Psychogenic Alopecia in Cats

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 [microscopic inspection of shed and purposely depilated hairs] 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.