Alice in Wonderland Syndrome - causes, symptoms and therapy

Alice in Wonderland Syndrome - causes, symptoms and therapy

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What is Alice in Wonderland Syndrome?

The mathematician Lewis Carroll published the world bestseller “Alice´s Adventures in Wonderland” in 1865. The Alice in Wonderland Syndrome (AIWS) is a perceptual disorder that can lead to perceptual distortions that are reminiscent of what is happening in the book. However, the syndrome is not psychiatric in nature. Rather, it occurs as a possible side effect of a migraine, epilepsy or other diseases. This article is about the backgrounds, causes, symptoms and therapy.

The syndrome

Alice in Wonderland Syndrome describes a perceptual disorder in which those affected see their environment and themselves distorted. Above all, people, animals and objects appear smaller and larger than they really are. The name is deceptive in that it is not an independent disease. Rather, such an aura occurs in the pre-phase of an epileptic seizure or a migraine attack. Some children experience migraines as dizzy spells, feel sick and vomit. Before that, they are plagued by vigorous hallucinations. As a rule, the syndrome does not occur alone, but together with other diseases, such as

  • Migraine,
  • Epilepsy,
  • Brain damage,
  • Creutzfeldt-Jakob disease,
  • high fever,
  • Drug consumption,
  • Hypnagogy (sleep paralysis),
  • Viral infections, e.g. with Epstein-Barr virus or Coxsackie virus B1.


Alice in Wonderland syndrome includes acoustic hallucinations, an increased sense of touch and a loss of feeling for time and space. Because their perception changes, those affected can lose their bearings and fall. Outsiders may also interpret behavior as a mental illness, but it is not. Other possible symptoms are:

  • Anxiety,
  • Panic attacks,
  • the feeling of going crazy
  • Confusion,
  • Perception of your own body changes,
  • consumed vision (metamorphopsia),
  • sudden fatigue,
  • Nausea and vomiting,
  • Dizziness,
  • A headache,
  • Paleness,
  • sudden changes in behavior in children, e.g. Silence and fear.


So far, Alice in Wonderland Syndrome cannot be treated independently. It is characterized by distortions of perception rather than hallucinations or illusions and must therefore be distinguished from psychotic disorders. Affected people should be informed that the symptoms themselves are not harmful. The focus is on the therapy of basic illness such as migraines. The syndrome often improves as soon as the underlying disease improves. If the syndrome occurs in childhood, it often disappears during puberty or in young adulthood.

Alice in Wonderland - Brief summary of the story

The adventures of Alice in Wonderland became a world bestseller. The girl Alice sees a white rabbit who looks at a watch and says it's too late. Alice follows him into the rabbit hole and comes to a room full of doors. She finds a key with which she opens the smallest door, but does not fit through. Then she drinks a potion that makes her small enough, but the door is now closed. Finally she comes to Wonderland, meets the white rabbit and grows gigantic. Then it gets small again and runs into the forest, a caterpillar brings it back to its normal size. Alice comes to the Duchess and meets the Cheshire Cat, after which she meets the March Bunny and the Mad Hatter at a crazy tea party. It ends up with the Queen of Hearts and the King of Hearts; the queen of hearts desperately wants to cut off someone's head Alice plays croquet with animals and anthropomorphic playing cards, the bat is a flamingo and the ball is a hedgehog. The Queen of Hearts condemns everyone except Alice to death, but the Queen of Hearts pardons her. A griffin leads Alice to the turtle soup, a mixture of kih and turtle. Then a trial follows, in which the heart boy must justify himself to have stolen the Queen's cakes. The mad hatter appears as a witness, as does Alice. However, it has now grown so large that it breaks the court. Before continuing, Alice wakes up next to her sister.

Did Lewis Carroll suffer from Alice in Wonderland Syndrome?

Following the strange happenings in the book, British psychiatrist John Todd gave the syndrome the name of Lewis Caroll's bestseller in 1955. The author may have suffered from migraines himself, and researchers suspect that even these visual hallucinations preoccupied him prior to his seizures. However, the story can also be explained as an LSD trip or as a shamanic experience in a trance state. As early as 1955 it was suspected that Carroll incorporated his own experiences in his books. This was controversial because the author never mentioned symptoms of migraines in diaries. But there are vague indications. Dr. Klaus Podoll from Aachen found a drawing by Carroll in which a figure lacks an area on the head. This indicates a blind spot that is typical of the aura before a migraine. (Dr. Utz Anhalt)

Author and source information

This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Dr. phil. Utz Anhalt, Barbara Schindewolf-Lensch


  • Jan Dirk Blom: Alice in Wonderland syndrome - A systematic review, Neurology Clinical Prctice, 2016, cp.neurology.org
  • Tirza Naarden, Bastiaan C. ter Meulen, Sarah I. van der Weele, u.a .: Alice in Wonderland Syndrome as a Presenting Manifestation of Creutzfeldt-Jakob Disease, frontiers in Neurology, 2019, frontiersin.org
  • Grant Liu, Alessandra Liu, Jonathan Liu, u.a .: Alice in Wonderland Syndrome: Presenting and Follow-up Characteristics (S19.003), Neurology, 2014, n.neurology.org
  • Reena Gogia Rastog, Juliana VanderPluym, Kara Stuart Lewis: Migrainous Aura, Visual Snow, and “Alice in Wonderland” Syndrome in Childhood, Seminars in Pediatric Neurology, 2016 Volume 23, Issue 1, Pages 14-17, sciencedirect.com

ICD codes for this disease: H53ICD codes are internationally valid encodings for medical diagnoses. You can find yourself e.g. in doctor's letters or on disability certificates.

Video: Alice in Wonderland Syndrome: 10 Interesting Facts (December 2022).