How to identify, treat self-injurious patients

How to identify, treat self-injurious patients

Keys to differentiating behavior patients from allergic and endocrine patients—and how to treat them
Jun 01, 2011

Self-traumatizing disorders, such as self-inflicted barbering or hair removal and abrasions or ulcerations of a body part, can occasionally start as a behavioral pathology. When presented with an apparently pruritic patient—or any patient that has caused damage to itself with its teeth, tongue, claws or even an external object—perform a thorough history and medical workup to search for the underlying cause. Endocrine, neurologic, musculoskeletal, infectious, immune-mediated, neoplastic, inflammatory, traumatic, dermatologic and behavioral causes can all play a part in an itching, scratching and chewing pet.

Case study

Photo 1: Morris is experiencing generalized hair loss and excessive grooming.
Morris, a 5-year-old neutered male cat, is brought in for evaluation because of generalized hair loss and excessive grooming (Photo 1). He began grooming more frequently during the past six months, primarily at night. The hair loss is mostly on the inside forelimbs and ventral abdomen. Morris is an indoor cat and the only cat in the household; there has been no change in his environment. He is up-to-date on vaccinations, is eating and drinking normally and has no history of vomiting, diarrhea, coughing, sneezing or increased thirst or urination. He has received the same adult-food diet for the past five years.

Physical examination reveals extensive regions of alopecia without redness, rash or skin thickening. The medical team obtains a standard dermatologic database that includes a skin scrape, skin cytology and fungal culture. The skin scrape and cytology reveal no abnormalities. An oral antihistamine for pruritus and topical antifungal medication for potential dermatophytosis are prescribed.

After two weeks, the dermatophyte culture results remain negative, and the owner reports that topical and systemic medications have not changed Morris' signs. The results of a complete blood count, serum chemistry profile, urinalysis and thyroid profile are normal.

After using a thorough protocol to help identify patients with allergic and endocrine-type skin disorders, the medical team determines that Morris does not appear to be afflicted by either of these conditions. They now must look to other possible causes of his chronic behavior.

Pruritic or other self-mutilatory disorders seen in the behavioral specialty can include compulsive disorders, displacement activities and stereotypic, attention-seeking and other anxiety-related behaviors. These are classified as primary behavioral disorders, with any skin manifestations occurring secondary to the self-induced trauma.