Cat aggression overview

Overview

Cat violence is not a single issue.There are different types of anger that cats can show, which are grouped into the following groups:

• Aggression because of not having enough social ties Not getting enough interaction and/or habituation.
• Play with force.
• Aggression between catsAggression: having a fight.
• Aggression in territory.
• Aggression out of fear, Fear: aggression.
• Abuse by mothers.
• Changing the target of anger Aggression: against other people.
• Aggression aimed at prey.
• Aggression based on assertion, position, or impulse control.

These conditions that involve aggression can be told apart by the following patterns:

Presenting signs

• Stiffening.
• Growl.
• Change in affiliative behaviors.
• Enhanced vigilance.
• Pupil dilation.
• Hiss.
• Bite.
• Ears back or flattened.
• Concomitant changes in elimination behaviors that may not be recognized by the Cat owner as being a concern.
• Scratch.
• Piloerection.
• Tail puffed up.
• No physical response until outright attack.

Acute presentation

• Cat owners complain to veterinarians about cats who actively bite and, or stalk them, and about cats who do not use their litter boxes.
• Cat owners almost never recognize early forms of feline aggression, nor do they intuitively know that in multi-cat homes, elimination concerns are almost always associated with stress or distress experienced by their cat as a result of relationships or interactions within the feline social group.

Location related

• Cats that live outside are more likely to engage in predatory behavior than predatory violence. However, because cats learn to be predatory, it is not clear if there is a link between the normal behavior and the problematic diagnosis.
• Cats that live outside are more likely to be involved in intercat violence, which is mostly between males competing for the attention of females that are in heat.
• Cats that live outside are more likely to actively check the areas they live in and the areas they cross a lot, which means they may be more likely to become territorial.It hasn't been looked into in depth whether the cat's behavior fits the description of real territorial defense.It is clear, though, that cats that live outside seem to use the waste products of regular elimination behaviors as a way to mark their territory, and that vocal fights between cats often turn into serious fights that hurt one or more of the cats and cause an abscess. There isn't enough solid information on marking, police behavior, and the number of injuries.
• Cats that live outside and have never been around people are more likely to be aggressive because they haven't had the chance to socialize or play with other cats. This is because they haven't had the same opportunities.
• There are no regional geographic data on this, but indoor cats may be more likely to act aggressively out of fear because they can't get away from their tormentor. When people live in small spaces, like in Japan, their tendency to be violent may be heightened.
• True intercat aggression, which is aggression between cats because of how they interact and live together, is more likely to happen with indoor cats because they can't leave.Emigration is normal for farm cats, and it may be one way for cats to settle disagreements about how to interact with each other and their social status when they are free to roam.
• Redirected aggression happens when an aggressor's attempt to act in an antagonistic way is blocked. If there is a lot of crowding, or cats living close together, and one group of cats has power over the others' movements, aggression is more likely to be directed at them. Because of this, indoor cats may be more likely to show redirected aggressiveness.There aren't any good pieces of information on similar cases.
• Unless someone ignores normal warning signs or the mother is too stressed, maternal aggression is generally a normal, adaptive form of aggression.In these situations, the mother may become very angry and continue to act aggressively as a way to protect herself, which is different from normal defensive anger in mothers.A small but noticeable number of queens eat their kittens when they are upset, and an even smaller number do it no matter what. This is a trait that seems to be passed down through the female line if females live to be sexual adults.Queens who have been exposed to poor nutrition, even while they were still in the womb, may be more reactive and more likely to act in ways that aren't acceptable for mothers, even when they're trying to protect their babies.
• Because, by definition, impulse control aggression is only directed toward humans, it is more likely in cats that are handled than in cats that are truly free-ranging. However, it is impossible to know how many indoor cats have been turned into outdoor cats because they couldn't handle living in the house from their owners' point of view.
• The effects of age

