Is It Psychological, Physical, or Both?: Sue M. Mcdonnell, PHD, Caab
Is It Psychological, Physical, or Both?: Sue M. Mcdonnell, PHD, Caab
Is It Psychological, Physical, or Both?: Sue M. Mcdonnell, PHD, Caab
Behavior changes in the absence of obvious physical causes are often challenging to diagnose. The
role of the veterinarian is to carefully rule out all possible physical root causes. Whether or not the
causes can be determined and whether or not the root cause is physical or psychological, behavioral
abnormalities provide an excellent opportunity for the veterinarian to recommend detailed monitor-
ing of the behavior and if necessary, involve the professional assistance of an equine-behavior
specialist. In many cases, detailed review of videotaped samples of the horse undisturbed in its stall
or paddock (“stall video”) can be an efficient aid in identification of physical discomfort. Author’s
address: Equine Behavior Lab, University of Pennsylvania School of Veterinary Medicine, New
Bolton Center, 382 West Street Road, Kennett Square, PA 19348; e-mail: suemcd@vet.upenn.edu.
© 2005 AAEP.
NOTES
Apparent reluctance to lie down and/or Limb pain, neck or back pain, sore feet Joint disease, fractured pelvis, neurologic
difficulty lying down or getting up disorders, back pain
Partial or full collapse
Forelimb bucking or falling to knees Central nervous system (CNS) disorders, Narcolepsy, cataplexy, epilepsy, inability to
cardiac dysfunction, recumbent sleep get down and up for recumbent rest
deprivation
Hindlimb collapse Neuropathy Cervical vertebral malformation (CVM),
equine protozoal myeloencephalitis
(EPM)
Forelimb and hindlimb collapse CNS disorders, cardiac dysfunction Narcolepsy, cataplexy, epilepsy, CVM
Stumbling, collapse when startled Neurologic disorders EPM
Seizure Neurologic disorders Epilepsy, EPM
Treading when recumbent Neurologic disorder Seizure
Altered mentation CNS disorders Narcolepsy, epilepsy, trauma,
tranquilization, fluphenazine toxicosis6,7
Ataxia Neurologic disorders EPM, CVM
Leaning hindquarters or side into wall, Neurologic disorders, hindlimb pain Narcolepsy, EPM
fence, or corner
“Non-physiologic” postures
Head tilt Head discomfort, neurologic disorder Vestibular disease, neoplasia, EPM
Head held lower than normal Neck discomfort, weakness EPM
Limb position not “corrected” from Neurologic disorder EPM, CVM
far forward or back, limbs crossed,
or limb “wide”
Stiff gait Muscle soreness, back pain, limb pain Lyme disease
Frequent pawing, rolling, dog-sitting Abdominal pain Gastric ulcers, colic
Tail lifting, slapping, wringing Abdominal, urogenital discomfort Vaginitis, urethritis, kidney stones,
testicular torsion
Frequent urination or posturing and/or Abdominal, urogenital discomfort Vaginitis, urethritis, bladder stones,
straining to urinate cystitis
Frequent defecation or posturing and/ Caudal abdominal discomfort Impaction, flatulent colic
or straining to defecate
Odd pawing or hind leg extensions into Extra-pyramidal signs Fluphenazine toxicosis6,7
space, odd neck extensions with
head tilt, glazed eye, “spacey” gaze
Hind leg lifting, drawing stifle toward Abdominal, pelvic discomfort Kidney stones, bladder stones, inguinal
body hernia, colic, jejunal abscess, gastric
ulcers, cystitis, pelvic fracture, genital
trauma
Kicking out with one or both hindlimbs Abdominal, pelvic discomfort Kidney stones, bladder stones, inguinal
hernia, jejunal abscess, gastric ulcers,
cystitis, testicular torsion, vaginitis,
genital trauma, seminal vesiculitis
