Leslie Sinn, DVM, DACVB
Sara worried about Joey, her four-year-old domestic shorthair. He was a friendly, well-behaved cat who enjoyed their evening cuddles and play sessions with toys, but something had changed. Off and on for the past few months, he had been chewing on household items, and recently he had been doing it almost compulsively. He no longer chewed only on toys or items left on the floor. Now he was actively pulling stuff off the counter—plastic bags and cell phone cords—and destroying them. His new habit was getting expensive and dangerous!
Sara didn’t think Joey was actually eating any of this stuff, but she had seen him spit up bits of plastic and was sure he was eventually going to hurt himself. Nothing she tried made a difference—yelling, spraying water, clapping her hands, booby traps. Joey just slunk away and then found something else to chew on.
What did change was Joey’s attitude toward Sara. He now ran away when she approached, and Sara was devastated. Friends and family told her that Joey was being spiteful because she worked long hours and left him alone for a good part of the day. But Sara really wondered whether maybe there was something more to Joey’s behavior. She reached out to her veterinarian for help.
The veterinarian checked Joey over from nose to tail, and the cat passed his hands-on exam with flying colors. Being thorough, the veterinarian also did some blood work. The good news was that Joey’s blood work was normal. His kidneys, liver, thyroid, and other organs seemed to be working just fine. The bad news was that there was no obvious cause for his behavior change. The veterinarian referred Sara and Joey to a veterinary behaviorist because the veterinarian was very concerned that Joey was showing signs of a compulsive disorder.
The diagnosis of a compulsive disorder is often a diagnosis of exclusion, meaning that all other possible causes must first be ruled out. There is no single test that will determine whether the problem is medical or behavioral. In fact, often the two go hand in hand.
During the behavioral consultation, the veterinary behaviorist reviewed Joey’s physical exam, laboratory findings, and history. He explained to Sara that sudden changes in behavior in adult cats are often due to a medical cause or a combination of a medical condition and unwanted behaviors that have become problematic. The big challenge is finding that underlying medical condition. In Joey’s case, further testing was needed.
A diagnosis of exclusion is often necessary when there isn’t a specific test for a suspected disorder. Changes in behavior are symptoms that can be caused by a physical illness or other changes or problems in an animal’s health, management, or environment. To make this kind of diagnosis, a medical professional must eliminate all the other possible causes of a symptom or set of symptoms.
When we think about compulsive behaviors, we tend to think about familiar problems in people, such as obsessive worrying, handwashing, or twirling or pulling of hair, as well as other repetitive behaviors. Cats can exhibit similar behaviors.
These behaviors are often symptoms of a physical illness or other issues surrounding a cat’s health, management, or environment. Before a medical professional can make a diagnosis of a compulsive disorder, she must rule out all the other possibilities (see “What Is a Diagnosis of Exclusion?” above). Screening tests such as blood work, X-rays, ultrasound imaging, and even biopsies are needed to figure out what is going on and whether there is a medical component.
Not all repetitive behaviors are compulsive disorders. Behaviors can also increase in frequency due to learning (the behavior was rewarded, so it is repeated), association with stress (your cat is anxious and worried, so he grooms himself excessively), or an underlying medical disorder (see “Possible Medical Causes of Repetitive Behaviors” later in this chapter).
A diagnosis of a compulsive disorder is made when a cat cannot seem to control his behavior and often cannot be interrupted or distracted. The behavior may be in response to some sort of trigger (such as cuddling or snuggling) but not always. It can have a dramatic effect on both the cat’s and the owner’s quality of life, interfering with normal interactions and day-to-day activities. Unfortunately, compulsive behaviors can lead to medical problems. Chronic licking and hair pulling can result in sores and infections. Ingesting objects and a subsequent blockage of the intestinal tract can result in stomach upset, vomiting, diarrhea, or even death.