Age tendency

• As with most social animals, cats start to act in strange ways when they become socially mature. These behaviors either go away or become clear during this time when the person's neurochemistry is changing so much.
• So, most violent cats started acting in ways that were either wrong or unwanted when they reached social maturity, which for cats is usually between the ages of 2 and 4 years.
• Most cats that are aggressive because they haven't been socialized are either very young (<3 months) or got that way because of how they were raised as babies.
• This finding in cats comes from how ancestors were born.The social changes that cats go through are similar to those in wild dogs like wolves: they happen quickly and early in life. This is called a "sensitive period."
• cats will almost always become aggressive toward humans if they are not handled by people before they are 12 weeks old. At that point, their play changes from roughhousing and socializing to hunting and fighting with other cats.
• There are a lot of free-ranging or possibly wild cats in cities, and people don't usually see very young kittens, even when they are there.
• As a result, the kittens don't gain from even the slightest interaction with people.
• Because cats only have a short window of time during which they can change and adapt optimally, the cats that come after them have never been around people, so the cycle of cats being aggressive when they meet people because they were never touched continues.
• No matter how "friendly" cats are by nature, they do best with people if they are touched for at least two weeks.It's so important to handle between 2 and 7 weeks that social problems were seen in studies where parts of this time were skipped.
• Cat owners need to be very aware of how different this trend is from dogs' and not think that cats are like small dogs.
• Even though dogs should be around new things, like people, as soon as possible, they are still much more open to new social interactions than cats are until they are 20 weeks old.
• Part of the proof for the claim that cats have not really been domesticated is this piece of paper.
• When cats act aggressively on instinct, either toward other cats or their own territory, it's usually because they are socially mature (2-4 years old) or are starting to become socially mature.
• Cats that act mean when they play are usually older kittens (12 weeks or higher) or subadults (less than 1 year old), and someone in the house encourages them to play rough.
• Some people say that cats who are diagnosed with play aggression are more likely to have been weaned or raised by hand, but there is no data to back this claim because no one has done a prospective study.
• Cats of any age can be victims of revenge aggression, fear aggression, or aggression that is meant to hurt another cat.
• It is important to remember that cats will learn to fear and avoid things they have never been actively scared of if they are the target of redirected hostility for a long time.
• Cats that are 8 years or older and have never been mean to anyone before rarely act mean.
• One exception is that these cats might act aggressively for a short time when a new cat, especially a young one, comes into the house.
• If these cats become mean, medical worries come first. There are two main reasons why older cats are often mean: they have hyperthyroidism or allergies.When the cat has hyperthyroidism, the owner may think that the cat is acting aggressively without thinking about it, or when the cat is in pain.
• Pain aggression is more common in cats that have to deal with young, active cats, dogs that are too rough, or people who are too rough and lively.
• This is a big problem when an unhealthy old animal lives with a child because babies don't see very well.

Gender 

• With the exception of the obvious categories of intercat aggression associated with mating (males over-represented) and maternal aggression (females over-represented) there are no accepted sex predispositions for any of the other conditions.
• This pattern may be due to the fact that no one has ever examined whether one sex or the other is truly over-represented.
• Cat social grouping are matrilineal and females who are related by blood may interact differently that those who are related by happenstance (which is usually what occurs when Cat owners add new cats to their family); however, no one has examined these relationships for potential differences.

Breed/Species predisposition

• Popular myth suggests that tri-color cats are unpredictable and more aggressive than other cats.
• It is unclear if this is true because no one has systematically collected the data.  However, there may be reason to encourage someone to do so because the expression of the 3rd color is due to the father's contribution on an X chromosome.
• Studies have supported the role for paternal genetics in the overall behavior of the kitten: kittens from outgoing fathers tend to be more outgoing themselves.
• Genes for many of the neurotransmitters associated with behavioral patterns can be found on the X chromosome.
• It would not be hard to design a decent study that examines whether the range of behaviors exhibited by tricolor cats is different from those who are two-tone or monochrome, but, to date, no one has done so.
• There are published accounts of laboratory colony cats recording the finding that adult, male, black cats appear to be the higher ranking cats in colonies, as determined by access to preferred perch sites, and that their degree of calm determines the overall pattern of the behaviors of the other colony cats.
• Finally, there is pervasive belief that fat-faced, intact (toms), orange / ginger male tabbies are inordinately friendly. Again, the data is lacking.
• The closer to the wild the cat breed, (Ocicats,   Bengal  cats), the more likely are Cat owners to notice behaviors that differ from those exhibited by previous house cats.
• The extent to which these ancestral behaviors and the manner in which the Cat owners manage the cats affects any feline behaviors is unexplored.
• Some breeds of cats (e.g., Siamese Siamese, Abyssinian Abyssinian, etc) are considered more outgoing, social, 'friendly', etc and so should be less at risk for any aggressive diagnoses.
• No studies have investigated these patterns.
• Breeds that are long-haired require considerable management and manipulation of their coats to keep the cats healthy.
• Whether this handling maps onto increased tractability and decreased incidences of diagnoses involving aggression is unknown.
• Finally, when cats are shown at fancier events they are manipulated in fairly unique ways that would be distressing to the uninitiated cat.
• Whether this makes these particular show cats calmer is unknown
• While the manipulation of dogs in the show ring is less invasive, the patterns of expected behavior are so simple and so clear that dogs that are problematic in other social situations can do quite well in the ring.
• Without study, we cannot know if cats respond to show-related expectations and rule structures in the same manner.

