Undesirable, Problematic, and Abnormal Feline Behavior and Behavioral Pathologies

Overview of Feline Behavioral Concerns

People misunderstand cats, and to some extent people expect to misunderstand cats. In part, much of the confusion about feline behavior is a function of their atypical, opportunistic “domestic” status.

We have not worked with cats historically to shape their behaviors for collaborative work with us in the ways we have for dogs, horses, and stock.

• Dogs, as a species separate from wolves, likely co-evolved with humans over thousands or tens of thousands of years, during which time they may not have been fully “domesticated.”

• “Domestication” may have occurred when we began to develop breed groups intended for specific tasks, which happened 3000 or more years ago. In contrast to wolves, which require handling by humans early in their ontogeny (beginning by at least 14 days of age) if they are not to be fearful and reactive to humans, most dogs can adapt to delays in handling and exposure, and their normal, innate sensitive periods are greatly expanded from those of wolves. When dogs cannot adapt or when they seem to have short sensitive periods, such patterns are indicative of pathology.

• In dogs, it is likely that this sensitive period expansion occurred concomitantly with changes in molecular and neurochemical function and gene expression (Saetre et al., 2004), which may represent some of the true outcomes of active “domestication.” In contrast to dogs but similar to other, non-domesticated species, cats have a relatively short and truncated sensitive period for exposure to humans (Karsh, 1983a, 1984), which may be associated with or evidence of lack of tampering associated with “domestication.” Combined with a remarkable neurology that allows for extremely rapid and pronounced arousal and reactivity (discussed later), this shortened sensitive period of cats may suggest why true domestication may be only ongoing now, while also shedding light on the potential etiology of some common feline behavioral patterns and pathologies (i.e., inter-cat aggression, impulse-control aggression, re-directed aggression).

• We have not selected cats to “please” us or to be easily handled by us, attributes that Galton (1865) stated were necessary for successful domestication to occur (see Chapter 8). No cat has been selected to work actively with us in a collaborative partnership, and although we lack extensive global data, the sensitive periods of cats who have been housecats for generations do not seem to differ from cats who have been free-ranging or feral for generations. Because of how cats may become feral, there may also be contributory genetic factors that influence the heritability of fear, which may influence how effects of social exposure are manifest or mitigated. There is scant research on this topic, but the implications for behaviors and interactions with humans are profound.

• Domestic cats have traditionally been defined as “sit-and-wait” predators, meaning that they hide from their prey and sit and wait by trails, dens, nests, et cetera, as indicated by physical, olfactory, and vocal cues about prey activity. Among mammals, cats are really the only “sit-and-wait” predators, and domestic cats are the quintessential mammalian species using this strategy. Coat color patterns in ancestral cats and many extant cat types/breeds act as disruptive coloration and aid the cat in hiding. As a condition of the “sit-and-wait” hunting strategy, cats are compelled to sit quietly hidden and then react almost instantly with a heightened level of arousal. The behavioral and neurochemical difference between sitting quietly hidden and the profound arousal and reactivity required for successful hunting may have placed constraints on feline brain development with respect to cognitive and social strategies. Cats have “normal” arousal patterns that are different from other species, an observation that likely has implications for how they develop problematic or pathological behaviors.

• As we have moved with cats to more urban lifestyles many of the behaviors that are normal for cats could be and frequently are problematic for their humans (i.e., eliminating and digging in gardens, especially if those gardens belong to others).

• Behaviors that people might find distressing (e.g., hiding, spraying, fighting with another cat) may be a fairly normal cat’s response to an environment that is confusing, stressful, or distressing to the cat.

• Left to themselves, cats range widely. When they are constrained to live within a house or an apartment, that spatial constraint may alter and/or intensify a number of behaviors other than behaviors associated with mobility.

