Introduction

Compulsive disorders in dogs and cats have also been referred to as obsessive-compulsive disorders (OCD) and stereotypies.^1,2 A stereotypy is an abnormal invariant, repetition of a motor pattern that serves no apparent function. These behaviors have been commonly reported in farm, zoo, and laboratory animal species, and initially arise in situations of conflict or frustration related to confinement or husbandry practices. Maternal deprivation has also been shown to contribute to the development of stereotypic behaviors.³ More recently, stereotypies have been described as invariant repetitive behaviors induced by frustration, inability to cope, or central nervous system (CNS) dysfunction.⁴ However, since the diagnosis is phenotypic and biological causes are as yet unknown, the term “abnormal repetitive behaviors” has been suggested.^3,5 This definition also allows inclusion of other environmentally induced frustration behaviors in farm animals, such as nonnutritive suckling in early weaned calves, which may be transient and variable.³ In dogs and cats behaviors such as tail chasing, rhythmic barking, wool sucking, or self-traumatic behaviors might also fit this definition. It is thought that some stereotypic behaviors, at least in their early stages, may provide a mechanism for the pet to cope. For example, nonnutritive suckling in calves may assist digestive processes.³ However, repetitive behaviors that persist over time become habitual and can lead to lifelong changes in CNS function and behavior, which affect both health and welfare.³

Compulsive behaviors are abnormal and repetitive, and may be variable in form and fixated on a goal.⁶ They are generally derived from normal behaviors such as grooming (psychogenic alopecia), predation (tail chasing, pouncing), ingestion (pica), or locomotion (fence pacing). Other abnormal repetitive behaviors which have been placed in the compulsive disorder spectrum in dogs appear to have a hallucinatory component such as snapping at the air, or upward gazing. Compulsive disorders first arise in situations of frustration or conflict but persist in situations outside the original context.² They most commonly arise in the prepubertal (e.g., 3–6 months) period, prior to social maturity (12–36 months), or after recognizable periods of change or distress.^1,7 The behaviors have no apparent goal and have an element of dyscontrol in either the initiation or termination of the behavior. They may be repetitive, exaggerated, sustained, or so intense that they might be difficult to interrupt. Although compulsive behaviors may also appear to provide a mechanism for coping for some pets (i.e., achieve behavioral homeostasis), the behavior becomes compulsive when the behavior does not help the pet to settle or cope and interferes with normal daily function.¹

The rationale for labeling these disorders in pets as compulsive is based in part on the use of the dog as a model for human OCD. Abnormal serotonin transmission has been identified as a primary mechanism by which compulsive disorders are induced and in humans the condition preferentially responds to drugs that inhibit serotonin reuptake.^8,9 Using dogs with acral lick dermatitis (ALD) as a model for the human disorder, drugs that inhibit serotonin reuptake, such as clomipramine, fluoxetine, and citalopram, were found to improve clinical signs while drugs that had more effect on norepinephrine reuptake, such as desipramine, were not effective.^10–13 Clinical studies and case studies on the treatment of compulsive disorders in dogs and cats have confirmed the use of a tricyclic antidepressant (TCA), clomipramine, or a selective serotonin reuptake inhibitor (SSRI), such as fluoxetine, as the most effective primary form of drug therapy for dogs and cats, with a decrease in behaviors reported of at least 50–75% within 4 weeks.^1,14–16

Compulsive disorders are most commonly seen in genetically predisposed individuals that are subjected to chronic or recurrent conflict or frustration or whose behavioral needs are not adequately met. In a study in Brazil of 20 dogs with ALD that could not be attributed to underlying medical causes, all dogs were described as having an anxious personality. None of the owners played with their dogs routinely, and 70% were never walked.¹⁷ A canine chromosome locus for flank and blanket sucking in Dobermans has recently been identified.¹⁸ Other inherited susceptibilities include tail chasing and spinning in German shepherd dogs, bull terriers, Anatolian sheepdogs, and Australian cattle dogs, and pica and wool sucking in Burmese and Siamese cats.^1,19–22

Compulsive disorders are derived from normal behaviors, such as grooming, ingestion, predation, and locomotion, although hallucinatory signs might be more difficult to categorize. Most common presentations include: (1) dermatologic (self-trauma); (2) locomotor and predatory; (3) neurological (including hallucinatory); and (4) oral/ingestive manifestations (Table 11.1).

