By Dr. Becker The medical name for excessive grooming in kitties is psychogenic alopecia. It happens when a cat’s normal licking activity crosses over into an obsessive behavior. Excessive grooming is one of the most common compulsive disorders in cats. Excessive Grooming Often Starts as a Displacement Behavior Psychogenic alopecia often begins as what’s called a displacement behavior. Cats need their daily routine to be very predictable and consistent. Some kitties, when they feel stressed by a change in their environment, will start performing a behavior like grooming themselves. This is an example of a displacement behavior. The type of stress that prompts excessive licking tends to be ongoing and is usually a combination of stressors that are cumulative. So… a new family member, a move to a new house, or even the relocation of the litter box can upset the average cat and trigger displacement behaviors. These displacement behaviors help to reduce emotional tension that the cat is feeling. Licking releases endorphins, so the behavior makes sense in the context of a cat who is trying to soothe himself. If the anxiety-producing situation continues, the cat may continue the displacement behavior repetitively, until it becomes obsessive. Some Cats are More Prone to the Behavior than Others Female cats tend to be more prone to psychogenic alopecia than males. The disorder can happen at any age, but is commonly seen about the time of puberty. There is probably a genetic basis for the condition, because it’s seen primarily in certain purebred cats – primarily the oriental breeds – with generally anxious temperaments. The disorder can also occur in kitties who are hospitalized, boarded, bored, deprived of their freedom, or who are generally stressed or have a high-strung disposition. Other Causes of Excessive Grooming It’s important to differentiate psychogenic alopecia from other reasons kitties will lick areas of their bodies, such as skin issues or pain. There are lots of medical reasons cats over-groom. If the problem is generalized itching, the licking is usually widespread. If there’s a painful area, the licking will be focused there. For example, back pain or anal sac impaction will prompt the cat to lick just that particular area. This behavior is also referred to as fur mowing. Where a cat focuses her licking can give clues to the root problem, which can be any number of things – fleas, a neurologic problem, a chiropractic problem, parasites, food allergies, or a reaction to dust, pollen, or mold. Conditions that aren’t skin-related but can cause excessive grooming include cystitis, hyperthyroidism, and anal sac problems. Identifying and correcting underlying medical issues is important before assuming your cat is licking for an emotional reason. If a kitty licks to the point of breaking the skin, infection can occur. The presence of infection will intensify the licking, which can result in an even more serious infection and a vicious cycle develops. How to Spot Excessive Grooming Behavior Cats spend about 30 to 40 percent of their day grooming themselves, and much of the remaining time is spent snoozing. So it’s common for pet owners to have no clue there’s a problem until they notice significant hair loss, bald spots, or scabs from over-grooming. It’s also possible cat owners don’t notice the behavior because when the person is there, the cat feels more comfortable and relaxed and doesn’t need to self-soothe by licking. Obvious signs of psychogenic alopecia are excessive licking and chewing. More aggressive kitties can resort to biting themselves and pulling out patches of hair. There may be shafts of hair that are chewed down to stubble, or there could also be skin wounds or ulcerations. Hair loss and skin damage will be localized to areas of the body where the cat actually can reach to lick and chew. Oftentimes, it’s the abdomen, flank, back, chest, and the inner legs. Often there’ll be a line of stubble down the back or on the front leg that looks a lot like a buzzed haircut. In addition to excessive licking, there can be other signs of stress, including hiding, refusal to eat, and nervousness. These are all general tip-offs that the behavior could have an emotional rather than a physical root. But I’ve seen plenty of excessive groomers where the only symptom of stress manifested as the psychogenic alopecia. The kitty appears to be calm, but is just over-grooming. Helping a Cat with Psychogenic Alopecia When all medical causes have been ruled out or resolved and you’ve narrowed the problem down to an issue of obsessive behavioral licking, treatment should be focused on stress reduction and environmental enrichment. Cats like to eat at the same time every day, so make feeding time very consistent. Keep food bowls and litter boxes in a consistent location and, of course, very clean. Provide your cat with hiding boxes, access to high perches, and appropriate scratching surfaces. Most kitties enjoy interacting with people, so take time every day to make sure your cat’s emotional needs are being met. You can involve physical activity with an interactive toy like a laser pointer. Brushing your kitty is beneficial for removing hair and cutting down on hairballs, and is quite enjoyable for many cats. Consider investing in a treat or food-dispensing toy for your cat. You can also think about window perches or even kitty videos to help provide environmental enrichment. You can talk to your holistic vet about stress remedies for anxious kitties. I’ve had success in treating these kitties with flower essences, homeopathics, and also acupuncture. Consider reducing stress with feline facial pheromone sprays such as Feliway. Most importantly, you need to be patient, as excessive grooming problems usually take quite some time to resolve. But with consistent attention, affection, and routine, most kitties do get their psychogenic alopecia under control. They re-grow their hair, and their quality of life improves within a few months’ time.
