Separation anxiety calls for specific diagnosis, treatment

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Terrier looking out window"Separation anxiety is not a disorder of dogs," Dr. Daniel Mills said at the outset of his July 13 session at AVMA Convention 2018 in Denver. A professor of veterinary behavioral medicine in the University of Lincoln School of Life Sciences in England, Dr. Mills addressed a standing room–only audience on new insights into the problem and their practical application.

Separation anxiety has several distinct forms based on a mixture of emotional and motivational states, he said. About 20 percent of dogs are affected. Consistently across studies, he said, 15 percent of dogs aren't responding to medication, and 15 percent aren't responding to behavioral treatment.

Many conditions are accompanied by signs that a primary caregiver can misinterpret as separation anxiety. "As clinicians, we have to look for a differential diagnosis," he said.

Signs that could be interpreted as pre-departure anxiety include an immediate reaction to the owner's departure, urination and vocalization, reaction to noises when alone, signs of poor frustration tolerance, a perceived strong bond with a single person or object, and overly enthusiastic greetings when the primary owner returns. However, Dr. Mills said, there are many theoretical reasons besides separation anxiety for such signs, from frustration and fear to external events and pain.

"Distress is not a useful sign of differentiating the different forms of separation anxiety. What it is useful for is reflecting how intense the arousal is," he said.

"If our diagnosis is nonspecific for separation anxiety, our treatment measures are also nonspecific. If we want good treatment success, we need to be more specific with our diagnosis and our treatment," he said.

Dr. Mills has been involved in what he called some of the most important work of his professional life, using principal component analysis to create seven phenotypes of separation anxiety and specific treatment plans focused on the needs associated with each profile. Two of the seven phenotypes seem to be clearly associated with disturbances of the owner-pet bond, possibly linked to the owner's caregiving style and not the pet's hyperattachment, he told JAVMA News. He plans to submit this work to a professional journal in the future.

He also shared insights about how a primary caregiver's behavior factors into the problem.

"Styles of maternal care result in the preferred form of attachment," he said. "Treatment may need to begin with restructuring owner behavior."