The patient has diagnoses of Borderline Personality Disorder (BPD). Binge Eating Disorder (BED), Body Dysmorphia Disorder (BDD), Unspecified Affective Disorder (UAD) and passive suicidal ideation. Case notes document that the patient has a long past history of anxiety, depression, abnormal behaviors, excess emotional sensitivity, and bullying since middle school. The patient has a learning disorder (LD) and repeated the 9th grade. The patient has had only limited benefit from multiple past treatments at the Inpatient Psychiatric (IP), RT (residential treatment) level, and outpatient treatment. Prior to the RT dates being currently evaluated, the patient was discharged from IP within the prior month.

The health plan's determination is overturned. The Residential Mental Health Treatment was medically necessary. In addition of having high emotional reactivity and sensitivity, this patient reproduced his pre-admission abnormal behaviors and dysphoric moods (anxiety, depression) during the RMHT under review and had only very short periods of normal mood. The patient continued to refuse to engage in therapy, refused to fill-in therapeutically appropriate forms, and refused at times to get out of bed. The patient eloped and when apprehended was increased in the intensity of care by admission to inpatient hospital. In addition to aspects of mood dysregulation, abnormal eating and body dysmorphia, the patient appears to have exhibited strong features of borderline personality disorder (BPD), a chronic, and difficult to treat disorder in a person with low motivation, poor insight, and refractoriness to new learning. The choice of dialectical behavior therapy (DBT) as the major subtype of cognitive therapy was appropriate, but, unfortunately, was not effective in this admission to RT. It is possible that any one of this patient's diagnoses could be treated at the Partial Hospital level, but the combination of diagnoses and refractory history of unresponsiveness to past treatments would make treatment at the PH level inappropriate.