Cat - Compulsive Disorders

My cat keeps doing the same behaviour again and again, why is this?

There are many reasons, why an animal may do the same thing again and again. It may be a response to something specific which triggers the behaviour. For example, the occasional flea bite might cause your cat to scratch itself repeatedly, it might be a sign of a neurological problem (such as a partial seizure) or it might be a largely psychological problem such as a compulsive behaviour. Many compulsive behaviours arise spontaneously as a response to conflict or anxiety, but behaviours may also become compulsive or fixed because they have been inadvertently trained by the owner through unintentional delivery of a positive outcome.

Distinguishing these different causes can be difficult and given the possible involvement of health related problems, it is essential to start with a thorough health check of your cat. Further tests may also be necessary before you assume it is a behavioural problem. The diagnosis and management of these cases can be very challenging and you may need to be patient as your veterinary surgeon works through the case, but you should also not be afraid to ask for specialist assistance if necessary.

What is a compulsive disorder?

When an animal repeatedly tries to do something, we might say that it has a compulsion to do the behaviour. Compulsive behaviours are often derived from normal behaviour patterns but appear to be abnormal because they are excessive, exceedingly intense, or performed out of context. In cats the most common compulsive behaviours relate to grooming.

Sometimes the drive for a specific behaviour lasts a long time, because the triggers remain in place. For example, a cat might develop a compulsion for chewing its foot, because it has an ongoing medical condition which results in the foot being sore. In other situations, the behaviour becomes more like a habit that the animal cannot stop. For example, the cat may continue to chew its foot even when the medical condition is resolved and it is no longer causing any discomfort.

Chronic stress and conflict may also give rise to repetitive behaviour problems. The behaviour, which is often completely unrelated to the conflict situation, may begin by being displayed at specific times of stress. However, as a result of sensitisation of the neural pathways controlling the behaviour, the behaviour may begin to be manifested during any state of stress or arousal. Eventually, the cat loses control over the initiation and termination of the behaviour. It may then be said to have become compulsive. The compulsive behaviour may eventually occur in situations when the cat is only minimally aroused.

Common feline compulsions include:

• Over-grooming or barbering of hair
• Self-directed aggression such as tail chasing or foot chewing
• Excessive sucking and chewing on objects or fabrics, such as wool
• Excessive vocalisation (in older cats this can be a sign of an age related decline and so expert veterinary help should be sought without delay)
• Hunting and pouncing at unseen prey
• Excessive running and chasing
• Paw shaking
• Freezing
• Feline hyperaesthesia – over sensitivity to touch
• Feline orofacial pain - pawing and striking at the mouth and tongue

Some of these behaviours are more common in certain breeds, and so there is almost certainly a genetic predisposition to them, but this does not mean they cannot be successfully managed with environmental intervention. Genetic factors might include a general predisposition to anxiety or to the specific behaviour. For example, wool sucking is observed more frequently in Oriental breeds.

How can compulsive disorders be treated?

Since some of these problems can be reflections of, or initiated by, underlying medical problems, a complete medical work-up and close monitoring of your cat by your vet is essential. Behaviours must be evaluated individually since not all require treatment. In fact, treatment may only be necessary if the behaviour poses health risks to the cat or seriously worries you for other reasons. Some people suggest that certain compulsive behaviours may be acceptable and non harmful methods of reducing stress. For example, wool sucking may cause no physical harm, but occupies and calms the cat. Therefore, it may be preferable to feed the cat’s compulsion with safe fibres than to use other interventions, but there still remains the question of why is your cat stressed in the first place. The need for further intervention will therefore depend partly on what can be done about these stressors.