• We have no idea how often we see the types of extreme behavioral pathologies in “domestic” cats that we now know appear endogenously in dogs. We do know that when such profoundly abnormal behavior reaches the level of true pathology, as is the case in feline obsessive-compulsive disorder (OCD), the manifestation of the condition always appears to have a component of environmental change or disruption. In other words, although it is possible that the cat may be exhibiting pathological OCD (or other truly abnormal behaviors) at some very low level, and/or the cat may have a risk/liability to develop OCD, the abnormality is not seen or fully manifest until the additional social or environmental stressor is supplied (Overall and Dunham, 2002). That the intersection of innate feline reactivity with other social/physical environments so consistently seems to be involved in some aspect of pathology may be further evidence that cats have not yet been “domesticated.”

The extent to which all of these patterns are attributable to the differences in our evolutionary history with cats compared with dogs or the extent to which these patterns are attributable to the uniqueness of a small, “sit-and-wait” predator who hides as a response to stress, is unknown. Because of the clear interplay of social and environmental effects in determining the manifestation or extent of abnormal feline behavior, and because so many normal feline behaviors are often considered undesirable or “abnormal,” no attempt to separate groups of problematic behaviors rigidly by class has been made here as was done for dogs. Instead, historical, social, environmental, endogenous, and evolutionary factors are discussed, when relevant, for each condition, as is the importance of client knowledge and expectations. It is hoped that this approach will allow the clinician to identify when behavioral pathologies and troublesome environments intersect in client complaints and so encourage the clinician to address and treat the whole cat and the cat-client relationship.

Zoonotic Concerns Relevant to Patterns of Feline Behavior

There are four main zoonotic concerns that are germane to cat behavior: rabies, cat-scratch disease (CSD), toxoplasmosis, and toxocariasis. Both cats and dogs are subject to rabies. In rabies-endemic countries, good vaccination programs are an essential part of rabies control and eradication. Rabies is such a commonly discussed public health concern that the average reader will be aware of it. The same may not be true for Bartonella infections (commonly called “cat-scratch disease/CSD/cat-scratch fever”), toxoplasmosis, and toxocariasis. These are the conditions about which clients may have some information that they find confusing. Because so many behavioral problems involve complaints about the cat’s elimination behaviors or rough treatment of humans by cats, it is imperative that we have an accurate assessment of zoonotic risk. Clients are often willing to tolerate some behavioral inconsistencies on the part of the cat (e.g., not always using the litterbox), and clients may adjust to some undesirable behaviors that the cat exhibits (e.g., never playing with the cat when he is on his back). However, these minor behavioral issues become major ones when any human health concern is raised and will become the reason that the cat is relinquished or euthanized. Especially in difficult economic times, cat behaviors—whether they are normal but undesirable or truly abnormal and damaging to the cat—must be viewed as one set of stressors in an interacting list of lifestyle stressors that can result in the client’s decision to remove the cat from the household. Most relinquished cats are never re-homed. Relinquished cats are most often killed.

Cat-Scratch Disease

• Each year in the United States, 22,000 cases (1.8 to 10 cases/100,000 people) of CSD have historically been reported. There have been 2,200 people hospitalized annually (Jackson et al., 1993).

• The presumptive agent in CSD is the rickettsial organism, Bartonella (formerly Rochalimaea) hensalae. An occasional contributory role has been postulated for the bacteria Afipia felis. Of 45 human patients with CSD, 38 had titers of at least 1 : 64 for B. hensalae. B. hensalae is likely the predominant, but not the only, cause of CSD, and other Bartonella species have been implicated in infection (Breitschwerdt, 2011).

• CSD is most commonly seen in the late summer and fall everywhere it has been studied and coincides with seasonality in births of kittens (spring) and the entry of these kittens into the house in the fall/winter (Sanguinetti-Morelli et al., 2011).

