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  Discussion on Equine Self-Mutilation SynDrOme: A Stereotypic Behaviour
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Member:
Nanb

Posted on Tuesday, Jan 31, 2006 - 2:02 am:

Hi Dr O:

In the fall 04' we purchased a Standardbred colt at the Hbg yearling sale. With never a problem
"Artie" trained down super until one day after training (spring) he 'out of the blue' began roaring (male or female), turning & biting his flank and kicking in the stall. As this studdy
'behaviour' worsened (mutilated his sides, kicked the padded boards down and window out) we decided to geld him and turn him out. For weeks following his surgery his behaviour got so intense (biting flank/kicking) we had to keep him outside in the paddock with a craddle around his neck. Once his behaviour improved he was turned out (2 mths) at a near-by boarding facility. It appeared that as his hormone level decreased, so too did his studdiness and self-mutilating tendencies.

When Artie first resummed back to his training schedule, he came back with a noticably better attitude (ears up/enjoyed his work) and then BOOM .. whether coincidental .. once he reached the level (2:10 mile) to where we had quit with (gelded) him, his self-mutilating tendencies began to resurface.

Because his symtoms (diarrhea/foul breath) were also common signs of colic we had a gastroscope done (Jan 2nd). No ulcers were found however he was tube-wormed and then prescribed 1 equvalan followed by a series (9) panacur syringes for bots. His diarrhea continued.

Although ulcers were ruled out, our track vet suggested starting him on gastrogard. At the same time, we discontinued his training/jogging schedule and turn him out during the day. We also sought approval from Ky Research to confirm that switching him from swt feed/pellet mix to extruded was appropriate. They agreed and recommended we also mix in probiotic. After a week ... his diarrhea, looking at his flank and then kicking the wall has not ceased.

Without any vets requesting the need for CBC, bloodwork/chem profile/fecal floats etc., all (3)state there's nothing more they can do. Based on description alone, one vet (never seen nor examined Artie) discounted any physical ailment and recommended 2 people for behavioural mod.

Although we don't discount the fact that Artie does in fact "fit" the symptoms of stereotypic behaviour, we feel his continuing to have diarrhea and smelly breath should in turn not be disregarded and overlooked. Based on the articles and research I've obtained from your site; we sent a chem profile and fecal sample to VitaTech lab for analysis and testing. We should have the results back tomorrow.

I discovered a interesting article today at www.usask.ca which answered alot of questions regarding ESMS. What I have learned is first and foremost; ESMS it is NOT a behavioural problem but rather a SYNDrOME.

As co-owner, trainer and driver, the most frustrating part about this for me and my husband is; other than the uncertainty (behavioural/synDrOme/ disease?) .. Artie has shown he has the ability and talent on the track and to look at him; he's a picture ... if only he could talk!

We're literally at our wits-end on what steps to take next. We'd really appreciate your insight, direction and help. Thanks Dr O

Nan B
Member:
Nanb

Posted on Thursday, Feb 2, 2006 - 10:33 pm:

Just an up-date. Artie was taken to O.V.C. Guelph University today for further tests, bloodwork and 24 hour observation. Interesting note: Artie wasn't in the stall 5 mins., before he turned around to look (sniff) himself, and immediately kicked the wall!!

If ESMS is the final diagnosis, the vet mentioned there are a few experimental drugs that she'd be interested to try on him. We should know the conclusive findings when Artie is released tomorrow.

NanB
Moderator:
DrO

Posted on Friday, Feb 3, 2006 - 9:38 am:

Hello Nancy,
I have doing a bit of research on this condition since your first post and certainly the most complete single piece on this is a 1994 paper that reviews 57 cases. YOu may have seen the summary in the article associated with this forum but there is more practical info in the article itself. There is a treatment study where the following therapies were found to substantially improve or cure in some cases. Note the number on top is the number helped substantially and the bottom is the total number treated with that particular medication:
Castration: 5/10
Remove concentrates from the diet: 3/9 (but there were usually other changes made too)
Change in companionship: 2/5
DMSO: 1/3 but very temporary
antihistimines: 1/2
steroids: 1/6
Regumate: 1/2
Fluphenazine: 2/2
Cribbing collar:1/2
Kicking chains: 1/1 (only stopped kicking and bucking)

Certainly along with these possibilities is doing all you can to provide a relaxing pasture environment with pasture mates and free choice forage along with decreasing energy intake. Let us know what they find Nancy and keep us appraised of treatment and results.
DrO
Member:
Nanb

Posted on Sunday, Feb 5, 2006 - 7:35 pm:

Thank you for your research Dr.O,
Artie was released from OVC on the 3rd.
In Clinic Summary:
Diagnosis: Equine self-mutilation synDrOme.
Test: Physical examination; per-rectum examination: plasma sex hormone levels; uninalysis.
Treatments: None

I have a 3 page Case Summary from OVC clinician, Dr. Suzanne Millman. She provided detailed instructions for behaviour modification to two of our employees that picked Artie up and forwarded a copy of these recommendations to the farm fax.

