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Basics ⬇

Basics

Definition

  • Fear is the feeling of apprehension resulting from the nearness of some situation or object presenting an external threat. The response of the autonomic nervous system prepares the body for “freeze, fight, or flight.” As such, it is a normal behavior, essential for adaptation and survival.
  • Anxiety is the anticipation of dangers from unknown or imagined origins that results in physiologic reactions associated with fear. Anxiety may occur in the aftermath of a fear-producing event or as a result of unrelated environmental changes that are unpredictable.
  • A phobia is a persistent and excessive fear of a specific stimulus, such as a thunderstorm or separation from an attachment figure.

Pathophysiology

  • Stress responses become problematic when the individual is not able to control the stressful situation by his or her actions or escape from it through appropriate behavioral responses.
  • Chronic anxiety or fear can lead to secondary behavior problems, such as overgrooming, spraying, or intercat aggression, or predispose the cat to health problems owing to a compromised immune system.

Systems Affected

  • Behavioral-hypervigilance, avoidance behaviors, possible aggression if handling or restraint attempted.
  • Cardiovascular-increased heart rate and blood flow to internal organs during fear-evoking incidents.
  • Endocrine/Metabolic-glucose release into the bloodstream, release of glucocorticoids.
  • Gastrointestinal-decreased appetite.
  • Hemic/Lymphatic/Immune-chronic stress effects on immune function.
  • Musculoskeletal-weight loss over time as response to chronic stress effects on appetite, decreased food intake due to hiding behavior.
  • Neuromuscular-may see a decrease in activity due to avoidance and hiding. Fearful/anxious reaction may also include pacing, trembling, repetitive activity.
  • Ophthalmic-dilated pupils in response to autonomic nervous system stimulation.
  • Respiratory-increased respiratory rate when anxious or frightened.
  • Skin/Exocrine-may show signs of secondary problem behavior such as overgrooming.

Genetics

  • Genetic component unknown but possible.
  • Breed/coat color and paternal personality have been linked to individual personality traits in cats.

Signalment

Any age, sex, or breed

Signs

General Comments

  • Signs of fear or anxiety can vary between individuals and with different stimuli.
  • In mild cases of anxiety or fear, the cat may become tense and more reactive to environmental stimuli. Some individuals may retreat to perceived safe hiding places or show little movement. Cats in a panic can become very aggressive or destructive in their attempts to get away from the thing they fear.
  • Stimuli triggering anxious or fearful responses may be very specific (a particular individual, noise, or situation) or more generalized.

Historical Findings

  • Obtain a clear description of the cat's body language, behavior, and events or situations that consistently trigger anxiety or fear. Information about specific triggers associated with anxious or fearful behavior may be helpful in setting up a behavioral modification and environmental management program.
  • Body postures associated with fearful behavior include ears flattened to the back or to the side of the head, crouched body posture when resting or moving, lowered head, tail tucked alongside the body or held low, piloerection, “Halloween cat” silhouette.
  • Pupils are often dilated; cat may be panting, shaking, drooling, or shedding hair.
  • If the fear is intense, cat may lose bladder and bowel control, express its anal sacs.
  • Vocalizations are usually minimal, unless the cat is showing defensive behavior in response to a perceived threat.
  • The cat may pace, vocalize, and solicit attention from the owner.
  • Urine spraying, destructive scratching may be seen in anxious cats.
  • Details of the cat's early life, if known, may indicate a history of poor socialization and environmental exposure or possible genetic influences, feral ancestry.

Physical Examination Findings

Usually unremarkable unless the cat has injured itself trying to escape or while seeking shelter during its fright. Cats in veterinary clinics often show behavior markedly different from what is seen at home.

Causes & Risk Factors

Fearful behavior in cats can be related to the following factors:

  • Genetic influences on temperament.
  • Lack of positive early experience and socialization, observational learning from fearful mother, other adult cats.
  • Learning from negative experiences.
  • Social stress, population pressure.

Diagnosis ⬆ ⬇

Diagnosis

Differential Diagnosis

A thorough medical history and physical examination will help differentiate physical causes from behavioral.

CBC/Biochemistry/Urinalysis

May be indicated by information obtained in the history and physical examination, or as premedication screen.

Other Laboratory Tests

As indicated if physical causes are suspected.

Imaging

May be indicated if history, physical, and laboratory tests suggest an organic cause for the cat's behavior.

Treatment ⬆ ⬇

Treatment

Activity

Normal interactions with owners encouraged, but contact/outgoing behavior should not be forced.

Diet

  • Normal dietary routine.
  • Placement of food, water, and litter box may need to be altered if anxious or fearful behavior is limiting access.

Client Education

General Comments

  • Discuss behavioral expectations. Owner expectations in regards to social interactions with him- or herself and with other cats may be contributing to the problem and could affect prognosis.
  • A reasonable treatment plan involving case-tailored behavioral modification and environmental adjustments, and ancillary information such as handouts or articles, will help the owner better understand the situation and implement treatment.

Behavioral Therapy

  • Identify the specific stimulus that provokes the fearful or anxious behavior.
  • Avoid exposure to the fear-producing stimuli, if possible. Provide ways for the cat to manage the situation, by noting its “hideout” preferences and creating a “safe place” for the cat to go to if the situation cannot be avoided.
  • If the cat must be handled while fearful, caution and physical restraint aids (cat muzzles, cat bags, towel wraps etc.) should be used to prevent injury and decrease stress for both cat and handler.
  • Desensitization and counter-conditioning to help decrease reactivity to the fear-producing stimulus. Systematic desensitization is a program of slowly increasing exposure to the object or situation the cat fears. Counter-conditioning consists of enhancing an internal and external environment counter to one of fear, usually accomplished with food rewards or other pleasurable stimuli such as playing with toys. See the suggested reading list for references that provide greater detail.
  • Address secondary problems such as strained social interactions subsequent to defensive aggression directed toward humans or other cats, or elimination problems that may be the result of fears or anxieties.

