Cats Who Bite People Who Pet Them
World Small Animal Veterinary Association World Congress Proceedings, 2006
Karen L. Overall, MA, VMD, PhD, DACVB, ABS Certified Applied Animal Behaviorist
Center for Neurobiology and Behavior, Psychiatry Department - Penn Med Translation Research Laboratory, Philadelphia, PA, USA

Epidemiology of Cat Bites

Problem aggression is second only to elimination disorders in commonness of complaints about cat behavior. Given the multifaceted role played by scent in feline social systems, this should not be surprising. Unfortunately, the extent to which the interaction between feline aggression and elimination disorders is involved in tough problems is under-appreciated. Feline aggression is emerging as a common and worrisome problem, especially when viewed with regard to its potential to cause serious illness in people.

Cat scratch disease: 22,000 cases--1.8-10 cases / 100,000 people--of cat scratch disease are reported each year in the U.S.; 2,200 people are hospitalized annually. The presumptive agent in cat scratch disease (CSD) is the rickettsial organism Bartonella (formerly Rochalimaea) hensalae, and a contributory role has been postulated for the bacteria Afipia felis. 38/45 patients with CSD had titers of >/= 1:64 for Bartonella hensalae. CSD is most commonly seen in the late summer and fall and coincides with seasonality in births of kittens (spring) and the entry of these kittens into the house in the winter. Flea infestation may be associated with a higher incidence of the CSD and most patients have at least 1 kitten that has fleas. Patients with CSD are more likely to have a kitten less than or a year of age, or to have been scratched by a kitten than are non-patients. While patients in kitten-owning households are more likely to have been scratched or bitten than patients in non-kitten owning households, there appears to be no association with patients' cats and those of controls with regard to indoor / outdoor status, litter box use, and hunting behaviors.

Cats transmitting CSD appear healthy although they have active B. hensalae infections that last months. People with CSD tend to have localized skin lesions that are followed by regional lymph node involvement 3 weeks post exposure. Lymph nodes remain enlarged for several months. Systematic illness is rare, but fever, headache, splenomegaly, and malaise are common. These are usually self-resolving; however, arthritis, neuroretinitis, pleurisy, pneumonia, osteolytic lesions, granulomatous hepatitis, and encephalitis, with coma and seizure, can be an unusual sequela. Individuals with AIDS or those immunosuppressed for other reasons are at risk for more severe disease, including bacillary angiomatosis.

In addition to being a human health hazard, CSD is costly: the cost of treatment for ambulatory patients averages $5.2 million per year, and the cost of treatment for hospitalized patients exceeds $6.9 million per year, in 1990s USD.

Cat scratch disease is an occupational hazard for those working in veterinary medicine. When cats are fearful or distressed, they try to escape and withdraw. As a precursor to withdrawal, or as a means to make withdrawal possible, cats will bit and scratch. Understanding how to better handle cats in veterinary settings and how to teach clients to better accustom cats to veterinary visits should reduce the number of injuries to humans.

Aggressive Behaviors

Survey studies indicate that, over their lifetime, 80% of cats hiss at each other, 85% swat at each other, 70% fight with each other occasionally, 25% hiss / growl at people and 60% of them scratch or bite people occasionally. 53.6% of the cats in this study exhibited hissing sometimes (1 time per month) or frequently (1+ times per week), 63.1% exhibited swatting sometimes or frequently, and 44.5% exhibiting fighting sometimes or frequently.

Statistical examination of data collected by Borchelt and Voith (1987) indicate that cats are more often aggressive to other cats than people in situations involving defensive and territorial aggression (p<0.05; Gadj=32.627 and 11.442, respectively), but are more often aggressive to people when compared with cats in circumstances involving play aggression (p<0.05; Gadj=25.091). Their study did not evaluate a baseline of normal behaviors (perhaps cats are not involved in play aggression often with cats because they are corrected by the other cats sufficiently early in the sequence of play to avoid frank aggression), but suggests situations in which people might be at risk.

The aggressive behavior of the cats may not be manifest the same way towards all people. There are few actual data on cat bites, and those that have been published generally provide no statistical examination of the data, but if authors publish their data, others can do I as have done, and provide the analysis. Careful examination of data published by Borchelt and Voith (1987) indicates that for cats that are deemed "frequently" aggressive, there is no difference between the frequency of growling or hissing that is directed towards strangers compared with that directed towards family members (ns; Gadj=0.209), but that family members are more frequently subjected to swatting, scratching and biting without breaking the skin, and bites that break the skin (p<0.05; Gadj=21.197,30.014, and 9.554, respectively). Closer statistical investigation reveals that family members are more frequently victimized than are strangers by cats that break the skin, only by cats that have inflicted 3,4, or more than 8 bites (p<0.05; Gadj=3.874, 4.179, 22.311, respectively).

