Update on Behavior Medicine

Debra Horwitz, DVM, DACVB

Veterinary Behavior Consultations
St. Louis, Missouri




Morning lectures

Canine aggression and assessing dog behavior:
using what you already know to help clients ........................ 1

Separation Anxiety in dogs .............................................................................................. 7

Canine Aggression toward people on walks and at the door ......................................... 11


Afternoon lectures

The link between house soiling and aggression in cats................................................. 17

Feline aggression toward people .................................................................................. 23

Update on medications in behavioral medicine ............................................................. 29

CANINE AGGRESSION AND ASSESSING DOG BEHAVIOR: USING WHAT YOU ALREADY
KNOW TO HELP CLIENTS

Debra Horwitz, DVM, DACVB
Veterinary Behavior Consultations
St. Louis, Missouri

Unfortunately, training in behavior is not available at many veterinary schools in the
United States leaving many veterinarians to question how much they know about behavioral
medicine. However, veterinarians by virtue of what they do every day have accumulated a
great deal of knowledge about animal behavior, most specifically about canine signaling
behavior. The ability to interact and treat dogs on a daily basis requires an understanding of
body postures and facial expressions that indicate fear, anxiety, threat and the precursors to
more dangerous behaviors such as biting. What is missing is the ability to actually see this as
knowledge and the inability to label this knowledge appropriately so it can be shared with staff
and owners to aid in developing better safety, welfare and handling practices for their patients.

Classification of aggression
Aggression is usually defined as threat or harmful action directed to one or more
individuals
1
. The behavior can consist of vocalizations, facial expressions, body postures,
inhibited attacks and physically injurious attacks. There are many different methods to classify
and categorize aggression in animals. The victim or target, the location where the aggression
occurs or the type of aggression such as offensive or defensive are also used to classify
aggressive behavior. In veterinary behavioral medicine, diagnostic categories classify
aggression in animals. Those commonly cited include: dominance/conflict aggression, fear,
possessive, protective and territorial, parental, play, predatory, redirected, pain induced or
irritable, pathophysiological or medical and learned
2,3,4
. However, no standardization of
diagnostic categories presently exists. In many cases, more than one form of aggression may
be exhibited in any one animal since aggressive responses tend to be multi-factorial and
complex.

Identifying indicators of aggression
Canids have evolved a series of facial expressions and body postures designed to
indicate their intention in social encounters with other canids and use these same signals in
their encounters with humans. Often the misunderstanding of these signals results in biting
episodes. In dogs, staring, snarling (lifting the lip), growling, snapping and biting are all
indicators of aggression and ones that veterinarians often understand. However, subtle
changes such as turning the head or body are also indications of discomfort with the social
encounter. In addition, the position of the ears, tail and hair indicate what the animal will do and
the underlying emotional state such as fear, anxiety, etc. It is the understanding of these
aggressive indicators that help veterinarians almost unknowingly avoid injury in many cases.
Not all dogs will go through the different signals in order, or slowly. The type of intruder, the
distance to the dog, the speed of approach and prior encounters will all influence the dogs
response. If a dog has learned that an aggressive response results in what the dog considers a
beneficial outcome, the aggressive response is likely to be repeated.

Why do dogs use aggressive signaling?
We all recognize that dogs are not verbal, they cannot tell us with words how they are
interpreting a social situation. Therefore, a dog will use various forms of signaling to broadcast
their intent in a social encounter. Some of these signals can be very subtle and easily missed
1
which may require the dog to use another more emphatic signal. Additionally, canines often
have different expectations in social encounters than do the humans with whom they interact.
In a canine to canine social encounter involving a possession or food, if dog A has the item
and dog B approaches, dog A may respond with an assertive and/or an aggressive response
which usually would clearly signal to dog B not to continue to try and obtain the object. This
dynamic may not necessarily be related to the size of the dogs involved, smaller dogs often
keep objects they have even when approached by larger dogs. However, when a human
decides that they want something the dog has, they will attempt to get it often despite low level
signals from the dog that are designed to discourage interaction and end the encounter. A dog
may use a subtle body posture or facial expression to slow or stop the approach of another dog;
they will use the same to humans who often are oblivious to the meaning. If these subtle
measures do not work, then often stronger ones may be utilized instead. Certainly
interpretations of the significance of the interaction, the intent of the approaching individual
whether a dog or a human and the individual temperament and experience of the dog involved
also influence what responses are offered.

What about dominance, submission and deference?
Much has been written and said about the dominant theory of dog communication both
between dogs and between humans. The concept of dominant and subordinate relationships
between animals was developed from observation of animals (wolves, baboons, chickens) living
in social groups.
5
Social hierarchies arranged around dominant and subordinate relationships
decrease the conflict associated with the allocation of critical resources, i.e. food, shelter, mates
and territory
6
. However, ones dominance is within the context of a relationship with another
individual, not of the individual himself and neither is dominance synonymous with aggression.
An individual could be dominant in one relationship and not in another. On the other side of the
dominance equation, is the use of subordinate and deferential acts between conspecifics that
help diffuse tension and conflict. The communication between people and dogs is across
species; therefore a more likely explanation that humans should use is that social encounters
are a dance between the participating individuals expectations and understanding. Dogs will
use canine communication methods and humans will use verbal communication methods. We
as humans are very in tune with verbal communication, but our canine counterpart in interaction
is concerned with visual communication; what we project with our body postures and facial
expressions. To have a meaningful encounter with dogs, we need to rely on the visual aspects
of canine communication signals-something that veterinarians do every day. Assertive
postures, head up, body stiff, tail up and direct eye contact should give us pause and suggest
that we rearrange our means of social interaction to diminish that tension. Subordinate and
deferential body posters, lowered and/or turned head and body and tail should caution us to
rearrange our body posture to diminish fear and anxiety. Rather than fight the body signals, we
need to embrace them, counter them with our own to diminish tension and reach an
understanding.

How best to interact with dogs?
The complex interspecies relationship between a companion dog and its human family
involves a variety of motivations and influences, including genetics, socialization, available
resources, fear, conflicts, learning, behavioral pathology, and disease. Communication is
hindered because of misunderstood meaning and intent behind each species communication
methods. Most dogs that are engaged in unwanted or undesirable behaviors are anxious and
fearful or misunderstand the social situation from our perspective. We as veterinary health care
professionals need to explain to pet owners what their dog means by its responses in social
encounters, including what happens in the examination room. A dog growling and snarling is
using threat behavior and hiding to indicate that they are fearful and want to avoid confrontation.
2
In this scenario, confrontation is likely to result in a further escalation of the aggressive
responses rather than a lessening and perhaps even biting behavior. When we approach a dog
who then lowers their head, averts their eyes and turns their head to the side we need to
recognize the message. In dog language, this indicates an unwillingness to interact, if we reach
out to touch the dog and the dog may snap or bite. We need to help people understand what
the dog is saying and help them understand although aggressive response are unwanted, to the
dog in a certain situation they may not be abnormal. Other factors also come into play.
Between humans and dogs, especially within the home environment, the owner may often defer
to a dog who assumes that their behavior is appropriate and working. This may allow the dog to
learn that he can influence the outcome and each interaction that ends with a beneficial
outcome for the dog reinforces that assumption. The animal has learned that certain behaviors
result in certain favorable outcomes. In addition, often a behavior occurs because it can, in
other words, the owners do not prevent the dog from engaging in a certain behavior and that
can be reinforcing and lead to repetition of the behavior. This is not dominance, but rather
learning that certain behaviors are acceptable and have beneficial outcomes. However, the
owner may be unaware that this dynamic is in place and when they change their mind and try to
intervene, the dog responds aggressively. The implicit understanding from the canine side of the
communication was not shared by the human participant.
Many dogs that are aggressive to family members are fearful or anxious and exhibit
conflict behavior
7
. Their behavior arises from uncertainty about their role or place within the
social group or the response to their actions both assertive and deferential. Their future
behavior is often determined by the responses to their threats, yet owners can be very
inconsistent, allowing behaviors at some times and punishing them at other times. Caution
should be exercised to avoid labeling all aggression toward family members as dominance
motivated aggression since this may be simplistic. Whenever you are dealing with an
aggressive dog, confrontations should be avoided, these will likely increase rather than
decrease aggression since they increase anxiety, fear and defensive responses.
Punishment is contraindicated because it can escalate rather than diminish aggression
by causing pain, fear or anxiety. In fact, in many cases underlying anxiety is what has induced
the aggressive responses. When interacting with an aggressive dog, all punitive measures
including alpha rolls and other attempts to dominate must be curtailed as these can increase
aggression rather than diminish it
8
.
Interactions between people and dogs should be clear and concise as well as giving the
dog the opportunity to signal if they are uncomfortable with the social encounter. Having simple
commands that are reliably performed can calm the pet because it tells them what to do.
Owners should be encouraged to teach their dog tasks such as sit and look that will allow
them to get the dogs attention. Food rewards and praise should be given liberally for earned
correct behaviors. Confrontations should be avoided since usually the humans are injured and
the human-animal bond threatened by aggression. Instead, people should take a step back and
determine if there is another way to get the animal to understand what is required of them. For
dogs that are very anxious, fearful and often aggressive the use of basket muzzles is extremely
helpful.

