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Body image disturbances (Alice in Wonderland syndrome)

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SYMPTOMS | PATHOMECHANISMS | HISTORY

Symptoms

Transitory aura symptoms

Visual illusions

Visual loss

Persistent aura symptoms

Psychological experience

Author: Klaus Podoll	23. March 2007
Edited by: Klaus Podoll

Body image disturbances (Alice in Wonderland syndrome)

Lewis Carroll, Manuscript of Alice's Adventures Underground (see here)

The Alice in Wonderland syndrome (AIWS), as described by Todd in 1955, denotes a variety of self-experienced paroxysmal body image disturbances affecting the experience of the size, mass, shape of the body or its position in space (obligatory core symptoms of the AIWS, e.g. macro- and microsomatognosia, out-of-body experiences) which may co-occur with depersonalization, derealization, visual illusions and disorders of the time perception (facultative symptoms of the AIWS).

The name comes, of course, from Lewis Carroll's 1865 novel "Alice's Adventures in Wonderland", which is believed to have been inspired by Carroll's own migraine experiences documented as early as 1856.

Recent studies of the AIWS occurring as migraine aura indicated that the body schema disturbance of macrosomatognosia most frequently affects the head and upper extremities, paralleling the extension of their representation in the human brain (Podoll and Robinson, 1999).

Illustration of macrosomatognosia with sensation of enlargement of the eye in Superman.

A migraine sufferer's report of the Alice in Wonderland syndrome

"Throughout my early childhood I suffered from migraine headaches. My mom got migraines too so she just gave me children's Tylenol and told me to tough it out. When I was 10 years old, I woke up one morning and I almost felt like I was still asleep and dreaming. I was still laying down in my bed and I held out my hands in front of me and they didn't feel like my hands, they felt like long skinny dry twigs. If I concentrate hard enough I can 'remember' the feeling and my hands start to feel that way again. After a few minutes it all went away and I didn't say anything to my parents about it. But for the next couple of weeks it happened more and more often, usually in the evening. Most of the time it was when I was sitting still, I would feel so incredibly heavy that I was sure I couldn't move any part of my body and my depth perception felt like it was completely off. One time while I was walking down the hall I felt like the walls were rushing past me at 50 mph. One afternoon after school I was sitting on my bed, which was a day bed with a spiraly-cast iron design on the headboard and while I was looking at it it started to move and rotate, like it was turning like a wheel. When I tried to explain this to my parents I got frustrated because my eyes were telling me that my bed wasn't moving, but my brain was telling me that it was moving. Every episode was accompanied with a strange feeling that at the time I didn't understand, but in retrospect I would call it an extreme-version of light-headedness, kind of like you're on laughing gas but highly uncomfortable and very scary. And every episode was followed by a killer migraine headache... An EKG, an MRI, and a couple of months later the diagnosis was I had an 'abnormal brainwave' which was 'triggered' when I had a migraine, causing hallucinatory side effects to my migraine. The doctor actually called it 'Alice In Wonderland Syndrome' saying that it was compared to how Alice felt while tumbling down the rabbit hole. At the time, we thought this could possibly be the delusions of a Southern California doctor who had spent a little too much time trying out 'herbal' remedies. But he had newspaper clippings and journal clippings to back up his theory."

(Jen Smith, Alice In Wonderland Syndrome forum, March 12, 2005)

As a misapprehension commonly encountered in the medical literature, it as been suggested to define the AIWS by the presence of visual rather than somesthetic perceptual disturbances, i.e., metamorphopsia and/or visual hallucinations, but this change and broadening of Todd's definition of the AIWS renders it to a both scientifically and clinically useless concept (Podoll et al., 2002).

E., Normal vision, 2005.

E., Metamorphopsia in left half-field of vision, 2005.

Obligatory and facultative symptoms of the Alice in Wonderland syndrome

"I am a female aged 57 and began having migraines with aura late last year. I have not had a painful migraine headache. Above are two photos, #1 an actual view, #2 my attempt to recreate what I experienced earlier this month. I had previously experienced the bright, flashing zigzag effects of migraine aura perhaps six or seven times during the period from November 2004 to April 2005. I saw a neurologist. I was unaware of any other types of aura until May 7.

The recreation (#2) represents my experience on May 7, 2005. It seemed as if my right eye saw the landscape realistically, but my left eye perceived a distorted view that seemed to be surging rapidly toward me [i.e. metamorphopsia in left half-field of vision]. There was a sensation of pressure on the eye from within. Then the left eyeball seemed to be on a stalk protruding from my face, turning to the left and right of its own accord [i.e. body image disturbance]. When I tried to describe what was happening to me, I told the people I was with 'Something isn't right and I'm going somewhere else.' I repeated that again to another friend by way of explanation as I left. I had trouble keeping my balance as I walked [i.e. ataxia], with the feeling that the landscape was out of synch with reality and the sensation of motion. This was accompanied by a feeling of fear that I was experiencing a stroke. Nausea followed, then later extreme exhaustion.

After a day in the local hospital's emergency room I was assured that this was another form of migraine aura. I began to learn more through research on the internet. This website, Migraine-Aura, has been most helpful. Through this search in the last week I formed the impression (which you describe as a misapprehension) that the 'Alice in Wonderland Syndrome' would apply to the sort of visual distortion or hallucination that I experienced. I had come to believe it was synonymous with metamorphopsia. However, perhaps the latter portion of the experience (protruding eye) could be labeled AIWS? [Yes, the latter portion of the experiences features a variety of body image disturbance as obligatory core symptom of the AIWS, occurring in succession with metamorphopsia as a facultative symptom of AIWS.] In any case, thank you for the extensive information presented on the website. I would have liked to read accounts [pending] from people who have had the type of visual distortion that I did."

(E., Emails to Klaus Podoll, May 15-16, 2005; additions in square brackets by Klaus Podoll)

References

Lippman CW. Certain hallucinations peculiar to migraine. J Nerv Ment Dis 1952; 116: 346-351.
Podoll K, Robinson D. Macrosomatognosia and microsomatognosia in migraine art. Acta Neurol Scand 2000; 101: 413-416.
Podoll K, Robinson D. Migraine Art - The Migraine Experience from Within. North Atlantic Books, Berkeley, California 2009, p. 85-146.
Podoll K, Ebel H, Robinson D, Nicola U. Sintomi essenziali ed accessori nella sindrome di Alice nel paese delle meraviglie. [Obligatory and facultative symptoms of the Alice in Wonderland syndrome. In Italian] Minerva Med 2002; 93: 287-293.
Todd J. The syndrome of Alice in Wonderland. Can Med Assoc J 1955; 73: 701-704.

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