Categories of Feline Aggression--Associations with Human / Cat Aggression

It's important to remember that some of the circumstances in which humans will be injured by cats may involve "normal" aggressive behavior on the part of the cat. Cats who protect their kittens when there is really a threat are not showing manifestations of a diagnosis of maternal aggression. Likewise, cats who are afraid of a real threat are behaving normally and appropriately, rather than demonstrating manifestations of fearful aggression. Seen within this context, much of the aggression demonstrated at veterinary practices is normal aggression associated with fear. Accordingly, we can address this by either learning how to anticipate the problem, and lesson the result, and, or by preventing it.

The easiest way to prevent such aggression is to acclimate the cat to the situation. Cats respond most plastically to novel stimuli between 5 and 9 weeks of age, and their ability to remain flexible in response to novel stimuli decreases greatly by 14 weeks of age, if they have not been previously exposed to novel situations. Although the data have not been completely collected, early exposure to a variety of stimuli that are not terrifying may be necessary for the cat to learn to learn. In other words, if the cat is "protected" from the world, they may have decreased plasticity in their responses to changes in social and environmental stimuli later in life. We can use this information to benefit the cat's overall "wellness" and mental health: simply, any client with a kitten should take advantage of the cat's natural curiosity and energy and stimulate the kitten to explore and interact with as many environments as possible.

First, clients should fit their kittens with harness and light-weight lead and encourage the cat to go for walks outside of the house or apartment. If the cat is slightly nervous, he or she can just sit on the client's lap and be an observer until the cat decides to venture forth. Even if the clients have a back yard, it is safer, more humane, and more considerate for neighbors if the cat is kept on a lead or a trolley. For these to be safe, clients need to supervise the cat. If clients wish to give their cat the experience of the outdoors without supervising them, outdoor habitats can now be built with very little effort or custom made to encircle trees, branches, decks, and windows.

Second, clients should be encouraged to carry and use treats for cats as they do for dogs. Most kittens will readily work for small shrimp, dried liver or bacon, or a dab of some of the salty, fermented spreads (e.g., Marmite, Veg-e-mite). The key is convincing the clients that their little balls of fluff are intelligent, cognitive, curious beings who can be trained to work with the client. If clients would interact with their cats in this manner both of their cognitive lives would be enriched.

Third, clients should be encouraged to take the cat with them--temperature permitting--in the car whenever they can. Cats can be restrained in car harnesses, in an open crate, or using pet gates.

Fourth, clients should be encouraged to take their cat visiting to the vet's multiple times during the cat's first year of life. If the cat visits the vet and all that happens is that the cat is petted, fussed over, played with, and given treats, the cat will learn that this is good place to visit. Routine exams will then become easier, if the vet continues buying into and encouraging the concept of positive rewards and interactions. For example, if the cat is not worried about getting into the carrier and going to the vets, then when he gets there he might be far more interested in the food treat that is smeared on the exam table than he is in fighting the vet.

Getting vets to buy into the idea of using toys and treats at every visit is not a trivial problem. Most vets are concerned about their tightly booked appointments and the time / money conundrum. However, most of us fail to accurately account for all the time we struggle with patients and clients, all the times we need more hands than we have to restrain an animal, and for the real cost to us and the patient--in both physical and emotional terms--of such struggles. Were we to do an accurate accounting, we would be investing in any strategy that lowers our frustration time and our patients' stress levels.

An easy way to get vets to start working with cats differently is to hold kitten classes. While many practices hold puppy classes, few practices in the US hold kitten classes (but many in Australia do: see Training Your Cat by Kersti Seksel, Hyland House, Australia, 2001). These are ideal for kittens 8-13 weeks of age, and if conducted in 2 sessions allows the veterinary staff to cover all relevant preventative behavioral and medical topics, and also permits adequate time to teach clients how to play with cats, to encourage clients to watch normal cat behavior, and to teach the cats to sit, stay, come, do a trick, and to walk on lead and harness.

Tables 1 and 2 contain a summary of information to discuss at the first appointments, or--preferably--in kitten classes. If it is impossible to cover all of this information during the first examination, a series of short-examinations, arranged as a package at one price, or a long first puppy or kitten visit (2 hours can be a realistic estimate) arranged as part of a package deal with all vaccinations can be options. Videos, client handouts, and support staff participation are invaluable. If the puppy or kitten is going to undergoing a series of three vaccinations, the information can be outlined at the first visit and a schedule of topics to cover at that and subsequent visits developed. There are many variants on this approach and ALL are somewhat labor intensive; however, that labor pays off. Clients want information and will pay for it and treatment later if they received it first. Also, pets that are killed because of later behavioral problems do not generate income and do not contribute to an attitude and bond that encourages the generation of income. What veterinarians should NOT do on the first visit, is rush the pup or kitten through in 5 minutes (because it is generally healthy) and quickly (and scarily--to the pet) vaccinate it.