• Flea infestations may be associated with a higher incidence of Bartonella infections, and it has been reported that most human patients with CSD have at least one kitten that has fleas (Zangwill et al., 1993). Patients with CSD are more likely to have a kitten 1 year of age or younger or to have been scratched by a kitten, than are non-patients (Zangwill et al., 1993). Although human patients diagnosed with CSD and living in households with kittens are more likely to have been scratched or bitten than humans living in households without kittens, there appears to be no association, other than age, with patients’ cats and cats of controls when indoor/outdoor status, litterbox use, and hunting behaviors are examined (Zangwill et al., 1993).

• Infection with Bartonella can occur without any history of bites or scratches by cats or exposure to cats. Coupled with the extremely complex relationship that the Bartonella organism has with vectors and reservoir hosts, it is not surprising that feline bartonellosis need not always manifest in the same manner across patients (Breitschwerdt, 2008).

• Cats transmitting Bartonella appear healthy, although they may have long-lasting, active B. hensalae infections (Regnery et al., 1992). People with what is viewed as traditionally conceived CSD tend to have localized skin lesions and regional lymph node involvement 3 weeks after exposure. Lymph nodes remain enlarged for several months. Systemic illness is rare, but fever, headache, splenomegaly, and malaise are common. These symptoms are usually self-resolving; however, arthritis, neuroretinitis, pleurisy, pneumonia, osteolytic lesions, granulomatous hepatitis, and encephalitis with coma and seizure can be unusual sequelae (Tompkins and Steigbigel, 1993). Individuals with immunocompromise or immunosuppression are at risk for more severe disease. Treatment ranges from outpatient care comprising relatively short courses of antibiotics to detailed, extended inpatient care.

• Bartonella species infections are increasingly implicated as a potential contributory factor in many immune diseases, including rheumatoid arthritis, and in vector-mediated chronic bacteremias (Maggi et al., 2012).

Because of the public health aspects of infection, fractious kittens should be sensibly and safely managed, and veterinarians should discuss the signs of Bartonella with the clients of such kittens. Any feline aggression should be treated as soon as it is recognized, which is also humane for the cat.

Toxoplasmosis

Toxoplasmosis, caused by Toxoplasma gondii, is an infection that may be mild or asymptomatic in adult humans but can be congenitally induced when pregnant females become infected with T. gondii. In adult humans, infection is usually, but not always, mild and may result in malaise, joint and muscle pain, transiently enlarged lymph nodes, and other non-specific signs of inflammation. Infants born with toxoplasmosis may have a range of profound problems primarily affecting the nervous system. For individuals infected in utero, pathology may include enlarged liver and spleen, gastrointestinal illness, hearing and/or vision loss or debility, seizures and cognitive impairments. For untreated infants, these conditions may become most pronounced as the nervous system matures when they pass through their teens. Maternal and fetal infections are treatable, but from the standpoint of the behavior of cats, most of these infections are preventable.

• T. gondii oocytes are shed in feces.

• Because cats are the final host and reservoir for T. gondii, cats are blamed for human infection. However, humans likely contact T. gondii most frequently through exposure to raw meat that has been infected because of poor hygiene (Torda, 2001).

• Human infection is rare and usually asymptomatic, unless the human is pregnant or immunosuppressed.

• Pregnant woman can pass T. gondii to the fetus during pregnancy, resulting in abortion, stillbirth, or neurological complications for the infant (Tenter et al., 2000).

• Immunosuppressed individuals may develop fulminant forms of the disease.

• Pregnant and immunosuppressed humans should not handle raw meat, cat feces, or cat litter; should cook all meat thoroughly to ensure that cysts are killed before consumption; and should wash their hands thoroughly after interacting with their cats.

• Information for clients is available on the following websites: www.petsandparasites.org./cat-owners and www.cdc.gov/parasites/toxoplasmosis/gen_info/pregnant.html (both accessed April 24, 2012).

Toxocariasis

• Toxocariasis is a zoonosis caused by accidental human ingestion of the embryonated eggs of the roundworms Toxocara canis and Toxocara cati, which routinely affect dogs and cats.

