Alice In Wonderland Syndrome: Breaking Down Micropsia
In 1955, Dr. John Todd discovered "The Syndrome of Alice in Wonderland" while observing patients with migraines and epilepsy. Dr. Todd described the symptoms of AWS as "illusory changes in the size, distance, or position of stationary objects in the subject's visual field, illusory feelings of levitation, and illusory alterations in the sense of the passage of time."
Many patients he observed had experiences that reminded him of Alice's famous experiences in Wonderland when she ate or drank the delicacies presented to her, either growing to enormous sizes while everything around her seemed to shrink or shrinking until everything around her seemed enormous.
Micropsia is one of the most common symptoms related to AIWS as detailed in Walsh and Hoyt’s Clinical Neuro Ophthalmology. It primarily presents through visual symptoms such as the distortion of objects. This distortion causes objects to appear much smaller than they are negatively impacting visual acuity. There are also variations of micropsia, including hemimicropsia, that can be evaluated using tools like a controlled size comparison task. Micropsia and its variants may distort visual perception and can feel unsettling for those who experience it. These feelings may persist even if a person knows how large an object is in real life as to them, it may appear significantly altered in their right or left visual field.
What is Alice In Wonderland syndrome?
A famous study surveyed 48 individuals with confirmed Alice in Wonderland Syndrome. Out of the 48 people examined, 69% reported experiencing symptoms of micropsia instead of the other visually impairing conditions that AIWS can produce. They also found that one-third of the participants surveyed reported that their symptoms continued over a span of time. However, most of the examined participants reported having symptoms and disease progression that continued to appear throughout their lives. Those living with micropsia often experience these manifestations in the evening or after sundown.
Many who experience micropsia can cognitively determine that the objects around them aren't warped, but the brain still registers the size discrepancy as a sensory experience. For example, an individual may perceive an observed object as tiny but understand that it will be averagely sized when they touch it.
Individuals who experience micropsia may feel like their body is disproportionate and may experience convulsing or severe trembling. They may experience hallucinations and seizures, which can lead to excessive fatigue. Some people also report feelings of levitation or flying. There is a link between micropsia and dissociative disorders, AIWS can feel like a frightening out of body experience whereas what the individual perceived as normal is not reality.
What causes Alice In Wonderland syndrome and its associated visual system changes?
In many cases, neurological concerns like migraines and seizures affect the probability that AIWS will manifest. In addition, AIWS may also be caused by substance use disorders. Drug use can cause AIWS, especially if an individual is using hallucinogenic drugs. Additionally, withdrawal symptoms that occur in detoxified substance users can include hallucinations including AWIS symptoms. Because individuals who experience AWS perceive their bodies and the objects around them as distorted, this condition can cause anxiety, fear, and discomfort. Micropsia is not limited to one age or demographic.
There are a variety of factors that can contribute to the onset of micropsia, including, but not limited to:
- Bacterial and viral infections such as Epstein-Barr virus infection, typhoid fever, Lyme disease, scarlet fever, chicken pox, and shingles
- Central serous chorioretinopathy (CSCR), which can cause a detachment of the neurosensory retina
- A migraine attack or other types of headaches, like cluster headaches and abdominal migraines
- Retinal edema, which can cause a dislocation of the receptor cells
- Temporal lobe seizures caused by conditions such as epilepsy
- Strokes including right temporoparietal infarction
- Recreational or hallucinogenic substances
- Some prescription medications
- Degenerative brain and nervous system diseases such as Creutzfeldt-Jakob disease or multiple sclerosis
- Brain tumors and lesions affecting the brain
- Psychological disorders such as schizophrenia or bipolar disorder, among others
Other symptoms of Micropsia (unrelated changes in visual acuity)
Micropsia often involves multiple side effects that can leave those with the condition significantly impacted. Migraines are one of the most common symptoms before and after an episode of micropsia. An episode can also alter one's perception of time, speed, and senses. Although symptoms of micropsia often occur in the evening or at night, some individuals may experience distortions throughout the day. This distortion can cause paranoia, anxiety, and restlessness.
Diagnosis and treatment
There are many tools that a doctor can use to diagnose the cause of AIWS. Consult with a neurologist if you are experiencing symptoms.
Tests and brain monitoring, such as MRI and CT scans, can reveal abnormalities or structural issues that can cause AIWS. Also, depending on the symptoms and suspected cause, a doctor may request a spinal tap to test the spinal fluid for signs of infection.
An EEG (electroencephalogram) can analyze brain activity to diagnose conditions like occipital lobe epilepsy and seizures that can cause AIWS. A doctor may also request tests that measure how the human eye interacts with the brain.
