{"id":127445,"date":"2024-11-18T20:44:41","date_gmt":"2024-11-18T20:44:41","guid":{"rendered":"https:\/\/todaysveterinarynurse.com\/?p=127445"},"modified":"2024-11-18T20:44:41","modified_gmt":"2024-11-18T20:44:41","slug":"completing-a-comprehensive-behavioral-history","status":"publish","type":"post","link":"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/behavior\/completing-a-comprehensive-behavioral-history\/","title":{"rendered":"Completing a Comprehensive Behavioral History"},"content":{"rendered":"<div class=\"su-spacer\" style=\"height:20px\"><\/div><div class=\"su-note\"  style=\"border-color:#d8d8d8;border-radius:3px;-moz-border-radius:3px;-webkit-border-radius:3px;\"><div class=\"su-note-inner su-u-clearfix su-u-trim\" style=\"background-color:#f2f2f2;border-color:#ffffff;color:#333333;border-radius:3px;-moz-border-radius:3px;-webkit-border-radius:3px;\"><b>Abstract<\/b><\/p>\n<p class=\"p1\">Veterinary behavior medicine relies heavily on having a thorough behavioral history on which the veterinarian can accurately base a diagnosis and treatment plan. A behavior treatment plan is only as good as the history collection. Collecting behavioral histories is time-consuming and is best accomplished by the veterinary nurse, who is in the prime position to explore the patient\u2019s challenges, translate the client\u2019s observations into usable information, and provide the attending veterinarian with pertinent details. Accurately and efficiently collecting a behavioral history is the most important aspect of treating behavior problems.<\/p>\n<p><b>Take-Home Points <\/b><\/p>\n<ul>\n<li class=\"p1\">Unlike other areas of veterinary medicine, behavioral histories rely more on client communication than on diagnostic testing.<\/li>\n<li class=\"p1\">It is helpful to know whether clients are anthropomorphizing their pet\u2019s behavior, believe in dominance theory, and can recognize normal versus abnormal behavior.<\/li>\n<li class=\"p1\">A thorough behavioral history should be gathered through information from a preappointment questionnaire and from an in-office interview.<\/li>\n<li class=\"p1\">A thorough behavioral history includes the patient\u2019s full developmental, learning, social, and medical information; the client\u2019s concerns and expectations; and the environment and lifestyle.<\/li>\n<\/ul>\n<\/div><\/div>\n<p class=\"p1\"><span class=\"s1\">B<\/span><span class=\"s1\">ehavior is considered a \u201csoft science\u201d because objective diagnostics are limited.<sup>1<\/sup> Thus, veterinary professionals must rely heavily on client communication and descriptions of problem behaviors. Most undesirable pet behaviors depend highly on the situational context and may not be exhibited in situations that veterinary professionals are likely to see. Behavioral inhibition is common during fear-inducing situations. In 2009, D\u00f6ring et al found that 78.5% of dogs displayed \u201cfearful\u201d behaviors during a standard examination in the veterinary setting.<sup>2<\/sup><\/span><\/p>\n<p class=\"p2\"><span class=\"s1\">Not all clients are able to discern which behaviors are normal versus abnormal. Their confusion is often compounded by the inability to find reputable sources of information.<sup>3<\/sup> Many clients may have a specific behavioral concern while not realizing that their pet is exhibiting multiple abnormal behaviors. For example, the client may be concerned that their dog exhibits aggression toward children in the home, only to learn that separation anxiety is the primary cause of the aggression. Being agitated and distressed increases the dog\u2019s irritability, lowers its patience, and results in aggression if the dog is disturbed while resting. Behavioral medicine therefore relies heavily on the subjective history obtained from clients. As veterinary nurses, our role is to obtain a thorough behavioral history and distill it into objective details that the veterinarian can then use for diagnostic and treatment plans.