Alice in Wonderland Syndrome (Guide)

Alice in Wonderland Syndrome

Alice in Wonderland syndrome is a condition in which person’s perception become distorted an disoriented. The person also faced visual, auditory, touch hallucinations.

Background

Alice in Wonderland syndrome (AWS) is a rare neurological disorder characterized by distortions of visual perception (metamorphopsias), the body image, and the experience of time. As noted as early as 1955 by John Todd, these symptoms may be accompanied by derealization and depersonalization.Patients suffering from AWS may end up consulting a neurologist or a psychiatrist, although in both specialties it is not as well-known as it deserves to be. This is at least partly due to the fact that major classifications such as the Diagnostic and Statistical Manual of Mental Disorders do not list it as a diagnostic category, while others, such as the International Classification of Diseases pay only limited attention to it. Another reason may be the relatively small number of published cases. A review of the extant literature, published in 2016, indicated that only 169 cases of AWS had been described since the syndrome’s conceptualization in 1955, which boils down to a mean number of 1.1 cases per year. Although this number has been rising steadily over the past few years, it currently lies around 180. Of note, these are all cases in need of medical attention, i.e., what we call “clinical cases.” Meanwhile, large-scale population studies indicate that symptoms of AWS are experienced quite frequently in the general population, with lifetime prevalence rates of up to 30% (5–7). Since the latter cases are typically fleeting and transient in nature, and seldom entail help-seeking behavior, they are referred to as “nonclinical cases.” Of the clinical cases, some 85% show involvement of only a single sensory modality.

What is Alice in Wonderland Syndrome?

Alice in Wonderland syndrome (AWS) is a rare condition Trusted Source that causes temporary episodes of distorted perception and disorientation. You may feel larger or smaller than you actually are. You may also find that the room you’re in  or the surrounding furniture seems to shift and feel further away or closer than it really is.

These episodes aren’t the result of a problem with your eyes or a hallucination. They’re caused by changes in how your brain perceives the environment you’re in and how your body looks.

This syndrome can affect multiple senses, including vision, touch, and hearing. You may also lose a sense of time. Time may seem to pass faster or slower than you think.

AWS primarily affects Trusted Source children and young adults. Most people grow out the disordered perceptions as they age, but it’s still possible to experience this in adulthood.

AWS is also known as Todd’s syndrome. That’s because it was first identified in the 1950s by Dr. John Todd, a British psychiatrist. He noted that the symptoms and recorded anecdotes of this syndrome closely resembled episodes that the character Alice Liddell experienced in Lewis Carroll’s novel “Alice’s Adventures in Wonderland.”

Symptoms of the Alice in Wonderland Syndrome

Image result for alice in wonderland syndrome

AWS episodes are different for each person. What you experience may vary from one episode to the next as well. A typical episode lasts a few minutes. Some can last up to half an hour.

During that time, you may experience one or more of these common Trusted Source symptoms:

Migraine

People who experience AWS are more likely to experience migraines. Some researchers and doctors believe AWS is actually an aura. This is an early sensory indication of a migraine. Others believe AWS may be a rare subtype of migraine.

Size distortion

Micropsia is the sensation that your body or objects around you are growing smaller. Macropsia is the sensation that your body or objects around you are growing larger. Both are common experiences during an episode of AWS. 

Image result for alice in wonderland syndrome

Perceptual distortion

If you feel that objects near you are growing larger or that they’re closer to you than they really are, you’re experiencing pelopsia. The opposite of that is teleopsia. It’s the sensation that objects are getting smaller or farther away from you than they really are.

Time distortion

Some people with AWS lose their sense of time. They may feel time is moving faster or slower than it really is.

Sound distortion

Every sound, even typically quiet sounds, seems loud and intrusive.

