A good example of the aforementioned elements of discussion is a group of problem behaviors in dogs that can be broadly termed as aggression toward family members. A review of the literature on this subject demonstrates that each author may use particular classifications and terminology.² In some cases, differences are just related to the words used to describe more or less the same conditions, whereas in others, deeper discrepancies are found regarding the biological interpretation of this behavior problem. Indeed, owner-directed aggression has been linked to different underlying causes, from a hierarchical conflict between the dog and its owners to simply an active avoidance reaction in contexts of conflict. Further, for some authors these forms of aggression are mostly considered an expression of normal behavior, whereas for others, they are often linked to a pathological state.

Another example of the difficulties in classifying behavior problems comes from a very interesting experience organized during the 5^th International Veterinary Behavior Meeting (Minneapolis, 2005). An international group of experts was asked to characterize a dog showing a problem of self-mutilation of the carpal area. The problem appeared only during the owner’s absence. The clinical case was termed by different participants as a stereotypic behavior, a compulsive disorder, and a separation anxiety with mutilation as a main clinical sign.

Some years ago a comprehensive system for the classification of behavior disorders in dogs was developed by French colleagues based on the analysis of more than 11 000 clinical cases. This approach partially follows the philosophy of the Diagnostic and Statistical Manual of Mental Disorders (DSM)³ system for the diagnosis of mental disorders in human beings, which itself is in draft for a fifth version (DSM-5) at the time of writing. Basically a list of well-defined and discrete categories of behavioral disorders is offered based on the observation of specific clusters of signs and symptoms. Each diagnostic category is considered the result of an underlying dysfunctional state (see glossary, Table 22.1). This assumption is reflected in the terminology used (i.e., sociopathy, hypersensitivity–hyperactivity (HS–HA) syndrome, Cocker spaniel dysthymia) as well as in the fact that psychotropic drugs are included in the treatment for the vast majority of disorders. Similarly to the DSM system, disorders are clustered in sections according to the patient’s age. One patient can show more than one of these conditions together. In addition to classifying behavior problems, the Pageat or French approach presents an alternative pharmacopoeia in terms of recommended drugs, as well as doses and indications.

Table 22.1 Glossary of terms used in the Pageat (French) approach

Bulimia	Conditions of increased food intake due to an emotional disorder. Pageat links bulimia to states of either permanent anxiety or chronic depression
Deficitary sign	Any clinical sign that represents a decrease in social interactions, communication and motivation
Depressive state	A reactive state characterized by a diminished receptivity to stimuli and a spontaneously irreversible inhibition
Dysthymia	A state characterized by sudden fluctuations of mood, impulsiveness, stereotypies, a lack of social inhibition, sleep disorders, and feeding disorders
Encopresis	Defecation in the resting location during a period of rest
Enuresis	Urination in the resting location during a period of rest
Normothymics	Mood stabilizers
Potomania	Psychogenic polydipsia
Productive sign	Any clinical sign that appears or increases its normal frequency or intensity
Antiproductive sign	Any clinical sign that decreases its normal frequency or intensity

All of the following terms, diagnoses, and treatments are attributed to Dr. Patrick Pageat and are included here for completeness and for the exposure of our readers to alternative approaches to behavioral conditions. The authors would like to thank Dr. Pageat for allowing his work to be reproduced in this book. In general, neuroleptics are more often recommended and doses and indications of commonly prescribed drugs might also be different. Clinicians must use their own judgment regarding applicability of this information to their clients and patients.

The Pageat (French) approach to behavior counseling

The main purpose of this chapter is to review part of this alternative approach, including some of the scales developed to assess the patient’s behavior. All the information in this chapter has been adapted from Pageat.⁴ Dr. Pageat’s approach to senior pet behavior problems can be found separately in Chapter 13. Note that the diagnoses and treatments reported here are based on Dr. Pageat’s research and writing.

Scales

Clinical ethology consultations should be viewed as having the same objectives as consultations conducted within all other clinical medical fields. They are concerned with recognizing signs that will help us to categorize the different clinical conditions, regardless of whether they are considered pathological or just an expression of normal behavior. The only specificity of our discipline lies in putting value upon the interview with the animal’s owners with a view to establishing the diagnosis. This interview process is the point at which inexperienced clinicians frequently encounter problems, since owners have an unfortunate tendency to give redundant, unreliable, and even unbelievable histories. In addition, since the owners are not usually well versed in ethology, they give information that has been subjected to cultural or emotional interpretation. In order to simplify the task for novice clinicians, a number of scales have been developed for data collection and assessment. In addition, the most significant presenting signs for each condition will be discussed.

In the interview, there is a degree of unearthing a certain amount of emotional motivation and impulse. The behavior consultation can thus be considered as the first step in developing a treatment program, since it will help to understand the functional perspective of the pet’s behavior within its own species, and within the family structure as the animal perceives it. This act of playing down the emotional and anthropomorphic aspects of the history, along with a clear explanation of the facts, is essential to the therapeutic contract to be agreed upon with the family. This ensures their commitment and cooperation. The consultation is carried out in several stages, but the order may differ from what is discussed below. For example, the physical examination may either follow or precede the consultation process, and some stages may occur simultaneously.