Due to our leaving (that same night) for holidays, we have not read her recommendations in written (faxed) form, however, based on our employee's explanation, they were sent home with a clicker with instructions of when/where/how to
apply in correlation to Artie's behaviour. Because his urinalysis came back negative, she recommended continuing with his daily routine of jogging/training. Feed is to remain as had already been changed ... extruded with a probiotic mixed in. Other recommendations; turn out as much as possible; Company, a horse on either side of him; toys - relocate and change every wk.; frequent but short urination was recorded so she advised that urethra tests were perhaps in order and although he'd been heavily treated for bots that he also be treated for tapes. The plasma sex hormone levels results are apparently to be back Tues/Wed.


At Dr Millman's request, Artie's daily caretaker is to record his behaviour in a daily journal and she would follow-up a visit (to farm) in 2 wks time. From the 10 recommendations listed in your report, the only treatment/therapies not yet tried are 4; different companion (goat etc), antihistimines, steroids and fluphenazine.

Artie is an extremely intelligent horse; very sensiative (did sensativity test re: rt side) and loves human contact and attention. I hope you don't mind if I forward your post on to Dr Millman and in turn; if you would like to read her discharge & recommendation statement please advise and I will forward it to you.

Nancy Brown
Moderator:
DrO

Posted on Monday, Feb 6, 2006 - 8:47 am:

Pleas go ahead, the reference above is from the Apr 15th 1994 JAVMA. Though I would be surprised if she had not reviewed it already. I was hoping they might find a medical cause and continuing searching for one certainly is a priority. Yes I would like to see her report but it is difficult to review emailed info. Could you scan and post it either using OCR or as a image?
DrO
Member:
Nanb

Posted on Monday, Feb 6, 2006 - 1:49 pm:

I am presently writing you from Hawaii (vacation) and therefore only have my laptop with me. The office does provide an email service or I could post her report in written form; or if you would prefer to speak with her directly I could forward you her email/ph numbers. Likewise, we were hoping a medical cause would be found. I have forwarded your report to Dr Millman. Thank you
Nancy Brown
Moderator:
DrO

Posted on Tuesday, Feb 7, 2006 - 8:25 am:

Hmmm..go ahead and post it. That way the members will benefit from your experience.
DrO
Member:
Nanb

Posted on Tuesday, Feb 7, 2006 - 11:03 am:

Case Summary:

"Avenue A", (Artie) a 3 year-old Standardbred gelding, was presented to the Ontario Veterinary College Veterinary Teaching hospital on Feb 2, 2006. He was referred to OVC for evaluation of a self-mutilation problem which began when he was approx. 2yrs old, and that worsened considerably in May 2005. The self-mutilation consisted of aggressive biting of the right flank, which had been breaking the skin. He also kicked out with his right hind leg excessively in his stall, breaking the wooden boards and the window. He was also observed to rub the right side of his body against his stall, and showed mild to moderate sensititity of the right flank area while being groomed. Some cribbing behaviour was also observed. These behaviours were seen both at his home farm and at Mohawk Raceway. He was gelded on July 2005 and rested completely from training. This seemed to temporarily alleviate his abnormal behaviour. Since then he has primarily been housed in a stall with occasional turnout in a dirt paddock. When he started training again this stereotypical and self-mutilatory behaviours returned and have been consistently instensifying since.

Avenue A has always had a good appetite and no history of previous illness. Within the last 10 days his feed has been changed to extruded pellets with a probiotic. He normally eats all his hay overnight, however he leaves hay after being jogged. Over the last few weeks his manure has taken on a softer consistency, especially in the mornings before and after work-outs. The feces improve overnight. His urine has also changed colour over the last week; it was initially dark, and has since taken on a creamy colour. He is up to date on all of his vaccines.

On presentation, "Avenue A" was bright, alert and in fit condition. All vital parameters were within normal limits. A small roughened area of hide approx 3 cm diameter was found on the right shoulder. This area may indicate a scar from a previous episode of self mutilations (no - it's where his blanket had rubbed) Two small hairless patches measuring 2 cm in diameter were noted on the left side of the neck near the shoulder; it was established that these were from his harness. Before the physical exam, the horse was observed kicking and flank-biting within minutes of being placed in the holding stall.

The horse was bedded on shavings in a padded stall in order to help prevent any injury due to kicking in the stall. Two video cameras were mounted in order to record his behaviour over a twenty-four hour period. Blood was taken to measure several sex hormone levels. These test results will be forwarded to you when they become available. The horse was monitored carefully overnight but allowed to display his natural behaviours.

