Phobias

SEPARATION ANXIETY, FEARS AND PHOBIAS HOW ARE THEY RELATED?

Diane Frank, DVM, Diplomate ACVB School of Veterinary Medicine University of Pennsylvania, Philadelphia, PA

Co-morbidity of anxiety disorders is common in human psychiatry. Two retrospective studies in the Behavior Clinic at the Veterinary Hospital of the University of Pennsylvania (VHUP) suggest that separation anxiety and thunderstorm and noise phobia may not be independent. We retrospectively examined all cases within the past year in which either separation anxiety, thunderstorm phobia or noise phobia occurred or any combination of these conditions co?occurred. We also looked (manuscript is being submitted) at co-occurrence with other behavioral diagnoses.

SEPARATION ANXIETY AND THUNDERSTORM/NOISE PHOBIA

The Behavior Clinic of the Veterinary Hospital of the University of Pennsylvania (VHUP) has a separate questionnaire specifically designed to gain insight on the frequency of different distress behaviors exhibited during owner absence, namely destruction, urination, defecation, vocalization and salivation. The same questions are repeated for virtual absence. Questions on behaviors exhibited during thunderstorms, fireworks are also included on this questionnaire. Owners are asked to list reactions to other noises as well. Sirens and garbage trucks were some examples cited by clients. The type of response to noises, thunderstorms or fireworks included salivation, defecation, urination, destruction, vocalization, attempts to escape, to hide, and trembling. Frequency of reaction is also recorded. Regardless of the presenting complaint, all clients coming to the Behavior Clinic for an appointment with their dogs fill in this separate additional questionnaire.

The frequency of noise/thunderstorm phobia and separation anxiety may well be underestimated if specific questions are not asked systematically. Routine questioning in private practice may also allow earlier detection of these patients and earlier intervention. The earlier we can intervene, the greater the chance of success. One particular client adopted a Basset Hound, 3 years of age who would chew items during owner absence. The client just thought the dog was misbehaving and proceeded to crate him. Four years later, after filming the dog's behavior in the crate, she realized that the dog paced and whined the entire time she was away from home. The owner filmed her dog for two periods of 6 hours. The dog was now also urinating in the crate. Not all dogs with separation anxiety exhibit all signs and not all dogs exhibit signs with the same intensity. Some dogs also have panic attacks, during which they desperately try to get out of the home or the crate. Serious injury to the dog (and home) can result.

Presence or absence of a panic component will dictate choice of medications for these patients. Noise and thunderstorm phobias are relatively common in dogs. These conditions may vary in commonness and intensity depending on geographic location and frequency and severity of storms. Not all reactions to thunderstorms are the same. Some involve avoidance, some involve fear and some are panic attacks. Left untreated, these problems almost without exception get worse. The more signs they exhibit, the longer the phobia has been ongoing. Treatment for separation anxiety and noise phobias (including thunderstorm phobia) focuses on altering the dog's response to the stimuli by teaching the dog the competing behavior of relaxing.

In the case of thunderstorm or noise phobias, behavior modification also requires that the dog not be rewarded for fearful or anxious responses. Clients should not say it is OK to the dog while it is shaking and drooling. Petting should also be discouraged, as it is a reward. Otherwise the dog is being rewarded for being anxious. The owners should either leave the dog alone as long as their pet is not putting itself at risk for injury or they can also sit and stay quietly by the dog. Quiet association may provide some security without accidentally rewarding the dog. They can also apply gentle pressure either with an arm or their body, on the dog. Pressure can decrease arousal. There should be no petting.

Desensitization and counter? conditioning can be used to treat thunderstorm phobias. If the reaction to noise or storms has just started, exposure to these sounds using tapes, records or compact discs played on a good sound system may work. However, if the reaction to noise is severe, or has been ongoing for a long time, exposure to recordings will not help and may hurt. Storms do not always sound the same depending on the geographic location. For some thunder?phobic dogs, the triggers are not only the sound, but can also be the flashes of light, the atmospheric pressure changes, ozone levels et cetera.

The most common treatment for thunderstorm and other noise phobias involves pharmacological treatment with drugs designed to reduce or abort anxiety and panic. Complete blood cell counts and serum biochemistry are done prior to prescribing any behavioral drugs. The drugs of choice are diazepam (Valium), clorazepate (Tranxene®), alprazolam (Xanax®). The key to success is to get the medication in the dog before there are any behavioral, physical or physiological signs of distress.

If there is a greater than 50% chance of a storm, the dog should be medicated. The benzodiazepines are listed in order of duration of effect from shorter to longer. These medications can be used on an "as needed" basis in addition to a maintenance medication such as amitriptyline or clomipramine two tricyclic antidepressants (TCA), or fluoxetine a selective serotonin reuptake inhibitor (SSRI). For dogs that have other concomitant anxieties or anxietyrelated problems (aggression, fear, separation anxiety) or for those noise?phobic dogs that are so profoundly affected, maintenance medication is helpful and will decrease overall reactivity and anxiety. Choices include amitriptyline (Elavil®), clomipramine (Clomicalm®), fluoxetine (Prozac®). Clomipramine is best suited for situations involving anxiety whereas fluoxetine is best suited for conditions involving reactivity. Dogs suffering from separation anxiety with a panic component will benefit greatly if they are medicated with a combination of a tricyclic antidepressant and a benzodiazepine.

DOSAGES

Diazepam (Valium): 0.5-2 mg/kg PO PRN

Clorazepate (Tranxene®): 0.5-2 mg/kg PO PRN

Alprazolam (Xanax®): 0.01-0.1 mg/kg PO PRN - Do not exceed 4 mg/dog

Amitriptyline (Elavil®): 1-2 mg/kg PO q 12h

Clomipramine (Clomicalm®): 1-3 mg/kg PO q 12h

Fluoxetine (Prozac®): 1 mg/kg PO q 24h

References

1. Overall KL: Handout for clients. General treatment paradigm for dogs with noise and thunderstorm phobia. 1998

2. Overall KL: Clinical Behavioral Medicine for Small Animals. St. Louis, Mosby?Year Book Inc., 1997