Alice in Wonderland Syndrome (AWS) is a rare condition that causes temporary episodes of distorted perception and disorientation. This syndrome is characterized by the person having a disrupted perception of their own body or the surroundings or both, making things look smaller or larger than they really are.1
AWS is also called Todd’s syndrome named after Dr. John Todd, who first discovered it and named it so because of the similarities between the episodes and the character of Alice from the famous novel Alice’s Adventures in Wonderland.1
MedBound Times reached out to Dr Shruti Agnihotri, MD Psychiatry, who is an Assistant Professor in Psychiatry at Gandhi Medical College, Secunderabad, Telangana, and also a Consultant Psychiatrist at Asha Hospital, Hyderabad, Telangana. She gave us her insights on Alice in Wonderland Syndrome (AWS). Dr. Shruti shared that it is commonly observed in children and adults, characterized by disturbances in how people perceive the world and leading to the illusory changes in the size, distance, or position of stationary objects in the subject's visual field; and illusory alterations in the sense of the passage of time.
For example, objects moving in slow-motion or speedy, body parts shrinking or swelling.Dr. Shruti Agnihotri, MD Psychiatry, Telangana
Symptoms and experiences
Symptoms that include visual perception are more common, than the symptoms of self-perception.2
Visual perception signs include:
Changes in size
Objects may appear larger or smaller than they actually are.
Changes in Distance
Objects appear closer or farther than they actually are.
Both size and distance
Changes in the object's appearance
The objects can appear distorted.
An alteration of visual perception is found in the way that the sizes of body parts or the sizes of external objects are perceived incorrectly. The most common perceptions are at night.4
Self-perception symptoms include
Derealization
This is a form of disassociation where the person feels disconnected from the world
Depersonalization
This type of disconnection makes the person feel disconnected from his own self, body, thoughts, and feelings. Some describe it as though watching yourself from a third person’s point of view.
Feeling of being split into two
The feeling of existing as two parts and where the person feels the right and left halves of their bodies are existing separately
Disruption in the sense of time
The ability to judge the time that has passed is also disrupted, either their time is slowed down or sped up
Causes of Alice in Wonderland Syndrome2
Interestingly, This syndrome doesn’t involve the eyes of the person nor are they hallucinating. Alice in Wonderland Syndrome(AWS) seems to disrupt the brain's ability to monitor your body for potential problems and changes.
Though the exact cause is unknown, it is speculated that the following underlying issues could be the reason for developing Alice in Wonderland Syndrome(AWS)
Migraines
The most common cause of AWS is migraine and it occurs along with a migraine aura.
Infections
One among the most common causes of AWS is infections like Epstein Barr virus (EBV0, type A or H1N1 influenza, varicella, typhoid fever, Lyme disease and scarlet fever.
Seizure
most commonly associated is epilepsy.
Medications
Drugs like dextromethorphan, montelukast which is used in asthma, and anti-seizure medications like topiramate can lead to AWS.
Recreational drugs like LSD
Brain tumors
This syndrome is more common in young children, and in those with the above-mentioned underlying conditions.
The exact causes of Alice in Wonderland syndrome remain shrouded in mystery. However, there are wide range of conditions that can be considered as causal factors including depression, schizophrenia, temporal lobe epilepsy, migraines, and, viral infections.Dr. Shruti Agnihotri, MD Psychiatry, Telangana
Lewis Carol, the writer of Alice’s Adventures in Wonderland, was possibly influenced by his own experience of migraine in writing the book. As in the story, Alice finds a bottle labeled "Drink Me" after which she shrinks to less than a foot tall. Immediately after she consumes a cake that causes her to grow very tall. 3
Diagnosis
The diagnosis of AWS is based on clinical evaluation as unfortunately there is no criteria for diagnosis and since the episodes of the syndrome are short-lived, however, your doctor may perform an MRI scan, EEG, and blood tests. 2
Dr Shruti Agnihotri shared that in children, the diagnosis is difficult as they may struggle to describe their unusual symptoms, and adults may be reluctant to describe their symptoms out of fear of being labeled with a psychiatric disorder, which can contribute to the difficulty in diagnosing Alice in Wonderland syndrome. she added that, Given the wide variety of metamorphopsias and other distortions, it is not uncommon for Alice in Wonderland syndrome to be misdiagnosed or confused with other etiologies.
Treatment
There is no treatment for AWS and the main aim of treatment is to manage or reduce the underlying cause.1
Given the wide variety of metamorphopsias and other distortions, it is not uncommon for Alice in Wonderland syndrome to be misdiagnosed or confused with other etiologies.Dr. Shruti Agnihotri, MD Psychiatry, Telangana
Alice in Wonderland Syndrome (AWS), or Todd's syndrome, causes temporary episodes of distorted perception where individuals perceive body parts and external objects as larger or smaller than reality. Associated with migraines, infections, seizures, medications, and brain tumors, AWS primarily affects children. Diagnosis involves clinical evaluation and exclusion of other conditions through tests like MRI and EEG. Currently, management focuses on addressing underlying causes due to the absence of specific treatments for AWS.
References
https://www.healthline.com/health/alice-in-wonderland-syndrome#causes (cited on 10/07/2024)
https://my.clevelandclinic.org/health/diseases/24491-alice-in-wonderland-syndrome-aiws (cited on 10/07/2024)
https://www.everydayhealth.com/migraine/interesting-facts-about-alice-in-wonderland-syndrome/ (cited on 11/07/2024)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4302569/ (cited on 11/07/2024)
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