Public health considerations

• There are 2 main public health concerns involving aggressive cats:
  • 'Cat scratch / bite fever'.
  • The risk of any injury, even the smallest scratch, to Cat owners who are immunocompromised.
• Cat owners who are immunocompromised also need to understand that the stress of the social environment that is facilitating or necessitating the aggression may also cause cats to shed toxoplasmosis cysts and nematode ( Toxocara cati) eggs, which might then become infective for this human sub-population.  For adult humans with intact immune systems the probability of contracting these conditions from cats is very small.
• Cats are the main reservoir of the bacteria Bartonella (formerly Rochalimaea Henselae) Bartonella, a hemotrophic, gram-negative rod bacterium, the presumptive agent in cat scratch disease (CSD) Cat scratch disease in the USA. A contributory role has been postulated for the bacteria Afipia felis, but it, alone, does not cause the disease. Up to 80% of cats tested have antibodies against B. henselae, and domestic cats can be bacteremic for as little as several weeks or as long as several years. 22,000 cases - 1.8-10 cases / 100,000 people - of cat scratch disease are reported each year in the USA; 2,200 people are hospitalized, annually. 38/45 patients with CSD had titers of >/= 1:64 for Bartonella henselae. CSD is most commonly seen in the late summer and fall and coincides with seasonality in births of kittens (spring) and the entry of these kittens into the house in the winter. The cat flea, Ctenocephalides felis , plays a major role in cat-cat transmission of the bacterium. Fleas infestations may be associated with a higher incidence of the CSD and most patients have at least 1 kitten that has fleas. Patients with CSD are more likely to have a kitten less than or a year of age, or to have been scratched by a kitten than are non-patients. This makes sense since the prevalence of bacteremia is higher in young cats (< 1 year) than in adults. While patients in kitten-owning households are more likely to have been scratched or bitten than patients in non-kitten owning households, there appears to be no association with patients' cats and those of controls with regard to indoor / outdoor status, litter box use, and hunting behaviors.
• Cats transmitting CSD appear healthy although they have active B. henselae infections that last months. People with CSD tend to have localized skin lesions that are followed by regional lymph node involvement 3 weeks post exposure. Lymph nodes remain enlarged for several months. Systematic illness is rare, but fever, headache, splenomegaly, and malaise are common. These are usually self-resolving; however, arthritis, neuroretinitis, pleurisy, pneumonia, osteolytic lesions, granulomatous hepatitis, and encephalitis, with coma and seizure, can be an unusual sequela. Individuals with AIDS or those immunosuppressed for other reasons are at risk for more severe disease, including bacillary angiomatosis. Treatment in humans involves repeated courses of antimicrobials; however, recent data from feline studies suggest that the same antimicrobials may reduce the level of bacteremia, but do not eliminate the infection. B. henselaeis an intra-ethrythrocytic organism, and intracellular organisms are often difficult to eliminate even with state-of-the-art treatment. This finding may have profound implications for immunocompromised individuals who have aggressive cats.  Flea control becomes of paramount importance, and for Cat owners in this situation selecting a feline companion, an older cat may be a better choice.  Regardless, frequent hand washing and immediate treatment for even the mildest of injuries are essential in this group of Cat owners.

