Treatment of feline CD includes educating owners, minimizing the repetitive behavior, reinforcing alternative behavior, and alleviating stress through environmental enrichment and anxiolytics.
Verbal or physical punishment (eg, yelling, swatting, scruffing) should not be used to treat CD. Because repetitive behavior often originates from stress or frustration, use of harsh verbal or physical punishment that increases the cat’s anxiety may exacerbate the disease. Moreover, cats may avoid punishment by learning to engage in the CD behavior out of the pet owner’s sight. If the cat engages in CD behavior and must be interrupted, it is best to use remote punishment not associated with the owner’s presence (eg, dropping a book to make a noise out of the cat’s sight, tossing a pillow across the cat’s line of sight to break its concentration).
Minimizing the practice of the CD behavior reduces opportunities for reinforcement of the behavior and may be necessary for the health and welfare of the cat, particularly if the behavior is self-injurious. If overgrooming or hyperesthesia results in wounds, an Elizabethan collar may be required. Similarly, cats exhibiting pica may need to be confined to a single room or cage where the environment and access to objects can be strictly controlled. Although necessary, these measures may increase the cat’s stress, which may perpetuate the CD behavior.
Preventing situations that trigger the repetitive behavior or preemptively engaging the cat in another activity before the CD behavior occurs is ideal. For example, childproof locks may help prevent a cat with pica from breaking into closets to chew on clothing or shoelaces. If bouts of overgrooming coincide with environmental stressors (eg, owner’s departure), owners can engage cats in play with a new toy before leaving. Attempts to distract the cat with food, toys, or attention while it is engaged in the repetitive behavior may inadvertently reinforce the behavior.
Positive reinforcement training should be used to teach alternative behavior and create pleasurable associations with previously stressful situations. For example, for cats that exhibit CD behavior associated with the owner’s departure, a positive emotional response may be elicited if the owner’s departure is consistently paired with a treat before the cat engages in the behavior. Cats that repetitively pace or vocalize can be taught to go to a specific spot (eg, a chair) on command to await a reward (eg, treat, play time, brushing). Directing the cat to a quiet, convenient location teaches an alternative coping strategy to mitigate the CD behavior.
In most cases, owners are unaware of the specific triggers of the behavior or the behavior occurs unexpectedly or not in the owner’s presence. In such cases, the goal of treatment should be to reduce the cat’s global anxiety and frustration through environmental enrichment and anxiolytics. Feline environmental enrichment provides a means to avoid stressful situations (eg, abundance and wide distribution of resources, including hidden or elevated spaces), mental and physical stimulation (eg, foraging toys, active play; see Suggested Reading), and opportunities to engage in normal, species-typical behavior (eg, provision of scratching posts and litter boxes). In a study of cats diagnosed with feline behavioral ulcerative dermatitis (ie, nonhealing ulcerations secondary to psychogenic pruritus), implementation of an environmental enrichment plan resulted in cessation of pruritus within 2 days and complete healing over several days depending on lesion severity; none of the cats that improved relapsed during the 12- to 24-month follow-up period.19
Treatment options to decrease anxiety include pheromones (eg, feline facial and appeasing pheromones), supplements (eg, α-casozepine, L-theanine), and pharmaceuticals (eg, tricyclic antidepressants, selective serotonin reuptake inhibitors; see Suggested Reading).
The relatively few anxiolytic efficacy studies that have been conducted for feline CD have produced varying results. For example, in a retrospective study, 5 cats exhibiting psychogenic alopecia groomed less frequently and experienced hair regrowth when treated with clomipramine (1.25-2.5 mg/cat PO every 24 hours)9; 3 of the 5 cats also received environmental modification to reduce stress. However, in a different prospective, double-blind, placebo-controlled study of 25 cats with psychogenic alopecia, 11 cats treated with clomipramine (0.5 mg/kg PO every 24 hours) for 56 days did not experience a significantly decreased number of grooming bouts or hair regrowth as compared with placebo-treated cats.11 Mixed success has also been reported following treatment with other behavior medications (eg, amitriptyline).9,20 These studies indicate that the response to psychopharmaceutical treatment is highly variable. Furthermore, because no medications are currently licensed by the US FDA for the treatment of feline CD, it is important to review possible adverse effects and obtain informed consent from the owner prior to use.