Kicking toward abdomen Abdominal discomfort Kidney stones, bladder stones, inguinal
hernia, jejunal abscess, gastric ulcers,
cystitis, testicular torsion, genital
trauma, seminal vesiculitis
Stomping, forelimb or hindlimb Skin irritation, abdominal discomfort, Chorioptic mange, back pain, myopathy
fasciculations
Throwing head or biting at dorsal Back pain, skin irritation Muscle soreness, Lice
midline
Throwing head or biting at abdomen Abdominal pain Colic
Throwing head or biting at shoulder, Pain, discomfort Myopathy
chest
Throwing head or biting at flank Abdominal, pelvic pain Kidney stones, bladder stones, inguinal
hernia, jejunal abscess, gastric ulcers,
cystitis, testicular torsion, seminal
vesiculitis
Biting at legs, rubbing one limb Pain, skin irritation Laminitis, degenerative hock disease,
against another chorioptic mange
Shifting weight frequently on Foot pain, back pain, caudal abdominal Pelvic fracture, laminitis
hindlimbs* discomfort, pelvic discomfort
Shifting weight frequently on Foot pain Navicular disease
forelimbs*
Shifting weight frequently from the Limb pain, back pain Laminitis, sore back
forelimbs to the hindlimbs†
Sudden interruption of quiet eating or Sharp intense pain Kidney stones, seminal vesiculitis
resting, as if startled
Muscle fasciculation at shoulder, flank, Myopathy, mini seizure Myopathy, epilepsy
or hindquarters
Head movements and non-physiologic
postures
Jerking up and down with snorting, Trigeminal irritation Photic headshaking syndrome (trigeminal
nose-flicking, nose-rubbing neuralgia)
Figure-eight head toss “Frustration” with any type of physical Kidney stones, testicular torsion
pain, usually intermittent acute
Apparent reluctance or discomfort to Neck discomfort Trauma
forage with head high (e.g., from
elevated hay rack)
Frequent rolling Abdominal pain, skin irritation Colic, lice
Teeth grinding Extreme physical pain, CNS neurologic Gastric ulcers
Lip quivering, repeated yawning Sudden intermittent or chronic pain, Colic, small airway disease, seminal
outside usual rest context, repeated irritation vesiculitis
flehmen response without olfactory
stimulus context, frequent lip
licking, lip smacking, sighing
Hyper-reactivity to visual, auditory, or Pain, CNS, trigeminal stimulation Trigeminal neuralgia
tactile stimulation
Frequent masturbation (⬎36 episodes Pain, genital irritation Laminitis, genital trauma
per 24 h for stallions and ⬎24
episodes per 24 h for geldings)
Rubbing hindquarters against objects Tail, anal, vaginal irritation Parasites, vaginitis, clitoral inflammation
*On fast-forward viewing, a rhythmic side-to-side rocking or sway at 1–5 s intervals (20 s–2 min real time) distinct from normal
standing rest and standing sleep. During undisturbed, normal standing rest, the hind quarters remain relatively motionless for
intervals of ⱖ30 s of viewing in fast forward, which at 22 times real time represents ⬎10 min real time.
†
On fast-forward viewing, a rhythmic rostral-caudal rocking is distinct from normal standing rest and standing sleep.
among the various services or consults and to lead detailed evaluation. Three examples are dis-
the client through the diagnostic plan. In our facil- cussed: a change in attitude and performance, a
ity, this is usually the admitting clinician (usually variety of types of episodes of hyper-reactivity, spoo-
sports medicine, medicine, reproduction, or surgery) kiness, or apparent panic with bolting and “freez-
and/or the behavior clinician. ing,” and self-mutilation.
