How to Deal with Anxiety and Distress Responses: Cats and Elimination, and Cats and Aggression

Karen L. Overall, MA, VMD, PhD, DACVB, ABS Certified Applied Animal Behaviorist

Feline elimination disorders:

The most common feline behavioral problems involve inappropriate elimination behavior. This inappropriate behavior can take the following forms: substrate or location aversion, substrate preference for urination, defecation, or both, location preference for urination, defecation, or both, and spraying. This is one set of behavioral problems that requires a substantial medical work-up and rigorous follow-up.

1.  Aversions to substrates or location can be difficult to distinguish from preferences, and invariably lead to the cat choosing another location or substrate for elimination. It may never be clear why the cat has developed an aversion to one location or one substrate; when this occurs it becomes apparent because of the cat's total avoidance of the offending area or surface. In cases involving aversions that have developed in response to an horrific experience, some owners have reported that the animal will hiss, growl, slink, or piloerect when found in proximity to the substrate or area. Declawing coupled with premature return to gravelly kitty litter has been implicated in the development of some aversions to substrate. For ultra fastidious cats, vomit or diarrhea, either their own, or a house mate's, may induce the same response. Location aversions are more often coupled to fearful or painful situations, such as injuries caused by doors or torment from another cat or a child. If a cat is absolutely avoiding a specific area or substrate for elimination, they will find another until they are presented with suitable options. This is discussed below in the specific preference categories.

2.  Substrate preferences for elimination are extremely common, particularly among long haired cats. This means that the cat prefers some other substrate than its litter for elimination. Although the substrate preferred is usually softer (sheets, underwear, bath mats, plastic trash bags), this does not have to be so, and some cats prefer open, reflective areas such as linoleum, wood floors, tiles, and bathtubs. The ancestral and wild condition for elimination in felids resembles the latter. This problem can develop spontaneously or be induced. Many owners complain of the problem after an extended vacation where someone fed their cat, but would not change the litter. The cat is repulsed by the filthy litter, seeks another area from desperation, and discovers that it prefers this substrate. Illness can also be implicated in the development of a preference; a cat with cystitis or diarrhea may not be able to make it to the litter box and in the process of covering up the urine or feces on the carpet, discovers that it likes carpeting. Cats who a reintroduced to hard litter too soon after declaw frequently develop a substrate aversion and subsequently identify a new preference. Treatment involves environmental and behavioral modification and may require pharmacological intervention. First, a physical exam is essential. This must include a complete urinalysis or fecal, depending on the nature of the problem, and might include blood work. A large number of cats (estimates hover around 1/3) with substrate preferences who either do not respond, or start to respond to environmental and behavioral modification and then relapse have apparent or occult UTIs. If the fecal/UA is positive, treat and suggest environmental/behavioral modifications, also, since as a result of the illness the cat could have shifted his preference.

3.  Location preferences require many of the same strategies as for substrate preferences, especially since many location preferences appear to be mixed substrate preferences. In a true location preference, the cat prefers one or a few areas for urination or defecation; none of these is generally its litter box. Cleaning and covering should be done as above. Then, a litter box with a litter the cat likes can be placed in the area. If the cat starts to use it, terrific. After a week or two the box can be slowly (1-2 inches per day) moved to a more appropriate area. The client should watch for relapses or sneaky elimination in new spots. If this doesn't work, the cat may respond to counter-conditioning: food dishes can be placed in the affected areas. Generally, cats will not eliminate where they are fed. Some will. If the number of locations is great, this will not work. If it is possible to rearrange the furniture so that the cat's favorite spot is covered, this should be done. Sometimes the cat shifts its spot; often this is suggestive of a mixed substrate preference. An in depth history of every area ever used for elimination is essential. Confinement and the protocol above should then be implemented. A note on cleaning: all layers must be cleaned. If the problem has been ongoing for some time the odor has soaked through the floor. In some cases floor boards need to be replaced, as does carpeting and padding. This is especially true if subfloors are involved.

