Lisa Radosta, DVM, DACVB
Florida Veterinary Behavior Service
Ariel Fagen, DVM
Florida Veterinary Behavior Service
Veterinary Behavior Consultations of Colorado
Separation-related disorders1 are characterized by physiologic and emotional distress occurring only when the patient anticipates or experiences an actual or virtual (eg, person present but not accessible) absence from a person with whom the pet is socially bonded.
Separation-related disorders are well recognized in dogs, but they are less understood in cats because of a lack of representation in the literature.2,3 Prevalence in dogs presented to a behavior specialist ranges from 14% to 50%4–7 compared with 19% in cats.2 These disorders are probably underreported in cats.
SYMPTOMS OF A Separation-related disorder can include destructive acts, such as destroying household objects, chewing furniture, and frantic scratching at door frames and window sills.
SIGNALMENT and PREDISPOSITIONS
Clinical signs in cats and dogs may develop at any age, in any breed, and in either sex. There is evidence that 55% of affected dogs exhibit clinical signs before 3 years of age8 and that cats older than 7 years may be predisposed.2 Known predisposing factors in dogs include neutering,9 absence of obedience training,8–10 and adoption from a shelter or rescue or being a found stray.8,9,11 Predisposing factors in both dogs and cats include daily extended periods of time without the owner, change in schedule or family makeup, and single-owner households.3,9 There may also be a hereditary predisposition in both dogs and cats.3,12
Onset of clinical signs in dogs and cats may occur with life events, lifestyle changes, or development of medical or other behavioral disorders (Box 1).3,13,14
Dogs with separation-related disorders can be divided into three classes: A, B, and C.1 Dogs in class A may show initial signs in puppyhood and display hyperattachment1 to one person by following them and soliciting attention and physical interaction.1,3,9,13,16,17 Dogs in class B display signs triggered by a change in schedule or lifestyle or by aging and often show distress only when left completely alone.1,14 Dogs in class C show clinical signs after a fearful experience and do not show hyperattachment.1
Clinical signs in both cats and dogs may start in anticipation of the owner’s departure.2,3,16 Dogs may exhibit aggression in an apparent attempt to keep the owner from departing3,8,12 or appear apathetic and withdrawn. Some dogs avoid participating in morning routines.8 Particular signs reported in cats include urination on the owner’s bed and destruction; these signs are more common among males than females.2,3
Step 1: Collect a Targeted History
Even in affected dogs, as few as 13% of owners may seek assistance.17 A simple behavior questionnaire with questions such as “Has your pet urinated or defecated in your house since your last visit?” or “Does your pet act differently as you get ready for work?” can decrease the time invested in the examination room. Signs of anxiety with departure cues strongly support a diagnosis of separation anxiety.13 Behaviors that indicate13 a diagnosis other than separation anxiety are those that:
- Do not occur consistently and exclusively with departures
- Occur only in conjunction with other environmental events (eg, storms)
- Occur only when the pet is confined
Step 2: Perform a Physical Examination and Appropriate Diagnostic Testing
Complete a full examination. In dogs, monitor for caudal wear of the canines, a marker of crate chewing.14 Complete blood count, blood chemistry, urinalysis, and thyroid testing should be performed to screen for underlying medical causes of the clinical signs and serve as a baseline before medication use.8,13 Conditions that can cause discomfort or pain can present similarly to anxiety.18 Depending on clinical presentation, initial diagnostics, and examination findings, additional diagnostics may be warranted.
Step 3: Rule Out Behavioral Contributors or Differentials
As many as 30% to 60% of dogs have comorbid noise and storm phobias.9,15,19 Confinement distress could be the sole cause of anxiety or a very large contributor.3,8,13 Testing the dog’s distress level with confinement when the owners are present13 and no confinement when the owners are not present can rule this out. Other diagnostic differentials to consider are listed in Box 2.
Video recording is helpful13 because many signs are “silent,” with no evidence of the behavior upon the owner’s return. In addition, video can confirm the diagnosis, provide a baseline, have treatment implications, and help monitor for treatment success. There are many ways to inexpensively record video, including smartphones, apps, and home security systems.
Step 1: Educate
Owners may have preconceived ideas of the cause of their pet’s disorder. The owner should understand that his or her pet is not acting this way out of spite or anger; that the owner didn’t cause the behavior by loving the pet too much, spoiling it, or not being dominant; and that the pet is not bored and getting another pet will not help.1,9,13
Step 2: Avoid and Manage Distress Immediately
As quickly as possible, put into place strategies and treatments to decrease or ameliorate the distress. This will ease owner stress and improve the pet’s quality of life while long-term treatments are instituted.