6. Examples of Common Behavior Complaints Change in Attitude and Performance
Certain types of behavior patterns are especially Psychologically stressful management, handling,
difficult to determine if the root cause is physical or training and work program, or social environment
psychological; these cases are commonly referred for alone can certainly induce changes in attitude and
Table 3. Reference Ranges for Behavior of Horses Alone in Stalls or Small Paddock
2,8
Behavior Typical Frequency and/or Duration
Major activity changes (eating, standing rest, standing 30–110 episodes, typically 20–60 min per activity when
alert, resting recumbent) undisturbed (includes stallions and estrus mares,
which typically have more changes than geldings and
non-estrus mares)
Standing rest 10–30 episodes, 5–120 min each, 8–12 h total
Recumbent rest 0–6 episodes, 10–80 min each, 0–6 h total
Eating when fed hay 2–3 times daily or continuously 10–30 episodes, 5–30 min each, 4–12 h total
Drinking 2–8 episodes, 10–60 sec each, 1–8 min total
Urination 4–15 episodes (greater for mares in estrus and stallions
in situations where marking behavior is elicited)
Defecation 4–15 episodes
Rolling 2–8 bouts, 2–8 rolls per bout
Spontaneous erection and masturbation stallions, 18–36 episodes; geldings, 9–24 episodes
performance in a physically healthy horse and may diminished and attitude soured to the point that she
adversely affect the horse’s physical health. Gas- aggressively refused to work and was retired to be a
tric ulcers is probably the best example. Many times, broodmare. On reproductive examination, a granu-
a sour attitude is assumed to be psychological; how- losa cell tumor weighing over 60 lb was identified.
ever, underlying physical problems are eventually Another classic case was a mare that showed a sour
identified as the primary cause. We have seen many attitude, and later, recurrent mild colic, whenever
examples of physical problems over the years. One getting ready for work. After months, she became
such example was a race mare whose performance dangerously resistant to work and at times, self-
236 2005 Ⲑ Vol. 51 Ⲑ AAEP PROCEEDINGS
IN-DEPTH: BEHAVIOR
mutilative. Eventually, a jejunal abscess was rhythmically repetitive in form. It may seem to be
found with a wire twist tie at the core. the result of boredom or frustration, because epi-
sodes tend to occur at similar times of the day when
Episodes the animal is not doing other meaningful activities
A common presenting complaint that can be chal- or being socially challenged. Like other stereotyp-
lenging to diagnose is an “episode” involving ies, such as weaving, episodes of this self-directed
changes in mentation, perception, or posture that inter-male aggression form of self-mutilation typi-
clients may refer to as spells, “zoning out,” falling cally begins slowly and may build to a frenzied rate
asleep, or “freezing.” Conditions such as narco- of fixed repetitions. Stallions may spin violently as
lepsy, cataplexy, and epilepsy or myopathies can if chasing their tail.
occur in mild and infrequent episodes that go unrec- In contrast, self-mutilation in response to physical
ognized. Minor episodes can be interpreted by pain or irritation does not usually include self-sniff-
owners and trainers as misbehavior, such as unwill- ing, sniffing of feces, or the inter-male type of vocal-
ingness to work. Because horses sometimes re- izations. Episodes often begin without warning,
spond as if frightened by the episodes, the behavior interrupting ongoing meaningful behaviors such as
may be interpreted by trainers as intermittent spoo- grazing or resting recumbent. In cases of sharp
kiness or “panic attacks.” The stall-video tech- pain, episodes often begin quite explosively. Ob-
niques described earlier can be extremely useful in servers often describe the horse as responding as if it
obtaining examples of the behavior, but depending has been stung by a bee. The horse may spin in
on the frequency of the episodes, it may take days to circles as if it is desperately trying to reach the site
catch an episode. We find it worthwhile in many of discomfort. The spinning, although similar to
instances to persist, because these horses are often the spinning seen in the inter-male form of self-
at a considerable risk of injury if used. If the be- mutilation, is usually shorter in duration, and it is
havior is seen in the undisturbed horse, it usually typically interrupted by other behaviors that seem
clarifies the cause immediately as physical; whether aimed at trying to reach the site of discomfort.
or not a specific diagnosis can be reached, it helps Another distinguishing feature of discomfort related
the owner or trainer understand that this is not a self-mutilative behavior is that there are usually
misbehavior. less conspicuous signs of discomfort, such as leg
lifting or occasional kicks toward the abdomen, in-
Self-Mutilation terspersed between the major episodes. These mi-
In the author’s experience, self-mutilation, includ- nor signs often go unnoticed in casual observation of
ing biting at the flank, chest, abdomen, or limbs, the horse, but they become more obvious when view-
kicking at the body or at walls, or stomping, more ing long video samples, especially in fast forward.