4.  Spraying can be done by male or female, intact or neutered animals. Clients often confuse spraying with urination. Encourage them to describe postures and note locations. If the cat is standing, wiggling its tail with a look of bliss on its face it is spraying. Sprayed urine hits vertical surfaces and drips down. Cats can also stand in the middle of a horizontal surface, such as a bed, a spray, in which case they will leave a long, thin wet area, rather than a puddle. Have clients crawl on their hands and knees over every inch of carpet; if there is urine in a puddle in the middle, but no where else, the cat is not spraying. Spraying can be triggered by hormones, in the affected cat or another in the household, by the addition of a new animal, by the visitation of a strange cat to windows or sliding glass doors, by partial obstructions, by seasonal changes, and by events only understood by cats. The above protocol for cleaning and litter box care should be followed. Many cats will spray against the inside of covered boxes. Regardless, the key to treating spraying is pharmacological.

First, any underlying medical cause (FLUTD, cystitis, UTI, obstruction, anatomical abnormalities) must be ruled out. Should there be no apparent medical cause treatment can proceed with diazepam (1.0-3.0 mg per cat q 12-24 h.). Diazepam, when used correctly, will control spraying in 75-90% of all cats. Generally, cats for whom it is successful will stagger mildly, with impaired depth perception for a few days; staggering should resolve spontaneously by the end of the week. Some cats may need to be on diazepam for a few weeks, some seasonally, some forever. The lowest effective dose should be used. Some cats who do respond to diazepam require a benzodiazepine with a longer half-life. Clorazepate dipotassium (Tranxene SD) at 0.55-2.2 mg per kg prn can be used; however, if the cat did not respond to diazepam, it may not respond to this.

A few cautionary notes regarding benzodiazepines. Clients should be cautioned that this is a humanly abusable drug. Clearly, some clients should not be given diazepam for their cat since it provides them with ready access to a controlled substance. While the cats do not get "hooked", a fear of many clients, blood work should be instituted on a regular basis to check for iatrogenic disturbances if the animal is on any drug for any length of time. There is some recent concern that the exceptional cat may develop hepatic failure when exposed to benzodiazepines. This needs to be more fully investigated and clients should be advised to watch for any signs of hepatopathy.

Tricyclic antidepressants (TCAs) act to inhibit serotonin re-uptake, and can be useful for some cats that spray, some who are averse to or anxious about their litter box, and cats who are experiencing anxiety about heir social situation. Drugs of choice include amitriptyline and its active intermediate metabolite, nortriptyline ( both at 0.5-1 mg/kg po q. 12-24 h). Clomipramine (Anafranil) (0.5 mg / kg po q. 24 h) may be an excellent drug for spraying, and is more specific in its serotonin re-uptake properties, as might the selective serotonin re-uptake inhibitors including paroxetine (Paxil) and fluoxetine (Prozac) Studies are currently underway that evaluate effects long-term treatment with clomipramine on feline spraying

Buspirone (BuSpar) is a newer non-specific anxiolytic. In cases where benzodiazepines and, or progestins fail it has been successful in controlling spraying, even in cats for whom spraying is associated with intercat aggression. It appears to have comparable side effects of many anti-anxiety drugs and owners should be warned that potential side effects include inappetence, lethargy, and possible interference with thyroid medication. If the symptoms are not transient, the drug should be withdrawn. The dose is 2.5-5 mg per cat q. 8-12 h.. The rationale for trying this drug latter, rather than earlier includes its cost and the fact that we just don't know as much about it in small animals as we do the other drugs. This will change in the next few years and the cost is not prohibitive for an animal a small as a cat.

The new treatment involving a synthetic analogue of feline cheek gland secretions (e.g, pheromones) (Feliway�; Abbott Laboratories) may show some promise for spraying that either has recently started and is related to the introduction of a new individual (human or animal), or to disruptions in the colony scent. No double-blind studies have been conducted, and the need for such studies is more critical in this situation than in those involving some oral medications because of the manner in which the pheromone is applied and the need for clients to be cautious in their interpretations. One study that has examined the use of Feliway for the treatment of spraying (Frank et al., 1998; Applied Animal Behavior Science) found that in many cases there was a statistically significant reduction in spraying, but few to no cats stopped spraying all together. That's to be expected if the problem is about anxiety and not about the actual pheromonal environment. In some cases the concomitant use of pheromonal agents and anti-anxiety medications may produce a quicker resolution than would be produced by either alone. The neurochemical mechanism by which such pheromonal sprays may work is unknown, but it might be worthwhile, given the patterns of findings in the Frank study, to explore the extent to which pheromones can act as aerosolizable anxiolytics.