Prevention
Interacting with pets in a respectful thoughtful manner should always be the goal. Staff
and owners should be made aware of low level signaling that broadcasts discomfort and
anxiety. When these appear, other options should be tried. If often helps to start off on the right
foot, using food rewards liberally and taking time for the animal to understand what is happening
to them. The time spent in forming a good bond with the client and pet usually pays off in the
end.
3

1
Beaver BV, The veterinarians encyclopedia of Animal Behavior. Iowa State University Press, Ames,
Iowa, 1994 pp. 6
2
Reisner IR An overview of Aggression In: BSAVA Manual of Canine and feline Behavioural Medicine
Eds. Horwitz, Mills and Heath, BSAVA, Gloucester, UK. 2002 pg. 181-194.
3
Houpt KA Domestic Animal Behavior for Veterinarians and Animal Scientists, Iowa State University
Press, Ames, Iowa, 1991, pp. 34-74.
4
Landsberg G, Hunthausen W, Ackerman L, Handbook of behavior problems of the dog and cat.
Saunders, Philadelphia, 2003, pp. 385-426
5
Alcock, J , Animal Behavior: An evolutionary approach. Edition 2. Sunderland, Mass, Sinauer
Associates Inc. 1979.
6
Voith, VL, Borchelt, PL, Diagnosis and treatment of Dominance Aggression in dogs, In: Veterinary
Clinics of North America: Small Animal Practice, Vol. 12:4, 1982, pp. 655-663.
7
Luescher UA, Reisner IR Canine Aggression toward familiar people: A new look at an old problem In:
VCNA Small Animal ed. Landsberg G, Horwitz D, Saunders, PA 38 (2008) 1107-1130.
8
Herron ME, Shofer FS,Reisner IR Survey of the use and outcome of confrontational and non-
confrontational training methods in client-owned dogs showing undesired behaviors. Applied Animal
Behaviour Science 117: 47-54 (2009)
4
Bite
Snap
Growl
Stiffening up, staring
Lying down, leg up
Standing crouched,
tail tucked under
Turning body away,
sitting, pawing
Yawning, blinking,
nose licking
Creeping, ears back
Walking away
Turning head away
Reproduced from Shepherd (2002) in BSAVA Manual of Canine and Feline Behavioural Medicine, edited by
Debra Horwitz, Daniel Mills and Sarah Heath, with the permission of BSAVA Publications (www.bsava.com).
Ladder of aggression
5

6
MANAGING SEPARATION ANXIETY: STEPS TO PROMOTE CLIENT COMPLIANCE

Debra F. Horwitz DVM, DACVB
Veterinary Behavior Consultations
St. Louis, Missouri

When separated from family members dogs may experience distress and engage in
problem behaviors related to that distress. These behaviors include destruction, vocalization,
elimination of urine and/or stool, anorexia, drooling, attempts at escape and/or behavioral
depression. However, separation anxiety is not a unitary phenomenon. Some dogs are
distressed about being home alone because the persons to whom they are attached is absent,
others are distressed because something fear or anxiety provoking has occurred while they
were alone. These two underlying motivations are not mutually exclusive; a dog can be
distressed for both reasons. The most common concomitant co-morbid diagnosis is storm/noise
sensitivities and separation anxiety. Treatment protocols include independence training,
elimination of responses to departure cues, training departures, pheromones and
pharmacological intervention.

History taking
Separation anxiety seems to be quite prevalent in the companion dog population. Dogs
that are adopted as adults from humane shelters may appear more frequently in behavior case
loads
1
. The problem behavior(s) in the history may include destruction, vocalization and/or
elimination in the house while the owners are gone.
While destruction, elimination or vocalization are common when the dog is left alone,
some dogs may show signs of increased attachment to the owner and exhibit distress as they
get ready to depart. The departure anxiety may be whining, panting or pacing while other dogs
may become immobile or hide. Most dogs engage in the separation related behaviors within 30
minutes of owner departure
2
. Self-mutilation, excessive licking, vomiting or diarrhea can also
occur as symptoms of separation distress. While most of the problem behavior occurs shortly
after owner departure, some dogs may cycle through periods of re-arousal perhaps brought on
by outside stimulus
3
. Geriatric dogs are more commonly seen for the behavioral complaint of
separation related anxiety when compared to younger dogs.
4
Other signs may occur including
excessive greeting behavior, persistent following behaviors when the owner is home and
unwillingness to be out of sight of the humans. In some extreme cases dogs may use
aggression to attempt to keep the owner from departing.

Diagnosis
Rule out other causes of house soiling, destruction and vocalization before establishing
a diagnosis of separation anxiety. Differential diagnoses for dogs that eliminate when left alone
include medical causes of house soiling, inadequate house-training techniques, marking and
prolonged periods without access to appropriate elimination locations. When dogs are
destructive or barking alternate explanations include young, energetic dogs with limited exercise
or play, external stimuli and territorial displays. Destruction may be a component in noise
phobias such as thunderstorm phobias. Geriatric dogs may be experiencing changes in
cognition and should show other signs of cognitive decline such as wandering, loss of house
training, disturbances in sleep/wake cycles and other symptoms that have been associated with
Cognitive Dysfunction Syndrome
4
. Some dogs may be distressed when the owner is gone due
to fears, phobias or anxieties about events that occur in the owners absence such as storms or
other loud noises
5
. If none of these apply, then a diagnosis of separation related anxiety is
appropriate. If the history is not clear, then owner journals, audio and/or video tapings and
7
appropriate medical testing may be helpful in establishing a diagnosis. In some situations, more
than one dog is showing anxiety and distress and all patients should be treated.

Treatment
Standard behavior modification treatment plans generally have the following components
6
:
Owner education
Counseling owners that the behavior is anxiety based, not spiteful.
Independence training
Make the dog less attached and interactions with the pet more focused and structured.
Recommendations include: ignoring attention-seeking behaviors (but not the pet), teaching
sit/stay, decreasing following behaviors and earning attention by performing a task first.
Institute a predictable routine for exercise, play and attention. Teach the dog to settle and relax
in a set location or on a bed or mat to teach the dog how to be calm on cue.
Departures and returning: habituation to the pre-departure cues, and changing the
leaving and return routine
The goal is to reduce the predictive value and thus anxiety producing quality of the steps in the
owners departure routine. To uncouple these cues from actual departures, the owner is to
perform them without leaving. For example, the owners might pick up their keys or purse, put on
a coat, or open and shut the door without actually departing. This is repeated 2-4 times a day
but the dog must be calm between presentations. Owners are instructed to ignore the dog for
15-30 minutes prior to departure and upon return to keep these times neutral and calm.
Counter conditioning to departure
Teaching the dog to engage in an alternate activity when the owner approaches the door and/or
departs may help some dogs cope more easily with owner departure. This can be a simple
sit/stay or the use of a food stuffed toy prior to departure. The dog can be asked to settle in its
previously learned safe location.
Graduated planned departures
The goal is to replicate real departures, using a new signal to facilitate the dog learning that
departures need not produce anxiety. These are generally not begun until the dog can settle
and relax on cue and no longer responds to departure cues with distress.

Drug and pheromone therapy
Prior to medications a physical examination and a minimum database of a Biochemical
Screen, CBC and urinalysis should be performed. Results with drug therapy may not be seen
for 14-30 days, the owner must be committed to continue usage. Two drugs are presently
formulated and licensed for the treatment of separation anxiety in dogs; Clomipramine
Hydrochloride (Clomicalm)
a
and Fluoxetine (Reconcile)
b
are FDA labeled to aid in treatment
of separation anxiety in the USA.
Tricyclic antidepressants (TCA) as a class of drugs primarily affect serotonin,
norepinephrine, acetylcholine and histamine. TCAs are contraindicated in hyperthyroidism,
seizure disorders, in animals on thyroid medication, amitraz or selegiline or animals
experiencing problems with urinary retention or urine flow. Common side effects with tricyclic
antidepressants include urinary retention, constipation, tachycardia, dry mouth, hypotension and
mydriasis
7
. Clomipramine is dosed at 2-4 mg/kg per day either as one dose or divided twice
daily
8
. The most common adverse reactions are vomiting, diarrhea and lethargy. Caution is
advised in using Clomicalm with other CNS active drugs including general anesthetics and
neuroleptics, anticholinergic and sympathomimetic drugs
8
. In the placebo blinded drug approval
study, the medication was used in conjunction with behavior therapy and withdrawn after 2

a
Novartis Animal Health, Greensboro, NC
b
Elanco, Indianapolis, IN
8
months. After week one, 47% of the dogs receiving Clomipramine and behavior modification
showed improvement compared to 29% of the dogs receiving behavior modification alone
9
. In
another placebo study by Podberscek et al on treatment for separation anxiety it was found that
the Clomipramine patients showed no greater improvement than those on placebo. However,
behavioral therapy on its own was highly effective
10
.
In a large multi-centered double blind, placebo controlled study Fluoxetine was dosed at
1-2 mg/kg once daily with all dogs receiving behavior modification. Seventy three percent of
dogs treated with medication and behavior modification showed improvement in overall severity
scores compared with 51% of placebo and behavior modification treated dogs at the study
conclusion after 8 weeks. Forty-two percent of treated dogs showed improvement within the
first week. The most common adverse events reported following fluoxetine treatment were
lethargy and vomiting. Seizures occurred in 3 fluoxetine-treated and one placebo-treated dog
therefore fluoxetine is not recommended in dogs known to suffer from a seizure disorder. Full
details of the study are recently published
11
. Fluoxetine should not be used concurrently with
monoamine oxidase inhibitors (selegiline and amitraz) nor with tricyclics.
Fluoxetine and Clomipramine should not be used concurrently due to the risk of
producing serotonin syndrome. When either is used in a treatment program, the medication
must be given daily and may take 2-4 weeks to see some effect. Patients may need several
months of treatment for sustained improvement to be noted. In some cases, withdrawal of
medication may result in the return of symptoms
12
.
Benzodiazepines have often been suggested for immediate relief or short term control.
Benzodiazepines such as alprazolam (0.02 to 0.1 mg/kg orally
13
) can be dispensed on an as-
needed basis shortly before departures. Benzodiazepines may inhibit learning, usually require
frequent dosing and may cause dependence and a rebound anxiety when discontinued.
DAP

(Dog Appeasing Pheromone)

c
may be useful in reducing anxiety associated with
owner departure in some dogs. DAP is available as a diffuser that plugs into the wall and
remains active for 30 days. One study comparing the efficacy of DAP versus Clomipramine for
the treatment of separation distress in dogs found to be them to be approximately equal with
respect to owner global assessment scores and there were no significant differences between
the two groups in individual signs
14
.