The treatment for AIWS may also vary according to the cause and diagnosis. Adults and children who experience intense and current migraines may be prescribed migraine medication, as people with epilepsy might undergo treatment for their seizures.
If AIWS is caused by a psychological or psychiatric disorder such as schizophrenia or depressive disorder, or if it results from a substance use concern, psychotherapy may be the most beneficial option. Talking to a sleep specialist can help you get started if your symptoms occur during sleep.
Afraid your perceptions aren’t in proportion with reality?
Treatment options
Although micropsia can be a rare vision condition, many individuals live with this syndrome. Understanding the underlying causes and symptoms makes it possible to get effective treatment for AIWS.
If you feel that you have symptoms of AIWS and micropsia, consult with a neurologist or talk to your primary care provider for a referral. They may conduct the tests and examinations necessary to determine the cause and set a course of treatment. Depending upon the cause, part of your treatment may include taking dietary supplements, specialty eyeglasses, or therapy.
For some, visiting a therapist in person is difficult, and meeting with a therapist through a computer screen may be a better option. Barriers may occur due to availability issues, scheduling issues, or issues related to social anxiety. Many find that online counseling offered on platforms like BetterHelp is a beneficial solution for those barriers to treatment.
In addition, research shows that internet-based therapy can be as effective as in-person treatment for mental health conditions like anxiety, depression, and trauma-related disorders. When you use online therapy platforms, you can choose between phone, video, or live chat sessions with your therapist and get on the schedule quickly. If your therapist believes your concern is due to a medical issue, they may also suggest you seek medical advice for your symptoms.
If you are experiencing trauma, support is available. Please see our Get Help Now page for more resources.
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Takeaway
Alice in Wonderland Syndrome is a rare neurological condition that can cause the feeling of being larger or smaller than your environment, strange bodily sensations, and dissociation. If you have experienced symptoms of this condition, consider contacting your primary care physician for further guidance. You can also talk to a therapist if this condition is causing you anxiety or seems related to a mental illness. You're not alone, and support is available.
What causes macropsia?
Macropsia is a visual distortion where objects appear larger than they actually are. It's a type of perceptual distortion that can be brought on by various factors, often related to neurological or physiological issues. Some potential causes of macropsia include:
- Migraine: Visual disturbances, including macropsia, can be a symptom of migraines. This can occur during the aura phase or even as part of the migraine headache itself.
- Alice in Wonderland Syndrome (AIWS): This is a rare neurological disorder that can cause distortions in perception, including macropsia. It's often associated with migraines or other conditions affecting the brain.
- Temporal Lobe Epilepsy: Seizures originating in the temporal lobe of the brain can lead to visual distortions, including macropsia.
- Certain Medications: Some medications, particularly those affecting the nervous system or brain, can lead to visual disturbances like macropsia as a side effect.
- Substance Use: The use of certain substances or drugs can cause alterations in perception, including macropsia. This can be temporary or related to substance-induced conditions.
- Brain Trauma or Injury: Head injuries or trauma to the brain can sometimes lead to visual disturbances, including macropsia.
- Retinal Issues: In some cases, problems with the retina, such as retinal edema, can lead to distortions in visual perception, including macropsia.
- Brain Tumors: Rarely, brain tumors or lesions affecting visual processing and lead to perceptual distortions like macropsia.
- Neurological Conditions: Certain neurological conditions, such as Charles Bonnet syndrome or certain types of stroke, can cause visual distortions including macropsia.
Experiencing macropsia or other visual distortions can be a sign of an underlying medical or neurological issue. If you or someone you know is experiencing persistent or severe visual disturbances, it's recommended to seek medical attention to determine the cause and receive appropriate treatment.
What does micropsia feel like?
Micropsia is a visual distortion that may impact your visual system, where objects appear smaller than they actually are. It's the opposite of macropsia, where objects appear larger. Micropsia can be a disorienting and unsettling experience, and it's often associated with neurological or visual issues. Individuals who experience micropsia might describe it in the following ways:
- Objects Appearing Smaller: The most prominent feature of micropsia is the perception that objects in the visual field appear smaller than their actual size. This can include everyday objects, people, and surroundings.
- Loss of Depth Perception: Micropsia can distort depth perception, and may perceive objects as closer together than they really are.
- Visual Distortion: The visual world might appear distorted, with proportions and dimensions appearing altered.
- Disorientation: Individuals might feel disoriented or confused by the size discrepancy of objects in their environment.
