Alice in Wonderland syndrome (AIWS) is a complex of disorientating neurological symptoms characterized by a wrong perception of the size and position of the body and violation of coordination. People who suffer from AIWS often see things smaller or bigger than in reality or feel their bodies changing in size (Naarden et al., 2019). In addition, patients with AIWS misinterpret time or things that surround them. The diagnosis of this syndrome requires a thorough neurological analysis, a session with a psychotherapist and other medical tests such as MRI. AIWS is a quite rare mental condition, and that is why it remains poorly explored due to the lack of scientific knowledge on its epidemiology and psychological consequences for the patients.
AIWS is also known as Todd’s syndrome since its major symptoms were established and described by British psychotherapist D. Todd in 1955. The predominant symptoms were related to the wrong perception of the body size and shape, and that is why the doctor called the disease AIWS, similarly to the tale by Lewis Caroll (Hossain, 2020). The majority of the symptoms described by Todd were connected to migraine or epilepsy, and it was established that patients who suffer from migraines are likely to have AIWS. It was also established that children are more susceptible to AIWS since severe childhood infections often increase the probability of further development of the disorder (Hossain, 2020). Thus, it is necessary to remember that infectious diseases in childhood may provoke AIWS even at an adult age.
It was already mentioned that AIWS belongs to the category of neuropsychological disorders. It is associated with health conditions accompanied by headaches, dizziness and altered consciousness. Therapy methods highly depend on the reasons that caused the development of the syndrome. That is why establishing etiology for every patient is the most crucial step in the diagnostic process. Since 1955 when AIWS was discovered, studies of different AIWS cases established several reasons for its emerging and further development. The leading cause of AIWS in adult patients aged from thirty to forty is migraine. Distorted perception may appear during the pains or right after them. Apart from that, people who have cancer, epilepsy or apoplexy often suffer from AIWS as well. Infectious diseases, especially Epstein-Barr virus or parotitis, are among the leading causes of AIWS in children (Blom et al., 2021). These diseases cause AIWS at an early age mainly because they significantly harm the neural system.
Extensive physical or psycho-emotional stress may provoke the appearance of single symptoms of the disorder that happen over time. However, if there are more factors than stress, such as migraine or infection, the former becomes the booster for AIWS (Holland, 2019). There is one more factor that may provoke the development of AIWS, but it is not connected with any infections or stress. It concerns the situations when people use psychoactive substances either forcefully, for instance, with medicine or voluntarily – in other words, using drugs (Viela et al., 2020). When speaking about AIWS development caused by medicine, it is worth mentioning a case of a sixty-seven-year-old woman who had depressive disorder, nontoxic goiter and dyslipidemia (Viela et al., 2020). She was periodically treated with sertraline, and the symptoms of altering body size appeared when she took medicine. It was established by different tests that the woman had AIWS provoked by sertraline.
AIWS may also be connected with other mental disorders, such as psychotic depression, though the cases are not numerous. It was scientifically established that recurrent depressive disorder is connected with AIWS since the simultaneous appearance and same clinical manifestations of AIWS and psychotic depression presume their common psychological basis (Yokoyama et al., 2017). However, people who have mental disorders accompanied by the symptoms of AIWS caused by medicine or their mental-health state often are not willing to describe their symptoms to doctors (Viela et al., 2020). It may happen because of their fear of being considered a person with a psychiatric disorder.
AIWS is characterized by the episodic emerging of the symptoms, which last from five seconds to three minutes, but in rare cases, the attack lasts till thirty minutes. During this period of time, a person feels migraine-like headaches and illusions that lead to distortion of the body and other objects – the patient sees them as either small or extremely big (Brooks et al., 2019). Another symptom typical of AIWS concerns the wrong interpretation of space. During the attack, people usually see things either closer or farther than they really are. In addition, people with AIWS do not orient in time during the attacks, and one minute may seem an hour to them (Holland, 2019). The majority of the patients are also unable to control their arms and legs because they feel heaviness in them. That is why they may encounter difficulties when doing something that requires fine motor skills – writing, using their phones or tableware.
