Vol. 22, No.

4 April 2000

CE Refereed Peer Review

Canine Separation
FOCAL POINT Anxiety
★Separation anxiety, a common The Veterinary Behavior Clinic
behavioral disorder of dogs, can Southern Pines, North Carolina
be treated with a combination Barbara S. Simpson, PhD, DVM
of environmental management,
behavior modification, and
pharmacotherapy. ABSTRACT: Separation anxiety is a clinical syndrome that can occur when dogs are estranged
from owners or caregivers. It is characterized by behavioral and autonomic signs of anxiety, in-
cluding destructiveness, housesoiling (urinary or fecal), distress vocalization, pacing or dig-
KEY FACTS ging, hypersalivation, and self-trauma. Effective treatment focuses on environmental manage-
ment, behavior modification techniques, and pharmacotherapy. Without proper treatment, the
misbehavior can negatively affect the human–animal bond. Affected dogs are commonly relin-
■ Separation anxiety affects up to quished to animal shelters, where they may be constantly placed in other homes or euthanized.
14% of pet dogs in the United
States.

S
eparation anxiety is a behavioral disorder characterized by signs of distress
■ Both male and female dogs can when affected dogs are alone or separated from owners. The disorder is diag-
be affected by the disorder; nosed in 20% to 40% of dogs presented to specialty behavior clinics.1–5 A re-
however, like many other cent survey a of dog owners indicated that 14% of dogs receiving regular veteri-
behavioral problems, separation nary care may be affected. The disorder is a common cause of destructiveness and
anxiety is slightly more common inappropriate vocalization5,6 and a common reason that dogs are given to animal
in males. shelters.7,8 Other signs of separation anxiety include housesoiling, pacing, digging,
and hypersalivation.9 Some signs may be evident to owners when they return
■ A diagnosis of separation anxiety home or reported by neighbors. Other behavioral signs may only be identified on
is made on the basis of the an audio- or videotape recorded during the absence of owners. A dog’s behavior
patient’s behavioral history and when it is alone usually contrasts markedly to its behavior in the presence of care-
exclusion of medical or other givers, when it may never exhibit anxiety-related problems. Many owners may be
behavioral differentials. unaware that the dog’s behavior is caused by an anxiety disorder and may retro-
spectively attribute behavioral signs to spite. Separation anxiety can thus erode
■ The objective of medical therapy the human–animal bond.10,11 Sequelae include abandonment, surrender to an ani-
is to relieve anxiety and calm the mal shelter, and euthanasia.
dog rather than treat the specific
signs of destructiveness or CAUSES
elimination. Separation anxiety probably results from the social nature of domesticated dogs
and their emotional attachment to humans. A specific cause of separation anxiety
■ The FDA has recently approved has not been identified, although many factors have been suggested. There is evi-
a new treatment that involves dence of inherited predisposition for separation anxiety.12,13 Selectively breeding in-
behavioral therapy and creasingly affectionate, socially dependent, and infantilized dogs may concomi-
administration of clomipramine tantly select for excessive attachment to owners and intolerance to being alone.14
hydrochloride. a
Results of a survey conducted by Allpoints Research, Winston-Salem, North Carolina,
February 1997.
Compendium April 2000 Small Animal/Exotics

