Differentiating Primary Behavior Disorders From Lack of Enrichment

Many companion animal behaviors perceived as problematic by pet owners are species-typical behaviors (see Species-Typical Behaviors Commonly Presented as Behavior Problems).^1-3 Cats and dogs need enrichment (ie, appropriate outlets for species-typical behaviors that also improve quality of life), including opportunities to chase, scratch or dig, play with objects, and engage in social interactions, as well as access to comfortable resting spots and space to avoid conflicts with other animals in the household. Lack of enrichment opportunities may result in expression of natural behaviors in undesirable ways, withdrawal and limited interest in engagement with humans and other animals in the household, or development of repetitive behaviors (eg, spinning, vocalizing).^4,5

In addition to basic needs (eg, food, water, shelter), owners should provide opportunities for companion animals to engage in species-typical behaviors, express agency (ie, engage in voluntary and goal-directed behavior), and participate in considerate and consistent social interactions.^6,7 Chronically unmet needs can lead to negative emotional states (eg, frustration, conflict, fear, anxiety) that can result in behavior disorders and somatic illnesses.^8,9 Owners may attempt to address undesirable behaviors with punishment or aversive techniques that can worsen the problem and contribute to behavior disorders.

Ask the Expert: How can behavior concerns caused by primary behavior disorders be differentiated from concerns caused by lack of enrichment?

Diagnosis of behavior concerns requires medical assessment, review of behavior history, and emotional assessment (Figure). Findings can help differentiate primary behavior disorders from species-typical behaviors expressed in an undesirable manner because of lack of appropriate enrichment.

FIGURE Assessment of behavior concerns

Medical Assessment

Medical assessment in a patient presented for a behavior concern should include evaluation of physical health and screening for systemic disease, which can cause or contribute to behavior disorders and influence species-typical behaviors, activity levels, and sleep patterns. Assessment should include physical examination; appropriate diagnostic testing (CBC, serum chemistry profile that includes symmetric dimethylarginine, thyroxine, urinalysis, and intestinal parasite screening that includes fecal antigen testing) based on the patient’s age, health, and clinical signs; and review of any medications or supplements administered.

Behavior History

Behavior history, including a description of the problem, and evaluation of the patient’s physical and social environment can be gathered using a questionnaire completed by the owner prior to the consultation or via discussion between the owner and a trained team member.

Description of the Problem

Detailed and objective descriptions can help differentiate signs of a primary behavior disorder from species-typical behavior. Owners often use subjective terms (eg, aggressive, fearful, unruly, stubborn) to describe behavior and should therefore be asked instead to describe what the behavior looks like.

Absence of signs of fear, anxiety, and distress during expression of the behavior suggests a species-typical behavior that lacks an appropriate outlet; however, inability to perform species-typical behaviors can cause frustration that appears similar to fear, anxiety, and distress. Destructive behavior, for example, can be a sign of a behavior disorder but could also be due to lack of enrichment. In a dog alone in the home, destructive behavior in addition to panting, pacing, vocalizing, yawning, or other signs of anxiety may indicate a separation-related disorder, but destructive behavior with loose, flexible body language (eg, pouncing, jumping, wiggling) and no signs of anxiety may indicate lack of enrichment.

Additional details to gather include triggering events and context in which the behavior occurs, how the owner and others respond to the behavior, how frequently the behavior occurs, and how the behavior has progressed. Asking the owner to provide videos of the behavior can be helpful, especially if the owner has difficulty describing the behavior objectively or the behavior occurs when the owner is not present. If the problem includes aggression, however, the owner should be cautioned not to provoke aggressive behaviors to obtain a video; descriptions of the patient’s body language should be sufficient.

Physical Environment

Assessment of the patient’s home environment can help determine whether and how the patient’s needs are met, quality and appropriateness of enrichment, and areas for intervention. Assessment should include how, where, and when resources (eg, food, water, resting and hiding areas) and opportunities to void the bladder and bowels are provided. For cats, type and location of scratching substrates and litter boxes, including litter type and litter box hygiene, should also be determined.

Social Environment

The social environment includes humans and other animals that live in the household, regularly visit the home, and/or interact with the patient outside the home. Interaction quality (eg, calm, patient, friendly; excited, agitated, rough); frequency, duration, and consistency of play, exercise, and training; training methods; and body language of the individuals involved in the interaction should be assessed. Asking the owner to outline a typical 24-hour period for their pet can also be helpful.

Emotional Assessment

Assessment for signs of fear, anxiety, and chronic distress can help determine whether a species-typical behavior is lacking an appropriate outlet or a behavior disorder is present.

In-Clinic Observations

Presence and intensity of signs of fear, anxiety, and distress during a visit to the clinic may indicate a generalized behavior disorder but cannot be used to determine a diagnosis.¹⁰ Behaviors and emotional states are context specific. The clinic can be a stimulating environment that causes behaviors not seen elsewhere. Conversely, patients may not display behaviors in the clinic that are displayed elsewhere.

Clinical Signs & Sleep Assessment

Clinical signs that indicate a behavior disorder include frequent signs of fear, anxiety, and stress in and/or outside the home; expression of more intense behavior than expected based on the situation (eg, dog greeting by jumping and showing wiggly body language but also biting with force); prolonged recovery from stressful events; exaggerated startle response to seemingly benign stimuli; and decreased or increased time resting or sleeping compared with what is considered typical for the species.^9,11,12

Conclusion

If a behavior complaint is mentioned during examination for a separate issue, the importance of a full evaluation should be emphasized and a separate visit scheduled. Diagnosis and/or treatment recommendations should not be given prior to gathering baseline information. Inadequately or incorrectly diagnosing or treating a behavior concern can perpetuate the patient’s negative welfare.