The following day, examination per-rectum indicated no palpable abnormalties and the horse showed no signs of unusual discomfort during the procedure. Urine was collected by free flow and submitted for analysis. There were no indications of inflammation or infection which could cause abdominal pain.

Dr Millman also performed several tests to assess response to grooming, handling and palpation which were captured on video. At this stage the working diagnosis is that of equine self-mutilation synDrOme. A complete report from Dr Millman detailing recommendations for behaviour modification will follow."
Nancy Brown
Member:
Nanb

Posted on Wednesday, Feb 8, 2006 - 2:55 am:

I received an email plus attachment from Dr Millman today, re: "Equine Behaviour Solutions" It is also 3 pages in length and covers; Behavioural Diagnostic Tests (1-4), Diagnosis; Recommended Treatment (1,2,3ab,4ab,5ab,6-9) and Follow-up. Please let me know if you would be interested in reading. Thank you
Nancy Brown
Moderator:
DrO

Posted on Wednesday, Feb 8, 2006 - 6:26 am:

Thanks Nancy, there is little for me to add at this point.
DrO
Moderator:
DrO

Posted on Wednesday, Feb 8, 2006 - 6:40 am:

Woops I had not read your latest post when I posted above, yes I would like to read them. If you like you can post them as an attachments if formatting prevents a simple cut and paste. You need to know the location of the file on your computer and use the upload attachment button at the bottom of the post form.
DrO
New Member:
444444

Posted on Wednesday, Feb 8, 2006 - 10:01 am:

Nancy, If possible I would appreciate reading the report as well. Thanks, Sue-B
Member:
Nanb

Posted on Wednesday, Feb 8, 2006 - 11:27 am:

Forgive me if I didn't forward attachment properly. I've never done uploads/attachments etc., before!! Thanks
Nancy Brown

application/mswordreceived documents
AvenueAFeb3.rtf (16.9 k)
Member:
Tuckern

Posted on Wednesday, Feb 8, 2006 - 2:26 pm:

Hi Nancy,

Thank you for sharing your information about Artie's condition and the Doctor's reports. I have never heard of Equine Self-Mutilation, and have found this thread so very interesting, and am learning a lot.

I'm keeping Artie in my thoughts, and am sending him positive and relaxing vibes.

I'm also looking forward to hearing how he responds to the recommended treatments.

Thanks,
Nicole
Member:
Wgillmor

Posted on Wednesday, Feb 8, 2006 - 3:01 pm:

Hi Nancy,

I saw an article in (I think) The Horse magazine a while back about the value of stall mirrors for stable vices. The article thought them particularly useful for weaving, so it may not apply to Artie's problem. Unbreakable mirrors are also expensive. But if you get desperate they may be worth a try, and you may be able to resell them.

Good luck,
Wiley
Member:
Nanb

Posted on Wednesday, Feb 8, 2006 - 3:23 pm:

I appreciate your thoughts and kinds words Nicole and thank you Wiley for directing me to The Horse magazine article. I will be sure to research further.

I attempted to upload a photo of Artie but I was denied because it was larger (64?) than what is permitted.

I will be sure to keep everyone posted on any up-dates.
Nancy
Member:
Warwick

Posted on Wednesday, Feb 8, 2006 - 3:29 pm:

Thank you for posting the report, Nancy. It was very interesting. I wish you the best of luck in curbing Artie's behavior. Please keep us updated on your progress.

(Wiley - I wanted to PM you so as not to sidetrack this thread but didn't see an email address in your profile. I'm interested in hearing more about the use of mirrors with weavers as I have a 3 year old filly that does this on occasion when agitated. Can you please PM me with more info at sgrimm@qltinc.com?)

Cheers
Sue
Moderator:
DrO

Posted on Wednesday, Feb 8, 2006 - 6:35 pm:

Wiley does have a good suggestion as this is one of the things that has helped horses with stereotypical behavior problems. Run a search as there has been some discussion of this in our forums.

Nancy thank you so much for sharing this problem. These type problems can be the most frustrating and this is an excellent guide for others on how to approach it. I can only hope we give back in kind.
DrO
Member:
Nanb

Posted on Friday, Feb 10, 2006 - 2:35 am:

Just wanted to inform everyone that we have some positive reports on Artie's response to the
clicker-training technique that Dr Millman recommended. Since Artie's discharge from OVC, (Feb 3) he has had only ONE ESMS episode which occured the following day (Feb 4). Since that time, he has remained relaxed, lays down (even to eat hay)and has been extremely well behaved.

Even with Artie training 2 trips ("trip" = 1 mile & 45 mins break inbetween trips) he never offered looking at his flank/kicking ... which is a huge breakthrough. As mentioned in my first post; as Artie was asked to "train down" lower, his self-mutilation behaviour intensified. Yesterday, Artie trained his 2nd trip by himself (no company), pacing the mile in 2:15, and final 1/4 in :29 and was very good on the track but more significant is he remained good throughout his cooling out/down period following that mile.