Early experience may play a role Traits Associated owners is common among dogs
in the development of separation with separation anxiety (see Traits
anxiety. Premature separation with Hyperattachment Associated with Hyperattach-
from the dam or other early inci- Dogs that exhibit separation anxiety often ment), behaviorists who treat ca-
dents of separation distress may have considerable affinity for their owners, nine separation anxiety often
produce subsequent difficulties a situation known as hyperattachment.9 The report cases with no signs of hy-
with routine separations.14 This re- perattachment.12 In addition, a
following traits are frequently (not always)12
action is expressed as signs (e.g., close hyperattached relationship
crying, motor restlessness) similar observed in affected dogs: between pet and owner may exist
to the emotional response of without separation anxiety.12 No
■ Remaining physically close to owners
young puppies when distanced evidence confirms that spoiling a
from the dam3,15 or nesting site.14 by following them around the house or dog by allowing it to sleep on a
Neurobiologic research in rats has frequently seeking to be petted or have bed or furniture or talking to it as
shown that early experience with other physical contact with owners if it were human contributes to
social separation produces perma- ■ Becoming distressed when the distance separation anxiety.20
nent deleterious effects on the ani- from owners increases (e.g., during a trip
mal’s response to gene expression to the mailbox or to take out the trash) SIGNALMENT
of corticotropin-releasing factor.16 AND HISTORY
■ Showing signs of restlessness or
This in turn may affect central The signalment for canine sepa-
norepinephrine levels in the locus behavioral depression as owners prepare ration anxiety varies. Both male
coeruleus of the pons and sero- to leave and female dogs can be affected;
tonin levels in the dorsomedian ■ Greeting owners with protracted, exuberant however, like many other be-
raphe of the medulla. 17 Other behavior when they return home havioral disorders, the problem
neurochemical correlates of sepa- ■ Displaying anorectic behavior when is slightly more common in
ration anxiety and social reward owners are absent and eating only in the
males.3,4,21,22 Affected dogs can also
18
are being investigated. be any age.3 Separation anxiety has
presence of owners
A conditioned (i.e., learned) been reported in dogs younger
component to separation distress than 1 year of age and is one of
is suggested by observations that the anxiety response in the more common behavioral problems in older dogs.23,24
many dogs is environmentally contingent. For example, Separation anxiety may occur in any breed or mix of
some dogs showing signs of separation anxiety when breeds. In a recent study of 93 dogs,25 30 breeds were
alone at home tolerate being alone in a familiar car.3 identified with separation anxiety, with mixed-breed
This observation suggests a conditioned response to the dogs most often represented (26%). When the percent-
owner’s departure from home that is not generalized to age of dogs presented for separation anxiety was com-
every environment. pared with the percentage presented for medical and
The environment can influence the expression of sep- surgical problems, mixed breeds were equally represent-
aration distress in other ways. New or changed environ- ed in both groups.4
ments may exacerbate the stress of being alone. When Dogs with separation anxiety commonly have a histo-
they are tested in a novel environment, dogs housed ry of adoption from animal shelters3,4,9,22 or rescue from
alone or with long-term kennel mates showed increased abandonment.9,26 Dogs with separation anxiety can be
activity and elevated glucocorticoid levels over control from single- or multiple-pet households.
values taken in a familiar environment.13 In contrast, The duration of separation anxiety can vary. The pa-
when dogs were tested in a novel environment with tient history may reveal whether affected dogs showed
their human caregiver, no increased activity or glucocor- signs of separation anxiety since puppyhood. Alternate-
ticoid levels over controls were observed.13 These find- ly, the disorder may occur in adulthood concomitant
ings suggest that the presence of a human attachment with an owner working more hours or a household
figure (but not a familiar kennel mate) reduces the stress move.29 Conditions that elicit signs can also vary. In
associated with a novel environment and that the emo- some cases, affected dogs tolerate regularly scheduled
tional bond between dogs and caregivers is particularly departures (e.g., when owners leave for work) but show
strong. signs of distress when owners leave at unpredictable
Pathologic hyperattachment between pets and owners times (e.g., weekends, evenings). In other instances,
has been proposed as a developmental anomaly that ex- dogs may exhibit signs when owners leave for work on
plains separation anxiety.19 Although hyperattachment to Monday after spending time together for the entire

NEUROCHEMICAL CORRELATES ■ ENVIRONMENT ■ HYPERATTACHMENT

Small Animal/Exotics Compendium April 2000

TABLE I
Signs Associated with Separation Anxiety
Sign a Medical Differentials Behavioral Differentials
Destructiveness None Playful or puppylike destructiveness or
(e.g., chewing, digging) overactivity, thunderstorm or other
environmental phobia, territorial aggression,
female nesting behavior

Distress vocalization None Territorial or alarm barking, social barking

(e.g., barking, howling, or howling
whining)

Inappropriate urinary Urinary tract disorders, prostatitis, Inadequate housetraining, insufficient

elimination endocrine disorders, seizures opportunity, urine marking, fear, excitement,
submission, cognitive dysfunction

Inappropriate fecal Gastrointestinal disorders, internal Inadequate housetraining, insufficient

elimination parasites, seizures opportunity, cognitive dysfunction
Inappropriate urinary and Seizures Inadequate housetraining, insufficient
fecal elimination opportunity
Gastrointestinal signs Numerous medical disorders Anorexia, social facilitation of eating
(e.g., anorexia, diarrhea,
vomiting)

Hypersalivation Toxin exposure, nausea None

Increased motor activity Primary neurologic disorders, dementia Thunderstorm phobia, territorial aggression
(e.g., pacing, digging,
circling, spinning)

Self-trauma (acral lick) Numerous dermatologic or neoplastic Compulsive disorder

causes, nerve conduction abnormalities,
trauma
a Behavior occurring only when the owner is absent.

