Alice in Wonderland syndrome (AIWS) is a rare condition that distorts the way your brain processes certain information it receives. It can impact the way you see your own body, the world around you, or both. For example, objects, people, or your own body parts may look larger or smaller than they really are. AIWS can warp your sense of time and reality, too. It’s a brain (neurological) condition, not a mental health condition.
Why Is It Called ‘Alice in Wonderland Syndrome’?
The syndrome is named after the famous children’s story Alice’s Adventures in Wonderland by Lewis Carroll. In the story, the main character, Alice, shrinks to the size of a mouse and later grows taller than a house. Some researchers think the author, whose pen name was Carroll, had visual distortions or changes in his vision that inspired him to write some of the scenes.
The term “Alice in Wonderland syndrome” was first used in 1955 by British psychiatrist John Todd, which is why AIWS is sometimes called Todd’s syndrome.
What Causes Alice in Wonderland Syndrome?
Doctors aren’t sure why AIWS happens, but they know it can be triggered by many things. Some causes of Alice in Wonderland syndrome include:
Migraine. One of the most common causes of AIWS is migraine. You can get AIWS with a migraine aura — the phase before or during a migraine when your brain takes in sights, sounds, or sensations differently.
“We now understand that migraines are more than just headaches,” says Hamid Djalilian, MD, a professor at the University of California, Irvine. Migraines are closely tied to brain inflammation and affect how your brain interprets information from your senses. When your brain is inflamed, it can misread signals from your eyes or body. That can cause the size and shape distortions typical of AIWS. If your child child has Alice in Wonderland syndrome, it may sometimes (but not always) be an early sign they’ll have migraines later in life, Djalilian says.
You can also get AIWS with other types of headaches, such as abdominal migraines (sudden, serious episodes of belly pain) and cluster headaches.
Infections. Bacterial and viral infections are another major cause of AIWS, especially in kids. Some of the most common infections linked to it include:
- Coxsackie B1 virus
- Epstein-Barr virus (EBV)
- Influenza A
- Lyme disease
- Scarlet fever
- The virus that causes chickenpox and shingles, varicella-zoster virus (VZV)
- Typhoid fever
Medications. Certain medications can bring on Alice in Wonderland syndrome as a side effect. Examples include:
- The anti-seizure medication topiramate (Topamax, Topiragen)
- The asthma medication montelukast (Singulair)
- Cough syrups that have dextromethorphan or dihydrocodeine and DL-methylephedrine)
Other causes of Alice in Wonderland syndrome
Not every case of Alice in Wonderland syndrome can be explained. “There are many causes, including infection, migraine, and even focal brain damage (stroke), but it can also occur in healthy individuals without any clear cause,” says Michael D. Fox, MD, PhD, a professor of neurology at Harvard Medical School.
“Recent research suggests that we have one brain region responsible for seeing bodies and a second brain region responsible for estimating size,” he says. If both regions don’t work normally at the same time, you can get AIWS.
Other causes of Alice in Wonderland syndrome include:
Recreational drugs. Substances like amphetamines, ayahuasca, weed, cocaine, LSD, MDMA, and inhalants like toluene have been linked to episodes of AIWS.
Mental health conditions. Some cases of AIWS are linked with conditions such as depression and schizophrenia.
Seizures. People with seizure disorders, especially epilepsy, can get AIWS as part of their neurological symptoms.
Certain types of strokes. People can also get AIWS after a stroke or any condition that reduces blood flow to brain regions that help control how you see yourself and objects around you.
Why are children at higher risk for developing Alice in Wonderland syndrome?
Alice in Wonderland syndrome seems to affect children the most. Research suggests that about two-thirds of cases happen in people under 18.
Kiara DeWitt, a pediatric neurology registered nurse and the head neurology and neuroscience educator at Cook Children’s Medical Center, says that from her clinical experience, it often shows up in kids under the age of 10 during their first major viral infection or their first migraine episode. Childhood is typically when these first-time events that can trigger AIWS tend to happen. This might explain why children develop AIWS more often than adults.
Another possible explanation is that children don’t always have the words to explain what’s happening. They may describe sensations like their body parts shrinking or growing, or the room suddenly getting bigger or smaller, says DeWitt. Adults can have similar experiences, but they tend to describe them as a migraine aura because they have more language to explain it.
Can long COVID cause or trigger AIWS?
Infections in general are a well-known cause of AIWS, but right now doctors don’t know enough to say whether long COVID can cause or trigger AIWS. A few case reports have linked COVID-19 infection to Alice in Wonderland syndrome.
What Are the Common Symptoms of Alice in Wonderland Syndrome?