Should none of these medications and modifications alter the cat's behavior, or should the client not wish to try drugs, options are limited. Often, making the cats into indoor/outdoor cats helps. Even if the cat is declawed, this may be an option if the owner is otherwise planning to euthanize the cat. Surgeries may be options of last resort.

A few general precautions: First any cat who doesn't respond to the above therapies should be medically worked up again. At VHUP, cultures reveal many infections not apparent on regular screens. Sometimes 2-3 UAs and 1-2 cultures are necessary before the complicating medical etiology is revealed. Tell clients this. Second, any multi-cat household will have greater problems. If one cat is spraying, chances are the others are, too. Once there are 10 or more cats in the household the chance of someone spraying at some point is 100 % Clients will deny it, but tell them anyway; many will call back to tell you they finally saw the third cat spray. Finally, watch out for bullies. The reason the kitten may not use the litter box is because someone else sits on top of, or behind it and swats the kitten every time it approaches.

Feline aggression: associations with elimination disorders:

Feline social systems differ from those of dogs primarily in the extent to which solitary versus social daily activities are prevalent. It is not surprising that the types of inappropriate aggression witnessed by owners differ and that they are understandable given the evolutionary context of feline social systems and the developmental context of sensitive periods. The latter is discussed in the handout on normal feline behavior.

Categorization of feline aggression is similar to that of canine aggression; differences in the manifestation of the aggressions may be attributable to differences in mating behaviors and differences in social hierarchies. Feline aggression includes:

•  aggression due to lack of socialization

•  play aggression

•  intercat aggression: most commonly male - male

•  territorial aggression

•  fearful aggression

•  maternal aggression

•  redirected aggression

•  >predatory aggression

•  assertion or status-related aggression.

Aggression due to lack of socialization: Cats who have not had contact with humans prior to 3 months of age have missed sensitive periods important for the development of normal approach responses to people. Lack of such socialization with other cats may result in the same lack of normal inquisitive response to other cats. Furthermore, total isolation from cats can have negative consequences for future interaction with humans. This constellation of deprivation scenarios may be contributory to many of the aggressions seen in urban, feral cats. These cats will never be normal, cuddly pets, although they may attach to one person or a small group of people over a period of time. If forced into a situation involving restraint, confinement, or intimate contact, these animals may become extremely aggressive.

Play aggression: Cats who were weaned early and then hand raised by humans may never have learned to temper their play responses. Social play in cats peaks early and is replaced by more predatory activities by weeks 10-12 and by social fighting by week 14. Cats who, as kittens, never learned to modulate their responses may play too aggressively with owners. These cats may not have learned to sheathe their claws or inhibit their bite. It is not clear if there is a component of oral response associated with an owner who bottle fed the cat. Were the kitten to nurse too hard on the mother or hurt her in play, the mother would have swiftly corrected the kitten. This appears to be less common among owners playing the nursing role, possibly because they are concerned about injuring the kitten. This is a valid concern; however, if they mimic feline behaviors such as neck bites an growls or hisses, the kitten learns to respond and inappropriate play behavior and play aggression may not develop. Should these problems still ensue, they are treatable using behavior modification.

