Feather Picking and Self-Mutilation in Psittacines

By Cinthia Fulton, B.S. Animal Science

Abstract

Feather picking is one of the most frequently presented problems to the avian veterinary surgeon. This paper explores the process of diagnosing the various medical or behavioural disorders that could lead to the onset of feather picking. Novel approaches to treatment, such as acupuncture and homeopathic remedies, and current research are included.

Introduction

Feather picking and self-mutilation in psittacines is the most commonly seen problem in the avian practice (Boyce & Jones, 1998). Feather picking can be defined as the pulling and / or barbering of feathers by the bird itself. Self-mutilation can be defined as the skin and tissue damage created by the parrot’s own beak or feet. Feather picking can occur within various degrees, from one or two feathers being barbered to entire areas of the body being barbered or plucked. Self-mutilation can also exist in various degrees, from a slight nibbling on the toes to deep wounds on the breast.

Feather picking and self-mutilation are symptoms, not diseases (Johnson-Delaney, 1992). The process of diagnosing the cause of the symptom can be extremely frustrating to both the parrot owner and the veterinary surgeon. There are multiple differential diagnoses for this problem, including medical and behavioural aetiologies. Only after a thorough case work-up can a proper diagnosis be derived. In many cases, the aetiology is never found. Whether or not an aetiology is found, there are multiple treatment types that may benefit the patient by decreasing or eliminating the symptoms of feather picking and self-mutilation.

History and Physical Examination

Taking the history is likely the ‘key’ part of diagnosing the cause of feather picking and self-mutilation. It is important to determine the conditions in which the parrot is kept in, including: cage size, cage location, number of perches and perch types, presence of other animals (including birds), amount of hours spent alone each day, type of attention given, exposure to fumes or smoke, water allowance for bathing, number and type of toys provided, hours of dark quiet time provided for sleep, frequency of cage cleaning, and diet. Questions about recent history should be asked: how long has the owner had this bird? Where was it obtained? Were there previous medical conditions in its lifetime? When was the bird’s last moult? How long did the last moult last? How often does this bird usually moult? Any changes in the bird’s daily routine and environment should be particularly noted, even if it is a slight change, such as a picture that was recently hung on the wall. Questions about added stress, such as argument/yelling or recent death (even of a pet) in the family, should also be asked. A questionnaire can be supplied to the parrot owner prior to entering the examination room.

The physical examination will help to differentiate between medical and behavioural aetiologies. The bird’s skin and feathers should be closely examined, both with the naked eye and with eye loops or magnifying glass. If the wing feathers are clipped, be sure to check that the clip is proper for the species (Rupley, 1997). Feather loss on the head should be particularly noted, as this means the feathers were not self-plucked. External parasites such as mites and lice should be searched for, as should signs of bacterial or mycotic skin infection. It is essential to determine if the feathers were lost due to natural moulting (there should be no bare patches of skin), due to plucking (indicated by the presence of bare patches of skin at any time), or due to a disease process (abnormal feathers being lost). Feathers should be checked for abnormalities, such as “retained feather sheaths, clubbed feathers, curling feathers, feathers “pinched” midway along shaft, marked stress lines, blood vessel retained in quill, [or] changes in feather pigmentation” (Doane, 1991). Any tissue damage should be noted. The feet and nails should also be closely examined for lesions, wounds, keratinisation, and pain. The beak should be examined for any abnormalities. Weight of the bird is also an important factor, and the owner should be asked if they weigh the bird regularly (and if so, has there been any weight changes recently).

Diagnostics

The amount of diagnostics performed should be determined on a case-to-case basis, depending on owner compliance and the bird’s history and physical examination. Radiographs should be taken to evaluate the overall internal status of the bird, and to check for abnormalities such as foreign bodies or neoplasias. A full thickness skin biopsy (a section of skin and feather follicle) is required to rule out dermatologic and neoplastic disorders (Schmidt, 1993). A culture (bacterial and fungal) of the skin and follicular material (Rupley, 1997) should also be performed. Blood should be drawn and the following tests performed: CBC, chemistries, viral tests as indicated by history (such as Psittacine Beak and Feather Disease and avian polyoma virus), chlamydias, and thyroxine levels. A fresh faecal examination, including the trichrome test for Giardia, should be performed in certain species to rule out internal parasites. Choanal and cloacal swabs should be performed and Gram’s stain and culture done to test for abnormal microbial flora (Johnson-Delaney, 1992).