Avoid departures in the initial stages of treatment14 through use of daycare, boarding, house sitters, or bringing the pet along when the owner departs. Confinement can prevent destruction but also can increase anxiety13,14 and is generally avoided because of the comorbidity with confinement anxiety. If crated, the pet should not wear a collar because of strangulation risk with escape attempts.14
Block off areas most likely to be damaged and clean soiled areas of the residence13 with a bacterial/enzymatic cleaner, like Anti-Icky-Poo (MisterMax Quality Products) or other cleaners such as Urine Off or Zero Odor.20 Play the radio, white noise, or music to prevent the pet from retriggering to external stimuli.13
Instruct the owners to avoid punishment, such as yelling, hitting, and shock collars. These types of treatments are contraindicated13,16 because they can increase anxiety and make the course of treatment longer. Be sure to remind clients that their pet is suffering from an emotional disorder and no amount of punishment will fix it.
Pair owner departures with positive things by setting up food-searching games and food toys3,13 before the first signs of distress. Adjust the pet’s feeding schedule to increase the likelihood of eating when the owner is gone,8 and use enticing food. Recommend that the owner keep departures and returns low-key.13 A regular and predictable routine should be provided.16
Consider medication. Medications can directly decrease anxiety and panic.14 Situational medications that take effect within 1 to 2 hours of administration can be essential in the treatment of separation anxiety and should be considered at the first appointment. Ideally, the medication would take effect before the patient shows clinical signs. Benzodiazepines (avoid diazepam in cats), trazodone, gabapentin, and clonidine can be used to reduce anxiety quickly.13,14 Acepromazine is not a good anxiolytic so should not be used alone, but it can be used at low dosages as an adjunct if additional sedation is needed.13
Step 3: Institute Behavior Modification So the Pet Can Learn to Stay Calm for Departures
Proper implementation of behavior modification maximizes the likelihood of a long-term positive outcome. In our experience, behavioral treatments increase the probability that medication doses can be reduced over time, if that is a goal of treatment, and decrease the likelihood of relapse. Ideally, a veterinary behavior technician within the practice would conduct behavior modification sessions in clear communication with the veterinarian so the plan and medications can be adjusted efficiently. All treatments should focus on conditioning the pet to feel calm and happy during departures by using things the pet likes.
Independence and relaxation exercises are a cornerstone of treatment.8,13 Examples include food-searching games at an increasing distance from the owner,10 relaxation exercises, and rewarding calm behavior.16 Treatment can be made simple in some cases by using food toys and remote treat-dispensing devices.
Structured interactions between the pet and the owner through positive reinforcement (eg, cueing the pet to sit before the pet receives attention) can promote consistency and predictability in the pet’s life.13,14 Adequate exercise and enrichment should be given to meet the pet’s general needs.13,16
Additional behavioral modification includes uncoupling departure cues and desensitization and counterconditioning to departures.13,14 Dogs can be taught to be comfortable with confinement if that is a goal of the owner or helps the dog feel safe.13 Caution should be exercised when recommending this because it can take months for often little yield.
As a warning, if pets are pushed too fast through these protocols, these methods can backfire and actually sensitize the pet to departures, making the patient worse.14 If you do not feel comfortable enacting these treatments and do not have a behavior technician on whom to rely, refer your patient to a board-certified veterinary behaviorist. If such a specialist is not available in your area, try the American Veterinary Society of Animal Behavior (avsab.org) to find someone qualified.
Step 4: If Indicated, Prescribe Longer-Acting Pharmaceuticals
Longer-acting pharmaceuticals may be indicated if owners have a difficult time predicting departures (making situational medications difficult to implement) or if situational medications are insufficient. Some patients may need polypharmacy.14 Tricyclic antidepressants and selective serotonin reuptake inhibitors can be helpful in easing anxiety over time. Substantial evidence supports use of clomipramine21–23 (Clomicalm, Novartis.com) and fluoxetine24,25 for separation anxiety in dogs. Clomicalm is the only drug on the market with a Food and Drug Administration label for separation anxiety in dogs older than 6 months.26 Other daily options to consider include sertraline or paroxetine.13,14 Supplements (Zylkene [vetoquinolusa.com], Solliquin [nutramaxlabs.com]), prescription diets (Royal Canin CALM [royalcanin.com]), and pheromone therapy can be considered.8,14,16,23
- Appleby D, Pluijmakers J. Separation anxiety in dogs: the function of homeostasis in its development and treatment. Vet Clin North Am Small Anim Pract 2003;33:321-344.