Intercat aggression: Intercat aggression is common between toms. In most wild, feline social systems, few males mate with most of the females. The skewed sex ratio in the breeding population is induced and maintained by vigilance and aggression on the part of the males. There is an additional olfactory component of spraying and non-spraying marking that contribute to the rank aggression. The aggression is classic and involves flattened ears, howling, hissing, piloerection, threats using eyes, teeth, and claws an combat. Early neutering (prior to 12 months of age) decreases or prevents fighting by 90%. It is not clear if very early spaying and neutering programs would further reduce this, but given the hormonal facilitation of the aggression one would hypothesize that this would be the case. Intercat aggression is more commonly based on conflicts within social hierarchies than it is with sex. Cats begin to become socially mature some where between 2 and 4 years of age. At this time, some cats may begin to challenge others. Problems arise when one cat will not accept lack of engagement by another cat. Responses include passive aggression (staring and posturing), active aggression, and marking. Cats that consider themselves as more equal are less likely to participate in overt aggression - expect covert aggression. Intercat aggression is extremely complex, often subtle, and under-appreciated. A heuristic device for appreciating and understanding some of this complexity is found in Table 2.

Territorial aggression: Territorial aggression can be exhibited towards other cats or people. Such cats may delineate their turf by patrol, chin rubbing, or spraying or non-spraying marking. Because of complex, transitive, feline social hierarchies, a cat that is aggressive to one housemate, may not be aggressive to another. If the cat is defending and, or marking a turf, and the perceived offender crosses into it, threats and a fight may ensue. If part of the struggle involves social hierarchy, cats may lure or seek out their challengers and then attack after the territory has been invaded. Because of the social component, territorial aggression can be difficult to treat, particularly if there is a marking component. Any marking problem should act as a flag for a possible underlying aggressive situation. Environmental modification, behavioral modification, and pharmacological intervention are all treatment options; however, aggressions involving strong, underlying social strife are notoriously difficult to treat. Ultimately, one cat may have to be placed in another home or be banished to another region of the property.

Fear / fearful aggression: There are genetically friendly cats and genetically shy cats. It is unclear the extent to which shy cats have the potential to become fearfully aggressive, but there are cats who, despite the best socialization possible, become aggressive whenever fearful. These cats also may become fearful without an apparent stimulus. Regardless, if threatened, any cat will defend itself. Depending on the outcome of the treat, the cat can learn to become fearfully aggressive. This is particularly important if small children are involved, since they may not know how to appropriately respond to a cat that is crouching. Any animal that is corned and cannot escape has the potential to attack. It is imperative that the cat not learn that his or her only recourse is aggression since this could lead to them becoming aggressive in response to any approach. Behavior modification can be very effective early in the development of the condition. Pharmacological intervention can be a useful adjuvant. It is not clear if any intervention can be successful if the condition is genetic.

Maternal aggression: Maternal aggression, as in canines, may occur in the periparturient period. Queens may protect nesting areas and kittens, but the aggression is usually in the form of threats, with long approach distances, rather than attack. Such threats are usually directed towards unfamiliar individuals, but in inappropriate aggression can be directed towards known individuals. Avoidance is the strategy of choice, since a cornered queen can attack. As the kittens mature the aggression resolves.

Redirected aggression: Redirected aggression is seen in felines, as well as in canines; however, it can be difficult to recognize and may only be reported as incidental to another form of aggression. In redirected aggression, any interruption of an aggressive event between two parties by a third party results in redirection of the aggressive behavior to the third party or to another, uninvolved individual. It is important to realize that the interrupted aggressive event may only be a threat, so that the person (or animal) interrupting it may not realize what is occurring. Cats appear to remain reactive for an extended period of time after being thwarted in an aggressive interaction. Clients need to realize this and to be aware of the subtleties of their behavior that communicate their intent. Since redirected aggression is often precipitated by another inappropriate behavior, it is important to treat that behavior, as well. Treatment involves standard behavior modification techniques. If there is a socially mediated conflict within the household cats, some environmental modification may be necessary to decrease the extent to which the involved cats are capable of interacting. Owners should be encouraged to use inanimate objects (battery operated water pistols, buckets of water, foghorns, et cetera) to intervene between fighting animals. This minimizes danger to the owners and may have the benefit of aborting the behavior while teaching the cat that there are consistent, undesirable consequences to its inappropriate behavior.

