Alice in Wonderland syndrome

In 1955, English psychiatrist John Todd (1914-1987) described Alice in Wonderland syndrome (AIWS) as self-experienced paroxysmal body image illusions involving distortions of the size, mass, or shape of the patient's own body or its position in space, often occurring with depersonalization and derealization.

Todd named AIWS for the perceptual disorder of altered body image experienced by the protagonist in the novel Alice's Adventures in Wonderland (1865), written by Lewis Carroll (the pseudonym of Reverend Charles Lutwidge Dodgson [1832-1898]), possibly based in part on Dodgson's own migrainous experiences.

In the story, Alice followed a talking white rabbit down a rabbit hole and then experienced several dramatic changes in her own body size and shape (e.g., shrinking to 10 inches high, growing unnaturally large, and growing unnaturally tall but not any wider).

Although Todd's report was the most influential, Lippman provided an earlier description in 1952. In Lippman's article, one of the patients reported feeling short and wide as she walked, and referenced Alice's Adventures in Wonderland in regard to her body image illusions, referring to them as a "Tweedledum" or "Tweedledee" feeling.

For the AIWS sufferer, the eye components are entirely physically normal. The AIWS involves a change in perception as opposed to a malfunction of the eyes themselves. The hallmark sign of AIWS is a migraine, and AIWS may in part be caused by the migraine. AIWS affects the sufferer's sense of vision, sensation, touch, and hearing, as well as one's own body image.

A prominent and often disturbing symptom is that of altered body image: the sufferer may find that he or she is confused as to the size and shape of parts of (or all of) his/her body. Alice in Wonderland syndrome involves perceptual distortions of the size or shape of objects. Other possible causes and/or signs of association with the syndrome are migraines, use of hallucinogenic drugs, and infectious mononucleosis.

Also, patients with certain neurological diseases have experienced similar visual hallucinations. These hallucinations are called "Lilliputian," which means that objects appear either smaller or larger than they actually are.

Patients may experience either micropsia or macropsia. Micropsia is an abnormal visual condition, usually occurring in the context of visual hallucination, in which affected persons see objects as being smaller than those objects actually are. Macropsia is a condition where the individual sees everything larger than it actually is.

One theory is that patients with Alice in Wonderland syndrome were associated with infectious mononucleosis. Neuroimaging studies have not revealed any link, and the relationship (if any) between the syndrome and mononucleosis remains unknown. One 17-year-old male described his odd symptoms. He said, "quite suddenly objects appear small and distant (teliopsia) or large and close (peliopsia). I feel as I am getting shorter and smaller "shrinking" and also the size of persons are not longer than my index finger (a lilliputian proportion). Sometimes I see the blind in the window or the television getting up and down, or my leg or arm is swinging. I may hear the voices of people quite loud and close or faint and far. Occasionally, I experience attacks of migrainous headache associated with eye redness, flashes of lights and a feeling of giddiness. I am always conscious to the intangible changes in myself and my environment."

The eyes themselves are normal, but the sufferer 'sees' objects with the wrong size or shape or finds that perspective is incorrect. This can mean that people, cars, buildings, etc., look smaller or larger than they should be, or that distances look incorrect; for example a corridor may appear to be very long, or the ground may appear too close.

The sufferer may also lose a sense of time, a problem similar to the lack of spatial perspective. That is, time seems to pass very slowly, akin to an LSD experience. The lack of time, and space, perspective leads to a distorted sense of velocity. For example, one could be inching along ever so slowly in reality, yet it would seem as if one were sprinting uncontrollably along a moving walkway, leading to severe, overwhelming disorientation. This can then cause the sufferer to feel as if movement, even within his or her own home, is futile.

In addition, some people may, in conjunction with a high fever, experience more intense and overt hallucinations, seeing things that are not there and misinterpreting events and situations.

Other minor or less common symptoms may include loss of limb control and general dis-coordination, memory loss, lingering touch and sound sensations, and emotional experiences.

Treatment is the same as that for other migraine prophylaxis: anticonvulsants, antidepressants, beta blockers, and calcium channel blockers. Chronic Alice In Wonderland Syndrome is untreatable and must wear itself out. Rest is the prime treatment, but another effective therapy is to join support groups to share experiences.