Denise Johnson, DVM
Cats often suffer from the perception that they are the easier option, the “set it and forget it” pet that requires less attention and is less impacted by our absence. In reality, they are complex individuals who are capable of forming deep social attachments and are susceptible to the potential consequences of forming close bonds. While their case presentation may differ from that of their canine counterparts, cats can experience separation related problems (SRP).1
Risk factors for development of SRP in cats appear to be consistent with those in dogs, including owners with long working hours, frequent owner travel, changes in schedule, and long-term or permanent departure of a pet or family member.2
Management of these cases comes with new challenges, in addition to those that we encounter when working with dogs showing signs of separation anxiety or distress. Detection itself can be more difficult, as stress in cats often manifests in passive ways such as reductions in appetite and play behavior.3 More overt behaviors may be labeled as “spiteful” and anthropomorphized in ways that exacerbate damage to the human-animal bond. Lack of awareness may prevent owners from seeking professional help until the situation is dire, making it all the more important for professionals to provide comprehensive care when consulted.
When looking for primary resources on management of SRP, behavior consultants are met with a distinct lack of feline-focused research. We all know that while there are fundamental behavior truths that apply across species lines, cats are not small dogs and we cannot assume that all canine research results can be generalized to a feline population. This article seeks to incorporate available feline research, canine research, and professional experience to better prepare behavior consultants for cases of SRP in cats. Though the patient name and minor details have been changed for the sake of anonymity, the case discussed throughout is real and represents one of the more common presentations I have encountered in clinical practice.
In addition to a clear lack of feline studies regarding separation and its related problems, there is also a lack of consensus regarding terminology. When sorting through available resources, you are likely to encounter separation anxiety, separation distress, separation anxiety syndrome, and similar. The term separation related problems has been chosen here because of its inclusivity. It encompasses a full range of behaviors and consequences associated with separation from a preferred individual, with or without clear signs of physiologic stress.4
Ginger is a 3-year-old female spayed domestic short hair cat with no known health concerns. She is affectionate, needy, and even “a little neurotic” according to her owner. She shares her home with two humans whose company she enjoys very much. She enjoys it so much that she would much rather eat socially and often waits to do so until they are home. Together they have moved three times in the last three years.
Clinical signs and case screening
Underreporting of SRP cases in cats is likely due to a combination of factors. As a predator that is also a prey species, it is in their evolutionary interest to conceal illness and withdraw during times of stress. This is characterized by decreased exploratory behavior, increased hiding, and vigilance.3 Unfortunately, a cat whose only clinical sign consists of hiding when no one is home is unlikely to receive care. Even when overt signs are present, they may be less dramatic than those seen in canine patients experiencing similar levels of distress. In a retrospective study screening the medical records of cats presenting for behavioral problems, the most common issue reported to occur during an owner’s absence was house soiling.1 Of the cats who had urinary house soiling during separation, 75% exclusively targeted their owner’s beds. Destructiveness and excessive vocalization were also noted, but less frequently. It is important to recognize that, as this was a retrospective study analyzing nine years of existing medical records, history taking may not have been equivalent across all cases or as directly probing as a prospective study might be. More targeted screening tools may reveal a different ratio of clinical signs at the population level or bring to light more subtle behavior patterns in the individual.
The recent development of one such questionnaire provides a starting point for those looking to incorporate SRP screening into their own history taking.4 This survey does rely on an awareness of activities and timing. Owners may not realize that unwanted behaviors are occurring when they are absent; they may assume that the cat is hiding their actions due to sneakiness or spite. If an unwanted behavior has never been witnessed, the possibility of SRP should be considered. Keep this in mind for multi-cat households where the identity of the mystery-urinator remains elusive as well as cases of alopecia where owners have not actually seen over-grooming. It is important to note that psychogenic alopecia is a veterinary diagnosis of exclusion that requires extensive dermatologic workup; in one study, 76% of cats referred to a veterinary behaviorist for psychogenic alopecia were ultimately found to have medical causes of their over-grooming while 14% were found to have medical causes as well as a compulsive component to their condition.5
In keeping with the Hierarchy of Procedures for Humane and Effective Practice, we must recognize the relationship between physical and behavioral health and the importance of early medical intervention. However, that does not mean that cats with medical conditions are ineligible for behavioral support until they receive a clean bill of health. The interdependence of physical and behavioral welfare is exemplified in cats suffering from feline idiopathic cystitis (FIC) and Pandora syndrome, both in the pattern of nervousness found in affected cats as well as the success of therapy using multimodal environmental modification.6-8 While a full review of these diagnoses is beyond the scope of this article, FIC is a condition characterized by chronic lower urinary signs while Pandora syndrome refers to cats affected by chronic lower urinary tract signs in concert with comorbid disorders.
