Hyperesthesia syndrome

Cutaneous sensory disorders are conditions in which a patient experiences a purely sensory complaint without clinical evidence of a dermatologic, neurologic, or medical condition.^1,11 In people, the pathogenesis is typically not identifiable, and the results of diagnostic tests prove unremarkable. Cutaneous sensory disorders occur in both dogs and cats. While dogs may have a disparate array of clinical signs, cats often have a more consistent pattern of signs characterized as feline hyperesthesia syndrome. Behaviors noted in affected cats may include 1) intense grooming behaviors, particularly directed at the tail, flank, anal, or lumbar areas; 2) rippling or twitching of the skin of the dorsum; 3) avoidance behaviors (running, jumping, hiding) in response to no identifiable, tangible stimulus; 4) avoidance or aggression in response to tactile stimulation, particularly of the dorsum; 5) distress vocalizations; and 6) behaviors similar to those observed in estrous females, such as increased motor activity, rolling, and crouching with elevation of the perineal region. Clinical signs may be variable, consistent, or episodic. Affected cats tend to be difficult to distract from the behaviors, or if successfully distracted, they remain so for only a short time.

CLINICAL MANAGEMENT

A thorough behavioral history, including considering the physical and social environment and directly observing the animal engaging in the self-directed behavior, is critical to effective clinical management. A videotape of the patient's behavior may not only be necessary to observe the behaviors, but may be complementary to direct observation by revealing environmental and social contexts in which the behavior occurs and providing an opportunity for more detailed analysis of behavior.

Effective behavioral management of patients with self-directed behaviors must integrate the treatment of concurrent medical conditions (primary and secondary), environmental management (addressing relevant social and environmental factors), and behavior modification. Pharmacologic support may be incorporated as well and, in my experience, is unlikely to be effective without concurrent medical treatment, environmental management, and behavior modification.

Environmental management and behavior modification

Because an animal's response to its environment may substantively contribute to self-directed behaviors, it is important to attempt to resolve or minimize any social or environmental stressors in the initial management of patients with self-directed behaviors. Behavior modification and pharmacologic support may be substantially hindered or ineffective if the provocative social and environmental factors are not addressed.

Since self-directed behaviors are often associated with emotional states of stress, anxiety, or arousal, behavior modification can minimize the stress response when the animal is exposed to these stimuli. Counterconditioning (establishing a different response to a provocative stimulus by engaging in a competitive behavior or activity) is an effective behavior modification technique to reinforce behaviors that encourage relaxation.¹² Appropriate responses are supported with encouragement, affection, and small food rewards as positive reinforcement. Rewards when the patient is relaxed and the problem behavior is absent can augment active counterconditioning. Massage therapy, when the patient is relaxed, can further facilitate relaxation and encourage appropriate interaction between the animal and client.

Desensitization (graduated exposure to a provocative stimulus to minimize a response) may be incorporated to further reinforce relaxed responses. For desensitization to be effective, the patient must accept the direction and leadership of the client. Deference to the client can be established through routine and regular reinforcement of leadership on a daily basis.

Although clients may be frustrated with the problem behaviors, they should avoid expressing it in any way in the presence of the patient. Physical or verbal expressions of the clients' frustration may reinforce any anxiety that the animals are experiencing. Neither should the client provide any measure of comfort—verbal, physical, or emotional—to the patient when it is behaving inappropriately. A client's withdrawal while an animal is engaging in the self-directed behavior (negative punishment) can decrease the incidence of the behavior and prevent the client from inadvertently reinforcing the behavior. In the case of attention-seeking behaviors, client responses to the patient should be minimal while an animal is engaging in the self-directed behavior. Attempts to distract or punish the behavior reinforce the behavior.

Specific protocols using the above noted behavior modification techniques are provided in a number of current veterinary behavioral medicine texts.