Differential Diagnoses

The list for differential diagnoses is quite extensive, and this is one of the reasons diagnosis of feather picking/self-mutilation is so difficult. Aetiologies can be divided into medical, environmental, and behavioural groups. Anything that upsets the bird in any way can lead to feather picking and self-mutilation. Feather picking and self-mutilation that has not been stopped for months to years can become habitual, with the original aetiology no longer present.

Medical Aetiologies:

·        Dermatological

o       Hyperkeratosis and dermatitis (Schmidt, 1993)

·        Viral

o       Psittacine Beak and Feather Disease (PBFD) causes the loss of abnormal feathers and abnormal beak growth.

o       Polyoma virus “primarily affects young birds” and can cause abnormal feathering in adults that survive (Bauck, 1998).

o       Unknown viral origin: Rosskopf and Woerpel (1990) note a syndrome of “recurring episodes of severe self-mutilation, usually in the wing web or leg areas.” Inclusion bodies have been found upon skin biopsy of many birds with the “attacks”. No specific virus has been isolated yet, but the lesions are similar to a poxvirus.

·        Bacterial

o       Folliculitis (Altman, 1997).

o       Gram-positive or gram-negative infection of choanae or cloaca.

·        Fungal

o       Candida yeast infection of choanae, crop, or cloaca.

o       Aspergillus infection.

o       Mycotic folliculitis (Altman, 1997).

o       Fungal growth on feathers (Altman, 1997).

·        Internal Disease

o       Liver disease.

o       Nephritis (Rupley, 1997).

o       Airsacculitis (Rupley, 1997).

o       Intestinal disease (Altman, 1997).

·        Endocrine Disorders

o       Hypothyroidism can cause hyperkeratosis and dry skin.

·        Trauma

o       Wounds to the skin and muscle can cause the bird to pick at itself.

o       Burns are painful and can also cause picking/self-mutilation.

o       Broken bones cause pain, therefore can cause picking/self-mutilation.

·        Nutritional

o       Vitamin A, choline, riboflavin, lysine, folic acid, iron, or carotenoid deficiencies (Rupley, 1997).

o       Nutritional hyperparathyroidism can cause fractures and pain.

·        Neoplastic

o       Feather cysts (not true neoplasias) can be painful and bird may try to pick them off.

o       Xanthomas and lipomas (Rupley, 1997).

o       Malignant neoplasias.

·        Abdominal Adhesions (Altman, 1997)

o       Cause great pain every time the bird moves.

·        Toxicities

o       Lead from parts of toys is often ingested. This is often apparent upon radiography.

o       Zinc.

o       Arsenic (Rupley, 1997).

·        Parasitic

o       Ectoparasites such as mites and lice. Visible upon magnification of skin and feathers. Can live inside the feather shafts. May be nocturnal.

o       Internal parasites such as Giardia (especially in cockatiels), ascarides, and cestodes (Rupley, 1997).

·        Allergic (Altman, 1997)

o       Internal parasites can cause allergic reactions leading to feather picking/self-mutilation.

o       Certain foods.

o       Contact allergies.

·        Genetic (Rupley, 1997)

o       Baldness can be congenital.

·        Iatrogenic (Rupley, 1997)

o       Praziquantel and fenbendazole can cause feather picking/self-mutilation.

Environmental Aetiologies:

·        Lack of quiet darkness for sleep

·        Cage too small

o       Minimum size should allow bird to turn around without any feathers brushing the sides of the cage. Too small of a cage can cause the bird to feel cramped and stressed.

·        Cage incorrect shape

o       Too tall of a cage does not allow much room for exercise.

·        Cage placed in too busy an area

o       Can cause the bird to feel insecure.

·        Cage too accessible by other pets

o       Bird may be afraid of cats and dogs or intimidated by other birds.

·        Improper amount or type of toys

o       Boredom results.

·        Improper amount or type of perches

o       If the bird is uncomfortable on its feet, it may feather pick/self-mutilate.

·        Exposure to cigarette smoke (Altman, 1997)

o       Irritates the bird. May take frustrations out on its self.

·        Too loud or too quiet environment

o       The natural environment has a lot of background noise (birds vocalising, etc.).

·        Low Humidity (Rupley, 1997)

o       Can cause dry, itchy skin.

·        Cage, food, or water not cleaned often enough

Behavioural Aetiologies:

·        Territorial

o       Birds feeling crowded in one cage.

