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Signalment factors, comorbidity, and trends

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in behavior diagnoses in cats:

736 cases (1991–2001)
Michelle Bamberger, MS, DVM, and Katherine A. Houpt, VMD, PhD, DACVB

Objective—To describe trends in behavior diagnoses
from 1991 to 2001; assess the relationship between
diagnoses and age, sex, reproductive status, and
breed; and evaluate associations between diagnoses
within the same cat (comorbidity).
Design—Retrospective case series.
Animals—736 cats.
Procedures—Medical records were reviewed for
species, breed, sex, reproductive status, consultation
year, birth date, and diagnoses.
Results—The caseload decreased over the course of
the study. Aggression toward people increased, and
spraying decreased. Cases involving Siamese cats
decreased over time. Siamese cats were evaluated
more often than expected in general and specifically
for aggression and ingestive behavior problems,
whereas Persian cats were evaluated more often than
expected for elimination outside of the litter box.
Domestic shorthair cats were evaluated less often
than expected in general and specifically for aggres-
sion, ingestive behavior problems, and house soiling.
Male cats were overrepresented. Cats with ingestive
behavior problems were evaluated at a median age of
1.5 years, compared with cats with other problems
(median age, 5.5 years). Certain diagnoses were clus-
tered, with a mean of 1.2 diagnoses/cat.
Conclusions and Clinical Relevance—Results sug-
gested that in cats, behavior problems changed over the
course of the study, age and breed distributions varied
among diagnoses, and certain diagnoses were likely
to occur together. (J Am Vet Med Assoc 2006;229:
1602–1606)
ABBREVIATIONS
ABC Animal Behavior Clinic at Cornell University
CUHA Cornell University Hospital for Animals
however, in several studies,11-13 aggression is listed first.
Although the age, sex, and breed distributions of behav-
ioral problems in cats have been described in several stud-
ies,1,3-6,8,10,13,14 none report or analyze associations between
diagnoses within the same cat or methodically evaluate
trends from year to year.
The primary objective of the study reported here
was to describe and analyze trends in feline behavior
diagnoses made at the ABC from 1991 to 2001 inclu-
sive. Secondary objectives included assessing the rela-
tionship between behavior diagnoses and signalment
factors (eg, age, sex, reproductive status, and breed),
assessing the distribution of these factors over time,
and evaluating comorbidity within the caseload.
Criteria for Selection of Cases
Criteria for the selection of cases have been
described.15 Medical records for 751 cats evaluated at the
ABC from January 1, 1991, through December 31, 2001,
were evaluated for this study. Records of 15 cats were
excluded from the ABC population because of incom-
plete data; therefore, 736 cats were included in the study.
Procedures
Breed, sex, reproductive status, consultation year,
birth date, and behavior diagnoses were gathered. A
maximum of 3 diagnoses were recorded for each cat;
these diagnoses were the first 3 listed in the record.
Cats (n = 23,701) evaluated at the CUHA over the

N umbers and types of behavioral problems may

change over time; it is therefore important that gen-
eral practitioners understand current trends as well as
same period served as the reference population for

distributions of affected cats by age, sex, and breed. Such

knowledge on the part of practitioners may greatly
reduce consultation time and aid in making the correct
diagnosis.
In studies1-4 based on cat owners’ opinions, house soil-
ing or nonbehavioral concerns3,4 have been reported as the
2

main problem. Results of most feline case studies5-10 also

indicate that house soiling is the most common problem;
From the Department of Clinical Sciences, College of Veterinary
Medicine, Cornell University, Ithaca, NY 14853. Dr. Bamberger’s pre-
sent address is Vet Behavior Consults, 1225 Hinging Post Rd, Ithaca,
NY 14850.
The authors thank Dr. Robert Strawderman for advice on statistical Figure 1—Plot of the number of cats evaluated for behavioral prob-
analysis, Dr. Robert Oswald for advice on data entry and analysis, lems at the ABC from 1991 to 2001. The y-axis is scaled as the
and Emma Williford and Doreen Turk for technical assistance. square root of the number of cats. The line is the linear regression
Address correspondence to Dr. Bamberger. of the data (slope = –0.355; SE = 0.08; r2 = 0.68; P = 0.002).