Research into the causes of compulsive disorders in cats is limited, so we are still unsure what causes these disorders. We do know that compulsive behaviors often begin in young adulthood (between one and two years of age), or spontaneously throughout a cat’s life, depending on the underlying cause. We also know that the sex of the cat might be a factor. In a retrospective study by Dr. Michelle Bamberger and Dr. Katherine Houpt, DACVB, male cats were overrepresented in compulsive behavior cases presented to veterinary behaviorists. Oriental breeds, especially Birmans and Siamese, appear to be more at risk for compulsive disorders than other breeds. We aren’t sure why that might be, but we suspect that genetics play a role in cats’ compulsive behaviors, just as they often do in people’s. In one study, Dr. Stephanie Borns-Weil, DACVB, found that early life development may be a risk factor, with small litter size and a weaning age of less than seven weeks associated with an increased risk of wool sucking in Birmans. In the same study, the presence of a medical condition increased the risk of wool sucking in Siamese.
Compulsive disorder: A diagnosis made when a behavior occurs at a high rate, nearly to the exclusion of typical feline behaviors, and interferes with the normal functioning of the cat. It may or may not have an underlying medical component.
Repetitive behavior: Any behavior that is repeated over and over again at a frequency, intensity, or duration beyond what is normal for cats. Not all repetitive behaviors become compulsive disorders, and some repetitive behaviors have an underlying medical cause.
Attention-seeking behavior: A behavior that’s intended to attract the owner’s attention. Common examples include yowling, scratching, and jumping on forbidden surfaces. Other behaviors may be more complex, such as tail chasing or eating nonfood items.
Seizure: A period of unusual behavior, loss of awareness, or even involuntary movements that cannot be interrupted. Seizures are caused by abnormal electrical activity in the brain, which can have several underlying causes; they vary in their severity.
The kinds of repetitive behaviors we see in cats with compulsive disorders include chewing and sucking on items such as wool or fabric, chewing and sucking on themselves, eating nonfood items (a condition known as pica), repeatedly licking surfaces or people, shaking or scratching the head and face, and chasing the tail. These behaviors often begin as repetitive behaviors that arise from normal activities but are directed at abnormal targets (chewing on plastic) or are excessive (grooming to the point of pulling out hair); are purposeless (sucking on fabric); or are repeated at a high frequency. Your cat may perform these behaviors so intensely and so often that he ignores you and won’t engage in normal activities, such as playing or eating. He may continue the repetitive behaviors even though he is physically hurting himself.
Compulsive disorders can be caused by many things, and they are not always clearly understood. Remember, a behavior is a symptom of an underlying problem, such as a medical condition. Attention seeking, frustration, and conflict may also play a role. True compulsive behaviors are caused by changes in neurotransmitters, the chemical messengers of the brain. Endorphins, dopamine, glutamate, and serotonin have all been identified as contributors to compulsive disorders.
Are all repetitive behaviors signs of a compulsive disorder? The short answer is no. Not all repetitive behaviors are abnormal, so not all are considered signs of a disorder. If a cat is rewarded for a behavior, he will increase the frequency and even the intensity of the behavior. Our attention is often very rewarding to our cats. If you praise your cat and pet him for bringing you his mouse toy, he will be more likely to bring it to you in the future—all very normal!
When you give your cat attention for any behavior (wool sucking, for example), that behavior could increase in frequency and possibly become repetitive. Yet it is unlikely that your attention alone will result in a compulsive disorder, because the behavior problem is usually more complex than that.
Repetitive behaviors are considered problematic when they occur frequently for long periods of time, when they put your cat’s health at risk, or when they begin to interfere with his normal functioning or interactions—in other words, when they begin to affect his quality of life and yours. At that point, they are labeled compulsive disorders. Owners of cats with repetitive behaviors often spend large amounts of time and money, as well as many sleepless nights, worrying about and trying to change their cat’s behaviors. Mounting frustration and stress over a seemingly unsolvable problem can erode the bond and personal connection they have with their cat.
What myths stand in our way of understanding this problem?
Can cats really be obsessive? That is actually a question we veterinary behaviorists ask ourselves all the time! We have no way of knowing whether cats obsess about things, since we can’t ask them what they are feeling or why they are doing certain things. As a result, there is a lot of discussion and disagreement about what to call repetitive behaviors.
In human medicine, compulsive repetitive behaviors are commonly labeled obsessive-compulsive disorder (OCD), because the behaviors are preceded by recurrent thoughts or images that drive the person to perform the behaviors. But since we don’t know what cats are thinking, many veterinarians simply refer to these behaviors as repetitive, and the diagnosis is a compulsive disorder.