weekend,23 or signs may manifest only when owners Dogs may exhibit one or more of the signs, often within
travel and the dogs are watched by friends or boarded at minutes of the owner’s departure.3 If the diagnosis is un-
kennels. certain, a video or audio record of the dog’s behavior in
The social conditions that trigger separation anxiety the owner’s absence may be helpful.26–29
can vary. Affected dogs may show signs of separation
anxiety when a particular attachment figure leaves and Destructiveness
can only be negligibly comforted by the presence of oth- Destructiveness, a common presenting sign in most
er caregivers. In other cases, affected dogs may be con- dogs with separation anxiety,3,21,22 can be conspicuous
tent if any human remains with it and exhibit signs only and costly to repair (Figure 1). A dog’s destructiveness is
when they are alone. often focused around the door through which the owner
departed or nearby windows. The molding around
DIAGNOSIS doors or windows may be chewed and/or clawed during
The diagnosis of separation anxiety is made on the attempts to escape, and the door itself may be extensive-
basis of the behavioral history and exclusion of diagnos- ly damaged. Dogs may also dig or tear at the base of
tic differentials that may be medical or behavioral (Table doors, resulting in damage to carpeting or other floor
I). Technically, to fulfill the criteria for separation anxi- coverings.
ety, behaviors should occur only when the dog is alone. Destructiveness may be targeted toward specific ob-

SOCIAL CONDITIONS ■ BEHAVIORAL DIFFERENTIALS ■ DIAGNOSTIC CRITERIA

Compendium April 2000 Small Animal/Exotics

Figure 2—Barking after owners have departed is common in

dogs with separation anxiety.

with separation anxiety include puppylike (i.e., playful)

destructiveness, thunderstorm phobia, and territorial be-
havior.6 Destructiveness is especially common in puppies
that are unsupervised. Careful history taking can reveal
whether the pet also chews objects when owners are
home. Dogs with thunderstorm phobia may exhibit de-
structive behavior because they were frightened by a
storm when owners were not home. Territorial behavior
may manifest as an act of aggression toward visitors (e.g.,
postal workers, delivery persons).
Figure 1—Severe destruction of a door by a dog with separa-
tion anxiety. (Courtesy of Brent Dugan, Raleigh, North Car- Vocalization
olina) Most dogs diagnosed with separation anxiety vocalize
(e.g., plaintive whining, howling, barking21) after own-
ers leave the house3 (Figure 2). Neighbors may report
jects in the house. Affected dogs may seek out and chew vocalizations to the owner. Some dogs whine as care-
articles of clothing, including shoes. The television re- givers prepare to leave; other dogs vocalize the entire
mote control, replete with olfactory clues from owners, time owners are gone.3 A cyclic pattern of vocalizing
is a common target. Occasionally, dogs pick up and car- may occur during the day.21 Bouts of vocalization may
ry an object that was handled by owners immediately be caused by external stimuli to which dogs with separa-
before they departed. Some dogs chew furniture, news- tion anxiety seem especially sensitive.21
papers, and magazines and upset trashcans. Although whining, barking, and howling occur in
Dogs kept outdoors may direct their destructiveness many contexts unrelated to separation anxiety,25 owners
toward the outside of doors and windows in attempts to often report that their dogs produce a particular distress
get inside the house. If they are confined to a pen or sound that is distinct from other vocalizations. Distress
yard, dogs may attempt to escape by digging or climb- vocalizations compatible with those of separation anxi-
ing. If dogs are liberated, they may remain at the door ety occurred in dogs adopted from an animal shelter
where owners departed. during a 5-minute period of isolation in a strange car.8
Dogs kept in crates when caregivers leave the house Diagnostic differentials for separation anxiety vocaliza-
may tear bedding or newspapers inside the crate or chew tions include territorial barking, alarm barking, or bark-
the bars of the crate. If the level of anxiety is intense, ing in response to signals from other dogs.
owners may find that the dog actually moved the crate
to a new location, turned it over, or escaped from it. Housesoiling
Both successful and unsuccessful attempts to escape can Fecal or urinary housesoiling, which can occur in
result in broken teeth or injured nails. dogs that have separation anxiety but are otherwise
Diagnostic differentials for destructiveness associated housetrained,3 is less common than is destructiveness or