• Especially in urban areas, cats with large—and likely untreated—worm burdens may use the same sandboxes and grassy areas in which human children play as areas to eliminate.

• If children ingest the eggs, the larvae hatch and migrate through the lungs and liver, causing inflammatory responses and clinical signs (visceral larval migrans), and/or the nervous system, potentially becoming stranded in the eye (ocular larval migrans) and causing blindness.

• Cats and dogs should be controlled in public spaces, and their feces should be picked up and disposed of hygienically. Children playing in public parks should be encouraged to wash their hands frequently. Clean water and cleansing agents should be provided in parks to facilitate hand washing. All cats and dogs who are at risk should be treated with anthelmintic agents, especially after giving birth. Because free-ranging and/or feral cats and dogs may be most at risk for contributing to this condition in the poorest neighborhoods, anthelmintic administration becomes a public health issue, requiring creative approaches (Hotez and Wilkins, 2009). Trap/neuter/release programs in cities with large numbers of cases of toxocariasis may wish to incorporate de-worming.

Veterinarians as Guardians of Feline Welfare

Many shelters consider cats relinquished for elimination complaints or other behavioral concerns unadoptable. This is unfortunate because often simply re-homing the cat may redress the concern, highlighting the extent to which physical and social stress affects manifestations of feline behaviors. Elimination and other behaviors that are problems for the client can become life-threatening problems for the cat.

Conversely, behaviors that are truly problematic for the cat may go unaddressed if they are not also problematic for the client. To protect the welfare of cats, veterinarians need to be objective observers and good educators about feline behavior.

Veterinarians should encourage behavioral observation at each veterinary visit and can facilitate discussions about behavior by using a short tick sheet that clients can complete on arrival at each appointment (see the following survey questionnaire about general cat behaviors; see also the short survey questionnaires to be used at all visits to monitor behavioral change in cats at the end of the text and on the accompanying website). History tick sheets not only allow veterinarians to assess behavior in a consistent manner at each visit and note potentially worrisome changes as early as possible, but also such tools teach clients which behaviors are important for them to monitor to provide the best care possible for their cats.

Clients should also be encouraged to maintain a library of videos of their cat’s basic behaviors so that when something changes, they can show the veterinarian video of the cat and environment before and after the change. Remember, in veterinary behavioral medicine, behaviors are the data. Once we can see the behaviors, we are best able to understand what they mean.

Feline Behavioral Concerns Involving Placement of Urine/Feces as Part of Inappropriate or Undesirable Elimination Behavior

It doesn’t matter whether you call it a toileting problem, a litterbox problem, or undesirable litterbox use, the most common behavioral concerns reported by clients about their cats involve elimination. Complaints about litterbox use can often be anticipated and can usually be successfully treated if the client becomes good at observing the cat’s behavior.

The most common behavioral complaint that clients have about their cats involves the location where the cat urinates or defecates. Some veterinary behaviorists divide complaints into those involving concerns with litterboxes (e.g., “toileting”) versus those involving some form of marking. From the standpoint of identifying the global behavioral concern, this is a fine way to conceptualize the issue. If we can also understand the variability of responses within these groups, we can best meet the cat’s needs from the cat’s viewpoint.

The key to resolving all elimination concerns—even those involved in marking—is to recognize and be able to identify the pattern in the choices the cat makes about elimination. The pattern involved in the cat’s behavior tells us what the cat’s needs are. If clients can meet the cat’s needs, the problem will resolve. Otherwise, the biggest reason why cats are relinquished or euthanized involves elimination that the clients view as problematic. Clients will keep cats about whom they have complaints pertaining to elimination behaviors 2 years before relinquishing, abandoning, or euthanizing them. This is sufficient time to resolve even tough elimination problems, but problems can be resolved only if veterinarians screen every cat at each visit (Fig. 9-1).

Fig. 9-1 Survey questionnaire about general cat behaviors.