Why Treatment Results Vary and May Fail
Drug therapy alone is rarely curative for most behavioral disorders: Medication alone will not
change behavior and will not teach the pet new behaviors.
If the pet is not taught how to remain home alone, and anxiety-producing cues are not
habituated to, very little improvement might occur. In fact, some dogs may become worse.
Concurrent additional anxieties (storm phobias, noise phobias, inter dog aggression issues)
that are not addressed may limit treatment success
Owner expectation of a quick cure. Response to behavioral medication can take time.
The ongoing destruction, vocalization and elimination continue to strain the human-animal
bond
Treatment failure is avoided by regular and detailed follow up either in person or by phone. The
behavior modification plan is not complicated, but can be administered incorrectly and result in
an increase in anxiety, rather than a lessening of symptoms. In addition, owners often want
resolution of the problem and may become discouraged and not notice improvement and small
steps in the right directions. Follow up visits in person or by phone allows the clinician or staff to
work with the owner to make sure treatment recommendations are properly followed and to

c
CEVA Sante Animale/VPL in US
9
point out the progress being made. If no progress is happening, then re-evaluation of the
diagnosis and treatment plan is necessary.


References
1. McCrave, EA. Diagnostic Criteria for Separation Anxiety in the Dog. Veterinary Clinics
of North America: Small Animal Practice, Mar.1991, 21:2 : 247-255.
2. Borchelt, PL, Voith, VL. Diagnosis and Treatment of Separation-Related Behavior
Problems in Dogs. Veterinary Clinics of North American: Small Animal Practice, Nov.
1982, 12:4 : 625-635.
3. Lund, DJ , J orgensen, MC. Separation Anxiety In Pet Dogs Behaviour Patterns and
Time Course of Activity. Proceedings of the First International Conference on
Veterinary Behavioural Medicine, Universities Federation for Animal Welfare, Great
Britain, 1997, p. 133-142.
4. Landsberg, GM, Ruehl, W. Geriatric Behavior Problems. Veterinary Clinics of North
America: Small Animal Practice, Nov. 1997, 72:6 :1537-1559.
5. Overall KL, Dunham AE, Frank DF. Frequency of nonspecific clinical signs in dogs with
separation anxiety, thunderstorm phobias, and noise phobia alone or in combination. J
Am Vet Med Assoc 2001;219:467-473.
6. Horwitz, DF Separation-related problems in dogs. In: BSAVA Manual of Canine and
Feline Behavioural Medicine, Ed. Horwitz, Mills and Heath, BSAVA, Gloucester, UK,
2001. pp 154-163
7. Overall, KL. Pharmacologic Treatments for Behavior Problems. Veterinary Clinics of
North American: Small Animal Practice, May 1997, 27:3: 637-665
8. Clomicalm package insert, Clinical and Technical Review, Novartis Animal Health, 1998.
Pp.17- 26
9. King J N, Simpson, BS, Overall KL et al Treatment of separation anxiety in dogs with
clomipramine: results from a prospective, randomised, double-blind, placebo-controlled,
parallel-group multicenter clinical trial. Applied Animal Behaviour Science. 2000 67: 255-
275
10. Podberscek, AL, Hsu Y, Serpell, J A Evaluation of clomipramine as an adjunct to
behavioural therapy in the treatment of separation related problems in dogs. Veterinary
Record, 1999, 145: 365-369.
11. Simpson BS, Landsberg GM, Reisner IR et al Effects of Reconcile (Fluoxetine)
Chewable Tablets Plus Behavior Management for Canine Separation Anxiety, Veterinary
Therapeutics, 2007 8: 18-31
12. King J N, Overall KL, Appleby BS, et al. Results of a follow-up investigation to a clinical
trial testing the efficacy of clomipramine in the treatment of separation anxiety. Appl
Anim Behav Sci 2004;89:233-242
13. Horwitz DF, Neilson J C Blackwells Five Minute Veterinary Consult Clinical Companion
Canine and Feline Behavior, Blackwell Publishing, Ames, 2007 pp. 531-536
14. Gaultier E, Bonnafous L, Bougrat L, et al. Comparison of the efficacy of a synthetic dog-
appeasing pheromone with clomipramine for the treatment of separation-related
disorders in dogs. Vet Rec 2005;156:533-538

10

CANINE AGGRESSION TOWARD UNFAMILIAR PEOPLE ON WALKS AND AT THE DOOR

Debra F. Horwitz DVM, DACVB
Veterinary Behavior Consultations
St. Louis, Missouri

Introduction
Canine aggression directed toward people is a serious problem. Several million people
are bitten each year, often by a dog familiar to them
1
. The injuries range from minor to severe
and even death. The causes of human directed aggression are varied yet the underlying
motivation is usually fear, or anxiety and not a desire to dominate or control.
Dog bites and canine aggression results from many factors and may a normal but
unwanted response or an abnormal response to a particular situation. Early environment,
genetics, learning, health (both medical and behavioral), and training contribute to aggressive
behavior.
On walks, the owner may inadvertently reinforce a tense and defensive behavior by
tightening the leash and/or with their vocal cues and body posture. When the owner tightens
the leash and draws the dog in closer they are usually doing so because they are unsure of how
their dog may respond. However, these behaviors (leash tightening and tense posture) may
signal to the dog that the impending approach is problematic, and therefore increase rather than
decrease the dogs emotional arousal.
Aggression at the door may be due to territorial responses and may be combined with
fear related aggression toward strangers. Some dogs will show intense responses when the
doorbell rings or someone knocks and then be fine when the people come inside. Others may
continue to posture aggressively and/or show fearful responses and perhaps injure visitors if
given access to them. The behavior can be directed toward everyone who comes to the home,
or only selected individuals.

History taking
Background information about the dogs early experiences with people should be noted
and recorded. The lack of appropriate and early exposure to people and new situations as a
puppy may contribute to fear based and aggressive responses as an adult. Other animals in
the home should be noted and determine if they also exhibit the same behaviors.
All previous attempts to change or correct the problem must be explored and detailed.
These might include training, treats, more exposure, confinement etc. Punitive measures
including leash corrections, shock collars, physical reprimands should be noted as they can
contribute to the anxiety surrounding the situation. Often owners have attempted to socialize
the dog by repeatedly taking them places where they encounter other people. This may
increase rather than decrease the aggressive responses resulting in discouraged owners and a
pet quite good at performing the unwanted responses.
The aggressive responses on walks should be explored in detail including location,
distance to the person and the response itself. Determine both a distance and response
gradient; at what distance does the response first begin (perhaps with just alerting behavior,
watchfulness and not full blown aggressive behaviors) and what does it look like. The goal is to
establish the distance at which the dog first notices another person, what the response is at that
time and also to determine when the response is at its peak and where the person is at that
time. The owner should be encouraged to describe the response in very precise detail including
body posture, vocalizations, and ability to control or divert the dog. Finally, how does the
encounter end and when or at what distance does the dog return to a baseline controllable
behavior?
11

For door related behaviors, the first episodes and several more recent episodes should
be explored. Any punishment, reprimands or confinement should be detailed. Are there any
people who can come into the home and the dog is relaxed and friendly? Does the behavior
occur if people get up and move about the house once they are inside? Are there categories of
visitors, i.e. familiar, somewhat familiar, unfamiliar and how does the behavior vary between
these groups? How many visits are needed for a person to become a familiar visitor? If they
always confine the dog with company, why do they do so? Has anyone been bitten by the dog
when they have entered the home?
Diagnosis
In both situations the responses tend to be a combination of fear based responses,
anxiety and learned responses. In some cases it is apparent that the dog has poor social
communication skills and does not read the social signals of people appropriately. Responses
at the door are usually a combination of fear, anxiety, territorial behaviors and learning
combined to solidify and intensify the behavior.

General treatment recommendations
All situations that cause either behavior to occur must be avoided. When the dog is able
to engage in the behavior repeatedly not only do they learn how to do it better, they may
actually bias the synapses for earlier responses. When the problem occurs on walks, all walks
must be curtailed until the dog learns new responses. If the only way the dog goes outdoors to
eliminate is on a walk then walks must be arranged at times and places where encountering
other people is less likely. If the problem is at the door, the dog must be securely confined each
and every time someone wants to enter the home. The dog should be placed in confinement by
an adult. If the dog will not tolerate confinement, then confinement training should be done as a
first step. It is important for the owner to gain control of their pet. Leashes are absolutely
necessary (not retractable leashes) and the use of head collars (Gentle LeaderPremier Pet
Products) and/or muzzles strongly recommended for dogs that will be in situations with people if
they cannot be avoided.

Treatment for aggression on walks
Treatment will focus on three areas, increasing control and ability to leave potentially
aggressive situations, systematic desensitization to people and classical counter conditioning to
the approach people
2
.
Two common treatment strategies are often employed. One is counter conditioning and
desensitization. The dog is taught to perform a different task that is calm and relaxed.
Desensitization is teaching the dog to accept the approach and greeting of people with relaxed
body postures. This is begun with people far from the dog until the dog is reliably able to
assume calm and relaxed behaviors. Gradually the dog is exposed to people at closer
distances
2
. The other approach is to classically counter condition the dog to associate
something pleasant with the sight and approach of people
3
.
Classical counter conditioning
Animals showing unwanted behaviors are usually experiencing the underlying emotions
of anxiety and fear that result in the outward aggressive responses. Changing underlying
emotional state can help change outward behavior. The goal is to teach the pet to relax AND to
associate the stimulus with something pleasant. The conditioning works to change the meaning
of the stimulus from one that predicts something unpleasant to one that predicts something
desirable.
Learning is unlikely to occur when an animal is highly emotionally aroused. In order to
change an emotional behavioral response you must understand how the response changes with
varying characteristics of the stimulus. To grade the response you need to know how the pet
responds to the stimulus as that stimulus changes either in its proximity, speed of approach,
12

location or other characteristics such as sound or size. Essentially you need to know, how the
pet responds when the stimulus is 20 feet away, 10 feet away and finally past the owner and
pet. And, does the pet respond the same way all the time? Can you grade the response in
some way? This helps not only to assess the behavior but can also be used to assess
treatment response.
To change underlying emotional state the animal must be offered something enticing
that evokes another hopefully happier response. Find a reward that the animal finds especially
enticing (an A treat) usually food, especially table food. Some dogs will find play an enticing
reward but not all dogs will switch gears for play. Training is more successful if there is a
gradient of rewards including those that are extremely desirable to less desirable ones.
Extremely desirable rewards are saved for training and conditioning sessions only and withheld
at other times