Medications ⬆ ⬇

Medications

Drug(s)

  • Medication can be a helpful adjunct to behavioral modification, if the animal's fearful or anxious behavior is so intense that it interferes with learning or other normal behavioral activities.
  • No drug is approved by the FDA for use in cats for fearful behavior; therefore, clients must be advised that information concerning efficacy, contraindications, and side effects is limited and often extrapolated from the human literature.
  • If there are questions or concerns about a specific patient or medication, a consultation with a veterinary behaviorist may be helpful.

Selective Serotonin Reuptake Inhibitors

  • Fluoxetine (Prozac) 0.5–1.0 mg/kg PO q24h.
  • Side effects: decreased appetite and irritability.
  • Paroxetine (Paxil) 0.5–1.0 mg/kg PO q24h.
  • Side effects: decreased appetite, irritability, constipation.

Tricyclic Antidepressants

  • Clomipramine 0.5 mg/kg q24h, 2.5–5.0 mg/cat PO q24h.
  • Side effects: sedation, anticholinergic effects, possible cardiac conduction disturbances in predisposed animals.
  • Amitriptyline 0.5–1.0 mg/kg PO q12–24h.
  • Side effects: sedation, anticholinergic effects, possible cardiac conduction disturbances in predisposed animals.

Azapirone

  • Buspirone 0.5–1.0 mg/kg q12h, 2.5–7.5 mg/cat PO q12h.
  • Side effects: GI upset, mild sedation, disinhibition of aggressive behavior.

Benzodiazepines

  • Alprazolam 0.125–0.25 mg/cat q12h.
  • Side effects: sedation, disinhibition of aggression, increased appetite.

Contraindications

  • Use of buspirone, TCAs, and SSRIs not recommended in animals with seizures. SSRIs and TCAs should not be used together nor combined with MAOIs such as amitraz and selegiline.
  • Diazepam (Valium) is not recommended for use in cats due to rare reported cases of fatal idiopathic hepatic necrosis.

Precautions

  • Basic laboratory tests are strongly suggested before placing an animal on a psychotropic medication, to ensure that liver and kidney functions are sufficient to metabolize the medication and to check for any physical condition that may be a contraindication to specific drugs.
  • Medicating cats can prove stressful, especially when the medication is not palatable, as are many of the above medications. Compounding medications in a more palatable form can ease administration, increasing consumption and effectiveness of the drug.

Possible Interactions

Discuss any questions on possible drug interactions with a veterinary behaviorist or a pharmacist.

Alternative Drug(s)

Pheromone therapy (Feliway), initially developed for urine marking cases, has been used as an aerosol spray and/or room diffuser to calm anxious and fearful cats, at home, during travel, and during hospitalization or clinic visits. Alternative medications such as herbal or dietary preparations including L-theanine have been suggested for anxious and fearful behaviors in animals; some have scientific studies showing efficacy for these conditions in cats. Concomitant use of some herbal remedies and psychotropic medications may lead to serious drug interactions, so clients should be questioned about over-the-counter remedies they are currently giving the cat.

Follow-Up ⬆ ⬇

Follow-Up

Patient Monitoring

Frequent follow-up either in person or by telephone is necessary, especially during the first few months of treatment, to motivate the client and monitor the effectiveness of any adjunct drug treatment.

Prevention/Avoidance

  • Calm interactions and positive associations with socialization from 2–7 weeks stimuli may keep fear-based reactions to a minimum.
  • Early socialization to people, places and things up to 7 weeks, and ongoing positive exposure during the first year may help prevent some later problems with fearful behavior.

Possible Complications

Secondary behavior problems may arise or persist after the fearful or anxious behavior has diminished and will need specific treatment.

Expected Course and Prognosis

  • Animals with shy personalities or poor socialization histories may show a minimal response to treatment.
  • A realistic “end point” depends on the animal's background (socialization history, genetic and individual differences in personality), the home situation, and other confounding factors such as the frequency of natural exposure to fear-producing stimuli.
  • Medication may help improve but not totally ameliorate signs.

Miscellaneous ⬆

Miscellaneous

Associated Conditions

  • Stereotypic or compulsive disorders.
  • Urine marking, inappropriate elimination.
  • Defensive aggression directed toward humans, other animals: may also make cat a target for aggression from other cats.

Zoonotic Potential

Fear-related aggression may lead to defensive biting or scratching and subsequent infections.

Pregnancy/Fertility/Breeding

Avoid use in pregnant animals.

Abbreviations

  • FDA = US Food and Drug Administration
  • GI = gastrointestinal
  • MAOI = monoamine oxidase inhibitor
  • SSRI = selective serotonin reuptake inhibitor
  • TCA = tricyclic antidepressant

Internet Resources

For information on pheromone therapy see: www.feliway.com.

Suggested Reading

Landsberg G, Hunthausen W, Ackerman L. Behavior Problems of the Dog and Cat, 3rd ed. Edinburgh: Saunders Elsevier, 2013.

Levine ED. Feline fear and anxiety. Vet Clin North Am Small Anim Pract 2008, 38(5):1065–1079.

Mendl M, Harcourt R. Individuality in the domestic cat: Origins, development and stability. In: Turner DC, Bateson P, eds., The Domestic Cat: The Biology of Its Behaviour, 2nd ed. Cambridge: Cambridge University Press, 2000, pp. 48–64.

Author Leslie Larson Cooper

Consulting Editor Gary M. Landsberg