Abnormal Canine Behaviors and Behavioral Pathologies Not Primarily Involving Pathological Aggression

Chapter 7


Abnormal Canine Behaviors and Behavioral Pathologies Not Primarily Involving Pathological Aggression


This chapter focuses on conditions, concerns, and diagnoses that do not have at their core aggressive behavior. Behavioral conditions are often co-morbid, however, and any one of these conditions may co-occur with a condition involving aggression as a primary or secondary diagnosis.


All of the conditions discussed in this chapter are or can become pathological. For dogs whose problematic behaviors involve elimination, the elimination behaviors may be the result of management practices or may be normal behaviors displayed in contexts clients find undesirable. The manner in which these problematic behaviors are addressed before veterinary intervention is sought can create anxiety (see Box 2-1 for a listing of non-specific signs of anxiety). Because of this and the risk of co-morbidity, concerns about elimination behaviors are addressed at the end of this chapter.





Fear/Fearful Behavior



Diagnostic Criteria and Description:



• True fear involves responses to stimuli (social or physical) that are characterized by withdrawal and passive and active avoidance behaviors associated with the sympathetic branch of the autonomic nervous system (Hydbring-Sandberg et al., 2004) and in the absence of any aggressive behavior.


• Fear and anxiety have signs that overlap. Some non-specific signs, such as lowering of the back, shaking, and trembling, can be characteristic of both fear and anxiety.


• Truly fearful dogs lower their entire bodies, necks, head, ears, and tails and appear to fold into their limbs (Galac and Knol, 1997). Anxious dogs do not do this and exhibit a wide range of stances.


• The physiological signs of fear and anxiety probably differ at some very refined level, and the neurochemistries of each are probably very different in a way that is not addressed by the relatively non-specific medications we commonly use (see Table 10-5 for a summary of the complexity of the distribution of subtypes of serotonin receptors).


• Refinements in qualification and quantification of the observable behaviors will hopefully parallel these differences.


• True fear always involves avoidance, with an apparent intent to decrease the probability of social interaction. This is in contrast to anxiety, where avoidance is not the first choice. Dogs who are driven primarily by anxiety may put themselves into a social system, although it makes them uncomfortable and worried.



Common Non-Specific Signs:



• Specific behavioral responses may include (Fig. 7-1):





Rule Outs:



• Endocrinopathies, including Cushing’s disease and hypothyroidism, can result in many of the same signs, but the pattern is usually different.



• There are periodic vogues for treating fear and a variety of anxiety-related conditions with thyroxine because the non-specific behavioral signs can occur with hypothyroidism. See the discussion in Chapter 6 on thyroidal involvement in aggression.



• Any infectious or toxic agent that can affect the nervous system could potentially cause many of these non-specific signs, but the pattern is different. Fear can be insidious in the way that it is characteristic of infectious/toxic conditions, but a dog’s behaviors are not usually dependent on the social or environmental context if he has a toxic or infectious condition.



Etiology, Epidemiology, and Risk Groups:



• There appear to be two main groups of fearful dogs:



• For both groups of dogs, there appear to be sporadic and heritable forms, although the data are poor.


• For very young puppies (5 to 8 weeks of age), fear can be due to lack of exposure or a heritable version of fear that appears to render the dogs averse to approaches of and interactions with strangers.



• These dogs may freeze when faced with unfamiliar humans, and if not completely problematic as puppies, they worsen as they move through social maturity.


• These dogs have consistent behavioral and physiological responses to unfamiliar people.


• These dogs are usually quite good with other dogs.


• Many lines of purpose-bred dogs have dogs who respond this way. Such behaviors may have been selected for during the process of trying to produce “tractable” laboratory dogs.


• This condition can be detected at the first veterinary visits. When tested using a series of behavioral provocations that are part of routine care, these puppies withdraw and become quiet, although they may pant (Godbout et al., 2007).



• If protected, these dogs can live a good life as pets, but people have to understand that they are likely never to be outgoing.



• For dogs who begin to show fear during social maturity or for dogs who worsen during this time, clients will often express concerns that they ignored about some behavior during puppyhood.


