Triaging Behavior Problems

This two-article feature provides commonsense approaches to investigating, managing, and treating behavior cases. The following presents methods for triaging behavior complaints; the companion article, Addressing Any Behavior Problem, addresses how to approach treatment of any behavior problem in any pet.

Addressing behavior problems can be difficult in a general practice setting. Owners may raise concerns as afterthoughts at the end of appointments, and practitioners may feel pressured to tackle a full behavioral workup in 20 minutes instead of the 2 hours a specialist might take.

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Does the patient pose a risk for injuring:

1. Humans (eg, owners, strangers, adults, children, veterinary team members)? 
2. Other animals (eg, housemates, unfamiliar animals, neighboring livestock)?
3. Itself (eg, self-injurious or escape behaviors, behaviors that lead owners to consider euthanasia)?

• If the pet poses a real risk for injuring or harming others, this must be discussed with the owners.
• Providing an idea of how easy or difficult improving the situation may be is recommended.
• The home environment (eg, young children), owner lifestyle (eg, frequent travel), and health issues (eg, chronic illness) should be considered and potential lifestyle changes discussed.
• Empathy is important; if practitioners are overly critical, owners may withdraw and not follow advice.
• If practitioners are unsure about specific treatment after they have completed triage, they should consider referral.

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Behavioral triage refers to assessing the degree of urgency and relative risk associated with a behavior problem. The urgency of a behavior problem is determined by its effect on patient safety and welfare: a dog with separation anxiety that escapes through a second-floor window has a higher degree of urgency than one that defecates inappropriately; a cat too anxious to come out from under the bed except to eat and drink has a lower quality of life than one that becomes scared only when guests are present.

Relative risk includes the owner’s perception of the problem’s severity and the degree of risk the problem poses for other animals and humans, particularly when addressing aggression. Performing behavioral triage and assessing relative risk can be organized by taking a B.I.T.E. out of the behavior.

Treating behavior issues is not an emergency, regardless of a client’s sense of urgency. The problem did not develop overnight and cannot be solved immediately. Assure clients that most behavior problems can be improved. Let clients know that at this initial triage consultation that it is important for the veterinarian to know what the pet is doing. Provide clients with instructions on staying safe and sane until a later meeting to discuss why the pet is having these problems and how to affect a long-term change in behaviors.

Assess the client’s presenting complaint in terms of absolute and relative risk. Rule out primary physical problems that can create behavior changes and secondary issues that may exacerbate preexisting behavior problems.

Determine whether the patient is aggressive and if so, how dangerous it is (eg, biting, causing other injuries) and who is at risk (eg, unfamiliar or familiar humans, children, cohabitating animals, unfamiliar animals). Next, evaluate the problem’s effect on the quality of life of the patient and others in the household, both human and animal. Are owners unable to leave the home together because of a pet’s separation anxiety? Do other pets isolate themselves because of one pet’s aggression?

Next, obtain a minimum database: thorough physical examination (sedating fractious animals, if necessary), CBC, serum biochemistry profile, urinalysis, and fecal analysis. If specific medical problems are suspected, additional appropriate diagnostics should be pursued.

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Owners are frequently misinformed about pet behavior and its causes. Inform them that, regardless of signs, most behavior problems are rooted in anxiety; this is especially useful when dealing with dogs that are aggressive toward humans. Many owners think that aggressive dogs are being “dominant.” Educate owners that pets are likely using aggression to escape situations that make them fearful and anxious. Once they are educated, owners may better understand how to keep everyone safe while changing the pet’s behavior.

Tourniquets are primarily avoidance techniques (read Addressing Any Behavior Problem). Use information from the focused history to provide the owner with explicit written instructions for keeping the pet out of triggering situations until a full behavior consultation can be scheduled. For example, dogs that become aggressive on walks should not be walked or walked only when and where they are unlikely to encounter other humans or animals. Fighting cats should be kept in separate parts of the home.

In extreme cases, the pet can be boarded for a few days to provide clients with a break and allow emotions to cool. This can give clients considering euthanasia an opportunity to reevaluate whether they want to pursue treatment or confirm that euthanasia is their preferred option.

Owners may have difficulty talking about a pet’s behavior problems. They may be embarrassed or fear being blamed. To help clients, it is critical to empathize with them. Let them know that they are not alone and that the entire clinical staff understands how much they care for the pet and want to help it.

Conclusion
Looking at the bigger picture, the triage appointment should be concluded by giving clients homework: completing behavioral history forms, writing accounts of their pets’ behaviors, taking pictures of the living arrangements, and making videos of the behaviors (except aggressive behaviors). With this additional information, a diagnosis can be made and a treatment plan (read Addressing Any Behavior Problem) can be implemented.

LAURIE BERGMAN, VMD, DACVB, owns Keystone Veterinary Behavior Services, a behavior house-call practice in Villanova, Pennsylvania, and is an active lecturer and consultant on behavior issues affecting small animals and wildlife. Dr. Bergman completed a behavior residency at University of California, Davis, and an internship in wildlife medicine at Tufts University. She has been involved in wildlife practice on Cape Cod and has consulted with local zoos and animal shelters in San Diego.

LORI GASKINS, DVM, DACVB, is assistant professor of animal welfare and behavior and veterinary ethics at St. Matthew’s University. After 15 years in practice, including 6 in which she operated her own pet behavior consultation practice, Dr. Gaskins completed a residency in animal behavioral medicine at University of California, Davis. She earned her DVM from North Carolina State University.