By: Iris Zhao
Alice in Wonderland Syndrome (AIWS)
What is Alice in Wonderland Syndrome (AIWS)?
Alice in Wonderland Syndrome (AIWS) is a rare, neurological condition that interferes with the brain’s ability to process sensory input. It is typically characterized by distorted visual perceptions, body schema, and experience of time, leading to distortions of an individual’s sense of reality. These individuals may undergo brief sensations and experiences of micropsia (when objects appear smaller) or macropsia (when objects appear larger). These senses are not the result of an individual’s issues with their eyes, ears, or hallucinations but it is instead due to alterations in how their brain perceives the environment. AIWS is often associated with migraines, infections, brain tumors, and epilepsy.
(Cleveland Clinic, n.d.; Hernandez, 2023; Mahbub, 2020)
History
This neurological condition, named from a famous children’s storybook, makes things look or feel larger or smaller than they actually are. In the book, “Alice’s Adventures in Wonderland” by Charles Dodgson, the main character Alice discovers situations where the sizes of objects, creatures, and even herself were distorted. Many medical experts suspected that what Dodgson wrote in the book was based on symptoms that he himself was experiencing. Some of his symptoms aligned with conditions that can also cause AIWS. Although, it was never officially uncovered whether or not he truly had AIWS. In 1955, British psychiatrist John Todd introduced the term “Alice in Wonderland syndrome” in order to help describe a set of symptoms that is associated with migraines, epilepsy, and other neuropsychiatric conditions.
(Cleveland Clinic, n.d.; Mahbub, 2020)
Causes
The exact cause of why AIWS occurs is unknown, however, many medical experts have figured out many potential conditions and circumstances that could cause it. For instance, potential causes may be due to migraines, infections, seizures, strokes, brain tumors, medications, mental health conditions, and recreational drugs (Cleveland Clinic, n.d.). Even though the pathogenesis of migraines is not fully understood, it is evident that there is a combination of both peripheral and central nervous system involvement in the cause of AIWS (Hernandez, 2023).
There is more evidence compared to other potential causes, that individuals who have seizure-related conditions (especially those with epilepsy) are more likely to experience AIWS. Specifically, temporal lobe epilepsy is a causal factor of AIWS (Stefan et al., 2014).
Signs and Symptoms
AIWS symptoms are broken down into two categories including self-perception symptoms and visual perception symptoms. Although many people can experience both types of symptoms, visual perception symptoms have been more commonly experienced by individuals with AIWS.
Self-perception symptoms may include:
- Altered body image: When you observe that the sizes of parts of your body may seem disproportionate. For instance, a part of your body may feel too big (partial macrosomatognosia) or too small (partial microsomatognosia). This may also cause your entire body to feel unusually tall (total macrosomatognosia) or unusually short (total microsomatognosia).
- Derealization: When you feel disconnected from the world and environment around you.
- Depersonalization: When you feel disconnected from your own body, thoughts or feelings. This can be described as feeling like you’re watching your own life in a third-person view.
- Feelings of being split into two: When you have this feeling as if your body’s left and right halves exist separately, but you can still feel both (also known as somatopsychic duality).
- Disruption in sense of time: When you feel that time is standing still, or that time is greatly slowed (like at a snail’s pace) or sped up (moving swiftly).
Visual perception symptoms may include:
- Changes in size and/or distance: Objects may seem to appear larger (macropsia) or smaller (micropsia) than they actually are. Objects may also seem to appear closer (pelopsia) or farther away (teleopsia) than they actually are. Sometimes, objects may also appear both smaller and moving farther away (porropsia).
- Changes in object appearance: Objects may appear distorted. For example, straight lines could look wavy or squiggly to the eye, and vertical or horizontal lines may look skewed or slanted.
- People appearing smaller than they actually are: This is known as Lilliputianism, which gets its name from the fictional, tiny residents of the island of Lilliput in the 1726 fantasy novel “Gulliver’s Travels” by Jonathan Swift. This is when you may perceive human-like or fantasy figures as being small.