I have emailed Dr Millman the news and she too is extremely pleased however she cautioned that he may go back and forth for awhile until further work/therapy is done. I will keep everyone posted.
Nancy
Member:
Dove2

Posted on Friday, Feb 10, 2006 - 7:50 am:

Nancy, That is wonderful news. As a strong believer in the value of clicker training, would you be kind enough to explain the clicker training intervention Dr. Millman recommended? You previously mentioned head lowering, but are there any other behaviors being taught to Artie through clicker training?
Alla
Moderator:
DrO

Posted on Friday, Feb 10, 2006 - 8:10 am:

Ditto Dove2's request, I see a overall description in the link you provide above but am uncertain how it is being applied.
DrO
Member:
Nanb

Posted on Friday, Feb 10, 2006 - 6:32 pm:

What's so surprising is Artie has only misbehaved once and likewise his caretaker only used the clicker-training technique once. My concern was that the clicker was to implemented daily and NOT exclusively for times to redirect his negative behaviour. I consulted Dr M on this confusion and attached her response.

Our latest report (earlier today) was Artie trained 2 trips again this morning. This time he went his last trip with another 3yo (filly) who raced last year at two and is preparing to qualify in a few weeks time. Our assistant trainer is absolutely shocked with Artie's turn around - on the track; without being asked/encouraged he refused to let the other 3yo by him and paced the mile in 2:08; last half in 1:00 with a final 1/4 in :29 He remains (1wk later) showing no signs of stress, anxiety nor episodes of ESMS behaviour. I'll keep everyone posted.
Nancy
Member:
Christel

Posted on Friday, Feb 10, 2006 - 11:52 pm:

Hi Nancy, when I click on the attachment it says, this page has been removed.
I am very intriqued w/ this like everyone else, thanks for sharing.
Chris
Member:
Nanb

Posted on Saturday, Feb 11, 2006 - 12:49 am:

Sorry about that!! As mentioned in an earlier post, I'm not too good at uploads/attachments etc., so I have typed out Dr M's response.

"I am delighted to hear of Artie's progress, but caution that this behaviour may come and go while we sort him out. This is excellent news! Obviously Julie (caretaker) and Wayne (ass't trainer) are doing a great job implementing my suggestions.
Regarding the clicker training and teaching Artie to relax, I would like this to be part of his daily schedule since it will help him learn to relax on command in future and provides an outlet for his energy/curiosity. If Julie confines its use to when he misbehaves or is highly aroused, he may learn to misbehave to get her attention if this is the only time he gets to play the Clicker Game (usually horses find this activity to be fun and mentally stimulating. They have to puzzle out what the handler is asking of them and the reinforcement is all positive.) However, I did tell Julie that if she sees him displaying anxiety, it is important to interrupt it by taking him out of the stall and diverting his attention. There are usually questions that arise once the protocol begins and a handler executes these methods."
Today, Julie called Dr M for clarification on implementing the clicker training in Artie's daily schedule. The command Julie was taught at OVC prior to Artie's release was: with a brush in one hand, a 'tiny' piece of carrot in the other, Julie used the clicker and Artie's immediate response was putting his head down by her clicker hand. It's this command that relaxes Artie. Artie is then rewarded with the piece of carrot. Julie proceeds to then rub/brushes his neck, loins etc., ... to totally relax him. As previously stated; Julie had only used the clicker technique once (Sat/bad behaviour) and she's just now (1 wk later) implementing it into his daily routine/schedule.

With our being on vacation it's difficult for me to say with any certainty; "what", "where" and "when" Dr M has instructed Julie to use the clicker training. Once we return home I will have the opportunity to visually see and then report with better clarity. All I know is; Artie's progress has gone from constant flank biting and kicking the walls to a calm, relaxed and more focused horse ... and, all within one week!! To us, this turn around is absolutely AMAZING.
Nancy
Member:
Christel

Posted on Saturday, Feb 11, 2006 - 11:16 am:

Thanks Nancy, don't feel bad, I have the same problem too.
I have spent the last month learning more about the hoof and noticed several natural hoof people are into the clicker training- which I on purpose ignored, but now am very interested in it. I guess a 'clean house' will have to wait again, while I explore the clicker training world- seems like amazing stuff- ok off I go to blow my mind again on this fascinating mind boggling stuff.
Wow Dr O, I cant thank you enough for such a great site- money very well spent.
Chris
Member:
Nanb

Posted on Saturday, Feb 11, 2006 - 12:47 pm:

With 35+ yrs., experience in the Standardbred Industry, we have NEVER heard nor seen of it ever being implemented in training/behaviour etc. To be sure; from the onset of Artie's negative behaviour, to his recent ESMS diagnosis, to his on-going progress with clicker-training .. all represent experiences we've never heard of/seen before.

