Inappropriate elimination or behavioral periuria/perichezia is likely the most reported feline behavioral problem worldwide. A change in behavior is often one of the early signs of physical disease and in addition can aggravate an existing behavioral response. An initial determination of causation is essential; is it medical or behavioral, or a combination of both? Stress activates both the sympathetic adrenomedullary system for short-term responses and the hypothalamic pituitary adrenal axis for long-term responses. Once medical problems have been treated or ruled out, attention should shift to minimizing and using various therapeutic options to help improve and/or resolve undesirable elimination problems.