<sup>4<\/sup><\/span><\/p>\n<h2 class=\"p3\">Potential History-Taking Challenges<\/h2>\n<p class=\"p2\"><span class=\"s1\">During the history-taking process, the veterinary nurse needs to navigate client biases without causing the client to feel criticized. A variety of communication techniques are available to enable the veterinary nurse to obtain objective observations without attacking the client\u2019s interpretation (<\/span><span class=\"s2\"><b>TABLE 1<\/b><\/span><span class=\"s1\">).<\/span><\/p>\n<p><a href=\"https:\/\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2024\/11\/Scheip_TVNWinter25_BehavioralHistory_Table1.png\"><img fetchpriority=\"high\" decoding=\"async\" class=\"aligncenter size-full wp-image-127447\" src=\"https:\/\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2024\/11\/Scheip_TVNWinter25_BehavioralHistory_Table1.png\" alt=\"\" width=\"2046\" height=\"812\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2024\/11\/Scheip_TVNWinter25_BehavioralHistory_Table1.png 2046w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2024\/11\/Scheip_TVNWinter25_BehavioralHistory_Table1-300x119.png 300w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2024\/11\/Scheip_TVNWinter25_BehavioralHistory_Table1-1024x406.png 1024w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2024\/11\/Scheip_TVNWinter25_BehavioralHistory_Table1-768x305.png 768w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2024\/11\/Scheip_TVNWinter25_BehavioralHistory_Table1-1536x610.png 1536w\" sizes=\"(max-width: 2046px) 100vw, 2046px\" \/><\/a><\/p>\n<h3 class=\"p4\">Anthropomorphism<\/h3>\n<p class=\"p2\"><span class=\"s1\">Clients frequently attempt to fabricate motivations for their pet\u2019s behavior; in other words, they may anthropomorphize, attributing human traits or emotions to nonhuman entities.<\/span><\/p>\n<h3 class=\"p4\">Belief in Dominance Fallacy<\/h3>\n<p class=\"p2\"><span class=\"s1\">For decades, American culture has been fixated on the concept that domestic dogs build dominance hierarchies with their owners.<sup>5<\/sup> Under this pretense, it is believed that pet owners who are not forceful enough will promote disobedient behaviors in their dogs. Such perceptions influence the way in which pet owners interact with their pets, support their needs, and empathize with their pet\u2019s behavior.<sup>6<\/sup><\/span><\/p>\n<h3 class=\"p4\">Misperception of Normal Behavior<\/h3>\n<p class=\"p2\"><span class=\"s1\">Another common challenge associated with collecting a behavioral history is the client\u2019s perception of normal behavior. \u201cNormal\u201d simply refers to the range of behavior frequently observed within a population (e.g., patient species, breed, home environment).<\/span><\/p>\n<p class=\"p2\"><span class=\"s1\">For example, it is commonly accepted that the degree of vocalization by the Siamese breed of domestic cats is much higher than that of other domestic cats. This interpretation can be real or another cat owner misconception.<\/span><\/p>\n<p class=\"p2\"><span class=\"s1\">Another example might be expecting border collies to need constant stimulation throughout the day. Although dogs of this breed may have more energy and drive than other dogs, it is not normal for any dog to require continual exercise for 10 hours each day. Thus, the veterinary nurse will need to have a solid understanding of normal behavior for the breed and be able to provide the client with appropriate examples.<\/span><\/p>\n<h2 class=\"p3\">History-Taking Procedure<\/h2>\n<p class=\"p2\"><span class=\"s1\">As with other aspects of medical history collection, taking a behavioral history starts broad, identifies specific areas of interest, then slowly focuses on each area individually. The different focus areas and specific pieces of information to ask for in each are as follows.