section epub:type=”chapter” id=”c0016″ role=”doc-chapter”> Kersti Seksel While many owners report perceived behavior problems with cats, few ever seek help for the problem, and many are not aware that psychoactive medications are available.1 This suggests that treatment of behavior problems in cats is a missed opportunity for veterinarians. When owners do report problems, the concerns can be categorized into two main areas: problem behaviors and behavioral problems (mental health issues). It is important that veterinarians distinguish between them so that they can recommend appropriate management and treatment programs. Problem behaviors are classified as behaviors that are part of the cat’s normal behavioral repertoire but are unacceptable to the owner or community. They fall in two main areas: (1) normal or typical feline behaviors and (2) behaviors that are a normal feline response to stress. Although it is considered problematic by owners, the behavior itself is normal. The behavior may be exhibited because of the owner’s failure to understand feline behavioral needs, lack of knowledge of feline social structure, or insufficient training of the cat. For example, a cat that jumps onto a kitchen counter may be doing this as part of the cat’s normal preference to be up high, and there may be a lack of other, more appropriate locations in the house (e.g., shelves). It is also possible that the cat has never been taught that sitting elsewhere, such as on a scratching post or play center, is the behavior preferred by the owner. Stress may also lead to behavioral changes that are normal for the cat to exhibit. For example, environmental changes may lead a cat to become stressed and then start to spray urine. When the stress is removed the behavior disappears. Behavioral problems, on the other hand, fall into two broad categories: (1) behaviors that may be normal for the cat to exhibit but are excessive in frequency, duration, or intensity and are exhibited in response to stimuli that should not elicit this response and (2) behaviors that are abnormal and thus indicate that the cat is unwell and should be considered as true mental health issues. Behavioral problems are generally maladaptive for the cat as well as problematic for the owner or community. Examples include obsessive-compulsive disorders (OCDs), self-mutilation, and phobias. Although these two categories are not mutually exclusive, classifying an unacceptable behavior in this way helps determine not only what advice should be given to the owner but also where to refer the owner, if necessary. The most common problems that cat owners report include behaviors that are risk factors for surrender to a shelter or another rehoming organization. These problems include aggression, house soiling, scratching, and fear- and anxiety-related behaviors.2 Some of these are normal behaviors and as such cannot be eliminated entirely. In fact, it is possibly detrimental to the cat’s welfare to try to stop these normal behaviors. However, steps can be taken to manage the behaviors. Some of these unacceptable, destructive, and nuisance behaviors are exacerbated by a lack of physical as well as mental activity. Cats are highly intelligent, active, social animals that need activity, company, and mental stimulation. Educating owners about the basic needs of cats (both physical and psychological) should help address many behavioral concerns. Veterinarians working in companion animal practice are increasingly recognizing that fear and anxiety are the underlying factors for many behavior problems. The actual prevalence of anxiety-related conditions is unknown, but they are probably the most common class of behavioral disorders in pets. Anxiety disorders make up well over 90% of veterinary patients presented for referral.3 Many cases that present in general practice with recurrent medical issues such as vomiting, diarrhea, or skin problems may be caused or influenced by underlying anxiety issues. The way an animal behaves depends on three key factors: genetic predisposition, previous experiences and what it has learnt from them, and environment. None of these factors acts in isolation. All need to be taken into consideration when dealing with animals that have behavioral issues. All behavioral problems require a systematic approach so that the best outcome is achieved for the patient. Use of a questionnaire, which is sent to the owner and filled in before the consultation, is one useful approach. The veterinarian is then prepared to ask specific questions about the behaviors during the consultation and begin to evaluate the environment, social interactions, and the specific behavior of the cat. This permits the veterinarian to determine the possible cause (or causes) and prognosis (likelihood of success) and devise a treatment and management program. The more detailed the information provided, the more specific the recommendations can be made. The process of evaluating this behavioral history in the context of other clinical information about the cat may take a significant amount of time, often 2 to 3 hours. Most cats that have behavioral problems cannot be cured, much as diabetes is managed not cured. However, with environmental management, behavior modification, sometimes medication, and monitoring of response, the cat’s quality of life can be greatly improved and the bond with the owners restored. Box 16.1 contains