- Impaired Visual Processing: People might struggle to accurately judge distances or navigate their surroundings due to the altered perception of size.
- Difficulty Recognizing Objects: Micropsia can make it challenging to recognize familiar visual objects, as their altered size can affect their visual features.
- Anxiety and Stress: Experiencing micropsia can lead to anxiety or stress due to the unfamiliar and distorted visual experience.
- Headache or Eyestrain: Prolonged or severe micropsia might contribute to headaches or eyestrain as the brain tries to process the distorted visual input.
- Associated Symptoms: Micropsia might occur alongside other visual disturbances, such as flashing lights, zigzag lines, horizontally aligned circles, or visual "floaters."
Micropsia, like macropsia, can be a symptom of various underlying conditions including migraines, epilepsy, certain medications, brain injuries, and more. If you or someone you know is experiencing micropsia or any other persistent visual disturbances, it's important to seek medical evaluation to determine the cause and appropriate treatment.
How do you test for micropsia?
Testing for micropsia typically involves a combination of medical history assessment, physical examination, and sometimes specialized tests to determine the underlying cause of the visual distortion. Here's how testing for micropsia might be conducted:
- Medical History: A healthcare professional will ask about your symptoms, including when they started, how often they occur, and any associated factors. They also may ask for a history of physical factors, such as an Epstein Barr virus infection, or psychiatric disorders or psychological factors to determine the cause of micropsia.
- Physical Examination: A thorough physical examination, including an assessment of your eyes and neurological function, will be conducted to rule out any obvious causes of the visual distortion such as age related macular degeneration.
- Eye Examination: An eye examination by an ophthalmologist or optometrist can help identify any underlying eye conditions or optical factors that might be contributing to the visual distortion.
- Neurological Examination: A neurological examination can help identify any neurological issues that might be causing micropsia. This can involve tests to assess sensory function, reflexes, and coordination.
- Visual Field Test: A visual field test measures your peripheral vision and can detect any abnormalities that might be contributing to micropsia.
- Neuroimaging: In some cases, neuroimaging tests such as MRI or CT scans might be ordered to assess the brain's structure and identify any abnormalities that could be causing the visual distortion.
- Blood Tests: Blood tests might be conducted to rule out underlying medical conditions that could lead to visual disturbances, such as metabolic disorders or infections.
- Migraine Assessment: If migraines are suspected as a cause of micropsia, a healthcare provider might assess your history of migraine headaches and associated symptoms.
- Medication Review: For psychiatric patients, if you're taking any medications, your healthcare provider might review your medication history to determine if any medications could be causing visual disturbances.
How common is micropsia?
Micropsia is a relatively rare visual phenomenon compared to more common visual disturbances, with between 5% and 6% of the general population experiencing micropsia, and around 15% of individuals who experience migraines also experiencing micropsia. It's often associated with certain medical conditions, such as migraines, frontal lobe epilepsy, temporal lobe seizures, and other neurological disorders. The exact prevalence of micropsia can vary depending on the specific underlying causes being considered.
How do you fix micropsia?
The treatment for micropsia depends on the underlying cause. Micropsia is often a symptom of an underlying medical condition or neurological issue, and addressing the cause is key to resolving the visual distortion. Here are some steps that might be taken to address micropsia:
- Medical Evaluation: If you're experiencing micropsia, it's important to seek medical attention. A healthcare provider will conduct a thorough evaluation to determine the underlying cause of the visual distortion.
- Treat Underlying Condition: Treating the underlying condition responsible for micropsia is the primary approach. For example, if micropsia is related to migraines, managing migraines with appropriate medications and lifestyle changes can help alleviate the symptom.
- Medication Adjustment: If medication side effects are contributing to micropsia, a healthcare provider might adjust or change the medications to address the issue.
- Neurological Management: If micropsia is related to neurological disorders such as epilepsy, treatment may involve managing the neurological condition with medications, lifestyle changes, or other therapies.
- Vision Correction: In some cases, issues with the eyes themselves might contribute to micropsia. Correcting refractive errors with eyeglasses or contact lenses can help improve visual clarity.
- Cognitive-Behavioral Therapy (CBT): If micropsia is related to migraines or stress, CBT might help in managing symptoms and improving coping strategies.
- Lifestyle Changes: In cases where triggers such as certain foods, stress, or lack of sleep are contributing to micropsia, making lifestyle changes to avoid triggers might help reduce the frequency or intensity of the symptom.
- Temporary Causes: If micropsia is caused by temporary factors like medication or drug use, discontinuing the medication or avoiding the substance might resolve the issue.