Cost considerations

• The calculation of the costs of having and treating an aggressive cat is not a simple one.
• Hidden costs of not treating these problems include changes in relationships with pets, and changes in future relationships with cats.
• Additionally, when cats become aggressive, Cat owners often fight within the household about 'fault', as they do when dogs manifest behavioral problems, so the 'emotional' cost to the household may be high.
• However, if a cat is euthanized because of its aggression and not all household members were equally comfortable with the decision, the cost of not seeking outside evaluation, preferably by a specialist in behavioral medicine, may be huge.
• The tangible costs for maintaining and treating these cats includes the cost of any hospital bills for injured humans, cats, and other animals, plus the actual costs of treatment.
• Costs of injury may be sufficient to suggest that outdoor cats with territorial aggression would require less veterinary care if kept indoors, but some cats don't make the transition well.
• Cat owners with cats with impulse control aggression may also have liability risks associated with visitors, should the cats not be safely contained.
• Cats exhibiting intercat aggression or redirected aggression seldom do actual physical damage to each other that is serious, but they do considerable 'psychological' damage to each other necessitating treatment for behavioral changes that may include medication and, or modifications to the home, including electronic doors that prohibit the entry of certain cats.
• The financial costs of treatment, itself, especially if the aggression is addressed early, are not huge.
• Most medications that are prescribed for any aggressive diagnosis address the underlying anxiety and reactivity that the cat is experiencing.
• Accordingly, the most commonly used medications are the tricylic antidepressants (TCAs) and the selective serotonin reuptake inhibitors (SSRIs).
• Pre-medication laboratory evaluation should be performed, adding nominally to the cost of treatment.
• Offsetting these costs are the less tangible benefits including, but not limited to, a lack of remorse, the humane aspect of pursuing diagnosis and treatment of a condition that has made everyone suffer, and the message sent to children that pets are not recyclable, disposable, or to be taken on in the absence of a true commitment.

Special risks

• Any anxious cat is at an increased anesthetic risk, as they are now more sensitive to alpha adrenergic pre-anesthetic agents. If the cat is taking a TCA there is also  a concern about alpha adrenergic pre-anesthetic agents. The concern is less if the medication is an SSRI.  Despite this risk, Cat owners are to be advised NOT to discontinue the medication prior to anesthesia if the cat is well regulated. The procedure for which the anesthesia is warranted is undoubtedly behaviorally provocative, and this cats are more at risk for a profound reaction. Accordingly, relapse is a concern that becomes more likely if the cats are withdrawn from their medication.
• Under no circumstances should cats treated with a TCA or SSRI be treated with any agent containing a monoamine oxidase inhibitor (MAO), eg selegiline, amitraz. These drug classes interact adversely and may lead to serotonin syndrome. Clinical signs of serotonin syndrome can  include an inability to relax, sleep, calm, eat, attend to anyone or anything, and potential hyperthermia.  This should be viewed as a medical emergency. It's important to note that none of the above medications are licensed for use in cats in the USA. Rhythm or conduction disturbances and tachycardias have been reported for all TCAs although they are extremely rare.
• Cats that are severely affected with aggression due to lack of socialization, fear aggression/impulse control aggression pose a risk to anyone who tries to restrain them.  Hence, routine veterinary care is generally risky for humans and patients, alike.

Causes

• The etiology of feline aggression can be understood - as is true with all behavioral diagnoses - at a number of levels.
• The easiest of these for the Cat owners to understand is the phenotypic one involving social interaction and provocation.
• The extent to which any cat is susceptible to provocation involves a complex interaction between genomic response surfaces, molecular and neurochemical flexibility, and neuroanatomical arousal.
• We do not understand this interaction for any behavioral diagnosis at present.

Predisposing factors

• Because the extent to which cats are outgoing v. withdrawn is greatly influenced by their paternal genetic contribution, fear aggression, fears, and learned aggressions that may develop as a result of fears could be lessened by breeding only friendly, outgoing male cats.
• This is practical in cattery situations, but unlikely in most other situations.
• Lack of early handling and exposure of kittens to new environments and people has an adverse effect on the extent to which cats can be influenced and adapt their responses in the future.
• It is possible that early handling, particularly that which occurs between 2 and 7 weeks, affects brain development and neurochemical effects on cells in specific regions of the brain.
• Such effects have been established for rodents, and are also likely to be important in cats since they have not been selected to be 'domesticated'. Part of the domestication process would have involved an expansion of these sensitive periods.
• Cats that are taught by their mothers to catch prey will likely exhibit predatory behavior later in life.  This learned response may not extend to aberrant behavior, like predatory aggression.
• Cats that are undernourished as kittens and those born to queens who were severely undernourished when pregnant have been shown to be more reactive, less calm, and more impaired in social learning.  The extent to which such nutritional concerns provide a fertile ground for the development of feline aggression has not been established, but may warrant serious thought.
• Underlying physical disease usually makes most animals more reactive and cats are no exception.
• The link between behavior and physical health is a complex one that is not sufficiently emphasized in most veterinary practices.
• Many of the immunosuppressive viral agents also exert non-trivial effects on brain development, memory, and certain types of behavior.
• These interactions are seldom explored, although FIV has been associated with increased reactivity in cats. Such reactivity could lead to a number of the aggressive conditions discussed.