As a chronic stressor, SRPs have the potential to contribute to clinical signs beyond the period of separation. Separation may be a daily occurrence, significantly impacting the central stress response system and aggravating underlying conditions even without apparent absence-associated behaviors. It is also very possible that under-diagnosis of SRP in cats is facilitated by an overlap in treatment modalities. Psychoactive medications have been widely and successfully used as treatment for urine marking and house soiling in cats, often but not always in conjunction with environmental management.9,10 These protocols overlap significantly with medical management of SRPs.2 If we target clinical signs rather than obtaining a clear diagnosis, underlying conditions and motivations may not be addressed comprehensively.11 Cases of SRP may respond to nonspecific therapy, behavioral or medical, but these patients could be better served with a mindful approach.
Incorporating SRP screening into practice
Now that we know to look, how do we incorporate SRP screening into our practice in balance with our other priorities? If we attempted to comprehensively screen each behavior case for every potential underlying condition, our intake forms would be unwieldy at best. As a veterinarian in general practice, my time is often limited, and history taking must be efficient. Thankfully, incorporating screening for SRP in behavior cases can start with the addition of two simple questions.
- How does your presence or absence impact the behavior?
- Would you be comfortable using a camera to monitor behavior change in your absence?
Open-ended questions encourage robust responses. By asking “How does it?” instead of “Does it?” we prompt the client for more information. If the answer to the first question is “I don’t know,” then we move quickly on to the second.
Atttachment and SRP screening
Cat owners may feel that their cats have rich home lives and become embarrassed or frustrated by the implication that they might not. In questioning owners, we need to be careful not to vilify the relationship that they have with their cat. The relationship between SRP and attachment style is an area of ongoing research in both dogs and cats, with findings more complicated than the assumption that hyper-attachment is the root cause.12-14 It is unhelpful to lead owners to believe that their closeness to their pet is the primary issue and may lead to resistance to therapy if owners feel that they must choose between a strong relationship and their pet’s overall success. Focus initial questions on the behavior occurring around and during the separation, addressing issues of attachment separately if indicated.
- What does departure look like?
- What does arrival look like?
- How does being alone affect their appetite?
- How does duration of absence impact their behavior?
If you encounter friction or defensiveness, propose video surveillance as a way to find stressors outside of the owner’s control, such as inter-pet conflict when unsupervised or signs of stress triggers coming from outside of the home.
The role of video surveillance in SRP diagnosis
Cameras are an absolute asset in the diagnosis and management of SRP and other behavior concerns. In the United States, for only $20 you can purchase a high-definition camera with in-app live-streaming to spy on your cat. If your client is concerned about the security of Wi-Fi-enabled cameras, encourage them to use an offline local storage option. Video monitoring can narrow down the suspects in multi-pet households, identify behaviors that do not leave evidence, track improvements over time, as well as provide material for lessons in body language. Platforms like Dropbox make video files easy to share, allowing clients to upload to a joint folder at their convenience.
Review videos for any changes in behavior prior to and following departure, bearing in mind that a decrease in activity may be the result of stress or a lack of stimulation. Let the cat do the talking; assess their body language in context to learn more about the motivation behind the behavior. What is the respiratory rate when they appear inactive: low and lazy or elevated and anxious? Is there tension? Frustration? Are they relaxed with loose body language as they joyfully wreak havoc? Are they house soiling because they have frozen in one spot without moving for the last eight hours?
Surveillance can be especially helpful for cats struggling with ongoing flares of FIC or Pandora syndrome, without known triggers. Stress-related illness disconnects the stressor from the consequence in a way that can make history taking more challenging.
Ginger presents for house soiling, which started shortly after their most recent move about two months ago. The soiling consists of normal urination, specifically where her owner has been sitting. Thankfully, the soiling is infrequent. It occurs when there have been significant changes in her environment and when she is left alone for a period of time. Ginger’s time limit is two days. Video is not currently available.
Treatment of SRP must address both the underlying anxiety as well as client concerns. Be mindful of their specific priorities, as ultimately we rely on their investment in plans moving forward. Management steps should progress through the hierarchy of procedures, as previously mentioned. This begins with a complete medical examination with diagnostics, as determined by the pet’s primary veterinary care provider.
Underlying medical conditions, such as those causing pain or hormonal imbalances, have substantial impacts on a patient’s stress level as well as their capacity to cope. House soiling may be compounded by dilute urine, urgency, or inflammatory disease. Older pets or those with cognitive decline may be less able to cope with the absence of a caregiver and have a higher risk of SRP.2
Mentally prepare clients for the possibility of a comprehensive work-up, as a physical exam alone may not be sufficient to rule out medical involvement. Leaving conditions untreated not only compromises wellness, but may sabotage our efforts in the long term.