It is also important to take into account that AIWS is not contagious, however, there is some evidence in which it can happen with infections that spread between people (e.g., the flu).
(Cleveland Clinic, n.d.; Stefan et al., 2014).
Diagnosis
AIWS is typically very rare and short-lived. Due to it being unusual and temporary, there is no official diagnosis of criteria for it. Therefore, there is no way to conclusively diagnose AIWS. But despite there being no definitive examination that is diagnostic of AIWS, the range of potential symptoms as discussed, is shown to be extensive.
Commonly, medical providers may try to diagnose this condition by asking questions about an individual’s perceived symptoms. They may also conduct neurological exams to check if there are potential issues with an individual’s other brain functions. In addition, they may recommend and ask for you to complete specific types of diagnostic tests in order to rule out other brain-related conditions that may also be affecting what’s causing your AIWS symptoms. For instance, imaging tests like computed tomography (CT) scans or magnetic resonance imaging (MRI) scans, will help look for structural changes or other issues in a person’s brain that may cause AIWS.
However, there is not a specific way to conclusively and effectively diagnose that an individual has AIWS.
(Cleveland Clinic, n.d.; Hernandez, 2023)
Treatment
Currently, there is no cure or treatment that is proven to be universally effective for people with AIWS. Chronic cases of AIWS specifically are untreatable and will wear out eventually. Individuals may get anxious or terrified due to the distortions and hallucinations they experience as a result of this condition however, these manifestations are not detrimental and are likely to fade after a period of time.
The most common way to treat AIWS is by treating what is specifically causing it, which is why a single treatment is not universally effective for all people with AIWS. Fortunately, there are treatment programs designed for the probable causes of the condition and are aimed at bringing about relief to the individual with AIWS. There is a vast number of potential treatments that can help alleviate AIWS based on what caused it. Your healthcare provider would be the best person to reach out to in order to get help with the recommended treatments and medications that are tailored to your specific circumstances and needs.
Very little is known among the research landscape of AIWS. Rare conditions such as AIWS are not adequately investigated which brings about critical challenges in providing accurate medical care because healthcare providers may not have enough insight regarding these conditions. As a result, it is important to encourage further research so that we can advance medical practice in this area.
(Mahbub, 2020; Stefan et al., 2014)
Conclusion
Alice in Wonderland Syndrome (AIWS) is a brain-related condition that is characterized by distorted body image and visual perception, most specifically where individuals may perceive the size of their body parts or external objects incorrectly. While the exact cause of AIWS remains unclear, it has been linked to several potential causes including migraines, temporal lobe epilepsy, brain tumors, drugs, and infections. There is still no universally proven cure or effective treatment for AIWS. Instead, current treatment approaches focus on addressing the underlying cause of AIWS pertaining to the individual in order to relieve AIWS symptoms. Further research is encouraged in order to continue adequately investigating rare conditions like AIWS so that medical practice can be advanced in these areas.
References
Cleveland Clinic. (n.d.). Alice in Wonderland Syndrome (AIWS): Symptoms & Treatment. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/24491-alice-in-wonderland-syndrome-aiws
Hernandez, J. (2023). The perplexing mental health comorbidity of Alice in wonderland syndrome (AIWS): A case study. Psychiatry International, 4(1), 30–34. https://doi.org/10.3390/psychiatryint4010005
Mahbub Hossain, M. (2020). Alice in wonderland syndrome (AIWS): A research overview. AIMS Neuroscience, 7(4), 389–400. https://doi.org/10.3934/neuroscience.2020024
Stefan M., Weissenstein, A., & Luchter, E. (2014). Alice in wonderland syndrome: A rare neurological manifestation with microscopy in a 6-year-old child. Journal of Pediatric Neurosciences, 9(3), 303. https://doi.org/10.4103/1817-1745.147612