Pre-training
The owner needs to identify 3 levels of treats, A treats (very delectable usually table
food), B treats (perhaps liver treats) and C treats (biscuits). The owner should also create a
treat jar; a plastic container with a lid that is filled with A, B, and C treats and a bell placed on
top. The pet is taught to come to the ringing sound and told to sit after which it will receive a
treat from inside the jar.
The dog is taught two baseline tasks. To get the pets attention, we teach the pet to look
at the owner using a phrase such as watch me or focus. The animal should maintain eye
contact for several minutes but remain neutral and relaxed. A leash and head collar should be
used for additional control. The task is first practiced in neutral, quiet surroundings until well
performed, and then distractions can slowly be added.
The second is a command that allows you to leave or end the situation. For problems
on walks, the dog is taught a phrase such as lets go or follow me and to turn 180 degrees
and briskly walk the other way. This should be performed quickly, but without anxiety or
tension. Again, this is first practiced in a quiet location so that the response is quick and reliable
each and every time. When the problem occurs indoors, the pet is taught a go to your mat
command to send the dog to a quiet location to settle and relax. This training is done in slow
steps, first taking the dog to the location and getting it to sit or down and stay with gradual
increase in time. The dog is rewarded for relaxed breathing, body posture and facial
expressions. In some cases, this mat may need to be in a room with a door that can be securely
closed and/or locked or a crate. If the pet is not crate trained this can be attempted if the owner
is willing to take the time to teach the pet how to be confined.
All of these steps must be in place before conditioning training can begin. Again, while
this pre-training is taking place the stimuli known to cause the problem behavior must be
avoided. This may mean curtailing walks, confining the dog when visitors come over, not
allowing the dog outside in the yard unattended and off leash, not allowing aggressive displays
at windows, doors and fences. The dog should be able to focus and then leave on command or
settle in their place, before you begin the conditioning.

Actual training sessions for aggression on walks
To help with control the pet should be wearing a flat collar or head collar and a leash that is
held by a responsible adult. Initial sessions begin with the stimulus at the predetermined
distance at which little or no response is noted. The owner must have the highly desired treat
available and ready. The pet is asked to focus and the owner will begin feeding the treat
regardless of what the pet does as long as they are not lunging or barking. They can look at the
stimulus. As the stimulus gets closer to the predetermined spot where undesirable behavior is
going to begin, you must quickly but calmly exit the situation using the lets go command. Do
several repetitions at the same distance. Knowing the response gradient is absolutely essential
13

to setting up successful training sessions. The goal is to help the pet learn that the arrival of the
stimulus predicts the desired treat and in the absence of the stimulus the treat is not
forthcoming. We want the dog to learn to associate the sight of the stimulus with something
pleasant.
The owner must not attempt to remain longer than the dog can behave. If the dog
becomes very reactive, the stimulus was too close or too intense and future sessions must have
better control of the stimulus intensity. Unwanted responses occur when you either do not have
good control over the stimulus or did not accurately define your response gradient. You may
need to be quite a distance away for the dog to be calm and controlled. Without control of the
stimulus it is unlikely that the dog will learn the wanted responses because they will be too
emotionally stimulated. Remember, the dog learns best when calm.
Punishment must be avoided, if the pet does not respond well to the stimulus you
must immediately leave and realize that something about the set up of the training session was
incorrect. You cannot punish away an emotion such as fear, anxiety or aggression. When you
do punish the pet in these situations you are punishing what they are doing at the time and this
can have several unintended consequences. You may change the outward expressions of the
behavior such as barking, lunging, growling without any effect on the underlying emotion. This
can result in a dog that does not signal but bites unexpectedly. Or, fear or anxiety toward the
stimulus may actually increase since the stimulus results in punishment and bad things
happening to the pet. In this scenario that intensity of the responses may actually increase
rather than decrease as the pet attempts to get the stimulus to leave to avoid a bad outcome,
i.e. punishment.
Limit the number of exposures within a training session. You want the dog to be
successful and end each session on a positive response. If the dog does extremely well in a
given training session, then they should receive a big reward and end the session. This
treatment can often help decrease the arousal level so that the dog can be controlled during the
situation.

Treatment of territorial aggression
Aggression toward people may only be exhibited when people enter the dogs property,
or what the dog considers his territory. Dogs may get highly aroused at the sight of people on
their territory and may even attempt to jump fences, go through windows or doors to get to the
intruder. Certainly, it is easier to prevent this type of aggression than to treat it. Dogs should
not be allowed to engage in prolonged aggressive displays at windows, doors and fences at
other dogs or people. Owners should strive early in the dogs life to get control of barking and
other territorial displays. Some dogs that act territorial are actually fearful and this can often be
determined in the history taking, concentrating on body postures and pet response to intruders
who do enter the house or yard.
Treatment for territorial aggression has several components. First, in the home the dog
can be taught a "quiet" command so that barking displays can be halted. This is often best
accomplished using a leash and head collar for control. Alternately, visual access could be
blocked to decrease the arousal level. The dog should not be allowed outdoor or window
access without supervision since engaging in the behavior is very reinforcing when the stimulus
leaves, causing it to continue and perhaps escalate. The cornerstone of treatment is to counter
condition and desensitized the dog to the approach of people in its territory. The use of a head
collar and/or muzzle is necessary for owner confidence and control. This is accomplished by
first teaching the dog a command incompatible with barking and lunging, such as a sit/stay.
Food rewards are often helpful in the beginning so that the dog is relaxed and compliant. Then
the dog is gradually exposed to people near the territory and praised for good behavior. At first
it may be necessary to use people that the dog knows and recognizes and progress to unknown
people
3
.
14

Teaching a new response to the doorbell and visitors to the home
Until the new behavior is mastered, it is important to avoid the full strength stimulus
(stranger coming up to the front door). If someone comes to the door, the dog should be safely
and securely confined. Daily training exercises should be short, 5-10 minutes in duration using
highly delectable food rewards. Training will focus on teaching the dog to settle on command,
teaching a new response to the approach of people to the door, rewarding good behavior.
Start the training with no distractions present (nobody at door, house quiet, other pets
elsewhere). The dog should be taught to go to a greeting spot (mat, rug, bed) on voice
command; the spot should be within sight of the front door but a few feet away from it. It is often
useful to use a head collar and leash and/or place the dog in a tie down for additional control.
Before proceeding to the next step the dog should reliably go to the greeting spot and hold the
sit/stay for 10 seconds when there are no distractions.
Set up daily exercises with one family member handling your dog and the other family
member being a visitor. The family member playing the visitor should have spent time with
the dog just prior to doing the training exercises. The dog should be on leash or there should be
some type of barrier across the door that allows full visualization of the visitor but no access
(screen door/baby gate) to the outdoors.
Have the visitor approach the open door and either knock gently or ring doorbell. The
handler should give the command to your dog to go to the greeting place and sit/stay. The
correct behavior is rewarded with a food tidbit and praise. Since the stimulus level is low
(familiar person, recently seen them) the dog should be able to perform the desired behavior
and be rewarded. If the dog isnt compliant, give no reward and reduce the intensity of the
exercise (maybe leave out knocking/doorbell ringing) at the next attempt.
Repeat until the dog is very obedient about going to the greeting location every time the
visitor approaches the open door and knocks/rings. Then close the door slightly so that it is
open 3/4 of the way and repeat entire sequence. Continue gradually closing the door over
multiple sessions until the visitor can approach a closed door and knock/ring and the dog will
hold a sit/stay at the greeting place as they enter the home.
After this has been successfully completed with the family member as the visitor, try to
recruit a less familiar person to be the visitor. Return to the open door and repeat until your
dog will hold the sit/stay even with a non-family member knocking/ringing bell of a closed door
and then entering the house. At this time, the entering fake visitor can shake the treat jar and
give the dog a reward.

Using Classical counter-conditioning to the doorbell
In other situations, it may be necessary to change the emotional state of the dog when
they hear the doorbell before any training can begin. This is especially useful for dogs that are
extremely emotionally aroused by the sound of the doorbell and bark, lunge and jump at the
doors and windows.
Favored food rewards should be identified for the dog, these must be extremely
delectable, generally table food. Place the dog unrestrained in another room away from the door
with one family member, while another family member quietly leaves the house and comes to
the unlocked front door. This person must have with them a large supply of the delectable treat.
If the dog could see them from windows these must be blocked.
This person should ring the door bell and the dog is allowed to run to the door
unimpeded as it usually would. As the outside person hears the dog approach, they open the
door, throw the treats inside and close the door. When the dog gets to the door, if the correct
food has been chosen the dog will usually eat the treats and perhaps also bark. Then the
outside family member rings the bell and throws in the treats again. This technique will not work
if the dog has seen the person exit the house or knows who is outside before they ring the bell.
15

A training session is usually only 1-3 repetitions since when the dog realizes it is a
known person at the door they may not bark. After several sessions, many dogs will decrease
their barking or at least diminish emotional arousal to the doorbell so other training techniques
can be utilized. At this point in time, training to sit and stay on a mat can begin and
desensitization training implemented.
These training protocols may change how the dog responds to people coming to the
door. If the dog is showing intense fear related aggression toward people and has bitten or
threatened to bite this may not be enough to allow them to interact safely with people who come
into the home. These exercises may only diminish reactivity so other training can be
implemented.

Prevention of aggressive displays at windows, doors, fences and on walks
Prevention is preferable to treatment. Good early socialization to other people, dogs,
and people entering the home and yard may help diminish territorial and aggressive responses.
Owners should strive to have good compliance with control commands such as come, sit, and
stay. Teaching a quiet command is useful so that the barking can be controlled once it begins.
Using a leash indoors for early teaching and control in young dogs can be particularly beneficial.

References:
1. Guy NC, Luescher UA, Dohoo SE et.al (2001) A case series of biting dogs: characteristics of
the dogs, their behaviour and their victims. Applies Animal Behavior Science, 74:43-47.
2. Bain, M (2009)Aggression toward unfamiliar people and animals In: BSAVA Manual of
canine and feline behavioural medicine 2
nd
edition ed. D. Horwitz, D Mills, BSAVA,
Gloucester UK, pp. 211-222
3. Horwitz DF, Neilson J C Blackwells 5 minute Veterinary Clinical Companion: Canine and
Feline Behavior, Blackwell Publishing, Ames, Iowa. 2007 pp. 71-78.


