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==Investigation==
 
==Investigation==
In true [[Alopecia and Hypotrichosis|alopecia]], hairs are easily epilated in the areas that are becoming bald, but the hairs remain normal to touch. When the hairs are being removed by deliberate grooming, barbering or hair-pulling then the hairs will feel '''spiky''' and '''sharp''' because the tips have been taken off. Microscopic examination of a hair pluck will confirm the state of the hair tips. '''Hair loss is restricted to parts of the body that may be reached whilst grooming with the tongue'''. These signs are an immediate indication that the cat is not suffering from a true alopecia. Parasitism and allergic skin disease are major differentials for overgrooming. Localised or referred pain, or deep pruritic conditions such as [[Feline Scabies|Notoedric mange]] may be a cause of overgrooming that progresses into self-harm.  
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Key aspects of investigation include:
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*Observation and characterisation of the behaviour
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*Identification of triggering situations and events
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*Investigation of underlying sources of stress (social environment, physical environment, health problems)
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*Examination of the skin
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*Microscopical analysis of hairs fats
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*Rule out of other potential causes and underlying actors (e.g. ectoparasites)
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Feline idiopathic cystitis (FIC) has recently been found to account for the vast majority of feline lower urinary tract disease. Cats with this condition, which has behavioural and medical components, will often barber and overgroom the perineal area to create a bald groin and abdomen. They may also bite and chew the skin in this area. Cats with overgrooming and hair loss that is chiefly restricted to this area should be investigated as potential cases of FIC. [[Feline Hyperaesthesia Syndrome|Feline hyperaesthesia]] can cause frantic bouts of self-biting and hair pulling, but this is accompanied by other signs that differentiate the condition from compulsive overgrooming or self-mutilation.
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n true [[Alopecia and Hypotrichosis|alopecia]], hairs are easily epilated in the areas of hair loss, but the hairs remain normal to touch. When the hairs are being removed by deliberate grooming, barbering or hair-pulling then the remaining hairs remain firmly attached but will feel '''spiky''' and '''sharp''' because the tips have been removed. Microscopic examination of a hair pluck will confirm the state of the hair tips. '''Hair loss is restricted to parts of the body that may be reached whilst grooming with the tongue'''. These signs are an immediate indication that the cat is not suffering from a true alopecia. Parasitism and allergic skin disease are major differentials for overgrooming. Localised or referred pain, or deep pruritic conditions such as [[Feline Scabies|Notoedric mange]] may also causes of overgrooming that progresses into self-harm.
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Feline idiopathic cystitis (FIC) has recently been found to account for a substantial proportion of feline lower urinary tract disease. Cats with this condition, which has behavioural and medical components, will often barber and overgroom the perineal area, leading a bald groin and abdomen. They may also bite and chew the skin in this area. Cats with overgrooming and hair loss that is chiefly restricted to this area should be investigated as potential cases of FIC. [[Feline Hyperaesthesia Syndrome|Feline hyperaesthesia]] can cause frantic bouts of self-biting and hair pulling, but this is accompanied by other signs that differentiate the condition from compulsive overgrooming or self-mutilation.
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Target areas for overgrooming include the flanks and abdomen, but it must be remembered that barbering of groin fur can be a sign of [[:Category:Urological Diseases - Cat|lower urinary tract disease]].
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Feline orofacial pain syndrome is a condition involving severe self-mutilation of the tongue and face which is especially prevalent in Burmese cats, although occasional cases have been seen in the domestic shorthair, Burmilla and Siamese. There may be a slight male predisposition and all ages can be affected. The precise aetiology of this condition is not understood, but it is thought to be a form of neuropathic pain.
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Feline orofacial pain syndrome is a condition involving gross self-mutilation which is especially prevalent in Burmese cats although occasional cases have been seen in the domestic shorthair, Burmilla and Siamese. There may be a slight male predisposition and all ages can be affected.  
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The most common sites for stress-related over grooming are the flanks and belly, but cats will also lick legs and feet.  
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====Clinical Signs====
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'''Stress-related causes for hair loss and self-injury should only be considered once all medical causes have been eliminated'''. However, stress is known to alter immune function, either exacerbating auto-immune disease or allergy, or causing immune suppression. The precise effect appears to depend upon the type of stress the individual experiences. Living in a stressful social or physical environment will therefore contribute to the worsening of many of the medical conditions that are differentials for compulsive overgrooming. Success in the treatment of these conditions may improve if the cat’s living conditions are improved.
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====Feline Orofacial Pain Syndrome===
 
The clinical signs are characterised by '''exaggerated licking and chewing movements, with pawing at the mouth'''. Typically the discomfort is '''unilateral''' or worse on one side and can be episodic or continuous. In the episodic version the distress usually occurs after eating and lasts between 5 minutes and 2 hours. There is a short prodromal period of anxiety preceding the episode. The cat will claw at its face, attempting to claw at, catch and pull at its own tongue. The aetiology of this condition is being investigated but several separate causes have been identified. Some cases appear to be associated with oral disease, which can be divided into 4 groups  
 
The clinical signs are characterised by '''exaggerated licking and chewing movements, with pawing at the mouth'''. Typically the discomfort is '''unilateral''' or worse on one side and can be episodic or continuous. In the episodic version the distress usually occurs after eating and lasts between 5 minutes and 2 hours. There is a short prodromal period of anxiety preceding the episode. The cat will claw at its face, attempting to claw at, catch and pull at its own tongue. The aetiology of this condition is being investigated but several separate causes have been identified. Some cases appear to be associated with oral disease, which can be divided into 4 groups  
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Treatment of, or natural resolution of the lesions can result in improvement, however many cases have recurrences which prove more difficult to successfully treat.  
 
Treatment of, or natural resolution of the lesions can result in improvement, however many cases have recurrences which prove more difficult to successfully treat.  
 
Removal of retained dental roots left after feline erosive neck lesions have caused teeth to break off, or when teeth have been inexpertly extracted, has benefited some cats. Cats with this pattern of self-mutilation can cause themselves great harm and demand the most thorough medical investigation.
 
Removal of retained dental roots left after feline erosive neck lesions have caused teeth to break off, or when teeth have been inexpertly extracted, has benefited some cats. Cats with this pattern of self-mutilation can cause themselves great harm and demand the most thorough medical investigation.
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====Psychogenic Causes====
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'''Psychogenic causes for hair loss and self-injury should only be considered once all medical causes have been eliminated'''. However, stress is known to alter immune function, either exacerbating auto-immune disease or allergy, or causing immune suppression. The precise effect appears to depend upon the type of stress the individual experiences. Living in a stressful social or physical environment will therefore contribute to the worsening of many of the medical conditions that are differentials for compulsive overgrooming. Success in the treatment of these conditions may improve if the cat’s living conditions are improved.
      
==Treatment==
 
==Treatment==
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