Predatory aggression: Predatory aggression in felines is similar to that in canines. Hallmarks of this aggression include stealth, silence, heightened attentiveness, body postures associated with hunting (slinking, head lowering, tail twitching, and pounce postures in cats), and lunging or springing at a prey item that exhibits sudden movement after a period of quiescence. Solitary predatory behavior is developed quite young in kittens (5-7 weeks), and cats can become proficient hunters by 14 weeks of age. Cats can exhibit appropriate, although sometimes undesirable, predatory aggression to small animals. Belling cats can give some advance warning to small prey items, but is not usually sufficient to ablate predation because of the element of stealth. Scat mats and indoor invisible fences can be used to deter cats from seeking out other pets, but the best insurance that outdoor wildlife are not preyed upon is to deny the cat access to them. It's important to distinguish predatory aggression - a diagnosis and abnormal manifestation of behavior - from predatory behavior - usually normal feline behavior, and contextually appropriate, if undesirable. There is a lot of variability in feline temperament regarding predatory inclinations. Some cats have no interest in hunting, whereas other cats make inappropriate context distinctions about prey items. The latter situations become a concern if the prey item is the owner's foot or hand, or a young infant. Any cat who exhibits the pre-pounce behaviors described above in these contexts may be at risk for inappropriate predatory aggression. This is another good reason to never leave young infants alone, unattended, when pets are present. The cat that regards infants as prey items usually ceases to do so once the infants have matured sufficiently to demonstrate postural responses. Regardless, this is a potentially very dangerous situation and utmost caution is urged.

Assertion or status-related aggression: Assertion or status aggression has been described as the 'leave me alone bite' and most frequently occurs when being petted. The most similar situation in canines is dominance aggression; however, the divergent evolutionary history of canine and feline social systems argues that these are not homologous situations. These cats share with dogs with similar problems the need for control of the situation. Nothing the owner did provoked the cat; rather the cat demonstrates a desire or need to control when the attention starts and when it ceases. Some cats do this by biting and leaving, while the occasional cat with take the owners's hand with its teeth, but not bite. Fortunately, owners can be taught observe signs of impending aggression (tail flicking, ears flat, pupils, dilated, head hunched, claws possibly unsheathed, stillness or tenseness, low growl) and interrupt the behavior at the first sign of any of these by standing up and letting the cat fall from their lap or abandoning the cat and refusing to interact until the cat is exhibiting an appropriate behavior. Clients should be discouraged from direct physical correction of the cat, since the cat may view that as a challenge and intensify its aggression. If the cat does not respond to passive control or redirects its aggression, it is safer to counter the behavior with a fog horn or a battery operated water pistol. Corrections must occur within the first 30-60 seconds of the onset of the inappropriate behavior to insure learning; corrections within the first second are best. Clients having such cats should be aware that their cats are never going to be hugely cuddly, although, if the client can refrain from petting them, they may be willing to sit quietly on the owner's lap for extended periods.

Table 1: Heuristic model for thinking about phenotypic patterns of feline aggression:

Potential axes:

•  overt v. covert aggression

•  active v. passive aggression

•  offensive v. defensive aggression

Sample scenarios:

•  overt, passive, offensive aggression: confident cat staring when another enters room

•  overt, passive, defensive aggression: less confident cat leaving room or backing up and withdrawing into smaller space, tail tucked vocalizing

•  covert, passive, defensive aggression: vanquished or less confident marking with mystacial glands in boundary areas or areas from which cat had been displaced

•  covert, active, offensive aggression: vanquished or less confident marking with urine or feces in boundary areas or areas from which cat had been displaced

•  overt, active, offensive aggression: chase and attack using teeth and accompanied by vocalization by resident cat toward new cat in environment

•  overt, active, defensive aggression: attack or response using hitting and or swatting while leaning back or avoiding further pursuit

•  covert, active, defensive aggression: withdrawal and marking of restricted area by victim cat

•  covert, passive, offensive aggression: displacement or theft of "bully" or higher ranking cat's toys, bed, food, or hidden copulations (?), accompanied by non-elimination pheromonal marking

References:

1.  Beaver BV: House soiling by cats: a retrospective study of 120 cases. JAAHA 1989;25:631-637.

2.  Beaver BV: Feline Behavior: A Guide for Veterinarians. W.B. Saunders Co., Philadelphia, 1992.

3.  Borchelt PL: Cat elimination behavior problems. Vet Clin NA: Sm Anim Pract 1991;21:257-264.

4.  Bernstein P, Strack M: A game of cat and house: Spatial patterns and behavior of 14 domestic cats (Felis catus) in the home. Anthrozo�s 1996;IX: 25-39.