16
THE LINK BETWEEN HOUSE SOILING AND FELINE INTERCAT AGGRESSION

Debra F. Horwitz DVM, DACVB
Veterinary Behavior Consultations
St. Louis, Missouri 63141 USA

Introduction
The two most common problems in companion felines are house soiling (elimination of
urine and stool outside of the litter box) and intercat aggression
1
. While either can occur in a
household with only one cat, often the problem occurs in a multiple cat home. An
understanding of feline social behavior and communication, elimination problem behavior and
feline aggression and can help with diagnosis and treatment of these two interlinked conditions.

The basis of feline social behavior
While cats were generally considered asocial, they are capable of and do live in groups. These
social groups tend to be matrilineal with related females (mothers, daughters, aunts) and
juvenile male cats. Within these groups, individual cats will form attachments to certain
individuals and actively avoid others
2
. These groups form around abundant food resources;
dairy barns, fishing wharfs, garbage collection sites and parks provisioned by humans. Social
groups formed of free roaming cats may change members with mature males and occasionally
mature females leaving the group. This is in contrast to the human household where the
humans artificially create social groupings and the cats do not have the ability to leave should
they find the situation unpleasant.

Bradshaw and Hall
3
did a preliminary study observing the affliative (friendly) behavior between
25 pairs of cats who had lived together for at least a year who boarded at a cattery. Related
pairs are commonly found in physical contact with one another when compared to non-related
pairs of cats. Unrelated cats tended to feed separately, while littermate pairs often ate from the
same bowl or side by side. Littermate pairs also groomed and rubbed one another more
frequently than non-littermate pairs. While it is not possible to infer a great deal from a small
study in an unfamiliar environment, this does begin to mimic relationships seen in free ranging
cats.

Other studies have attempted to assess whether or not cats have some sort of social ranking
system for determining access to resources. An early study by Bernstein and Strack
4
included
14 cats within one household, seemed to indicate that space within the household was not
shared equally with certain individuals having greater access to resources than others do. While
this is not necessarily evidence of a social ranking pattern, Knowles
5
also found some
correlations between agonistic interactions away from food and ability to control interactions at
the food bowl. Others have suggested that agonistic social interactions have more to do with
perception of personal space than social dominance but neither ascertain is supported in all
cases. Another possible theory is that cats fight to increase individual distance between them,
and is not about territory at all
6
.

Elimination problem behavior
Feline toileting in the wrong location (away from the litter box) and marking are the most
common feline behavioral problems of cats. House soiling can often be precipitated by medical
problems, a good physical examination and urinalyses are essential for all patients that are
house soiling. Inappropriate elimination can also be a symptom of other medical abnormalities,
such as hyperthyroidism, diabetes mellitus or liver disease. Studies have indicated a correlation
17
between underlying social issues between household cats and urine marking and exploring
relationships between cats is prudent to establish a diagnosis
7
.

History for toileting and marking problems
A complete and thorough behavioral history is essential to determine what is going on and help
formulate a treatment plan. Essential points include:
Establishing the duration and progression of the problem behavior. Is this a new
behavior, or a chronic one?
What type of elimination is deposited outside of the litter box; urine, stool or both?
Location of the elimination, i.e. vertical deposition of urine or horizontal deposition.
Information on the litter box is useful and essential. Litter box size, covered box vs.
uncovered box, litter type, number of boxes and rate of cleaning, box location must
all be discussed.
A diagram of the locations of inappropriate elimination
The frequency of urination or defecation outside the litter box
When (time of day) the owners find the elimination outside of the litter box.
What substrate (material) does the cat eliminates on; different substrates for urine
and stool?
Information about the household routine and any changes in the home.
How many other pets are in the household especially additional cats?
Social relationship between cats in the household, including any overt signs of
aggression (hissing, growling, chasing) and covert signs of aggression (blocking,
staring, supplanting from spaces)
All previous treatment attempts, behavioral, medical and pharmacological.

Diagnosis
The major diagnostic categories for feline inappropriate elimination include location preference,
substrate preference, litter aversion, location aversion, and marking
8
. Non-litter box use can
also be influenced by stress, anxiety, and litter box factors such as size, cleanliness and
placement. The use of a diagnostic category will help in the formulation of a treatment plan.

Aggression between household cats
Fights can occur between cats that have lived together for some time perhaps due to a change
in social status or a traumatic event, fights may be the sequel to redirected aggressive behavior
or another anxiety producing event, aggression may occur with the introduction of another cat,
or due to illness or social changes within the home. Fear, anxiety and territorial responses all
contribute to intercat aggression within a household. In all situations, contributory medical
factors must be ruled out, identified and treated.

History taking
History taking should collect information regarding the daily routine, pet-owner interactions and
how resources are allocated within the home. All participants in the aggressive behavior must
be identified. Detailed descriptions of several selected aggressive episodes will help to identify
triggers, participants, owner responses and possible treatment options. Aggressive behaviors
include blocking access to territory, staring, chasing, hissing, growling, biting and attacks, facial
expressions and body postures. Identify any treatment options already tried and discuss
implementation and effect they may have had on the problem behavior. Examine the ongoing
behaviors of the cats involved noting signs of anxiety, fear and defensive behaviors (hiding,
inappetence, lack of evidence of grooming) to determine the effect of treatment and resolution
on these signs. Examine litter box use by all cats within the home since social issues often
contribute to non-litter box usage or urine marking behaviors.
18

Diagnosis
After a behavioral history is taken, attempt to reach a diagnosis. Common diagnostic categories
include territorial aggression, social status aggression, redirected aggression, fear aggression,
defensive aggression, irritable aggression, defensive aggression, offensive aggression and
intermale aggression.

Factors that lead to house soiling due to aggression
Chasing and overt aggressive threats such as growling, hissing, biting may be evident.
However, threats between cats can be covert including blocking access to locations, staring or
supplanting. In territorial disputes, one cat (the aggressor) will usually chase another (the
victim). These chases are accompanied by vocalizations such as hissing, growling and yowling.
This may result in one cat living in a restricted area to keep away from the aggressor.
Therefore, it may be necessary to create separate areas for food, resting places and litter boxes
for each cat in order to create harmony.



Essential elements in treatment of house soiling linked to aggression between cats
Within a multiple cat household, there should be multiple litter boxes, food bowls, water bowls
and resting areas. These should not be clustered together, but placed throughout the
environment keeping in mind how the various cats access the space available to them. Some
cats may only have access to certain household areas and if resources are not within those
areas anxiety and house soiling may result.

When multiple cats share litter boxes the size and cleanliness of those boxes may become an
issue. Research has indicated that when given a choice, cats prefer clumping litter materials to
clay materials and larger size boxes. Litter boxes must be scooped out daily, and totally
emptied, washed and refilled every 10-14 days.

In order to create harmony, it may be necessary to keep fighting cats separated unless
supervised or using structured introductions. Introductions can be accomplished using food or
play and the goal is to associate pleasant things with the presence of each cat. It also might be
helpful for the aggressor to wear an approved cat collar with a large bell that will forewarn the
victim of their approach allowing the victim to escape.

Re-introducing fighting cats
Immediately after a fight, create separate spaces for isolation of fighting cats where they can
stay while the owner works on introductions. This must be a secure area with a door that
latches completely and/or locks. In the room the cat must have a feeding/watering site; a
litter box; perches at different vertical heights, hiding spots, scratching posts/pads, toys, etc.
Make sure to remove all items of value or those that might be dangerous to the cat (e.g.
plants, electric cords, strings) and any target items that may encourage inappropriate
elimination (e.g. plush bath mats).
A pheromone diffuser, Feliway, should be placed in the isolation areas and in the other
parts of the home.
To facilitate re-introductions identify favored activities/treats for all cats involved in the
problem behavior.
19
Encourage play through the door. One option is to create a dumbbell toy under the door that
separates the cats by tying two toys together with heavy string and place one toy on each
side of the closed door.
Facilitate scent transfer between cats. Use a common piece of material to pet each cat
every day; wiping the towel against the cheek area and the base of the tail alternating from
one cat to the other.
Do not allow overt persistent aggression such as hissing and growling at the barrier door. If
this occurs, create a neutral zone by closing another door or creating separation using baby
gates in hallways
The next step is to progress to short (<5 minutes) visual introductions. Cats are contained in
some manner (in crates, on harnesses/leashes; behind doors with windows) so they cant
make physical contact but they can see each other. Try to engage cats in a favored activity
in their respective locations during these visual opportunities. Perform these 2-3 times daily
until all cats appear relaxed and there is no aggressive posturing. If there is aggressive
posturing, the cats must be separated to avoid intimidation.
Once the cats are relaxed when they visualize each other, food introductions outside of the
isolation area can begin.

Details of counter conditioning and desensitization
The focus is on counter conditioning and desensitization exercises to re-introduce the cats to
one another. The goal is to allow the cats to be together without any aggressive behavior
(growling, hissing, chasing, staring etc.). Introductions are done slowly, using food to facilitate
calm, non-anxious behavior (counter-conditioning). The cats need to be far apart or on either
side of a closed door, so that they are relaxed (desensitization). Each cat is offered a
delectable food treat that they will eat. For safety and control, it is often advisable that each cat
wear a harness and leash. If the cats will not eat, then they are too anxious and probably too
close together and should be moved further apart. If the cats still will not eat, then separate
them until the next feeding. If the cats do eat at that time, they remain together while they eat
and then separated. The next feeding is at the same distance. If things go well at that session,
the next time the dishes can be moved closer together, but only 6-8 inches. If the cats are
comfortable, sometimes they are left out but leashed far apart and under supervision so that
they can groom, and then separated again. Two feedings without the expression of any
aggressive or anxious behavior are done at the same distance before the bowls are moved
closer together. Clients should be cautioned that this is a slow process and not to rush.
Allowing the cats to interact in an aggressive manner sets the program back and makes
resolution more difficult. Keep cats separated except for introductions and always supervised
when they are together. It also may be helpful to switch litter pans between the cats to aid in
familiarization. Another technique that may help is to rub the cats with towels and switch from
one cat to the other to mix their scents. Crates or some other see through barrier can also be
used for introductions to allow the cats to see one another, but not get too close.