Does my cat just need more activities and exercise? Lack of attention and exercise, though not usually the cause of a compulsive disorder, often contribute to it. A bored, stressed, under-exercised, environmentally deprived cat doesn’t have many options, and some may choose to engage in repetitive behaviors. Honestly evaluating the amount of attention and exercise your cat is receiving is an important part of a comprehensive treatment plan.
By making sure your cat has many ways to spend his time, you can provide him with healthy alternatives to his unwanted repetitive behaviors. Generally, this is referred to as enrichment, a concept that has been widely embraced by animal behaviorists worldwide.
Cats in the United States are commonly kept indoors and have limited choices about how to spend their time. Providing them with perches, resting spots, hiding boxes, novel toys, food-dispensing toys, things to look at, playtime, and other ways to fill their days may help diminish behaviors such as compulsive fabric sucking. Providing exercise opportunities in the form of harness training and subsequent time outdoors on walks, fishing-pole toys or crinkle balls, an outdoor enclosure or catio, or even trick training are all wonderful ways to keep your cat engaged in positive interactions with you and his environment. (See chapter 3 for more information on providing the ideal environment for your cat. The Indoor Pet Initiative at The Ohio State University College of Veterinary Medicine website, https://indoorpet.osu.edu, is also a great place to learn about enriching your cat’s environment).
Is my cat being spiteful? No. Repetitive behaviors are often due to an underlying medical condition, especially when they involve overgrooming or the cat chewing on himself. Your cat may be responding to pain and discomfort and cannot stop these behaviors. He may even be doing so to try to make himself more comfortable. He deserves your tolerance and patience, as well as a visit to your veterinarian.
Remember, some of these medical problems can be hard to diagnose and include dental problems, gastrointestinal issues, arthritis, and bladder pain, to name just a few. The process may entail multiple visits to your veterinarian and a team approach to finding a diagnosis, treatment, and, hopefully, a cure. It may also include seeking out veterinary specialists. In a case series by Dr. Stephen Waisglass and Dr. Gary Landsberg, DACVB, for example, eighteen of twenty-one cats who were thought to be pulling out their hair due to abnormal behavior were actually found to have underlying medical problems when additional laboratory tests were performed.
Is my cat doing these things to get my attention? Maybe, but it’s unlikely. Certainly, a repetitive behavior is a plea for help. Your cat is not eating plastic because it is fun. He is most likely engaging in this abnormal behavior because his stomach hurts or he lacks appropriate items to chew on. Remember, a behavior can be reinforced by repetition—often accidentally—causing the cat to do it more frequently.
We can’t give very effective advice on preventing compulsive behaviors because we don’t always know what causes them in the first place. Avoiding early weaning (before seven weeks of age), providing an enriched home environment, and trying to eliminate sources of stress for your cat may help. Even with these proactive measures, some cats might begin to perform repetitive behaviors that may at some time become compulsive due to abnormal brain chemistry or other health disorders.
Repetitive behaviors call for prompt veterinary intervention. Do not assume that your cat will get better on his own or with time. And don’t assume that the cat will get better if you just ignore the behavior. Get help as soon as you possibly can. The longer a repetitive behavior continues, the more difficult it can be to successfully treat it.
Your veterinarian and any specialists he may refer you to will be able to rule out medical causes for your cat’s behavior changes. Be especially suspicious if it is a problem, as with Joey, that appears suddenly in middle age, with no apparent underlying trigger.
Before you talk to your veterinarian, sit down and make some notes about the behavior. When did it start? Have there been any changes in your cat’s environment? Can you develop a timeline? When does your cat perform the behavior now? How often? For how long? Can you identify a trigger? What have you tried to do to help his behavior? What made it better, and what made it worse? All of this information will provide vital clues to determining the underlying cause.
Be aware that many of the medical causes of repetitive behaviors can be hard to find and may require the help of a veterinary specialist and advanced testing to uncover. If you are referred to a veterinary behaviorist, she will need a detailed history to help your cat. Journaling is an excellent way to keep track of pertinent information. In addition, once a treatment plan is put in place, continued journaling will help you and your cat’s medical team track the success of the plan.