Development

• We know so little about true behavioral pathology that we can only guess at the numerous underlying contributory factors to feline aggression.
• Because cats have been used as models for many human brain conditions (eg epileptic kindling) we actually know a lot about changes that occur subsequent to chronic stimulation.
• The amygdala is the region of the brain that is most often associated with the development and execution of fearful responses and behaviors.
• Cell bodies and ganglia within the amygdala give rises to nerve tracts to diffuse regions of the brain stem and the brain cortex.
• In cats, responses to stimulation are quick, act to recruit other cells and brain regions, and are prolonged for a considerable amount of time after the stimulus is discontinued.
• The hypothalamus in cats responds to stimuli in a region-dependent manner, and recruitment of firing neurons depends on where the largest stimulus is.
• Accordingly, active biting attacks and quiet predatory attacks with real prey items involve different parts of the hypothalamus.
• The extent to which cellular and molecular learning, or long-term potentiation, is involved in these triggered responses has not been investigated in cats.
• However, the patterns of behavior suggest that such processes act to change neurochemistry with each repeated exposure wherein the cat reacts, so that threshold levels are changed, and other social patterns altered.
• In the absence of definitive pathological information the best advice practitioners can give to Cat owners is to treat cats with aggression early and often, learn to recognize the signs of the aggression so that help can be sought early, and avoid behaviors and situations that could encourage aggressive responses.
• This dialog should occur at the time of the kitten appointments, and veterinarians should emphasize that it is because we know so little that early reliance on non-specific signs and potentially worrisome behaviors becomes critical.
• We don't know enough about these conditions at any level other than the phenotypic one, which is not helpful for understanding most pathophysiology.
• Laboratory experiments have show that stimulation of the ventromedial hypothalamus [VMH] provokes active defense behaviors in cats whereas lesioning the VMH increases frank aggression post-lesion.
• Stimulation of the lateral hypothalamus [LH] provokes predatory attack whereas lesion the LH results in a decrease in aggression or its abolition.
• Given these findings, understanding the neural circuitry and it's molecular associations involved in feline aggression should be research focus.
• Now that we have the ability to use molecular probes, functional imaging, and post-mortem immunohistochemistry our emphasis should be on understand the mechanism underlying our phenotypic diagnoses.

Time related

• With the exception of the aggressions that develop early due to lack of early learning and exposure (eg aggression due to lack of socialization, play aggression), the vast majority of feline aggressions develop at social maturity and are more specific manifestations of anxiety disorders.
• The hallmark of social maturity in all species that have been studied involves complex brain neurochemical changes that are disruptive and then settle into the individual's characteristic 'pattern' at the end of this period.
• The period of social maturity is separate from the period of sexual maturity but sexual hormones likely have some interactions with those that are changing during social maturity.
• A rough approximation of the age at which social maturity occurs in cats is 2-4 years.
• This estimate fits well with data on free-ranging cats that indicate in resource-rich environments, sub-adult cats 18 + months of age remain with their family groups and help with other young, rather than breeding independently. 
• The onset of an anxiety disorder is almost impossible for the Cat owner to recognize because the behavior may not be viewed as aberrant or troublesome, and the pattern is not clear.
• Accordingly, most anxiety disorders are recognized only when fully formed so it is almost impossible know the true timecourse.
• That said, some anxiety disorders develop quickly and abruptly, and some develop as if by accumulation.
• This gross observation suggests that various genetic response surfaces comprise the population, and the extent to which environmental stimuli interact with these increases the variability. Once established, these conditions do not improve on their own, and the earlier the intervention in the development of any pathology involving aggression, the more likely treatment is to be shorter.  Once fully established, the reversal of learned behaviors becomes a real challenge, and treatment that minimally involves management is lifelong.

Cat population

• The population dynamics have largely been discussed earlier.  However, Cat owners need to be reminded that the population that they must address is that of their entire household, and one cat with an anxiety-related condition, particularly if aggression is involved, can dysregulate all relationships, not just those involving the cats.
• By watching such relationships, the Cat owners are likely to detect changes earlier.