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breed, sex, reproductive status, and age comparisons. with the CUHA population. In general, more males had

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Breed, sex, reproductive status, and age data from the diagnoses in the categories of aggression, ingestive behav-
CUHA population were gathered independently. Over ior problems, and house soiling. For most diagnoses,
the entire study, a breed was assigned to all cats, and more neutered cats were evaluated in the ABC popula-
sex and reproductive status were specified for > 98% of tion, except for the diagnoses of ingestive behavior prob-
the cats. The owners were able to specify the age in lems, defecation outside of the litter box, and urination
62% of the cats. Further procedures for this study have and defecation outside of the litter box, for which no dif-
been described.15 Ninety-six diagnoses taken from orig- ference was detected between the populations. No trends
inal records were assigned to general categories. over time in sex were detected in either population.
Statistical analysis—Statistical methods used in Table 1—Distribution (No. of affected cats [%]) of diagnoses
this study have been described.15 All analyses were per- among 736 cats evaluated for behavioral problems at the ABC
formed with standard software.a All tests were 2-tailed, from 1991 to 2001.
and values of P < 0.05 were considered significant. Diagnosis No. of cats (%)
Aggression 268 (36.4)
Results People-directed aggression 100 (13.6)
The number of cats evaluated at the ABC decreased Owner-directed aggression 95 (12.9)
(slope = –0.355; SE = 0.08; r2 = 0.68; P = 0.002) between Dominance-related aggression 48 (6.5)
Animal-directed aggression 190 (25.8)
1991 and 2001 (Figure 1). In the CUHA population, the Intercat aggression 185 (25.1)
number of cats increased over the same period (slope = Anxieties 15 (2.0)
0.99; SE = 0.06; r2 = 0.96; P < 0.001). Locomotor behavior 0
Ingestive behavior 32 (4.3)
Self-directed aggression 6 (0.8)
Distribution of diagnoses—The number and per- Grooming behavior 9 (1.2)
centages of affected cats for all major category diagnoses Fears 2 (0.3)
and all diagnoses with an absolute number of 32 or more House soiling 418 (56.8)
Marking 128 (17.4)
affected cats over the entire study period were deter- Spraying 128 (17.4)
mined (Table 1). The category of house soiling account- Elimination 317 (43.1)
ed for the largest percentage of affected cats evaluated Urination 170 (23.1)
Urination and defecation 101 (13.7)
during the study period, followed by aggression, inges- Defecation 46 (6.3)
tive behavior problems, unruly behavior, anxieties, mis- Miscellaneous 13 (1.8)
cellaneous, excessive vocalization, excessive grooming, Phobias 0
self-directed aggression, sexual behavior, and fears. Sexual behavior 5 (0.7)
Unruly behavior 29 (3.9)
Vocalization behavior 10 (1.4)
Trends in diagnoses—Trends were detected for 2
diagnoses (Table 2). In the subcategory of people- Percentages do not add to 100% because each cat may have had
up to 3 diagnoses. Major category diagnoses and all other diagnoses
directed aggression, an upward trend was observed, with $ 32 cases/y over the study period are listed.
whereas for spraying, a downward trend was observed.
Relationship between diagnoses and age— Table 2—Results of logistic regression analysis of the frequency
Comparisons within the ABC population were made of various behavior diagnoses in cats from 1991 to 2001.
(Figure 2), and only diagnoses with an age difference
Diagnosis Slope SE P value
(between populations of affected cats with the diagno-
sis and those without) of > 2 years were considered to Aggression directed at people 0.100 0.036 0.006
Spraying –0.103 0.035 0.003
be clinically important, as described.15 Overall, median
age at evaluation was 4.5 years, mean age was 5.6 Slope = Slope of the regression line.
years, and the interquartile range was 2.5 to 7.5 years. P value indicates comparison with a slope of 0.
Only the diagnosis of ingestive behavior problems was
significantly (P < 0.001) different and clinically impor-
tant regarding comparison between affected cats with
the diagnosis (median age, 1.5 years; interquartile
range, 1.5 to 3.5 years) and those without the diagno-
sis (median age, 5.5 years; interquartile range, 2.5 to
7.5 years). For all diagnoses, an upward trend for
median age over time was observed (slope = 0.26; SE =
0.094; r2 = 0.46; P = 0.022); corresponding data from
CUHA revealed no trend (Figure 3).
Relationship between diagnoses and sex—Sex dif-
ferences among cats with various diagnoses were deter-
mined (Table 3). Overall, neutered males (ABC, 95%;
CUHA, 81%) and neutered females (ABC, 93%; CUHA,
80%) were evaluated much more often than sexually
intact cats. Overall, more male cats and more neutered Figure 2—Histograms of the percentage of cats evaluated at the
cats were evaluated in the ABC population, compared ABC and CUHA as a function of age.

