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How to identify, treat self-injurious patients
Keys to differentiating behavior patients from allergic and endocrine patients—and how to treat them


DVM360 MAGAZINE


Categorizing, defining self-injurious behaviors


Table 1: Categories of compulsive disorders*
Self-injurious behaviors in pets can be compared to the human equivalency of trichotillomania and obsessive-compulsive disorders (OCD), although these diagnoses aren't all inclusive.
  • Trichotillomania: In people, this disorder is defined as the recurrent pulling out of one's hair. The disturbance isn't accounted for by another mental disorder, such as OCD, or to a general medical disorder, such as a dermatologic condition.1 Displacement and stereotypical grooming in pets may fall under this description and are discussed below. Self-injurious behavior may relieve emotional pain or discomfort in some people.2
  • Compulsive disorders: OCD in people is defined as repetitive behaviors one feels driven to perform. The behaviors are mental acts aimed at preventing or reducing distress. These behaviors, however, aren't connected with what they were designed to neutralize or are clearly excessive.1 Whether obsessive thoughts occur in animals has been debated, so many behaviorists label OCD-type conditions in animals as simply compulsive disorders. In veterinary behavior medicine, compulsive disorders have been defined as sequences of movements that serve no obvious purpose or function, occur repetitively, are out of context or at an excessive frequency or duration, interfere with the patient's ability to function normally in its social environment and persist regardless of the environment.3,4 Compulsive behaviors are usually derived from behaviors that are part of the animal's normal repertoire and are categorized according to their origin (Table 1).
  • Stereotypies: Other behaviors can be repetitive but aren't necessarily classified as compulsive. A stereotypy is a display of a repetitive behavior that serves no apparent function.4 Stereotypies also are often extensions of a normal behavior such as locomoting or grooming. To establish the behavior as compulsive, it must interfere with the patient's ability to function normally and persist regardless of the environment.3,4
  • Displacement behaviors: These behaviors are exhibited when a pet is in a state of conflict or is frustrated because it is unable to achieve a goal. Conflict occurs when the animal is motivated to perform two opposing behaviors. Frustration occurs when a pet is motivated to perform a behavior but is unable to do so. The animal may respond with a displacement behavior (that can include grooming-type responses) considered inappropriate or out-of-context with respect to the stimulus.
  • Attention-seeking behaviors: These behaviors can also be repetitive but occur only in the presence of the owner and are performed by the animal to receive a reward from the owner (often involving attention or affection). The behavior may not have started as an attention-seeking response, but rather a displacement or random behavior that the owner may have inadvertently reinforced.

Diagnosis

A self-mutilatory behavioral disorder should be diagnosed only after a thorough dermatologic and medical evaluation. Even after a presumptive behavioral diagnosis is made, secondary medical complications may exist that need to be treated (e.g., infection associated with self-induced injuries). Medical problems can be the initiating cause for some compulsive behaviors that later are maintained for other reasons.

The dermatologic workup for these disorders includes skin scrapings, cultures, biopsies, serum chemistry profiles that include endocrine testing, diet trials, tests for parasites, allergy testing, etc. Neurologic and orthopedic examinations and associated diagnostics also are warranted in many cases, as pain and neuropathies can contribute to self-damaging behaviors.

A comprehensive behavioral history should be taken, including:
1. Signalment
2. Description or video of the behavior including:

  • When the behavior started and its progression
  • When the behavior occurs
  • Pattern (times or situations)
  • What precedes the event
  • If the behavior can be interrupted
  • Intensity and duration

3. Any changes in family, home environment, schedules
4. Concurrent medical conditions and medications
5. Owner's response to the problem
6. Specific types, amount and frequency of exercise
7. Form, duration and frequency of interactions with owners and others.


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Source: DVM360 MAGAZINE,
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