• Reducing stress or finding methods of decreasing the sources of arousal and conflict are the first aspect of treatment that should be explored. Inconsistent interaction, or inconsistent use of reprimands may lead to problems in your relationship with your cat. If necessary seek expert help to ensure that you (and all members of the family) are behaving consistently and in a way your cat can understand.
• As already mentioned, it is important that your cat receives sufficient stimulation to encourage a full range of normal feline behaviours which can be carried out at a low level of arousal. Minimising human involvement in these activities is often beneficial. The use of indirect play by using fishing rod style toys to provide sufficient outlets for predatory and feeding behaviour should be considered. You might also consider training your cat to use a puzzle feeder rather than using a food bowl, or scatter its food around different locations in the home in order to increase the amount of the daily time that is taken up with searching for, finding and consuming food.
• Specific behavioural modification exercises, which involve initiating behaviours that are incompatible with the problem behaviour, are most appropriate if you can identify and predict those situations and times when compulsive behaviours are likely to arise.
• It is important to remove all attention or rewards, for the compulsive behaviour. You may have been inadvertently rewarding the problem, either by giving attention, (including reprimands) when your cat does the behaviour or by attempting to calm your cat down by holding it or cuddling it in a reassuring manner. Either of these forms of interaction can unwittingly reinforce the behaviour and it is important to be as neutral as possible when the inappropriate behaviour begins. When the behaviour is exhibited in your presence, attention can be withdrawn passively by walking away.
• Denying your cat access to the focus of its behavioural needs to be done with caution. For example, a bandage or an elizabethan collar may allow the lesions (sores) of overgrooming to heal, but once the collar is removed, the problem may recur. In many cases, restricting access will worsen the problem by increasing frustration, anxiety or arousal. Long term resolution or control can only be achieved if the underlying cause can be identified, and either removed or modified in significance through behavioural therapy.
• If your cat is scratching at itself with its claws, then these should be clipped and blunted to reduce the amount of damage done. However, this is only a temporary measure to limit the potential for injury and the aim must still be to identify and address the cause of the behaviour.
• Drug therapy may be useful for some cats with these problems just as it is in humans with obsessive-compulsive disorders. Drugs that help reduce impulsivity and improve mood may be effective and may be recommended by your veterinary surgeon. A short course of therapy may also be useful for cats that have recovered from their original bout of compulsive behaviour but are then going to be exposed to a potentially stressful or anxiety producing situations at a later date (new home, dramatic change in schedule, new baby, etc.). Medication in this situation can help to reduce the risk of recurrence.
• Other substances which can be used as part of a behaviour therapy programme (with or without the use of drugs) include the pheromone products. A synthetic version of a naturally occurring scent signal used by cats is available in the form of diffuser device (Feliway). This can be applied to the environment as a means of providing reassurance and a sense of security. There are also a growing number of food additives (nutraceuticals) which claim to reduce anxiety, but it is important to look for sound scientific evidence of efficacy for any products that you are thinking of using, and best to ask an independent specialist. It is also important to remember that drugs, pheromones or nutraceuticals must be seen as adjuncts to the primary focus when dealing with these cases, which is to identify and address the primary cause of the problem.

What is feline psychogenic alopecia?

Alopecia (hair loss) can result when cats over-groom and remove fur. Over-grooming can take the form of excessive licking or the pulling out of tufts of hair. The diagnosis of psychogenic alopecia as a compulsive disorder is reserved for those cases in which no underlying medical problem is evident. Many cats with alopecia have an underlying skin disorder such as fleas, flea bite hypersensitivity, inhalant allergies, food allergies, parasites, bacterial or mite infections or hormonal imbalance, while others are suffering from painful medical conditions such as lower urinary tract disease or osteoarthritis. If food allergies are suspected a 6-8 week food trial may often be recommended before considering behavioural options, while in potential pain related cases a trial period with appropriate medication for the underlying medical condition may be recommended.

Cats normally are fastidious groomers and as much as 30-50% of their time awake is spent performing some type of grooming behaviour. As with other compulsive disorders, feline psychogenic alopecia may begin as a result of conflict, anxiety or frustration, but might in time become compulsive. Some of the treatment measures outlined above can be used but specific behavioural approaches include:

• Increasing environmental stimulation (cat activity centres, food or catnip packed toys, kitty videos, toy medicated play). Toys should be changed around on a frequent basis. They should be rotated every 1-3 days to keep sensory stimulation at a significant level and to give the impression of a range of different play items being available.
• Attention should never be given to your cat when the undesired behaviour is exhibited. As soon as the undesirable behaviour ceases, you should immediately engage your cat in an alternative acceptable behaviour (such as indirect fishing rod style play).
• You should try to identify environmental or social changes that may be contributing to anxiety. While this may sound easy it can be extremely difficult in some cases to accurately identify these factors. You may require expert guidance. Do not be afraid to ask for expert assistance if necessary – your veterinary surgeon can arrange referral if they cannot assist you adequately from within the practice.
• Drug treatment may also be necessary in some cases, at least in the short term. The aim is to improve the mood of your cat and so reduce the behaviour. The exact drug chosen will depend on the clinical impression of the veterinary surgeon managing the case, and may require referral to a vet working in behavioural medicine.