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Relationship between diagnoses and breed—For

SMALL ANIMALS

breeds that had ≥ 30 cats with any diagnosis and for

breeds with the 3 highest percentages of cats with each
category of diagnosis, the percentages of affected cats,
compared with all affected cats, were determined for
the ABC population; corresponding percentages for
these breeds were also determined for the CUHA pop-
ulation (Table 4). Across all diagnoses, Siamese cats
comprised a significantly higher percentage of the
total number of cats in the ABC population, compared
with the CUHA population; American Domestic
Shorthair cats comprised a lower percentage of the
total number of cats. The diagnosis of ingestive behav-
Figure 3—Box-and-whisker plots of age (years) versus year of
ior problems was given to a low number of cats over
diagnosis for all cats evaluated at the ABC. The line is the linear the study (n = 32) and, thus, low numbers of cats in
regression of the data (slope = 0.26; r2 = 0.46; SE = 0.09; P = most breeds (1 to 2); because of this, only 2 breeds
0.022). were reported for this diagnosis. A downward trend
was detected over time in numbers of Siamese cats
Table 3—Distribution of sexes for cats with various behavior (slope = –0.191; SE = 0.061; P = 0.002); a similar trend
diagnoses, 1991–2001. was also seen in the CUHA population (slope =
–0.073; SE = 0.011; P < 0.001). When regressions
Diagnosis Male (%) Female (%)
between the ABC and CUHA populations were com-
All diagnoses 57.6* 42.4 pared, a significant (P < 0.001) difference was detect-
Aggression 57.1* 42.9
People-directed aggression 58.0† 42.0 ed in Siamese cats—the number of Siamese cats in the
Dominance-related aggression 68.8* 31.3 ABC population decreased at a greater rate than in the
Animal-directed aggression 57.4* 42.6 CUHA population.
Ingestive behavior 65.6* 34.4
House soiling 56.2* 43.8
Spraying 75.0* 25.0 Comorbidity—Of all cats, 79.6% had 1 diagnosis,
Defecation 65.2† 34.8 15.4% had 2 diagnoses, and 5% had 3 or more diag-
*Significantly (P # 0.05) greater than values in the opposite sex
noses made at the time of evaluation. The mean num-
in the ABC population and values for the same sex in the corre- ber of diagnoses per cat was 1.2, and certain diagnoses
sponding reference CUHA population. †Significantly (P # 0.05) occurred in clusters. Significant associations between 2
greater than values in the opposite sex in the ABC population only. diagnoses that occurred together were determined
For the CUHA population, percentages of male and female cats
were 50.3% and 49.7%, respectively. (Table 5). Most associations occurred between diag-
noses in the house soiling category.
Table 4—Distribution (%) of breeds in a reference (CUHA) population and among cats with various
behavior diagnoses evaluated at the ABC from 1991 to 2001.

