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BEHAVIOR & TRAINING
TOPICS
DOGS:
Bark
Collars
Coprophagia in
the Canine
Parmacologic
Treatment of Separation Anxiety
Behavior
Modification: Departures
Behavior
Modification: Relaxation
Behavior
Modificaition: Uncouple Departures and Departure Cues
CATS:
Kitten
behavior and training
Toilet Training
your Cat
Feline
Agression
GENERAL:
Fears and
Phobias
Destructive
Behavior
Compulsive
Behavior
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COMPULSIVE DISORDERS
Introduction
Discussion
Treatment
Summary
References
Key
Principles
Author Gary
M. Landsberg, D.V.M.
Subject Animal Behavior
Day 2/12/01
Time
09:00:00
Western Veterinary Conference
Introduction
Compulsive disorders
often arise out of situations of conflict
or frustration. Conflict
occurs when the pet is motivated to
perform two opposing behaviors
(such as approach to greet and
fear of punishment). Frustration refers
to a situation in
which the pet is motivated to perform a behavior but
is not
able to do so (such as when the pet is confined behind a
barrier but is motivated to chase). The response may be a
displacement behavior, a response that is out of context
response
to the stimulus (eg, tail chasing). In some cases the
owner’s response
to the pet’s actions has reinforced the
behavior, so that the pet has
become conditioned. When the
conflict, frustration, or reinforcement
persists or regularly
recurs, the behavior may become compulsive.
Compulsive
disorders are those in which the behavior is exhibited
outside
or independent of the original context and have no apparent
goal.1 They can be repetitive, exaggerated, sustained, or so
intense that they might be difficult to interrupt.1 Many cases
can
be successfully controlled with a combination of drug
therapy,
behavior modification, and modifications to the
environment.
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Discussion
There is no stringent
definition to describe all aspects and
forms of compulsive disorders,
but there are generally some
hallmarks of the clinical signs that aid
in the diagnosis.
Although the behavior might be normal if displayed
in context,
the behavior is abnormal because it is out of context.
Examples of compulsive disorders in dogs might include
self-directed or self-injurious behaviors, such as acral lick
dermatitis, flank sucking or tail chewing, air biting or
fly-snapping, spinning or tail chasing, pacing, freezing,
licking,
staring, chasing objects whether real (lights,
shadows) or imaginary,
polydypsia, pica, attacking inanimate
objects, checking of the rear
end, and barking.1
In cats, compulsive licking or hair pulling,
(psychogenic
alopecia), tail attacking, pawing at the face, staring,
polydypsia, picas including wool or fabric sucking, and
perhaps
hyperesthesia might all be compulsive disorders.1 In
some cases there
can be breed predilections, such as flank
sucking in Doberman
pinschers, spinning in English bull
terriers, tail chasing in German
shepherds, and wool sucking
in Oriental breeds of cats.1
The
diagnosis is based on first ruling out all possible
medical causes for
the presenting clinical signs. Dermatologic
diseases, painful
conditions, organ dysfunction, metabolic
diseases, diseases of the
special senses and neurologic
diseases, including seizures, may all
need to be ruled out.
Seizure foci differ from compulsive disorders in
that seizures
arise independent of any specific stimuli, they do not
appear
with any predictability, cannot be interrupted, may have a
recognizable pre- and or post-ictal phase, and may respond to
anticonvulsants.
After
underlying medical problems have been ruled out or
treated, the
behavioral history is needed to confirm the
diagnosis and design an
appropriate treatment plan. Because a
pet seldom exhibits the behavior
in the veterinarian’s
presence, having the owners make a video of the
problem can be
a valuable tool.
The history
should include a description of the problem and
details about the
onset of the problem, including any changes
in the household, and the
stimuli and situations in which the
problem arose. This should then be
compared with the current
presentation; whether it has changed in
frequency, expression,
intensity, or the type of stimuli that set off
the problem.
The owner’s response to the problem, the pet’s reaction,
what
has been successful and what aggravates the problem must also
be determined. The amount and type of training and exercise,
relationships with family members and other pets, environment,
schedule,and the rewards that best appeal to the dog should be
reviewed.
Beta-endorphins, dopamine, and serotonin have all been
implicated, primarily based on evidence of response to
therapy.