It is both reassuring and useful for clinicians to have objective clinical tools to help them confirm their patient’s state. On the other hand, these evaluation systems do not replace a close attention to clinical signs. Their role is to help us identify the stage of development, assess the progression of the behavior problem, and thus objectively assess the effect of the treatment.

Currently, three scales are utilized that have been partially validated in terms of reliability and sensitivity. The scale for assessment of old dogs, known as the Age-Related Cognitive and Affective Disorders (ARCAD) scale, is discussed in Chapter 13.

Scale for evaluation of aggressiveness

For clinicians, assessing aggressive dogs constitutes a serious problem due to the complexity of a patient’s clinical picture as well as the ethical and legal consequences of any errors in evaluation. This scale classifies aggression into three types of sequential organization. It measures the intensity with two types of measurement: a global aggressiveness index (Iag) and a social aggressiveness index (Ias), as well as the ratio of the two (Ias/Iag) × 100 (expressed as a percentage). Three types of sequential organization are possible: type 1, growls; type 2, growls and attempts to bite; type 3, direct bite (without warning).

The global aggressiveness index and social aggressiveness index are calculated from the scores obtained in Form 22.1 using the following eight parameters:

Form 22.1

Evaluation grid of aggressiveness in dogs (client form #7, printable version available online)

		Score
A: Attitude of the owner towards the dog
Frightened	4
Apathetic, carefree	3
Disappointed	2
Anger	2
B: Use of the dog
Guard and defense	3
Herding	2
Companionship	2
Breeding, show	2
C: Frequency of aggressive manifestations
Daily	5
Weekly	4
Monthly	3
Very spread out	2
Never*	1
D: Gender
Castrated male	3
Spayed female	3
Male	2
Female	2
E: Age of the dog
>5 years	5
1–5 years	3
<1 year	1
F: Description of the bite
It releases but remains threatening	5
It releases and goes away quietly	4
The dog holds assertively (not shaking and tearing)	3
It releases and hides	1
G: Reaction after reprimand from the owner
The dog defends itself	4
It tries to flee	2
It accepts punishment	1
H: Degree of access of dog
The whole house	4
All rooms excepts the parents’ bedroom	3
The whole house except the bedrooms	2
Limited to a few rooms	2

^*In this case, F and G should both receive a value of 1.

The higher the score, the less favorable the prognosis. Thus, the fact that a dog has displayed aggression, followed by a new threatening phase, is more unfavorable than withdrawing rapidly to hide, which leads to a score of 5 for the former and 1 for the latter. Each parameter should be determined by questioning the owners rather than allowing them to read the grid, to reduce the possibility of distorting the answers. People who are offered a questionnaire often tend to try to improve their image to the “pollster” or create empathy by supplying answers they think the clinician wants to hear.

The Iag global aggressiveness index evaluates the intensity and frequency of all of a dog’s aggressive behavior within a social group (e.g., pack, family) and its interactions with a given person. A measurement will therefore have to be carried out for each member of a group. Approximations of the group may lead to underevaluation of the seriousness of the problem and distort the initial evaluation as well as the patient’s monitoring. The global index is calculated thus:

The Ias social aggressivity index helps evaluate the intensity and frequency of aggressive behavior that is connected with maintaining hierarchical rank or the acquisition of a higher status. It is calculated thus:

Finally, the ratio (Ias/Iag) × 100 provides an estimate of the role of social phenomena in the genesis of aggressive manifestations. For each age and sex group, it is possible to give “normal” value ranges, i.e., corresponding to the values obtained from animals not displaying any affective behavioral symptoms and not living in a hierarchically unbalanced group.

It is also possible to compare the values obtained for a given patient with the norms of its age and sex group (Table 22.2). These measurements help to simplify differential diagnoses of behavioral changes associated with an aggressive case:

• In primary hyperaggressiveness (idiopathic or caused by lesions), aggression is type 3. Iag is strongly increased (35–40%) while Ias remains unchanged or decreases slightly (10–15%). The ratio between the indices is strongly decreased. This type of aggression is abnormal in sequence, intensity, context, and/or degree of inhibition.

• In reactional aggressiveness (while this type may be normal, it is essentially stage 1 of sociopathies), only the Ias index is increased. It may then represent 70–90% of Iag. Aggressions are of type 1 or 2 form.

• In secondary hyperaggression (instrumentalization of the previous types), both indices are increased and aggression is type 3. The ratio between the indices is often quite close to normal values.

Table 22.2 Normal values of aggressiveness indices: results of 270 dogs

This scale was published by Pageat in his text ⁴ using 270 control dogs and 132 dogs suffering from behavioral disorders (Table 22.2).

Scale for evaluation of emotional and cognitive disorders (EDED scale)

This scale’s objective is to measure emotional disruptions in all age groups. It is constructed using simple behavioral parameters that are modified by affective disorders. These parameters were selected following factorial analysis of the history associated with each type of complaint. The scale was then validated by Pageat with a population of 190 controls and 215 dogs suffering from affective disorders. The result is an approach in four parts:

1. centripetal behavior: self-centered behaviors are termed centripetal. They include abnormalities of feeding, drinking, elimination, and sleep and somatoesthesic behavior

2. centrifugal behavior: behaviors resulting in a modification of the environment (i.e., exploration, aggression)

3. cognitive evaluation

4. somatic examination.