Table 11.1 Expression of compulsive disorders in dogs and cats

¹Dodman NH, Cottman N. Animal behavior case of the month. J Am Vet Med Assoc 2004;225:1339–1341.

Behavioral pathogenesis of compulsive disorders

Stereotypic and compulsive disorders are most likely to arise in situations of conflict or frustration where the pet does not have a strategy (control) for effectively dealing with the situation. The result may be a displacement behavior where the response to the stimulus or situation is inappropriate or out of context (e.g., circling, tail chasing) or a redirected behavior where the pet exhibits the behavior toward another target e.g., redirected aggression, urine marking).

Conflict occurs when the pet is motivated to perform two opposing behaviors. This might occur when a pet is uncertain about the outcome (e.g., meeting new people or dogs) or when the owner’s responses to the pet’s behavior have been inconsistent. Frustration refers to a situation in which the pet is motivated to perform a behavior but is not able to do so. This might occur when a pet is aroused by other animals, people, or prey outside the window. Pets placed in a yard may begin repetitive pacing or barking if unable to access potential playmates, territorial intruders, or prey. Pets may also be mentally frustrated if they are inhibited from playing, chasing, jumping up, or barking due to previous punishment (Table 11.2).

Table 11.2 Glossary of terms

Maternal deprivation may also lead to stereotypic behavior in young pets due to frustrated motivations to suckle or insufficient social contact. While some of these behaviors may be transient, some may persist into adulthood.³ Maternal deprivation can also lead to heightened fearfulness, anxiety, and alterations in how the pet responds to stress, which may contribute to a greater potential for the development of stereotypic behaviors when exposed to stressors later in life.³ Conversely, some behaviors may not show up until later in life. Providing optimal housing, adequate social and environmental enrichment, and giving the pet control to engage in desirable behaviors and avoid the undesirable can have positive benefits for all pets but particularly those who are anxious or whose early environment was impoverished.

Stress and conflict can also arise from housing in unnatural, restrictive, or suboptimal environments for the pet’s needs. Inconsistent or unpredictable consequences and punishment, especially if inappropriately timed or particularly aversive, can further add to the pet’s conflict and frustration. Illness, injury, and inadequate attention to welfare issues such as food, water, temperature control, and freedom from pain or discomfort might also contribute to stress.

Conflict and frustration-induced displacement behaviors are likely to be seen in response to a specific stimulus (e.g., visual, auditory, odor, tactile) or event, and are likely to resolve when the inciting factors are removed. However, owner responses may further aggravate the problem by inadvertently reinforcing the behavior or increasing fear and conflict through the use of punishment. Medical factors may aggravate the problem if the consequences of the behavior (e.g., tail chasing, self-trauma) lead to pain, injury, or infection. In fact, deep infections are often a consequence of self-trauma; therefore both medical and behavioral therapy would need to be instituted concurrently.²³

Constant or repeated exposure to conflict can eventually contribute to the behavior becoming habitual and compulsive. Pathological changes developing in the brain require a combination of environmental and behavioral management as well as drugs to achieve improvement. Owner responses, medical consequences, and the level, frequency, and intensity of stressors can all contribute to whether behaviors become compulsive. Many of these pets have an anxious disposition and genetic factors have been identified.

Inciting factors and early intervention

Providing appropriate and sufficient enrichment in the form of social interactions and play, a predictable and comfortable environment, and predictable consequences that focus on rewarding what is desirable can reduce stress for most pets. However, breed, individual differences, maternal effects, early development, and socialization all play a role in how pets manage stress. If the pet begins to display behaviors that are unusual or out of context, immediate attention to address the underlying cause might prevent the behavior from becoming compulsive (Box 11.1).

