What is Alice in Wonderland Syndrome (AWS)?

Alice in Wonderland Syndrome

What is AWS?

Alice in wonderland syndrome (AWS) is a condition that causes temporary disorientation and distortion of perception. The actual size or shape of you may appear to be different. Occasionally, a room’s or surrounding furniture’s dimensions might seem to shift and move further or closer than they really are.

The episodes aren’t related to your vision or a hallucination. They arise from changes in the way your brain perceives surroundings and the way you look.

Visual, tactile and hearing senses can all be affected by this syndrome. The sense of time may also be lost. Your perception of time may be different from your actual experience.

AWS primarily affects children and young adults. Generally, most people grow out of this disordered perception as they age, but it can still occur in adulthood.

AWS is also referred to as Todd’s syndrome. It was first identified by a British psychiatrist in the 1950s, Dr. John Todd. The symptoms and anecdotes recorded for this syndrome are similar to those of Alice Liddell from Lewis Carroll’s “Alice’s Adventures in Wonderland.”

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How does AWS present?

Each person experiences AWS differently. Each episode will also differ from one another. Typical episodes last between four and six minutes. Some can last up to 30 minutes.

Some of the symptoms you may experience during that time include:


AWS causes migraines more frequently in people. AWS is believed to be an aura by some scientists and doctors. An early symptom of a migraine is a feeling of numbness. Some researchers believe only a small number of people get AWS.

Size distortion

You may experience micropsia when it feels as if you’re shrinking. When you perceive that your body or the objects around you are getting larger, it’s macropsia. It is common to have both experiences during an AWS episode.

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Perceptual distortion

Pelopsia is a sensation of objects around you growing larger and closer to you than they really are. Teleopsia is the opposite. It occurs when you believe objects are closer or further away than they actually are.

Time distortion

AWS can cause some people to lose track of time. People may perceive that time is moving more quickly or more slowly than it is.

Sound distortion

The sound of almost every sound seems loud and obtrusive, even usually quiet sounds.

Loss of coordination or loss of limb control

Symptoms of this condition occur when muscles feel like they are acting involuntarily. You might feel as if your limbs aren’t under your control. Likewise, the altered sense of reality can affect how you move or walk. There may be difficulties moving around or feeling uncoordinated as usual.

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What causes alice in wonderland syndrome?

Physicians are trying to understand AWS, but the causes are still unclear. They know it does not originate in your eyes, you are just hallucinating or you are suffering from a neurological or mental disorder.

The abnormal blood flow to parts of the brain involved in interpreting visual information in your environment is believed to be caused by abnormal electrical activity in the brain. Several factors may contribute to this unusual electrical activity.

Researchers found that 33 percent of patients with AWS had an infection. 6 percent of the AWS episodes were related to headaches and migraines. There were no known causes for more than half of the AWS cases.

The most common cause of AWS among adults in the United States is migraines. Additional research is needed to confirm this. Children with AWS are most often infected.

The following are other possible causes:

  • Stress
  • Cough medicine
  • Use of hallucinogenic drugs
  • Epilepsy
  • Stroke
  • Brain tumor

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What risk factors are associated with the condition?

AWS is linked to several conditions. You may be at greater risk for it if you are at risk for the following:

  • Migraines: AWS is a sensory warning that may precede a migraine. There is also some evidence that AWS is a migraine subtype.
  • Infections: The Epstein-Bar virus (EBV) may cause AWS episodes as an early symptom. It can lead to mononucleosis or infectious mono.
  • Genetics: You may be more likely to experience this rare condition if you have a family history of migraines and AWS.

What is the diagnosis of AWS?

If you experience symptoms similar to those described for AWS, schedule an appointment with your doctor. If you have any concerns about your symptoms, you can discuss them with your doctor.

It is impossible to diagnose AWS with a single test. If your symptoms are not caused by any other causes or explained by any other explanations, your doctor may be able to make a diagnosis.

The following procedures may be performed by your doctor:

  • MRI scan:  Your brain can be seen in fully detailed images by means of an MRI.
  • Electroencephalography (EEG): An EEG measures the electrical activity of the brain.
  • Blood tests: Infections such as EBV can cause AWS symptoms, but your doctor can rule them out or diagnose them.

AWS may be under diagnosed. Since these episodes typically last only seconds or minutes, people experiencing them may not be concerned. Young children are especially vulnerable to this.

Doctors can also have a hard time studying AWS and better understanding its effects because the episodes tend to be fleeting.

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Alice in wonderland syndrome treatment

As far as we know, there is no treatment for AWS. It is best to rest and wait for symptoms to pass if you or your child experiences them. It is also important to make sure you or a loved one understand that the symptoms are not dangerous.

You and your doctor may be able to prevent AWS episodes by treating the underlying cause. For instance, migraines can be treated to prevent future episodes.

The symptoms of infection can also be controlled by treating the infection.

It may be possible to reduce symptoms of MS through meditation and relaxation if you suspect stress is involved.

Is it possible for AWS to cause complications?

Alice in wonderland syndrome often improves over time. Rarely does it cause complications or problems?

Although migraines aren’t necessarily associated with this syndrome, having these episodes makes it more likely that you will develop them. According to one study, an AWS can lead to migraine headaches for people who do not suffer from them.

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What are the prospects?

It is not harmful to experience these symptoms, even if they are disorienting. Moreover, they don’t indicate an even larger problem.

Sometimes alice in wonderland syndrome episodes can occur repeatedly for several days in a row, followed by months in which none of the symptoms appear.

Over time, your symptoms will likely reduce. It is possible that the syndrome will disappear entirely when you are an adult.

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