The Cluster B personality disorders, which include narcissistic personality disorder, borderline personality disorder, histrionic personality disorder, and antisocial personality disorder, are characterized by dramatic, emotional, and erratic patterns of thinking and behavior. Of these, NPD and BPD are the two most commonly seen at Dr. Steinbok's Boca Raton practice and the two for which psychodynamic and psychoanalytic treatment has the most developed clinical framework. Both disorders involve significant difficulties in the regulation of self-esteem and the management of interpersonal relationships, though they do so through different psychological architectures.
NPD is organized around a grandiose self-presentation that functions to manage underlying shame and vulnerability, producing characteristic patterns of entitlement, difficulty with empathy, and intense sensitivity to perceived criticism or failure. BPD is organized around profound instability of self-image, emotion, and relationships, producing the cycles of idealization and devaluation, the fear of abandonment, and the emotional dysregulation that define the disorder. Dr. Steinbok works with both presentations at his Boca Raton practice, applying psychodynamic approaches that engage the underlying psychological structure of each disorder rather than focusing primarily on managing surface behavior. Patients with NPD and BPD who have had previous treatment are often well-placed to benefit from this depth of engagement, particularly if prior treatment addressed symptoms without reaching the personality level dynamics that generated them.