Cat owner history

• The general complaint in the Cat owner's history is that they do not understand what caused the problem.
• That lack of understanding is usually related to a fuzzy or wrong understanding of feline social systems.
• This problem must be addressed before the Cat owners can provide meaningful history information.
• The Cat owners usually also report some non-specific 'change' in either the cat's behavior or the relationships between individuals in the house.
• The Cat owner will often note a change in the physical or social environment in the home, but they may have to be questioned carefully about this to realise that a change may have occurred and that it's important.
• Cat owners may also report elimination problems; sometimes they only report elimination problems and fail to realise that aggression is also ongoing.
• Cat owners will only rarely report that they have seen overt aggression between any cats, or that humans or other animals did anything provocative.
• This is an important issue for veterinarians to address.
• Cat owners - quite rationally - consider 'provocative' behaviors only as those that are teasing, manipulative, deliberate, etc.
• When dealing with an abnormal animal normal behaviors are viewed - by the patient - as 'provocative'.
• Accordingly, Cat owners need to understand this bizarre logic to avoid injury, to provide a more accurate history, and to actively aid in the animal's improvement.

Clinical signs

• Changes in patterns of social behavior, eating behaviors, sleeping and resting behaviors, and, or elimination behaviors.
• Increased arousal as indicated by the non-specific signs that are associated with anxiety: increased vigilance and scanning, changes in motor activity, heightened autonomic reactivity, etc.
• Cat owners may need to be educated to note the physical signs associated with the underlying physiological changes (eg piloerection, pupil changes, ear position changes, tail position changes, body shape changes, etc).
• Concomitant changes in elimination behaviors generally involving failing to use the litter box for all elimination and, or marking associated with urine, feces, or sprayed urine.
• Cats will also alter the way they mark with all skin gland and rub the base of their tail, their tail, their cheeks, their chin, and the top of their head and neck on many more surfaces.
• The locations they choose will be very informative.
• Cat owners need to be told to look for these changes, but once they are aware of them they will find them obvious and easy to report.
• Overt aggression, oddly enough, is the exception, and Cat owners notice it most when it's directed towards them (in which case it appears quite common).

Diagnostic investigation

• Full physical and laboratory evaluation (CBC Hematology: complete blood count (CBC), chemistry panel, urinalysis) should always been performed on all cats with behavioral problems.
• Diagnosis is made on the basis of the definition criteria described early.  The 2 main questions that Cat owners and veterinarians need to ask are:
  • Is the behavior in question appropriate, given the overall context?
  • Does the behavior in question deviate from 'normal' or average?
• Only when the criteria / definitions of specific aggressions are met should a diagnosis be made. Otherwise, the risk is that the veterinarian will treat only a non-specific sign and fail to recognize the tremendous range of effects - both on the patient and anyone living with him or her - that the diagnosis entails.
• Manipulation of different behavioral and physical environments to tease apart social relationships.
• Accurate diagnosis of behavioral conditions requires that we alter the way we practice veterinary medicine.
• Veterinarians seldom ask about routine behaviors at veterinary visits, and so deprive themselves of information that could also help them address may feline 'medical' conditions.
• In cats, especially, somatic conditions involving stress are mirrored by behavioral ones, and vice versa.  In no place is this more obvious than in the constellation of elimination conditions that cats experience.
• If veterinarians begin to require that Cat owners complete a short behavioral questionnaire at each visit they will accomplish the following goals:
  • They will alert the Cat owners to the behaviors that may indicate problems.
  • They will inform Cat owners that behavioral concerns are important.
  • They will now have data before them with which they can track changes with time.
• ECG, thyroid profile (must have a full profile).
• Key to the diagnosis of any behavioral problem is an adequate history.
• Numerous published history questionnaires are available and unless veterinarians are comfortable or familiar with patterns of behavioral questioning, they should consider using one of these when they start to integrate behavior into their practice.
• Neurological examination, including ophthalmological exam.
• The most powerful tool Cat owners and veterinarians have to aid in the diagnosis of any behavioral concerns is the videocamera.
• Cat owners should be encouraged to video the cat in all normal social interactions and in all routine environments.
• The video should, ideally, contain a sequence of the cat exhibiting the behavior in question if doing so is not injurious to any animal or human.
• videotapes of all resident cats in any situations involving aggression or elimination are essential.
• Cat owners may see - given the ability to rewind - what they cannot see in real time.
• Veterinarians no longer have to rely on awkward description, and can provide an unbiased interpretation of the behaviors seen.
• For the latter to be really useful the veterinarians need to be educated in behavior to at least the extent of understanding basic feline signaling.

Confirmation of diagnosis

Discriminatory diagnostic features

• If the environmental and social manipulations are sufficiently discrete and deliberately designed to address the concerns about the phenotypic diagnosis, it is possible to consider the diagnosis as a hypothesis to be tested, and the treatment the test.
• In most cases veterinarians may find this difficult.