additional resources for diagnosing and treating feline behavior problems. Although the terms anxiety and fear are often used interchangeably, they are not the same. Fear is related to the specific behaviors of escape and avoidance, whereas anxiety is the result of threats that are perceived to be uncontrollable or unavoidable. Both fear and anxiety may be adaptive in some circumstances, whereas phobias are maladaptive. The prefrontal cortex, amygdala, limbic system, and the hypothalamic–pituitary–adrenal axis are thought to be involved in the regulation of fear. Serotonin, noradrenaline, dopamine, and gamma-aminobutyric acid (GABA) are neurotransmitters involved in the development of fear and anxiety. Serotonin has been identified as a mediator of fear and anxiety. Fear is a physiologic, behavioral, and emotional reaction to potentially injurious stimuli. The fear response is a complex physiologic response that involves several areas of the brain. Cognitive, musculoskeletal, and neuroendocrine responses occur when an animal perceives a frightening situation.4 Experiencing fear is a survival mechanism and an adaptive response that usually occurs in response to a specific stimulus. Fear is often connected to pain or a traumatic event. For example, if a cat falls down a flight of stairs, it may develop a fear of stairs. Fear-evoking situations lead to activation of the locus coeruleus, the key noradrenergic area of the brain. This stimulates neurotransmission in the noradrenergic pathways projecting to the cerebral cortex, limbic system, and spinal cord and prepares the cat physiologically to deal with the threat. Various emotional stages of fear correspond with the physiologic effects of the sympathetic nervous system: the flight, fight, or freeze responses. The muscles used for physical movement are tightened and primed with oxygen and glucose in preparation for a physical fight-or-flight response. For example, a cat may try to run away from a fear-evoking stimulus (e.g., a veterinarian). However, if cornered, it may freeze or become defensively aggressive. There is also a fourth emotional response: the fiddle response (displacement behavior). In this case the cat faced with the fear-evoking stimulus may yawn or lick its lips. The physiologic reaction results in increased heart rate, increased respiratory rate (panting), sweating, trembling, pacing, and possibly urination and defecation. Cats exhibit changes in body posture and activity when afraid and may engage in an avoidance response such as fleeing or hiding. A fearful animal may assume body postures that are protective, such as lowering the body and head, placing the ears closer to the head, widening the eyes, and tucking the tail under the body (Fig. 16.1). If the animal perceives a threat, the response can also include elements of defensive aggression. Whether an animal fights or flees when fearful or defensive depends on its genetic predisposition, its previous experiences, and its current environment. Normal fear is adaptive and transient. A phobia is defined as an irrational, intense, persistent fear of certain situations, activities, things, or people. The fear (or panic) response is out of proportion to the stimulus and is maladaptive. Animals with phobias do not habituate to the stimulus, even after many harmless contacts, and the response does not decrease with time. Common phobias in animals involve noises and places. Phobic responses are physiologic, behavioral, and emotional responses similar to fear, but they are extremely exaggerated. Fear should be distinguished from anxiety, which typically occurs without any external threat. Anxiety is defined as the anticipation of future danger or misfortune. The threat may be real or imagined, and the response of the cat may be normal or abnormal depending on the context. Anxiety may also be an adaptive response to a specific threat in some circumstances. However, whereas fear is usually of acute onset and transient in duration, anxiety is a more chronic state of nonspecific apprehension. Dysregulation of fear pathways plays a key role in anxiety. Changes in the activity of neurotransmitters in anxiety disorders results in changes across many neurochemical systems, including the serotonergic, noradrenergic, dopaminergic, and GABAergic systems. Because these systems are closely integrated, changes in one system elicit effects in another. Corticotrophin-releasing factor has been identified as a stress neurotransmitter that effects changes in the serotonergic system through changes to receptor function that contribute to the onset of anxiety.5 Chronic anxiety leads to sympathetic arousal and is usually accompanied by signs of hypervigilance, such as scanning; autonomic hyperactivity, such as gastrointestinal upsets; and increased motor activity, such as pacing. Anxiety can occur after sensitization to a specific stimulus and can then become generalized to other situations. It may also be nonspecific in origin. It is problematic to the cat when it is out of context and occurs at a constant and elevated level or interferes with normal functioning. Although panic attacks are not experienced by every animal that suffers from anxiety, they are relatively common. Panic attacks usually come without warning, and although the fear is generally irrational, the perception of danger is very real. Anxiety-related disorders in cats may include excessive