Feline Compulsive Disorders - Overview

Key Points
The prevalence of compulsive disorders in cats is not known Anecdotally, the commonest forms involve self-maintenance behaviours, such as over-grooming. Treatment includes environmental enrichment and anti-compulsive medication

Introduction

There is no reliable evidence regarding the prevalence of "compulsive disorders" in cats. In cats, the commonest compulsive behaviours involve repetitious or exaggerated self-maintenance or self-directed behaviours such as grooming, sucking or self-mutilation. Cats may also develop compulsive behaviour that originates in a range of other activities. For example, light spot or shadow chasing, and excessive consumptive behaviours (water or food). Compulsively excessive water consumption or play is sometimes referred to as psychogenic polydipsia, but this is an inappropriate use of a term taken from human medicine; in humans psychogenic polydipsia is problem of excessive water consumption that is associated with a range of mental health problems (most commonly psychosis) but it is also very often a side effect of medication (for example, antipsychotic drugs). It is a descriptive term that covers a wide range of different problems with diverse aetiologies and has no equivalent in veterinary patients.

In humans, some disorders that were previously classified as compulsive, such as trichotillomania, have now been reclassified as dysfunctions of impulse control rather than compulsive motivation (for example, body-focussed repetitive behaviour). Given that almost nothing is known about the aetiology of compulsive disorders in cats, it is possible that a similar change of classification may occur and the term "compulsive disorder" should be regarded as an interim description.

Hyperaesthesia syndrome, is often included under the umbrella of compulsive disorders. However, the behaviour in hyperesthesia syndrome is variable between cats and it is probable that a range of different aetiologies will become apparent as the condition is better understood. Indeed, it may be found to share greater aetiological similarities with oro-facial pain syndrome (seen primarily in Burmese) and feline idiopathic cystitis, and is not a true compulsive disorder.

Underlying Factors

The cat is highly self-reliant and depends on its own ability to control and utilise resources in its environment. It experiences strong drives to hunt, feed and carry out self-maintenance behaviours at set intervals. Hunting, for example, is not primarily regulated by appetite or satiation so cats will continue to hunt regardless of their earlier success or failure. The cat’s normal behavior is therefore highly structured and self-disciplined. This reflects the fact that, in a given area, the territories of several cats may partially overlap so that each individual can gain access to certain common resources, or traverse areas of each other’s territory in order to get from place to place. The temporal structure of the cat’s behaviour, combined with its system of marking, allows each cat, or group of cats, to exist in isolation from others, thus minimising conflict and maximising each cat's ability to utilise resources as it needs them. Great importance is therefore placed on the reliability of access to resources and avoidance of conflict with conspecifics.

Feline compulsive disorder is associated with a lack of ability to carry out normal behaviour, combined with the social stress of perpetual competition and conflict. Improvement of the physical and social environment is therefore critically important for cats with compulsive disorders. Even without a compulsive element, the cat is likely to increase the amount of self-maintenance behaviour it performs as a substitute for constrained opportunities to perform other behaviours such as hunting behaviour and territory maintenance.

In a domestic environment, cats experience a range of constraints on their behavioural needs, which can lead to stress and frustration that contribute to the expression of compulsive behaviour. Some are due to human lifestyle, such as being kept indoors because the apartment has no outdoor access. Others are due to misunderstanding of the cat's needs, such as meal feeding instead of ad-lib or activity feeding, or the introduction of a new cat in order to provide company for a single resident cat. Inappropriate feeding is a very common cause of problems; cats would normally eat 10-20 small meals each day when given free choice. When fed two meals a day, as is typical in many households, this is the equivalent of a person only being given food every second or third day and results in prolonged periods of hunger for the cat. For the cat to live in an environment that places it in close proximity with potential competitors, inside or outside the home, and with limited control over access to resources and territory, can be highly stressful.

Environmental factors are therefore extraordinarily important in all feline behavioural problems, especially compulsive disorders.

There are large individual differences in behaviour and personality between between cats, which result in variation in stress response to living conditions. For example, a cat with low sociability may have much more difficulty coping with the introduction of a new cat to the household, especially if the home does not provide sufficient resources and opportunities for the resident cat to maintain distance form the new arrival.