In Joey’s situation, the veterinary behaviorist carefully reviewed his physical examination, laboratory results, history, and behavior with Sara. She shared the fact that Joey had a sensitive stomach. He vomited once or twice a week, often just liquid with no food or hair in what he threw up. With this important piece of information, the veterinary behaviorist asked for help from an internal medicine colleague. They decided to do an ultrasound of Joey’s belly. Fortunately, they didn’t see any plastic or other foreign objects there, but they did find thickened intestinal walls, which can be a sign of irritation of the intestinal tract. Inflammatory bowel disease was the likely cause of Joey’s behavior.
Joey was started on antinausea medication and a hypoallergenic diet. The veterinary behaviorist also developed a management, environmental enrichment, and behavior modification plan tailored to Joey and his home environment. Thankfully, Joey responded well to this comprehensive combination of medical care and other interventions.
What a lucky cat Joey was to have an owner like Sara, who didn’t give up in her search for a solution to his behavior problem!
Overgrooming and hair pulling: inhaled and food allergies, fungal disease, gastrointestinal disease, pain, altered sensation (paresthesia)
Fabric sucking: gastrointestinal disease
Pica (eating nonfood objects): gastrointestinal disease, endocrine disease, neurological disease
Excessive licking: gastrointestinal disease
Circling or pacing: pain, neurological disease, endocrine or metabolic problems, ophthalmologic problems, cognitive decline
Nighttime waking and excessive vocalization: pain, cognitive decline, arthritis, hyperthyroidism, other endocrine or metabolic problems
Source: Adapted from Karen L. Overall, “Medical Differentials with Potential Behavioral Manifestations,” Veterinary Clinics of North America: Small Animal Practice 33, no. 2 (2003): 213–29.
What can you do to control, change, or work through a compulsive disorder? What results can you expect, and how quickly?
If your cat has a true compulsive disorder, it must be actively managed, and that management must be ongoing. This section addresses some key points, but your cat’s situation is unique, so be sure to work with your veterinarian or veterinary behaviorist to develop a plan that offers the best possible fit for you and your cat.
The first step with any behavior problem, no matter what the cause, is to prevent your cat from repeating the same behavior over and over again. This is key. If your cat sucks wool blankets, put away the blankets. If he chews and eats plastic, put away the plastic bags and cords. Can’t put everything away? Create a hazard-proof safe room where your cat can go when you can’t supervise him.
Some things are hard to prevent. For example, how do you keep your cat from licking himself or pulling out his hair? In some situations, a physical barrier may be necessary, such as a soft collar or a cat onesie that will make it impossible for him to overgroom. But don’t fool yourself; this is only a stopgap measure for your cat’s safety. It is most definitely not a cure! And it can backfire if it increases your cat’s anxiety and distress.
If you know your cat’s compulsive behavior has a specific trigger, do everything you can to avoid that trigger. It’s important to prevent your cat from practicing and getting better at performing his compulsive behavior. For example, if your cat’s hair pulling and licking is set off by the presence of outside cats, block visual access by covering the patio door with opaque window film, or block his access to the ground-level window wells by closing the basement door.
If your cat’s repetitive behaviors are set off by a specific trigger and you can identify it but not eliminate it, gradual exposure to the trigger while offering the cat something he enjoys, such as food or play, may help. This is called desensitization and classical counterconditioning. (See chapter 6 for more information on this process.)
For example, this technique could be used with a cat who frantically begins to pluck his hair whenever the grandchildren run screeching through your house. Provide your cat with a safe room so that he can avoid the kids in most situations. Under supervision, you might engage your cat in some pleasant way, such as with gentle petting or by feeding him a meal, while your grandchildren play quietly nearby, then return him to his safe room before the kids resume their rambunctious games.
Teaching an alternative behavior that is more appropriate, especially a behavior that is likely to prevent the undesired one, is a very successful strategy. For example, your cat can’t yowl if you encourage him to pick up and retrieve a toy in a situation that would normally trigger him. (See “Putting It All Together” later in this chapter for an example of how this might work.)
Regardless of the cause, redirecting your cat away from his repetitive behavior is a critical part of management. You can do this in a number of ways by interrupting or distracting him. Examples include calling his name, throwing a toy, rustling a treat bag, getting up and walking away, using a birdcall whistle, or otherwise distracting his attention away from himself and directing it toward you.