Although 3 vets said; there was nothing more they could do; I certainly am thankful for Dr O's site. I searched in vain to find some sort of direction, thereby discovering ESMS. Thank you Dr O.
Nancy
Moderator:
DrO

Posted on Saturday, Feb 11, 2006 - 7:19 pm:

Thank you Nancy it is great posts like this that continue to help make us what we are. The information on clicker training for relaxing is entirely new and should give ideas and hope to all folks out there with horses displaying the more common sterotypies.
DrO
Member:
Nanb

Posted on Monday, Feb 13, 2006 - 12:51 pm:

I found another very interesting read on ESMS;

www3.vet.upenn.edu/labs/equinebehavior/faq/selfmutilation.htm

Nancy
Moderator:
DrO

Posted on Tuesday, Feb 14, 2006 - 7:29 am:

Nancy I cannot get the above link to work, either I get a does not exist or forbidden access. Have you another link and if not could you cut and paste it onto our site?
DrO
Member:
Nanb

Posted on Tuesday, Feb 14, 2006 - 11:07 am:

Sorry about that Dr O ... it's long; but here it is:

Equine Self Mutilation
It's a beautiful winter weekend, and finally you have a full morning to spend at the barn. You're happily grooming your horse when you notice a cluster of patches of wet hair on his side. Peculiar pattern to the wet hairs -- all are lying forward as if combed with a wet brush. Oh well, odd but probably nothing, you think. But wait, some of the wet spots have hairs missing or chopped off bluntly. You check the other side, and there you find some more patches, like the wet ones, but as if they have now dried. What's going on? There are more of these patches on the left side than on the right side, but they all are in the same area of the abdomen, from the ribs to the stifle.

Just then the barn manager comes in all excited. She's glad you're there early today, because when she was feeding this morning, she found your horse spinning in his stall, tearing at his blanket and biting at his sides. Her first reaction was to scream at him to stop--and he did. She figured the blanket was the problem, maybe it was rubbing or pinching him under the leg. She got some help to investigate. They couldn't find anything out of order with the straps or the blanket, but took it off anyway. Then, just as they closed the stall door, he really went nuts, spinning in a very tight circle, biting his left flank. With each bite, he squealed and kicked out. As he was turning and nipping, he sometimes was bucking and squealing. They were too scared to open the door. He went on for what seemed like forever, as if he wouldn't stop until he tore up the stall or killed himself. Then he gradually came out of it.

"When we screamed his name, he turned toward the stall door, looking at us with a sort of a worried, glassy eye, like he didn't know what was happening. We threw him his hay, and he's been pretty quiet since."

You run your fingers over the wet areas on his flanks and feel some crusty bumps on the underlying skin. Separating the hairs, you can feel little marks in the skin -- anywhere from one-quarter to one inch in diameter. Some are fresh nicks, some are scabbed over, some look healed. The rest of his coat is unblemished. No marks, no wet spots, no chopped or missing clumps of hair other than on his flanks and over his ribs.

So what is going on here?

This behavior commonly is called flank biting or flank sucking. The biting is one aspect of a cluster of behaviors called self-mutilation, because the horse likely will incur serious self-injury during these explosive episodes.

In addition to biting the flanks, self-mutilation sequences can include seemingly uncontrollable violent behavior. From horse to horse, the sequence and form can vary, but most typically includes spinning in circles, bucking, and kicking out with one or both back legs while nipping at the flank, shoulders, or chest. In the photos at the bottom of page 76, there is an example of a horse biting more violently at his chest, and a resulting chest avulsion.

In extreme cases, the horse can violently lunge its body or head into a wall or other solid object. More rarely, a horse might "throw itself" to the ground (from standing to lateral recumbency). A single episode can last from a few seconds to several minutes, uninterrupted. The horse can work up a lather and steam in cool weather. Episodes usually occur in a series separated by a few seconds to a few minutes over a period of minutes, to hours. The total daily time spent self-mutilating can vary from a few seconds to an hour or more. In addition to bite wounds, the most common injuries are to the legs and feet from the spinning and kicking.

Self-mutilation behavior of one form or another has been described in many different species, including humans. Dog and cats lick and chew on their paws or tails. People do all sorts of things--pull out their hair, bite their fingernails or lips, scratch themselves, or deliberately inflict burns, cuts, or other wounds.

People who have seen a horse in the midst of attacking itself often describe the episodes as the most bizarre animal behavior they ever have seen. Mental health professionals or others with first-hand experience with human psychopathology often ask whether this might be the horse equivalent of severe neurotic or even truly psychotic behavior seen in people. For example, Dr. Nicholas Dodman, a veterinary animal behavior specialist at Tufts New England Veterinary College, said he has wondered whether certain forms of self-mutilation in horses might be similar to Tourette's SynDrOme in humans. There are some interesting similarities, and some clear differences.