·        Loneliness

o       Not enough attention given. The bird may be left alone for most of the day and cooped up in its cage all the time.

·        Boredom

o       Not enough toys. Lack of attention. Lack of company (human or animal).

·        Lack of stimulation

o       Mentally bored. Bird may not be allowed out of its cage.

·        Inability to accept change

o       Lack of socialisation while young, especially in African Greys. Change of routine, change of diet, change of family, change of environment, and death of family member or pet.

·        Attention-getting (Altman, 1997)

o       Bird may be feather picking/self-mutilating for another reason, then the owner pays more attention or scolds it when noticing the behaviour. The bird likes the attention and relates the behaviour to the attention.

·        Stress

o       Arguments and or yelling in the household. Death of a family member or pet.

·        Sexual frustration

·        Broodiness (Altman, 1997)

·        Habitual

o       Feather picking/self-mutilation for more than a month can become habitual.

·        Over-preening

o       Normal preening behaviour can become excessive.

·        Psychosis (Rupley, 1997)

o       Years of neglect/abuse can lead to psychotic behaviours such as feather picking/self-mutilation and head bobbing. Other causes of psychosis are possible, mostly unknown.

·        Poor feather clip (Rosenthal, 1993)

o       Causes an imbalance that may make the parrot afraid to move (fear of falling). The feather clip may also be irritating to the bird, with feather shafts rubbing the skin.

Treatments

The immediate treatment may be to place a preventative collar on the bird. Collars are indicated mostly for birds that mutilate themselves. Some species (such as African Greys) may be too sensitive to be collared, in which case the collar should only be used as a last resort. Collars may have to be worn by the psittacine for up to nine months and as little as two weeks. Often the placement of a collar will allow the bird to forget about its feather picking/self-mutilating “habit”.

There are three types of preventative collars for psittacines. The most well known is the “Elizabethan Collar”, which is funnel-shaped. This can be made of plastic or radiograph film. Another type of collar that may be tolerated well by other birds is the “tube collar”. Pipe insulation material (foam-like) can be cheaply obtained at a local hardware store and cut to specifications. This collar is particularly lightweight and does not obstruct the bird’s vision. The third type of collar on the market is the “plate type collar”, which is a variation of the tube collar. The plate collar is made of hard plastic material. An alternative to a collar is a “hexcelite ‘T-shirt’ to prevent tissue damage in birds that react badly to collars” (Beynon et. al., 1996).

Traditional treatments usually include pharmaceuticals. For medical aetiologies, it is fairly easy to determine the course of treatment. Antibiotics shall be used for bacterial infections and antifungals for mycotic infections. PBFD can be treated by stimulating the immune system with drugs such as “levimasole, avian interferon, and avian interleukin I” (Doane, 1991). Polyoma virus has no cure. Thyroxine replacement therapy should be used for hypothyroid birds (Doane, 1991). Wounds, fractures, and burns due to trauma or self-mutilation should be repaired, surgically if necessary. If nutrition is the possible aetiology, the bird should be placed on a good plane of nutrition by changing to a commercial pelleted diet supplemented with fresh foods. If the bird will not convert to pellets, the diet should consist of good-quality seeds, grains, and fresh foods along with an avian vitamin mixture. Fresh water should be available at all times. Any neoplasias should be surgically removed where possible, as with abdominal adhesions. Giardia can be treated with ipronidazole, dimetridazole, or metronidazole (Bauck, 1998).

Allergies are still controversial in the world of avian medicine (Fraser, 2002). This is due to the fact that birds’ immune systems are somewhat different than mammals’ and an allergic mechanism is still unknown. Treatments for allergies are currently being researched. “Therapeutically, some Psittaciformes will show decreased self-mutilation in response to the use of glucocorticoids, suggesting an allergic or autoimmune basis to the condition. Unfortunately, apart from side effects recognised in mammalian species, the use of glucocorticoids in birds may induce fault-lines in newly forming feathers” (Macwhirter and Mueller, 1998). Macwhirter and Mueller (1998) “evaluated immediate intradermal skin test reactivity to a limited array of environmental allergens in normal Psittaciformes and in birds showing clinical evidence of self-mutilation”. Many more (93%) self-mutilating birds developed a wheal due to intradermal allergen injection compared to normal psittacines (2%) (Macwhirter and Mueller, 1998). This strongly suggested that allergies do exist in birds. In domestic mammals such as dogs and horses, “hyposensitisation or allergen avoidance has been a successful treatment modality” for allergies (Macwhirter and Mueller, 1998). Further research is necessary to determine if such strategies will work for psittacines.

