Causes of behavior problems

Knowledge of medicine, health, and pathology provides an important dimension for the veterinarian working with companion animal behavior problems. Prior to performing the actual behavioral consultation, it is critical that a thorough physical examination with appropriate diagnostic testing be done to rule out underlying medical conditions. For example, using behavioral modification alone for a cat with housesoiling is counterproductive if there is a urinary tract disorder or diabetes mellitus. The various categories of medical conditions that might lead to behavioral signs are discussed in Chapter 6.

Presenting signs may arise as a result of a disease process, primary behavior problems, or some combination of these factors. Signalment should be considered when determining which medical problems could be contributing to the behavioral signs. Congenital conditions might be more common in young pets, while a range of medical problems, including endocrinopathies, arthritis, alterations in the immune response, sensory decline, neoplasia, and age-related organ dysfunction (including brain aging), are more common with increasing age.^1,2 Medical conditions in senior pets and their potential effects on behavior are discussed in Chapters 6 and 13.

Another important reason for physical examination and screening tests is to establish a baseline prior to the use of any pharmacologic therapy and to ensure that there are no contraindications for using the medication(s) being considered. In general, the minimum assessment that should be collected for most behavior problems would be a physical examination, hemogram, biochemical profile, urinalysis and, where indicated, endocrine screening tests to rule out thyroid disease and diseases of the hypothalamic–pituitary–adrenal axis.

The presence of a medical problem does not necessarily mean that it is the cause of the behavioral signs. For example, a cat with a positive feline leukemia virus test might be aggressive or spraying for reasons independent of its positive viral state. Genetic, medical, and environmental effects could also contribute to a state of behavioral pathology, where neurotransmitter dynamics have been altered.

Undesirable behavior or abnormal behavior

In the absence of a medical cause, most behavioral problems are a result of the owner’s inability to manage and control an otherwise normal behavior. Some examples of normal but unacceptable behaviors might include guarding toys and food, protective aggression toward visitors to the household, digging, chewing, and intraspecies aggression. Abnormal behaviors are those that are considered dysfunctional. They may be associated with extreme anxiety, may be out of context or inappropriate with respect to the stimuli, or may be excessive, uninhibited, or impulsive. These types of problem can be due to inherited factors, the effects of endogenous factors (endocrine, metabolic, inflammatory, immunological, and aging changes) and exogenous factors (such as the effects of deprivation or repeated or chronic exposure to situations of stress, anxiety, or conflict). Compulsive disorders, excessive fear, panic and phobias, aggression arising from dyscontrol or lack of inhibition, and learning deficits associated with hyperactivity are abnormal behaviors or mental health disorders. In these cases, altered neurotransmitter and receptor function, may be present and drug therapy may be a necessary part of the therapeutic program.

Families require education as to what is normal canine and feline behavior. They also need to know how these problems can best be managed using behavior modification, learning principles, and environmental management.

Preparation before the session

Since behavior counseling requires a knowledge and understanding of a wide variety of problems, it is seldom practical to perform a behavioral consultation without some advance preparation. Gathering information can be very time-consuming work. It is therefore advisable to request that the family fill out a history questionnaire so you can use this information to research the problem thoroughly before the counseling session. Using a history questionnaire will facilitate collection of data, keep information together so it can be readily referenced during follow-ups, and help the consultant avoid overlooking important questions. It is advantageous to have the questionnaire filled out and returned at least 48 hours prior to the consultation time, so that you have adequate time to review it beforehand. The 48-hour return policy also helps with the appointment schedule. When your receptionist notes that a form has not been returned in a timely manner (forgetful owner or cancellation without notification), a call can be made as a reminder, and if there is a cancellation the appointment time can be freed.

The behavior data sheet questions should explore a wide variety of pertinent information. You can design your own forms using the outline in Table 5.1 as a guideline/ checklist (form 18 printable from web), or you can use the forms that accompany this book (see Appendix C, form C.5, client form #3, printable version available online) and 2 more comprehensive questionnaires, one for dog cases (form 19) and one for cat cases (form 20) which have not been printed within the text but are available as printable version online. There are many other such forms available for this purpose, including those at www.sabs.com.au, westwoodanimalhospital.com and www.northtorontovets.com. If you design your own forms, be certain to include questions that address all aspects of the pet’s health and behavior, since the primary complaint may be only one sign of a more complex health or behavioral problem.

Table 5.1 Basic information checklist for history collection – This can be used as a guide for history collection (printable form 18 from web)

It is advisable to counsel and inform clients about simple behavioral concerns during their regular veterinary visits. However, for more involved problems it is best to schedule a separate appointment. This will allow the practitioner to spend an adequate amount of time discussing the problems rather than hurriedly trying to collect information and give treatment recommendations during a medical visit. Tackling more difficult problems, such as aggression or complex phobias, is best reserved for behavioral specialists or those veterinarians who have already acquired significant experience in behavior counseling. If you feel uncomfortable with your ability to handle some cases, consider referring them, or set up your own telephone consultation with a behavior referral center. Veterinarians should not attempt to counsel cases beyond their abilities. Incomplete, insufficient, or inaccurate advice could lead to worsening of the problem, injuries, liability, and loss of the client’s confidence.

Scheduling the behavior consultation

Behavior consultations are like medical consultations in that there rarely are quick fixes you can offer to mend a long-standing problem. A significant amount of time is required to diagnose the problem, determine the prognosis, formulate a safe and effective treatment plan, and present the treatment plan so that the owners can fully process the information and make informed decisions about committing to an action plan. A consultation requires the time and commitment of both veterinarian and client. An action plan cannot be determined until all factors related to the pet’s health, the problem, the level of risk or danger, the environment, the family, and the owner’s commitment to proceed have been assessed. Rarely is it possible to offer any meaningful behavioral advice for a difficult problem during a 15–20-minute routine office visit. Schedule 1–2 hours for the initial interview. Whenever possible, have all members of the family present. See Chapter 1 for a discussion of the economics of behavior visits.

There are also considerations as to where the behavior consultation should take place. Since the history with respect to the environment can be an important component for some problems, a house call can be a practical way to assess first-hand where the pet lives, how it is housed, and the role that the environment might play in the management of the problem. However, a house call may be impractical for some practitioners and costly for clients, and may not have a significant impact on success if the consultant has good history taking skills. The advantages and disadvantages of each are discussed in Table 5.2.

Table 5.2 The advantages and disadvantages of different locations for behavioral consultations