Breed CUHA All diagnoses Aggression Ingestive behavior House soiling

ADS 80.6 66.8* 71.3* 43.8* 65.6*
Domestic longhair 8.0 8.3 7.8 9.1
Persian 1.4 5.0†
Siamese 3.6 6.0† 6.0† 31.3†
For the CUHA population, values indicate percentage distribution of cats for each breed.
*Significantly (P # 0.05) less than that of the CUHA population. †Significantly (P # 0.05) greater than that of
the corresponding CUHA population.
All diagnoses = Breeds with 30 or more cases; for all other diagnoses, values are given for the top 3
breeds with regard to the number of cats with each diagnosis, except when numbers were equal or case
numbers were low. ADS = American Domestic Shorthair.

Table 5—Associations between pairs of diagnoses in 736 cats evaluated at the ABC form 1991 to 2001.

D1 D2 No. D1 D2 P value
Spraying Urination 17 128 (13.3) 170 (10.0) 0.004
Spraying Urination and defecation 15 128 (11.7) 101 (14.9) 0.033
Play aggression Dominance-related 6 24 (25.0) 48 (12.5) , 0.001
directed at aggression
owners
Play aggression Attention-seeking 7 24 (29.2) 25 (28.0) , 0.001
directed at behavior
owners
Intercat aggression Urination 5 185 (2.7) 170 (2.9) , 0.001

No. = Number of cats with both diagnoses. D1 = Number of cats with diagnosis 1 (percentage of cats that
also had diagnosis 2 in parentheses). D2 = Number of cats with diagnosis 2 (percentage of cats that also had
diagnosis 1 in parentheses). The last column gives the value of P as determined by the Pearson χ2 test.

