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Equine self-mutilation syndrome (57 cases)

Article  in  Journal of the American Veterinary Medical Association · May 1994

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 Journal Title: J A V M A Call #: Vet J o u r n a l Stacks

Volume: 204 Location:

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Issue: 8
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• —<• Pages: 1219-1223
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Notice: This material may be protected by copyright law (Title 17 U.S. Code)
 EQUINE

E q u i n e self-mutilation s y n d r o m e
( 5 7 cases)

Nicholas H. Dodman, BVMS; Jo Anne Normile; Louis Shuster, PhD; William Rand, PhD

ported the successful use of a pure opioid

Summary: Owners who believed they had a horse with antagonist to suppress self mutilation in a stallion,
self-mutilating behavior were asked to complete a ques-thereby implicating the stress-induced release of
tionnaire to obtain information on the signalment, clin-endogenous opioids in this stereotypic behavior.
ical history, clinical signs, management, and treatment They proposed that the analgesic effects of opioids
of the condition. Fifty-two owners of 59 horses re- may permit self-biting to continue by obtunding
sponded; 2 cases were omitted because an organic the normal cortical perception of pain. Other in-
cause was determined. Owners also were asked to com-vestigators have devised nonpharmacologic
6
strate-
plete information for unaffected horses on the same gies for managing self mutilation.
farm. Various breeds were affected, and of the 57 Little is known about the syndrome of self mu-
horses, 20 were stallions, 31 were geldings, and 6 were tilation in horses. An unpublished survey" of > 700
mares. Affected horses tended to develop the condition horses, which was conducted by researchers at the
prior to sexual maturity. Clinical signs included glanc- Ontario Veterinary College at Guelph, revealed the
ing or biting at the flank or pectoral areas, bucking, prevalence of self mutilation to be 1.9% in stallions
kicking, vocalizing, rubbing, spinning, or rolling. Sev-and 0.7% in geldings. Mares were not reported to
eral management and environmental factors were ex- be affected. The purposes of the study reported
amined, but none were found to be exclusively related here were to determine the signalment, history,
to expression of the disorder. Castration was associated clinical signs, and management factors associated
with improvement in 7 of 10 stallions. Medications and with equine self-mutilation syndrome and to eval-
changes in management reduced or prevented the be-uate possible treatments.
havior in some horses. The syndrome appears to be
similar to Tourette's syndrome of human beings. Materials and Methods
We asked 48 regional and national equine-ori-
ented magazines and newsletters to publish a notice
of our interest in contacting owners of horses that
E quine self-mutilation syndrome was first re-
ported as flank biting by Houpt and Wolski.1
Houpt2 later described the condition in more detail
appeared to have self-mutilation syndrome. The
notice, although sometimes edited by the journals,
as involving self-biting, kicking out with the hind contained words such as self mutilation, self-mu-
limbs, and vocalization, and suggested that it is tilation syndrome, and flank biting, and described
seen almost exclusively in stallions, possibly in re- the abnormal behavior as biting at the flank, chest,
sponse to stall confinement, sexual frustration, or or legs. Nineteen magazines with a combined cir-
both. Murray and Crowell-Davis3 reported similar culation of over 450,000 (including Western Horse-
signs in a gelding affected with what they termed man, Equus, and Horse and Horseman) published this
psychogenic colic. More recently, Houpt4 con- notice, and additionally, a similar notice was placed
firmed that self mutilation occurs in horses of both at an annual state stallion exposition in Michigan.
sexes, although it is more common in stallions. A Owners' verbal or written responses were
mechanism proposed by Dodman et al5 suggested screened to confirm the classical repetitive and re-
involvement of endogenous opioids in the propa- fractory characteristics of their horse's behavior.
gation of the condition. These investigators re- These owners were sent a 3-page questionnaire to
collect information on the signalment of the af-
From the Department of Surgery, School of Veterinary Med- fected horses, the clinical signs and development of
icine, Tufts University, 200 Westboro Rd, North Grafton, MA the condition, the environmental and management
01536 (Dodman); Departments of Pharmacology and Experi-
mental Therapeutics (Shuster) and Community Health (Rand), factors, and the results of any treatments attempted.
Tufts University School of Medicine, 136 Harrison Ave, Boston,
MA 02111; and Brookside Acres Inc. 10801 Last Dr, Plymouth, "Leuscher UA, McKeown DB. Data on file. Department of
MI 48170 (Normile). Population Medicine, Ontario Veterinary College, Guelph, Ont.