SEVERE DESTRUCTIVENESS ■ CYCLIC WHINING PATTERNS ■ DISTRESS SOUNDS

Small Animal/Exotics Compendium April 2000

vocalization.25 Even after short tion. Although hypersaliva-

absences, owners may return tion occurring only during
and find feces, urine, or both the owner’s absence is usually
in the house or crate. indicative of separation anxi-
Diagnostic differentials for ety, toxin exposure should be
this behavior include inade- excluded.
quate housetraining, insuffi-
cient opportunity to eliminate, Motor Activity
urine marking, and noise pho- Dogs with separation anxi-
bia. The behavioral history ety may show altered patterns
should be investigated to verify of motor activity for several
that the dog never eliminates hours after owners depart.3,21,28
in the house unless owners are Some dogs exhibit ritualized
absent. pacing or circling,30 and some
The numerous medical tremble. Other dogs exhibit
causes of inadequate control decreased motor activity, of-
of feces or urine should also be ten described as depressed or
investigated. Inappropriate fe- catatonic by owners who have
cal elimination may be caused viewed the behavior in video
by internal parasites, enteritis, recordings. Affected dogs may
and malabsorption syndrome. remain immobile in a specific
Cystitis, cystic or urethral cal- location (e.g., in a closet, un-
culi, diabetes, or iatrogenic der a bed) until the owners re-
causes of polyuria are medical turn.
reasons for inappropriate urine
elimination. Seizures that have Self-Trauma
occurred when the owner is Figure 3–An excessive amount of saliva on windows adja- Self-inflicted lesions or trau-
absent may only be evidenced by cent to the door through which the owner departed. ma caused by attempts to es-
(Courtesy of Gail Harward, Raleigh, North Carolina)
the presence of feces or urine cape are commonly noted in
in the house. Medical causes dogs with separation anxiety.
of inappropriate elimination must be excluded in dogs Acral lick dermatitis in the absence of a specific medical
that are well housetrained. cause may result from the repetitive self-licking associ-
ated with separation anxiety (Figure 4).
Gastrointestinal Signs
Although many normal dogs demonstrate social facil- TREATMENT
itation of eating (i.e., eschewing food when owners are Treatment of separation anxiety consists of environ-
absent), dogs with separation anxiety commonly reject mental management, behavior modification, and phar-
special tidbits when owners leave and then eagerly in- macotherapy (Table II). In many cases, the best long-
gest the tidbits when owners return. Anxiety-associated term success is obtained when all three treatments are
gastritis (exhibited as vomiting) or anxiety-associated combined.3,25,31,32 Dogs treated with environmental and
cholitis (exhibited as diarrhea) may be evident, particu- behavioral therapy (without medication) show im-
larly when dogs are alone for an extended period in a provement over time.4,22,25,32 However, the relative value
new environment (e.g., boarding kennels). of specific environmental and behavioral protocols for
treating separation anxiety has not been rigorously test-
Hypersalivation ed in scientific trials.33
Hypersalivation occurs in a small percentage of dogs The objective of medical therapy is to relieve anxiety
with separation anxiety (Figure 3). In these cases, own- and calm the dog rather than treat the specific signs of
ers may return to find their dog’s face, chest, and fore- destructiveness or elimination. Anxiolytic medications
limbs soaked with saliva. Dogs kept in crates may be can reduce the extreme emotional state experienced by
standing in a puddle of saliva at the end of the day. dogs with separation anxiety. Adding psychotropic med-
Owners often report excessive water consumption after ication to the treatment regimen expedites improvement
they return—a sign that the dog might be compensat- and may enhance the level of overall improvement.25
ing for transient dehydration secondary to hypersaliva- Only clomipramine hydrochloride, a tricyclic antide-