This also applies to cases where levels of anxiety or panic prevent pets from fully benefiting from behavioral intervention. Consider the likelihood that a cat who is too anxious to eat or ambulate during absence will meaningfully interact with food puzzles. Although working from home has become more common in recent times, many clients have needs and obligations that do not allow them to prevent all absences throughout the treatment process. If we cannot avoid flooding, we should provide a life-jacket. This may take the form of nutraceuticals and/or medications on a situational or routine basis. Behavior consultants without prescribing privileges should be empowered to communicate their questions and concerns regarding medical management with the cat’s primary provider, including reporting the need for additional support during behavior modification.
The decision to incorporate medication into the treatment plan, including drug choice and dosing schedule, is at the discretion of the prescribing veterinarian. This does not mean that veterinarians are the sole purveyors of wellness and welfare; environmental management is a key component of feline wellness. In order for an intervention to be defined as environmental enrichment, it must result in an improvement in welfare.15 Perform an enrichment inventory, reviewing the environment for current and potential opportunities to express normal behaviors and engage with surroundings, to establish a baseline. If asked what they have tried, owners often report that they have done everything already. The definition of “everything” varies widely. Ask for specifics, validating the efforts they have made without assuming the extent.
- It sounds like you have devoted a lot of resources to this issue already. To keep us efficient and avoid retracing our steps, what specifically have you tried so far?
- Clearly you have been busy looking for solutions! Walk me through what you have done already so that we can then focus on new opportunities.
- I don’t want to tell you what you already know. What has already been put into place?
Keep in mind that some interventions may have been necessary but not sufficient; encourage owners to make use of resources that they still have on hand, which may be more effective in combination with the support that you add. There are plentiful resources available that discuss the implementation and evaluation of environmental enrichment for cats.6,15-17 Once basic needs have been met, explore specific adjustments that can be made to set the individual up for behavioral success.
Ginger’s physical exam was normal, with a soft and comfortable abdomen on palpation. She solicits attention with repeated approach and bunting, but appears tense with stiff body language when exploring the exam room. Due to financial constraints, bloodwork and a urinalysis were thoroughly discussed but must be postponed. Her basic needs are met with one large meal of a balanced dry food each day, one litter box which is scooped weekly, and regular interactive and independent play. She enjoys birdwatching and her multilevel cat tree.
Based on her exam and complete history, which has been abridged for this article, Ginger is diagnosed with generalized anxiety disorder (GAD) and separation related problems characterized by urinary house soiling and hyporexia (reduced appetite). An anti-anxiety medication (fluoxetine) is elected due to GAD and the severity of SRP, with the goal of reducing her stress level to a point where food may be used as enrichment when unattended. In order to establish routine use before this goal is achieved, entry level food puzzles will be introduced while the owner is at home. For additional support while medication is reaching therapeutic levels in her system, which may take up to eight weeks, a calming nutraceutical (Composure Pro) is recommended 30 minutes before departures. Litter box hygiene is discussed at length. Automated toys are recommended as an option to increase independent play opportunities.
Antecedent arrangement requires an understanding of the cat’s behavior as well as how changes in the environment and our own actions impact it. The most obvious solution is to force the client to stay with the cat at all times until interventions are complete, but unfortunately this option may be overly invasive from the human perspective.
Select clients are able to limit travel or to work from home during initial management, but some departures are inevitable. As in cases of canine separation problems, departures and arrivals should be made as calm as possible. Excessive fanfare may cause overstimulation and exacerbate anxiety.2 This does not require complete ignoring of the cat, as that in itself may be distressing.
Clients should be cautioned not to sneak out or distract their cat in ways that result in a sudden realization that they have been left alone. Despite the anxiety that they produce in the moment, departure cues provide predictability for a stressful event. The provision of “positive, consistent and predictable human–cat social interaction” represents the fourth pillar of a healthy feline environment, within the environmental needs guidelines published by the American Association of Feline Practitioners and International Society of Feline Medicine.15 I propose that it is more humane to focus efforts on improving the positivity of departure by reducing the underlying anxiety, rather than removing the predictability of absence. Arranging an environment that addresses individual case concerns and provides outlets for otherwise unwanted behavior aids in this process.