self-grooming, changes in appetite, and changes in elimination. Stress or anxiety in cats may manifest in many ways. The following are the most commonly seen behavioral signs: Many factors are reported to result in anxiety in cats. These include environmental changes such as moving to a new house, a new baby or spouse, separation from the owner, an excessive number of cats in the household or area, presence of new cats in the area, loss of territory, punishment by the owner, lack of stimulation, and even the presence of attacking birds (e.g., magpies). However, it may not be possible to determine all factors. Medical conditions such as hyperthyroidism have also been associated with anxiety in cats, as have some medications. Feline anxiety disorders include some types of aggression, separation anxiety, noise phobias, pica, and OCDs. Diagnosis is based on a complete behavioral history and thorough physical examination. It may involve complete blood work, urinalysis, dermatologic and neurologic workup, and radiography or other imaging modalities to rule out contributing or concurrent medical factors. Treatment usually involves behavior modification techniques, environmental management, and the use of psychotropic medications. Medications that influence serotonin metabolism, such as the selective serotonin reuptake inhibitors (SSRIs) and the tricyclic antidepressants (TCAs) have been used in the treatment of anxiety-related disorders (see Chapter 17: Behavioral Therapeutics). Anxiolytic medication (e.g., benzodiazepines) has also proved useful in some cases in combination with a TCA or SSRI, especially if the cat has phobias or experiences panic attacks. Monitoring of the response to medications should be done regularly, for example every 2 weeks initially then every month or two. The owner should set realistic goals and recognize that in most cases the behavioral problem can be successfully managed but not necessarily eliminated. This will require a lifetime commitment from the owner. Punishment is not recommended because it serves to further increase the anxiety as well as impede learning of appropriate behavior. In cats, OCDs include stereotypies and self-directed behaviors. These are defined as being constant and repetitive in form, appearing to serve no obvious purpose, and interfering with the animal’s normal functioning (ability to live a normal life). These disorders are often derived from otherwise normal behaviors such as grooming, eating, or walking, but they are abnormal in that they are excessive in duration, frequency, or intensity in the context in which they are performed. Thus, some causes of overgrooming, pica, and vocalization may be considered part of the OCD complex. The anatomic focus of OCD is believed to be the limbic system. Computed tomography indicates that the basal ganglia near the caudate nucleus are involved. Dopaminergic, serotonergic, and opioid pathways are thought to be involved in compulsive and self-injurious behaviors. Aberrant serotonin metabolism and possibly endorphin metabolism are also thought to contribute. Increased dopamine in the basal ganglia and a relative increase in serotonin metabolite 5-hydroxyindoleacetic acid in cerebrospinal fluid have also been detected.6,7 Diagnosis is based on a complete behavioral history and thorough physical examination. It may involve complete bloodwork, urinalysis, dermatologic and neurologic workup, and radiography or other imaging modalities to rule out contributing or concurrent medical factors (e.g., seizures). Treatment usually involves behavior modification techniques; environmental management; and in most cases, the use of psychotropic medications. Medications that influence serotonin metabolism, such as the SSRIs and the TCAs, have been used in the treatment of OCD (see Chapter 17: Behavioral Therapeutics).8,9 The cat should not be punished because its behavior is not deliberate, and punishment may serve to further increase the anxiety and thus the behavior. Grooming is a normal behavior of cats and serves many purposes, including cleaning, removing parasites, regulating body temperature, and alleviating stress. It is often seen after a stressful encounter with a stimulus (e.g., an aggressive encounter with another cat) or after punishment (e.g., yelling by owners). Normal adult cats spend about 30% to 50% of their waking hours grooming. Currently, feline hyperesthesia, overgrooming, self-mutilation, and psychogenic alopecia are considered to be part of an anxiety complex. Hair loss and discoloration occur only on the parts of the body that can be reached by the teeth and tongue. This hair loss is usually most noticeable around the sides and rump, back legs, and groin. The head and back of the neck may still have a normal hair coat. Usually, the alopecia is nonsymmetrical, and the skin may look normal. Hair can be removed by plucking, barbering, or licking and excoriation. The plucked hair has evidence of shearing. In some cats the grooming becomes excessive, and self-mutilation and ulceration occur in the affected areas. Secondary bacterial infections may then occur that also need treatment. Occasionally, the overgrooming is so severe that ulcers develop in the mouth (tongue and pharynx), making eating very difficult or even impossible. Many conditions, such as flea allergy, dietary allergy, and sensitivity to dust mites, have been known to trigger the initial grooming