Understanding and Addressing Separation Anxiety in Veterinary Practice: Diagnostic Criteria, Assessment, and Treatment Strategies
A diagnosis of separation anxiety may be assigned to a patient exhibiting signs of distress in the absence of or inability to access a significant social figure. Diagnostic criteria include: 1) the behavior is rarely exhibited in the presence of the significant social figure, and 2) the behavior occurs consistently, rather than occasionally, whenever the patient is left without this social figure. The actual behaviors exhibited can vary based on the individual patient and the species.
The most commonly reported separation-related behaviors in dogs are destructive behavior, vocalization, and house soiling. Other behaviors include salivation, anorexia, and self-injurious behaviors. Many dogs begin to exhibit these signs during their caregiver’s pre-departure preparations.
It is not abnormal for a social animal to become distressed when alone, but high levels of stress compromise the physical health and well-being of pets as well as their caregivers. Dogs have been the subject of most of the research related to the pathophysiology and treatment of separation-related behaviors and will be the focus of this report. Diagnostic and treatment protocols can be modified to provide good care for patients regardless of species.
Terminology and Pathophysiology
Although the term "separation anxiety" is widely recognized by pet caregivers and veterinary professionals alike, new research suggests that anxiety is just one of the possible emotions contributing to a dog’s distress. The term "separation-related problems" may be more appropriate. (DeAssis)
The level of stress an individual dog experiences may vary based on their emotional state. In one study, salivary cortisol, an indicator of a dog’s stress level, was higher in dogs that actively communicated their distress by barking, running, and jumping and lower in dogs that were considered more passive, hiding, or salivating without much physical activity. (Ogata)
Although accurately confirming an individual patient’s emotional or psychological state may not always be possible, observations of behavioral patterns can be used to suggest underlying emotions based on current research and our understanding of species-typical behaviors. This assessment of the underlying motivation or emotion will be used to develop an effective and efficient treatment plan.
Assessment Plan
Four questions need to be answered:
Does the behavior reflect emotional distress—sadness (depression), panic, and/or frustration?
What specific behaviors does the patient exhibit when alone?
What emotional state do these behaviors reflect?
What medications and what physical or organic illnesses could be contributing to the behavior?
Diagnostic Tools
Videorecordings
The most effective way to determine a patient’s level of distress is to videorecord several departures. Caregivers can purchase a camera, use a security camera already in place, or download an app that will allow them to observe their pet’s behavior.
Behaviors consistent with distress include pacing, panting, plaintive vocalization, and restlessness. Pets may urinate, defecate, chew furniture or personal objects, and/or aggressively scratch or chew points of egress. These behaviors may begin immediately after the person has left or after a period of restless pacing.
When the spycam reveals a patient with relaxed body language, sleeping often and occasionally chewing toys or possibly inappropriate items, then the diagnosis of a separation problem related to anxiety or frustration may not apply. This pet may require additional environmental enrichment to replace the loss of social enrichment that necessarily occurs when they are left alone.
Another behavior that may be seen is a dog that goes to the door, signaling an attempt to access an outdoor elimination area but when the door is not opened, they may then squat to eliminate and go back to resting, suggesting a physical urgency rather than emotional distress related to being alone.
Some dogs rest but then damage points of egress in response to external triggers. This behavior does not relate to separation-related distress but more typically reflects either territorial behavior, which is a frustration-based behavior, or a fear of noises such as seen in noise-phobic patients. Upon further questioning, caregivers typically note that they do see this behavior when they are home with the dog.
Behavioral History
A thorough behavioral history should include a detailed list of the specific behaviors that are exhibited when the pet is left alone. All of these behaviors may not resolve at once, but improvement in any category suggests that the treatment strategy is at least partially effective and should be adjusted but not abandoned.
Destructive behavior—does the pet target small objects, furniture, or points of egress? Confirm that destructive behavior is rare in the presence of the caregiver.
Elimination—does the pet urinate, defecate, or both? Elimination can reflect physical urgency, particularly when it occurs late in the absence rather than immediately after the caregiver has left.
Vocalization—does the dog bark intermittently and in response to external triggers or is vocalization plaintive and frequent with no evidence of any trigger other than being alone?
Emotional State
Many pets exhibit signs of extreme anxiety or panic as soon as they are left alone. They begin to pace, salivate, and/or eliminate early in the departure or even as their special person is preparing to leave. They often howl and rarely rest. Chewing small objects or furniture may be self-soothing. These behaviors reflect anxiety, and relieving anxiety should be the focus of the treatment plan. Triggers for distress should be identified, and when possible, a desensitization protocol developed. To avoid inadvertent sensitization, it is important to carefully and regularly monitor the effect of treatment.
For some dogs with separation-related problems, the main underlying emotion is frustration. Frustration-related behaviors include rigorously damaging points of egress, shredding furniture, and actively vocalizing. Frustration is most often related to confinement. Any barrier, including the front door, can contribute to confinement frustration. Frustration may also be experienced by dogs that regularly exhibit a high level of demanding or attention-seeking. When they are left alone, their solicitations, which may include barking, scratching doors, or picking up small objects, do not yield the expected results.
Treatment plans focus on improving frustration tolerance in other contexts. For many patients, behavior modification is used to improve tolerance of confinement. Caregivers' responses to demanding behaviors also need to be addressed.
Medical Workup
A full physical and behavioral workup should be done. Underlying diseases, including concurrent behavioral illnesses, must be identified and treated for a positive outcome. A minimal database for most patients includes: physical examination including hands-off observations to assess overall comfort and perception, CBC/chem profile; free T4/TSH; urinalysis; anxiety screen; aggression screen.
Physical illnesses can cause or exacerbate behavioral conditions. Illnesses, such as IBD or diseases causing PUPD, as well as certain medications such as corticosteroids, can increase the need to eliminate. Dogs experience discomfort and distress when an appropriate toileting area is not available. A dog that is well-trained may become frustrated that the door did not open to give them access to the yard. Dogs that have been scolded for eliminating indoors may become anxious when, out of necessity, they soil during their caregiver’s absence.
Pain and discomfort may reduce a pet’s tolerance for being alone. Painful patients have difficulty settling. They often change position while seeking a more comfortable resting place, which can then contribute to pacing. Degenerative joint disease can prevent easy access to favored settle spots. Painful pets often seek companionship for relief, and, in the absence of a significant social figure, may become distressed. Stress itself can exacerbate the physical sensation of pain.
Most dogs and cats experience some age-related cognitive decline. Cognitive dysfunction syndrome is associated with disorientation, loss of learned behaviors, altered social behaviors, and anxiety. Affected pets may have a reduced tolerance for being alone. Their multimodal treatment plan should address distress related to separation.
An extensive physical workup is needed for pets experiencing a sudden onset of distress in the absence of any significant change in the home environment.
General Concepts
Any change in the household or home environment can reduce a pet’s comfort with being alone. Some animals are sensitive to sound and do not settle easily when noise-muting carpets or curtains are removed.
It is always important to assure that your patients receive adequate enrichment. This includes social enrichment such as playing with their caregiver, cognitive enrichment such as reward-based training and puzzle toys, and physical exercise compatible with their physical health. Environmental enrichment should include comfortable access to comfortable bedding and a toilet area.
Dogs that use toys when left alone should be provided with favored toys. Housetrained dogs that must be left beyond their holding capability should be provided with an indoor bathroom area.
Summary
Separation-related problems may vary in etiology and intensity. It is important to identify the underlying physical and emotional factors contributing to the behavioral pattern in each individual patient to design an effective treatment strategy.