Feline Grooming Disorders

Key Points

Over-grooming is common in cast, as a response to stress It can progress to self-mutilation in cases of chronic stress Grooming may become compulsive, beginning got interfere with normally motivated behaviour Treatment involves reducing underlying stress Psychoactive medication may be effective, particularly in long standings cases or those involving self-mutilation or compulsiveness Feline Orofacial Pain Syndrome is not a grooming disorder, but may be presented as such by owners

Introduction

During periods of stress, cats may exhibit changes in behaviour. Positive signs of stress include behaviours that are increased or seen for the first time during stress, and include aggression, and indoor marking. Negative signs of stress include behaviours that are reduced, or stop altogether, during periods of stress, such as play and exploratory behaviour. Grooming is a behaviour that can be either a positive or negative sign of stress, due to individual differences. In most cases, grooming increases during stress, anxiety or emotional conflict, and it is hypothesised that it is a form of self-appeasement behaviour. Stress can arise from the social or physical environment, and also from physical health problems. Grooming can become excessive if stress is chronic or repeated. Stress related grooming may have little effect on coat condition, as the cat will not systematically clean its entire body in the manner typical for purposeful grooming. Instead, some areas are targeted for additional grooming, resulting in focal areas of hair loss whilst the rest of the coat my be normal or even unkempt. It can become compulsive when the cat carries out the behaviour to the detriment of its own health and in the place of normal behaviour or in inappropriate contexts.

Investigation

Key aspects of investigation include:

• Observation and characterisation of the behaviour
• Identification of triggering situations and events (e.g. situations of stress, frustration or emotional conflict)
• Investigation of underlying sources of stress (social environment, physical environment, health problems)
• Examination of the skin
• Microscopical analysis of hair shafts
• Exclusion of other potential causes and underlying factors (e.g. ectoparasites)

In true 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 sarcoptic mange may also be causes of overgrooming that progresses into self-harm.

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 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.

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.

The most common sites for stress-related over grooming are the flanks and belly, but cats will also lick legs and feet.

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.

Overgrooming may be considered "compulsive" when it is excessive, ritualised, repetitive, non-functional, and interferes with the performance of normal behaviour. However, it also resembles the pattern of body-focussed repetitive behaviour seen in humans, which is now considered to arise from a problem of impulse control.

Feline Orofacial Pain Syndrome (FOPS)

Although not a problem of over grooming, FOPS may be presented by owners as a grooming problem. 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. Episodes of FOPS are often triggered by mouth movements during eating or grooming, indicating a problem of allodynia. As a result, cats will often become anorexic or stop grooming. Self-mutilation may be very severe, involving partial removal of the tongue. The aetiology and genetic basis of this condition are under investigation.

Two groups of FOPS cases are observed; those with continuous symptoms, and those with intermittent bouts of symptoms. FOPS can begin at any age, but in most cases is seen in older animals and there may have been a history of a brief episode of facial pawing earlier on in life, even if that did not lead to tongue damage. This implies that there is a lifelong sensitivity issue that is exacerbated by certain medical problems. Oral health plays a significant role, with FOPS being associated with dental disease (such as periodontal disease and dental resorptive lesions), dental eruption and mouth ulcers. It is also common for FOPS to become symptomatic after dental work, particularly removal of tartar or teeth, when either dental neck lesions are exposed or tooth roots are not completely removed. Treatment involves resolution of the underlying problem, such as ulcers or dental problems, combined with the use of analgesic drugs, including those typically used for treating epilepsy or neuropathic pain. In a recent study some cases with gingivitis appeared to respond to antibiotics, although spontaneous remission could not be ruled out. NSAIDs provided effective analgesia for some mildly affected cases. Opioids proved to be very useful for hospitalised cases; but anti-epileptic drugs (diazepam or phenobarbitone) gave more sustained and consistent relief. Occasionally life-long therapy is required. Some cases, especially those with chronic dental disease, responded to steroid therapy.

Treatment

Given that stress and anxiety are significant factors in overgrooming, it is vital to improve the cat’s physical and social environment to reduce underlying stress. Increasing the range of activities available to the cat will use up a greater proportion of its time and energy budget, leaving less time for grooming. A proper assessment of inter-cat relationships within the home should be made, so that underlying psychosocial stress may be alleviated. More information is available in the sections on feline housesoiling and feline aggression. If specific events or stimuli are associated with signs of anxiety, fear or directly with bouts of excessive grooming, then these may be desensitised and counter-conditioned. Any additional underlying factors that may have initiated another period of self-mutilation should then be identified and resolved. Relapses are common, but may be managed effectively using the same methods as for initial treatment.

Drug Therapy

Psychoactive medication is indicated in cases of "compulsive" over-grooming, or over-grooming that is leading to self-mutilation, or over-grooming with a strong underlying aspect of anxiety. Serotonergic medication such as the serotonin reuptake inhibitor (SRI) drug clomipramine or the selective serotonin reuptake inhibitor drug fluoxetine have anxiolytic and anti-compulsive effects. Fluoxetine can also improve impulse control in impulsive individuals. With clomipramine, cats may show adverse effects of lethargy and anorexia at higher doses, so treatment should start with a low dose, increasing it if there is no effect after 4-6 weeks. Clients should record the number and severity of self-grooming bouts seen during the 7-14 day period before treatment, as a baseline. The minimum treatment period is usually 6-8 months, with treatment being withdrawn once the cat's coat is fully restored and there has been a period of 6-8 weeks without signs of over-grooming or self mutilation. The withdrawal period should be 1 week per month of treatment, with withdrawal in three stages (75%, 50% and then 25% of therapeutic dose). Successful drug therapy should produce around 70% reduction in the behaviour and an increase in normal activity as a substitute. If there is a relapse, psychoactive drug treatment can be reinitiated. However, anecdotally, the response to successive courses of the same SRI or SSRI drug may diminish, so that it is sometimes better to treat relapses with a different psychoactive drug from the same class.

Summary of Treatment for Grooming Disorders

• Rule out all other medical and behavioural causes.
• Record baseline rate and severity of bouts of over-grooming or self-mutilation attacks as a comparison for future reassessment.
• Investigate and rectify underlying environmental and social factors that may be the cause of anxiety or stress.
• Consider drug therapy for refractory cases.