A dedicated “sanctuary”
A compact sanctuary setup allows high-stress low-activity cats to more easily access needed resources. While it is generally recommended to provide ample space between food, water, and litter boxes, a cat who is not yet able to comfortably make full use of their space benefits from improved accessibility. Ensure that the immediate area meets basic needs as well as provides comfort. Helpful additions to consider include pheromone diffusion, familiar smells such as an owner’s dirty laundry, and auditory support. Numerous auditory support options are available, from noise-blunting white or brown noise to cat music composed with feline internal rhythms in mind.18 Consider a rotation of audio tracks to help reduce risk of habituation.
Managing house soiling
When troubleshooting house soiling cases, owners sometimes resist the recommendation to increase the number of litter boxes. Concerns of smell in common areas and the challenge of finding sufficiently out-of-the-way locations are minimized when the need for added boxes is only during absence. I don’t care if there is a litter box in the middle of my living room, if it only lives there when I am gone. Putting away a situational box on arrival is easier than cleaning soiled carpeting or dealing with urine-saturated hardwood.
Another option to improve client acceptance of additional boxes is to perform a litter box buffet to determine ranked litter preferences. Locations where owners are hesitant to place boxes can be stocked with litter that the cat accepts but is less enthused about, while locations that the owner prefers are stocked with the cat’s favorite litter to incentivize use. I have had tremendous success with framing this as providing a much-needed emergency toilet for times of necessity, with the master bathroom providing an experience worth the effort when effort is possible.
Throw blankets with moisture barriers built in allow comfortable protection of couches, chairs, and bedding. Waterproof mattress protectors have advanced far beyond the crinkly garbage bag stereotypes of the past. I recommend both to clients, as throws are most easily washed when soiled but mattress covers provide more complete base protection.
Channeling destructive behavior relies both on the removal or protection of targets and placement of enticing alternatives in their stead. For in-depth review of scratching solutions, please see my article “Scratch This Not That” in the Spring 2020 issue of the IAABC Journal. “Destroy toys” also provide an outlet for frustration and destructive behavior. Toilet paper or paper towel tubes can be pinched off at their ends, sealing kibble inside for a rattling target. Holes may be cut from the side for easier access during the introduction phase.
“Tissue paper lasagna” provides a softer option, which may be more accessible for cats who are not fluent in cardboard destruction. The lasagna is assembled using alternating layers of tissue paper, toys, catnip and/or silver vine, as well as favorite treats or kibble. For cats who are less confident when engaging with new items, I recommend making the lasagna directly on the floor. Deconstruction can be made more challenging in the future by layering within a “lasagna pan,” such as a low sided cardboard box.
Interfering with the ability to practice unwanted behaviors and providing appropriate alternatives may be enough to address specific client concerns. Changing the underlying emotional state can be more directly accomplished with systematic conditioning and reinforcement of desired behavior.
It is difficult to determine whether Ginger’s soiling is due to extended inactivity in an area that smells like her preferred human, intentional marking for scent layering purposes, or another reason entirely. Video may reveal more about the associated body languages and behaviors; without it, recommendations consider both potentials mentioned. These include: covering the seating area with a water-impervious blanket, set-up of a compact sanctuary centered on Ginger’s preferred spot, placing an emergency litter box in the immediate area for extended absences, adding more scratching opportunities to channel normal marking behavior, and use of enzymatic cleansers on any soiled items.
In addition to the misconception that cats require little time and attention, their trainability is often underestimated. The fundamentals of marker training cross species boundaries, making clickers a useful tool in teaching cats how to cope with absence. Even without the use of a marker, cats have the capacity to learn a wide range of behaviors through positive reinforcement. You may find that training cats is better accomplished with shorter sessions, keeping in mind that smaller stomachs are satiated more quickly.
My preferred foundation for separation training is establishing a cue to go to a mat, bed, or towel. This can be accomplished many ways, including free shaping or luring. As a veterinarian with an interest in lowering stress associated with handling, I am biased toward the use of towels as targets. Initially, the cat is lured to investigate the towel as it lies flat on the floor, using placement of a small amount of food just under the closest edge. Tent the towel with your hand to allow easy access to the food. Repeat, gradually inching the placement of subsequent food farther from the proximal edge until the cat enters one end of the towel and reaches the food at the other end. Once full tunneling has been achieved and is reliably cued by presentation of the tented towel, deliver the reinforcement directly after tunneling rather than having the food lying in wait.
At this point, the offered behavior can be further developed in several directions with the common theme being that the towel is highly rewarding to interact with. The time between tunneling and delivery of food can be extended over time to promote lying in place beneath the towel. Pressure from either side or other gentle control may be added prior to reinforcement in order to condition towel restraint for handling needs.