BEHAVIORAL HISTORY ■ ACRAL LICK DERMATITIS ■ TREATMENT GOALS

Compendium April 2000 Small Animal/Exotics

pressant, has been tested in sion, or lights) should be done

double-blind, placebo-con- at least 30 minutes before own-
trolled studies.22,25 The effica- ers depart so that the changes
cy of other drugs is suggested do not trigger the arousal associ-
by case reports and clinical ex- ated with separation anxiety.
perience. The only change in the environ-
ment should be the owner’s de-
Environmental parture.
Management Very destructive dogs may
Several changes that may need to be confined to a crate
reduce the expression of sepa- or restricted area to prevent
ration anxiety can be made in extreme damage to the home
the environment and lifestyle or themselves. Affected dogs
of affected dogs (Table II). Op- should be gradually condi-
portunities for play and exercise tioned to spending time in
should be increased to meet the crate over a period of sev-
breed-specific needs. Daily in- eral weeks3 so that the crate is
teractions that last at least 20 associated with a positive ex-
minutes between dogs and perience. In animal shelters,
caregivers may reduce separa- crate training has successfully
tion anxiety.11 reduced the development of
When possible, owners separation anxiety after adop-
should not leave affected dogs tion.3,28 Without proper con-
alone at home until therapy ditioning, confinement to a
has been established for 2 to crate often increases barrier
4 weeks. Each episode of ex- frustrations and exacerbates
treme anxiety further rein- Figure 4A separation anxiety (Figure 5).
forces fearful responses and After several weeks of therapy,
thus may inhibit progress.3 In dogs that seem to adjust to
addition, not leaving the dog crate confinement may show
alone resolves the issues of additional improvement when
property destruction and self- removed from the crate in the
injury. Owners should thus owner’s absence.34
consider the possibility of Treatment of separation
taking their dogs to work, anxiety occurs under a specific
boarding them for the day, or set of social and environmen-
leaving them with neighbors. tal circumstances. If those cir-
In some areas, day care for cumstances change, the disor-
dogs is available. If affected der may recur. For example, if
dogs must be alone during there has been a move to a
the day, owners should con- Figure 4B new house or the owner has
tinue to depart as usual. returned to work after a vaca-
Unless dogs are anorectic, Figure 4—(A) Self-trauma inflicted on the digits of the left tion at home, signs of separa-
owners should leave a favorite hindlimb of an Irish setter secondary to separation anxi- tion anxiety may recur. The
ety. (B) Close-up view of the same limb.
treat to distract the dog and es- possibility for relapse should
tablish a positive association be anticipated, and therapy
with the owners’ departure. An ideal choice for some dogs should be reinitiated before significant social or environ-
is a hollow rubber chew toy filled with flavored food (e.g., mental changes occur.27
cheese, peanut butter) or a tidbit. The time required to Acquiring another dog as a companion is often sug-
consume the treat aids in the transition to a quiet envi- gested as treatment for separation anxiety; however, this
ronment. When owners return, they should remove the approach has not been shown to be helpful.30,32 In fact,
toy or treat so that it is associated only with departure. dogs from multiple-dog households are often presented
Environmental changes (e.g., turning off the radio, televi- for separation anxiety.32

LIFESTYLE CHANGES ■ MEASURING PROGRESS ■ GRADUAL CONDITIONING

Small Animal/Exotics Compendium April 2000

TABLE II
Treatment of Separation Anxiety
Method Specific Treatment
Environmental management Increase the amount of exercise; initially avoid leaving the dog alone to prevent
continued anxiety responses; leave the dog with a special treat before departure;
make changes in the environment 30 minutes before departure; use a crate if
essential to avoid damage to the home but only after the dog has been positively
conditioned to it

Behavior modification Do not punish the dog retrospectively; be calm around the dog 30 minutes before
departure and while departing but avoid talking to and petting the dog; devalue
departure cues (pick up keys repeatedly without departing, ignore the dog’s
response); practice graduated departures daily without leaving (train the dog to
stay calm while reenacting departure steps without leaving)

Pharmacotherapy Tricyclic antidepressants (with food, single dose or divided)—oral clomipraminea

2–4 mg/kg/day, oral amitriptyline 2–4 mg/kg/day, oral imipramine 2–4 mg/kg/day
Selective serotonin-reuptake inhibitors (single dose)—oral fluoxetine 1 mg/kg/day
in the morning, oral paroxetine 1 mg/kg/day

Benzodiazepines (alone or judiciously combined with antidepressants) 1 hour

before departure—oral alprazolam 0.01–0.1 mg/kg, oral clorazepate 0.55–2.2
mg/kg, oral diazepam 0.55–2.2 mg/kg
aOnly drug listed that has FDA approval as treatment of separation anxiety.

Behavior Modification laxing at home, they should have their dogs stay a short
Owners vary in their ability to understand behavior distance away and off the furniture instead of always al-
modification techniques and their willingness to imple- lowing them to be in close contact. Owners should in-
ment them. Instructions by veterinarians should thus teract with their dogs only when owners initiate atten-
coincide with the owner’s ability and interest to practice tion and ignore their dogs when they solicit attention.
specific techniques. All owners should be advised not to Practicing these exercises is believed to promote inde-
reprimand or punish the dog retrospectively (Figure 6). pendence from caregivers and discourage hyperattach-
Owners must often be educated not to perceive the dog ment.22
as spiteful or angry. Owners with this perception often To desensitize dogs to cues associated with departure,
punish their dogs retrospectively for signs of separation owners should practice these cues without leaving.35
anxiety (e.g., destructiveness, elimination). Punishment Thus owners need to identify a specific activity (e.g.,
may increase separation anxiety and associated signs. picking up car keys) that communicates departure and
To prevent excessive arousal, owners should avoid talk- elicits anxious behavior. Only one of these cues should
ing to, petting, or playing with their dogs 30 minutes be- initially be used for desensitization. For example, the
fore departure. Extended goodbyes or admonitions to be owner should pick up the keys and then put them down
good should be avoided because this type of stimulation without departing. The dog should be ignored and not
contrasts the silence and lack of interaction that occurs af- receive reinforcement for any anxiety-associated behav-
ter owners depart. The goal is to ease the transition from ior (e.g., pacing, agitation). Owners should continue
the time owners are present to the time they are absent. this exercise many times a day for several weeks. As the
When owners return, they should greet their dogs in dog’s response decreases to negligible levels, the owner
a matter-of-fact manner and avoid interacting with should add more cues to the departure sequence, in-
them until they are calm. Owners should then reward cluding putting on shoes, picking up a briefcase, open-
their dogs with positive interaction (e.g., talking, eye ing the door, and briefly going outside. In each case, the
contact, petting). In general, the goal is to reward calm, owner should execute the departure sequence without
obedient behavior with attention and ignore (not re- actually leaving the property and proceed with an unre-
ward) excited or anxious behavior. When owners are re- lated task when the sequence has been completed. These