First visits may not even involve a vaccination--that activity may be better executed the next day (when it could be done quickly after a temperature check if the first visit included a thorough physical examination). The first visit should involve acquaintance with the staff, play, fuss, treats, a physical examination, and possibly, a vaccination sneaked in at the end of play. Encourage clients to return between appointments to just visit--this is great for the puppy or kitten and them. Of course they will ask your staff questions, but they can also be told up front, when invited to drop in, that if the staff is too busy for the visit they will say so.

These activities are outlined in the checklists in Tables 1 and 2. Clients should practice these activities often, whether the pet "needs" them or not. Obviously, toe nails should not be clipped or filed unless needed, but the client can manipulate the kitten's toes and hold them in the way they would when they clip them. This will make the actual activity easier. Repeated exposure of the new pet to these activities will help the client in two respects: (1) they will help render then pet more tractable and less fearful of manipulation, and (2) they will familiarize the client with "normal" so that they can report deviations from this to you.

When considering whether a cat's aggression is contextually appropriate or 'normal', it is important to bear in mind the evolutionary derivation of domestic cats, especially since this differs dramatically from that of dogs.

Feline social systems differ from those of dogs in the extent to which solitary versus social daily activities are prevalent. Cats are primarily solitary hunters, ingesting prey that is smaller than they are, whereas most wild canids work in groups to obtain prey larger than themselves. These forces will act to shape social relationships within groups. Cats can hunt sufficiently for one meal alone, while dogs use this only as a back-up foraging strategy. Dogs are more aligned with the "binge and gorge" eating style than are cats. Because cats don't rely on running down prey and exhausting them before the group moves in to attack, stealth is much more important to cats than it is to dogs, and it may be associated with the cat's normal tendency to hide when stressed or distressed. Finally, it's really important to remember that the history of cats and humans is the history of disease control: cats were attracted to rodents who are always attracted to human garbage. Cats killed the rodents that carried diseases or vectors of disease. Consequently, there has been little artificial selection by humans on how cats behave. In fact, selection for how they look is fairly recent and only taken place intensely in the past 200 years. Dogs were selected because of their shared behaviors with humans to help humans in tasks in which both species engaged. Hence, breeds in dogs have their roots in the jobs the dogs did--not what they looked like.

As a consequence of their evolutionary system, matrilineal social system, and skewed sex ratios for mating in free-ranging domestic casts, most normal aggression between cats appears to occur in contexts involving territory and social rank which are complexly interrelated. It is not surprising that the types of inappropriate aggression witnessed by owners differ from those that we perceive in dogs, and that they are understandable given the evolutionary context of feline social systems and the developmental context of sensitive periods.

Attention has been paid to the extent to which feline aggression is covert, rather than overt and defensive, rather than offensive (Table 3). These can be useful distinctions in understanding and intervening in the interactions between cats and other individuals involved in the aggressive circumstances. Clients must learn to read the signs of these behaviors to correctly interpret the ongoing interaction and to help us to treat the problem appropriately. Offensive aggression generally involves components that decrease the distance between the individuals. These behaviors can include approach (as a threat with subsequent flight of the other individual) and attack. Regardless, the aggressor controls the interaction through the use of threat or the escalation of violence. Defensive aggression involves passive behaviors designed to encourage avoidance and withdrawal. This serves to remove the stimulus for further aggression (Young, 1988). Spraying can act as a defensively aggressive behavior when it serves this purpose.

Client often have trouble recognizing aggression within their feline household because they are only aware of overt forms of aggression. It will help them if you emphasize that cats are not small dogs: the most common form of aggression in cats is subtle, covert aggression that involves posturing on the part of the aggressor and deference on the part of the recipient of the aggression. Assertions that cats are not social have interfered with our ability to understand both these types of aggressions when they occur between cats and when they are directed by the cat to people (assertion or status-related aggression). Cats generally exhibit overt aggression when they perceive each other as equal rivals and neither cat defers to the other. This situation is more common in crowded situations like laboratory colonies, households with too many cats, or urban, stray groupings. Covert aggression is more likely to occur if cats know each other well, and if all cats involved either agree that they do not see each other as equals, or if some cat is not sufficiently confident to overtly challenge another cat. Spraying and non-spraying marking can play a role in both of these circumstances.

