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Proceeding of the NAVC

North American Veterinary Conference
Jan. 8-12, 2005, Orlando, Florida

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The North American Veterinary Conference – 2005 Proceedings

CANINE ANXIETY DISORDERS I – are most severe close to the separation, and many anxiety-
CO-MORBIDITY AND ASCERTAINMENT related behaviors (autonomic hyperactivity, increased motor
activity, and increased vigilance and scanning) may become
OF A DIAGNOSIS
apparent as the client exhibits behaviors associated with
leaving.
Karen L. Overall, MA, VMD, PhD, Diplomate ACVB, ABS
College of Veterinary Medicine
(2) Noise Phobia: Necessary and sufficient conditions:
University of Pennsylvania, Philadelphia, PA
Sudden and profound, non-graded, extreme response to
noise, manifest as intense, active avoidance, escape, or
Separation anxiety is one of the most common and most
anxiety behaviors associated with the activities of the
devastating behavioral conditions diagnosed world-wide in
sympathetic branch of the autonomic nervous system;
pet dogs. As is true for most behavioral conditions, the signs
behaviors can include catatonia or mania concomitant with
associated with In the absence of treatment the outcome for
decreased sensitivity to pain or social stimuli; repeated
affected dogs usually involves relinquishment to a humane
exposure results in an invariant pattern of response.
society or shelter, abandonment, or euthanasia. Noise and
thunderstorm phobias are among the most commonly
(3) Thunderstorm / Storm Phobia: Necessary and
recognized canine diagnoses associated with panicky or
sufficient conditions: Sudden and profound, non-graded,
phobic responses, although no data exist on relative
extreme response to thunderstorms or any aspect of them
incidence of these problems. Based on the findings of a
(e.g., wind, noise, lightening, changes in barometric pressure,
preliminary study finding a high concordance between dogs
rain, darkness, ozone level changes, et cetera) noise,
who exhibited signs of separation anxiety and those who met
manifest as intense, active avoidance, escape, or anxiety
the criteria for noise or thunderstorm phobias, a detailed
behaviors associated with the activities of the sympathetic
study (1) found an important correlation between these
branch of the autonomic nervous system; behaviors can
phobic responses and separation anxiety that suggests that
include catatonia or mania concomitant with decreased
the presence of one condition can affect the development
sensitivity to pain or social stimuli; repeated exposure results
and outcome of other related conditions.
in an invariant pattern of response.
We now know: (1) that the development or expression of
The use of such criteria allowed us to examine the
noise / thunderstorm phobias and separation anxiety are not
distribution of non-specific signs independent of diagnosis.
independent, and the extent to which they co-vary may
Non-specific signs may be uniquely important for assessing
suggest differences in mechanisms for thresholds of anxiety -
psycho-pathologically distinct groups (3). Improved
related disorders, and (2) that incidence and co-morbidity of
understanding of the intensity, duration, age on onset, et
both conditions may be underestimated or incompletely
cetera for specific symptoms will improve our description of
represented, even in a tertiary care behavioral practice
the variable behavioral phenotypes that are associated with
setting, in the absence of a questionnaire or evaluation tool
diagnostic sub-groups (4). The use of explicit definitional
that systematically explores all responses to both related
criteria are key to insuring that observed heterogeneity is not
situations in all patients.
an artifact of careless classification.
This pattern appears to hold true for other behavioral
Elimination, destruction, and vocalization are the most
conditions suggesting that the ontogeny of such conditions
obvious and hence the most commonly reported behaviors
needs to be explored. In this case one can postulate, but not
associated with separation anxiety. It’s important to realize
yet know that (1) reactions to noise may predispose dogs to
that clients complain about these behaviors because they are
other anxiety related conditions, and (2) the interaction of the
easy to recognize and are problems for the client. However,
two conditions may have time penetrance, and the longer an
it is less easy to recognize dogs that are distressed when left,
animal has been affected with one condition, the more at risk
but exhibit less obvious signs like withdrawal and inactivity,
it might be either for a more complex form of the conditions
salivation, soft whimpering (or frank barking and howling if
(e.g., a greater number or intensity of signs). These
there are no near neighbors), and pacing. These dogs are
questions are important if we are to understand the variability
also painfully affected by separation anxiety, but their
in behavioral conditions, and how best to treat them when
problems are not problems for the clients, so they seldom get
first noticed. Finally, associations of any anxiety-related
help. With these dogs included, the population of dogs with
conditions with noise are important. Many human psychiatric
separation anxiety, while unknown, is likely to be large
patients experience aberrant noise reactivity, as do their
indeed, and all dogs can benefit from treatment.
unaffected, first degree relatives. Hence, understanding
A study of 141 dogs diagnosed with any of these conditions
early responses that may contribute to overall reactivity and
during a 12 month period produced the following patterns (1).
that may have heritable or genetic bases needs to become a
1. In the combined data, the frequency of separation
research focus.
anxiety as the sole diagnosis was significantly higher
In the example of separation anxiety and noise and
thunderstorm / storm phobia the following definitions of the (G test; P #0.05) than expected under the hypothesis
conditions were used to screen all patients for the relevant of independence of diagnoses.
diagnoses (2). 2. The observed frequency of noise phobia as the sole
diagnosis was significantly lower (G test; P #0.05) than
(1) Separation Anxiety: Necessary condition - Physical expected under the hypothesis of independence of
or behavioral signs of distress exhibited by the animal only in diagnoses.
the actual absence of, or lack of access to (virtual absence) 3. The observed frequency of a diagnosis of separation
the client; Sufficient condition - Consistent, intensive anxiety + thunderstorm phobia and of separation
destruction, elimination, vocalization, or salivation exhibited anxiety + noise phobia was significantly (G tests; all P
only in the virtual or actual absence of the client; behaviors #0.05) lower than expected under the hypothesis of