Since self-mutilation occurs in other animal species and a variety of human psychopathologic synDrOmes, it's probably too early to conclude that any of the self-mutilation seen in horses represents the same pathology as Tourette's in people. In other species, the trend in clinical veterinary behavior has been to label self-mutilative behavior "obsessive-compulsive disorder," or OCD.

This synDrOme in humans has two distinct components. One component is the compulsive, repetitive behavior, such as repeatedly checking to see if the stove has been left on. The other component is the accompanying obsessive thoughts or worries, such as concerns about being caught in a burning building. Often the thoughts or worries are related to the compulsive behavior and logically appear to drive it.

In the case of animals, we don't know whether they think or worry, so this label of obsessive-compulsive behavior might be too elaborate. Some behaviorists now are calling these behaviors in animals simply compulsive behavior.

There are at least three distinct types of self-mutilative behavior in horses. One type is simply an "extreme" behavioral response to physical discomfort. We know that physical pain alone, particularly in the abdominal area, can evoke behavior similar to that of the horse in the situation described above. We know it is physical pain because coincident with finding and correcting an apparently or potentially painful condition, the self-mutilative behavior stops without any other treatment. For example, the classic behavior we associate with colic or early labor in broodmares involves turning the head back toward the flank, either looking or nipping at the flank, and sometimes kicking out. Although it is not as common, some horses' behavioral response to physical pain has more violent episodes, including spinning, kicking, bucking, and serious self- biting. Some of the less-common physical root causes for violently colic-like behavior have been a twisted testicular cord, an abdominal abscess, urethral tears, or gastric ulcers. These sometimes can be intermittent and difficult to find. This is in contrast to the other types of self-mutilation. When there is a physical cause, there often is an increase in the behavior in association with work. The most explosive episodes might be during or soon after work. As time goes on, the horse might anticipate the exacerbation of pain with work, so can become agitated when being prepared for work.

A second type of self-mutilation is what could be called self-directed intermale aggression. This type occurs in stallions and geldings. The sequence follows what two stallions at liberty would do when meeting, except that the stallion himself is the target of his own behavior. When stallions meet, they typically stand parallel to one another, head-to-tail. They investigate each other's flank area, usually sniffing and nipping at the flank and genitals. The encounter can be pretty noisy. The stallions usually squeal and kick out with each nip or bite. They also might spin, buck, stomp, and romp, going around one another in circles. The sniffing of each other's flank and genitals, and of each other's feces, is an important trigger for the nipping and biting.

Sometimes the self-mutilation process begins over a stud pile. In the stallion which is sniffing and biting himself, each episode begins with the sniffing of his own feces or feces of other stallions in shared turn-out facilities. Oily body residues on stall walls, fences, or doorways can trigger episodes. We have seen several cases of self-mutilation that appeared to have started when a stallion was exposed to the smelly residues of another stallion in a trailer.

Unlike the pain-related self-mutilation, this type usually develops over a period of months. It can start as early as the first year of life or as late as the teens. It typically continues for the life of the stallion.

A third type of self-mutilation is a more quiet, rhythmic, repetitive nipping at various areas of the body. It looks similar to stereotypic weaving or stall walking in that it appears that the horse has nothing better to do. By formal definition, stereotypic behavior is characterized by repetitive, highly stylized, and seemingly functionless movements and sequences of movements.

Spanning the top of pages 76 and 77 is a series of photos of a stallion which had a very fixed pattern of biting himself from flank to shoulder to chest to opposite shoulder to opposite flank and on and on. He did it at the same place in the pasture at the same time of day for the same length of time, just as some horses walk their stall in very complex and fixed patterns day after day.

Stereotypies occur in one form or another in all captive wild and domestic animal species, and are a common feature of human psychopathology, as well as developmental and neurologic disorders. Subadequate environment and nutrition seem to be the major factors predisposing animals to stereotypies.

In horses, the classic stereotypies are cribbing, weaving, pacing, stall-circling, and head-shaking. Certainly, in cases in which a physical root cause is not apparent, self-mutilation fits this definition of a stereotypy. Of course, the performance of a stereotypy, no matter what the initial precipitating cause, is self-rewarding. Endorphins are released, and they can be positive reinforcement sufficient to sustain the behavior as a habit. We often wonder if self-mutilation, for which we can find no contemporary physical cause and that doesn't quite fit the self-directed intermale aggression type, might have started during a period of physical discomfort, but now is a lingering habit.

How Common Is Self-Mutilation?