Dopaminergic drugs, such as amphetamines, may induce
stereotypies; and
dopamine antagonists, such as haloperidol,
may result in suppression
of stereotypies.1 Compulsive
disorders may also be mediated through
opioid receptors, as
opioid antagonists (drugs that block central
endorphin
receptors), such as naltrexone, have been successful at
reducing “stereotypies” in some cases.2,3 In addition, drugs
that
supply an exogenous source of opiates, such as
hydrocodone, have also
been reported to be effective in the
treatment of acral lick
dermatitis.4
Serotonin depletion has also been suggested to be a
mechanism
by which stereotypies are induced. Based on human models for
the treatment of obsessive-compulsive disorders, drugs that
inhibit serotonin reuptake appear to be most effective in the
treatment of canine and feline compulsive disorders.
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Treatment
Treat underlying or
concurrent medical problems.
Identify the cause of anxiety or conflict
and treat.
Change the owner’s response, ie, no reinforcement, no
punishment.
Disruption
devices can be used to stop the behavior and
ensure that no reward is
given (eg, alarm/ultrasonic, water
rifle, remote citronella, or remote
leash with head collar)
Determine if serious enough to warrant
treatment.
Reward-based training--ensure that all rewards (attention,
treats) are earned-–never initiated by the pet.
Head halter
training can improve training and help to calm.
Increase stimulation
and distractions-–scheduled, intensive
play, exercise and training
sessions; highly motivating
toys.
Environmental
modifications, ie, novelty, distractions.
Calming cues-–blanket, novel
odor, dog bed, TV, or CD.
Reinforce desirable responses, eg, play with
own toys.
Punishment-–no verbal or physical. Remote devices or devices
activated by the pet (booby traps) may be successful.
Restrain or
prevent. This may increase anxiety but may be
needed to break the
habit (eg, e-collar, confine, booby
trap).
Drug therapy
concurrent with behavioral therapy
Compulsive disorders: clomipramine
at 2 mg/kg twice daily
for 1 to 3 months before weaning or
discontinuing. Can
increase to 3 mg/kg twice daily if insufficient
improvement.
Could try an SSRI such as paroxetine or fluoxetine at
1
mg/kg per day to start if clomipramine contraindicated or
adverse effects. A trial with a narcotic (eg, hydrocodone)
may be
warranted especially for oral self-directed
behaviors.
Treatment
for a minimum of 6 to 8 weeks is likely needed
to determine if drug
therapy is to be successful.
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Summary
Compulsive disorders
may initially arise out of anxiety,
conflict, frustration, or medical
problems and may be further
aggravated by owner reinforcement or
inappropriate punishment.
When they become intense and exaggerated and
begin to be
exhibited independent of the inciting stimuli, then they
may
meet the diagnostic criteria for compulsive disorders. At that
point, even if the initiating cause can be addressed and
treated,
intensive behavioral intervention, modifications to
the environment,
and drug therapy are also likely to be needed
for successful control
or resolution.
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References
Luescher UA.
Compulsive behaviour in dogs. Vet Int.
1998;10:7-12.
Dodman NH,
Shuster L, White SD, et al. Use of narcotic
antagonists to modify
stereotypic self-licking, self chewing
and scratching behavior. J Am
Vet Med Assoc.
1988;193:815-819.
Brown SA, Crowell-Davis S, Court
MH, et al. Naltrexone
responsive tail chasing in a dog. J Am Vet Med
Assoc.
1987;190:1434.
Brignac MM. Hydrocodone treatment of acral
lick dermatitis.
Proceedings of the 2nd World Annual Congress of
Veterinary
Dermatology, Montreal, Quebec, 1992.
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Key Principles
Medical problems that
might be responsible for the clinical
signs must be ruled out before a
diagnosis of compulsive
disorder can be ruled in.
When there is
an ongoing source of anxiety, conflict, or
frustration responsible for
the signs, then behavioral and
drug therapy must first be instituted
to resolve these
problems.
A combination
of environmental modification, behavioral
modification, and drug
therapy may be needed concurrently to
control or resolve the
signs.
Drug therapy
with clomipramine (licensed for this application
in Canada) or an
SSRI, such as fluoxetine or paroxetine, is
likely to be useful but may
require 2 months of therapy to
assess the full effect.
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