332 VetMedToday:AnimalBehaviorCaseoftheMonth JAVMA,Vol234,No.3,February1,2009

Statement of the Problem

A dog was examined because of a 10-month history of extreme fearful behavior toward the male owner, a freeze-or-flight response when confronted with unfa-miliar people or novel objects, and a reluctance to leave the house.

Signalment

The dog was a 21-month-old neutered male Dachs-hund that weighed 6.3 kg (13.9 lb).

History

The dog had been acquired by its owners from a breeder at 11 months of age and had been raised by the breeder at her home in a rural area. The dog had had contact with other dogs in the breeder’s home and yard, but had not been exposed to other conditions or to other humans except for the female breeder. The dog was reported by the breeder to have had no behavioral problems. However, it immediate-ly showed extreme fearful behavior toward the male owner when the female owner brought the dog home to their apartment in an urban area. The dog hid in its crate whenever the male owner was present, and the dog trembled, showed pupillary dilation, tucked its tail, laid its ears back, and rolled on its side and ex-posed its abdomen whenever the male owner reached toward the dog. In addition, the dog appeared reluc-tant to leave the apartment, and the female owner had to carry the dog outside. Once outside, the dog was reluctant to walk and stood with its tail and ears tucked and its body low to the ground. The dog froze in place or tried to run away, pulling hard on its leash, whenever it encountered people or novel objects, such as a bicycle. The dog barked and exhib-ited similar body language when guests arrived at the owners’ apartment and hid if the guests entered the apartment. Similar behaviors were seen independent of the female owner’s presence such as, for example, when a new fax machine was brought into the apart-ment. However, the dog did not respond fearfully to familiar household items or noises and did not show any signs of aggression.

The owners never punished the dog in an attempt to discourage the fearful behavior. The dog had a consistent daily routine and spent most of its time with the female

This report was submitted by Jeannine Berger, DVM, DACVB; from the Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, CA 95616.

owner, who worked from home. The dog was walked outside on a flat collar 3 times a day, had access to the living area during the day, and slept in its crate at night. Dry food and water were available ad libitum; intake was normal. Feces were normal in consistency and volume. The dog had had no formal obedience training.

The dog was left alone in the apartment a few times a week for a few hours each time and spent that time in its crate. Whenever the owners expected to be gone for more than a few hours, they brought the dog to a day care facility. There, the dog spent its time loose in a large enclosure with other dogs and no human contact; the dog appeared eager to interact with other dogs. The dog always greeted the female owner by wagging its tail and jumping up on her. At the time of initial examina-tion, the dog had been treated with clomipramine (3.2 mg/kg [1.5 mg/lb], PO, q 24 h) for 8 months, and the female owner indicated that she thought the medica-tion might have had some positive effect on the dog. The owners’ goals were for the dog to be more comfort-able with the male owner and other people and to learn more commands.

Physical Examination Findings and Laboratory Results

A complete behavioral history was obtained at the time of the initial evaluation. A physical ex-amination was not performed and blood and urine samples were not collected for analysis because of the dog’s extremely fearful behavior. However, it was recommended that the owners have a CBC and serum biochemical panel performed to assess he-patic and renal function, especially given the extra-label use of clomipramine, and results of a CBC and serum biochemical panel performed 8 weeks later were unremarkable.

At the time of the initial examination, the dog was brought into the examination room in a carrier. The carrier was placed on the examination room floor and the door was opened, but the dog did not exit the carrier for 20 minutes. When the dog did exit the carrier, it was trembling, and although its ears were erect, its tail was down and curled toward its abdo-men. The dog whined and avoided eye contact with the clinician and jumped on the couch where the fe-male owner was sitting and hid behind the owner.

Diagnosis

The crouching, trembling, and freeze response or escape behavior when exposed to a wide variety of

Animal Behavior Caseof the Month

In cooperation with

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stimuli (eg, the male owner, new people, and novel objects) were deemed to be manifestations of ex-cessive fearful behavior, and persistent, pathologic, pronounced fear of people1 and novelties (neopho-bia)2 was diagnosed. Phobias are evident as sudden, profound fear responses toward a specific reproduc-ible trigger or triggers that result in fearful body postures.3,4 By definition, phobias are characterized by excessive fear reactions and a lack of natural ha-bituation,2,3 and the dog described in the present report continued to exhibit strong phobic reactions even after 11 months of harmless encounters with fear-eliciting stimuli. The dog avoided phobic situa-tions whenever possible by hiding, but when phobic situations were unavoidable, such as during leash walks, the dog showed catatonia or strong escape behaviors.

Other potential causes of the crouching, trem-bling, and hiding that were considered included vari-ous medical disorders, such as pain, neuromuscular weakness, electrolyte imbalances, and other sys-temic illnesses, including endocrine disturbances.5,6 However, physical examination findings and results of clinicopathologic testing, together with the dog’s clinical appearance, did not provide any evidence of systemic illness, weakness, or guarding of any body part, and further testing for a medical disorder was not warranted.

