Pandora Syndrome in Cats: Diagnosis and Treatment

original article by C.A. Tony Buffington for Today's Veterinary Practice can be viewed here:           and-treatment/

paraphrased by Michele Bane for Country Care Pet Hospital client education

What is Pandora Syndrome?

The Pandora's Box of Greek mythology was a vessel which, when opened, unleashed a whole variety of horrors upon the world.  By the same token, "Pandora Syndrome" describes a phenomenon in which cats have urinary challenges, which turn out to be related to a variety of different organs and systems.  These cats have been helped by making changes to their environments.  Modification of the environment has been shown to clear up the urinary challenges as well as the other organ issues.

How do cats get Pandora Syndrome?

Pandora syndrome results from stress. Cats have a stress response system, and sometimes this system can be stuck in a loop, being triggered over and over again even in the absence of a traumatic event. When this happens, the cat  perceives a consistent threat that is beyond his control. This perception can activate the nervous, endocrine, and/or immune systems, resulting in a variety of illnesses affecting any or a combination of organs.

The stress response system can become extra sensitive after an individual is exposed to a threatening event. This can occur as early as pre-birth, but a sufficiently traumatic event could occur at any life stage.

How do I know if my cat has Pandora Syndrome?

Diagnosis of Pandora Syndrome can be tricky. Some things to look for:

  • Symptoms that come and go with environmental changes
  • Any chronic disease which might be causing stress
  • Appearance or behavior that seems extreme in relation to what the vet can see with diagnostics
  • All symptoms subside in response to environmental modification

Your veterinarian will ask you about multiple factors when diagnosing and planning treatment:

  • Life history: any adverse experiences (stray? orphaned? bottle-fed? trauma? unstable environment?)
  • Health history: does the cat have multiple problems? Are recurrences frequent? Are they associated with environmental stressors? Are they associated with fearful or anxious behavior?
  • Home environment: Does the cat have safe resting places? Ample resources? Opportunities to operate on his environment on his own terms? A choice in whether to interact with people and other animals at home? Does the cat follow people around?

How can we help my cat?

Treatment of  Pandora Syndrome isn't complicated. Ideally it takes place in the home, or somewhere the cat already feels safe. Treating in the vet clinic can increase stress, which can make the cat feel worse. However, there are even some things we can do in the hospital to reduce stress for your cat.

At Country Care Pet Hospital, the staff is aware that providing safe hiding spaces, warm bedding, access to all of their needs, and a variety of calming stimuli (low lights, low noise, visual barriers to other animals, regular schedules, and lots of attention) can all lower stress and promote healing. The CCPH staff is also trained in Low-Stress Handling, after completing Dr. Sophia Yin's Low-Stress Handling University.

Gemmy explores a safe place with a litter box water bowl and soft blanket at Country Care Pet Hospital

Gemmy explores a safe place with a litter box, water bowl and soft blanket at Country Care Pet Hospital

Country Care Pet Hospital does its best to help owners help their cats. While no cure is currently available for Pandora Syndrome, treatments and changes in the home can help alleviate many of the associated symptoms and illnesses. Our staff understand the difficulties associated with sharing space with a cat with this condition, and want to help you gain some control over the situation.

At- home treatment for Pandora Syndrome is multifaceted. First, your veterinarian will discuss any changes in diet and feeding schedule, as well as any medicines that will potentially alleviate specific symptoms. In all cases of Pandora Syndrome, however, modifications to the cat's at-home environment should be made. The idea is to give the cat a decreased perception of threat, and an increased perception of control over his surroundings. With a few changes, you can create an environment in which your cat feels safe, and also has unrestricted access to new experiences, activity, and interactions with other animals (including you!) One simple thing you can do is to extend the "1+1" rule traditionally applied to litter boxes (1 for each cat in the home, plus 1 more) to all pertinent resources, like food bowls,  water bowls, and places to rest and hide.

There are 5 main components of effective environmental modification:

  1. Space.Each cat needs a safe refuge: a cozy bed in a desirable (to the cat) location in the home and outfitted for the cat’s comfort. Try a cat carrier with soft blankets and treats inside! Cats also need opportunities to scratch (both horizontal and vertical surfaces), climb, hide, and rest, preferably in multiple locations in the home.



Deming enjoys hiding in a paper bag

Deming enjoys hiding in a paper bag


Dr. Science enjoys a high-up perch to survey his surroundings

Dr. Science enjoys a high-up perch to survey his surroundings.


Some cats enjoy scents (e.g., catnip, silver vine, Tatarian honeysuckle, and valerian [a constituent of Feliway spray.]) Other cats prefer social interaction with the owner over food, toys, and scent.


  1. Food.Cats prefer to eat alone in a safe, quiet location. Some cats prefer wet foods, possibly because of the more natural feel in their mouth; others prefer dry foods. When a diet change is appropriate, offering the new food in a separate container next to the usual food, rather than removing the usual food and replacing it with the new food or mixing foods, allows cats to express their preferences. Natural cat feeding behavior also includes predatory activities such as stalking and pouncing. These behaviors may be simulated by hiding small amounts of food around the house or by putting food into food puzzles (


  1. Litter boxes.Sometimes, cats have litter box issues even in the absence of urinary tract disease. Litter boxes should be placed in an area of the home where the cat feels safe, and be large enough for the cat to move around comfortably inside it. Giving the cat options (hooded vs. open; various kinds of litter including pine, newspaper, wheat, and clay) will allow the cat to express his preferences. Excellent recommendations for optimizing your cat's litter box experience are available from the American Association of Feline Practitioners (AAFP) ( and elsewhere.


Cinnamon Roll tries out a new litter texture

Cinnamon Roll tries out a new litter texture.


  1. Play.Many cats enjoy play interactions with their people and can be easily trained to perform certain behaviors (sit, high-five, wear a harness, etc.)  Although cats readily respond to positive reinforcement (food), they do not respond to punishment. Training sessions should happen when the cat is hungry, not right after a meal. Cats seem to like novelty, so try swapping out their toys for others to keep it interesting! Some cats prefer to chase birds, whereas others prefer to chase mice, lizards, or bugs. You can offer toys that mimic each of these. Instead of play, some cats seem to prefer to be petted and groomed.


Squeak enjoys this novel drinking station, and gets extra stimulation from the fish who lives inside

Squeak enjoys this novel drinking station, and gets extra stimulation from the fish who lives inside


  1. Conflict. When cats feel like they don't have control over their environment, some become aggressive, some become withdrawn, and some become ill. Conflict may occur between cats when multiple cats are housed indoors together and health problems are present. Conflict among cats can develop because of access to valued (or scarce) resources (e.g., food, resting areas, litter boxes, human attention,) other animals in the home, or outside cats. Providing a “house of plenty” may minimize these risks. More information about addressing conflict is available at


Conflict arises when cats don't feel a sense of control over their environment

Conflict arises when cats don't feel a sense of control over their environment

It's important to follow up with your vet once you start implementing these changes. Give us a call 1-2 days into it, and again after a couple of weeks. We can help you make small changes that might make big differences!


How do I prevent Pandora's Syndrome in my new pet?


Preventing Pandora Syndrome in the first place is, of course, the simplest way to fight it. Any cat who has experienced a traumatic event could be vulnerable to Pandora Syndrome. Proactively using environmental modification techniques to enrich your pet's life will improve your cat's health and well-being, and may minimize risk for Pandora Syndrome.