Pathophysiology of compulsive disorders

There may be a common pathophysiology for all compulsive disorders but it is also possible that the neurotransmitters involved may vary between presenting complaints or that there may be changing involvement as the problem progresses. Locomotor compulsive disorders such as tail chasing tend to develop after repeated conflict, are displayed most commonly in situations of high arousal, and are often so intense that it may be difficult to calm the dog or interrupt the behavior. By contrast, oral compulsive behaviors (such as flank sucking and ALD) may develop more acutely, are most likely to be displayed in situations of minimal or insufficient stimulation, and may sometimes help the pet to cope or settle better. It has been suggested that oral stereotypies might involve the mesolimbic dopaminergic system while locomotor stereotypies may involve activation of the nigrostriatal dopaminergic system.²⁴ Hallucinatory-type behaviors such as fly snapping and pouncing may involve different pathophysiologic mechanisms. There also may be differing levels of cognition ranging from spontaneous, seemingly uncontrollable reactions to pets that search for or fixate on specific targets.

Beta-endorphins, dopamine, glutamate, and serotonin have all been implicated, primarily based on response to therapy. However, it has been suggested that the role of gamma-aminobutyric acid, neuroactive peptides such as cholecystokinin, corticotrophin-releasing factor, neuropeptide Y, and tachykinins such as substance P should also be considered.²⁵

Dopaminergic drugs such as amphetamines may induce stereotypies and dopamine antagonists such as haloperidol may result in suppression of stereotypies.^26–28 In one study higher prolactin levels were found in dogs with chronic stress, stereotypic behaviors, fear aggression, and autonomic signs, while lower levels of prolactin were associated with acute fearful and phobic events.²⁹ Thus, drugs that enhance dopamine transmission such as selegiline might be indicated in stereotypies associated with chronic stress.

Another possibility is that compulsive disorders are mediated through opioid receptors, since opioid antagonists such as naltrexone have been successful at reducing stereotypies in dogs, sows, and horses.^27,30–31 In addition, drugs that supply an exogenous source of opiates, such as hydrocodone, have been reported to be effective for ALD.³² It has been suggested that endorphins act as an internal mechanism for reinforcement, and that they might play a role in the early development of compulsive disorders. However, an increase in blood endorphin levels has not been identified.

Altered glutaminergic neurotransmission may also be a factor, since blocking glutamate-sensitive N-methyl-d-aspartic acid (NMDA) with drugs such as memantine or dextromethorphan may be effective.^33,34

Abnormal serotonin transmission has been suggested to be the primary mechanism by which compulsive disorders are induced. As in human models of OCDs, drugs that inhibit serotonin reuptake (e.g., clomipramine, fluoxetine, fluvoxamine, citalopram) have been shown to be most effective in the treatment of canine and feline compulsive disorders.^1,10,11–16 Animal studies have also identified direct evidence of serotonin involvement.⁸ In some animal studies, the serotonin reuptake inhibitor citalopram and not the neuroleptic clozapine was effective in reducing stereotypic behavior in female voles.³⁵

In time, it is probable that different neuropathological mechanisms may be identified for different presentations. In fact, another school of veterinary behavior from France believes that abnormal repetitive behaviors arise as a result of a number of different behavioral disorders, including permanent anxiety disorder, where the dog is constantly in a state of inhibition and prone to displacement behaviors (which may respond to selegiline, a TCA (clomipramine) or an SSRI); unipolar disorder, where the dog may be hypervigilant, overexcitable, and unable to stop behavioral sequences (which may respond to selegiline); hyperactivity disorder or attention deficit disorder with hyperactivity (which might respond to methylphenidate, fluvoxamine, fluoxetine, imipramine, or amitriptyline); deritualization anxiety, where there has been a change in the social group and the dog becomes withdrawn and overly defensive (which may respond to selegiline); and dissociate disorders, where the dog becomes increasingly less receptive and may have hallucinatory events (which may respond to risperidone).³⁶ (See Chapter 22 for further details.)