What is feline hyperaesthesia?

Feline hyperaesthesia is a poorly understood condition that has also been referred to as rippling skin syndrome, rolling skin syndrome, or twitchy skin syndrome. It is probably not a true compulsive disorder, but rather a sensory problem. The normal response of many cats to having their back scratched can include rippling of the skin, an arched back and varying degrees of vocalisation. In hyperaesthesia, the affected cat may have a more exaggerated response to touching, rubbing or scratching of the back. This behaviour may then become more fixed as the frequency increases. The response becomes more intense and the signs begin to appear with little or no apparent stimulation. In addition to rolling skin, muscle spasms and vocalisation, the cat may have dilated pupils, and may seem to startle, hallucinate and dash away. Some cats will defecate as they run away. There may also be some grooming or biting at the flank, tail, or back, displayed along with the above behaviours. Some individuals will engage in mounting behaviour directed towards cushions, soft toys or pieces of the owner’s clothing.

Behavioural management requires the identification and control of the types of handling that lead to the behaviour.

• Avoiding or minimising these types of handling is important in the short term. Once the cat is less aroused it maybe possible to institute desensitising and counter-conditioning techniques, which enable the cat to learn to 'tolerate' these stimuli.
• Treatment with anti-anxiety drugs or anti-depressants, may also be necessary, at least in the short term.
• For some cats who appear to be experiencing seizure related behavioural responses, anti-epileptic therapy may be effective although these drugs may act by generally reducing the cat’s level of arousal.

What is feline orofacial pain syndrome (FOPS)?

In common with feline hyperaesthesia the condition of FOPS is not a true compulsive disorder but the resulting behaviour of pawing at the mouth and tongue is certainly repetitive in its presentation. The condition is characterised by resulting face and tongue mutilation and affected cats most commonly present with exaggerated licking and chewing movements, and pawing at the mouth. More severe cases have mutilation of tongue, lips and buccal mucosa (gums). FOPS was first reported in the early 1990’s and is predominantly (although not exclusively) presented in Burmese cats. It appears that a genetic predisposition to the condition can be triggered by a number of environmental and social stressors as well as by the presence of oral lesions. Orofacial pain disorders, such as trigeminal neuralgia and glossodynia, are well described in humans and FOPS shows some similarities to these.

Clinical signs can be episodic or continuous. In episodic FOPS distress is often triggered by mouth movement, such as eating or grooming. Episodes last between several minutes to several hours and are often preceded by a short period of behaviour suggesting anxiety. With continuous FOPS, affected cats appear to be in discomfort all the time and signs increase in intensity when excited, stressed or after mouth movement. These cases are at risk of severe oral cavity or face mutilation.

There is no definite diagnostic test for this disease and the diagnosis is made on the basis of the history and identification of contributory causes. Other potential medical causes must be ruled out and these include neurological and dental disease. Referral to specialists in these fields may be appropriate, so you should talk to your veterinary surgeon about the options that are available.

As environmental factors can influence this condition it is important to look for possible contributory factors such as social stress. Identification of social incompatibility in a multi-cat household is a key step, and referral to a specialist in behavioural medicine is worth considering.

Management to minimise the risks of physical injury is important so mittens and elizabethan collars may be considered. However, this is a condition associated with neuropathic pain and therefore treatment with appropriate analgesic medication is essential.

Environmental factors should also be addressed. It is essential that there is appropriate distribution of the five essential feline resources – food, water, resting places, latrines and points of entry and exit into the territory. The cat should also have the ability to hide and elevate (sit high up) in order to control stress and it would be beneficial to consider the use of pheromone therapy in the form of a Feliway diffuser in order to increase the cat’s sense of safety and security within the home.