Drug therapy
For some cases, the addition of psychotropic medication and pheromones can be helpful in
resolving the urine spraying and the aggression. The drugs that are presently being used are
not approved for use in cats and therefore are extra label drug usage. Prior to use, all animals
should have physical examinations, laboratory screenings for liver and kidney function and in
some cases, electrocardiograms. Signed consent and release forms are advisable. Owners
should be informed of potential side effects and plan to be home to monitor their pet for the first
1-2 days of treatment. Several classes of drugs have been used to treat aggression in cats.
Medications for urine spraying are detailed in another proceedings paper for this conference
20

Fluoxetine and Paroxetine are selective serotonin re-uptake inhibitors used to treat aggression
in cats. Selective serotonin reuptake inhibitors may take several weeks to become effective.
Common side effects include constipation, urinary retention, anorexia, gastrointestinal signs,
tremors, irritability and lethargy. Starting at a low dose for 1-2 weeks and gradually increasing
the dose can minimize side effects. Toxicity due to serotonin syndrome is possible when more
than one antidepressant is used and this should be avoided.
o Fluoxetine 0.5-1.0 mg/kg every 24 hours;
o Paroxetine 0.25-.5 mg/kg every 24 hours
9
.

Clomipramine and Amitriptyline HCL are tricyclic antidepressants used in the treatment of
aggression in cats. Clomipramine is a serotonin re-uptake inhibitor while amitriptyline and also
inhibits both the reuptake of norepinephrine and serotonin. Most tricylic antidepressants have
some anti-histamine actions and can interfere with thyroid medications. Clomipramine and
amitriptyline must be given daily to be effective and can take 2-4 weeks to facilitate a change in
behavior. Common side effects include tachycardia, urinary retention, and sedation, G.I.T.
upset, mydriasis and a dry mouth. Amitriptyline is very bitter and therefore administration may
be extremely difficult. Because of potential increases in heart rate, exercise caution in patients
with cardiac disease and an EKG prior to use may be prudent.
o Clomipramine 0.25-0.5 mg/kg, PO every 24 hours
10
.
o Amitriptyline 0.5-1.0 mg/kg PO q 12-24 hours
9
.

Medication is generally used for 6-12 weeks and if the behaviors have changed the animal is
weaned off the medication by decreasing the dose 25% every 2-4 weeks while watching for a
return of any aggressive indicators such as growling, hissing or chasing. If aggressive
behaviors return, the pet is maintained at the same dose for several weeks to see if the animal
stabilizes before attempting to decrease the dose again.

CONCLUSION
In all house soiling cases consider the interactions between the cats. Questions targeting the
use of space, which cats spend time together sleeping and grooming and placement of
resources throughout the home will help determine if these areas also must be targeted in the
treatment plan. Without treating the social problems, house soiling is likely to continue and be
unresolved.

References
1. Denenberg, S., Landsberg, G.M., Horwitz, D., Seksel, K., A comparison of cases
referred to behaviorists in three different countries. Proceedings 5th IVBM 2005 pp 56-
62.
2. Crowell-Davis SL, Curtis TM, Knowles RJ Social organization in the cat: a modern
understanding. J ournal of Feline Medicine and Surgery 2004; 6:19-28.
3. Bradshaw J WS, Hall SL. Affiliative behavior of related and unrelated pairs of cats in
catteries: a preliminary report. Applied Animal Behavior Science 1999; 63: 251-255
4. Bernstein P, Strack M Home Ranges, favored spots, time sharing patterns, and tail
usage by 14 cats in the home. Animal Behavior Consultants Newsletter, J uly 1993; 10:
1-3.
5. Knowles RJ , Curtis TM, Crowell-Davis SL Correlation of dominance as determined by
agonistic interactions with feeding order in cats. AJ VR 2004; 65: 1548-1556.
6. Barry, K. Intercat aggression in the household AVMA Convention Notes, 1999.
Veterinary Software Publishing
21
7. Pryor PA, Hart BL, Bain MJ , Cliff KD, Causes of urine marking in cats and the effects of
environmental management on frequency of marking J AVMA, 2001; 219:12: 1709-
1713.
8. Horwitz, DF. Housesoiling by cats In: BSAVA Manual of Canine and Feline behavioral
medicine. Eds. Horwitz, Mills and Heath. BSAVA, Gloucester UK, 2002, pp 97-108.
9. Mills, DS. Simpson BS(2002) Psychotropic agents In: BSAVA Manual of Canine and
Feline Behavioral Medicine Eds. Horwitz, Mills and Heath. BSAVA, UK. pp. 237-248
10. King J N, SteffanJ , Heath SE, Simpson BS et al (2004) Determination of clomipramine
for the treatment of urine spraying in cats J AVMA 225:6 881-887


22
FELINE AGGRESSION TOWARD PEOPLE

Debra F. Horwitz DVM, DACVB
Veterinary Behavior Consultations
St. Louis, Missouri 63141 USA


Overview of Feline Aggression
Naturally any medical or environmental issues can influence aggressive responses. Therefore
a good medical examination and behavioral history are essential for diagnosis and treatment.
Historical questions should include when and where the aggressive episodes occur, who the
victims are, what is the body posture and facial expression of the cat before, during and after
the incident. Victim responses can influence the pattern of aggression and should be explored.
Determination of the frequency of aggressive episodes will help determine both prognosis and
treatment response. Finally, an attempt should be made to assess the intensity of the
aggressive response, hissing, swatting, growling, chasing, wrestling, biting and scratching.

Understanding feline body language will help with diagnosis. Cats use body postures to attempt
to avoid outright aggression if possible. Threatening body postures include hissing, piloerection,
arching of the back and side presentation. Ear posture can be helpful as well; ears turned to the
side and back usually indicate defensive aggression while ears turned back and up at the ends
are often offensively aggressive.

Cats that are restricted in movement may chose to fight when unable to flee resulting in
defensive and possible fear motivations. Ability to get away and under something or up high
can influence the expression of the aggressive response.

Misdirected Play related Aggression
Signalment and History taking
This is an extremely common behavior problem in young cats and kittens often beginning at
about 12 weeks of age. Predatory play is an integral part of feline play behavior and early
learning
1
and probably contributes to this problem. Rough play and encouragement by people
contributes to a lack of inhibition and contributes to this problem. The signs include attacking
moving owner body parts, surprise attacks and perhaps biting hands when petted often without
aggressive signalling such as growling and piloerection. The problem most commonly occurs in
households with singleton cats less than 2 years of age, or cats housed with other animals that
will not play. It can also occur in cats that are left alone for long periods of time during the day.
2


Diagnosis
Movement by the people in the home seems to elicit the behavior, going up and down stairs,
moving under bed covers, making the bed or stepping out of the closet
3
. Descriptions of the
body posture of the cat during episodes will help confirm the diagnosis. The contexts for the
behavior and body posture of the cat can help establish a diagnosis.

Treatment
Treatment protocols focus on channelling the normal playful energy of the kitten or cat toward
appropriate play and discouraging inappropriate play. Behavior modification alone will resolve
this problem; medication is neither needed nor appropriate. The cats need for aerobic exercise
and mental stimulation must be met. The proper use of toys; hanging toys, cat fishing rods,
small wads of paper, feeder toys, boxes, and bags can all serve as stimulation for a cat. Cats
and kittens may quickly habituate to the characteristics of a toy during play and the intensity of
23
the play may diminish, switching to another toy after a short delay will result in a resumption of
uninhibited play
3
. Owners should strive to offer multiple play sessions daily. Often picking up
toys and rotating them every few days will keep a cat interested and increase playful activity.
Owners should be discouraged from using their hands to play and wrestle with the kitten/cat.

Interruption of attacks directed toward humans in the home is best accomplished through the
use of noise distracters that will startle the cat such as; a noisemaker, a can of compressed air,
a shaker can or an air horn. Once the cat stops the inappropriate behavior it is redirected to an
appropriate outlet such as a toy.

Awareness of where and when these attacks occur and anticipating them is useful. A journal
may help identify locations and times when attacks are likely. Owners can change the
environment to prevent the attacks, or distract the cat before the attack takes place. A bell on a
breakaway collar may help owners know the location of the cat and use the other techniques
mentioned.

Harsh physical discipline is always contraindicated. Not only can it make the problem worse,
but it can also create a cat that becomes anxious and fearful of people, an extremely
undesirable side effect. It is important to redirect the behavior, not punish it.

Frustration related aggression
Signalment and history
This type of aggression is not often documented in the literature
4,5
with very little agreement on
diagnostic criteria. It seems to involve elements of control of the social situation with the
humans and tend to occur most frequently toward familiar people and especially when the cat is
denied something it wants or expects. This may be evident in hand reared cats or those that
are very demanding and typically occurs over feeding, interaction or access to the outdoors.
Diagnosis may be difficult since other forms of aggression may also be present
5
.
Treatment
Treatment is aimed at controlling the environment and making the cat more responsive to the
owner by earning all things. Cats can learn basic commands such as come using food
rewards. Commands and rewards are then used to remove the cat from certain situations. The
owner must learn to identify signs of impending aggression and interrupt the behavior by leaving
the situation. An aggressive cat may have its head down, its tail away from the body, possibly
twitching quickly back and forth, ears with their openings pointing to the side. An inhibited cat
may crouch and perhaps roll over with ears back. A frightened cat will crouch, may hiss and will
flatten its ears to its head. An extremely fearful cat may arch its back, piloerect its hair, hold its
tail straight up, flatten its ears and may become aggressive if cornered. In addition, direct
confrontation must be avoided or else aggression may escalate.

Petting related aggression
Signalment and history
Some cats may respond aggressively when petted. The cat will allow petting for a certain
period of time and then turn and bite the owner and leave. The cat may even solicit attention
but end it by biting, grabbing and running away. Usually these are inhibited bites without
serious injury. Some authors speculate that the problem is with the individual cats threshold for
attention, internal conflict between adult feline responses and juvenile responses and perhaps
even hyperesthesia may play a role in the response
6
.