JAVMA, Vol 204, No. 8, April 15, 1994 Original Study 1219
 Subsequently, a supplementary questionnaire
was sent to all participating horse owners, which
requested information on the nonaffected horses
that these owners kept to be used for comparison
purposes. Data were entered into a data base man-
agement program, which was used to calculate the
reported statistics. When appropriate, the binomial,
X2, and Fisher exact tests were used to test for sta-
tistical significance.
Results
Fifty-two owners of 59 horses requested and
returned questionnaires describing affected horses
and detailing their behavior. These owners were
contacted by telephone to gather data that were
omitted. Two horses were eliminated from the anal-
ysis because an organic cause for the disorder be-
came apparent. In one, the horse had testicular
torsion and in the other, the behavior started late
in life following head trauma in which a fractured
jaw was sustained. Thirty-one respondents had
sought veterinary advice to rule out other causes;
3 had consulted clinicians at veterinary schools,
and 2 had necropsies performed on their horses,
but no abnormalities were detected. Information
concerning the management and environment of
unaffected horses was received from 48 owners.
These unaffected horses served as a control group
with which to compare affected horses.
Although most of the horses with reported self-
mutilation syndrome were Arabians (n = 14),
Quarter Horses (n = 9), or American Saddlebreds
(n = 8), 11 other breeds were represented, and 6
horses were of mixed breeding. The median age of
affected horses at the time of the survey was 6 years
(range, 10 months to 32 years). Twenty (35%) of
57 affected horses were stallions, 31 (54%) were
geldings, and 6 (11%) were mares. The median age
of castration of the males was 17 months (range, 6
months to 8 years), with 25% of the males castrated
at < 1 year and 25% castrated when they were >
3 years. Thirty-seven (65%) of the affected horses
were used for pleasure, 25 (44%) were used for
show, 13 (23%) were used for breeding, and 4
(7%) were used for racing. The geographic distri-
bution of affected horses was 21 from the Midwest,
8 each from the mid-Atlantic states and the South-
west, 6 each from the Northwest and New England/
Canada, and 4 each from the Plains states and
California.
The median pasture size of affected horses was
1 acre (range, 0 to 18 acres). The majority (73%)
of unaffected (control) horses on the premises had
the same pasture access. Fifty-eight percent of af-
fected horses were stalled > 50% of the time. Eigh-
teen percent were stalled < 50% of the time, and
24% of the affected horses had free choice between
boarding and pasture. Two affected horses were
never stalled. The percentage of time stalled was
distributed almost evenly between 0 and 90%.
Stalling arrangements were the same for most
1220 Original Study
(74%) of the horses in the control group. At least
1 unaffected horse was present on the premises
with each of the affected horses. Equine compan-
ions were reported to be visible to the affected
horses in 47 cases. Four affected horses could not
see other horses, and 1 sometimes had equine com-
panions visible. Control horses had essentially the
same visual contact with other horses. Over 50%
of owners of affected horses reported that they
spent at least 2 hours per day with their horses
(range, 5 minutes to 6 hours). Control data pro-
vided a similar spectrum of time spent with unaf-
fected horses, with 77% of respondents describing
the same contact hours.
Most of the horses in the study were reported
to have normal appetites (n = 42), with 7 reporting
excessive appetite and 1 reporting poor appetite.
Molasses regularly was a component in the diet for
35 affected horses. Five horses sometimes were fed
molasses-sweetened rations, and 9 horses never re-
ceived molasses in their diet. Percentage of the hay
that was alfalfa ranged from 0 to 100%, with half
of the affected horses eating between 10 and 80%
alfalfa. Control data did not indicate any notable
differences in the feeding of molasses or alfalfa. A
mineral salt block was available to 44 affected
horses and was not available to 4. The deworming
medication, deworming schedule, and vaccination
procedures were virtually the same for affected and
control horses (88, 93, and 90% agreement, re-
spectively).
Self-mutilation syndrome was first observed in
the horses of this study when they were a median
age of 18.5 months. A quarter of the horses exhib-
ited the behavior when < 11 months old, and a
quarter of the horses started when they were > 2
years old. None of the horses developed the be-
havior when they were > 4 years old. Thirty-one
horses were stallions, 7 were geldings, and 6 were
mares at the time the condition was first noticed.
The sex distribution differs significantly (P <
0.001) from that of the control group. Eleven of
the affected stallions were subsequently castrated;
in 10, the surgery was performed as a treatment.
Seven horses were known to have been castrated
prior to the onset of the condition. None of the
behavior patterns was totally uniform among the
horses, although attempted or actual biting at the
flank area, limbs, or lateral thoracic region was the
most common behavior. Other target areas for bit-
ing included the pectoral region and tail. Although
most horses (61.4%) bit at both sides, those horses
that bit at only 1 side predominantly bit at their
right side (8 vs 1, P < 0.02, binomial test). In ad-
dition, all the mares kicked with their hind limbs,
whereas only slightly more than half of the stallions
and geldings kicked out in this way (P = 0.071,