Definitive diagnostic features

• See discussion above and the specific entries for fear aggression and intercat aggression.
• Gross necropsy findings:
  • Gross necropsy in most behavioral cases is non-informative.
• This is likely due to the fact that the relevant changes are at the molecular level and that of the neurochemical receptor, detection of which required skilled, immunohistopathology, a diagnostic tool that is not routine.
• Additionally, the baseline data for 'normal' cats don't exist in a format useful for veterinarians.

Differential diagnosis

• Other aggressive diagnosis, and other behavioral diagnoses related, primarily, to elimination.
• Rabies and other infectious conditions that affect the CNS, toxic conditions, endocrinopathies.
• Rare diseases like prion diseases.

Treatment

Initial symptomatic treatment

• Treatment generally involves environmental modification, pharmacological intervention, and behavioral modification, generally in combination.
• Cat owners should be told that these conditions are not easy to treat and resolve without work, and drugs, alone, cannot 'cure' anything.

Initial symptomatic approach

• The key step in an initial symptomatic approach - an approach that is recommended ONLY as a stop-gap - is to identify the provocative or contributing stimuli and to avoid them.
• This may mean isolating a cat, feeding cats separately, separating cats that previously have been friendly, avoiding all play, etc.
• A competent, inclusive history will tell the veterinarian what should be avoided.
• Behavioral and environmental modification can be extremely effective if the needs of the cat(s) involved are met.
• The first step in treating any behavioral problem is to avoid the circumstances in which the aggressive behaviors occur.
• This may mean separating cats, or changing locations in which they are kept.
• The second step is to begin to reward the cat for behaviors that are to be encouraged.
• Food, play, praise, and in some cases, physical attention can all have roles in behavior modification.
• Once the cat understands the association between good and desired behavior and reward, true desensitization and counter-conditioning can be used.
• For desensitization the cat is exposed to the stimulus at a level below which they react.
• By adding a reward they do not react and gradually increasing the intensity of the provocative stimulus, counter-conditioning can be added to the behavioral repertoire.
• The TCAs and the SSRIs actually help facilitate behavior modification because of their effects on neuronal trophic facts in regions of the brain involved in associative learning. 
• The use of harnesses and leads allows Cat owners a degree of safety and control when working with aggressive cats.
• Cats that are too aggressive to take food treats from the Cat owners directly should have them dropped for them, or should be engaged with another reward system.
• The use of pheromone products Pheromone therapy has been hugely promoted in the past couple of years.
• The mechanism of action of these products is largely unknown, in part because we poorly understand the roles of various feline glandular secretions.
• Regardless, these products are not true pheromones, which require a specific molecular and neuronal response in order to be so labeled.
• Rigorous placebo-controlled, double-blind studies using a well-defined diagnostic and response group are lacking.
• Some clinical trials have noted a partial effect, but few cases respond as do the ones reported on the packet literature.
• As part of an integrated treatment plan, pheromone products may help, but it will be difficult for the Cat owner to tell which aspect of the treatment plan was efficacious.

Standard treatment

• The medications of choice for most aggressions follow.
• Cats are notoriously variable in the response to most medication.
• If Cat owners are going to worry or the cat is prone to sedation, it may be easiest to start with daily dosing.
• If this is not sufficient, increasing to twice/day is then rational and allows the Cat owners to compare the responses to the 2 different doses.
• This gives Cat owners some control over the medication and also makes them a partner in its monitoring, which usually is associated with better compliance and outcome.