Specific diagnoses pertaining to lack of litterbox use and marking are individually discussed. An accompanying flow chart is provided in Figure 9-2.

Fig. 9-2 Flow chart for treatment and diagnosis of feline elimination complaints. (Thanks to Mary Anna Labato, DVM, DACVIM, for input into a very early version of this flow chart.)

Cats Who Do Not Use Their Litterbox

Concerns about litterbox use generally involve one or more of the following client complaints:

• The cat doesn’t use the box at all.

• The cat uses the box for either urine or feces but not both.

• The cat eliminates right next to or on the box but not in it.

• The cat uses the box but doesn’t cover urine or feces.

All of these could be normal behaviors, but when they represent a change in former behavior, they generally flag a behavioral problem.

Covering Urine and Feces

Ancestral cats, their wild relatives, and their feral counterparts may never cover their urine or feces. Not covering urine or feces may act to inhibit disease transmission if ova of parasites dry, but this behavior also acts to provide a visual and olfactory statement of feline presence and identity. In such cases, urine and feces are currency, not just elimination products. Some cats will never cover their urine and/or feces but may still vigorously scratch in the box. If the cat’s behavior changes and previously covered urine and/or feces is now not covered, clients should also be alert to changes in scratching behaviors. Cats who like their litterboxes scratch a lot, whether or not they cover urine and/or feces (Sung and Crowell-Davis, 2006).

Complaints about litterbox use are almost always related to one of four diagnostic categories:

• substrate preference for elimination,

• substrate aversion for elimination,

• location preference for elimination, and

• location aversion for elimination.

These four diagnostic categories are represented by the heuristic scheme in Table 9-1.

TABLE 9-1

Scheme for Thinking about the Most Common Reasons Why Cats Do Not Use Their Litterboxes

Preferences for locations or substrates used for elimination are “diagnoses” that may not represent abnormal feline behavior. Cats have different innate preferences, and they likely have different aversion thresholds. Cats who may have endogenously expressed one preference may develop a secondary preference subsequent to developing an aversion. Cats may demonstrate preferences and aversions for all elimination or only for eliminating urine or feces. The extent to which (1) distress and anxiety are expressed by the cat as part of these aversions and preferences, (2) the problematic elimination behaviors represent changes in behavior from former behaviors that the clients found acceptable, and (3) resolution of the concern becomes difficult all likely reflect the extent to which the cat may be exhibiting abnormal behaviors that are a function of underlying anxiety. In such cases, diagnoses pertaining to elimination behaviors reflect true behavioral pathologies.

Feline Marking Behaviors Using Urine or Feces

Marking behaviors that use elimination include spraying and non-spraying marking. Both spraying and non-spraying marking can be part of the normal signaling repertoire in cats.

• Non-spraying marking: The pattern of deposition of urine or feces distinguishes non-spraying marking behavior from substrate or location aversions/preferences. When non-spraying marking is a consideration, the amounts of urine or feces are small and distributed over areas associated with social stimuli, not with substrates or locations (Table 9-2).

TABLE 9-2

Patterns That Separate Non-Spraying Marking from a Substrate or Location Preference or Aversion

• Marking behavior involving spraying: In marking involving sprayed urine (spraying), the cat treads on its front feet, raises its tail, quivering the tip, and sprays urine vertically (Fig. 9-3). If the cat is not backed against a vertical surface, sprayed urine makes a linear pattern on horizontal surfaces. Urine sprayed against a vertical surface drips and puddles (Fig. 9-4). Regardless, sprayed urine covers a larger surface area with urine than does squatting and so likely communicates different information than urine voided in a squat. The information communicated could simply be that the cat was confident enough to engage in the very visual behaviors that accompany spraying. Both male and female cats can and will spray, as will neutered/desexed cats. Neutering can decrease or stop spraying if it has been occurring for only a short while or it is related solely to estrus cycles or responses to them, and neutered cats spray less frequently than do cats who have not been neutered.