24
Treatment
To begin therapy, the owner needs to find the threshold that elicits the aggression and stay
below it. Tail flicking and flattening of the ears and perhaps dilation of the pupils usually
precede aggression and indicate a desire to end physical contact. The owner can gently stand
up and allow the cat to slip off their lap ending the interaction. This may allow some cats to learn
to remain calm if they wish to remain on the owners laps. Interactions should focus on types of
interactions the cat likes best: light petting on the head but not on the body, sitting on the lap
without physical contact. Cats can be conditioned to accept longer periods of contact using food
rewards for good behavior. The owner pets the cat a few times staying below the irritation
threshold and rewards the cat with food for good behavior. Each session tries to add in a slightly
increased amount of contact and reward good behavior.

Redirected Aggression
Signalment and history
Redirected aggression arises from the cat being in an aggressive or agitating circumstance, but
unable to vent that aggression on the causative agent
6
. If the redirected aggression is directed
toward people, usually the problem arises because the people interact with the cat when it is
agitated perhaps by some other stimuli. Stimuli that can potentially cause redirected aggressive
behavior include the sight, sound or odour of another cat or other animal, unusual noises,
unfamiliar people, unfamiliar environments and pain
5
. Often avoidance of the aggression-
producing situation may be possible.
Treatment
If avoidance of the eliciting stimulus is not an option, but the situation comes up infrequently, the
owner can be instructed to stay away from the cat and not pick it up until it is calm. To calm an
agitated cat put the cat in a darkened room with food; water and litter box and leave it there.
Some cats may be so agitated, picking them up may be dangerous and injury to owners is
possible. For those situations, herding the cat using a broom, lifting the cat with heavy gloves
on or throwing a blanket over the cat so it can be lifted is safest. The cat may need to be kept in
the dark for several days until it is calm. The owner can go in, turn on the light only to feed the
cat and then leave. Once the cat begins to approach the owner calmly and with relaxed body
postures the cat may be ready to be let out. Long periods of time may be necessary for some
cats to calm down and premature interaction may cause the cat to become aggressively
aroused again. Counter conditioning and desensitization to the situations that aggravate the cat
is the long term approach.

Fearful or defensive aggression
Signalment and history taking
Fear related or defensive aggression can occur both to family members in the home or to new
people in the home. The cat assumes a fearful or defensive posture (crouched, ears flat, pupils
dilated, piloerection and hissing, spitting or growling) and may bite if touched
2
. Cats without
proper socialization may be at a greater risk of developing fear related aggression toward
people. In situations where flight is denied and aggression rewarded by cessation of the
unwanted approach the behavior can become intensified and quite strong. Early traumatic
experiences, inappropriate punishment or reinforcement of the aggressive behavior can all
contribute to the expression of the aggressive behavior. History taking should include who,
what, when, victim, responses of victim and owner, frequency and consequences of the
behavior.

Diagnosis
The diagnosis is based on body postures and facial expressions denoting a fearful motivation.
The type of stimuli should also be included in the diagnosis.
25

Treatment
This type of aggression is best treated with a counter conditioning and desensitization program.
To begin the program, the cat must first be taught to associate good things with calm and quiet
behavior. The next step is to set up situations where the cat is calm and slowly work at getting
closer to the cat using tasty food rewards to facilitate change. Distance from the cat is an
important factor in the behavior modification plan and the person may need to be quite a
distance away for the cat to remain calm. If the cat continues to eat in the presence of the
person, then the person should try moving slightly closer. The situation must progress slowly
until the cat will accept the person petting it while it eats. It is very important to move slowly and
allow the cat to be calm and non-anxious or fearful during sessions. The person needs to avoid
the cat at other times if that can be arranged. The goal of treatment is for the cat to experience
proximity to the person without experiencing the fear. Play therapy may also be helpful in these
cases.

If the fear is toward visitors who come to the household, counter conditioning and
desensitization can also be implemented. The cat should be on a harness and leash for safety
or in a crate or carrier. Start with people that the cat knows, and reward the cat for being
around them using tasty food treats. As in the previous examples, the distance to the people is
an important factor and should be manipulated so that the cat is not anxious or fearful. Once
the cat has mastered the technique with people it knows, you can progress to less familiar
people. Counter conditioning and desensitization is a very slow process, and care must be
taken to proceed slowly and only reward calm, non-anxious behavior. If the owner is unwilling
or unable to carry out a desensitization program, for everyone's safety, the cat should be
confined when visitors are in the home.

For some cases, the addition of psychotropic medication and pheromones can be helpful in
resolving the aggression. The drugs that are presently being used are not approved for use in
cats and therefore are extra label drug usage. Prior to use, all animals should have physical
examinations, laboratory screenings for liver and kidney function and in some cases,
electrocardiograms. Signed consent and release forms are advisable. Owners should be
informed of potential side effects and plan to be home to monitor their pet for the first 1-2 days
of treatment. Several classes of drugs have been used to treat aggression in cats.

Fluoxetine and Paroxetine are selective serotonin re-uptake inhibitors used to treat aggression
in cats. Selective serotonin reuptake inhibitors may take several weeks to become effective.
Common side effects include constipation, urinary retention, anorexia, gastrointestinal signs,
tremors, irritability and lethargy. Starting at a low dose for 1-2 weeks and gradually increasing
the dose can minimize side effects. Toxicity due to serotonin syndrome is possible when more
than one antidepressant is used and this should be avoided.
o Fluoxetine 0.5-1.0 mg/kg every 24 hours;
o Paroxetine 0.25-.5 mg/kg every 24 hours
7
.

Clomipramine and Amitriptyline HCL are tricyclic antidepressants used in the treatment of
aggression in cats. Clomipramine is a serotonin re-uptake inhibitor while amitriptyline and also
inhibits both the reuptake of norepinephrine and serotonin. Most tricylic antidepressants have
some anti-histamine actions and can interfere with thyroid medications. Clomipramine and
amitriptyline must be given daily to be effective and can take 2-4 weeks to facilitate a change in
behavior. Common side effects include tachycardia, urinary retention, and sedation, G.I.T.
upset, mydriasis and a dry mouth. Amitriptyline is very bitter and therefore administration may
26
be extremely difficult. Because of potential increases in heart rate, exercise caution in patients
with cardiac disease and an EKG prior to use may be prudent.
o Clomipramine 0.25-0.5 mg/kg, PO every 24 hours
8
.
o Amitriptyline 0.5-1.0 mg/kg PO q 12-24 hours
7
.

Medication is generally used for 6-12 weeks and if the behaviors have changed the animal is
weaned off the medication by decreasing the dose 25% every 2-4 weeks while watching for a
return of any aggressive indicators such as growling, hissing or chasing. If aggressive
behaviors return, the pet is maintained at the same dose for several weeks to see if the animal
stabilizes before attempting to decrease the dose again.


1
Bateson, P, Martin, P. (1988) Behavioral development in the cat In: The Domestic Cat: The
Biology of its behavior. Eds. D. Turner, P. Bateson. Cambridge University Press, pp.9-22.
2
Borchelt, PL, Voith, VL. (1982) Diagnosis and Treatment of Aggression Problems in Cats
Veterinary Clinics of North America: Small Animal Practice, 12:4, pp. 665-671.
3
Hall S.L., Bradshaw J .W.S., Robinson I.H. (2002)Object play in adult domestic cats: the role of
habituation and disinhibition. Applied Animal Behavior Science. 79: 263-271.
4
Heath, S (2009) Feline Aggression In: BSAVA Manual of Canine and Feline Behavioral
Medicine Eds. Horwitz, Mills and Heath. BSAVA, UK. , pp.228.
5
Landsberg, G, Hunthausen, W, Ackerman, L (2003) Feline Aggression In: Handbook of
Behavior Problems of the dog and cat 2
nd
edition, Saunders, Philadelphia, pp. 427-453.
6
Beaver, B (1994). The Veterinarians Encyclopedia of Animal Behavior ,Iowa State University
Press, Ames, Iowa, pp.224
7
Mills, DS. Simpson BS(2002) Psychotropic agents In: BSAVA Manual of Canine and Feline
Behavioral Medicine Eds. Horwitz, Mills and Heath. BSAVA, UK. pp. 237-248
8
King J N, SteffanJ , Heath SE, Simpson BS et al (2004) Determination of clomipramine for the
treatment of urine spraying in cats J AVMA 225:6 881-887
27

28
AN UPDATE ON MEDICATIONS USED IN BEHAVIORAL MEDICINE

Debra F. Horwitz DVM, DACVB
Veterinary Behavior Consultations
St. Louis, Missouri 63141 USA

Introduction
The use of psychopharmacology in behavioral medicine is an evolving discipline. At the present
time, in the United States only three medications are approved for the treatment of behavioral
disorders (Reconcile, Clomicalmand Anipryl). While medication can be useful in the
treatment of phobic, panic and anxiety disorders, the level of strong evidence for certain
interventions may be lacking. When considering the use of medication in a specific case it is
essential to determine your diagnosis, which cases and patients are good candidates for drug
therapy and what medication to utilize, the dosage and length of therapy. Finally, medication
alone is rarely if ever appropriate as a sole treatment modality because it will not change the
relationship to the stimulus or learned responses therefore concurrent behavior therapy is
always recommended.

Diagnosis
Many texts are available that detail how to take a history and diagnose behavior problems in
companion animals (see reading list at the end of the paper). Without a proper diagnosis using
medication at best may not be helpful and in the worst case harmful. The conditions that benefit
from the addition of medication include anxieties (separation anxiety
1,2
, global anxiety), fears,
phobia (noise and storm phobia
3
), urine marking in cats
4,5
, and selected cases of aggression in
dogs and cats (extremely impulsive, explosive aggression).

Determining if medication is appropriate
Once a diagnosis has been established, which cases and patients make good candidates for
medication? It is essential to initially rule out any medical causes of the unwanted behavior by a
good physical examination, laboratory testing (for baseline values prior to medication) and
perhaps imaging studies. Make sure your diagnosis is established, and a behavior modification
plan is in place and being implemented by the owner. Ascertain if there are any
contraindications for drug usage including; poor safety measures in place, high risk of injury to
humans or other animals, the home shows poor compliance for following recommendations.
Medication is indicated when the animals welfare is compromised which may occur in severe
fears, anxieties and phobias and when the addition of medication will enhance the behavioral
modification process. It is also appropriate to inform clients when medication is being used in
an off label or non approved manner.