Treatment for behavioural and environmental aetiologies is variable. Changing the environment to meet the needs of the bird is the first step. Ensuring the proper cage size, location, and number/type of toys/perches is relatively easy. The bird should get at least 8-12 hours of quiet darkness per night so that it can sleep. Daily misting or showering of the bird is very good, but not all birds (or owners) enjoy this. The bird should at least have a shallow dish of fresh water to bathe in every day. Stressors should be eliminated or decreased. If the bird is to be left alone during the day, the television or radio should be left on so that it is not lonely (and in the wild, birds are accustomed to background noise). The owner needs to spend as much time as possible with the bird, and the bird should have at least a couple of hours of out-of-cage time. If territorialism is deemed to be an aetiology of feather picking/self-mutilation, the bird should be placed in a cage of its own and away from other birds. It is imperative that the owners not respond to the bird when it feather picks or self-mutilates (no scolding or watching), as this encourages the attention-getting behaviour.

If changing the bird’s environment does not work, if the bird is an extreme danger to itself, or if all else fails, psychotropic drugs may be used. Many of these drugs have side effects, and most owners would complain of sedation. Drugs with the most sedating effects are: “Amitriptyline, Doxepin, Trimipramine, [and] Trazodone” (Johnson, 1987).

Of the tricyclic antidepressant drugs, Doxepin has shown to be useful in feather-pickers (Johnson, 1987). Ramsay and Grindlinger tested Clomipramine (another TCA drug) in 1992. Clomipramine was not as effective as expected, with “only 2 of 11 birds” stopping their “obsessive behaviour” in response to the drug (Ramsay & Grindlinger, 1992). Opioid antagonist drugs have been found to be highly effective in treating feather picking and self-mutilation. Two studies with haloperidol (Iglauer & Rasim, 1993; Lennox & VanDerHeyden, 1993) have shown that it works best with self-mutilators, but can be helpful with feather pickers if given daily. Naltrexone hydrochloride is another opioid antagonist that shows promise with stopping feather picking (Turner, 1993).

When no aetiology can be found for feather plucking/self-mutilation, psychotropic drugs and new approaches to treatment might be considered for use. New approaches to treatment in the past few years have included acupuncture and homeopathic remedies. A study on 28 psittacines by Worell and Farber in 1993 showed: “Certain types of birds, in particular, Umbrella Cockatoos and Moluccan Cockatoos, show very positive and beneficial responses to acupuncture therapy for feather picking…while the Eclectus males and African Greys demonstrated a poor response.” Some of these birds, however, did not receive treatment very long due to being withdrawn from the study by their owners.

Homeopathic remedies are becoming increasingly common in veterinary medicine, although few studies have been performed. One new herbal formula has been developed recently. “Since 1997, this formula has been used on over 500 patients…it appears that in most cases this formula decreases the severity of feather picking and a significant number of birds have stopped this behavior altogether” (Bennett & Kelleher, 2002). Other recommended homeopathic remedies have been the Bach Flower Essences (and other flower essences) and Grapefruit Seed Extract (GSE). The flower essences are supposed to have a calming effect on birds and other animals, helping to place their emotions back into equilibrium. GSE is a potent extract that has antimicrobial, antibiotic, and anti-parasitic effects (further studies required for use in avians).

Summary

More research is needed to discover unknown aetiologies of feather picking and self-mutilation. For example, the “syndrome” described by Rosskopf and Woerpel (1990) could have viral origin. The virus needs to be isolated and classified, vaccines developed, and anti-viral treatments pursued. Many of the psychotropic drugs have only been clinically tested in small numbers of birds, so that the outcomes of the studies may not be too reliable. Studies of these drugs should be performed on many more subjects of a variety of species within the psittacine family. The veterinary homeopathic community contains only a handful of avian veterinary surgeons. Avian veterinary surgeons should explore the alternatives to traditional drugs, and clinical studies should be performed on some of the homeopathic treatments that are currently being recommended.