episodes. These must be eliminated as causes or contributing factors. In the case of fleas, treatment must be instigated even when no evidence of fleas is seen.10 Conditions causing pain, such as lower urinary tract disease (which may lead to abdominal grooming), as well as any source of trauma or infection, must be eliminated as contributing factors. Treatment of any concurrent or underlying medical problem, such as fleas, or resolution of food allergy by changing the diet is essential. If anxiety is suspected as a factor, the cause of the anxiety should be minimized or removed, if possible. Pain should always be a consideration in feline patients and should be addressed in any management program. The cat should be provided with a regular, predictable routine. This includes feeding and playing at a set time each day. In many cases medication is also necessary. Medications that influence serotonin metabolism, such as the SSRIs and the TCAs, have been used in the treatment of anxiety-related disorders. Other anxiolytic medications have also proved useful in some cases. At this stage the comparative effectiveness of each medication remains to be evaluated and may depend on the underlying factors or eliciting causes as well as each individual cat’s metabolism and hence response. Complete bloodwork, including a biochemistry panel, and urinalysis should be done before administering medication to determine a baseline, especially for liver and kidney parameters. Many cats may require medication for a prolonged period (at least 6 to 12 months, to allow hair regrowth and for the condition to be assessed); then slow withdrawal of medication should be attempted. If cats require longer term or lifetime medication, monitoring of a biochemistry panel should be carried out every 6 to 12 months or more often if indicated by clinical signs. Punishment is not effective in changing these behaviors. It serves only to increase the anxiety, as well as impede learning of nonanxious behavior, and it should always be avoided. Pica involves the ingestion of non-nutritive substances. However, eating substances other than food is not always abnormal. Consumption of plant material may be caused by lack of access to grass or vegetation, or it may be normal investigatory behavior. Young cats may chew, but not necessarily ingest, nonfood substances as part of their normal exploratory behavior. Cats have been reported to ingest many substances. In one survey of 91 cats with pica, shoelaces and thread were the most common objects ingested, followed by plastic, fabric, rubber, paper or cardboard, and wood.11 Individual cats tend to ingest one type of substance only. Some of these behaviors may be more annoying than damaging until they start interfering with the cat’s normal functioning. One survey of behavior diagnoses in cats from 1991 to 2001 found that 4% of cases were diagnosed with pica, the first evaluation was at a young age (median, 1.5 years), and male cats were overrepresented.12 Fabric-eating cats appear to start by eating woolen fabrics. They may then proceed to other fabrics, such as cotton, silk, and synthetics, but this is not always the case. While the cat is chewing, it appears to be totally engrossed. The cat pulls and tugs on the wool and then grinds it with its molars. Large quantities can be ingested, and this is a problem if blankets, socks, and sweaters are eaten because these items may cause an intestinal obstruction. This behavior is reportedly more common in oriental breeds such as Siamese and Burmese, although it has been reported in all breeds, as well as nonpedigreed cats. No sex predisposition for wool eating has been reported, and the behavior can occur from the ages of 2 to 8 months up to 1 to 2 years. It is believed to be more common in cats that are kept exclusively indoors. Some cats appear to grow out of it, and the problem resolves during early adulthood without treatment.13 There are many postulated causes such as: Several medical conditions can lead to pica. These include hyperthyroidism, lead intoxication, dietary deficiencies, intestinal parasites, and anemia. It may also be normal investigative behavior, which is more common in young cats. It is important that medical conditions be addressed. If the behavior is causing problems, the cat must be kept away from potentially harmful ingestible materials. Taste deterrents such as commercial products with bitter flavors or chili pepper have been reported as helpful in deterring some cats. These substances may be more potent if they are paired with a distinctive scent such as eucalyptus oil or cologne to provide an additional (olfactory) cue that the substance is to be avoided. The cat learns to associate the smell with an unpleasant taste, and eventually the scent alone is enough to make the cat avoid the material. This technique appears to deter some cats if the behavior is of recent origin and the substances ingested are limited. Establishing a predictable routine appears to help many cats by minimizing stress. This may mean having set times to feed the cat and play or otherwise interact with the cat. Providing an environment that meets the behavioral needs of the cat by supplying toys and other forms of mental and physical stimulation has also been reported to be helpful. Planting an indoor garden with grass, catnip, or cat mint can provide a safe source of vegetation (fiber), as well as a means of