CoChat
Sign Up
Cited by 143Hallucinations in medical conditionsMental Health and PsychiatryPsychosomatic Disorders and Their Treatments

Alice in Wonderland syndrome: A systematic review

Open access
Blom, Jan Dirk·2016·Neurology Clinical Practice
DOI 10.1212/cpj.0000000000000251PMC PMC4909520
Open this paper in CoChat — free accountOpen PDF

Abstract

PURPOSE OF REVIEW: To summarize the literature on Alice in Wonderland syndrome (AIWS), a disorder characterized by distortions of visual perception, the body schema, and the experience of time. RECENT FINDINGS: On the basis of 169 published case descriptions, the etiology of AIWS is divided into 8 main groups, with neurologic disorders affecting mostly adults and elderly patients and encephalitides affecting mostly patients aged ≤18 years. Symptoms of AIWS are also experienced in the general population, with up to 30% of adolescents reporting nonclinical symptoms. SUMMARY: In clinical cases of AIWS, auxiliary investigations (including blood tests, EEG, and brain MRI) are strongly advised. Treatment should be directed at the suspected underlying condition, although reassurance that the symptoms themselves are not harmful seems to suffice in about 50% of the cases. International classifications such as the DSM and ICD should consider placing the syndrome on their research agenda.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1212/cpj.0000000000000251

Cites

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • HPPD and Alice in Wonderland syndrome have substantial phenomenological overlap.

    “In light of the substantial phenomenological overlap between HPPD and Alice in Wonderland syndrome, a comparison may teach us something about HPPD and, in particular, its treatment.”

    From Pharmacological Treatment of Hallucinogen Persisting Perception Disorder (HPPD): A Systematic Review (2025) · cites this paper as [7]

    The Etiology section identifies substance-induced AIWS with HPPD, supporting a close relationship between the syndromes. The Limitations section also refers to their overlap, but says its extent needs to be assessed; it does not establish that the phenomenological overlap is substantial. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • A recent systematic review reported that sensory distortions characteristic of Alice in Wonderland syndrome make up 76% of HPPD symptoms.

    “a recent systematic review reported that these experiences make up 76% of HPPD symptoms.7”

    From Pharmacological Treatment of Hallucinogen Persisting Perception Disorder (HPPD): A Systematic Review (2025) · cites this paper as [7]

    The Phenomenology section describes Alice in Wonderland syndrome experiences as sensory distortions, and the Etiology section identifies a substance-induced form associated with HPPD. Neither section reports that these experiences make up 76% of HPPD symptoms; a search for that figure found no supporting passage. (LLM, conf=0.78)

    Experimental — accuracy not yet measured

  • People with HPPD who suffer from comorbid anxiety or depressive disorder tend to have less favorable prognoses.

    “What is relevant is that people with (either type of) HPPD who suffer from comorbid anxiety or depressive disorder tend to have less favorable prognoses.7”

    From Pharmacological Treatment of Hallucinogen Persisting Perception Disorder (HPPD): A Systematic Review (2025) · cites this paper as [7]

    The Discussion sections on etiology and limitations identify HPPD as related to Alice in Wonderland syndrome. The Treatment and prognosis section discusses outcomes for AIWS, including cases associated with migraine or epilepsy, but does not link anxiety or depression to prognosis in either type of HPPD. Searches for comorbid anxiety, depression, and HPPD prognosis found no such passage in our copy. (LLM, conf=0.76)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

No citation lists for this paper

No citation lists for this paper yet — checked again daily.