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Small Animal - Behavior
independence of diagnoses.
4. Finally, the observed frequency of a diagnosis of
thunderstorm phobia + noise phobia and of separation
anxiety + noise phobia + thunderstorm phobia was
significantly (G tests; all P #0.05) higher than expected
under the hypothesis of independence of diagnoses.
The null hypothesis that individual diagnoses (SA, TP,
NP, SA+TP, SA+NP, TN, and SA+TP+NP) are
independent was rejected (likelihood ratio chi-squared
test, Q = 28.17, df = 6, P = 0.0001).
These data are important because they suggest that the
interaction of multiple pathological responses to noise likely
either reflects an altered, dysfunctional, underlying
neurochemical substrate, or is the result of one. While not
definitively tested here, the extent to which such dynamic
interactions shape expressed behavioral phenotypes is
supported by differential responses to behavioral medications
(5-7). The newer psychotropic medications [tricyclic
antidepressants (TCAs), selective serotonin re-uptake
inhibitors (SSRIs), and monoamine oxidase inhibitors (MAO-
Is)] utilize the same second messenger systems and
transcription pathways that are used to develop cellular
memory or to “learn” something via mediation and induction
of long-term potentiation (LTP) in the CA1 region of the
hippocampus (8, 9).
It’s interesting to note that client responses about the
number of signs exhibited and the intensity / frequency of
these signs were not independent of diagnosis or suites of
diagnosis. Again, this finding supports the conclusion that
the interaction of multiple pathological responses / diagnoses
to situations associated with distress (noise phobia,
separation anxiety, thunderstorm phobia) may either reflects
an altered, dysfunctional, underlying neurochemical
substrate, or is the result of one, and that the varying
phenotypes displayed are the result of this dysfunction.
The roles played by arousal and reactivity cannot be
ignored if we are to understand dogs with anxiety-related
conditions like separation anxiety, noise phobia, and
thunderstorm phobia. Some dogs respond either more
quickly to a stimulus, or react more intensely to a given
stimulus than other dogs. At some level this “hyper-
reactivity” is probably truly pathological and represents yet
another phenotypical manifestation of some neurochemical
variation associated with anxiety. If so, the more frequently
the dog reacts to the anxiety provoking stimulus, the worse
and more rapid the response. At some point any exposure
can then result in a full-blown, non-graduated anxious
reaction in which true panic may be involved. Accordingly,
anticipation and early treatment is critical for these
individuals, again supporting the concept that behavioral
phenotype and underlying neurochemical response are
linked in a dynamic way. Early intervention can only be
accomplished by understanding the spectrum of signs
exhibited in related conditions. If dogs follow the pattern
common for co-morbid diagnoses as is found in humans,
longer persistence of the signs and a less favorable overall
outcome maybe one outcome of co-morbidity (10-11). In
human medicine, childhood separation anxiety is seen as an
important antecedent in adult panic disorder, and is prevalent
as an undercurrent in the dreams of human panic disorder
patients. This suggests that in humans, as in pets,
separation anxiety can occur separate from panic disorder
and other phobia-related conditions, but that when the two
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co-occur the interaction is an important factor in the
assessment and treatment of either. If the phobic reactions
to noise and storms are related to panic in dogs, such
interactions are important.
The conditional probability (see table) that a patient has
separation anxiety, given that they have noise phobia is high
(88%) and approximately the same as if they have
thunderstorm phobia (87%). However, the probability that a
patient has noise phobia is higher (74%) than the probability
that they have thunderstorm phobia (61%), given that either
have separation anxiety. These data, combined with the
finding that the probability of having a noise phobia given a
thunderstorm phobia is not equivalent to the converse (90%
v. 76%), supports the hypothesis that neurochemical
responses to noise are different from those to thunderstorms,
if the behavioral phenotypes or endophenotypes are
manifestations of repeated exposure and LTP. The property
of unpredictability / uncertainty associated with
thunderstorms may have a role in shaping the neurochemical
and behavioral responses to anxiety provoking situations,
suggesting future areas of exploration for understanding
anxiety-related responses in dogs.
Conditional Probabilities for Associations between SA,
NP, and TP:
P [SA / TP] = 0.8701 (87%)
P [TP / SA] = 0.6147 (61%0
P [SA / NP] = 0.8804 (88%)
P [NP / SA] = 0.7364 (74%)
P [TP / NP] = 0.7609 (76%)
P [NP / TP] = 0.8974 (90%)
The data presented here demonstrate that when any noise
reaction is involved the probability of having separation
anxiety is greater than would otherwise be expected if the
associations were random. This finding strongly suggest that
adverse reactivity to noises, in general, may predispose a
dog to separation anxiety, and that unless veterinarians
carefully question clients about the pet’s behavior both of
these conditions could remain undiagnosed. The extent to
which early fearful behaviors contribute to the development of
separation anxiety is unknown. Overly fearful human
youngsters are at risk for later emotional distress, including
anxiety and depression, suggesting that such associations
should be investigated in veterinary behavioral medicine.
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The North American Veterinary Conference – 2005 Proceedings

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