Categorization of feline aggression is similar to that of canine aggression; differences in the manifestation of the aggressions may be attributable to differences in mating behaviors and differences in social hierarchies. Diagnoses of feline aggression that involve humans include:

1.  Aggression due to lack of socialization

2.  Play aggression

3.  Fearful aggression

4.  Pain aggression

5.  Redirected aggression

6.  Assertion or status-related aggression

These are the behavioral, functional, phenomenological classifications of aggression. It should be noted that cats, like dogs, can be aggressive because of or as a sequelae to underlying organic disease. Medical rule-outs for feline aggression include hepatoencephalopathy, feline ischemic encephalopathy, lead poisoning, hyperthyroidism, epilepsy, and rabies. To the extent that pain aggression is sometimes associated with illness, it should act as a flag for a possible underlying condition; however, in the sense that the term is used here, the aggression is the result of the pain, not of the underlying condition.

1. Aggression Due to a Lack of Socialization

The effect of exposure during sensitive or developmental periods in young animals has been debated. In the 1950s Scott and Fuller investigated the role of developmental periods within the first few months of dogs' lives on their ability to develop appropriate social behaviors. While these periods, called "sensitive" periods by Bateson exist, they are best viewed in the context of risk assessment. Animals for whom all sensitive period requirements were met can still have problems, and animals who missed socialization for the relevant periods can do well; however, the risk of having problems attendant with the respective socialization or sensitive period increases if exposure during the that period is missed.

For example, cats who have not had contact with humans prior to 3 months of age have missed sensitive periods important for the development of normal approach responses to people. Karsh and Karsh and Turner (1988) examined the extent to which the social environment experienced by cats affected their ability to interact with people. Among their findings, which are more fully discussed in the chapter on normal cat behavior, were that cats that were not handled until 14 weeks of age, were fearful and aggressive to people, regardless of the circumstances. These cats would not volitionally approach humans, and were aggressive if they could not escape. In contrast, cats handled for as little as 5 minutes per day from the day they were born until they were 7 weeks of age were quicker to approach and solicit people for interaction and gentle play, were quicker to approach inanimate objects, and were quicker to play with toys. This suggests that there are complex, far-reaching consequences of early interaction with people. Lack of such social interaction with other cats may result in the same lack of normal inquisitive response to other cats. This negative response can be augmented by sub-optimal nutritional conditions for the pregnant queen. Kittens born to such queens generally have a delayed developmental skills in addition decreased ability to learn, and increased (and usually inappropriate) reactivity to novel situations and stimuli, and an inappropriate response to other cats (this is more fully discussed in the chapter on normal feline behavior). The chance of such cats responding normally to most situations involving any interaction is diminishingly small. Furthermore, total isolation from cats can have negative consequences for future interaction with humans. This constellation of deprivation scenarios may be contributory to many of the aggressions seen in urban, feral cats. These cats will never be normal, cuddly pets, although they may attach to one person or a small group of people over a period of time. If forced into a situation involving restraint, confinement, or intimate contact, these animals may become extremely aggressive.

2. Play Aggression

Cats who were weaned early and then hand raised by humans may never have learned to temper their play responses. Social play in cats peaks early and is replaced by more predatory activities by weeks 10-12 and by social fighting by week 14. Cats who, as kittens, never learned to modulate their responses may play too aggressively with owners. These cats may not have learned to sheathe their claws or inhibit their bite. 7/27 cats studied by Chapman and Voith (1990) were diagnosed with play aggression. The frequency of this aggression is likely to be directly related to the demographic environment of the cat community--urban practices may have more cats with a history consistent with the development of play aggression.

It is not clear if there is a component of oral response associated with an owner who bottle fed the cat. Were the kitten to nurse too hard on the mother or hurt her in play, the mother would have swiftly corrected the kitten. This appears to be less common among owners playing the nursing role, possibly because they are concerned about injuring the kitten. This is a valid concern; however, if they mimic feline behaviors such as neck bites and growls or hisses, the kitten learns to respond and inappropriate play behavior and play aggression may not develop. Should these problems still ensue, they are treatable using behavior modification that interrupts the inappropriate behavior and replaces it with a more appropriate one. For example, the kitten that is playing roughly can be blasted with a water pistol or a compressed air canister at close range to startle it; this is most effective if the startle occurs as the cat is commencing the inappropriate behavior. Then, when the cat seeks out the owner's company, the owner can strike, massage, and provide the cat with food treats whenever it is acting calm. Owners must be vigilant for the first signs of any inappropriate behavior (pupils dilating, claws unsheathed, ears back, legs and shoulders stiffening, tail twitching) and correct the cat using a correction designed to startle as early in the sequence as possible. The startle technique, whether tapping on the nose, blowing in the face or using a water pistol or air canister, should be humane: this means that the lowest level of stimulus that gets the desired effect of aborting the behavior and moving on to another is the one that should be used.