Timing is very important. You don’t want to accidentally make a link between the unwanted behavior and a reward. That is, you want to avoid teaching your cat to make the association When I do X behavior, I get something good. Preferably, have your cat do something else first, such as sit or come, then reward him with a treat, a toy, or some one-on-one time.
You may have heard that you can interrupt your cat with a loud noise or some other action, such as using a spray bottle, that will startle him and cause him to stop his unwanted behavior long enough to direct him to another, more desirable activity, such as chasing a tossed toy. There are problems with this approach, though, because it can cause a fear reaction in him. In some situations, rather than stopping the unwanted behavior, your cat will simply associate you with the scary noise.
Remember Sara’s cat, Joey, and how he started to avoid her when she clapped her hands or used a spray bottle to stop his chewing? Proceed cautiously, and if anything you try seems to make the situation worse, stop and seek help from a veterinarian or veterinary behaviorist.
We have already discussed how your cat’s environment can contribute to repetitive behaviors, especially if he experiences it as stressful. Make a careful assessment of your home and be sure your cat has an abundance of resources, such as water, food, perches, hiding boxes, resting places, scratching posts, litter boxes, toys, food-dispensing toys, playtime, and anything else you can think of. His environment should be peaceful and cat-centered, addressing his particular feline needs (see chapter 3).
It’s important for your cat to remain active. Indoor cats in particular may not get enough exercise and may begin to fill their time with repetitive behaviors. Inactivity may contribute to boredom, and boredom may make a repetitive behavior worse. One way to combat this common problem is to set aside fifteen minutes twice a day to play, groom, exercise, and train your cat. (See chapter 6 for more on training.)
If your cat has multiple problems, all of them need to be addressed at the same time. This includes both behavioral and medical issues. Cats can experience a variety of health problems linked to stress, including inflammatory bowel disease, chronic cystitis, and dental disease, among others.
Many of these medical conditions have behavioral signs, such as eliminating outside the litter box, pica, increased aggression associated with pain, and decreased interest in play and human companions. All medical and behavioral conditions must be identified and addressed simultaneously.
Sally was a cute, tiny domestic shorthair. She had been found as a kitten and bottle-fed by her owners. She never really thrived and had difficulty leaping on and off elevated surfaces. She was evaluated by her veterinarian, and X-rays revealed that her growth plates (areas of tissue near the ends of bones that normally fuse as the cat matures) had never closed. She was diagnosed with a rare condition, congenital hypothyroidism, and treated successfully with an oral thyroid hormone.
Around one year of age, she began chasing her tail, sometimes catching it and chewing on it until it bled. Pain medication seemed to help some, but the tail chasing and self-injury continued.
Sally’s veterinarian referred her owners to a veterinary behaviorist. The veterinary behaviorist completed a physical exam and found that Sally was sensitive over her pelvis, where her tail met her back. Whenever that area was touched, her skin would ripple and she would try to move away. The veterinary behaviorist suspected pinched nerves due to Sally’s skeletal abnormalities and recommended long-term treatment with a medication designed to help with nerve pain.
The behaviorist also recommended interrupting Sally if she started chasing her tail and rewarding a more appropriate behavior instead. Her owners discovered that gently swaddling her in a thick blanket was the best way to interrupt her inappropriate behavior. Anything else they tried only made the behavior worse.
In addition, the veterinary behaviorist suggested using targeting—having Sally touch her nose to one of the owners’ fingers for a treat—as a competing appropriate behavior that could be rewarded. Sally enjoyed the new game and the activity it created for her. She became a targeting champ! Whenever her owners felt that she might be likely to chase her tail, they would ask her to target their finger and reward her with a treat and lots of attention.
By starting Sally on a more effective pain medication and rewarding a competing and more appropriate behavior, her owners were able to stop her self-mutilation and reduce her tail chasing from multiple times a day to once every few weeks.
Medication can help cats with compulsive disorders. The choice of drugs can be limited, though, as little research has been done on cats (most studies involve dogs). The two most commonly used psychoactive drugs for compulsive disorders affect the production and effect of serotonin, a neurotransmitter within the brain that regulates mood. Individual studies by Dr. Kersti Seksel, DACVB, and Dr. Karen Overall, DACVB, have shown that this class of drugs is effective in treating compulsive disorders in cats.
