Separation anxiety (Proceedings)

Definition

Symptoms of anxiety, distress or panic exhibited when animals are left alone. Separation anxiety can be characterized by pacing, drooling, vocalization, destruction, and elimination which are not related to other behavioral disorders. All or some of these behaviors can be present.

Behavioral symptoms

     • Monotonal Vocalization/Barking - Typified by barking and whining which begins soon before or after departure and persists for a large percentage of the time the dog is alone. Often is reported to the owners by neighbors.

     • Inappropriate Elimination - Depositing of urine and/or stool in various locations around the home (as opposed to in a single, consistent location). Only occurs when the dog is alone or perceives that they are alone. Stool may be abnormal in appearance (is commonly mucoid).

     • Destructive Behavior - Characterized by damage to exit points from the home (doors and windows) or destruction of personal items (pillows, clothing, remote control units). Confinement in a cage often escalates the destruction and can result in injury to the animal (tooth or toenail fracture for example)

     • Hypersalivation - Is often considered to be highly suggestive of separation anxiety when the behavior is restricted to those times when the dog is alone or perceives to be alone.

Data collection

     • Physical Examination

     • CBC

     • Chemistry Profile

     • Thyroid Profile

     • Urinalysis

     • Fecal Exam

Behavioral history - who, what, when, where

     • Who is present at the time of the behavior (is the pet alone or are there people present), before the behavior begins (departure) and afterwards (arrival).

     • Who is the primary caretaker of the animal and how does the pet interact with this person (follows the person or is willing to be voluntarily separated from that person)

     • Describe the behavior. What does the pet do when alone? Videotaping the dog's activity when alone can help to verify whether the pet appears anxious (panting, pacing, etc)

     • When does the behavior occur? Is the pet alone or does it perceive to be alone (while owner is sleeping or in the shower, for example). Or does the pet have full access to the owner when the behavior occurs.

     • Where does the behavior occur? Are the behaviors directed toward exit points or are there multiple locations vs. single locations in the home.

Previous history

     • Age of onset and character of the behavior at onset

     • Changes in the pet's environment at onset such as a move, work schedule change, or loss of a house member

     • Treatments attempted previously and outcome

Medical differential diagnosis

Hypersalivation

     • Dental Disease

     • Oral Foreign Body

     • Oral Toxin

     • GI Distress

     • Medical Differential Diagnosis

Vocalization - Any Condition Resulting in Pain

     • Otitis

     • Osteoarthritis

     • Dental Disease

     • Severe Dermatitis

     • Etc

Inappropriate elimination

     • Lower Urinary Tract Disease

     • Diabetes Mellitus

     • Cushing's Disease

     • Renal Failure

     • Colitis

     • Inflammatory Bowel Disease

Behavior differential diagnosis

Hypersalivation

     • Only known behavioral cause of hypersalivation is anxiety, most commonly separation anxiety

Vocalization

     • Territorial Behavior

     • Attention Seeking Behavior

     • Hyperactivity

     • Play Behavior

     • Behavior Differential Diagnosis

Destructive behavior

     • Normal Puppy Behavior

     • Exploratory Behavior

     • Food Acquisition Behavior

Inappropriate elimination

     • Failure to Housetrain or Loss of Housetraining

     • Marking Behavior

Co-morbidity

High probability of dogs with noise phobia or thunderstorm phobia to also have separation anxiety

If any of these conditions are present in a pet, carefully evaluate the animal for the other conditions

Treatment

The overall goals of treating separation anxiety are to reduce dependence on the owners.....

Attention seeking behavior

Owners should not respond in ANY way to the pet's attempts to get attention from them by such behaviors as barking, whining, jumping up, pawing, etc. They should not look at, talk to or touch their dog at these times. Expect the behavior to initially get worse and more physical.

Departure and Arrival Routine

Have the owners ignore the dog for 30 minutes prior to leaving home. This is meant to prevent inadvertent reinforcement of anxious behavior as they prepare to leave.