3. Fearful, Fear, or Fear-induced Aggression

Fearfully aggressive cats will hiss, spit, arch their backs, and piloerect, if flight is not possible. Flight, a defensive activity, is virtually always a component of fearful aggression in cats. As they are pursued with increasingly less escape space, cats will draw their head in, crouch, growl, roll on their back if approached (this is NOT a "submissive" behavior in cats--it is an overt, defensive behavior), and paw at the approacher. If the approacher continues his or her pursuit, the fearfully aggressive cat will try to strike at him or her, and follow this with holding the approacher, using the forepaws, while kicking with the pack feet and biting around the neck. Most people who have seen or experienced rough play from cats are also familiar with this sequence of behaviors. When fearful aggression involves other cats, the cats that are fearfully aggressive generally do not seek out the other cat for aggressive interactions. Fearful aggression usually involves a combination of offensive and defensive postures and overt and covert aggressive behaviors (Leyhausen, 1979).

There are genetically friendly cats and genetically shy cats. It is unclear the extent to which shy cats have the potential to become fearfully aggressive, but there are cats who, despite the best socialization possible, become aggressive whenever fearful. These cats also may become fearful without an apparent stimulus. Regardless, if threatened, any cat will defend itself. Depending on the outcome of the treat, the cat can learn to become fearfully aggressive. This is particularly important if small children are involved, since they may not know how to appropriately respond to a cat that is crouching. Any animal that is cornered and cannot escape has the potential to attack. It is imperative that the cat not learn that his or her only recourse is aggression since this could lead to them becoming aggressive in response to any approach. Behavior modification can be very effective early in the development of the condition. Pharmacological intervention can be a useful adjuvant. It is not clear if any intervention can be successful if the condition is genetic.

4. Pain Aggression

As is true for dogs, cats that are painful, either because of an injury or as a sequelae to an underlying medical condition, can be painful upon manipulation. Practitioners can often induce this type of aggression in injured or arthritic and dysplastic cats. It can often become fearful aggression if it is result of long-term painful treatment. It is a defensive aggression, and will respond to measures that alleviate the pain, and minimize the potential to be exposed to it. Companion animal analgesia is finally receiving the attention it deserves. Appropriate use of such analgesia can minimize painful aggression in any animal.

Cats who have gotten their tails caught in doors are often very aggressive whenever anyone attempt to touch their tail. Some of this could be fear, but even when restrained they appear to become aggressive during manipulation. It is possible that they have some long-standing damage that is not apparent in medical and neurological work-ups. Behavior modification designed to teach them to relax and tolerate touching can be useful, as can anti-anxiety medication. The same phenomenon is infrequently reported for cats that have undergone declaw and who now will not use their feet. When their feet are manipulated these cats are, apparently, painfully aggressive. Full work-ups, including radiography, usually reveal no detectable abnormality, leading to discussions of "phantom" pain. Pain is a complex issue and probably under-appreciated in such circumstances. These cats also often respond well to behavior modification designed to teach them to relax and to anti-anxiety medication.

If there has been no painful medical intervention and the cat appears to exhibit this behavior, consider abuse. Cats, particularly strays, are good victims for torture, and may represent the first sign that untoward events are occurring in a household where there are children.

The role of pain aggression in cat-cat interactions has been under-explored, but, especially when cats are mismatched by size, health status, or temperament, is probably not a trivial problem. This would be particularly true for cats that have already been in fights and may have painful abscesses--any physical contact by another cat may cause them to react defensively in an aggressive manner.

5. Redirected Aggression

Redirected aggression is seen in felines, as well as in canines; however, it can be difficult to recognize and may only be reported as incidental to another form of aggression. In redirected aggression, any interruption of an aggressive event between two parties by a third party results in redirection of the aggressive behavior to the third party or to another, uninvolved individual. It is important to realize that the interrupted aggressive event may only be a threat, so that the person (or animal) interrupting it may not realize what is occurring. Cats appear to remain reactive for an extended period of time after being thwarted in an aggressive interaction. Clients need to realize this and to be aware of the subtleties of their behavior that communicate their intent. Since redirected aggression is often precipitated by another inappropriate behavior, it is important to treat that behavior, as well. Treatment involves standard behavior modification techniques. If there is a socially mediated conflict within the household cats, some environmental modification may be necessary to decrease the extent to which the involved cats are capable of interacting. Owners should be encouraged to use inanimate objects (battery operated water pistols, buckets of water, foghorns, et cetera) to intervene between fighting animals. This minimizes danger to the owners and may have the benefit of aborting the behavior while teaching the cat that there are consistent, undesirable consequences to its inappropriate behavior.