OWNER EDUCATION ■ PROMOTING INDEPENDENCE ■ DESENSITIZATION

Compendium April 2000 Small Animal/Exotics

exercises help devalue the trig- Successful completion of an

gers that signal the owner’s obedience training class with-
departure. out specifically applying the
In a process called counter- exercises for separation anxiety
conditioning, dogs should be has little effect on resolving
trained to associate their own- separation-related behavior
ers’ departure from home with problems.2,20 Similarly, com-
a new response: calm behav- pletion of obedience training
ior. Initially, during short (5- does not prevent anxiety-relat-
to 15-minute) sessions, dogs ed problems.20,24 In one study,
should be taught to sit (or lie dogs that received obedience
down) and stay in a comfort- training along with behavior
able location as owners take a counseling had a lower inci-
few steps away and then re- dence of separation anxiety
turn with a small treat. Alter- than did those that received
nately, using massage tech- obedience training alone.11
niques, the dog can be trained
to relax in lateral recumben- Medication
cy.36 Owners can add a safety Medication plays an impor-
cue that dogs associate with tant role in the treatment of
the practice sessions, such as a separation anxiety because it
verbal phrase (e.g., be calm), reduces arousal and anxiety
a pleasant environmental sound during behavior modification
(e.g., bell, classical music), or exercises and actual depar-
an olfactory cue (e.g., spritz Figure 5—In some dogs, being confined to a crate can in- tures or absences31 (Table II).
of room deodorant on a cloth crease the frustration associated with separation anxiety. In one double-blind, placebo-
placed near the dog).3,23 (Courtesy of Roxanne Flores, El Paso, Texas) controlled study of dogs with
After the initial “stay” train- separation anxiety (n = 77)25
ing shows signs of success, owners should practice grad- more dogs treated with behavioral therapy and clomi-
uated departures during the next several weeks. Depar- pramine showed overall improvement than did those
ture sequences include moving away from the dog and treated with behavioral therapy alone. In another con-
then returning, going to the door and then returning, trolled study (n = 49),22 dogs treated with an intensive
and stepping outdoors and then returning while the dog behavior modification program alone showed signifi-
is commanded to stay. The duration of graduated depar- cant improvements in specific behavioral signs over time.
tures should extend from seconds to minutes. If the dog However, there were few differences in improvement
is unable to remain in place, whines, or trembles, the ex- between these dogs and those treated with intensive be-
ercises are being done too closely together or are pro- havior modification and clomipramine,22 suggesting
gressing too rapidly. With each session, the goal is to re- that medication may be adjunctive when the owner
ward calm behavior and associate that behavior with does not practice an intensive behavior modification
increasing distance and then separation from the owner. program. In dogs with severe cases of separation anxiety
The interactions should be positive and not punitive. or if euthanasia is being contemplated, behavioral ther-
Dogs in animal shelters may benefit from gradual train- apy and medication should be initiated immediately to
ing to minimize the development of separation anxiety maximize treatment success.
after they are adopted.28 Each animal should be medically evaluated as a can-
After a dog remains calm when owners depart for sever- didate for a particular agent. Veterinarians should be fa-
al minutes, an intermittent reinforcement schedule vary- miliar with the uses, side effects, and drug interactions
ing the amount of time owners are absent should be im- associated with the medication selected.37,38
plemented. For example, owners may initially leave for 1 Clomipramine, in conjunction with behavioral therapy,
minute, return, and reward the dog, Next, owners should recently received FDA approval as treatment of separation
leave 2 minutes, return, and reward the dog followed by a anxiety.39 Unless there are contraindications to its use (most
1-minute absence and then 3 minutes. When the dog re- notably cardiac and hepatic risk factors), clomipramine
mains relaxed during a 30-minute absence, the owner can should be the first pharmacologic treatment choice for sepa-
more rapidly progress to longer absences.5 ration anxiety because other agents can only be used on an