Ignore dog upon arrival until it is relaxed

Arrival routine

The owners should not interact with their dog when they arrive home until the pet is completely calm.

Distraction at Departure

Use a Kong Toy stuffed with a treat, or some similar product, at the time of departure. This is meant to distract the dog away from the act of the owners departing from the home. The toy should be given approximately 5-10 minutes before departure.

Use of Punishment

The owners should not use physical or verbal punishment in response to destructive behavior or elimination. These behaviors are symptoms of anxiety and punishment, especially after the fact, will increase the level of anxiety.

Uncoupling departure cues (habituation)

This refers to making a list of activities the owners perform prior to leaving home which signals to the pet that they are leaving and results in the dog getting more and more anxious. These activities are then performed at times when there is no intention of leaving the home.

Indoor relaxation exercises

Have the owners train the dog to assume a calm, relaxed behavior during gradually increasing periods of separation. This is commonly done when moving casually from room to room.

Graduated departure exercises

Have the owners train the dog to assume calm, relaxed behavior during gradually increasing periods of separation as they leave the home. They may need a "bridge" cue to signal "safe" departures.

Exercise

Consistent exercise in the form of walks and play can serve to reduce anxiety by decreasing the dog's focus on the owner's departure from the home.

Anti-anxiety medication

The judicious use of medication can decrease the overall level of anxiety and enable the pet to respond better to the behavioral tasks just outlined

Clomipramine

     • A Tricyclic Antidepressant (TCA) that functions primarily to elevate the levels of serotonin and norepinephrine in the synaptic cleft of brain neuropathways

     • 1-4 mg/kg bid

     • Allow at least 2-4 weeks for onset of action

     • Expect sedation and anorexia as common side effects. Increased anxiety, aggression and hepatic disturbances are less common

     • Preliminary CBC/Chemistry Profile and Thyroid Panel pre-treatment

     • CBC/Chemistry Profile 4 weeks post-treatment

     • Allow 2-3 months on the medication with the behavior being relatively normal

     • Begin weaning by decreasing the dose by 25% every 3-4 weeks until off the medication or when symptoms return. Then return to the previously effective dose.

Fluoxetine

     • Fluoxetine is a Selective Serotonin Reuptake Inhibitor (SSRI). Only has an effect on Serotonin and not on other neurotransmitters

     • 1-2 mg/kg SID

     • Allow at least 6-8 weeks for onset of action

     • Expect sedation and anorexia as common side effects. Increased anxiety, aggression and hepatic disturbances are less common

     • Preliminary CBC/Chemistry Profile and Thyroid Panel pre-treatment

     • CBC/Chemistry Profile 4 weeks post-treatment

     • Allow 2-3 months on the medication with the behavior being relatively normal

     • Begin weaning by decreasing the dose by 25% every 4-6 weeks until off the medication or when symptoms return. Then return to the previously effective dose.

Benzodiazepines

     • These are typically used in Separation Anxiety to treat panic behavior seen at time of departure to help ease the transition

     • Diazepam (Valium)

     • Alprazolam (Xanax)

     • Clorazepate (Tranxene)

All have short onset, short half-lives and are used in conjunction with TCA's and SSRI's

Trazodone

     • It is a serotonin agonist at 5HT1A receptor and a weak serotonin reuptake inhibitor.

It is unclear which of these effects is responsible for the reduction in anxiety that occurs with its use.

     • 1-3 mg/kg dose either as needed or up to 3 times per day

     • Begin at the low end of the dose range for 3 days then increase dose gradually as needed

     • Can be used along with an SSRI or TCA but use carefully to minimize possible side effects

     • drowsiness, nausea/vomiting, headache and dry mouth, dizziness, constipation, urinary retention

     • Hypotension, tachycardia, syncope, arrhythmias

Factors effecting outcome

     • The older the patient at the time of onset or presentation, the poorer the prognosis

     • Multiple diagnoses will decrease the prognosis

     • The ability of the owners to follow through on recommendations

     • The ability to administer medication and the patient's response to that medication

     • The living situation of the owners (neighbor complaints or degree of damage to the home)