Attention-seeking behavior was ruled out as a cause of the trembling and hiding because other signs associated with fearful arousal, such as dilated pupils and tucked ears and tail, were seen even when the female owner was not present.4 General anxiety is characterized by a chronic state of nonspecific apprehension, persistent sympathetic arousal, in-creased vigilance, scanning, and increased motor activity.2,3 Chronic anxiety generates stressful sym-pathetic arousal and potentially underlies the devel-opment of neophobic and xenophobic tendencies.2 The dog’s consistent, sustained, and nongraded re-sponse, manifested as intense active avoidance and signs associated with the sympathetic branch of the autonomic nervous system, was dependent on spe-cific external stimuli, and the dog was able to relax and showed no signs of apprehensive anticipation of fear when at home alone with the female owner. Therefore, a diagnosis of generalized anxiety was dismissed.3 Fearful behavior appears to be influenced by genetic and neurobiological predispositions, early social and environmental exposure deficits or aver-sive handling, and dysfunctional learning.1–3,7–9 Dif-ferentiating between genetic predispositions and so-cialization deficits can be challenging because they both result in similar signs. To rule out a genetic predisposition, it would have been helpful to have information on behavior of the dog’s sire, dam, and siblings. However, a history of inadequate socializa-tion and environmental exposure during the dog’s early development was provided. It has been shown that a lack of experience of urban environments between 3 and 6 months of age can be associated with avoidance behavior.10 The dog viewed such environments as a potential threat because it had

never learned to anticipate beneficial outcomes in association with unfamiliar situations. Aversive ex-periences during early life are also a major cause of phobic behavior in adult dogs2; however, traumatic conditioning and inadvertent reinforcement were ruled out on the basis of the dog’s history.

Treatment

The goal of treatment was to replace intense fear responses to various stimuli with acceptable relaxed responses,1,3,4 and a behavior modification plan com-bining systematic desensitization and countercondi-tioning with controlled exposure to various stimuli in a nonthreatening and positive way was recommend-ed.1,3,9 An alternative feeding schedule was imple-mented to train the dog to accept food in the pres-ence of the male owner.8 Initially, the male owner was to toss highly palatable food from a distance (approx 4 m). As the dog’s fear abated, the male owner was to gradually decrease the distance until feeding occurred out of his hand. The next step was to ask the dog to sit for a food reward. The behavior modification plan in-cluded establishing a pattern of calm relaxed responses in a neutral environment (apartment) combined with controlling the dog’s environment to prevent expo-sure to fear-provoking stimuli and situations.1 During the first 6 weeks of the behavior modification plan, for instance, the number of visiting guests was to be minimized, and the dog was to be placed in its crate in the upstairs bedroom with a long-lasting treat while guests visited. In addition, no new objects were to be brought into the apartment. Walks were to be short and limited to familiar, quiet places during low-traffic times, and a head collara was fitted to improve control on walks.11 The female owner was instructed to en-gage the dog in play and confidence building several times a day by asking the dog to respond to familiar commands for rewards and teaching new commands by means of positive reinforcement methods.8,11 Both owners were instructed that punishment should not be used in response to the dog’s fear behaviors.1,3,4 Ow-ing to the complex nature of the dog’s fear behaviors, the owners were given oral and written instructions for the treatment plan.

Clomipramine belongs to the group of tricyclic antidepressants predominantly regulating serotonin and has been approved by the US FDA for the treatment of separation anxiety in dogs. It also has been shown to be effective in controlling a number of anxiety-related behavior problems in dogs when used in combination with behavior modification techniques.9,12–14 Because clomipramine was reported to have had a slight posi-tive effect on the dog and did not induce any adverse effects, it was recommended that the owners continue to administer it. However, the dosage was increased to 2 mg/kg (0.9 mg/lb), PO, every 12 hours, and the owners were advised to monitor for adverse effects.12–15 Alprazolam, a rapid-acting benzodiazepine, has been shown to be useful in treating panic in dogs,3,12 and its use as an adjuvant if treatment with clomipramine and behavior modification did not sufficiently decrease the dog’s fear was discussed.

