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What is Alice in Wonderland Syndrome

About Alice in Wonderland Syndrome

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Alice in Wonderland Syndrome is a rare disorder that can involve a variety of distressing perceptual abnormalities. The name of the disorder may make it sound dream-like or even fun – but the actual experience is far from pleasurable.

What Exactly Is Alice in Wonderland Syndrome?

Alice in Wonderland Syndrome (AIWS) is a neurological condition that temporarily disrupts a person’s ability to perceive themselves, their surroundings, and the passage of time. It is sometimes also referred to as dysmetropsia and Todd’s syndrome.

The first two experts to describe these symptoms were American neurologist Caro Lippman in 1952 and British psychiatrist John Todd, MD, in 1955. 

The condition earned its name after Lippman and Todd noticed that the altered perceptions it causes are similar to what Lewis Carroll’s fictional character, Alice, experiences in the novels Alice in Wonderland and Through the Looking Glass. For example, at various times in the novels, Alice grows to an extraordinarily large size, shrinks to the size of a caterpillar, and finds herself in situations where time seems to either stand still or run backwards.

Alice in Wonderland Syndrome is so rare that researchers have not been able to definitively establish how many people have developed it. In 2015, a PubMed search of literature dating back to 1955 found 70 articles on the disorder with references to a total of 169 patients.

Common causes of Alice in Wonderland Syndrome include:

  • Migraine
  • Temporal lobe epilepsy
  • Brain tumors
  • Psychoactive drugs
  • Infection with Epstein-Barr virus (EBV)

The disorder is more common among younger people, but it can affect individuals of all ages. The researchers who conducted the 2015 PubMed study noted that the dominant risk factors for this condition may change as people age:

  • Among children who developed Alice in Wonderland Syndrome, the most common cause seems to be encephalitis (an inflammation of brain tissue) that results from EBV infection.
  • Among adults and seniors who had AIWS, migraine and other neurological conditions were the most frequently identified causes.

Symptoms of Alice in Wonderland Syndrome

Disrupted perception can be symptomatic of schizophrenia, schizoaffective disorder, and other psychotic disorders. Among people who have these types of disorders, altered perceptions often involve hallucinations and delusions.

Symptoms of Alice in Wonderland Syndrome differ from psychotic disorders in several ways, such as:

  • Symptoms of AIWS occur most often among children and adolescents, while schizophrenia and related conditions typically affect adults.
  • The symptoms of Alice in Wonderland Syndrome don’t include delusions, disorganized speech, grossly disorganized behaviors, or negative symptoms, all of which are associated with schizophrenia and other psychotic conditions.
  • The hallucinatory aspects of AIWS involve altered perceptions of existing people, animals, or objects – but they don’t usually involve seeing things (such as people or light patterns) that don’t actually exist.
  • As noted in the previous section, experts believe that the symptoms of AIWS are most often caused by medical or neurological abnormalities, not psychiatric concerns.

When someone develops AIWS symptoms, here are a few examples of what they may experience:

  • Migraine is one of the most common symptoms of Alice in Wonderland Syndrome. This experience can include severe headache, nausea, vomiting, and auras, which are blind spots, light flashes, or other visual disturbances that typically precede the other symptoms.
  • Items in their field of vision, including people, animals, and inanimate objects, may appear much larger or much smaller than they really are. These sensations can cause the individual to feel as though they have either grown or shrunk significantly. Perceiving things as larger than they are is referred to by clinicians as macropsia, while the opposite effect is known as micropsia.
  • Their body or certain body parts – often their head or their hands – may appear to be too large (a phenomenon known as macrosomatognosia) or too small (microsomatognosia).
  • People, animals, or objects may look like they are much farther away (telopsia) or much closer (pelopsia) than they really are. 
  • The faces of other people may seem to be distorted. One person who experienced this symptom, which is known as prosopometamorphopsia, described the distortions as giving people a “demonic” appearance. 
  • They may perceive voices or other sounds as being much louder or quieter than they actually are.
  • They may feel like time is passing either much faster or much slower than it normally does.

Sometimes, these symptoms arise and dissipate within a matter of minutes. At other times, they may endure for hours or longer. 

Problems for Those With This Syndrome

The symptoms of Alice in Wonderland Syndrome can understandably be sources of considerable distress. When a person is in the midst of an episode, it can extremely difficult for them to work, attend school, or simply interact with other people.

Until a person receives an accurate diagnosis, their AIWS symptoms may cause them to fear that they are “losing their mind,” going through a psychotic episode, or displaying evidence of brain damage. 

For young people, there is also the possibility that their descriptions of AIWS symptoms may initially be discounted as merely the results of an overactive imagination. This can delay treatment and contribute to distrust between the child or adolescent and their parents or other caregivers.

Is There Treatment for Alice in Wonderland Syndrome?

There is no treatment that is specifically designed to address Alice in Wonderland Syndrome. Instead, treatment for this condition typically focuses on the cause of the symptoms that the individual is experiencing. 

For example, if a person’s AIWS symptoms are related to a brain infection or tumor, treatment to heal the infection or remove the tumor should result in an elimination of the symptoms. 

If someone develops these symptoms after taking certain medications or abusing certain substances, the best course of care would likely involve adjusting their medication regimen or helping them end their recreational drug use.

Though AIWS symptoms are usually associated with a medical issue or neurological disorder, people who have schizophrenia or some other mental health conditions may develop similar symptoms. If a person’s assessment rules out a medical or neurological cause, a mental health evaluation may be necessary. 

In cases where a person’s AIWS symptoms are associated with schizophrenia, schizoaffective disorder, or another mental illness, appropriate treatment may involve medication, therapy, or a combination of the two.

Contact Montare Behavioral Health Today

If you have been experiencing symptoms of Alice in Wonderland Syndrome that are related to a mental health disorder, Montare Behavioral Health is here to help. 

Our network of mental health treatment facilities offers personalized inpatient and outpatient programming at several convenient locations in Southern California. We will work closely with you to identify the full scope of your needs and help you set appropriate short- and long-term goals. Then, we’ll select the therapies and support services that can help you achieve improved health and a more hopeful future.

To lean more about how we can help you or a loved one, or to schedule a free assessment, please visit our Admissions page or call us today.