If your cat is diagnosed with a compulsive disorder, he may need medication for months or even for life, depending on his situation. Psychoactive medication must be withdrawn slowly and only under direct veterinary supervision. Side effects of these drugs are, thankfully, rare, but carefully following safety protocols will help minimize the likelihood of an adverse response.
If your cat doesn’t respond to medication, it may indicate that there is an underlying medical problem that has not yet been identified. To help make a diagnosis, your veterinarian may suggest trying different medications that treat suspected physical problems for a period of two to three weeks each and seeing whether your cat responds.
Response to treatment acts as a real-life test. For example, if your veterinarian suspects that pain is playing a role in your cat’s behavior but cannot identify the source of the pain, she may ask you to give him pain medication for two to three weeks and report back about any changes in his behavior. If his behavior has improved, it suggests that he is uncomfortable or in pain, and the medication is helping reduce his discomfort.
Avoid triggers.
If a trigger can be identified, desensitize and countercondition your cat.
Redirect your cat’s behavior to a more appropriate alternative.
Avoid accidentally reinforcing the behavior.
Enrich your cat’s environment.
Use medications, if needed.
Keep in close contact with your veterinarian and other members of your cat’s health care team.
Having a cat who behaves oddly can be an isolating experience. Well-meaning family and friends are always ready to provide free advice. One of the common themes is blaming the owner, meaning that somehow you caused your cat to behave this way. Frequently, owners blame themselves. But, as discussed in this chapter, most of these behaviors have a medical basis, so it’s unlikely that you caused the behavior.
Communicating with your cat’s health care team is vital. That means sharing information and asking questions. Dealing with repetitive behaviors is a process of discovery that often involves multiple steps and many visits to your veterinarian or one or more veterinary specialists. A clear and open exchange of information is critical to be able to determine the underlying cause of your cat’s behavior and to address all of his issues, as well as your concerns. Work with your cat’s veterinary team to determine the best course of action for you and your cat.
Keep a record of your cat’s behavior and his response to your interventions. Start with the baseline assessment you made when you first spoke to your veterinarian. Has anything changed about when your cat performs the behavior, how often, or for how long? What interventions have worked? What has made the behavior worse? Charting your cat’s behavior will help you discover the best strategies for successfully dealing with the problem.
Frustration is common and understandable. One way to combat frustration is to have an action plan. Another is to use journaling to remind yourself that things are getting better.
As frustrated as you may get, avoid yelling, reprimanding, or otherwise punishing your cat. Remember that he is doing these things because he cannot help himself. Do you bite your nails when you are nervous? Do you twirl your hair before you have to speak in public? Would it help you to be more at ease if someone yelled at you or even hit you?
Punishment is never a good choice. It only increases fear and anxiety and will not resolve the behavior. Instead, your cat may start to fear and avoid you. See chapter 6 for more on the fallout associated with using punishment. The American Veterinary Society of Animal Behavior also has an excellent position statement on punishment (https://avsab.org/wp-content/uploads/2019/01/Punishment-Position-Statement_bleeds-10-2018-updated.pdf).
Similarly, you may feel or be told that your cat is being defiant or getting back at you by performing this behavior. As discussed earlier in this chapter, such behaviors are caused by underlying medical or psychological conditions, not feelings of revenge. Your cat would stop if he could, but he cannot.
Finally, be patient. Figuring out what is causing a compulsive behavior can be challenging and may involve trial and error and multiple medical tests. This process can be time-consuming and sometimes expensive. Once a treatment plan is set, actually changing the behavior may take some time as well. Behavior change doesn’t happen quickly in any species, so it’s best to embrace a long-term outlook that will involve months rather than days of work to see improvement.
A compulsive behavior is often due to an underlying medical condition.
Compulsive behaviors may be exacerbated by stress or a poor environment.
It is important to treat the whole cat and address the overall environment and all the enrichment options.
Treatment focuses on management, avoiding triggers, providing an enriched environment, uncovering any underlying medical problems, redirecting your cat, and reinforcing appropriate behaviors, as well as classical counterconditioning and desensitization if a trigger can be identified.
Medications can be very helpful in decreasing the intensity and frequency of compulsive behaviors.
Compulsive behaviors can take time to address, so patience, celebrating small victories, and ongoing communication with your veterinary team is critical in helping your cat.