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55 MAY/JUNE 2017 ■ TVPJOURNAL.COM PEER REVIEWED causes of the clinical signs and serve as a baseline before medication use. 8,13 Conditions that can cause discomfort or pain can present similarly to anxiety. 18 Depending on clinical presentation, initial diagnostics, and examination findings, additional diagnostics may be warranted. Step 3: Rule Out Behavioral Contributors or Differentials As many as 30% to 60% of dogs have comorbid noise and storm phobias. 9,15,19 Confinement distress could be the sole cause of anxiety or a very large contributor. 3,8,13 Testing the dog's distress level with confinement when the owners are present 13 and no confinement when the owners are not present can rule this out. Other diagnostic differentials to consider are listed in Box 2 . Video recording is helpful 13 because many signs are "silent," with no evidence of the behavior upon the owner's return. In addition, video can confirm the diagnosis, provide a baseline, have treatment implications, and help monitor for treatment success. There are many ways to inexpensively record video, including smartphones, apps, and home security systems. TREATMENT Step 1: Educate Owners may have preconceived ideas of the cause of their pet's disorder. The owner should understand that his or her pet is not acting this way out of spite or anger; that the owner didn't cause the behavior by loving the pet too much, spoiling it, or not being dominant; and that the pet is not bored and getting another pet will not help. 1,9,13 Step 2: Avoid and Manage Distress Immediately As quickly as possible, put into place strategies and treatments to decrease or ameliorate the distress. This will ease owner stress and improve the pet's quality of life while long-term treatments are instituted. Avoid departures in the initial stages of treatment 14 through use of daycare, boarding, house sitters, or bringing the pet along when the owner departs. Confinement can prevent destruction but also can increase anxiety 13,14 and is generally avoided because of the comorbidity with confinement anxiety. If BOX 2 Differential Diagnoses for Separation Anxiety in Dogs and Cats 3,8,13,14 DOGS and CATS • Storm phobia • Noise phobia • Confinement distress • Panic disorder • Cognitive dysfunction • Marking • Fear • Excitement • Reaction to external stimuli • Territorial aggression • Lack of house training • Lack of opportunity to reach elimination areas DOGS • Overactivity • Socially facilitated • Drive to roam • Play • Normal puppy behavior • Lack of enrichment/stimulation CATS • Litterbox aversion • Litterbox preference • Substrate aversion • Substrate preference • Normal scratching behavior shutterstock.com/zossia