August 30, 2023
By Julie A. Jacob
Aggression, anxiety, destructive behavior, and other behavioral issues are a common reason for companion animals to be surrendered to shelters or euthanized. A retrospective study of 2,211 dogs and cats returned to the Charleston Animal Society from 2015 to 2019 found behavioral issues were the reason for the surrender of 36.1 percent of dogs and 19.7 percent of cats.1 Another study, an analysis of the veterinary records for nearly one million dogs in Australia, found 29.7 percent of deaths of dogs under age three were attributed to undesirable behaviors, most commonly aggression.2
Despite the sobering statistics, the outlook for dogs and cats with behavioral issues is much brighter than it has been in the past.
Growing awareness among both veterinarians and pet owners about the importance of treating behavioral issues in pets, a better understanding of the root causes of undesirable behaviors, and a comprehensive approach to treating them are resulting in more companion animals being successfully treated.
Demand for the services of board-certified veterinary behaviorists has surged over the past few years.3 It’s the dogs and cats that keep coming back for years that make veterinary behaviorists smile. Those visits mean the pet is still alive and living happily with their family, instead of being euthanized or rehomed.
“I certainly remember cases where the family thought the animal would have to be euthanized or rehomed unless their behavior changed, and I am still seeing their pet four or five years later,” says Kate Anderson, DVM, assistant clinical professor at the Cornell Duffield Institute for Animal Behavior.
“We used to be booked out several weeks in advance, but now we are booked up for several months,” says Dr. Anderson.
While veterinary behaviorists cannot point to one definitive reason for the increased demand for their services, the growing awareness of mental health issues in humans may be spilling over to a greater awareness of mental health issues in companion animals. In addition, COVID-related disruptions in household routines may have exacerbated anxiety in pets4–although the impact is difficult to quantify.
“I feel like it had to affect our pets in some ways,” says Anderson. “Some things are actually better. We were bracing ourselves for separation-related problems because people were going back to work, but we haven’t seen that as much as expected. The world has changed with hybrid work schedules.”
Further, the extra time people spent at home with their pets may have caused pet owners to observe behavior they otherwise may have overlooked.
“There seems to be more increased awareness and more demand than ever,” says Marie Hopfensperger, DVM, DACVB, assistant professor at Michigan State University College of Veterinary Medicine.
There has been a shift in the understanding of the root causes of behavioral issues in companion animals. The idea that social hierarchy and dominance struggles were the reasons for aggressive behavior in dogs has given way to a greater understanding among both veterinarians and pet owners that aggression, destructive behavior, and other behavior issues are mental health conditions that are often intertwined with physical health issues.
“Years ago, behavioral problems were considered as a group of problems different from other veterinary specialties, or human specialties,” says Carlos Siracusa, DVM, DACVB, DECAWBM, associate professor of clinical behavior medicine at the University of Pennsylvania School of Veterinary Medicine (Penn Vet).
“Now we know that is not the case. Now we know behavior is a physical manifestation of something wrong in the behavioral system in the body of the animal. It is not a physical problem versus a behavioral problem, but in many cases, the interaction of these two components results in some type of atypical or abnormal behavior,” Dr. Siracusa adds.
The role of pain and discomfort in behavioral changes is becoming clearer. “We have evidence that pain or discomfort can cause anxiety-fueled problems and a relapse of existing problems, such as separation anxiety, or a generalization of fear,” Siracusa says.
In tandem with the growing understanding of the interlinking of physical and behavioral issues is an embrace of a comprehensive approach to addressing behavioral problems. Years ago, a veterinarian may have simply advised a client, with a dog presenting aggression, to find a trainer; but now, addressing behavioral issues involves a combination of medications, behavioral therapy interventions, and environmental management.
“My approach is a global one,” says Leticia Dantas, DVM, DACVB, clinical assistant professor at the University of Georgia College of Veterinary Medicine. “Behavioral interventions, medications that can help, management changes … it’s a very comprehensive type of treatment that tries to support their brain to function at a more normal and high level with a better quality of life.”
While medication is usually the foundation of treatment, it must be combined with training and environmental management to provide the best outcome for dogs, says Dr. Siracusa.
“Drug treatment can help with increasing the receptivity of the dog, the responsiveness of the dog to behavioral modification; but drug treatment alone, without a more comprehensive behavior plan, is not effective in most of the canine problems,” Siracusa says.
Other treatment modalities may eventually be added to the toolbox of antidepressants and anti-anxiety medication, environmental management, and behavior training. For example, a growing body of research in both humans and animals points to a link between inflammation and behavior, says Siracusa, which may someday lead to treatments that modulate inflammation as a tool for regulating undesirable behaviors in companion animals. Researchers at Penn Vet are currently conducting two studies investigating whether chronic inflammatory disease in dogs and cats is associated with behavioral changes.