<\/span><\/p>\n<h3 class=\"p4\">Preappointment Questionnaire<\/h3>\n<ul>\n<li class=\"p5\"><span class=\"s1\">Having a preappointment behavior questionnaire, available from most veterinary behavior textbooks, is helpful. A questionnaire can be used to:<\/span><\/li>\n<li class=\"p6\"><span class=\"s1\">Consolidate information into a single, organized document<\/span><\/li>\n<li class=\"p6\"><span class=\"s1\">Provide a reference for specific dates and circumstances<\/span><\/li>\n<li class=\"p6\"><span class=\"s1\">Screen for other, more subtle, behavior concerns that could be influencing the main behavior concern<\/span><\/li>\n<li class=\"p6\"><span class=\"s1\">Enable clients to contemplate and effectively describe why they are seeking assistance with their behavior concerns<\/span><\/li>\n<li class=\"p7\"><span class=\"s1\">Help prepare the clinician and veterinary nurse for how the case may proceed, which specific details to highlight, and where client education may be needed<\/span><\/li>\n<\/ul>\n<h3 class=\"p4\">General Patient Overview<\/h3>\n<ul>\n<li class=\"p6\"><span class=\"s1\">Patient\u2019s name<\/span><\/li>\n<li class=\"p6\"><span class=\"s1\">Species, breed, age, sex, current weight<\/span><\/li>\n<li class=\"p6\"><span class=\"s1\">Chronic health conditions<\/span><\/li>\n<li class=\"p6\"><span class=\"s1\">Personality<\/span><\/li>\n<li class=\"p6\"><span class=\"s1\">Typical daily routine<\/span><\/li>\n<li class=\"p6\"><span class=\"s1\">Typical ingestive behaviors (e.g., nutrition, treats, inappropriate ingestion of toys)<\/span><\/li>\n<li class=\"p6\"><span class=\"s1\">Typical social behaviors<\/span><\/li>\n<li class=\"p6\"><span class=\"s1\">Typical exercise and enrichment routine<\/span><\/li>\n<li class=\"p6\"><span class=\"s1\">Typical affiliative behaviors (i.e., behavior with family and nonfamily members)<\/span><\/li>\n<li class=\"p7\"><span class=\"s1\">Typical elimination behaviors<\/span><\/li>\n<\/ul>\n<h3 class=\"p4\">Household Setup and Dynamic<\/h3>\n<ul>\n<li class=\"p6\"><span class=\"s1\">People who live within the household, even part time (names, ages, occupations, hours away, relationship with the patient)<\/span><\/li>\n<li class=\"p6\"><span class=\"s1\">Any other animals with which the patient routinely interacts (names, ages, species, breed, relationship with the patient)<\/span><\/li>\n<li class=\"p6\"><span class=\"s1\">Type of home, size, outdoor areas, fenced or unfenced yard<\/span><\/li>\n<li class=\"p6\"><span class=\"s1\">Activity level<\/span><\/li>\n<li class=\"p7\"><span class=\"s1\">Degree of predictable versus unpredictable routine<\/span><\/li>\n<\/ul>\n<h3>Patient\u2019s Early History<\/h3>\n<ul>\n<li class=\"p6\"><span class=\"s1\">Birth, early environment, littermates, maternal behaviors from the dam<\/span><\/li>\n<li class=\"p6\"><span class=\"s1\">Age, source, process of acquisition and integration into the home<\/span><\/li>\n<li class=\"p6\"><span class=\"s1\">Interactions with people and other animals in the first year of life<\/span><\/li>\n<li class=\"p7\"><span class=\"s1\">General socialization process<\/span><\/li>\n<li class=\"p4\">Patient\u2019s Learning History<\/li>\n<li class=\"p6\"><span class=\"s1\">Training styles used<\/span><\/li>\n<li class=\"p6\"><span class=\"s1\">Response to training<\/span><\/li>\n<li class=\"p6\"><span class=\"s1\">Ease of learning<\/span><\/li>\n<li class=\"p6\"><span class=\"s1\">Skills\/behaviors learned<\/span><\/li>\n<li class=\"p6\"><span class=\"s1\">Any use of pet professionals (e.g., companies, names, techniques)<\/span><\/li>\n<li class=\"p6\"><span class=\"s1\">Type(s) of equipment used for training previously<\/span><\/li>\n<li class=\"p7\"><span class=\"s1\">Type(s) of equipment used for training currently<\/span><\/li>\n<\/ul>\n<h3 class=\"p4\">Common Anxieties, Fears, and Displays of Aggression<\/h3>\n<ul>\n<li class=\"p6\"><span class=\"s1\">Behavior as the family prepares to leave<\/span><\/li>\n<li class=\"p6\"><span class=\"s1\">Behavior when home alone (e.g., property destruction, vocalization, elimination, vomiting)<\/span><\/li>\n<li class=\"p6\"><span