The presence of a behavior in the grid does not mean that it has to be pathological, but only that it is statistically associated with clinical pictures of emotional disorders. With each category, some selected types of behavior are taken into account and the different configurations that they may take are assigned an arbitrary numerical score between 1 and 5. The highest score is given to the poorest prognosis. The final mark, called the EDED value, is the result of adding all the scores together (Form 22.2 and Table 22.3).

Form 22.2

Evaluation of dog’s emotional and cognitive disorders (EDED scale) (client form #17, printable version available online)

Table 22.3 Interpretation grid of EDED scores

EDED value	Interpretation
9–12	Normal state
13–16	Phobias
17–35	Anxieties
36–44	Emotional (thymic) disorders

Once clinicians have obtained this score, they can evaluate it using the interpretation grid (Table 22.3). As with the aggressiveness indices, the EDED score does not replace the clinical approach; it complements it, facilitates the differential diagnosis, and helps objectively evaluate the animal’s progress during treatment. As with the other forms, the evaluator and not the owner should complete the form.

The ARCAD scale

The calculation grid of the ARCAD score was constructed according to the same rules as EDED (see Chapter 13). While the parameters that make up both scales are very similar, they can have different diagnostic meanings. Therefore, while the EDED scale helps evaluate dogs of all ages, the ARCAD measurement provides a better means of assessing problems that might be specific to the older dog. For example, old dogs can obtain an EDED score of the anxious type, while their ARCAD score suggests a temperament disorder. The EDED scale is not designed to assess mood disorders (see Chapter 13), which have a more discrete symptomatology in old dogs. Moreover, the ARCAD scale helps discriminate affective disorders (emotional score) from cognitive disorders to determine if drugs such as selegiline might be indicated.

Specific therapies

In the field of veterinary behavioral medicine, most behavior modification techniques are aimed at improving the dog’s reaction when exposed to stimuli triggering a problem behavior. These techniques are mainly based on learning principles and include desensitization and counterconditioning.

In addition to these techniques, which are described elsewhere in the book, a set of qualitatively different techniques is usually implemented by behaviorists following this alternative approach. The discussion of all these therapeutic options is beyond the scope of this book. Nevertheless, a brief description of some is now presented for a better understanding of the treatment protocols outlined below.

Cognitive therapies

Cognitive therapies are based on an indirect modification of problem behavior by introducing changes in the social and affective domains. The best example is what is called directed social regression. It is aimed to modify the perception of the dog about its hierarchical position within the family. Family members are instructed to behave in a specific and coordinated way in different daily situations that involve an interaction with the dog.

Another cognitive therapy is based on repeatedly presenting the dog with easy-to-solve instrumental tasks. This could be helpful to treat depressive and permanent anxiety states, where dogs have entered a vicious cycle by generalizing downfalls from one situation to another one.

In addition to cognitive therapies applied to the dog, interventions aimed to modify the family’s perceptions and attitudes are also used.

Behavior disorders

The criteria used are, first of all, of a clinical and progressive nature, as we are actually trying to follow the usual path of development of these disease entities. Many of these pathologies seem to depend on the animal’s stage of behavioral development, so this is an important aspect of the classification process.

The classification, arbitrary but with a logical base, should not obsess clinicians. The main objective is to have a correct symptomatic approach, which is the only means of understanding the condition, and put together a treatment. For each of the conditions described, the treatment generally requires both biological intervention as well as many of the behavioral techniques discussed elsewhere in the book.

Disorders appearing during puppyhood or adolescence

Sensory homeostatic disorders

In this category, we shall group both clinical pictures dominated by a hyperreactivity concerning one or several sensory systems associated with a lack of control of motor responses, and affective disorders ranging from phobia to depression. This highlights how both hyperproductive and deficiency states may be observed in these cases. Passing from one clinical form to another is often the rule. This is why we will focus on those problems that are most often the source of diagnostic difficulty.

Hypersensitivity–hyperactivity syndrome

Prognosis

This depends on the stage of development and the duration of the clinical picture. It is especially the age at which treatment is started that seems to determine the establishment of self-control. An analysis of therapeutic results from 120 dogs, as published in Pageat’s text,⁴ relates to the juvenile period, but no particular age within this period. Conversely, subjects treated after the start of sexual activity respond less well to treatment, and good control of dietary behavior (dog continues to steal food) and activity level are rarely obtained. Stage 2 shows a greater resistance to treatment. Usually, dietary and sleep disorders require drug therapy for almost a whole year. Whatever the age when treatment is started, it seems necessary to warn owners of the handicap this illness constitutes for the learning of complex tasks (hunting, search and rescue, drugs and explosives detection, guide dog, hearing dog for the deaf, or dog for the disabled). An early diagnosis must therefore be encouraged to help owners have realistic expectations about the dog’s potential abilities and limitations. In all cases, it is essential to warn the owners of the long duration of the treatment (5–9 months).