Also known as self-trauma, psychogenic alopecia occurs when the cat pulls out so much hair that the coat gets thin and uneven, or even bald. Psychogenic means that the problem begins in mental or emotional conflict. Pulling out hair is compulsive; the cat just can’t stop licking and over-grooming and pulls out hair that is not yet ready to shed. Sometimes the cause is partially medical, but usually it’s a behavior problem caused by conflict, uncertainty or frustration.

Examples of those situations include moving to a new place; disliking or being afraid of another pet; a new person or pet moving in; fighting for food or litter box use; or neighborhood cats outside the windows. The activity is called a displacement behavior and the self-trauma may end when the cause is removed, such as rehoming one of the animals.

In the beginning, the skin may just look irritated from too much scratching (pruritus), or the results of too much itching. In cats and dogs, the itchiness can involve not only scratching but also licking, chewing, or biting at the skin, and it is the most common symptom of skin disease in cats and dogs.

The most commonly affected areas are the flanks (sides).

Some owners may not notice overgrooming because the cat only does it when alone or at night, but they can see what happens to the skin.

Diagnosis

As there are no tests that can diagnose this condition, psychogenic alopecia is diagnosed by figuring out what conditions the cat does not have; that’s called a rule out. Medical causes have to be ruled out to make sure that it is not just a physical issue but either a behavioral one or both.

In a study of 21 suspected cases, 16 cats had a medical cause, two had only psychogenic alopecia, and three had both medical and behavioral causes. Most of the medical issues were bad reactions to foods, allergies, or parasites; half of the 21 cases had more than one cause.

To diagnose it, your pet’s doctor will look at the skin cells and skin scrapings, culture for fungus, treat any parasites, check thyroid values, and have you switch to a hypoallergenic diet. Basic blood and urine tests will also look for medical clues. If all of these are negative, you can then try giving glucocorticoids, such as prednisolone; if the hair loss is caused only by behavior, then the drugs won’t make any difference and you’ll know it’s behavioral, but the tests must be done before taking the drugs because parasite problems and skin infections also may not improve on the drugs. Diagnosing psychogenic alopecia can be difficult because the self-trauma may lead to physical complications, and stress alone can also cause physical problems. It’s hard to tell, which is why so many tests are needed to rule out everything else.

The conditions seem to happen more often in Siamese and other Asian breeds.

Treatment

Because these cases are so personalized, behavior therapy has to be tailored to the cat, its home, and what the owner can do.

Behavioral Therapy

Examples of possible environmental stressors for cats include:

• Limited access to important resources, such as food, water, litter boxes, and perches
• Moving to a new home
• Changes in household routines or family members
• Isolation
• Status or territorial conflicts with other cats
• Overcrowding
• They’re bored and aren’t getting enough exercise.

Once a stressor(s) is identified, you can first work to prevent the cause and then start a desensitization and counterconditioning program in which you teach the cat to make a positive association with whatever is causing the distress. If you have more than one cat, make certain that all of the cats’ needs are effectively met or you might fix one cat but cause problems in another one. Give the cats things to do to increase activity levels and play, such as cat perches and hiding food in toys, and play sessions. Provide a predictable daily routine and sleep areas that are theirs alone.

For more information about giving them a more enriching environment, see The American Association of Feline Practitioners and The Indoor Pet Initiative.

Medical Therapy

Behavioral medications can help too. Examples include:

• Pheromone products help reduce anxiety in some cats. Pheromones are chemicals that cats produce as a means of communication, and the products you can buy use the kind of pheromones that reduces anxiety. They can be used while you are also changing the environment and other behavioral therapy. You can get either a room diffuser or collar.
• Clomipramine (Clomicalm®) is an antidepressant like people use. A low dose may not be sufficient for psychogenic alopecia. Benefits may not be seen for several weeks.
• Fluoxetine (Prozac®) is also is an antidepressant. Start at a low dose and then increase if needed. Benefits may not be seen for several weeks.
• Amitriptyline (Elavil®) is another antidepressant that also has an antihistamine. It does not work well for compulsive disorders, but may be useful to stop itching.

Any skin infections created by the self-trauma must also be treated with antibiotics.

Monitoring and Prognosis

After the self-trauma has stopped and the hair has regrown, you can slowly discontinue behavioral medications while watching the cat to make sure the same behaviors are not starting all over again. The cat’s long-term prognosis depends on what the underlying behavioral condition is. Some may need drugs for a long time, or even for life, while others don’t.

If your efforts aren’t successful, your veterinarian can refer you to a veterinary behaviorist.

Some cases are easier than others to treat; some methods that work can be discovered early on, and some behavior may never be entirely gone. Much depends on how much you can address the cat’s source of stress. Whatever can be done to reduce the stress should help make the cat feel at least a bit better, even if it’s not enough to entirely stop the self-trauma from continuing.