Fisher exact test). Other behaviors reported in af-
fected horses included bucking (40%), vocalization
(32%), hypersensitivity to touch (39%), and rub-
bing, spinning, or rolling (40%). Rubbing, spin-
JAVMA, Vol 204, No. 8, April 15, 1994
Table 1—Results of treatment for self-mutilation syndrome mutilating behavior by the owner shouting or oth-
in 33 horses erwise distracting the horse. Only 4 owners
No. with Slight Substantial Compe lte reported that their horse could not be distracted in
No. of improve- improve- improve- improve- this way. Although a seasonal exacerbation was re-
Method horses merit ment ment ment
ported by some owners, no particular seasonal
Castration 10* 3 3t predilection was apparent.
Change in sta-
bling 6 1 Several treatments for the condition were at-
Change in de i tS 9 7 tempted (Table 1). In 10 stallions that were cas-
Change in com- trated as a treatment, the condition was improved
pano i nshp i 5 2
Topical applica- in 7, and 3 of these 7 were apparently cured. Other
tions! 12 10 treatments tried with some degree of success in-
Anthelmintic 2 2 cluded changing stabling arrangements or diet
Ucl er medication
(histamine H; an- (avoiding sweetfeed and reducing grain in ration),
tagonist) 3 3 the iv administration of dimethylsulfoxide, and the
Antihistamines 2 1
Steroids 6 5 administration of dopamine-blocking drugs. Treat-
Nonsteroidal anti-inflammatories ment was not universally effective.
Phenyb l utazone 3 3
Dimethylsulf-
oxide 3 2 Discussion
Flunixin megu l- Analysis of the results of this study indicated
mn ie 1 1 that self-mutilation syndrome occurred in many
Synthetic proges- horse breeds. Males were more likely to develop
terone 2
the condition than were females, and the condition
Dopamn ie antagonists
Acepromazn ie was most likely to arise in the first 2 years of the
mae l ate 1 1 horse's life. Most of the affected horses were ob-
Ful phenazn ie served to exhibit self-aggressive behavior on a daily
decanoate 2
Preventvi e devci es basis and some horses had numerous episodes each
Cribbing collar 2 1 1 day. Self-mutilation syndrome usually was ex-
Kicking chan is 1 pressed as an attempt to bite the flank area or
1tt
•Included 2 horses castrated after the dates of the study, tin 1 horse, caslimbs, tra- although biting attempts directed at the lat-
tion, diet change, and stabling changes were made simultaneously. tOther factors eral thoracic wall, pectoral area, and tail also were
were changed simultaneously, {Included decreasn i g grain in ration, increasing fre-common. Episodes of self mutilation frequently
quency of feeding, and addition of minerals or amn i o acid suppel ments. [Included
antiseptics, soap and shampoo, parasiticides, anti-inflammatory agents, and aver-were precipitated by environmental stresses, in-
sive substances. ^Compe l te m
i provement lasted 8 to 12 hours each time on 4 cludingsep- anticipation of eating, interaction with
arate occaso i ns when dimethylsulfoxide was administered iv. lOrally administered
acepromazn i e was effective for only 3 days. "Improvement lasted 34 days.other horses (particularly the opposite sex), inac-
tChains prevented striking out and buckn i g only. tivity, and several other factors that presumably in-
crease anxiety or the level of arousal.
Veterinarians encountering cases of equine
rolling was reported significantly (P = 0.034, x2 self-mutilation syndrome have suspected chronic
test) more frequently in mares and geldings than in colic, dermatologic conditions, viral neuritis, epi-
stallions. Most horses (75%) could be stopped from lepsy, and hormonal imbalance as causal factors.
the behavior by a distraction. Actual episodes of self This confusion is understandable because many of
mutilation lasted from seconds to hours, with the these conditions may have similar clinical signs. In
median being between 1 and 10 minutes, and half our study, 1 horse with testicular torsion and 1
of the horses had bouts lasting between 30 seconds with head trauma originally were suspected to have
and 15 minutes. The bouts were reported to occur primary self-mutilation syndrome. We are aware of
from 25 times/d to monthly. Owners reported pre- 2 other horses that also had similar signs, 1 of these
cipitating factors to be seasonal changes (44% of had an hepatic tumor and the other had an abscess
horses), anticipation of food (37%), excitement or in the flank region. Differentiation between self-
stress (35%), inactivity (23%), the presence of mutilation syndrome and such conditions can be
mares (for males; 12%), and smelling manure/urine difficult and should be based on the signalment of
the horse, the history of the disorder, and the lack
Owners reported in 15 cases that relatives of of associated medical conditions.
the self-mutilating horses had similar behavior. In Inactivity or confinement may be involved in
21 cases, owners reported that relatives did not dis- the development of equine self-mutilation syn-
play such behavior, whereas, in 21 cases, this in- drome. Although the environment may appear to
formation was unavailable. Forty owners believed be adequate to the horse owner or breeder, it often
that the episodes were initiated by environmental is much different than the horse's natural environ-
events, 6 said they were not, and 11 did not com- ment. Feral horses live in herds, have complex so-
ment. Anticipation, stress, and excitement were cial interactions, and travel large distances daily. In
common inciting factors. Most of the horses could addition, they spend much time grazing, a primary
be interrupted and stopped during a bout of self- occupation when not on the move or resting. The