• Dogs can become fearful with time, but when this happens, the fear is not usually global, and identification of stimulus/stimuli that trigger the response will help in the process of treating it.



Common Myths That Can Get in the Way of Treatment or Diagnosis:



• He’s just “shy.”



• This is “normal” in this breed.



• He will “grow out of it.”




Commonly Asked Client Questions:



• Will he/she ever be normal?



• Are drugs needed for the rest of his life?



• Could we have prevented this?



• Should we have known this would happen?



• Are we to blame?



• People often engage in behaviors that scare dogs and most dogs are recoverable. Fearful dogs, by definition, are not recoverable easily. If people subjected a dog to a set of behaviors they knew to be causal of fear for that dog or if they did not intervene when they saw this happen, they are to blame.


• Most people are misinformed or uninformed. This is sad and may make them feel terrible, but intent matters, so they are not really to blame.


• Once clients know what the problem is and that there is help available, they become responsible for that dog. If they continue to put the dog in untenable conditions (from the dog’s perspective) or refuse to give it appropriate care, the balance of blame shifts in their direction.


• A more useful focus is assigning responsible roles for everyone in the dog’s anticipated improvement.



Treatment:



• Management:



• Part of the management of this condition involves screening for it at every single veterinary visit.



• Dogs with this condition should be protected from stimuli known to trigger it until they are engaged in an active behavior modification plan, combined with pharmacological treatment to facilitate the behavior modifications.



• Behavior modification:



• Medication/dietary intervention:



• Supplements containing omega-3 fatty acids and other polyunsaturated fatty acids (PUFAs) may have a beneficial effect on fearful behaviors by preventing damage to neurons that could inhibit the ability to recover from a fearful event.


• Available nutriceuticals (alpha-casozepine [Zylkene], l-theanine [Anxitane], Calmex, and Harmonese) may benefit fearful dogs because they all have some effect on γ-aminobutyric acid and promote calmer behaviors through inhibition. Some of these may also have neuroprotectant effects (see Chapter 10).


• Royal Canin’s CALM diet contains alpha-casozepine, and studies to date have shown very mild but potentially promising effects on behavioral indicators of stress (Kato et al., 2012; Palestrini et al., 2010).


• In all but the mildest circumstances, medication may be warranted because:



• Medications that may help come from the following classes of drugs:



image TCAs (amitriptyline, nortriptyline, clomipramine) may help dogs to be less anxious and more outgoing as they modulate neurochemical activity. Broad-spectrum TCAs affect many norepinephrine/noradrenaline (NE/NA) and 5-hydroxytryptamine (5-HT) receptors and so may address a variety of neurochemical variants of fear. If the fearful response involves any ritualistic components, clomipramine may be the first drug of choice.


image SSRIs (fluoxetine, sertraline) have been shown to be helpful in some forms of panic, fear, and profound anxiety. Because they target specific 5-HT1A subtype receptors, they mostly affect regions of the brain involved in learning and so may have their greatest effect in combination with behavior modification designed to teach patients more successful and less distressing behaviors.


image Benzodiazepines (BZDs; alprazolam, clonazepam) and related compounds (gabapentin) may be essential for alleviating fear and incipient panic and can be given daily or as needed.


image Alpha-2 agonists (clonidine) can be useful for extreme fear with enhanced reactivity because they alter the peripheral vascular tone that is part of the feedback coupled to reactive responses. These can be used daily or as needed.


image Serotonin-2 antagonist reuptake inhibitors (SARIs; trazodone) affect 5-HT2A receptors and given the distribution of these may modulate some activity/motion associated with fear. It is unlikely that in profound, non-situational fear, treatment with trazodone alone, will be helpful, but it is often used situationally because it is a sedative.


• Miscellaneous interventions:





Last Words:



• People become worried and scared when their dog is fearful and may delay seeking help in the hopes that the dog “will grow out of it.” Truly fearful dogs do not “grow out of it,” and the risks must be frequently and clearly explained because the earlier these dogs are treated, the more normal they become. When deciding whether to use medication on a very young dog, minimize the cost of error, which is that the dog will worsen, and consider early use of medication in combination with true behavior modification (not just training or obedience training).