Medication for acute situations
Certain medications work relatively quickly and are well suited in situations where immediate
effect is needed. These medications can be used concurrently to provide immediate short term
relief with a chronic medication that may take longer to reach efficacy. Alternately these
medications may only be used in acute situations that are intermittent, situational and
predictable. Some situations that fit this description include car or airline travel anxiety, specific
episodic noise events for noise phobic pets, separation anxiety when the dog must be alone and
chronic medication is not active or not strong enough.

Benzodiazepines
These are the most commonly utilized class of drug in this category. They work by enhancing
GABA, an inhibitory neurotransmitter. An additional benefit is that not only do they diminish
29
anxiety, but are safe with animals that have seizure disorders. Benzodiazepines have a short
duration of action of 4-6 hours and must be administered 30-60 minutes prior to the trigger
event. Approximately 10% of animals show excitement rather than a diminished anxiety when
given a benzodiazepine, switching to another medication within the same class may help.
Caution is advised when using this class of drug in animals showing fear based aggression
because disinhibition of the aggression is possible. Over time tolerance may develop and
higher dosages needed for the same effect. Generally this class of drug is given orally but other
preparations exist. Benzodiazepines are a controlled class of medication that also has the
potential for human abuse.

Trazadone
This is an atypical antidepressant that has recently been utilized as an event drug for additional
control for anxious animals that are also on other serotonin enhancing medications. It is usually
administered one hour before the onset of the event
6
. Limited information is available on
potential side effects and long term usage.

Phenothiazines
This class of drug has often been utilized for anxiety situations but is not a particularly good
choice. Although they incapacitate the animal, they do not affect underlying anxiety and thus
are not really a useful adjunct for diminishing the underlying emotion that may be causing the
behavioral problem.

Medication for chronic use
Daily medication is indicated in clinical cases where anxiety is underlying the primary diagnosis.
The group of drugs most commonly utilized are serotonin enhancing drugs including fluoxetine,
paroxetine and sertraline (Selective Serotonin reuptake inhibitors), clomipramine, and
amitriptyline (Tricyclic antidepressants). This class of medication works by enhancing serotonin
levels within the brain. Serotonin is a neurotransmitter that has multiple functions and receptor
sites in the body. Little real information is available in animals, but in humans, low serotonin
levels are associated with irritability, hostility, depression and impulsivity. Enhancing serotonin in
humans has been associated with a diminishing of depression, alleviating anxiety and changing
temperament. Unfortunately the behavioral effect of this class of drug is not immediate; it may
take 7-31 days before a behavioral effect is noted. It is important to stress to clients that these
are not event medications and they must be given daily for an effect to occur.

Separation anxiety
1,2
and extreme or self injurious storm and noise phobias
3
respond well to
serotonin enhancing medications. Underlying anxiety may be present in animals showing
aggression
7
, compulsive disorders
8,9
and urine marking and serotonin enhancing drugs may be
useful in these conditions.

Another syndrome, cognitive dysfunction may present with chronic behavioral changes and may
benefit from the use of a MAOI selegiline.

The preferred method of administration of serotonin enhancing drugs is orally. Although the use
of transdermal medication has been advocated, current studies have shown only limited
absorption
10
and therefore the usefulness of this modality for psychotropic medication appears
limited at this time. Although often used transdermally especially in feline patients, information
on actual dosing levels needed is unknown at the present time.

Side effects
30
Side effects are possible with any medication and the client should be advised to watch the
patient carefully for the first few days of medication administration. In elderly or compromised
individuals beginning medication at one third to on half the recommended dosage or at an every
other day dosing may be prudent. If no side effects are noted after a few weeks and if no
therapeutic effect is seen, the dosage can slowly be increased to recommended levels.
Tricyclic antidepressants (TCA) may have anticholinergic, antihistaminic and adrenergic side
effects including dry mouth, urinary retention or GIT upset. Cardiac problems are possible but
not reported in companion animals but care should be exercised in compromised individuals.
This class of drug is contraindicated in animals with seizures.
Selective serotonin reuptake inhibitors have a lower side effect profile and rare anticholinergic or
adrenergic side effects but may cause appetite suppression and have a long half life of
metabolic clearance. SSRI medications may also inhibit cytochrome P450 enzyme pathways
and decrease the clearance of other medications utilizing the same pathway. SSRIs are also
contraindicated in animals with seizure disorders.

Goal of therapy
The goal of drug therapy is to use medication for a limited time (3-6 months) to enhance the
application and administration of a behavioral modification plan. The hope is that the animal will
learn appropriate new responses and behavior in the previously problematic situations. Once
new behaviors are learnt and stable, weaning off medication is advised. Weaning is usually
accomplished by diminishing the dosage by 25-50% weekly of semi-weekly and watch for a
return of the problematic responses. If the signs return, remaining at the lower dose for several
weeks may allow stabilization of the behavior and weaning can commence again. Some
patients however may never be able to come off medication either because of the lack of owner
compliance with behavior modification plans, genetic predisposition to anxiety or continued
exposure to the causative stimuli that is unavoidable. Those patients should be evaluated on a
regular basis (1-2 times yearly) for both response to medication and a recheck of laboratory
values to assess liver and kidney function.

Serotonin syndrome
This is a potentially fatal side effect that may occur with high doses of serotonin enhancing
medications or combinations of serotonin enhancing medications such as MAO inhibitors
(amitraz, selegiline), other SSRIs, TCAs, tramadol, tryptophan, buspirone, St. J ohns Wart,
amphetamines, dextromethorphan and bromocriptine. Therefore, combinations of serotonin
enhancing drugs must be avoided.

Final word of caution
With the exception of the medications mentioned in the first paragraph, most psychotropic
medications are not approved for use in dogs and cats. Dosage recommendations are primarily
based on anecdotal reports and are not based on placebo controlled studies. Caution should be
exercised when dosing animals and supervision and re-evaluation are important components to
psychotropic drug usage.



Drug Class Canine Feline Freq route
Diazepam Benzo 0.55-2.2 mg/kg 0.2-0.5 mg/kg q 6-24 H PO
Alprazolam Benzo 0.01-0.1 mg/kg 0.05 mg/kg q 8-12 H PO
31

Acut
e
medications dogs and cats

Chronic medications and dosages in dogs

Drug Class Canine Freq Route
Clomipramine TCA 1.0-2.0 mg/kg Q 12 H PO
Fluoxetine SSRI 0.5-2.0 mg/kg Q 24 H PO
Buspirone Azapirones 0.5-1.0 mg/kg Q 8-12 H PO
Sertraline SSRI 1-3 mg/kg Q 24 H PO
Selegiline MAOI 0.5-1.0 mg/kg Q 24 H PO

Chronic Medications and dosages for cats

Reading list
Horwitz DF, Mills D. (2009) BSAVA Manual of Canine and Feline Behavioral Medicine second
edition. British Small Animal Veterinary Association, Gloucester, UK.

Horwitz DF, Neilson J , (2007) Blackwells 5 Minute Veterinary Consult Clinical Companion:
Canine and Feline Behavior, Blackwell Publishing, Ames IA

Landsberg G, Hunthausen W, Ackerman L (2003). Handbook of Behavior Problems of the Dog
and Cat, 2
nd
edition, Saunders, Edinburgh, UK

References

1
King J N, Simpson, BS, Overall KL et al Treatment of separation anxiety in dogs with
clomipramine: results from a prospective, randomised, double-blind, placebo-controlled,
parallel-group multicenter clinical trial. Applied Animal Behavior Science. 2000 67: 255-275
2
Simpson BS, Landsberg GM, Reisner IR et al Effects of Reconcile (Fluoxetine) Chewable
Tablets Plus Behavior Management for Canine Separation Anxiety, Veterinary Therapeutics,
2007 8: 18-31
3
Crowell-Davis SL, Seibert LM, Sung W, et al. Use of Clomipramine, Alprazolam, and Behavior
Modification for Treatment of Storm Phobia in Dogs J AVMA (2003) 222[6]:744-748
4
Pryor PA, Hart BL, Cliff KD et al (2001) Fluoxetine hydrochloride for urine marking in cats: a
double blind, placebo-controlled clinical trial. JAVMA 219: 1557-1561
5
Hart BL, Cliff KD, Tynes VV, Bergman L (2005)Control of urine marking by the use of long-
term treatment with fluoxetine or clomipramine in cats JAVMA 226: 378-382
Lorazepam Benzo 0.1-0.2 mg/kg 0.02 mg/kg q 12-24 H PO
Trazadone SARI 2-5 mg/kg Not used in cats q 8-12 H PO
Drug Class Dose Range Frequency Route
Fluoxetine

SSRI 0.5-1.0 mg/kg Q24H PO
Paroxetine SSRI 0.25-0.5 mg/kg Q24H PO
Clomipramine
9
TCA 0.25-0.5 mg/kg Q24H PO
Amitriptyline TCA 0.5-1.0 mg/kg Q12-24H PO
Buspirone Azapirone 0.5-1.0 mg/kg Q 12-24 H PO
Selegiline MAOI 0.5-1.0 mg/kg Q 24 H PO
32

6
Gruen ME, Sherman BL. 2008 Use of trazodone as an adjunctive agent in the treatment of
canine anxiety disorders: 56 cases (1995-2007) JAVMA 233 (12) 1902-1907
7
Dodman NH, et al (1996) Use of fluoxetine to treat dominance aggression in dogs J AVMA
209:1585-1587
8
Hewson CJ , Luescher A, Parent J M, Conlon PD, Ball RO. (1998)Efficacy of clomipramine in
the treatment of canine compulsive disorder. JAVMA 213 (12) 1760-1766.
9
Seksel K, Lideman MJ (1998) Use of clomipramine in the treatment of anxiety-related and
obsessive compulsive disorders in cats.. Aust. Vet. J. Vol. 76, No. 5, pp. 317-321
10
Ciribassi J , Luescher A, Pasloske KS et al. (2003) Comparative Bioavailability of fluoxetine
after transdermal and oral administration to healthy cats AJ VR 64:8 994-998.

33