6. Assertion or Status-related Aggression

Assertion or status aggression has been described as the 'leave me alone bite' and most frequently occurs when being petted. The most similar situation in canines is dominance aggression; however, the divergent evolutionary history of canine and feline social systems argues that these are not homologous situations. These cats share with dogs with similar problems the need for control of the situation. Nothing the owner did provoked the cat; rather the cat demonstrates a desire or need to control when the attention starts and when it ceases. Some cats do this by biting and leaving, while the occasional cat will take the owner's hand with its teeth, but not bite. Fortunately, owners can be taught observe signs of impending aggression (tail flicking, ears flat, pupils, dilated, head hunched, claws possibly unsheathed, stillness or tenseness, low growl) and interrupt the behavior at the first sign of any of these by standing up and letting the cat fall from their lap or abandoning the cat and refusing to interact until the cat is exhibiting an appropriate behavior. Clients should be discouraged from direct physical correction of the cat, since the cat may view that as a challenge and intensify its aggression. If the cat does not respond to passive control or redirects its aggression, it is safer to counter the behavior with a fog horn or a battery operated water pistol. Corrections must occur within the first 30-60 seconds of the onset of the inappropriate behavior to insure learning; corrections within the first second are best. Clients having such cats should be aware that their cats are never going to be hugely cuddly, although, if the client can refrain from petting them, they may be willing to sit quietly on the owner's lap for extended periods.

Table 1. Techniques to demonstrate at the first visits or in kitten classes.

1.  Nail-clipping--reticent clients can learn to use an emery board; clients should be able to visualize the vein using a mag light, and should be able to outline its margin using a Sharpie

2.  Tooth brushing--using pediatric toothbrushes, gauze, or washcloths

3.  Grooming--for coat health and for fleas / ticks; will require at least a flea comb and a good brush; some cats should have mat combs and brushes introduced

4.  Temperature taking--use a digital thermometer--they don't break and are easy to read, but you will have to show clients how to clean them without damaging them

5.  Pilling--particularly cats--practice with food ball 'blanks' and encourage the clients to give treats as part of the process or afterwards

6.  Ear cleaning--clients may want to purchase a disposable otoscope so that they know what a cat's ear looks like

7.  General lymph node palpation and mammary gland palpation

8.  Fitting, adjustment, and use of harnesses

9.  Age and size appropriate toys

Table 2. Issues to be discussed at the first visits or in kitten classes.

1.  Nail trimming, scratching rationale, scratching posts, onychectomy / tenectomy

2.  Urine and feces as communication signals and roles for marking

3.  Sexual dimorphism and sexually dimorphic behaviors: roles for neutering

4.  Sexual maturity (6-9 months) and social maturity (24-48 months): what they are and how they affect behavior

5.  Origin of cats, lack of selection for behavior (in contrast to dogs) and matrilineal social systems

6.  Non-urine / fecal marking: roles for rubbing and scratching

7.  Roles for overt and covert aggression and the importance of understanding social signaling

Table 3. Heuristic model for thinking about phenotypic patterns of feline aggression.

Potential axes:

 Overt vs. covert aggression

 Active vs. passive aggression

 Offensive vs. defensive aggression

Sample scenarios:

 Overt, passive, offensive aggression: confident cat staring when another enters room

 Overt, passive, defensive aggression: less confident cat leaving room or backing up and withdrawing into smaller space, tail tucked vocalizing

 Covert, passive, defensive aggression: vanquished or less confident marking with mystacial glands in boundary areas or areas from which cat had been displaced

 Covert, active, offensive aggression: vanquished or less confident marking with urine or feces in boundary areas or areas from which cat had been displaced

 Overt, active, offensive aggression: chase and attack using teeth and accompanied by vocalization by resident cat toward new cat in environment

 Overt, active, defensive aggression: attack or response using hitting and or swatting while leaning back or avoiding further pursuit

 Covert, active, defensive aggression: withdrawal and marking of restricted area by victim cat

 Covert, passive, offensive aggression: displacement or theft of "bully" or higher ranking cat's toys, bed, food, or hidden copulations (?), accompanied by non-elimination pheromonal marking

Table 4. Survey questionnaire about general feline behaviors--to be used at all visits1.

1. Client(s):

2.a Today's date: ___ (day) / ___ (mo) / ___ (year)

2b. Cat's date of birth: ___ (day) / ___ (mo) / ___ (year)
[ ] estimated? [ ] known?

3. Patient's name: __________

4a. Breed: __________

4b. Weight: __________lbs / ________kg

4c: Sex: [ ] M [ ] MC [ ] F [ ] FS4

4d: If your cat is castrated or spayed [neutered] at what age was this done? ____________weeks / months (circle)

5a. Age in weeks at which your cat was adopted?

________________weeks / months (circle)

5b. How many owners has your cat had?

[ ] 0 [ ] 1 [ ] 2 [ ] 3 [ ] 4 [ ] 5+ [ ] unknown

5c. How long have you had this cat?