Monitoring

• If any medication is used to treat the aggression both behavioral and medical monitory are necessary.
• Cat owners should understand that cats frequently worsen slightly before they begin to improve whether or not they are taking medication.
• This is usually a response to a changed social and physical environment that is now uncertain to the cat.
• One way in which cats can get information about the change is to provoke the situation.
• Because of this it is extremely important for Cat owners to emphasize positive rewards when any behavior that the Cat owners are trying to encourage is exhibited, even if the appearance of this behavior is accidental (e.g., sleeping). 
• Some of the medications that can be used to help treat aggression can have paradoxical reactions in cats.
• The paradoxical reaction to benzodiazepines (BZ) involving hyperactivity in cats is well known.
• They can exhibit a similar response to any medication that augments serotonin (primarily the TCAs and SSRIs).  These responses are rare, but Cat owners should be aware of them.
• Cat owners should watch for any sedation that may follow the administration of medication.
• If sedation does not wear off within a few days, the drugs should be stopped or the dosage decreased.
• If sedation continues to be an issue veterinarians may wish to consider changing medications.
• Cat owners should be encouraged to monitor normal cat behaviors in addition to those potentially associated with side effects.
• A response to medication that removes normal behaviors and makes the cat robotic is not the intended treatment response and should be considered undesirable.
• Pre-medication laboratory evaluation is essential in cats, since most behavioral medications involve glucuronidation.
• The more specific TCAs and SSRIs can affect cardiac rhythm so baseline ECGs are a good idea in cats for which there is some concern.
• These same evaluations should be repeated every 6-12 months as needed, or as warranted by age or condition.
• Most problems can be managed with adjustment of medication.  For example, should hepatic enzymes rise to the point that clearance may be an issue, a decrease in dose or frequency of the medication may be sufficient to continue to help the cat and spare his or her renal and hepatic systems.
• Most behavioral medications are metabolized through microsomal enzyme systems, which are polymorphic.
• The information of common sub-types in domestic animals is extremely limited.

Subsequent management

Treatment

• Long-term monitoring will focus on watching the sentinel signs that first alerted the Cat owner to the problem.
• Cat owners become better educated and more sensitive to behavioral changes in their household after working with a cat or dog with behavioral problems.
• Cat owners need to understand that behavioral conditions are just like diabetic ones - we can mange these conditions but a lack of clinical signs does not mean that we have cured the condition and ongoing treatment is not required.
• Accordingly, medication may be lifelong, and if so, the cats should have annual laboratory evaluation and ECG to insure that there are no untoward side effects of treatment.
• The easiest way to monitor the behavioral changes is to keep a log, which can involve a monthly assessment, or to videotape the cat(s) on a routine basis and compare the behaviors in the videos.
• The Cat owners may not know what to call the behaviors but they are quite good at recognizing what is the same and what is different.
• videos also allow the Cat owners to share concerns about potential behavioral changes with their veterinarian in a meaningful way.

Prevention

• Not applicable except for conditions induced by humans, like play aggression.
• Cat owners can sometimes avoid problems developing by not adding additional cats to their household which makes the social environment more complex and more unpredictable.
• Ideally, risks for the development of many aggressions - and the subsequent risk of pharmacological treatment - can be minimized by exposing kittens to the veterinary environment in a manner that is pleasing, rather than distressing.
• Frequent visits to the vet just for treats and exposure, and frequent handling by the Cat owners in a way that mimics veterinary procedures are the easiest ways to teach kittens that they need not fear veterinary care.
• Unfortunately, the veterinary community is not yet uniformly committed to the idea of behavioral prophylaxis where all feline and canine patients are encouraged to feel comfortable in, rather than fear, a veterinary setting.
• A kitten's first introduction to the vet generally involves scary noises and smells, uncomfortable surfaces, and painful experiences (vaccination and temperature assessment).
• The philosophical change that this need not be so must come if we are to decrease stress-related physical and behavioral conditions in cats.

Outcomes

• In the event that a veterinarian finds one anxiety-related disease, they are aware that they should continue to look for others.
• The main problem probably won't go away completely unless all of the things that make it worse are dealt with in a coordinated way.
• When help for behavioral problems doesn't work, the only options are rehoming, abandonment, or death.
• A traumatic event in a close relationship could have long-lasting affects that hurt the bond between people and animals and the veterinary field.
• These possible results should be enough to get everyone to work together to solve the problems.
• The outlook is good for most aggressions that aren't caused by male genetics or ontogeny, as long as the aggressions are caught early and treated properly, and cat owners are realistic about what they can expect.
• Realistic standards say that cat owners should protect people and other animals that the cat could hurt.
• Cat owners should also know that changes in the cat's surroundings and social life could make them upset.
• When the conditions are right, aggressions involving genes and development can be stopped by treating them with kindness.
• When these things happen, cat owners need to be even more realistic about their hopes. They need to know that the material they have to work with will slow down change and maybe even stop it from getting back to normal.

Response to treatment

• Any cat that is being violent will calm down if it stays away from things that make it angry.
• With more medical and behavioral treatment, the behaviors that cause worry should happen less often and with less intensity, and more normal and friendly behaviors should become more common.

Reasons for treatment failure

• The wrong diagnosis, wrong ideas about the risk, and the wrong therapy plan.
• The most common reasons why treatment doesn't work are cat owners not following through, either because they don't understand or because it doesn't fit with their lifestyle.