Alice in Wonderland Syndrome

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Alice in Wonderland syndrome (AIWS) is a form of sensory disturbance. The most common symptoms are micropsia and macropsia, which causes objects to appear much smaller or larger than they truly are. For example, a chair may appear half of its typical size. However, AIWS can distort one’s sense of touch or hearing as well.

Alice in Wonderland syndrome is named after Lewis Carroll’s book Alice’s Adventures in Wonderland. In the story, the protagonist shrinks down to the size of a mouse, then later on grows larger than a house. Some researchers have hypothesized that Lewis Carroll himself may have had AIWS.

Symptoms of Alice in Wonderland Syndrome

Alice in Wonderland syndrome causes temporary distortions in perception. Most episodes only last a few minutes. Although the symptoms may feel disorienting or confusing, they are generally harmless.

There are 58 recognized symptoms of AIWS, although most only appear in a handful of cases. Some of the most common symptoms are:

  • Micropsia: Objects appear much smaller than they really are.
  • Macropsia: Objects appear much larger than they are in real life.
  • Teleopsia: Objects seem further away than they are.
  • Pelopsia: Objects seem closer than they are.
  • Dysmorphopsia: Straight lines or edges appear to be wavy.
  • Macrosomatognosia: A person’s own body feels much larger than it is. (Microsomatognosia is when one’s body feels smaller.)
  • Quick-motion phenomenon: Time seems to go much quicker than it really is, as if the surrounding world is on fast-forward. This could manifest as objects appearing to rush around or as voices talking too quickly.

Alice in Wonderland syndrome is not a sign of psychosis. Unlike a hallucination, which often causes people to see things which aren’t there, AIWS causes people to see a skewed version of their present environment. The affected individual generally knows that what they are seeing is strange or unreal. AIWS is a neurological issue, not a mental health diagnosis.

What Causes Alice in Wonderland Syndrome?

There are many factors that can cause Alice in Wonderland syndrome.

  • Migraines: A 2016 literature review estimates 27% of AIWS cases co-occur with migraines. Some researchers theorize that AIWS is a rare type of migraine aura, which is a sensory warning of an oncoming migraine.
  • Infection: Around 23% of AIWS cases seem to be caused by infections, the most common being the Epstein-Barr virus. Infections can cause parts of the brain to swell, which affects cognitive functioning.
  • Head Trauma: Injuries to the brain cause 8% of AIWS cases. When damage occurs in the parts of the brain that combine and interpret sensory information, a person can get distorted vision or have trouble sensing their own body.
  • Epilepsy: Around 3% of AIWS cases may be caused by epilepsy.
  • Medications or drugs: Certain medicines, especially cough medicines, may cause AIWS symptoms. Hallucinogenic drugs have also been implicated in some cases.

Around one in five cases of AIWS have no obvious cause.

Most cases of Alice in Wonderland syndrome (65%) occur in children. The mean age of onset is 8 and a half years. Most individuals grow out of the syndrome with age. Around one-third of cases have persistent symptoms, and these cases often co-occur with migraines.

Alice in Wonderland Syndrome Treatment

There has not been much research on Alice in Wonderland syndrome. Since the symptoms aren’t dangerous and only last a few minutes, many cases go unreported. It is exceedingly rare for researchers to be able to observe AIWS symptoms as they occur.

There is no test to diagnose Alice in Wonderland syndrome. Instead, clinicians will work backwards, ruling out other potential causes of the symptoms. For example, a doctor may order blood tests done in order to diagnose any viruses in the person’s body. MRI scans may be used to examine the brain.

Treatment for Alice in Wonderland syndrome usually addresses the underlying causes. For example, if a person’s symptoms are caused by migraines, anti-migraine medication can help reduce symptoms. When stress exacerbates AIWS symptoms, meditation and relaxation techniques can help individuals cope. However, most cases of Alice in Wonderland syndrome will disappear with time.

References:

  1. Blom, J.D. (2010). A dictionary of hallucinations. New York, NY: Springer.
  2. Blom, J. D. (2016) Alice in Wonderland syndrome: A systematic review. Neurology Clinical Practice, 6(3), 259-270. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4909520
  3. Liu, G., Liu, A. Liu, J., & Liu G. (2014, April 29). Alice in Wonderland syndrome: Presenting and follow-up characteristics (S19.003). Neurology. Retrieved from https://n.neurology.org/content/82/10_Supplement/S19.003
  4. Mastria, G., Mancini, V., Vigano, A., & Di Piero, V. (2016). BioMed Research International. Retrieved from https://doi.org/10.1155/2016/8243145
  5. Stapinski, H. (2014, June 23). I had Alice in Wonderland Syndrome. The New York Times. Retrieved from https://well.blogs.nytimes.com/2014/06/23/alice-in-wonderland-syndrome
  6. What is Alice in Wonderland syndrome (AWS)? (n.d.). Healthline. Retrieved from https://www.healthline.com/health/alice-in-wonderland-syndrome

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