How Alice in Wonderland Syndrome Distorts Your Perception

Medically reviewed by Shaheen Lakhan, MD, PhD, FAAN

Alice in Wonderland syndrome (AIWS) is a neurological condition that alters how the brain processes and perceives information. This condition can skew someone's perception of time, hearing, touch, sight, and any other type of sensation.

AIWS commonly occurs in children but can affect people of all ages. The symptoms are often short-lived, and it's believed that AIWS symptoms can typically result from migraines.

How Alice in Wonderland Syndrome Got Its Name

In the famous children's story Alice in Wonderland by Lewis Carroll, the main character Alice often experiences reality-altering adventures that skew her visual perception and sometimes how she perceives herself.

Psychiatrist John Todd named the syndrome in 1955 after Alice's characters, considering the symptoms mimic Alice's distorted reality.

Distortions related to how someone with AIWS may perceive the size of their body parts (either as too small or too big) are also called Lilliputian hallucinations. This name originated from Jonathan Swift's novel Gulliver's Travels. The island the story takes place on is known as Lilliput, where the island's inhabitants are only a few inches in height.

Alice in Wonderland Syndrome Symptoms

AIWS causes a range of symptoms. Symptoms can generally be categorized into different types of distortions.

Symptoms of AIWS fall into one of three categories:

1. Self-perception: These symptoms affect how you see yourself and how you believe that you relate to the world around you

2. Time: These symptoms involve how you perceive the passage of time

3. Visual: These symptoms affect your perception of any object, person, or color that you see

Self-Perception and Time Distortion Symptoms

Examples of symptoms that affect self-perception include:

• Macrosomatognosia: Feeling like parts of your body are larger than they are

• Microsomatognosia: Feeling like parts of your body are smaller than they are

• Levitation: A person may feel as if they're hovering over the ground, floating

• Somatopsychic Duality: Feeling like your body has been split into two parts

• Derealization: Thinking that your surroundings are not real

• Depersonalization: Believing that you do not exist or are not real
  

• Distorted Time: Being unable to adequately judge time passage (i.e., either thinking it’s going by too fast or too slow)

Visual Perception-Related Symptoms

Examples of symptoms that skew your visual perception include:

• Porropsia: Objects seem like they're moving away from you when they're stationary

• Pelopsia: Objects seem a lot closer to you than they are

• Micropsia: Objects seem smaller than they are

• Macropsia: Objects look bigger than they are

• Dysmorphopsia: Straight lines look wavy

• Hyperchromatopsia: Colors seemingly look much more vivid than usual
  

Please note, the above symptoms are not an exhaustive list. For example, other symptoms include seeing different colors, distorted faces, or perceiving that objects look flat rather than three-dimensional.

Diagnosing Alice in Wonderland Syndrome

AIWS is not an official diagnosis in DSM-5-TR. So, to determine whether or not you're experiencing AIWS, a doctor will review your medical history and try to rule out any other conditions that may cause hallucinations or illusions.

Testing for AIWS

There are currently no medical tests that can diagnose AIWS specifically. So, blood tests and imaging tests such as computed tomography (CT) or magnetic resonance imaging (MRI) scans might be conducted. 

Causes of Alice in Wonderland Syndrome

It’s a little unclear what exactly causes AIWS to develop. Researchers believe that migraines and other types of headaches are likely the most common cause.

Other potential causes of AIWS that have been identified include the following:

• Infectious conditions: Bacterial and viral infections may lead to AIWS. Epstein-Barr virus, influenza, typhoid, and Lyme disease have also been identified as causes.

• Substance use disorder: Misusing particular drugs, especially drugs capable of altering your sense of reality, such as LSD, has been associated with AIWS.

• Mental health disorders: A history of specific mental health conditions could trigger AIWS. Conditions like schizophrenia, Capgras syndrome, and schizoaffective disorders have been listed as possible causes.

• Specific medications: Symptoms of AIWS may be brought on as a side effect of using particular medicines. These medications include cough medication containing dihydrocodeine, DL-methyl ephedrine, and anti-seizure and asthma drugs.

• Other brain disorders: Other conditions that affect the brain could result in AIWS. Temporal lobe epilepsy, acute disseminated encephalomyelitis, and glioblastoma are three conditions that have been linked.

• Creutzfeldt-Jakob Disease: In a 2019 study, researchers looked into the link between AIWS and Creutzfeldt-Jakob Disease. In rare cases, AIWS combined with cognitive decline indicates a variant of Creutzfeldt-Jakob Disease, a fatal neurodegenerative condition.

Related:How the Peripheral Nervous System Works

Treatment for Alice in Wonderland Syndrome

There is currently no cure for AIWS, but this shouldn’t cause you to worry. The condition's symptoms are often temporary. In many cases treating the root cause of the condition will help resolve any symptoms you might be experiencing.

To ensure that the condition isn’t disrupting your daily functioning, your healthcare provider might also focus on treating the symptoms you are exhibiting.

Coping With Alice in Wonderland Syndrome

Properly managing the underlying condition triggering AIWS is the best way to cope with AIWS. Specific causes like migraines can cause a person to experience recurring episodes of AIWS.

Alice in Wonderland Syndrome Prevention

Considering that the development of AIWS is often linked to migraines and other types of headaches, ensuring that you lessen your chances of getting migraines may help ward off AIWS.

Adopting healthy lifestyle changes and eating nutritiously to keep your migraines at baymay help to prevent AIWS.

Frequently Asked Questions

Is Alice in Wonderland syndrome a form of schizophrenia?

While it's possible that schizophrenia might trigger AIWS symptoms, AIWS and schizophrenia and other schizoaffective disorders are not the same conditions. This is because AIWS symptoms are related to the perception of one's surroundings, while schizophrenia's symptoms involve legitimate hallucinations and illusions.

How long do Alice in Wonderland symptoms last?

AIWS symptoms are usually short-lived (between a few minutes and a few days). However, there are some cases where symptoms might last longer.

Is AIWS fatal?

Although AIWS is a non-fatal condition, it may be triggered by a more severe and potentially fatal disease. Seeking treatment as soon as you observe symptoms is crucial.