There are dozens of symptoms with Alice in Wonderland syndrome. These include:
Visual distortions. These affect how you see objects around you. For example, you may have:
- Dysmorphopsia, in which lines and contours appear wavy
- Kinetopsia, in which still objects appear to move
- Macropsia, in which you see things larger than they are
- Micropsia, in which you see things smaller than they are
- Pelopsia, in which things seem closer than they actually are
- Teleopsia, in which things seem farther way than they really are
Body image distortions. These affect how you see your own body. For example, you may see your body or body parts as larger than they really are (macrosomatognosia) or as smaller than they really are (microsomatognosia).
Time distortions. You may feel like your sense of time is off. For example, it might feel like time is speeding up or slowing down.
You may also feel like the world is unreal (derealization) or feel like you’re not real (depersonalization).
How long do Alice in Wonderland syndrome symptoms last?
Most episodes of Alice in Wonderland syndrome are short-lived, usually lasting from a few minutes to a few days. In rare cases, symptoms may last for years or be lifelong.
How Is Alice in Wonderland Syndrome Diagnosed?
There’s no single test to confirm Alice in Wonderland syndrome. Doctors usually diagnose it by asking detailed questions about your symptoms and medical history. They’ll also do an in-depth physical exam. They’ll typically check your nervous system, ears, and eyes for any signs of problems.
If your doctor thinks there may be a problem in your brain, they may order additional tests such as:
- Blood tests
- An electroencephalogram (EEG), a test that uses electrodes placed on your scalp to record your brain’s electrical activity
- A brain magnetic resonance imaging (MRI) scan, which makes detailed images of your brain
What other conditions can cause similar symptoms?
Other conditions can cause symptoms similar to Alice in Wonderland syndrome. “Migraines with aura, temporal lobe seizures, and even some medication side effects are among the conditions that can cause similar symptoms,” DeWitt says. “Sleep disorders can also cause unusual perceptual changes at times.”
Because AIWS is so easily confused with other conditions, doctors carefully check your symptoms over time.
What’s the Treatment for Alice in Wonderland Syndrome?
Treatment is only needed if symptoms happen often or if they’re disruptive. In that case, doctors focus on managing the underlying trigger. For example, if an infection causes Alice in Wonderland syndrome, you may get antibiotics or antiviral medications. If epilepsy is the cause, anti-epileptic medications may help. When migraine causes AIWS, doctors may prescribe medications to prevent migraine attacks.
“At our tinnitus clinic, we often see AIWS with other atypical migraine symptoms like fluctuating tinnitus, vertigo, and visual snow,” Djalilian says. These symptoms often get better with a combination of medications, nutraceuticals (food products with health benefits beyond the basic nutrients), and lifestyle changes aimed at managing migraine.
Is there a cure for Alice in Wonderland syndrome?
There isn’t a direct cure for Alice in Wonderland syndrome because it’s usually a symptom of an underlying condition, not a disease itself. In some people, AIWS symptoms go away on their own without treatment.
Is Alice in Wonderland syndrome dangerous?
Although Alice in Wonderland syndrome can be scary, the condition isn’t usually dangerous. “AIWS is common in healthy children and adolescents and not necessarily cause for concern if it occurs without any other symptoms,” Fox says. But you should always speak to a doctor about your or your child’s symptoms.
What Parents Need to Know About Alice in Wonderland Syndrome
Even though Alice in Wonderland syndrome is usually harmless, it can be very scary for a child to experience. “A single episode in an otherwise healthy child may be dismissed as a strange dream or hallucination if it goes away after 10 minutes,” DeWitt says. “However, if a child has recurrent episodes, for example, three or more in one week, or if they complain of balance problems or trouble recognizing objects for 20 minutes or longer, that should merit a pediatric neurology consult.”
The best way for parents to support their children is to monitor their symptoms and provide reassurance. “Sometimes, all a child needs is to know they are safe, even when their world does not seem real to them,” DeWitt says.
Do kids grow out of Alice in Wonderland syndrome?
Yes, many children eventually outgrow Alice in Wonderland syndrome.
Takeaways
Alice in Wonderland syndrome is a brain-related condition that can cause a wide range of symptoms. These can include:
- Visual distortions
- Changes in body image
- Altered sense of time
- Feelings that you or the world around you aren’t real
Often, AIWS is caused by an underlying trigger, such as a viral infection or migraine. Although it can be very frightening to experience, it’s usually temporary or treatable.
FAQs About Alice in Wonderland Syndrome
Here are some commonly asked questions about Alice in Wonderland syndrome.
How rare is Alice in Wonderland syndrome?
Doctors don’t know exactly how many people have Alice in Wonderland syndrome, but it’s considered rare. In people with migraine, up to 15% may have it. Research shows that individual symptoms of AIWS, like seeing objects appear too big or too small, are more common than the full syndrome — affecting up to 6% of adolescents in some studies.
Is Alice in Wonderland syndrome a sign of autism?
No, Alice in Wonderland syndrome is not a sign of autism.
Is Alice in Wonderland syndrome a personality disorder?
No, Alice in Wonderland syndrome is not a personality disorder.