Diagnosing compulsive disorders

Management and treatment of compulsive disorders

Behavioral approach

Treatment of compulsive disorders generally requires the selection of appropriate pharmacological intervention and a behavioral program that focuses on the following:

1. consistent and predictable environment and daily routine over which the pet has control to engage in desirable activities (e.g., resting, perching, object play) and preventing undesirable behaviors (set the pet up to succeed; see Chapter 4)

2. consistent and predictable consequences that use rewards to encourage desirable behavior rather than punishment to discourage undesirable behavior (see Chapter 4)

3. providing sufficient enrichment and outlets to meet the pet’s behavioral needs (see Chapter 4)

4. ensuring owner responses do not further reinforce or aggravate the response (e.g., anger, punishment, agitation, inconsistent responses to the pet’s behavior)

5. management of the problem and environment to prevent recurrence

6. identification and removal or reduction of stressors that lead to conflict

7. identification and prevention or avoidance of triggers that precede displacement or compulsive behaviors

8. teaching an appropriate desirable behavior to replace the undesirable (response substitution) using reinforcement-based techniques to mark the behavior properly (e.g., clicker or Manner’s Minder and food reward) and to repeat until the behavior is captured (i.e., the pet has learned the desired response). An example would be to focus on reinforcement of desirable alternative behaviors to the compulsive behavior, such as resting on a mat or chewing on an appropriate chew toy

9. developing techniques and tools for owner interruption of the behavior each time it is displayed

10. teaching owners to identify triggers and read facial and body language to be able to pre-empt the behavior and direct to an acceptable behavior.

By evaluating the pet’s household, daily routine, and the undesirable behavior itself, including when and where it occurs, and the consequences that arise from engaging in the behavior, a specific program can be designed to reduce stress and conflict and direct the pet into acceptable and desirable alternative outlets. For some problems, such as flank sucking in Doberman pinschers, or the golden retriever that carries towels in its mouth, the problem may be sufficiently benign that treatment may not be necessary or may be more disruptive than the problem itself. If the behavior is a successful coping mechanism for reducing stress or resolving underlying conflict and the owner is addressing the pet’s needs effectively, additional treatment may not be warranted unless the pet’s welfare is affected or the problem is unacceptable for the owners. However, if the behavior has a negative effect on normal behaviors or leads to secondary medical problems such as pain, inflammation, or infection, then both medical and behavioral approaches will be required.

Predictability and control: environment, routine, and consequences

Pets that develop compulsive disorders may be particularly sensitive to inconsistency or lack of predictability in their daily schedule and in their interactions with the family. Therefore, the daily program should include a regular routine of social interaction with people in the form of reward-based training, play, and exercise, and opportunities for social interactions with other pets (if these are not a source of conflict). Owners might be encouraged to focus on play that simulates the normal activities of the species or breed (e.g., pulling carts, or retrieving for dogs, hunting games for cats). Feeding times should be scheduled throughout the day (rather than free-choice feeding), utilizing feeding toys and foraging stations so that the pet needs to work (or play) and expend energy to obtain food. In fact, working for some of the daily food can be a useful component of treatment. Following social sessions with the owner, the pet must learn to settle or play with its own toys (rest or object play) without the need for owner attention (i.e., learning to accept inattention). Cats can be encouraged to use an elevated area for perching or a cat play center. Dogs can be taken to a resting or bedding area and, if not inclined to nap or sleep, offered enrichment toys (feeding, chew and manipulation toys) that provide novelty and complexity to keep the pet motivated and challenged.

Training – predictable consequences

Training should encourage behaviors that are desirable rather than punishing behaviors that are undesirable. Casual and inconsistent owner interactions should be replaced by a program of predictable rewards where the owners ensure that all rewards, including affection, toys, and food, are given for behaviors that are incompatible with the compulsive disorder (e.g., resting on a mat, playing with a favored toy). See handouts on reward training (Box 4.12, client handout #22, printable version available online) and teaching pets to settle (Box 7.2, client handout #23, printable version available online). Encouraging desirable outcomes helps reduce stress and can be achieved by several means: encouraging settled behaviors; maintaining a calm household; calm and consistent owner responses; and the appropriate use of rewards. Clicker training can help immediately reinforce desirable behaviors. A leash and head halter for dogs or a harness for cats can be used to prompt the desired response as well as to inhibit, disrupt, or prevent undesirable behavior. The Manners Minder (Figure 7.5) (www.drsophiayin.com) is also a useful device to train dogs to settle on a mat or bed for progressively longer and more relaxed responses. All owner-inflicted punishment must be avoided. Prevention is preferred. If the problem should arise in the short term, disruptive devices or booby traps (to keep pets away from problem areas) might be used, as long as they provide consistent consequences.