COUNTERCONDITIONING ■ DEPARTURE SEQUENCES ■ ADJUNCTIVE THERAPY

Small Animal/Exotics Compendium April 2000

extralabel basis. As a tricyclic an- petence, tremors, nervousness,

tidepressant, clomipramine acts and lethargy. Starting at one
selectively on the serotonin and half the dose for 1 week and
norepinephrine neurotransmit- gradually increasing the dose
ter systems in the central ner- to the recommended level can
vous system.37,40 After 3 months minimize side effects.
of administration to healthy As with any antidepressant,
dogs with separation anxiety, therapeutic benefits may be
clomipramine had no signifi- observed immediately or may
cant effect on hematology, bio- not become apparent for up
chemistry, or body weight.25 to 4 weeks. Concomitant use
Other tricyclic antidepres- of monoamine oxidase inhibi-
sants have also been used as tors (e.g., deprenyl, amitraz)
treatment of separation anxi- may cause serotonin syndrome,
ety. Amitriptyline, a relatively a serious condition resulting
inexpensive tricyclic antide- from excessive accumulation of
pressant, has been used3,10,12,24 serotonin in the central ner-
but seems to be less effective vous system, and should be
than clomipramine in treat- strictly avoided.43
ing signs of separation anxi- Refractory cases may require
ety. 30 Imipramine has been alternative or combination
shown to be effective in man- therapy. Benzodiazepines,
aging separation distress in which act on the γ-aminobu-
dogs41 and has been used to tyric acid neurotransmitters in
treat enuresis (bedwetting) in the central nervous system,
children and may thus be par- Figure 6—Retrospective punishment for destructiveness or may be used alone or in com-
ticularly useful in cases of inappropriate elimination associated with separation anxi- bination with antidepres-
urine housesoiling associated ety should be avoided. This dog is exhibiting submission sants12,44 and are generally well
and fear postures in response to scolding. (Courtesy of Rox-
with separation anxiety.37 anne Flores, El Paso, Texas)
tolerated by dogs. Side effects
The side effects of tricyclic include dose-related ataxia, se-
antidepressants include leth- dation, or (less often) paradox-
argy and occasional vomiting. In general, lethargy is ic agitation. Benzodiazepines (e.g., alprazolam, clor-
dose related and often resolves after 2 to 7 days as toler- azepate, diazepam)38 act immediately, although their
ance is achieved. Vomiting may be avoided by giving duration of action is relatively short. They have been used
the medication with food or dividing the dose. Because to treat the immediate postdeparture signs of separation
tricyclic antidepressants can cause cardiac conduction anxiety.12 When they are used alone, these agents tend to
disturbances in humans predisposed to the condition, be disappointing in the treatment of separation anxiety.32
careful cardiac auscultation is recommended. Further When used in combination with antidepressants, the
cardiac assessment is indicated in dogs with heart mur- benzodiazepines offer a way to treat cases of self-injury
murs, endocrine disorders, or other health risks. Tri- and severe destructiveness that necessitate immediate re-
cyclic antidepressants can lower the seizure threshold; sponse to treatment. For example, after the dog has been
thus their use is contraindicated in animals with a his- started on a clomipramine regimen, alprazolam (which is
tory of seizures. Tricyclic antidepressants are toxic in used to treat panic disorder in humans) may be adminis-
overdose; all precautions should be taken to prevent ac- tered 1 hour before the owner departs. Eventually, ben-
cidental ingestion by children or animals. zodiazepines can be gradually withdrawn and the patient
Antidepressants other than tricyclic antidepressants can be maintained on an antidepressant. After daily use
have also been used to treat separation anxiety,42 particu- at therapeutic doses for more than a week, immediate
larly in cases in which tricyclic antidepressants are con- withdrawal of a benzodiazepine may lead to a discontin-
traindicated or ineffective. Fluoxetine, a selective sero- uation reaction.38 Multiple-drug therapy increases the
tonin-reuptake inhibitor (SSRI), may be helpful in cases complexity of treatment and constitutes extralabel use.
that are refractory to tricyclic antidepressants or involve
cardiac risk factors. Side effects of the SSRIs observed in Duration
dogs parallel those reported in humans and include inap- The duration of treatment varies. Medical treatment