JAVMA, Vol 204, No. 8, April 15, 1994 Original Study 1221
lack of freedom, reduced opportunities for social-
ization, and the relatively short time that domesti-
cated horses spend eating are believed to contribute
to frustration or stress.7 This frustration may result
in displacement activities, such as cribbing or pos-
sibly self mutilation. Confinement may be a specific
provocateur of self-injurious behavior for vulnera-
ble human beings.8 Our results indicated that the
disorder occurs in horses over a wide range of con-
finement situations, and that these situations were
shared by the majority (three-fourths) of unaffected
horses on the same premises. This does not support
the hypothesis that confinement is a primary factor
in the expression of the disorder, however, for
more definitive conclusions, it would be necessary
to compare domesticated horses living on farms
with their feral equivalents in the wild.
Diet has been implicated in the expression of
equine sterotypies, particularly the feeding of
highly palatable rations.15 We found that the diets
of affected and control horses were similar for most
horses, and, more specifically, that affected horses
were no more likely to be receiving sweetfeed grain
than were control horses. One respondent reported
that her horse stopped self-mutilative behavior
when sweetfeed was eliminated from the diet, but
other therapeutic measures were instituted simul-
taneously.
Geographic location does not appear to be a
factor in the development of equine self-mutilation
syndrome. All geographic regions of the United
States were represented, indicating that the behavior
occurs over a wide range of climatic and geoponic
conditions. The apparently high representation of
the Midwest probably is a reflection of the study
location.
There are several purported mechanisms for
equine self-mutilation syndrome, though it may re-
quire more than 1 to be operating simultaneously
for the full expression of the disorder. Findings in
our study suggested that heritable factors may be
involved. Two horses in our study sired 3 affected
colts. Four horses had a sire and, in 1 case, a sire
and grandsire that were affected. In addition, 5
horses had half siblings affected with the disorder.
Dodman et al5 reported that a sire and sibling of
an affected stallion both exhibited self mutilation.
Endogenous opioids may be involved in the
propagation of sterotypies, including self-mutila-
tion syndrome.9 Their release is facilitated in a
stress-primed system, and they may sensitize
dopaminergic mechanisms directly involved in the
repetitious behavior.10 Opioid activation of the re-
ward centers in the brain and an increase in pain
threshold may further reinforce or support the be-
havior. Some evidence for opioid modulation of
equine self-mutilation syndrome is provided by the
dramatic reduction in self-biting attempts afforded
b
Becker TJ. The use oj sustained release opioid antagonists in
the treatment of a stereotypic behavior (cribbing) in the horse.
degree thesis. Tufts University, Boston, Mass, 1992.
1222 Original Study
by nalmefene, a pure opioid antagonist.5 The ben-
eficial effects of the dopamine antagonists, ace-
promazine and fluphenazine, reported in this
study, were compatible with the theory of opioid-
dopamine interaction. One may speculate that non-
specific serotonergic agonists also could reduce the
frequency of self mutilation, because serotonin in-
hibits dopaminergic neurotransmission.
Factors that need to be reconciled with any
theoretical explanation for self mutilation are the
development of the condition predominantly in
males during adolescence and the improvement re-
ported in 7 of 10 stallions after castration. The be-
havior appears to be androgenically driven to some
extent; however, high levels of male sex hormones
apparently are not necessary for its development or
propagation, because it occurs in castrated horses
and in mares, and usually continues to some degree
after castration. The expression of the disorder may
simply be a function of aggressive tendencies,
which are pronounced in males. Self-injurious be-
havior has much in common with aggressive be-
havior.11 Intermale aggression in horses generally
takes the form of biting directed at the neck or
limbs of other horses. In the absence of another
male to direct aggression toward in the establish-
ment of dominance rituals, it may be that aggres-
sion is self-directed. Similarly, self mutilation
occurs in male primates that are socially isolated
from counterparts during a socially formative pe-
riod.12 Male behavior mechanisms are engendered
in the developing brain in utero as it is exposed to