It's very difficult to estimate how many horses suffer from self-mutilation. My guess would be that the problem occurs in less than 0.005% of all horses. Most equine veterinarians might see only a few cases in their entire careers. Self-mutilation can occur in stallions, mares, and geldings. Of course, the self-directed intermale aggression type is almost always in stallions and geldings. We don't know whether or not the predisposition for self-mutilation is highly heritable. We know that the behavior probably is the result of domestic environmental and nutritional factors, in that it apparently does not occur in wild or feral horses.

Where Does It Hurt?

For those horses whose self-mutilation episodes looks like a violent form of colic, it is critical to look for and immediately treat any possible causes of discomfort. Except for classic colic, this often is easier said than done. It sometimes can be tough to find (see the boxed table of examples of possible physical causes of discomfort on page 74). No matter what the slickest animal psychic would have us believe, our animals, like human infants, have only their non-verbal behavior as clues to tell us where they hurt. After years of losing sleep trying to find causes of self-mutilation in horses, I think our best hope for figuring out potential physical sources of discomfort that might be provoking episodes of self-mutilation turns out to be pretty inexpensive and very low tech. It is simply to critically observe the horse for hours at a time. This can be done live, but there are many advantages to video recording the behavior.

Long, continuous observation periods allow the horse to go back to its ongoing behavior, as opposed to being distracted by human presence. Long observation periods also will enable you to see how the self-mutilation episodes start and stop, and what in the environment might provoke them. When casually watching a self-mutilating horse, your attention is drawn to the noisy, more violent episodes. When watching the horse continually for hours, you likely will see mild and violent episodes. The milder episodes often are more useful than the explosive episodes in localizing potential sites of discomfort.

Once you have a clue as to where the pain might be, you can be aggressive with veterinary diagnostics. This might include classic radiography, scintigraphy, endoscopy, and ultrasound imaging.

Even if it appears to be a classic stereotypy, or a psychological behavior problem, we should never stop looking for a possible physical cause. A great example illustrating this point in horses is the case of head shaking behavior. For many years, veterinarians have looked for possible sources of discomfort in cases of head shaking. Many times a source could be found--things like ear mites, tooth abcess, guttural pouch problems, or allergies. But many times, nothing physical could be found and it was assumed that the problem was psychological. Only a few years ago did scientists in the United Kingdom and California find that some headshaking in horses appears to be induced by bright light or loud sound. It is a real physical problem involving hyperactivation of a nerve tract that is physically irritating to the horse. (See The Horse of October 1996, page 70.)

What Else Can You Do?

The best outcome of immediate and aggressive veterinary evaluation is to identify and quickly treat a physical cause. An equine behavior specialist can be a valuable member of a veterinary team. By evaluating the behavior, possible sites of discomfort can be identified, and an opinion can be offered on primary or secondary psychological components to the episodes. If physical discomfort is eliminated, the self-mutilation typically stops almost immediately. We have seen cases in which months or years passed before a root physical cause was found, in which the self-mutilation stopped immediately when the discomfort was alleviated.

Unfortunately, often a physical cause is not found and the conclusion is drawn that this is the self-directed intermale aggression type, or is simply a stereotypy. Over the years, mostly by trial-and-error, we have found a number of different treatment approaches, each of which typically is either helpful, or at least does not exacerbate the self-mutilation. Most are simple management changes that seem to work by distracting the animal to another activity; some involve sophisticated pharmacology.

Physical restraint Traditionally, a large percentage of the effort, thought, and expense of treatment of self-mutilation has involved various methods of physically preventing or discouraging the behavior. This often is the first thing you will want to consider while further evaluation is organized. Special neck cradles and side poles, grazing muzzles, bibs, and protective wraps and blankets can be used to prevent injury. Physical restraint alone rarely "cures" self-mutilation. All too often when the horse is effectively restrained from performing one behavior, another problem behavior develops. If biting is prevented, the horse might start kicking or lunging into walls. In the short term, while looking for and treating possible causes, it is wise to creatively work at keeping the animal from further injury.

For any restraint, care must to taken in devising materials that don't cause new rub sores or other irritations. My favorite of all the restraints for self-biting is the grazing basket shown on page 78. The horse effectively can eat hay and grass through the openings. The basket inhibits a substantial grab of flesh, although the persistent horse still can work a small nip of hair or skin through the basket openings.

Social, feeding, and work distractions Typically, the most effective management changes are those that seem to provide motivation for a substitute behavior or a strong distraction to focus on something else. For a stallion, self-mutilation sometimes can be relieved significantly if the stallion is turned out to live in a large pasture with one or more mares. In that situation, the stallion becomes a harem stallion with great responsibility to herd and defend the mares. Those harem maintenance behaviors seem to occupy the stallion's time and distract him from the problem behavior. If he is not supplemented with concentrated feed, his grazing and resting fully occupy the remainder of his time.