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Discussion
House soiling was diagnosed in more than half of
all cats, and < 75% of these occurrences were caused by
elimination outside of the litter box. More than half of
the elimination cases were associated with urination
(53.6%), followed by urination and defecation
(31.8%), and then defecation (14.5%). Others have
found that elimination outside of the litter box was the
most common behavioral problem in cats.5,7,16-18 In the
study reported here, aggression accounted for 36.4% of
all cats evaluated and was primarily caused by fighting
between cats. Ninety-five percent of aggression against
people was directed at owners, and more than half of
these cases involved status-related issues, although
others have found either play aggression19 or redirected
aggression20 to be the main causes of aggression
towards people. Because both house soiling and
aggression can be associated with difficulties in treat-
ment and management, they are important to recog-
nize and understand.
An upward trend in people-directed aggression was
detected. In addition to aggression related to status,
aggression also occurred during play and when situa-
tions caused the cat to redirect its aggression at the
owner. To make an accurate diagnosis, veterinarians
should quiz owners on specific contexts of the aggres-
sion.21,22 The upward trend in people-directed aggression
may be attributable to an increasing tendency to keep
cats inside the home (and thus interacting more with
people) and may be a result of efforts by welfare and
wildlife groups.23 A downward trend was detected in
spraying, which was similar to findings of the
Association of Pet Behaviour Counsellors14 in their
review of cases from 1995 to 2000. The downward trend
in spraying may be indicative of general practitioners’
willingness to treat rather than to refer such cats and to
the efficacy of serotonergic agents such as clomipramine
and fluoxetine24-27 as well as pheromones28,29,b in manag-
ing this problem.
Siamese cats were evaluated more frequently than
expected overall for aggression as well as for ingestive
behavior problems (pica was the largest individual diag-
nosis in this category with 40% of cases). Results of
other studies also indicate that Siamese cats are overrep-
resented for aggression30 and pica.31-33 Under the house
soiling category, Persian cats were the only breed to be
overrepresented overall for several elimination problems
(urination or defecation outside of the box). Himalayan
cats and mixed-breed cats were evaluated more fre-
quently only for the individual diagnosis of urination
and defecation outside of the litter box. No breed was
overrepresented regarding spraying. Results of other
studies17 have also implicated Persian cats as being over-
represented for elimination outside of the litter box.
Siamese cats were the only breed for which signif-
icant changes were detected in numbers of cases dur-
ing the study in both the ABC and CUHA populations.
It is interesting that the change was a downward one,
with changes significantly greater in the ABC popula-
tion, and is interesting to speculate, as suggested for
selection of dog breeds,15 whether the high percentage
of behavioral problems in this breed may be affecting
prospective owners’ selection of this breed as a pet.
JAVMA, Vol 229, No. 10, November 15, 2006
The median age at evaluation for all behavioral
SMALL ANIMALS
problems combined was 4.5 years, and the mean age
was 5.6 years. Mertens and Dodman5 found the largest
age category of cats with behavioral problems to be 4
to 5 years, whereas a study1 based on an owner survey
found the mean age at evaluation to be 5 years. In our
study, ingestive behavior problems was the only diag-
nosis with both a clinically important and significant
age difference between cats with that diagnosis (medi-
an age, 1.5 years) and cats with any behavioral diagno-
sis (median age, 5.5 years). Bradshaw and Neville33
reported that pica often occurred between 6 and 18
months of age, occurring most frequently in the 2
months following adoption.
An upward trend was detected in the median ages
of cats over the study period. Because a similar trend
was not detected in the CUHA population, this
increase cannot be attributed to cats living longer lives.
However, one could speculate that this trend may be a
result of owner awareness and willingness to treat con-
ditions such as cognitive dysfunction, coupled with
veterinarians’ increasing ability to treat behavioral con-
ditions previously considered to be caused by old age
and unmanageable. To our knowledge, no other study
has examined changes in age over this period of time
or considered these factors.
Males were evaluated more frequently than expect-
ed overall (57.6%) in the study reported here, and
numbers of neutered cats always exceeded those of
sexually intact cats, reflecting the current common
practice of neutering pets routinely. For most diag-
noses, neutered cats were also evaluated more often
than expected, compared with the CUHA population.
Others have also reported evaluating more males and
more neutered cats in general for behavioral prob-
lems.5,6 We found males to be overrepresented in the
house soiling category (all house soiling diagnoses
combined) as well as in the diagnoses of spraying and
defecation outside of the box. Others have found an
equal sex distribution for defecation outside of the
box9 but also found that males were evaluated more
frequently than expected for spraying.9,17 Males and
neutered cats were overrepresented in the category of
aggression; this has been reported in 1 other case-
review study.30 In the study reported here, males were
also overrepresented for ingestive behavior problems;
Bradshaw and Neville33 reported similar findings in
their study on pica.
Because of the difficulty that may be involved in
making correct diagnoses, especially involving house
soiling,34 it would greatly benefit veterinarians to be
aware of which diagnoses may occur together. In our
study, the largest number of significant associations
occurred between spraying and urination outside of
the box or between spraying and urination and defeca-
tion outside of the box. Owners with cats eliminating
outside of the box should be questioned carefully dur-
ing history-taking to rule out concomitant spraying.
Social issues among cats may also lead to house soil-
ing.35,36 In the present study, intercat aggression and uri-
nation outside of the litter box occurred together more
often than chance would predict. Because aggression
between cats may be passive and difficult for the owner
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to detect, careful questioning during the consultation
SMALL ANIMALS
is necessary and may help to define these issues and
link them if both are indeed present. Also, play aggres-
sion was associated with attention-seeking behavior as
well as status-related (dominance-related) aggression.
Knowing that these behaviors can occur together will
help veterinarians to educate owners and tailor a treat-
ment plan to address all issues. It is important to keep
in mind that the data reported here represent only cats
referred to veterinary behaviorists and that breed dis-
tributions reported in this study do not necessarily
reflect breed prevalence of behavioral problems.
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urine spraying by the domestic cat (abstr), in Proceedings. 1st
Conf Vet Behav Med 1997;262.
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