often than not indicates current physical discomfort. We do see cases for which commonly used diag-
This is particularly true in mares. In stallions and nostics for various conditions have been negative,
geldings, on the other hand, there seems to be two yet serious physical problems are eventually identi-
forms of self-mutilative behavior. One form is the fied as the root cause of self-mutilative behavior.
result of current pain or irritation. The other less One recent example was a young stallion with inter-
common form is self-directed inter-male aggression. mittent flank-biting, kicking, and bucking self-mu-
Some of the elements of these two forms can be tilative behavior. Episodes had been noticed when
similar, but with careful evaluation, one can usually the horse was challenged socially by another stallion
distinguish between them. or when sexually excited and thwarted from reach-
In the self-directed inter-male aggression form of ing the mare. This behavior had been of some con-
self-mutilation, the sequence includes most or all of cern but had been present intermittently for several
the elements of the natural interactive agonistic years and was accepted as “just stallion behavior.”
sequence that would occur between two stallions When the horse was presented for evaluation of
meeting under natural social conditions.5 The af- questionable semen quality, the manager asked if
fected stallion typically sniffs his flank, groin, feces, something could be irritating the testicle and pro-
or oily body residues on walls, gates, or doorways voking the episodes, which had worsened in recent
and then nips at his flank or testicles. This se- months. Examination of the testicles failed to iden-
quence is what two stallions would do in a typical tify a problem that would account for the behavior.
inter-male head-to-tale posturing and marking se- Evaluation of video samples as described above sug-
quence, except there is only one stallion and he is his gested episodic mild to severe caudal abdominal
own target of the sniffing and biting. The sequence discomfort that at times interrupted ongoing eat-
often includes squealing or barking grunt vocaliza- ing and resting behavior. Several times per 24-h
tions, striking, and kicking, just as would occur sample, the explosive reaction was judged to be life-
among two stallions. Usually the first and most threatening in stall confinement. In some in-
common site of self-biting is the flank, but the stal- stances, episodes were associated with posturing to
lion may also bite his shoulders, abdomen, chest, urinate. Urinalysis and hematology values were
and limbs. This type of self-mutilation may become within the normal range. On transabdominal ul-
similar to a stereotypy in that it becomes fixed and trasound examination, a 5-cm cluster of nephroliths
AAEP PROCEEDINGS Ⲑ Vol. 51 Ⲑ 2005 237
IN-DEPTH: BEHAVIOR
was identified in the left kidney. In post-nephrec- behavior. This can also cause confusion
tomy video samples (2–5 days post-surgery), the about the root cause of the behavior. The an-
stallion was free of self-mutilating behavior, and thropomorphic interpretation can be that the
eating and resting behavior patterns returned to horse is fine as long as he gets to do what he
what is normal for a stalled stallion. wants to do (e.g., the horse looks colicky until
Stall or paddock videotaping as described earlier he is fed).
can be extremely efficient in differentiating the two ● In some cases, we find that a horse may have a
forms of self-mutilation. It can also provide insight number of seemingly minor physical problems,
into the location and severity of the discomfort. each of which alone would be judged unlikely
Episodes may occur so quickly, and sometimes so to be the sole cause of a behavior prob-
explosively, that it is difficult to discern what is lem. We sometimes conclude that the prob-
bothering the horse. Video evaluation usually re- lems together are the cause of the behavior
veals behavior occurring between episodes that problem.
gives insight into the site of the problem (e.g., the ● In general, we find some horses to be ex-
horse may turn the head toward or nuzzle or gaze tremely stoic in that they tolerate and work
toward the site of discomfort). through considerable pain. This makes it
easy to miss physical problems.
7. Additional Comments on Physical Versus ● We also find most horses to be sincere in their
Psychological Causes of Behavior Change behavior in that the behavior quickly returns
to normal when the behavior-changing discom-
● The expression of undesirable behavior, fort is eliminated. In other words, a horse
whether physical or psychological, seems to be may have ample opportunity to learn that
affected by a novel environment, either wors- limping leads to less work; however, when the
ened or improved. This can complicate the pain is eliminated, the horse does not continue
evaluation and identification of the primary to limp to reduce his work.
cause.
● It is not unusual for a physical problem to be References
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