Abstract
Diagnoses are widely used in both human and veterinary medicine to describe the nature of a condition; by contrast, syndromes are collections of signs that consistently occur together to form a characteristic presentation. Treatment of syndromes, due to either their lack of a clear biological cause or multiple causes, necessarily remains non-specific. However, the discovery of interventions may help refine the definition of a syndrome into a diagnosis. Within the field of veterinary behavioral medicine, separation related problems (SRPs) provide a good example of a syndrome. We describe here a comprehensive process to develop a diagnostic framework (including quality control assessments), for disambiguating the signs of SRPs as an example of a heterogeneous behavioral syndrome in non-human animals requiring greater diagnostic and treatment precision. To do this we developed an online questionnaire (243 items) that covered the full spectrum of theoretical bases to the syndrome and undertook a large-scale survey of the presenting signs of dogs with one or more of the signs of SRPs (n = 2,757). Principal components analysis (n1 = 345), replicated in a second sample (n2 = 417; total n = 762), was used to define the structure of variation in behavioral presentation, while hierarchical agglomerative cluster analysis cross checked with the partitioned around medoids method was used to determine sub-populations. A total of 54 signs were of value in defining a latent structure consisting of seven principal components (termed “exit frustration,” “social panic,” “elimination,” “redirected frustration,” “reactive communication,” “immediate frustration,” “noise sensitivity”), which divided the population in four clusters (termed “exit frustration,” “redirected reactive,” “reactive inhibited” and “boredom” related SRPs) with 11 sub-clusters (3, 3, 3, and 2, respectively). We used a bottom-up data-driven approach with numerous quality checks for the definition of robust clusters to provide a robust methodology for nosological studies in veterinary behavioral medicine, that can extend our understanding of the nature of problems beyond SRPs. This provides a solid foundation for future work examining aetiological, and differential treatment outcomes, that will allow both more effective treatment and prevention programmes, based on a fully appreciation of the nature of the problem of concern.
Highlights
Even though both the research base and practice of veterinary behavioral medicine has grown rapidly over the last 20 years, the field still lacks standardized protocols for diagnosis that reliably tease out different psychological forms of common presenting complaints
To do this we developed an online questionnaire (243 items) that covered the full spectrum of theoretical bases to the syndrome and undertook a large-scale survey of the presenting signs of dogs with one or more of the signs of separation related problems (SRPs) (n = 2,757)
A second Principal Component Analysis (PCA) was performed on this subpopulation and showed a similar structure
Summary
Even though both the research base and practice of veterinary behavioral medicine has grown rapidly over the last 20 years, the field still lacks standardized protocols for diagnosis that reliably tease out different psychological forms of common presenting complaints. Diagnoses are widely used in both human and veterinary medicine to describe the nature of a condition; by contrast, syndromes in the human medical field are collections of signs that consistently occur together to form a characteristic presentation which initially do not have a known cause (e.g., the initial identification of Down’s syndrome by Victorian physician John Langdon Down). In some cases this remains the situation, as is the case with irritable bowel syndrome [1]; certain conditions with a known cause which might present with similar signs are not included in the syndrome (e.g., celiac disease is not part of irritable bowel syndrome). Within the field of problem animal behavior (veterinary behavioral medicine) separation related problems in dogs provide a good example of a syndrome as well as the problems associated with confusing “a syndrome” with “a diagnosis.”
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