TRICYCLIC ANTIDEPRESSANTS ■ THERAPEUTIC BENEFITS ■ COMBINED DRUG THERAPY

Compendium April 2000 Small Animal/Exotics

conventionally continues for at least 1 to 2 months after 5. Landsberg G: The distribution of canine behavior cases at
the dog responds satisfactorily to behavioral and medical three behavior referral practices. Vet Med 86:1011–1018,
1991.
therapy. After the dog tolerates long separations, the dose 6. Lindell EM: Diagnosis and treatment of destructive behavior
can be gradually reduced (over a period of weeks) while in dogs. Vet Clin North Am Small Anim Pract 27:533–547,
behavioral treatment continues.31 Gradual withdrawal al- 1997.
lows veterinarians to determine the extent to which the 7. Miller DD, Staats SR, Partio C, Rada K: Factors associated
with the decision to surrender a pet to an animal shelter.
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tion regimen and to immediately reinstate medication if 8. Van der Borg JAM, Netto WJ, Planta DJU: Behavioural
signs recur. Difficult cases may require medication for testing of dogs in animal shelters to predict problem be-
months to years. Dogs that relapse may be particularly haviour. Appl Anim Behav Sci 32:237–251, 1991.
9. McCrave EA: Diagnostic criteria for separation anxiety in
challenging, and each relapse tends to be more difficult the dog. Vet Clin North Am Small Anim Pract 21:247–255,
to manage.12 If untreated, separation anxiety can lead to 1991.
relegation to an animal shelter and/or euthanasia. 10. Houpt KA, Honig SU, Reisner IR: Breaking the human-
companion animal bond. JAVMA 208:1653–1659, 1996.
Outcome 11. Clark GI, Boyer WN. The effect of dog obedience training
and behavioral counseling upon human-canine relationship.
In one study of dogs with separation anxiety,4 a fol- Appl Anim Behav Sci 37:147–159, 1993.
low-up of 37 cases at 1 year revealed that 84% of dogs 12. Overall KL: Clinical Behavioral Medicine for Small Animals.
treated with environmental management and behavior Philadelphia, Mosby, 1997, pp 210, 215–219.
modification showed some improvement. A control 13. Tuber DS, Hennessy MB, Sanders S, Miller JA: Behavioral
and glucocorticoid responses of adult dogs (Canis familiaris)
group of 11 untreated animals with separation anxiety companionship and social separation. J Comp Psychol
revealed that 45% showed some improvement. In an- 110:103–108, 1996.
other double-blind, controlled study of 77 dogs,25 the 14. Serpell J, Fagoe JA: Early experience and the development of
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Behaviour, and Interactions with People. Cambridge, Cam-
ioral therapy alone after 3 months was nearly the same bridge University Press, 1995, pp 80–102.
as the number that showed improvement with behav- 15. Elliot O, Scott JP: The development of emotional distress re-
ioral therapy and clomipramine. These findings indicate actions to separation in puppies. J Gen Psychol 99:3–22, 1961.
that behavioral therapy alone can lead to improvement 16. Nemeroff CB. The neurobiology of depression. Sci Am 42:
49, 1998.
over time and that this effect persists. However, adding 17. Price ML, Curtis AL, Kirby LG, Valentino RJ, Lucki I. Ef-
medication may expedite the response to therapy.25 fects of corticotropin releasing factor on brain serotonergic
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Separation anxiety is a treatable condition. The great- Ann N Y Acad Sci 807: 78–100, 1997.
est success is obtained by a multifaceted treatment pro- 19. Pageat P: Pathologie du Comportement du Chien. Cedex. Edi-
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dogs through behavioral therapy, and provides antianxi- 20. Voith VL, Wright JC, Danneman PJ: Is there a relationship
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ety therapy in the form of appropriate medication. Ear- thropomorphism, and obedience training? Appl Anim Behav
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GRADUAL WITHDRAWAL ■ FOLLOW-UP STUDY ■ EARLY INTERVENTION

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Behavior Clinic, a behavior specialty referral practice in
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36. Tuber DS. Teaching Rover to relax: The SOFT exercise. Southern Pines, North Carolina, and is affiliated with the De-
Anim Behav Consult News 16:2–3, 1999. partment of Clinical Sciences, College of Veterinary
37. Simpson BS, Simpson DM: Behavioral pharmacotherapy. Medicine, North Carolina State University, Raleigh, North
Part I. Antipsychotics and antidepressants. Compend Contin Carolina. She is a Diplomate of the American College of
Educ Pract Vet 18:1067–1081, 1996. Veterinary Behaviorists and is certified as an Applied Animal
38. Simpson BS, Simpson DM. Behavioral pharmacotherapy.
Part II. Anxiolytics and mood stabilizers. Compend Contin Behaviorist by the Animal Behavior Society. Dr. Simpson
Educ Pract Vet 18:1203–1213, 1996. served as an independent investigator in FDA clinical trials
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Technical Review, Greensboro, NC, 1998.