Hair pulling, or trichotillomania, now recognized in humans as an obsessive-compulsive disorder (OCD), was formerly classified as an impulse control disorder. The new definition helps us better understand and determine the cause, course, and therapy of the feline equivalent, psychogenic alopecia. One of the results of compulsive hair pulling in humans and cats is alopecia (baldness). The problem can be so mild as to be barely discernable or so severe as to warrant wigs for affected persons and to make cats diagnosable from the top of a double-decker bus with a telescope turned the wrong way round. The Humble Beginnings You’ve probably all seen cats groom themselves nonchalantly in moments of anxiety, stress, or indecision. People engage in similar behavior. If a person is in a situation of conflict, a stop-go situation, such as being stuck in traffic, they too engage in self-grooming to pass time and relieve the stress. Look to the side of you next time you’re stopped at a traffic light. Chances are the person in the car next to you will be looking in the driving mirror, straightening his hair or picking his teeth. These stop-go conflict behaviors are called displacement behaviors because the person or cat, when caught between two opposing objectives or drives, will displace into a third seemingly irrelevant behavior, in this case, self-grooming. Now picture a situation in which the conflict is chronic and associated with anxiety. In this scenario, the self-grooming displacement behavior will be performed for prolonged periods of time to a point at which it becomes habit and is performed out of context. That is to say, even when the conflict is relieved, the cat (or person) continues to self-groom to the point of overgrooming. At this point, hair, sometimes skin and nails, too, are licked, chewed, damaged, and stripped, leaving telltale signs of depilation and damage. The areas most commonly involved are the abdomen and the inside of the limbs. At this stage, the condition is diagnosable as OCD. There may be some slight skin damage but more often than not this is not the case. Where nails are chewed these can become shortened and frayed. There are natural and nurtural components to the condition. It is more prevalent in oriental breeds of cat, possibly because they are more highly strung. Domestic moggies that have had a rough ride growing up, especially those that have been improperly socialized or abused as youngsters, seem to be more prone. Conditions to “Rule-out” Medical conditions that can be confused with psychogenic alopecia and must be ruled out before the diagnosis can be confirmed. These are: Skin parasites (mites, fleas) might cause excessive irritation and thus overgrooming. For those familiar with psychogenic alopecia, the appearance is fairly typical, and parasites are fairly easy to detect, but confusion is possible in some cases unless a careful inspection is made. Skin scrapings may be needed. Fungal infections of the skin. Skin scrapings and fungal culture should be performed. A trichogram can be helpful. With psychogenic alopecia it is common to find broken, barbered hair shafts rather than intact hairs with the root attached. Hormonal conditions can be ruled out by means of appropriate blood work. Allergies can produce a similar pattern of baldness and their possible contribution should be carefully considered. Sometimes the irritation caused by allergies can focus an anxious cat on self-grooming so that the two conditions become intertwined. A simple rule to remember to assist in diagnosis is that allergies respond to treatment with corticosteroids whereas OCD does not. The Clinical Picture An anxious, nervous, perhaps overly attached cat in a seemingly stressful environment. Baldness across the abdomen and inside the limbs. Usually no obvious skin lesions, no ectoparasites, no medical explanation for the problem, no response to corticosteroid treatment. Owner-reported excessive self-grooming – perhaps induced by obvious stress. Stressors for cats include other cats in the house, people who the cat doesn’t like but is forced to tolerate, outside cats, wild animals, and separation distress. Oriental breed, most likely, or history of improper socialization/early abuse/neglect. Treatment Eliminate environmental stressors, if at all feasible. Separate feuding cats and gradually reintroduce them under pleasant circumstances. Countercondition to strangers and all incumbents using food treats/meal feeding. Keep outdoor animals away from windowsills and gardens. Motion-sensitive lawn sprinklers can be useful here. Click and treat train the cat (see separate section). Encourage and reward independence for cats with separation anxiety. Enrich the cat’s environment. Moving toys, food puzzles, climbing frames, a room with a view, window bird feeders, fish tanks, pet rats or mice, white noise, exercise, quality time and interactions with the owner. Treat concomitant medical conditions. Pharmacological treatment designed to stabilize mood, reduce anxiety and reduce compulsive behavior. The most useful drugs are the selective serotonin reuptake inhibitors (SSRIs) like fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft). They take a while to work, 3-6 weeks normally, may take as much as 4 months to reach their peak effect, and are usually necessary long term (at least one year). Side effects are uncommon if the dose is titrated properly and are usually transient. The most common side effects are drowsiness, reduced appetite and (paradoxically) increased anxiety. Not all cats with psychogenic alopecia respond to SSRIs. For those that don’t, the anxiety-reducing drug buspirone (Buspar) may be tried. It takes at least two weeks for the effects of buspirone to be seen. Side effects of buspirone are uncommon but include increased affection, increased playfulness, occasionally hyperactivity 30-40 minutes post-pilling, and occasional spats of aggression between formerly non-aggressive cats.