Breed Predisposition

There is some anecdotal evidence of breed predisposition in the incidence of compulsive disorder, with Burmese, Siamese and other purebred oriental cats showing higher rates of wool-sucking and self-mutilation. This may reflect a genetic component to the disorder, but it must also be remembered that these cats are often reared and housed differently from non-pedigree cats. Concerns over disease transmission mean that they are often reared in a ‘non-domestic’ situation, such as a cattery. This limits the exposure these animals have to social interaction and common domestic stimuli and events, which would seem to predispose them to a range of fear and anxiety problems. As adults, their financial value means that they are less likely to have outdoor access, which places even greater pressure on the cat if the indoor environment is unsuitable for them. There also appears to be a higher prevalence of urine marking, inter-cat aggression and attachment disorders in these breeds, which suggests that they may experience more stress from living in domestic environment than they typically experience. Whilst these cats may have some genetic predisposition towards a range of problems, their rearing and husbandry is probably a significant factor.

Investigation

A full history should be taken, including:

• Information about the origin, rearing environment and experience of the cat
• Age at onset
• Progression of signs
• Contexts and situations in which the behaviour occurs
• Stimuli and events that trigger bouts of the behaviour
• Detailed characterisation of the behaviour (including video)
• Other emotional or behavioural problems (including identifying situations in which the cat shows signs of anxiety, fear or stress)
• The methods the owner has tried to resolve the problem
• The cat's living conditions (physical and social environment)

Differentials include CNS lesions, epilepsy, specific conditions that could cause the same pattern of behaviour (e.g. specific causes of polyphagia, polydipsia or over grooming), conditions that alter mental function (e.g. thyroid dysfunction or cognitive dysfunction). Apart from differential diagnoses, contributory medical factors should also be considered, such as pain.

Treatment/Intervention

Speedy intervention is important in the treatment of compulsive disorders. Compulsive behaviour becomes more pervasive over time as the animal ‘learns’ that performing compulsive behaviour provides reliable relief from negative emotional situations. Compulsive behaviour can ultimately become a substitute for a wide range of normal behaviour so that, even when presented with a substantially-improved environment, the cat continues to behave compulsively.

Treatment typically involves:

• Environmental enrichment (in particular, restoring that cat's control over resource access and reducing sources of frustration).
• Identifying and treating specific emotional problems, such as fears and phobias.
• Medication to reduce compulsiveness (sometimes to reduce underlying emotional problems such as fear of anxiety).

The use of medication for these conditions is sometimes controversial because it may be regarded as merely reducing the incidence of unsightly behaviour that is an expression of the animal’s attempts to cope with wholly-unsatisfactory living conditions. However, the use of medication is absolutely justifiable if it enables the animal to engage in normal behaviour in an enriched environment. In this situation, the drug is being used to facilitate rehabilitation and restore normal motivation and decision making. Serotonin reuptake inhibitor drugs, such as clomipramine and fluoxetine, which are anxiolytic and anti-compulsive, are most useful where their use will enhance the animal’s response to environmental improvement.

Where social stress between resident conspecifics is a factor, synthetic pheromones (e.g. Feliway) may be used to reduce tension, in addition to environmental enrichment.

Attempts to physically prevent compulsive behaviour or punish the animal, are inappropriate and ineffective. Compulsive behaviour forms part of the animal’s coping strategy so that preventing one expression of compulsion just forces the animal to find other opportunities. For example, using flavour or odour aversion to deter pica related to one type of material, such as wool, will merely encourage the cat to find something else to suck or chew instead. The motivation to carry out some kind of related compulsive behaviour remains. Punishment may increase stress that contributes to the problem.

Common Feline Compulsive Disorders (and related conditions)

• Hyperaesthesia
• Psychogenic alopecia (over-grooming)
• Self-mutilation
• Pica
• Wool-sucking

Preventing Compulsive Disorders

• Kittens should be exposed to a wide range of stimuli during the sensitive period (people, domestic activities, interaction with other species).
• The domestic environment should provide security, mental stimulation and free access to resources. This is particularly important for indoor-only cats.
• Avoid overpopulation, especially with oriental breed cats.
• If establishing a multi-cat household, choose kittens from parents that already live in successful multi-cat households.

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