enriching the cat’s environment. The following suggestions may also help: Punishment (e.g., yelling, hitting) is detrimental as it may increase anxiety and exacerbate the problem. Treatment with psychotropic medication such as an SSRI or a TCA may be necessary if a diagnosis of OCD is made. A complete blood count (CBC) and serum biochemistry panel are recommended before prescribing medication to provide baseline values, especially if the cat stays on long-term or lifetime medication. These tests should be repeated every 6 to 12 months depending on the age and health status of the cat. A minimum treatment period of 9 months is recommended because some medications may take 6 to 8 weeks to reach therapeutic levels. Gradual weaning from medication may be attempted when the behavior has been successfully managed for at least 6 months. Separation anxiety is just one term that is used to describe cats that appear to be overly attached or dependent on people, especially family members. In the only published study in cats (136 cases), clinical signs were typical of those seen in dogs with separation anxiety (e.g., vocalization, destruction, house soiling, inappetence, inactivity, vomiting, or diarrhea).14 Seventy-five percent of the cats with urination in inappropriate places urinated exclusively on the owner’s bed. Defecation in inappropriate places was identified significantly more often in neutered females than neutered males. Cats with separation anxiety tend to follow their owners from room to room and begin to display signs of anxiety as soon as their owners prepare to leave. This can occur as early as when the alarm clock rings in the morning. Some affected cats also exhibit excessive attention-seeking behaviors and may seek physical contact with their owners. During separations the cat may vocalize, eliminate, and refuse to eat or become very quiet and withdrawn. Not all cats exhibit all the signs; however, in general, the more signs that are exhibited, the more difficult it is to manage the case. Although the behavior usually occurs every time the owner leaves, it sometimes happens only on selected departures, such as when the owner leaves for work or when the owner leaves again after coming home from work. Because the separation anxiety complex involves many different signs, a complete physical examination as well as blood and urine testing are necessary to rule out other causes for the signs exhibited. For example, this should include other causes of elimination outside the litter box or any condition causing pain that may lead to vocalization. The aim of management is to teach the cat to cope without human company. This process may be slow, and the owner must be patient as well as consistent. The sooner steps are taken to reduce the cat’s anxiety, the easier it should be to manage. The first step involves helping the cat to relax while the owner is present. This is done by quietly whispering (e.g., “good kitty”) to the cat when it is resting comfortably. No treats are given, just quiet praise. When the cat learns to be relaxed in one place (e.g., in its bed or on a special mat) rather than constantly following the owner around, it will be possible to teach the cat to accept even the shortest of separations. It can also be useful to help the cat associate a scent or odor (e.g., lavender) with the bed or mat and being calm. The owner should establish a predictable routine, feeding and playing with the cat at a set time each day, and provide toys (and rotating them regularly), hiding places, and play opportunities. However, care should be taken not to provide too many choices, which may exacerbate anxiety. Medication is often needed, especially in severe cases. Medication is best started early in treatment rather than after the anxiety has increased to a level that makes it difficult to manage. According to studies, dogs improve about three to four times faster when antidepressant medication (e.g., clomipramine) is used in combination with behavior modification than when behavior modification is used alone.15 The same is likely to be true for cats. Medications that influence serotonin metabolism, such as the SSRIs and the TCAs, have been used in the treatment of anxiety-related disorders. Situational anxiolytic medication (e.g., benzodiazepines, serotonin antagonist reuptake inhibitors) have also proved useful in some cases in combination with TCAs and SSRIs, especially if the cat exhibits panic attacks. Ideally situational medications should be given before a potentially stressful event such as the owner leaving. The synthetic facial pheromone analog Feliway (Ceva Animal Health) has been reported to be useful in decreasing anxiety in some cats.16 A product containing hydrolyzed milk protein (Zylkene, Vetoquinol) has also been reported to be helpful for some anxiety disorders in cats.17 Physical or verbal punishment is always discouraged as it increases anxiety and impedes learning of more appropriate behavior. Complete bloodwork and urinalysis should be done before medication is administered to determine a baseline, especially for liver and kidney parameters. The cat may require medication for prolonged periods (up to 12 months) or even for life. Owners should be informed of the possibility of lifelong medication at the outset of a management program. Vocalization is a normal behavior of cats. Cats make many sounds, including purring, trilling, and