The behavior of a dog experiencing anxiety or conflict may include licking its nose and lips repeatedly, yawning, shaking its head, or pacing, in addition to the more obvious signs such as cowering with its head and tail tucked and attempting to hide. Anxiety may also be accompanied by increased heart and respiratory rates, salivation, and dilated pupils, although these signs may be difficult to differentiate from those shown by many animals anxious about being in the veterinary clinic.

Situations that may lead to anxiety, conflict, or frustration include insufficient stimulation, alterations in routine, inconsistency of owner interactions such as improper use of punishment, the addition or departure of family members including other pets, and intense or recurrent fear-provoking events.² In addition, since temperament plays an important role in the development of anxiety-related behavior problems, veterinarians should learn to recognize the signs that a dog has a fearful or anxious temperament.

Keep in mind that multiple causal factors play a role in the development of many behavior problems, and anxiety-related and compulsive disorders are no different. Often, the situation or medical condition that elicits a problem is not be the same one that maintains it,² making the collection of the behavior and medical history critical to an accurate diagnosis. For example, medical conditions that cause pain or discomfort may lead to anxiety, and the anxiety may lead to displacement behaviors that with time can become compulsive behaviors. Because of this, correcting a medical condition may not always result in an immediate change in a behavior; behavior modification and environmental management (see below) may still be needed to change the behavior.

Once it has been determined that the licking is a primary behavior problem stemming from anxiety, conflict, or frustration, treatment should consist of a combination of behavior modification, environmental management, and pharmacologic intervention.¹⁰ Using only one of these three components decreases the likelihood of achieving long-term success. The goal of these treatments is to decrease the anxiety and conflict that might have led to the compulsive disorder.^2,8

As part of treatment, remind the owner to ignore the dog every time it begins to perform the behavior. Even if it is not the primary cause, an owner inadvertently rewarding the dog for licking can contribute to the persistence of the behavior.

Environmental management

The primary aim of therapy is to provide the dog with an environment that is as free of anxiety and conflict as possible, is appropriately stimulating (allows for normal species-typical behaviors), and in which owner interactions are predictable and consistent.^2,8 Whenever possible, the source of conflict should be identified and removed from the animal's environment. When the source of anxiety or conflict cannot be removed (e.g. a new baby or pet), then desensitization to the anxiety-inducing stimuli should be attempted. Desensitization procedures have been well-described elsewhere.¹⁶

If the dog is not being provided with adequate exercise, encourage the owner to find ways to increase the dog's exercise that fit with their lifestyles. Although this may simply mean longer walks, aerobic exercise, such as chasing a ball or participating in flyball or agility training, is ideal. Many owners need to be taught that leaving a dog in the yard all day does not guarantee that it is getting adequate exercise. Most dogs, especially those living in single-pet households, do not exercise themselves. They sleep most of the day and wait for their owners to come home and then attempt to initiate interactions with them.

Enriching the dog's environment with a variety of interactive objects,² such as toys that move or make noise when the dog interacts with them or toys that dispense food (e.g. Kong or Busy Buddy [Premier], Buster Cube [Kruuse A/S]), gives the dog an opportunity to get some exercise while home alone. It also allows the dog to exhibit normal species-typical behaviors, such as chewing and exploring. Each dog's preferences may need to be explored to determine what type of objects will most appeal to it. The toys should be rotated regularly so that they continue to be new and interesting to the dog.