a traumatic early childhood, either secondary to sexual abuse and/or malignant narcissistic assault from one or both parents or prime caregivers.  It completely disrupts their physiology, their limbic system is a total mess, and the end result is that they are scared to DEATH of becoming attached.  It represents a death knell for them.  I urge the reader to check out Dr Sam Valknins site for a remarkably thorough and easy-to-digest account of NPD as it relates to love and attachment.  So what is the "cure"?  Of course we don't use the "C" word, but learning to trust, bond, attach, and love, is the remedy.  How?  By doing so with someone who is very safe, in a safe and protected environment, and very, very slowly, without knowing what is happening!  How does this treat the sex addicted NPD?  Because it allows them to s-l-o-w down, to stop diving in for the DA hits by having lots of unattached sex, and when there is trust, attachment, and love, OT and AVP flow like the Trevi fountain.

To my patients in treatment I become the veritable love-hate object.  The more attached they become, the more resentment and anger and unadulterated FEAR they have for me.  In Freudian terms, it is the epitome of the Madonna-Whore complex in all its glory.  Male sex addicts, be they gay or straight, or somewhere in the middle, are generally petrified of women (though deny it with no small modicum of vehemence they initially do).  Why - refer to the previous post.  Women - that would be women with whom they are either attracted to or have respect for - the later part being in short supply - represent a mother that never attached to them, and/or protect them from a raging out-of-control malignantly narcissistic father.  Women are perceived as either exceedingly weak or embodying the power of some mythical goddess capable of snuffing out their existence with the mere blink of an eye.  Emotional castration on the half-shell.  Give away your power to one?  Tell them your secrets? Hell, fall in love with one?  Are you KIDDING me?? That would be the penultimate suicide, and not a quick one at that.  To be out of control and in total service to the one thing you so fear?  Therapy with this population is neither for the faint of heart or inexperienced.  So then.  Is treatment really possible?  For those willing to do the work, of course it is - possible and effective, and I dare say not just a tad humbling on my end.

Alcon likens childhood trauma to memories encapsulated in one of those familiar snow globes wherein he cautions  "Like falling snowflakes that obscure a miniature landscape under glass, the memories take time to settle down before the scene within slowly becomes visible" (1994, p.xviii).



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