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Follow-up

The dog was reexamined 8 weeks and 1 year after the initial examination, and substantial improvement was ev-ident during both recheck examinations. The owners re-ported during the 8-week recheck examination that they had implemented the suggested behavior modification plan and that the dog now anticipated the male owner’s arrival by waiting at the door. The female owner was us-ing the head collar when walking the dog and reported that this appeared to help the dog focus on her and had decreased pulling when the dog encountered unfamil-iar stimuli while walking. The dog was brought into the examination room in its carrier and exited immediately after the door was opened. It looked around the room with its ears forward and tail in a neutral position and then jumped on the couch. The female owner demon-strated the new commands the dog had learned since the initial examination. At this time, the female owner was instructed to gradually extend the dog’s daily walks into unfamiliar territory and was told that when approaching unfamiliar territory, she should ask the dog to perform easy commands and provide the dog treats for relaxation. When guests were present, the dog was to be placed in its crate with the door open so that the dog could approach the guests if so desired. The same treatment schedule initially used for the male owner was implemented for unfamiliar people.2 Further, it was demonstrated how to gradually introduce new objects to the dog’s environment through desensitization and counterconditioning. A bal-loon was chosen as a novel object for the initial session at home because various aspects could be manipulated, such as size, distance, color, movement, and form.

Over the course of a year, the female owner was able to successfully introduce the dog to several differ-ent new objects, first at home and later outside, through the use of these techniques. At the time of the 1-year re-check examination, the dog was happily going on walks and had been able to participate in an obedience class. The dog now approached people, but would freeze when an unfamiliar person reached for it. The owners were pleased with the outcome. The gradual process of slowly tapering the medication by decreasing the daily dosage over a 3-week period was discussed at the time of the 1-year recheck examination.

a. Gentle Leader Headcollar, Premier Pet Products, Richmond, Va.

References1. Landsberg G, Hunthausen W, Ackermann L. Fears and phobias.

In: Landsberg G, Hunthausen W, Ackermann L, eds. Handbook of behaviour problems of the dog and cat. Oxford, England: But-terworth-Heinemann, 1997;227–267.

2. Lindsay SR. Fear and phobias. In: Lindsey SR, ed. Handbook of applied dog behavior and training: etiology and assessment of behavior problems. Vol 2. Ames, Iowa: Iowa State University Press, 2000;69–92.

3. Overall KL. Fears, anxiety, and stereotypies. In: Overall KL, ed. Clinical behavioral medicine for small animals. St Louis: Mosby Year Book Inc, 1997;209–250.

4. Nielson JC. Fear of places and things. In: Horwitz DF, MiIls DS, Heath S, eds. BSAVA manual of canine and feline behavioural medicine. Gloucester, England: British Small Animal Veterinary Association, 2002;173–180.

5. Nelson RW, Couto CG. Electrolyte imbalances. In: Nelson RW, Couto CG, eds. Small animal internal medicine. 2nd ed. St Louis: Mosby, 1998;818–835.

6. Ettinger SJ. Weakness and syncope. In: Ettinger SJ, Feldman EC, eds. Textbook of veterinary internal medicine: diseases of the dog and cat. 5th ed. Philadelphia: WB Saunders Co, 2000;11–16.

7. Casey R. Fear and stress. In: Horwitz DF, MiIls DS, Heath S, eds. BSAVA manual of canine and feline behavioural medicine. Gloucester, England: British Small Animal Veterinary Associa-tion, 2002;144–153.

8. Lindsay SR. Fear and phobias. In: Lindsey SR, ed. Handbook of applied dog behavior and training: procedures and protocols. Vol 3. Ames, Iowa: Blackwell Publishing Professional, 2005;121–180.

9. Walker R, Fisher J, Neville P. The treatment of phobias in the dog. Appl Anim Behav Sci 1997;52:275–289.

10. Appleby DL, Bradshaw JW, Casey RA. Relationship between aggressive and avoidance behaviour by dogs and their expe-rience in the first six months of life. Vet Rec 2002;150:424–438.

11. Landsberg G, Hunthausen W, Ackermann L. Prevention: the best medicine. In: Landsberg G, Hunthausen W, Ackermann L, eds. Handbook of behaviour problems of the dog and cat. Oxford, England: Butterworth-Heinemann, 1997;27–72.

12. Crowell-Davis SL, Seibert LM, Sung W, et al. Use of clomip-ramine, alprazolam, and behavior modification for treatment of storm phobia in dogs. J Am Vet Med Assoc 2003;222:744–748.

13. King JN, Simpson BS, Overal KL, et al. Treatment of separation anxiety in dogs with clomipramine: results from a prospective, randomized, double-blind, placebo-controlled, parallel-group, multicenter clinical trial. Appl Anim Behav Sci 2002;67:255–275.

14. Overall KL. Noise phobia in dogs. In: Horwitz DF, Mills DS, Heath S, eds. BSAVA manual of canine and feline behavioural medicine. Gloucester, England: British Small Animal Veterinary Association, 2002;164–172.

15. Landsberg G, Hunthausen W, Ackermann L. Drug dosages, ap-pendix D. In: Landsberg G, Hunthausen W, Ackermann L, eds. Handbook of behaviour problems of the dog and cat. Oxford, Eng-land: Butterworth-Heinemann, 1997;531–535.