Loss of limb control or loss of coordination

This symptom occurs when muscles feel as if they’re acting involuntarily. In other words, you may feel as though you’re not controlling your limbs. Likewise, the altered sense of reality can affect how you move or walk. You may feel uncoordinated or have difficulty moving about as you normally would.

https://eyewiki.aao.org/w/images/1/e/e8/Alice_1.jpg

Some other symptoms are as follows:

  1. Metamorphopsia – visual distortions
  2. Macropsia – seeing images larger than normal
  3. Micropsia – seeing images smaller than normal
  4. Achromatopsia – inability to perceive colour
  5. Teleopsia – seeing farther than normal
  6. Pelopsia – seeing closer than normal
  7. Visual hallucinations
  8. Partial/total body macro/micro-matognosia
  9. Quick-motion phenomenon
  10. Dysmorphopsia – lines and contours appearing wavy
  11. Feeling of derealisation, depersonalization, somatopsychic duality
  12. Alteration in judgement of time

Distortion of self-image as shown in the book “Alice in wonderland”

Micropsia and Telopsia are the most common symptoms.

Proposed classification of symptoms in AWS:

TypesObligatory symptomsFacultative symptoms
AAschematia:partial or total macrosomatognosia or microsomatognosia; paraschematiaDerealization, depersonalization, somatopsychicduality, aberration in judgement of time
BMacro- and micropsia and/or tele- and pelopsia.When micropsia and telopsia appear at the same time and for the same object:porropsia

Lilliputianism (people appearing smaller)

CType A + type B symptoms

Causes

It’s not clear what causes AWS, but doctors are trying to better understand it. They do know that AWS isn’t a problem with your eyes, a hallucination, or a mental or neurological illness.

Researchers believe unusual electrical activity in the brain causes abnormal blood flow to the parts of the brain that process your environment and experience visual perception. This unusual electrical activity may be the result of several causes.

One study found that 33 percent of people who experienced AWS had infections. Both head trauma and migraines were tied to 6 percent of AWS episodes. But more than half of AWS cases had no known cause.

Although more research is needed, migraine is considered the leading cause for AWS in adults. Infection is considered the primary cause for AWS in children.

Other possible causes include:

  • stress
  • cough medicine
  • use of hallucinogenic drugs
  • epilepsy
  • stroke
  • brain tumor

 Associated conditions or other risk factors

Several conditions are linked to AWS. The following may increase your risk for it:

  • Migraines. AWS may be a type of aura, or a sensory warning of a coming migraine. Some doctors also believe AWS may be a subtype of migraines.
  • Infections. AWS episodes may be an early symptom of the Epstein-Bar virus (EBV).This virus can cause infectious mononucleosis, or mono.
  • Genetics. If you have a family history of migraines and AWS, you may have a higher risk for experiencing this rare condition.

Diagnosis

If you’re experiencing symptoms like the ones described for AWS, make an appointment with your doctor. You and your doctor can review your symptoms and any related concerns.

There isn’t any one test that can help diagnose AWS. Your doctor may be able to make a diagnosis by ruling out other possible causes or explanations for your symptoms.

To do this, your doctor may perform:

  • MRI scan. An MRI can produce highly detailed images of your organs and tissues, including the brain.
  • Electroencephalography (EEG). An EEG can measure the electrical activity of the brain.
  • Blood tests. Your doctor can rule out or diagnose viruses or infections that could be causing AWS symptoms, such as EBV.

AWS may be underdiagnosed. This is because the episodes — which often last only a few seconds or minutes — may not rise to a level of concern for people experiencing them. This is especially true with young children.

The fleeting nature of the episodes can also make it difficult for doctors to study AWS and better understand its effects.

Clinical diagnosis:

Diagnostic criteria for migraine associated with AWS

  1. One or more episodes of self-experienced body schema illusion or metamorphopsia
  2. Duration < 30 min
  3. Accompanied by headache or a history of migraine
  4. RMI, CSF, and EEG all normal (visual evoked potentials may be abnormal)

Lanska and Lanska proposed that Alice in wonderland syndrome can be divided into Pure Alice in wonderland(Inter-personal) and Alice in wonderland like syndrome(Extra-personal), latter being more common.