6a. Is your cat (please circle):
indoor, only
outdoor, only
indoor / outdoor

6b. How many litter boxes does your cat have:
[ ] 0 [ ] 1 [ ] 2 [ ] 3 [ ] 4 [ ] 5+
6c. What types of litter do you use? _______________
6d. How often do you change the litter box completely?
_________times weekly / monthly (circle)
6e. How often do you scoop the box?
_________times daily / weekly (circle)

7a. Does your cat leave urine or feces outside the litterbox?

[ ] Yes [ ] No [ ] don't know;
if you answered yes,
[ ] urine--where specifically? __________
[ ] feces--where specifically? __________
[ ] both--where specifically? __________

7b. Does your cat spray?

[ ] Yes [ ] No [ ] don't know;
if you answered yes, where specifically?

8. Do you have any concerns, complaints, or problems with urination in the house now?

[ ] Yes [ ] No;
if you answered yes,
(a) where is the cat urinating that you find undesirable (list all areas)?
(b) how many times per week is the cat urinating in places you find undesirable?
(c ) at what time of day is the urination occurring?
(d) is the pattern different on days when you are home and days you are not home?
(e) are you at work during the hours when the cat urinates?
(f) how many times per day does your cat usually urinate when he or she is not urinating in places you find undesirable?

9. Do you have any concerns, complaints, or problems with defecation in the house now?

[ ] Yes [ ] No; if you answered yes,
(a) where is the cat defecating that you find undesirable (list all areas)?
(b) how many times per week is the cat defecating in places you find undesirable?
(c) at what time of day is the defecation occurring?
(d) is the pattern different on days when you are home and days you are not home?
(e) are you at work during the hours when the cat defecates?
(f) how many times per day does your dog usually urinate when he or she is not urinating in places you find undesirable?

10. Did your cat destroy any objects while teething?

[ ] Yes [ ] No [ ] Unknown;
if you answered yes, what objects--specifically--did the dog destroy?

Please list all of them and note which--if any--you had given the dog as toys or to play with by putting a * next to them.

11. Does your cat destroy any objects or anything else by chewing, sucking, or eliminating on them (e.g., furniture, rugs, clothes, et cetera) now?

[ ] Yes [ ] No;
if you answered yes, what objects--specifically--does the cat destroy?

Please list all of them and note which are destroyed when you are home or not home--please note that of they destroy at both times--tick both columns:


When home

When gone







12. Does your cat mouth, bite, suck, or anything or anyone

A [ ] Yes [ ] No if you answered yes, what or whom does the cat mouth?
b. Is this a problem for you? [ ] Yes [ ] No

13. Does your cat exhibit any vocalization about which you are concerned?

[ ] Yes [ ] No;
if you answered yes, what is / are the vocalization(s) and when do they occur: vocalization situation in which it occurs
[ ] a. barking __________
[ ] b. growling __________
[ ] c. howling __________
[ ] d. whining __________

14. Does your cat show any signs of growling, barking, snarling or biting?

[ ] Yes [ ] No;
if you answered yes, what is / are the sign(s) and when do they occur: sign situation in which it occurs
[ ] a. barking __________
[ ] b. growling __________
[ ] c. snarling __________
[ ] d. biting __________

15. Have you ever been concerned that your cat is "aggressive" to people?

[ ] Yes [ ] No;
if you answered yes, why?

16. Have you ever been concerned that your cat is "aggressive" to cats?

[ ] Yes [ ] No;
if you answered yes, why?

17. Have you ever been concerned that your cat is "aggressive" to animals other than cats?

[ ] Yes [ ] No;
if you answered yes, why?

Does your cat hunt or prey on other animals?

[ ] Yes [ ] No;
if you answered yes, which animals and where?

18. Has your dog even cat ever bitten or clawed anyone, regardless of the circumstances?

[ ] Yes [ ] No;
if you answered yes, did you think the bite was:
[ ] a. accidental? Why? __________
[ ] b. deliberate? Why? __________
[ ] c. the cat's "fault"? Why? __________
[ ] d. not the cat's "fault"? Why? __________

19. Has your cat had any changes in sleep habits?

[ ] Yes [ ] No;
if you answered yes, what are these, specifically?

20. Has your cat had any changes in eating habits?

[ ] Yes [ ] No;
if you answered yes, what are these, specifically?

21. Has your cat had any changes in locomotory behaviors or it's ability to get around or jump on the bed, et cetera?

[ ] Yes [ ] No;
if you answered yes, what are these, specifically?

22. Has anyone ever told you that they were afraid of your cat?

[ ] Yes [ ] No;
if you answered yes, what did they say?

23. Has anyone every told you that your cat was ill-mannered?

[ ] Yes [ ] No; if you answered yes, why--what did the cat do that made them say this?