“Obesity in humans is associated with a larger inflammatory response and is also associated with cognitive decline, and we have found similar results in our preliminary data in cats–senior cats with a history of higher body score are associated with worse cognitive decline,5” Siracusa says.
“I do think we will arrive at the point where our psychopharmacology will be based on managing the immune response,” he adds.
There is also research indicating a link between the gut microbiome and behavior in both animals and humans,6 which could lead to the use of probiotics as another modality for improving behavioral issues in companion animals.
“There’s really good research in rodents and people, but we still need a lot more information,” says Anderson. “It won’t be a cure-all, but it is an interesting area of research. We know that people with irritable bowel syndrome (IBS) are more prone to cognitive issues later in life like dementia, and dog cognitive decline is very similar to human Alzheimer’s,” she adds.
Veterinary behaviorists interviewed have suggestions for how vets in general practice can incorporate behavioral health into their patient care. First and foremost, they say, it is crucial to integrate behavior health education and assessment into routine preventive care for dogs and cats.
“It’s very important to have a proactive approach, not when the problem is established, and something bad happens and then you talk,” says Dr. Dantas.
Client education should start in the waiting room with handouts, posters, and videos with information on decoding animal body language and recognizing signs of aggression and anxiety in their pets, adds Siracusa. The American College of Veterinary Behaviorists (ACVB) has handouts on its website, and the American Animal Hospital Association (AAHA) website has downloadable dog7 and cat8 behavior posters.
Anderson recommends vets observe every new puppy on the floor for two minutes for their behavior and, if the puppy demonstrates abnormally fearful or anxious behavior, to discuss it with the client. A 2007 study of 102 puppies9 between eight and 16 weeks old found about 10 percent of the sample exhibited abnormal expressions of anxiety and fear during a routine physical examination.
“There’s a tendency to think that puppies will outgrow it, but they really continue to grow into it, and it gets worse as they get older, especially those outlier puppies,” says Anderson.
“Be able to have those difficult conversations with clients and recognize when their pets are struggling and knowing what you can offer and when to refer,” she adds.
Simple screening tools are available. Penn Vet’s C-BARQ10 and FE-BARQ11 behavioral assessment questionnaires are available for free to veterinaries, trainers, shelters, and pet owners. The AAHA offers a free behavioral management toolkit12 for veterinarians.
It’s also crucial to develop relationships with reputable local trainers who use positive training methods and then refer clients to trainers who use force-free methods. The ACVB has a guide13 for evaluating trainers.
“Try to develop relationships with force-free trainers in the area so you can focus on prescribing, and they can do the behavior modification,” says Dr. Hopfensperger.
It is also helpful for general practice vets to become familiar with medications used to treat behavioral issues14 and become comfortable prescribing them, she adds.
“Prescribing is more of an art than a science,” says Dr. Hopfensperger. “What works for one may not work for the other. It’s a matter of looking at that patient, what they are presenting, and other health concerns and identifying the best medication for them. There’s an element of trial and error, just like with human psychiatry and what works for one may not work for another.”
While a veterinary behaviorist may not be within driving distance of the client—for example, only 17 board-certified veterinary behaviorists are located within 500 miles of Chicago according to the ACVB directory—most are happy to do a phone consultation or conduct video sessions with the client, as long as the primary vet can prescribe medications if the behaviorist practices in another state.
“Go to the ACVB website and find a colleague and give them a call,” says Dr. Dantas. Do it sooner rather than later, she adds. “A lot of the patients I see, especially with the really severe cases, have been through several professionals who were not qualified to help, and things got much worse.”
Finally, if treatment fails to bring about a change in behavior, or if the pet owners are unable or unwilling to commit to the training and environmental management, it is important to be prepared to have a difficult conversation with the pet owner and be supportive of their decision, if they decide to euthanize or rehome the animal.
“I routinely ask clients how much stamina they have for continued treatment and management of behavior patients,” says Hopfensperger. “I also discuss the construct of One Welfare, meaning it’s important to look at the welfare of the whole system—client, pet, other pets in the household … I assure clients I would support them 110 percent should they elect to pursue euthanasia.”
However, more often, those conversations do not need to happen because early intervention, medication, and training are helping more pets struggling with behavioral issues to be treated successfully and lead contented and long lives.
The key to successful treatment, Siracusa says, is understanding the cause of the dog’s or cat’s behavior and then figuring out the best way to address it.
“I want to encourage colleagues not to focus only on drugs—which are an extremely important component of treatment—but to really understand the motivation and complexity of behavior problems and to investigate the external environment and physical health of the patient and to understand their body language and what they are trying to tell us, and to have a more contemporary approach and reach out for help to a veterinary behaviorist if the cause is complex.”
Julie A. Jacob is a communications professional and writer who often contributes to Veterinary Practice News. She lives in Wisconsin with her poodle.
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