class=\"s1\">Aggression displayed during a variety of social situations (<\/span><span class=\"s2\"><b>BOX 1<\/b><\/span><span class=\"s1\">)<\/span><\/li>\n<li class=\"p6\"><span class=\"s1\">Aggression displayed during interactions with people (<\/span><span class=\"s2\"><b>BOX 2<\/b><\/span><span class=\"s1\">)<\/span><\/li>\n<li class=\"p6\"><span class=\"s1\">Reaction to loud noises, fireworks, and\/or thunderstorms<\/span><\/li>\n<li class=\"p7\"><span class=\"s1\">Degree of interest in being outside versus inside<\/span><\/li>\n<\/ul>\n<div class=\"su-box su-box-style-default\" id=\"\" style=\"border-color:#606060;border-radius:3px;\"><div class=\"su-box-title\" style=\"background-color:#939393;color:#FFFFFF;border-top-left-radius:1px;border-top-right-radius:1px\">BOX 1 Triggers for Aggression Displayed During Social Situations*<\/div><div class=\"su-box-content su-u-clearfix su-u-trim\" style=\"border-bottom-left-radius:1px;border-bottom-right-radius:1px\">\n<ul>\n<li>Frequent visitors<\/li>\n<li>Occasional visitors<\/li>\n<li>Unknown female<\/li>\n<li>Unknown male<\/li>\n<li>Unknown child\/children<\/li>\n<li>Unknown dog on leash<\/li>\n<li>Unknown dog off leash<\/li>\n<li>Crowds and busy areas<\/li>\n<li>Vehicles (e.g., trucks, bicycles, buses, cars)<\/li>\n<\/ul>\n<p><em>*Determine whether inside or outside the home<\/em><\/div><\/div>\n<div class=\"su-box su-box-style-default\" id=\"\" style=\"border-color:#606060;border-radius:3px;\"><div class=\"su-box-title\" style=\"background-color:#939393;color:#FFFFFF;border-top-left-radius:1px;border-top-right-radius:1px\">BOX 2 Triggers for Aggression Displayed During Interactions With People*<\/div><div class=\"su-box-content su-u-clearfix su-u-trim\" style=\"border-bottom-left-radius:1px;border-bottom-right-radius:1px\">\n<ul>\n<li>Being handled and\/or groomed<\/li>\n<li>Being petted and\/or hugged<\/li>\n<li>Being disturbed while resting<\/li>\n<li>Being disciplined<\/li>\n<li>Having food taken away<\/li>\n<li>Having objects taken away<\/li>\n<\/ul>\n<p><em>*Determine whether aggression is toward primary owner, co-owner, children, and\/or other people<\/em><\/div><\/div>\n<h3 class=\"p4\">Targeted Behavior Information<\/h3>\n<ul>\n<li class=\"p6\"><span class=\"s1\">Age and scenario around the first incident<\/span><\/li>\n<li class=\"p6\">How the undesired behavior has progressed with time<\/li>\n<li class=\"p6\"><span class=\"s1\">Frequency of the undesired behavior<\/span><\/li>\n<li class=\"p6\"><span class=\"s1\">Severity of safety risk (see Dr. Ian Dunbar\u2019s Dog Bite Scale, <\/span><a href=\"http:\/\/go.navc.com\/3XVHRqh\" target=\"_blank\" rel=\"noopener\"><span class=\"s2\">go.navc.com\/3XVHRqh<\/span><\/a><span class=\"s1\">)<\/span><\/li>\n<li class=\"p6\"><span class=\"s1\">Recovery period after an incident<\/span><\/li>\n<li class=\"p6\"><span class=\"s1\">Common environmental factors (e.g., location, animals and people present)<\/span><\/li>\n<li class=\"p7\"><span class=\"s1\">Techniques used to address the undesired behavior and their success or failure<\/span><\/li>\n<\/ul>\n<h3 class=\"p4\">Cat-Specific Information<\/h3>\n<ul>\n<li class=\"p6\"><span class=\"s1\">Litter box details (e.g., size, covered\/uncovered, type of litter, cleaning schedule)<\/span><\/li>\n<li class=\"p6\"><span class=\"s1\">House soiling (e.g., common locations, horizontal versus vertical surfaces, frequency)<\/span><\/li>\n<li class=\"p6\"><span class=\"s1\">Consumption of nonfood items, especially plastics, rubber, and paper\/cardboard<\/span><\/li>\n<li class=\"p7\"><span class=\"s1\">Each cat\u2019s selected territory, including resources available (e.g., scratching posts, sleeping spots)<\/span><\/li>\n<\/ul>\n<h3 class=\"p4\">Welfare Assessment<\/h3>\n<ul>\n<li class=\"p6\"><span class=\"s1\">Degree to which behaviors are influencing the client\u2019s emotional and physical welfare<\/span><\/li>\n<li class=\"p6\"><span class=\"s1\">Whether the animal is at risk for rehoming, abandonment, or