Minimizing access to conflict- and frustration-inducing stimuli

Music, radio, TV, or white noise can help reduce anxiety and minimize audible stimuli that might contribute to stress or anxiety. Other products that might help reduce anxiety in some pets include Thundershirt or Anxiety Wraps, Calming Caps, and goggles that reduce visual stimuli, or thunder bands, Mutt Muffs, or sound baffling that reduce audible stimuli (see Chapter 12).

Response substitution

Ideally the owners should be aware of when and where the behaviors are about to arise so that they can proactively or pre-emptively focus on achieving the desirable behavior. If compulsive behaviors arise in the owner’s presence, the pet should be interrupted immediately and calmly with a moderate, novel noise then cued to engage in an appropriate alternative behavior (e.g., lie down, go to your mat, play with your toy) which can then be rewarded response (response substitution). If the pet cannot be effectively interrupted, a leash and head halter in dogs or a leash and body harness in cats can be used to interrupt the undesirable behavior and gently guide the pet into the desirable behavior. Owners should not give the reward until the alternative desired behavior is achieved. On occasion, a remote-activated spray collar may be an effective tool for interruption, provided it is used consistently, does not cause fear, and the pet can then be cued to engage in a desirable behavior. When the family cannot be present to interrupt the behavior, some other means of prevention may be needed. Cage confinement or Elizabethan collars (E-collars) may be useful, but these products can further aggravate the pet’s anxiety (see Box 11.2, client handout #4, printable version available online).

Box 11.2

Stereotypic and compulsive disorders (client handout #4, printable version available online)

1. Compulsive disorders often arise from situations of conflict or anxiety, but can appear spontaneously for no apparent reason. If the source of the stress or conflict can be identified, it should be addressed. Early intervention, before the problem becomes habitual or complications arise, provides the best opportunity for success. While pets likely have a genetic susceptibility to developing compulsive disorders, reducing sources of stress and providing outlets and opportunities to keep the pet stimulated and enriched can help to prevent the development of these problems or reduce their frequency or intensity. However, when the problem begins to affect the pet’s normal daily functions or the problem is too frequent or intense, then it has likely become a compulsive disorder, which generally requires a combination of behavioral management and drug therapy.

2. Medical problems may be the cause of the behavior. Therefore, before diagnosing a compulsive disorder, all possible medical problems must be considered. In addition, if the pet begins to lick or chew at itself, regardless of whether the initial problem was behavioral or medical, the pain and infection caused by the licking will first need to be resolved. Unfortunately, since pets cannot let us know how they feel (i.e., itchy, painful, unable to help themselves) your veterinarian will need to determine this by diagnostic tests and possibly by a medication trial.

3. The treatment program should begin by identifying sources of stress and conflict for your pet and resolving them. By looking at when, where, and in what situations the problem was first seen, it might be possible to identify the stressors that caused the problem, so that these might be resolved. However, while this can be an excellent starting point, when the problem has become compulsive, treating the stress and conflict alone is seldom sufficient. For the behavioral workup and to measure progress, it may be helpful to make a video recording of the problem and keep a diary.

4. If you can determine when the problem is likely to arise and in what situations, it might be possible to prevent the problem or preoccupy the pet with another activity that is incompatible with the undesirable behavior. Environmental enrichment when you are not around should include toys, chews, or other activities that can help to keep the pet occupied and distracted.

(a) Cats: Give your cat new places to perch, new areas to climb or scratch, or paper bags or boxes to explore. Some cats will show interest in the television or a video. One way to keep a cat’s interest is to find toys that simulate prey so that it has opportunities to hunt, chase, bat, or pounce on the toy. Toys that can be batted along the floor, hung from door frames, or are battery-operated will get the cat’s interest if they are the right size and texture and are changed intermittently so they remain novel. Another way to maintain interest is to stuff toys with food, treats, or catnip. Some of the new toys now available are designed to be filled with food, treats, or catnip and require manipulation to remove them from the toy. Some cats are attracted to kitty herb gardens.

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