When speaking about the clinical manifestations of AIWS, it is worth mentioning that the disease is not a mental disorder or ophthalmological pathology. The violations occur in the cerebral cortex and are caused by anatomical or functional changes in information perception through the sensory networks (Viganò et al., 2020). That is why people with AIWS are not able to perceive images of different origins adequately. As a rule, visual images are the most often distorted ones.
If people often have AIWS episodes, the quality of their lives significantly decreases. The attacks are sudden, and it is impossible to predict their frequency and length. People have to stop driving cars, doing sports, working or even going outside of their houses. Children who suffer from AIWS are more susceptible to emotional disorders than those who are healthy (Blom et al., 2021). If the episodes are rare and the symptoms do not last long, children may perceive them not as a disease but as a game. However, in the majority of cases, perception distortions become the reason for anxiety, fear, or uncertainty and further development of depression, sleep violations or phobias.
AIWS has a wide variety of symptoms and no established criteria for diagnosis. As a rule, doctors prescribe blood testing, neurological tests, including the MRI of the brain and electroencephalography (EEG) that helps in identifying epilepsy (Millar, 2020). Apart from that, doctors often prescribe psychiatric and neurological consultations to those who may have AIWS that will help in assessing their mental health states. AIWS treatment is individual for each patient’s personal case. For instance, rare symptoms in children and teenagers may disappear without treatment when they reach adulthood. However, those who suffer from frequently repeated episodes of AIWS are treated with the medications that target the main disease – migraine, epilepsy, or infection (United We Care, 2021). Thus, the treatment of AIWS targets mainly the reason that provokes it but not the syndrome itself.
Taking into consideration everything mentioned above, it is possible to conclude that AIWS is a rare psychiatric disorder that is characterized by perceptive distortions. People who suffer from it may not orient in time or space during the attacks as well as see their bodies and things that surround them as extremely big or small. The syndrome cannot be cured because it is not a separate disease but the consequence of migraine, epilepsy or infection, and it is the reason that is usually treated.
References
Blom, J. D., Nanuashvili, N. & Waters, F. (2021). Time distortions: A systematic review of cases characteristic of Alice in Wonderland syndrome. Frontiers in Psychiatry, 12. Web.
Brooks, J. B. B., Prosdocimi, F. C., Da Rosa, P. B. & Fragoso, Y. D. (2019). Alice in Wonderland syndrome: “Who in the world am I?” Arquivos de Neuro-psiquiatria, 77(9), 672-674. Web.
Holland, K. (2019). What is Alice in Wonderland syndrome? (AWS) Healthline. Web.
Hossain, M.M. (2020). Alice in Wonderland syndrome (AIWS): A research overview. AIMS Neuroscience, 7(4). Web.
Millar, H. (2020). What is Alice in Wonderland syndrome? Medical News Today. Web.
Naarden, T., TerMeulen, B. C., Van Der Weele, S. I. &Blom J.D. (2019). Alice in Wonderland syndrome as a presenting manifestation of Creutzfeldt-Jacob disease. Frontiers in Neurology. Web.
United We Care. (2021). Explaining Alice in Wonderland syndrome and its treatment. United We Care Blog. Web.
Viela, M., Fernandes, D., Salazar Sr, T., Maio, C. & Duarte, A. (2020). When Alice took sertraline: A case of sertraline-induced Alice in Wonderland syndrome. Cureus, 12(8). Web.
Viganò, A., Maestria, G., Mancini, V., DI Piero, V. (2020). Adding pieces to the Alice in Wonderland syndrome puzzle: A comment to the paper by Brooks and colleagues. Arquivos de Neuro-psiquiatria, 78(4), 242-243. Web.
Yokoyama, T., Okamura, T., Takahashi, M., Momose, T. & Kondo, S. (2017). A case of recurrent depressive disorder presenting with Alice in Wonderland syndrome: Psychopathology and pre- and post-treatment FDG-PET findings. BMC Psychiatry, 17(1). Web.