It's important to work closely with healthcare professionals to determine the appropriate course of action for your specific situation. Self-diagnosis and self-treatment are not recommended, as addressing the underlying cause of micropsia requires a proper medical assessment and diagnosis.
Why do I suddenly see things smaller?
Seeing things smaller than they actually are, a phenomenon known as micropsia, can occur for various reasons. It's important to note that sudden changes in visual perception should be evaluated by a medical professional, as they can be indicative of underlying medical or neurological issues. Some potential causes of suddenly seeing things smaller include:
- Migraine: Micropsia can be a symptom of a visual aura that some people experience before a migraine headache. This can include sudden changes in visual perception, such as objects appearing smaller.
- Epileptic Seizures: Certain types of seizures, particularly those affecting the temporal and occipital lobes of the brain responsible for visual processing, can cause visual distortions including micropsia.
- Medication Side Effects: Some medications, particularly those affecting the nervous system or brain, can lead to visual disturbances as a side effect.
- Eye Conditions: Issues with the eyes themselves, such as retinal problems, retinal detachment, or changes in eye structure, can affect visual perception and cause objects to appear smaller.
- Neurological Disorders: Conditions such as Alice in Wonderland Syndrome (AIWS), which affects visual perception and can cause distortions in object size, might lead to sudden changes in visual perception.
- Stress or Fatigue: Intense stress, fatigue, or exhaustion can sometimes lead to visual disturbances, including micropsia.
- Neurological Trauma or Injury: Head injuries or trauma to the brain can lead to changes in visual perception and other visual disturbances.
- Temporary Factors: Certain substances or temporary factors, such as drug use, alcohol consumption, or lack of sleep, can temporarily alter visual perception.
- Psychological Factors: In some cases, as a clinical feature, psychological factors such as anxiety or high stress levels can influence how individuals perceive the world around them.
Because the potential causes of suddenly seeing things smaller are diverse, it's important to seek prompt medical evaluation to get a positive diagnosis if you're experiencing this phenomenon. A healthcare provider can conduct a thorough assessment, including a medical history, physical examination, and a controlled size comparison task or other tests, to determine the cause of the sudden change in visual perception and recommend appropriate treatment if needed.
Is micropsia a disorder?
Micropsia is not a standalone mental disorder, but rather a visual perceptual distortion where objects appear smaller than they actually are. It's often a symptom or manifestation of an underlying medical or neurological condition. Micropsia can occur in various contexts and can be associated with different conditions, including migraines, epilepsy, and certain neurological disorders.
Is micropsia a hallucination?
Micropsia is not considered a hallucination in the traditional sense. Hallucinations involve perceiving things that are not present in the external environment. Micropsia, on the other hand, involves a distortion in the perception of the size of objects that are actually present in the environment.
In micropsia, objects that are physically present appear smaller than they actually are. This can be due to various factors, such as neurological conditions, migraines, medication side effects, or eye issues. The individual experiencing micropsia is not perceiving nonexistent objects; rather, they are perceiving real objects with altered dimensions.
What is an example of micropsia?
An example of micropsia is when someone looks at an everyday object and perceives it as being significantly smaller than it actually is. This visual distortion can affect how the person interacts with their environment and how they perceive the world around them. Here's an example:
Imagine someone is looking at a chair in their living room. Due to the phenomenon of micropsia, the chair appears much smaller than it normally would. The person might feel like the chair has been shrunken in size, even though they know the chair hasn't physically changed. As a result, they might perceive the chair as uncomfortable or impractical to use due to its altered size perception.
What is the difference between micropsia and macropsia?
Micropsia and macropsia are both visual perceptual distortions, but they involve opposite alterations in the perception of object size. Here's the difference between the two:
Micropsia:
Micropsia is a visual distortion where objects appear smaller than their actual size. It can make the surrounding environment and objects seem shrunken or diminished. This phenomenon can be associated with various underlying conditions, such as migraines, epilepsy, certain neurological disorders, and even medication side effects. Micropsia can impact a person's depth perception and overall sense of space.
Example: If someone with micropsia looks at a table, it might appear as though the table has been reduced in size, making it seem smaller and more compact than it actually is.
Macropsia:
Macropsia is the opposite of micropsia. It's a visual distortion where objects appear larger than their actual size. This phenomenon can create a sense of exaggerated size and proportion in the environment. Like micropsia, macropsia can also be associated with various medical and neurological conditions, such as migraines, epilepsy, and certain brain disorders.
Example: Someone experiencing macropsia might look at a door and perceive it as much larger than it truly is, creating a sense of the door dominating their field of view.
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