5.  Bernstein P, Strack M: Home ranges, favored spots, time-sharing patterns and tail usage by fourteen cats in the home. Anim Behav Cons Newslt 1993;10(3):1-3.

6.  Bertilsson L, Baillie TA, Reveriego J. Factors influencing the metabolism of diazepam. Pharm Ther 1990;45:85-91.

7.  Bertram BCR: Social factors influencing reproduction in wild lions. J Zool 1975;177:463-482.

8.  Borchelt PL, Voith VL. Aggressive behavior in cats. Comp Cont Educ Prac Vet 1987;9:49-56.

9.  Buffington CAT, Chew DJ, DiBartola SP: Interstitial cystitis in cats. Vet Clin NA: Sm Anim Pract 1996;26:317-326.

10. Burt WH: Territoriality and home range concepts as applied to mammals. J Mammalogy 1943;24:346-352.

11. Center SA, Elston TH, Rowland PH, Rosen D, Reitz BL, Brunt IE, Rodan I, House J, Banks S, Lynch L, Dring L, Levy J: Fulminant hepatic failure associated with oral administration of diazepam in 12 cats. JAVMA 1996;209:618-625.

12. Coop CF, McNaughton M. Buspirone affects hippocampal rhythmical slow activity through serotonin1A rather than dopamine D2 receptors. Neuroscience 1991;40:169-174.

13. Cooper L, Hart BL. Comparison of diazepam with progestin for effectiveness in suppression of urine spraying behavior in cats. JAVMA 1992;200:797-801.

14. File SE: Interactions of anxiolytic and antidepressant drugs with hormones of the hypothalamic-pituitary-adrenal axis. Pharm Ther 1990;46:357-375.

15. Frank DF, Erb HN, Houpt KA. Urine spraying in cats: presence of concurrent disease and effects of a pheromone treatment. Appl Anim Behav Sci 1999;61:263-272.

16. Hart BL, Cooper L. Factors relating to urine spraying and fighting in prepubertally gonadectomized cats. JAVMA 1984;184:1255-1258.

17. Hart BL, Eckstein RA, Powell KL, Dodman NH. Effectiveness of buspirone on urine spraying and inappropriate urination in cats. JAVMA 1993;203:254-258.

18. Hughes D, Moreau RE, Overall KL, Van Winkle TJ. Acute hepatic necrosis and liver failure associated with benzodiazepine therapy in cats. JVECC 1996;6(1): 13-20.

19. Jaeken J, Casaer P, Haegele KD, Schlechter PJ. Review: normal and abnormal central nervous system GABA metabolism in childhood. J Inher Metab Dis 1990;23:793-801.

20. Macdonald DW, Apps PJ, Carr GM, Kerby G. Social dynamics, nursing coalitions, and infanticide among farm cats, Felis catus. Adv Ethology [Supplement to Ethology] 1987;28:1-64.

21. Moynihan M. Control, supression, decay, disappearance and replacement of displays. J Theor Biol 1970;29:85-112.

22. Moynihan M. Why is lying about intentions rare during some kinds of contests? J Theor Biol 1982;97:9-12.

23. Olm DD, Houpt KA. Feline house-soiling problems. Appl Anim Beh Sci 1988;20:335-345, 1988.

24. Osborne CA, Kruger JM, Lulich JP, Polzin DJ: Feline lower urinary tract diseases. In: Textbook of Veterinary Internal Medicine, eds. Ettinger SJ, Feldman EC. WB Saunders and Co., Philadelphia: 1805-1832, 1995.

25. Overall KL: Clinical Behavioral Medicine for Small Animals, Mosby, St. Louis, 1997.

26. Wemmer C, Scrow K: Communication in the felidae with emphasis on scent marking and contact patterns. In: How Animals Communicate. Edited by TA Sebeok, Indiana University Press, Bloomington: 749-766, 1977.