- Schwartz S. Separation anxiety syndrome in cats: 136 cases (1991-2000). JAVMA 2002;220(7):1028-1033.
- Schwartz S. Reference point: separation anxiety syndrome in dogs and cats. JAVMA 2003;222(11):1526-1532.
- Bradshaw JW, McPherson JA, Casey RA, Larter S. Aetiology of separation-related behaviour in domestic dogs. Vet Rec 2002;151(2):43-46.
- Voith VL, Borchelt PL. Separation anxiety in dogs. In: Voith VL, Borchelt PL, eds. Readings in Companion Animal Behavior. Yardley, PA: Veterinary Learning Systems; 1996:124-139.
- Denenberg S, Landsberg GM, Horwitz D. A comparison of cases referred to behaviorists in three different countries. In: Mills D, Levine E, Landsberg GM, et al (eds). Current Issues and Research in Veterinary Behavioral Medicine. West Lafayette, Indiana: Purdue University Press; 2005:56-62.
- Landsberg G. The most common behavior problems in older dogs. Vet Med 1995;90(suppl):16-24.
- Horwitz DF, Neilson JC. Blackwell’s Five-Minute Veterinary Consult Clinical Companion Canine & Feline Behavior. Ames, Iowa: Blackwell Publishing; 2007.
- Flannigan G, Dodman NH. Risk factors and behaviors associated with separation anxiety in dogs. JAVMA 2001;219(4):460-466.
- Clark GI, Boyer WN. The effects of dog obedience training and behavioural counselling upon the human-canine relationship. Appl Anim Behav Sci 1993;37(2):147-159.
- Blackwell E, Twells C, Seawright A, Casey R. The relationship between training methods and the occurrence of behavior problems, as reported by owners in a population of domestic dogs. J Vet Behav 2008;3:207-217.
- Simpson BS. Separation anxiety in dogs. Compend Contin Educ Pract Vet 2008;30(1):27-42.
- Landsberg GM, Hunthausen W, Ackerman L (eds.). Fears, phobias, and anxiety disorders. In: Behavior Problems of the Dog & Cat. 3rd ed. Philadelphia: Saunders; 2013:181-208.
- Overall KL. Abnormal canine behaviors and behavioral pathologies not primarily involving pathological aggression. In: Manual of Clinical Behavioral Medicine for Dogs and Cats. St. Louis: Mosby; 2013:231-309.
- Palestrini C, Minero M, Cannas S, Rossi E, Frank D. Video analysis of dogs with separation-related behaviors. Appl Anim Behav Sci 2010;124(1):61-67.
- Seksel K. Separation anxiety in dogs and cats with reference to homeostasis. In: Proceedings. Veterinary Behavior Chapter. Science Week 2013. 2013:22-26.
- Simpson BS. Canine separation anxiety. Compend Contin Educ Pract Vet 2000;22:328-338.
- Frank D. Recognizing behavioral signs of pain and disease: a guide for practitioners. Vet Clin Small Anim 2014;44(3):507-524.
- Ogata N. Review: Separation anxiety in dogs: what progress has been made in our understanding of the most common behavioral problems in dogs? J Vet Behav 2016;16:28-35.
- Melese P. Detecting and neutralizing odor sources in dog and cat elimination problems. Appl Anim Behav Sci 1994;39:188-189.
- King JN, Simpson BS, Overall KL, et al. Treatment of separation anxiety in dogs with clomipramine: results from a prospective, randomized, double-blind, placebo-controlled, parallel-group, multicenter clinical trial. Appl Anim Behav Sci 2000;67:255-275.
- King JN, Overall KL, Appleby D, et al. Results of a follow-up investigation to a clinical trial testing the efficacy of clomipramine in the treatment of separation anxiety in dogs. Appl Anim Behav Sci 2004;89:233-242.
- 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(17):533-538.
- Landsberg GM, Melese P, Sherman BL, et al. Effectiveness of fluoxetine chewable tablets in the treatment of canine separation anxiety. J Vet Behav 2008;3:11-18.
- Simpson BS, Landsberg GM, Reisner IR, et al. Effects of Reconcile (fluoxetine) chewable tablets plus behavior management for canine separation anxiety. Vet Ther 2007;8(1):18-31.
- US Food and Drug Administration. Clomicalm FOIA Drug Summary. Available at: fda.gov/downloads/AnimalVeterinary/Products/ApprovedAnimalDrugProducts/ FOIADrugSummaries/ucm117165.pdf. Accessed March, 2017.