euthanasia<\/span><\/li>\n<li class=\"p7\"><span class=\"s1\">Client\u2019s goals and perceptions of the problem<\/span><\/li>\n<\/ul>\n<h3 class=\"p4\">In-Office Interview Process<\/h3>\n<p class=\"p5\"><span class=\"s1\">Depending on the depth of preappointment screening, the in-office oral interview should take approximately 20 to 30 minutes. The veterinary nurse should thoroughly review the questionnaire before the start of the patient\u2019s behavioral assessment. The purpose is to develop a framework on which to build specific details around the client\u2019s concerns. The interview should then focus more on the progression of the patient\u2019s behavior and include questions such as:<\/span><\/p>\n<ul>\n<li class=\"p6\"><span class=\"s1\">\u201cHow was the patient first integrated into the household?\u201d<\/span><\/li>\n<li class=\"p6\"><span class=\"s1\">\u201cWhen was the first time you noticed a problem?\u201d<\/span><\/li>\n<li class=\"p6\"><span class=\"s1\">\u201cTell me how the problem progressed over time. Did it get worse, better, different?\u201d<\/span><\/li>\n<li class=\"p7\"><span class=\"s1\">\u201cCan you identify any common triggers present when the behavior occurs?\u201d<\/span><\/li>\n<\/ul>\n<p class=\"p5\"><span class=\"s1\">The questionnaire will also allow opportunity to screen for abnormal behaviors the client may not think to address. Should one of these questions be answered in the affirmative, they can be explored further in the interview. For example:<\/span><\/p>\n<ul>\n<li class=\"p7\"><span class=\"s1\">\u201cI see you indicated on your form that [patient\u2019s name] often spins or chases their tail. Tell me more about that.\u201d<\/span><\/li>\n<\/ul>\n<p class=\"p5\"><span class=\"s1\">The interview should also focus on the emotional welfare of the clients. Caring for a patient experiencing behavior problems can be highly distressing and affect the quality of life for the entire household. An example of a question to ask regarding the effects of the behavior on the household is, \u201cIt sounds like you\u2019re worried about the safety of your children. How is that affecting you?\u201d<\/span><\/p>\n<p class=\"p5\"><span class=\"s1\">Determine how much patience the client has and which resources are available. If the clients are struggling and considering rehoming or euthanasia, a more aggressive treatment plan will need to be implemented to save the patient.<\/span><\/p>\n<p class=\"p2\"><span class=\"s1\">There may be small details brought up by the client that provide further context to the undesirable behavior. If so, they should be explored in detail by using a combination of open-ended and closed-ended questions as well as active listening skills.<\/span><\/p>\n<h2 class=\"p3\">Summary<\/h2>\n<p class=\"p2\"><span class=\"s1\">To properly diagnose and treat behavior disorders, the veterinary team must have a thorough understanding of the patient\u2019s undesired behaviors (e.g., the patient\u2019s history, the client\u2019s concerns and expectations, the various social dynamics present within the household). Therefore, collecting a thorough behavioral history is arguably the most valuable part of a behavior problem assessment. <\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>A behavior treatment plan is only as good as the history collection.<\/p>\n","protected":false},"author":236,"featured_media":127446,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"iawp_total_views":0,"footnotes":""},"categories":[806],"tags":[145],"class_list":["post-127445","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-winter-2025","tag-peer-reviewed","column-skills-check","clinical_topics-behavior"],"acf":{"hide_sidebar":false,"hide_sidebar_ad":false,"hide_all_ads":false},"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v24.7 (Yoast SEO v27.4) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Completing a Comprehensive Behavioral 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