• None of us are perfect, and no dog needs to be perfect. Clients who can adequately protect dogs from the objects of their fear may choose protection as a strategy, but they need to ensure that they can continuously implement the protection over a decade or more. Few clients have stable enough lives to guarantee this approach.


• There are lines within breeds where all or most of the dogs exhibit some form of fear. Genetic counseling can help breeders to make choices that can alter this pattern.


• Noise reactivity may enhance the risk for some types of fears and anxieties. Whether this is the case for true fear is currently unknown.


• Dogs who are fearful may be difficult to assess medically, especially for pain. The sympathetic response to fear will mask a number of non-specific signs of physical ailments and may ultimately worsen pain. If the dog is painful after the fearful event, chances are he was painful before it. Medication and rehabilitative therapy to alleviate the pain should be considered, especially because nociceptive perception and anxiety become neurochemically associated centrally.



Generalized Anxiety/Generalized Anxiety Disorder (GAD)




Common Non-Specific Signs:



• These dogs are often identified by some combination of the following behaviors:



• Specific behavioral responses to stimuli can include pacing, barking, whining, and lunging, all of which are triggered at levels below which most dogs react and which persist for longer periods of time than would be true for normal dogs.



• Most “normal” dogs will habituate to the triggers that provoke the vigilance and scanning and autonomic hyper-reactivity and hyperactivity that occurs in GAD.



Rule Outs:



• The signs of GAD are sufficiently non-specific that they can be associated with pain, cardiac disease, or endocrinopathies.


• True hyperactivity may be a concern, but the attentiveness and monitoring that are characteristic of GAD are lacking.


• In elderly dogs, cognitive dysfunction (CD) can share signs with GAD, and GAD may be a sequela to changes involved in early CD and/or “normal” aging in which visual and auditory capabilities change suddenly.


• Inflammatory bowel disease/irritable bowel syndrome (IBD/IBS) is an often diagnosed but seldom verified condition. Any dog with IBD/IBS should undergo a complete behavioral history and evaluation. If IBD/IBS is not confirmed but the behavioral history is informative, the diarrhea may be a non-specific sign of heightened reactivity and autonomic arousal.



Etiology, Epidemiology, and Risk Groups:



• As with most behavioral conditions, GAD becomes most apparent as dogs pass through social maturity, suggesting that shifts in neurochemistry and/or regional brain activity are contributory.


• There are no population-level data about prevalence and risk.


• GAD may run in family lines, but there are no conclusive data.


• GAD is often co-morbid with other anxiety-related conditions, especially noise reactivity/phobia.



• Diagnoses involving aggression (e.g., true inter-dog aggression, impulse-control aggression) are often secondary to GAD.



• Attention-seeking behavior must be a diagnostic rule out because some dogs can learn that they can encourage non-stop attention by constantly moving and engaging in similar behaviors.



• Other dogs in the household appear to know that these dogs are abnormal and may avoid them when they are very reactive. If the client has another dog, the comparison of the behaviors of the two dogs can be dramatic and informative.



Common Myths That Can Get in the Way of Treatment or Diagnosis:




Commonly Asked Client Questions:



• Is this the result of the dog’s diet?



• Is this the result of vaccinating the dog?



• Does this mean the dog is not getting enough exercise?




Treatment:



• Management:



• Controlling exposure of triggers that elicit the most extreme responses may help to keep the dog’s responses in a more manageable range. Curtains/drapes may help for dogs who respond to movement. Crating or gating the dog away from windows, doorways, letterboxes, et cetera, may help him not to react and so modulate the extent to which he becomes vigilant.


• Clients have usually yelled at or reprimanded these dogs frequently. Yelling and reprimands don’t work, and the risk is that dogs learn to tune out most of the client’s requests. Teaching the client to talk to and interact with the dog only when the dog is sitting still and is quiet and attentive is a challenge but necessary if the client is to expand the extent of time in which the dog can focus on anything.


• Clients should avoid as many circumstances as possible that trigger or worsen the behaviors. This may mean that the dogs have to stop going in the car or to the dog park, but such deprivations will be temporary, and the activities can be slowly resumed as the dog improves.