Of course, this often is not a plausible solution for the fancy breeding or busy performing stallion. There might be some difficulty and danger in taking such a stallion or his mares in and out of such a situation. Most stallions will not want to leave their mares. But to the extent that the stallion can be distracted socially, in some cases it is worth trying.

Horses appear to find meaningful social companionship from animals of other species. Donkeys, goats, rabbits, and even chickens are useful as stall or pasture companions. In my experience with chickens as stall companions for self-mutilators, it seems that the horse sometimes is reluctant to move around the stall, lest it cause the chicken to scurry and flutter. Some stallions also seem distracted by their effort to avoid stepping on the chicken.

Another effective distraction for many self-mutilators is a vigorous appetite. A change in diet from one heavy with grain to one of grass and grass hay only (without any grain or richer forage) often can lead to a remarkable change in behavior. The horse might spend almost all of its time eating and resting, with seemingly no time for anything else, including self-mutilation. A grazing muzzle like the one described earlier can effectively prolong the eating time.

The all-grass, no-grain diet might have other benefits for behavior. We know from work in horses and other grazing species that grain diets predispose an animal to stereotypies and other behavior problems. The grain diet might alter the brain neurochemistry, setting the animal up for developing abnormal behavior. We long have appreciated that grain increases the risk of behavior problems and high-forage diets reduce the risk of behavior problems.

Work For the self-directed intermale aggression type of self-mutilation, the behavior seldom is seen during work. Moderate work also stimulates appetite. A horse which works one to two hours a day and which is fed ad lib grass and grass hay almost always will spend 60% or more of his time eating and 20% of his time resting. This approaches the natural time budget of a horse at liberty or in the wild. Breeding work sometimes reduces and sometimes increases the frequency and intensity of self-mutilation.

Gelding stallions? For the self-directed intermale aggression type self-mutilating stallions, some veterinarians recommend castration, and in some cases it works very well. Unfortunately, it also can get worse or won't change. When advising clients on this option, I always am reminded of the dozen or so geldings we have known which seemed normal as colts, but were first seen to self-mutilate soon after castration.

Medications Pharmacologic aids, which in some cases have appeared helpful in relieving self-mutilation, include long-acting tranquilizers, tricyclic anti-depressants such as imipramine and clomipramine, progesterone, and the nutritional supplement l-tryptophan. Some of these have been discovered by accident and some are based on theories of brain neurochemistry. None of these medications alone or in combination is likely to eliminate self-mutilation completely. The particular choice depends on the severity and nature of the self-mutilation. In combination with management changes, medications often are judged to be valuable parts of the plan to eliminate self-mutilation. The tendency is for people to over-estimate their potential. An important concern for clinicians who medicate the horse early in the evaluation is that the drugs might help a horse to cope with physical discomfort, thus could effectively mask the symptoms and delay diagnosis of a treatable physical problem.

Other treatment tips For horses whose self-mutilation seems to be triggered by male odors and feces, any number of creative steps can be taken to reduce the stimulation. Odor-masking preparations can be applied to the nostrils, the horse can be bathed frequently, and feces and oily residues can be removed from stalls and pastures. Sometimes, the sight or smell of another stallion seems to provoke episodes. Housing changes can reduce the frequency and severity of self-mutilation.

In our clinic we find that long-term video surveillance of the horse can reveal events and situations that provoke the behavior. Often these "provokers" can be simply and inexpensively eliminated. For example, occasionally you find a horse which only bites himself when the feed cart is coming down the aisle, or when other stallions are on their way to the breeding shed.

Tie-stalls For reasons I'm not sure we ever will understand, simply housing a horse in a tie-stall can effectively eliminate self-mutilation. Recent work with tie-stalled horses in the pregnant mare urine industry has indicated that abnormal behavior in general is very low in tie-stalled horses compared to box-stalled horses.

No one treatment alone is likely to be effective. The cases for which the greatest relief has been achieved have involved simultaneously implementing as many of the treatment steps as possible. We recommend spending time with your veterinarian to develop a custom plan based on everything you know about the horse. Once everything is organized, we recommend implementing all the changes and treatments at once. This is not good science in that you might never know which of the changes were most effective, but experience has taught us that major change often is more effective than a systematic, step-wise approach.

In summary, we really know very little about the causes of self-mutilation, other than physical discomfort. It is important to realize that except for those cases for which a physical discomfort can be identified and eliminated, the self-mutilation likely will never be cured. The current treatments for the self-directed intermale aggression and stereotypy types of self-mutilation rarely effect a cure. At best, diligent attention and care will keep the levels of injury low.

Nancy
Moderator:
DrO

Posted on Wednesday, Feb 15, 2006 - 7:04 am:

Thanks Nancy, I think this does a great job explaining the problem.
DrO
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