When presented with an untented towel, cats who have been tunnel trained will often make contact with it in an attempt to elicit reinforcement; this interaction with the untented towel can be shaped and reinforced as a “go to mat” behavior. Any of these towel interactions may be associated with a verbal cue if desired, or cued by the position of the towel itself when presented.
Regardless of the training method or whether you make use of a towel or mat, the target should be comfortable, as the ultimate goal is for it to serve as a place of rest. Between sessions, store the mat out of sight so that its presence indicates active training. This facilitates the use of the mat as a safety signal when progressing to desensitization of departure and absence. Reinforce for duration of contact with the mat and relaxation in advance of any absence work to establish a calm baseline. Delivery of reinforcement should be calm and direct, reducing unnecessary movement and excitement, which are counterproductive to our goals.
For cats who enjoy it, brushing can be an excellent reinforcer for relaxation. Avoid agitation by monitoring body language closely and focusing brushing on the head or shoulders. Once the mat is linked with rest and extended relaxation, distance and ultimately departure may be gradually introduced. To keep the mat as a safety signal, it should not be used in an actual departure until training has progressed to a point where the given absence is known to be tolerable. Remote video is extremely helpful to monitor tolerances and determine an appropriate pace for desensitization.
Learn more about the utility of mat work in certified dog behavior consultant Sarah Dixon’s article entitled “Using Mat Work Training in Behavior Modification,” available in the Fall 2019 issue of the IAABC Journal.
Build a cohesive treatment plan by situating the mat in the cat’s compact sanctuary space or near prioritized behavior outlets. Ultimately the goal is not for the cat to remain on a prison mat for the entire absence, but to be able to learn coping skills that then enable them to interact positively with their environment. This is especially important to develop in cats whose level of distress or presentation of clinical signs correlates with duration of separation.
To address this, consider incorporating environmental engagement into your positive reinforcement plan. This can be as simple as using clicker training to capture or shape interaction with toys and food puzzles, encouraging investigation of novel items. Reinforce desired behavior to establish a well-practiced routine for them to rely on during absence; this may include reinforcing the use of litter boxes or intended scratching surfaces.
If clients are struggling with the concept of clicker training or capturing behavior, I instruct them to treat their clicker like a camera. Click to take a photo of the behavior you want, follow it with a treat to develop that behavior. While not the most elegant analogy, it functions as an accessible introduction. Check in often and be mindful not to overwhelm owners with the overall treatment plan. Open communication is required to determine the number and complexity of tasks that they can reasonably implement at once. Particularly in cases where the mildness of clinical signs is in contrast with the severity of the cat’s experience, we are most successful when we apply the principles of LIMA to both the pet and the client.
Ginger and her owner are new to training. A clicker is provided, with the recommendation to start by practicing reinforcement of litter box use. Further behavior modification is held in reserve to avoid overwhelming the owner, as medication and environmental discussion has been extensive. A follow-up call is scheduled in two weeks, with an in-clinic recheck in six weeks for medication evaluation and diagnostics.
Two weeks later, environmental management is going well with food puzzle participation while the owner is present. Ginger is tolerating her medication well so far. Positive reinforcement has been challenging but the household is optimistic overall. Litter box hygiene has improved.
Following seven weeks of fluoxetine therapy, Ginger’s diagnostics look fantastic and refills are approved. She has not had any episodes of house soiling since the initial visit, despite several extended trips. She is eating well when left unattended, fully utilizing her food puzzles. Due to her separation success and overall improved anxiety level, the decision is made to continue her anti-anxiety medication long term. The importance of combined medical and environmental wellness is reiterated, with further follow-up aligning with her preventative care schedule.
As behavior professionals, we should have SRPs in cats on our radar with the awareness that more cats may be affected than we or their owners realize. We likely can and do help many of these individuals with overall promotion of feline behavioral wellness and broad enrichment education. Careful screening and directed treatment allow us to go beyond that, with the opportunity to grow as a field and develop science-based treatment strategies. Despite the comparative lack of feline-focused research into SRP, using the evidence that we do have as well as the extensive library of canine information, we are able to assemble an extensive list of potential interventions to select from. While the plural of anecdote is not evidence, the sharing of your thoughtful and thorough case reports takes us in the right direction. Look back on cases where SRP may have been a factor and look forward to bringing targeted support to an underserved population.
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Dr. Denise Johnson is a general practitioner of veterinary medicine with a special interest in behavior, particularly feline behavioral wellness. Her project, Committed to Claws, aims to reduce declawing by providing cat owners and pet professionals with humane scratching solutions that strengthen the human-animal bond. She also serves as a handling lab facilitator for the Ohio State University College of Veterinary Medicine, with qualifications including level three Fear Free Certification and Low Stress Handling Silver Certification.