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Basics ⬇

Basics

Overview

Thunderstorm phobia is a disorder in which there is persistent and exaggerated fear of storms or the stimuli associated with storms. Fears of noises other than thunder also occur, such as fireworks or gunshots. Pathophysiology involves physiologic, emotional, and behavioral components.

Systems Affected

  • Behavioral-avoidance or escape attempts.
  • Cardiovascular-tachycardia.
  • Endocrine/Metabolic-increased cortisol levels, stress-induced hyperglycemia.
  • GI-inappetence, gastrointestinal upset.
  • Musculoskeletal-self-induced trauma resulting.
  • Nervous-adrenergic/noradrenergic overstimulation.
  • Respiratory-tachypnea.
  • Skin-displacement grooming.

Signalment

  • Occurs in dogs and cats, but dogs more often presented for treatment. Cats with noise aversion might present with redirected aggression.
  • No association with sex or neuter status.
  • Any breed can be affected. In one study, thunderstorm phobias were most prevalent in herding breeds.
  • Dogs may begin exhibiting signs as puppies but may not be presented until adulthood.

Signs

Historical Findings

  • One or more of the following occurs during storms, or when the pet is exposed to the eliciting noise: panting, pacing, trembling, remaining near owner, hiding, salivating, destructiveness, vocalization, self-inflicted trauma, and inappropriate elimination.
  • Stimuli that can elicit fear during storms include rain, lightning, thunder, wind, and possibly static electricity and changes in barometric pressure.

Physical Examination Findings

Unremarkable, except if self-inflicted or escape-related injuries.

Causes & Risk Factors

May include combinations of the following:

  • Lack of exposure to storms or noises early in development.
  • Unintentional reinforcement by owner.
  • Highly aversive experience, such as exposure to a violent storm.
  • Genetic predisposition for emotional reactivity.

Diagnosis ⬆ ⬇

Diagnosis

Differential Diagnosis

  • Conditions causing similar behavioral responses include separation anxiety, barrier frustration, and other phobias.

  • Underlying medical conditions including pain, GI, endocrine or dermatologic should be ruled out.

CBC/Biochemistry/Urinalysis

Results should be within normal ranges.

Other Laboratory Tests

Tests for thyroid or adrenal disease may be indicated.

Imaging

Radiographs to help identify sources of pain.

Diagnostic Procedures

Skin biopsies if a primary dermatologic condition is suspected.

Treatment ⬆ ⬇

Treatment

Environment

Avoid crate confinement if risk of injury.

Behavior Modification

  • Neither punish nor attempt to comfort the animal during noise exposures or storms.
  • Desensitization involves exposure to a recorded stimulus at a volume that does not elicit fear. The volume is gradually increased only if the animal remains relaxed.
  • Counter-conditioning involves teaching a response (sit, relax) that is incompatible with the fear response. Food rewards are often used to facilitate learning.
  • Audio recordings of noises or storms are commercially available.
  • Improper use of these exercises can worsen the condition.
  • Exercises will be ineffective if the animal does not react to recorded thunderstorm sounds.

Medications ⬆ ⬇

Medications

Drug(s) Of Choice

  • Use of medications is considered extra-label.
  • Azapirones, TCAs, and SSRIs require 2–4 weeks for effect and must be given daily during storm season to control anxiety. They can be used in combination with fast-acting medications.

Medications for Acute, Short-Term Control of Anxiety or Adjunctive Use

Benzodiazepines

Alpha-2 Adrenergic Agonists

Clonidine-dogs, 0.01–0.05 mg/kg PO q6–24h prn

Serotonin-2 Antagonists, Reuptake Inhibitors

Trazodone-dogs, 2–10 mg/kg PO q12–24h

Azapirones

Buspirone-dogs, 0.5–2.0 mg/kg PO q8–12h; cats, 2.5–7.5 mg/cat PO q12h

GABA Agonists

Gabapentin-dogs, 10–20 mg/kg PO q12h; cats, 5–10 mg/kg PO q12h

Medications Used Daily Year Round or Throughout Thunderstorm Season

Selective Serotonin Reuptake Inhibitors

  • Fluoxetine-dogs, 1–2 mg/kg PO q24h; cats, 0.5–1 mg/kg PO q24h
  • Paroxetine-dogs, 1 mg/kg PO q24h; cats, 0.5–1 mg/kg PO q24h
  • Side effects: inappetence and irritability

Tricyclic Antidepressants

  • Clomipramine-dogs, 2 mg/kg PO q12h; cats, 2.5–5 mg/cat PO q24h
  • Side effects: sedation, GI and anticholinergic effects, and cardiac conduction disturbances.

Phenothiazine Tranquilizers

  • Acepromazine-dog 0.1–1 mg/kg PO q6–8h
  • Poor anti-anxiety properties
  • Use only if further sedation needed to prevent injury.

Contraindications/Possible Interactions

  • Use benzodiazepines with caution in cats and aggressive dogs-disinhibition of aggression possible.
  • Avoid using TCAs and phenothiazines in breeding males, patients with seizure disorders, cardiac disease, diabetes mellitus, glaucoma, or thyroid disease.
  • Decrease dose or avoid use of these medications in geriatric patients and patients with impaired hepatic or renal function.
  • TCAs, SSRIs, SARIs, and phenothiazines should never be combined with monoamine oxidase inhibitors.

Follow-Up ⬆ ⬇

Follow-Up

Patient Monitoring

With medication use, CBC and biochemistry profiles should be monitored periodically.

Prevention/Avoidance

  • Puppies and kittens should be exposed to a variety of stimuli under benign conditions.
  • Ignore mild signs of anxiety during storms to avoid reinforcing these behaviors.

Possible Complications

Severe injuries and property damage

Expected Course and Prognosis

Prognosis depends on severity, duration, and the ability to prevent injuries. The condition can progress if left untreated.

Miscellaneous ⬆

Miscellaneous

Abbreviations

  • GI = gastrointestinal
  • SARI = serotonin-2 antagonist reuptake inhibitor
  • SSRI = selective serotonin reuptake inhibitor
  • TCA = tricyclic antidepressant

Author Lynne M. Seibert

Consulting Editor Gary M. Landsberg