Feather picking and self-mutilation are very frustrating symptoms of a multitude of potential problems that make diagnosing very difficult. A proper history and examination are essential to a successful diagnosis. One unasked (and unanswered) question may lead to a diagnosis of “unknown aetiology” or “behavioural feather picking”. Veterinary surgeons must remember that the owner knows their bird best and should sincerely listen to and respond to their concerns and observations. The owner may push for certain treatments for feather picking/self-mutilation, so the veterinary surgeon must be careful not to be swayed into using the trial and error method of diagnosis and treatment. They should continue using the scientific empirical method.

Sources

ALTMAN, R.B., CLUBB, S.L., DORRESTEIN, G.M., & QUESENBERRY, K. (1997)

Avian Medicine and Surgery. Philadelphia, Pennsylvania, W.B. Saunders Company.

p. 229

BAUCK, L. (1998) Caged Birds. The Merck Veterinary Manual. Philadelphia,

Pennsylvania, National Publishing Inc. pp. 1308-1309

BENNETT, T. & KELLEHER, D. (2002) Herbal Treatment of Feather Picking. Exotic

DVM 4 (3) 31-33

BEYNON, P.H., FORBES, N.A., & LAWTON, M.P.C. (1996) BSAVA Manual of

Psittacine Birds. pp. 107-111

BOYCE, J.R. & JONES, J.P. (1998?) A Job Analysis for Entry-Level Practice in

Veterinary Medicine. http://www.nbec.org/pdf/job.pdf p.9

DOANE, B.M. (1991) The Parrot in Health and Illness. New York, NY, Simon &

Schuster Macmillan Company. pp.218-229, 152-158

FRASER, M.A. (2002) Avian Atopic Skin Disease and Intradermal Skin Testing.

British Veterinary Zoological Society Proceedings of the Autumn Meeting 26-27

IGLAUER, F. & RASIM, R. (1993) Treatment of psychogenic feather picking in

Psittacine birds with a dopamine antagonist. Journal of Small Animal Practice 34

(11) 564-566

JOHNSON, C.A. (1987) Chronic Feather Picking: A Different Approach to Treatment.

Proceedings of the Annual Conference of the Association of Avian Veterinarians 125-

142

JOHNSON-DELANEY, C. (1992) Feather Picking: Diagnosis and Treatment. Journal of

the Association of Avian Veterinarians 6 (2) 82-83

LENNOX, A.M., & VanDerHEYDEN, N. (1993) Haloperidol for Use in Treatment of

Psittacine Self-Mutilation and Feather Plucking. Proceedings of the Association of

Avian Veterinarians 119-120

MACWHIRTER, P.J. & MUELLER, R. (1998) Comparison of Immediate Skin Test

Reactions in Clinically Normal and Self-Mutilating Psittaciformes. Proceedings of

International Virtual Conferences in Veterinary Medicine.

http://www.vet.uga.edu/ivcvm/1998/macwhirter/macwhirter.htm

RAMSAY, E.C., GRINDLINGER, H. (1992) Treatment of Feather Picking With

Clomipramine. Proceedings of the Association of Avian Veterinarians 379-382

ROSENTHAL, K. (1993) Differential Diagnosis of Feather-Picking in Pet Birds.

Proceedings of the Association of Avian Veterinarians 108-112

ROSSKOPF, W. & WOERPEL, R. (1996) Diseases of Cage and Aviary Birds. Hong

Kong, Williams & Wilkins. pp. 529-532

ROSSKOPF, W. & WOERPEL, R. (1990) The Psittacine Mutilation Syndrome:

Management, Incidence, Possible Etiology and Therapy. Proceedings of the Association of Avian Veterinarians 301-

304

ROSSKOPF, W. & WOERPEL, R. (1986) Feather Picking in Psittacine Birds – A

Clinician’s Approach to Diagnosis and Treatment. Proceedings of the Annual

Conference of the Association of Avian Veterinarians 265-279

RUPLEY, A.E. (1997) Manual of Avian Practice. Philadelphia, Pennsylvania, W.B.

Saunders Company. pp. 233-246

SCHMIDT, R.E. (1993) Use of Biopsies in the Differential Diagnosis of Feather Picking

and Avian Skin Disease. Proceedings of the Association of Avian Veterinarians 113-

115

TURNER, R. (1993) Trexan (Naltrexone Hydrochloride) Use in Feather Picking in Avian

Species. Proceedings of the Association of Avian Veterinarians 116-118

WORELL, A.B., & FARBER, W.L. (1993) The Use of Acupuncture in the Treatment of

Feather Picking in Psittacines. Proceedings of the Association of Avian Veterinarians

121-126