 Treatment

There’s no treatment for AWS. If you or your child experiences symptoms, the best way to handle them is to rest and wait for them to pass. It’s also important to reassure yourself or your loved one that the symptoms aren’t harmful.

Treating what you and your doctor suspect is the underlying cause for AWS episodes may help prevent an episode. For example, if you experience migraines, treating them may prevent future episodes.

Likewise, treating an infection could help stop the symptoms.

If you and your doctor suspect stress plays a role, you may find that meditation and relaxation can help reduce symptoms.

Can Alice in Wonderland Syndrome lead to complications?

AWS often gets better over time. It rarely causes any complications or problems.

Although this syndrome isn’t predictive of migraines, you’re more likely to develop them if you have these episodes. According to one study, a third of people without a history of migraine headaches developed them after experiencing AWS. Outlook:

While the symptoms can be disorienting, they aren’t harmful. They’re also not a sign of a more serious problem.

AWS episodes can happen several times a day for several days in a row, and then you may not experience symptoms for several weeks or months.

You’ll likely experience fewer symptoms over time. The syndrome may disappear entirely as you reach early adulthood.

FAQs: Alice in Wonderland Syndrome

What is AWS?

Alice in Wonderland syndrome (AWS) is a rare condition Trusted Source that causes temporary episodes of distorted perception and disorientation. You may feel larger or smaller than you actually are. You may also find that the room you’re in or the surrounding furniture seems to shift and feel further away or closer than it really is.

What causes AWS?

It’s not clear what causes AWS, but doctors are trying to better understand it. They do know that AWS isn’t a problem with your eyes, a hallucination, or a mental or neurological illness.

Some possible causes include:

  • stress
  • cough medicine
  • use of hallucinogenic drugs
  • epilepsy
  • stroke
  • brain tumor

Are there associated conditions or other risk factors?

Several conditions are linked to AWS. The following may increase your risk for it:

  • Migraines. AWS may be a type of aura, or a sensory warning of a coming migraine. Some doctors also believe AWS may be a subtype of migraines.
  • Infections. AWS episodes may be an early symptom of the Epstein-Bar virus (EBV). This virus can cause infectious mononucleosis, or mono.
  • Genetics. If you have a family history of migraines and AWS, you may have a higher risk for experiencing this rare condition.

How is AWS diagnosed?

If you’re experiencing symptoms like the ones described for AWS, make an appointment with your doctor. You and your doctor can review your symptoms and any related concerns.

To do this, your doctor may perform:

  • MRI scan. An MRI can produce highly detailed images of your organs and tissues, including the brain.
  • Electroencephalography (EEG). An EEG can measure the electrical activity of the brain.
  • Blood tests. Your doctor can rule out or diagnose viruses or infections that could be causing AWS symptoms, such as EBV.
  1. What treatment options are available?

There’s no treatment for AWS. If you or your child experiences symptoms, the best way to handle them is to rest and wait for them to pass. It’s also important to reassure yourself or your loved one that the symptoms aren’t harmful.

Treating what you and your doctor suspect is the underlying cause for AWS episodes may help prevent an episode. 

Can AWS lead to complications?

AWS often gets better over time. It rarely causes any complications or problems.

Although this syndrome isn’t predictive of migraines, you’re more likely to develop them if you have these episodes.

  1. What’s the outlook?

While the symptoms can be disorienting, they aren’t harmful. They’re also not a sign of a more serious problem.

AWS episodes can happen several times a day for several days in a row, and then you may not experience symptoms for several weeks or months.

You’ll likely experience fewer symptoms over time. The syndrome may disappear entirely as you reach early adulthood.

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Alice in Wonderland Syndrome (Guide)

Juanita Agboola

Juanita Agboola is the editor in chief of HFNE and an expert in mental health online. She has been writing about online behaviour, mental health and psychology issues since 2012. All Guides are reviewed by our editorial team which constitutes various clinical psychologists, PhD and PsyD colleagues.