24. Do you have any concerns about your cat's grooming behaviors?

[ ] Yes [ ] No;
if you answered yes,
[ ] a. little to no grooming
[ ] b. sucking
[ ] c. chewing
[ ] d. licking
[ ] e. self-mutilation / sores
[ ] f. barbering / trimming
[ ] g. plucking out clumps of hair

25. Is the cat exhibiting any behaviors about which you are concerned, worried or would like more information?

[ ] Yes [ ] No; if you answered yes, please list these behaviors below:

Table 5 Feline aggression screen1.

Key: NR = no reaction; S = stare; B = bite; H = hiss, howl, growl, vocalize (not purr); SW = swat / scratch; P = piloerect / arch / puff up; TS = switch or twitch tail; NA = not applicable

This screen can be used in three ways: 1) to note the presence or absence, at any time, of any of the behaviors, 2) to keep as a log about the baseline behavior, noting how many times the behavior occurs, given the number of times it is attempted, per unit time (i.e., per week), and 3) to keep a log about frequencies of the occurrence behaviors, given the number of times the circumstance has been encountered, during treatment so that these numbers can be compared with (2). Please note if the reaction is consistent in style, or only directed towards one person, or only present in one restricted circumstance. If using this screen as a client log, the circumstances must be evaluated for all people to whom the cat reacts. For any of the uses it is worth noting whether the cat is subjectively becoming more or less intense [or harder or easier to interrupt] in its behavior {>I, <I, relatively}. If using this screen only for the first use, note if the cat has been worsening in intensity or frequency in any category.

Please note--we want to know what your cat does when you routinely interact with it--if you don't know how your cat would react in the following circumstances, please do not try to find out. You may provoke the cat.











Take cat's food dish with food



Take cat's empty food dish



Take cat's water dish



Take food (human) that falls on floor



Take real bone



Take food treat



Take toy



Human approaches cat while eating



Another cat approaches cat while eating



Human approaches cat while playing with toys



Another cat approaches cat while playing with toys



Dog approaches cat while eating



Dog approaches cat while playing with toys



Human walks past cat in doorways



Human approaches/disturbs cat while sleeping



Cat approaches/disturbs cat while sleeping



Step over cat



Push cat off bed/couch



Reach toward cat



Reach over head



Put on harness or collar



Push on shoulders or rump



Pet cat when in lap



Pet cat when not in lap



Towel when wet



Bathe cat



Groom cat's head



Groom cat's body



Trim cat's nails



Put on nail caps



Stare at



Stranger enters room



Cat in yard--person passes



Cat in yard--dog passes



Dog enters room where cat is



Human physically carries cat



Cat in vet's office



Cat in boarding kennel



Cat in groomers



Cat yelled at



Cat physically punished--hit



Squirrels, cats, small animals approach



Cat sees another cat through window



Cat sees squirrels, birds, dogs through window



Human approaches cat who is at top of stairs



Cat removed from hiding place



Human body parts move under covers on bed



Crying infant



Playing with 2-year-old children



Playing with 5-7-year-old children



Playing with 8-11-year-old children



Playing with 12-16-year-old children


1. From: Overall KL. Manual of Clinical Behavioral Medicine for Small Animals, Elsevier, to be published 2007.


1.  Adamec RE. The interaction of hunger and preying in the domestic cat, Felis catus: an adaptive hierarchy. Behav Biol 1976; 18: 263-272.

2.  Borchelt PL, Voith VL. Aggressive behavior in cats. Comp Contin Educ Pract Vet 1987; 9: 49-56.

3.  Chapman BL, Voith VL. Cat aggression to people: 14 cases. J AM Vet Med Assoc 1990 ; 196: 947-950.

4.  Jackson LA, Perkins BA, Wenger JD. Cat-scratch disease in the United States. Am J Public Health 1993; 83: 1707-1711.

5.  Karsh EB, Turner DC. The human-cat relationship. In: The Domestic Cat: The Biology of Its Behavior, eds. Turner DC, Bateson P. Cambridge University Press: Cambridge, England, 1986: 159-177.

6.  Leyhausen P. Cat Behavior. New York, Garland STPM Press, 1979.

7.  Tompkins DC, Steigbigel RT. Rochalimea's role in cat scratch disease and bacillary angiomatosis. Ann Intern Med 1993; 118: 288-290.

8.  Zangwill KM, Hmilton DH, Perkins BA, Regnery RL, Plikaytis BD, Hadler JL, Carter ML, Wenger JD. Cat scratch disease in Connecticut-epidemiology, risk-factors, and evaluation of a new diagnostic test. N Engl J Med 1993; 329: 8-13.

Speaker Information
(click the speaker's name to view other papers and abstracts submitted by this speaker)

Karen L. Overall, MA, VMD, PhD DACVB
Center for Neurobiology and Behavior
Penn Med Translation Research Laboratory
Philadelphia, Pennsylvania, USA

MAIN : Standards of Care : Cats Who Bite People
Powered By VIN