What is Alice in Wonderland Syndrome?

Many are awed by Lewis Carroll’s display of creative imagination in the fantastical tale “Alice’s Adventures in Wonderland.” The adventurous young girl, Alice, experiences peculiar physical transformations with mysterious drinks and cake, making her grow and shrink within seconds. Imagine if you were to experience the same, that too, in the absence of magical potions. It seems unreal, yet some do report similar distorted experiences–a condition famous as Alice in Wonderland Syndrome (AIWS). Let us understand the syndrome by exploring the associated symptoms, possible causes and treatment options. 

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Understanding Alice in Wonderland Syndrome 

AIWS is a rare disorder characterised by perceptual disturbances of body image, time and vision. It is also called Todd’s syndrome after the British psychiatrist John Todd who was the first to describe the associated symptoms using anecdotal evidence. The symptoms affect multiple senses. People experiencing the syndrome often report losing the sense of time, feeling smaller or larger than they actually are and difficulty perceiving the location of objects. A patient seemed puzzled about putting on a hat because one side of their head was bigger than the other! 

AIWS is common among children and young adults with the likelihood of developing the syndrome decreasing with increasing age. Since 1955, around two hundred AIWS cases have been documented, highlighting how rare the syndrome is. 

Symptoms of Alice in Wonderland Syndrome 

AIWS episodes often last a few minutes, rarely stretching to thirty minutes. Around 9% of cases involve distorted self-perception, wherein individuals perceive their body size incorrectly and experience a disturbed sense of reality and time. Disturbed visual processing is reported in 75% of AIWS cases. Some of the common symptoms are: 

• Self-perception Symptoms: These include a distorted perception of body size, with the body feeling unusually small (microsomatognosia) or large (macrosomatognosia). Individuals may also feel disconnected from themselves (depersonalisation) and their surrounding environment (derealisation). Some experience somatopsychic duality wherein they feel that their body exists in two separate halves, right and left. People also report a disturbed sense of time–either slowing down, speeding up or coming to a halt. Some also report the illusion of levitation, feeling like they are floating in the air. 
• Visual processing Symptoms: These include a distorted sense of both object size and distance. Micropsia means objects seem unusually smaller, and macropsia means objects seem unusually larger. Individuals also report pelopsia, wherein objects appear unusually closer, and teleopsia, appear falsely farther away. At times, disturbances in time and distance occur simultaneously such that objects appear to be moving farther away, becoming smaller (photopsia). In Lilliputian distortions, people perceive others as much smaller than their actual size. Other perceptual disturbances are associated with object appearance, such as perceiving straight lines as wavy.

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Possible Causes of Alice in Wonderland Syndrome 

Medical experts are still trying to figure out the aetiology of AIWS and are working towards unravelling the medical enigma. It is proposed that abnormal brain activity, resulting from diverse causes, disrupts blood flow to the brain areas responsible for perceptual processes. Among adults, the leading cause of AIWS is migraine, and among children, infection is the primary risk factor. Some of the causes of disturbing brain activity are: 

• Genetic predisposition: Individuals with a family history of AIWS and migraines are at an increased risk of developing the syndrome. 
• Infections: Infections like encephalitis caused by the Epstein-Barr virus, typhoid and swine flu can cause AIWS, especially among children. 
• Migraines and other headaches: AIWS is most commonly associated with migraine aura–the period before the headache begins. It is also associated with other types of headaches, such as abdominal migraine. 
• Specific drugs and medications: AIWS also results from consuming drugs such as hallucinogens and cough medications. These drugs have the potential to alter one’s perception of reality, whereas these medications include AIWS symptoms are side effects. 
• Other causes: Medical conditions such as epilepsy, brain tumours, and stroke and psychiatric disorders such as schizophrenia that affect brain activity may result in AIWS. Neurodegenerative conditions involving cognitive decline, like Creutzfeldt-Jakob Disease, are also linked to AIWS. At times, excessive stress may also cause the syndrome. 

Diagnosis of Alice in Wonderland Syndrome 

The rare AIWS is often underdiagnosed with no epidemiological studies conducted to provide statistics about the overall prevalence. Also, medical experts find it difficult to study AIWS because the symptoms are temporary and are present for short durations. Further, there is no agreed method or criteria for diagnosing the syndrome, resulting in a reluctance to seek medical care. 

Usually, doctors perform tests such as MRI and EEG scans to identify the underlying cause of AIWS symptoms and to rule out other possible diagnoses, such as psychiatric disorders and brain lesions. For instance, blood tests indicate the presence of specific infections producing the symptoms. 

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Treatment of Alice in Wonderland Syndrome 

The cause of AIWS determines treatment options. For instance, if migraine is identified as the possible cause, it is recommended to maintain a tailored diet free from food items that trigger migraine, such as chocolate and alcohol. Medications like antiepileptics and antivirals are prescribed if AIWS is caused by epilepsy and brain infection, respectively. Similarly, if stress is the underlying cause, practising meditation can help deal with the symptoms. 

While AIWS symptoms are usually temporary, consulting medical professionals is essential to rule out any serious underlying health conditions such as stroke and brain infection. Health check-ups are an effective means to prevent worsening health and get the required medical care. On the brighter side, AWIS does not lead to further complications. 

AIWS, alone, is not dangerous but the underlying conditions may signal emergencies. Managing the underlying condition by incorporating the necessary lifestyle changes reduces AIWS symptoms. The rare perceptual disorder is mostly a short-lived concern for the few of us who encounter it. 

FAQs 

What is Alice in World Syndrome? 

AIWS is a rare disorder characterised by perceptual disturbances of body image, time and vision. It is also called Todd’s syndrome after the British psychiatrist John Todd who was the first to describe the associated symptoms using anecdotal evidence. The symptoms affect multiple senses. People experiencing the syndrome often report losing the sense of time, feeling smaller or larger than they actually are and difficulty perceiving the location of objects. 

What are the symptoms? 

AIWS episodes usually last a few minutes, rarely extending to half an hour. Around 9% of cases involve distorted self-perception, wherein individuals perceive their body size incorrectly and experience a disturbed sense of reality and time. Around 75% of cases include disturbed visual processing. 

How common is AISW? 

AIWS is common among children and young adults with the likelihood of developing the syndrome decreasing with increasing age. Medical literature consists of around 200 documented cases since 1955, highlighting the rarity of the syndrome. 

What leads to AISW? 

Medical experts are still trying to figure out the aetiology of AIWS and are working towards unravelling the medical enigma. It is proposed that abnormal brain activity, resulting from diverse causes, disrupts blood flow to the brain areas responsible for perceptual processes. Among adults, the leading cause of AIWS is migraine, and among children, infection is the primary risk factor. 

How AISW symptoms are treated? 

The cause of AIWS determines treatment options. For instance, if migraine is identified as the possible cause, it is recommended to maintain a tailored diet free from food items that trigger migraine, such as chocolate and alcohol. Managing the underlying condition by incorporating the necessary lifestyle changes reduces AIWS symptoms.