• Behavior modification:



• Clients and trainers often find it extremely hard to work with behavior modification in dogs with GAD. The lack of focus and willingness to pay attention and the hyper-reactivity and distress are challenges. For dogs who are unable to work with basic behavior modification until they begin to respond to medication, simply teaching the dog to sit quietly, look at the client, and take a deep breath—even if the dog must get up after each iteration of this exercise—will lay the foundation for using improved communication for helping the dog as the medication renders him less reactive.


• The protocols for deference, relaxation, and deep breathing all will help, and all are necessary, but complete engagement in these may not be possible until the dog has begun to respond to medication.


• Medication/dietary intervention:



• There is some weak evidence that extremely high protein levels may render some dogs more reactive if these dogs are not working hard physically. If the dog is eating a very high-protein diet (>25%), lowering the protein may help the dog improve.


• Medication is usually the key first step in allowing the dog to be less vigilant, less distressed, and more attentive to the client and other dogs about whether there are legitimate reasons for arousal.


• Medications to which these dogs best respond include:



image Gabapentin, alone or in combination with TCAs and/or SSRIs. Gabapentin is ideally suited to decrease overall arousal and non-specific anxiety levels with very few potential side effects.


image TCAs (clomipramine, amitriptyline if in combination with SSRI) will affect both NE/NA and 5-HT subtype receptors, and their ultimate effects may be determined by the overall distribution of those in the specific patient’s brain. Generally, both NE/NA and 5-HT receptors are involved in the behaviors associated with most anxieties, although the relative contributions may vary among patients.


image SSRIs (fluoxetine, sertraline, luvoxamine) primarily affect the 5-HT1A subtype receptor and so may exert their largest effects in the hippocampus and cortex in regions involved in learning. As such, they should speed the acquisition of new, more suitable coping behaviors taught through behavior modification and modulate arousal level.


image SARIs (trazodone) affect 5-HT2A subtype receptors, which are commonly involved in anxiety-related conditions involving repetitive movement.


image Central alpha agonists (clonidine) stimulate central NE/NA receptors and modulate NE/NA receptors in the peripheral vasculature decreasing the agonistic sympathetic response. Depending on the level of the arousal response, they may be helpful. When used with TCAs, which also potentially increase central NE/NA and/or the efficiency of receptor actions and turnover, clients should be asked to watch for side effects, including agitation, that can result from increased central NE.


image BZDs (alprazolam, clonazepam) may be helpful if there is concomitant noise reactivity/phobia or the dog’s reaction to a specific stimulus or set of stimuli is extreme. BZDs affect the reticular activating system and may help to engender a lower reactive state in general. BZDs can be used as outlined in the protocols for noise/storm phobias and panic.


image Because diarrhea may be a non-specific sign of arousal combined with distress, treatment as needed with loperamide (Imodium) may be beneficial because it will decrease a physiological component of arousal.


• As these dogs improve, clients note that they begin to gain weight despite the same diet. Clients can be instructed to watch for weight gain as a sign that the dog is no longer patrolling so much as part of his need to be hypervigilant.


• Clients may also note that if there are multiple dogs in the house, all dogs seem calmer and may play more as the GAD resolves or is controlled.



Miscellaneous Interventions:



• Some clients in desperation may have tried severe control techniques, including extensive and inappropriate crating, which usually makes the dog worse including non-jumping harnesses, which may injure active dogs; and electric shock to stop the dog. None of these are likely to be effective, but their discussion or use can be a gauge of the extent to which these dogs are disrupting the household.


• For dogs who are always monitoring the auditory environment, white noise may help, as may headphones (e.g., Muttmuffs) or ear plugs if the dogs will wear them.


• At first, the presence of other dogs is unlikely to help because these patients are too reactive and worried to focus on them. As affected dogs begin to improve, they may play more and become more able to use non-reactive dogs as models for calmer behaviors and sensors for true risk.



Helpful Handouts:


Aug 15, 2016 | Posted by in SMALL ANIMAL | Comments Off on Abnormal Canine Behaviors and Behavioral Pathologies Not Primarily Involving Pathological Aggression
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