endogenous testosterone in the latter stages of ges-
tation.13 The higher level of innate aggressiveness
of the male, conditioned by but not dependent on
testosterone, would explain why castration does
not prevent the development of the condition but
may ameliorate signs in affected stallions. It is pos-
sible that overly aggressive mares were overrepre-
sented in our study. Intraspecific aggression in
mares normally is expressed by kicking with the
hind limbs,4 and kicking was a feature of the con-
dition in all of the affected mares in our study. Af-
fected geldings exhibited substantially more rubbing
against objects, spinning, and rolling than stallions
and, in this respect, resembled the mares.
There are several parallels between the condi-
tion of equine self mutilation and that of Tourette's
syndrome, which affects human beingsH-c (Table 2).
Tourette's syndrome, presumed to be a basal gan-
glia disorder, has certain similarities with Syden-
ham's chorea. In Sydenham's chorea, damage to the
caudate and putamen nucleus neurons is believed
to arise following rheumatic fever.15 A similar
mechanism might be responsible in affected horses
following streptococcal infections. Because almost
40% of owners reported that their horses were sen-
sitive to touch in the flank region (suggesting some
Ticamele
DVMWL, Goldberg RL. Tourette syndrome (abstr). Fed
Proc 1988;37:115-119.
JAVMA, Vol 204, No. 8, April 15, 1994
Table 2—Comparison of equine seI/-mutiIation syndrome ever, and there is no doubt as to the compulsive
and Tourette's syndrome nature of this condition. Obsessive compulsive dis-
Equn i e leH-mutilation orders in people often involve ritualized grooming
Feature syndrome Tourette's syndrome or hand-washing behaviors and equine self-muti-
Age of onset Generayl S2 years Meda i n age at onset, 7 lation syndrome could be viewed as an excessive
years self-grooming activity. Grooming is a species-typical
Sex About 7 times more commoA nt least 3 times more behavior that incorporates fixed-action patterns of
in mae ls common in mae ls behavior and that has complex environmental in-
Genetci predisposi- • Two horses each sired 3Safu-ggested determination
tion fected colts by a domn i ant autoso- teractions. The possible link with obsessive com-
• The sires of 5 afected mal gene with n i com- pulsive disorder does not preclude a Tourette-like
horses also were afected plete penetrance etiogenesis, because obsessive compulsive disorder
• Fvie afected horses had af- symptoms are common in Tourette's syndrome.15
fected half siblings
• Both the sire and grandsire One way of testing the obsessive compulsive dis-
of 1 afected horse were af- order theory of equine self-mutilation syndrome
fected would be to administer some of the newer antiobs-
Trauma as a cause One horse, 22 years old, de B-rain injury can be a pre-
veo l ped self-mutilative be- cipitating factor essional drugs, such as clomipramine or fluoxetine,
havior 1 month after severe to affected horses and observe any changes in their
head injury behavior.
Course Persistent. Compe l te resolu- Usualy lifelong, although
tion without treatment not temporary remissions
reported may occur References
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every day veterinarians and animal scientists. Ames, Iowa: Iowa State Uni-
Body parts in- Repetive neck movements, Head and neck most fre- versity Press, 1982;312-313.
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or atempted bites of body and !:rrbs problem. Equine Pract 1983;5:6-8.
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Impariment All afected anm i asl learned Normal inteligence; no
basci training and many marked m i pariments 8. Winchel RM, Stanley M. Self-injurious behavior: a re-
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race horses chiatry 1991;148:306-317.
9. Herman BH, Hammock MK, Egan K, et al. Role for
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Because some horses with equine motor neuron 11. Gualtieri CT. The measurement of self-injurious be-
disease also display altered skin sensitivity, similar- havior. ] Neuropsychiatry 1991;3:S30-S34.
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of self-injurious behavior in rhesus monkeys. Prog Neuro-
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16 17
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orders, which affect human beings. This disorder. Neuropsychopharmacology 1991;5:1-22.
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JAVMA, Vol 204, No. 8, April 15, 1994 Original Study 1223
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