meowing, and each may indicate a different purpose or function, such as a need for social contact, attention, or food. Excessive vocalization may be a normal innate behavior in some breeds, such as the Siamese. It has also been reported in cats that are on restricted calorie diets, which may indicate hunger. Pain should always be a consideration if vocalization is of sudden onset. Cats with cognitive dysfunction may also vocalize more than normal. The vocalization is of changed duration, frequency, or intensity. It may be a nocturnal behavior, or it may be more noticeable to owners at night. It is relatively common in older cats with decreased perceptual and locomotor abilities. Anxiety is also said to increase in older animals in general. It may also be due to reduced cognitive function (e.g., senility). Vocalization may be a normal behavioral response to physical stressors such as cold and hunger. Hyperthyroidism, cognitive dysfunction, hyperesthesia syndrome, and any condition leading to pain should be considered as contributing factors. Cats in estrus also vocalize. The presence of classical behavioral signs of restlessness, frequent urination, spraying, rolling, and lordosis during the breeding season help differentiate this as a diagnosis in intact queens. Concurrent or underlying medical problems should be treated. Normal feline behavior should be explained to owners to help them understand that some vocalizations cannot be eliminated but may be managed. Concurrent or underlying medical problems should be treated. If possible, triggers for anxiety should be removed or minimized. A regular, predictable routine should be established, with the owner feeding and playing with the cat at a set time each day. The cat should be provided with toys (which should be rotated regularly), hiding places, and play opportunities that meet its individual behavioral needs. In cases of severe anxiety, treatment may also include medication. Medications that influence serotonin metabolism, such as the SSRIs and the TCAs, have been used in the treatment of anxiety-related disorders. Treatment for cognitive decline may also be attempted with natural supplements such as Senilife (Ceva Animal Health), the nutraceutical Aktivait (VetPlus; a combination of phosphatidylserine and antioxidants), or S-adenosylmethionine. Such products are not always licensed for use in cats. Selegiline (Anipryl, Zoetis [also known as L-deprenyl]) at an oral dose of 0.5 to 1 mg/kg once daily has been reported to be effective but is not licensed for use in cats. Other anxiolytic medications have proved useful in some cases. It should be noted that the benzodiazepines can lead to increased vocalization in some cats and there are some concerns in human medicine that long-term use of these drugs may increase the risk of dementia. Feliway has been reported to be useful in decreasing anxiety in some cats.16 Physical or verbal punishment should always be avoided as it increases anxiety and impedes learning of more appropriate behavior. A serum chemistry panel and urinalysis should be evaluated before medication is administered to determine a baseline, especially for liver and kidney parameters. The cat may require medication for prolonged periods (up to 12 months). Elimination problems are the most common behavioral condition reported in cats, accounting for up to 79% of reported behavioral problems.2,18,19 It can be a significant welfare issue, as up to 23% of cats relinquished to animal shelters are reported to have elimination behavior problems.2,20 Both males and females, neutered and intact, present with elimination problems, and elimination problems have been reported in all breeds and across all age groups. In one study, about 25% of kittens adopted from a shelter were reported to be house soiling within 30 days of adoption; this decreased to about 8% 1 year later.21 Elimination problems (not using the litter box) must be differentiated from spraying or marking behavior. Clinical signs include urination (periuria), defecation (perichezia), or both outside the litter box. The elimination is changed in amount, frequency, or location and may be associated with an underlying medical condition. It may also be a normal response to stress. Urination or defecation outside the litter box is generally unacceptable to owners. In a survey of 800 cat owners, 11% complained of elimination problems with urine.22 The cat usually squats to produce a normal quantity of urine. A horizontal surface is used, and the cat often scratches the surface afterwards. In one study, cats with elimination behavior problems spent significantly less time digging in the litter than cats without problems; this may be a sign of litter aversion.23 Defecation outside the litter box is only rarely a marking behavior; typically, it is for elimination of waste. Predisposing factors for elimination behavior problems include the following:
Behavior Problems
INTRODUCTION
ANXIETY, FEAR, AND PHOBIA
Overview
Fear
Phobia
Anxiety
ANXIETY-RELATED DISORDERS
Obsessive–Compulsive Disorders
Overgrooming
CLINICAL SIGNS
DIFFERENTIAL DIAGNOSIS
MANAGEMENT
Pica
CLINICAL SIGNS
DIFFERENTIAL DIAGNOSIS
MANAGEMENT
Separation Anxiety
CLINICAL SIGNS
DIFFERENTIAL DIAGNOSIS
MANAGEMENT
Excessive Vocalization
CLINICAL SIGNS
DIFFERENTIAL DIAGNOSIS
MANAGEMENT
Elimination in Unacceptable Locations
Clinical Signs
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