References 40 · Cited by 143

Research works printed but not linked: 37

  1. [2]Blom JD, Looijestijn J, Goekoop R, et al. Treatment of Alice in Wonderland syndrome and verbal auditory hallucinations using repetitive transcranial magnetic stimulation. A case report with fMRI findings. Psychopathology 2011; 44: 337– 344. 21734437
  2. [3]Morland D, Wolff V, Dietemann JL, et al. Robin Hood caught in Wonderland: brain SPECT findings. Clin Nucl Med 2013; 38: 979– 981. 24152648
  3. [4]Kuo YT, Chiu NC, Shen EY, Ho CS, Wu MC Cerebral perfusion in children with Alice in Wonderland syndrome. Pediatr Neurol 1998; 19: 105– 108. 9744628
  4. [5]Gencoglu EA, Alehan F, Erol I, Koyuncu A, Aras M Brain SPECT findings in a patient with Alice in Wonderland syndrome. Clin Nucl Med 2005; 30: 758– 759. 16237308
  5. [6]Brumm K, Walenski M, Haist F, Robbins SL, Granet DB, Love T Functional magnetic resonance imaging of a child with Alice in Wonderland syndrome during an episode of micropsia. J AAPOS 2010; 14: 317– 322. 20598927 PMC2928409
  6. [7]Losada-Del Pozo R, Cantarín-Extremera V, García-Peñas JJ, et al. Caracteristícas y evolución de los pacientes con síndrome de Alicia en el País de las Maravillas. Rev Neurol 2011; 53: 641– 648. 22086425
  7. [8]Liu AM, Liu JG, Liu GW, Liu GT “Alice in Wonderland” syndrome: presenting and follow-up characteristics. Pediatr Neurol 2014; 51: 317– 320. 25160537
  8. [9]Eshel GM, Eyov A, Lahat E, Brauman A Alice in Wonderland syndrome, a manifestation of acute Epstein-Barr virus infection. Pediatr Infect Dis J 1987; 6: 68. 3822619
  9. [10]Lahat E, Eshel G, Arlazoroff A “Alice in Wonderland” syndrome: a manifestation of infectious mononucleosis in children. Behav Neurol 1991; 4: 163– 166. 24487499
  10. [11]Bui E, Chatagner A, Schmitt L Alice in Wonderland syndrome in major depressive disorder. J Neuropsychiatry Clin Neurosci 2010; 22: 352. 20686154
  11. [12]Todd J The syndrome of Alice in Wonderland. Can Med Assoc J 1955; 73: 701– 704. 13304769 PMC1826192
  12. [14]Veraguth O Ueber Mikropsie und Makropsie. Dtsch Z Nervenheilkd 1903; 24: 453– 464.
  13. [15]Bonnier P L'aschématie. Rev Neurol 1905; 13: 605– 609.
  14. [16]Wilson SAK Dysmetropsia and its pathogenesis. Trans Ophthalmol Soc U K 1916; 36: 412– 444.
  15. [17]Pötzl O Über Anfälle vom Thalamustypus. Z Gesamte Neurol Psychiatr 1943; 176: 793– 800.
  16. [18]Gelb A, Goldstein K Zur Psychologie des optischen Wahrnehmungs- und Erkennungsvorganges. Z Gesamte Neurol Psychiatr 1918; 41: 1– 141.
  17. [19]Seitelberger F Über Phantomerscheinungen bei Thalamuserkrankungen. Wien Z Nervenheilkd Grenzgeb 1952; 4: 259– 265.
  18. [20]Coleman SM Misidentification and non-recognition. J Ment Sci 1933; 79: 42– 51.
  19. [21]Lippman CW Certain hallucinations peculiar to migraine. J Nerv Ment Dis 1952; 116: 346– 351. 12991095
  20. [22]Podoll K, Robinson D Lewis Carroll's migraine experiences. Lancet 1999; 353: 1366. 10218566
  21. [23]Restak RM Alice in migraineland. Headache 2006; 46: 306– 311. 16492240
  22. [24]Carmichael C Wonderland revisited. London Miscellany 1996; 28: 19– 28.
  23. [26]Lanska JR, Lanska DJ Alice in Wonderland syndrome: somesthetic vs visual perceptual disturbance. Neurology 2013; 80: 1262– 1264. 23446681
  24. [27]Blom JD, Sommer IEC, Koops S, Sacks OW Prosopometamorphopsia and facial hallucinations. Lancet 2014; 384: 1998. 25435453
  25. [28]Willanger R, Klee A Metamorphopsia and other visual disturbances with latency occurring in patients with diffuse cerebral lesions. Acta Neurol Scand 1966; 42: 1– 18.
  26. [30]Smith RA, Wright B, Bennett S Hallucinations and illusions in migraine in children and the Alice in Wonderland syndrome. Arch Dis Child 2015; 100: 296– 298. 25355729
  27. [31]Abe K, Suzuki T Prevalence of some symptoms in adolescence and maturity: social phobias, anxiety symptoms, episodic illusions and idea of reference. Psychopathology 1986; 19: 200– 205. 3562750
  28. [32]Abe K, Oda N, Araki R, Igata M Macropsia, micropsia, and episodic illusions in Japanese adolescents. J Am Acad Child Adolesc Psychiatry 1989; 28: 493– 496. 2788641
  29. [33]Lipsanen T, Lauerma H, Peltola P, Kallio S Visual distortions and dissociation. J Nerv Ment Dis 1999; 187: 109– 112. 10067951
  30. [34]ffytche DH, Howard RJ The perceptual consequences of visual loss: “positive” pathologies of vision. Brain 1999; 122: 1247– 1260. 10388791
  31. [35]Deecke L, Mergner T, Plester D Tullio phenomenon with torsion of the eyes and subjective tilt of the visual surround. Ann NY Acad Sci 1981; 374: 650– 655. 6978652
  32. [36]ffytche DH, Blom JD, Catani M Disorders of visual perception. J Neurol Neurosurg Psychiatry 2010; 81: 1280– 1287. 20972204
  33. [37]Ceriani F, Gentileschi V, Muggia S, et al. Seeing objects smaller than they are: micropsia following right temporo-parietal infarction. Cortex 1998; 34: 131– 138. 9533999
  34. [38]Kew J, Wright A, Halligan PW Somesthetic aura: the experience of “Alice in Wonderland.” Lancet 1998; 351: 1934. 9654271
  35. [39]Litjens RP, Brunt TM, Alderliefste GJ, et al. Hallucinogen persisting perception disorder and the serotonergic system: a comprehensive review including new MDMA-related clinical cases. Eur Neuropsychopharmacol 2014; 24: 1309– 1323. 24933532
  36. [42]Morehead DB Exacerbation of hallucinogen-persisting perception disorder with risperidone. J Clin Psychopharmacol 1997; 17: 327– 328. 9241019
  37. [43]Lerner AG, Lev Ran S LSD-associated “Alice in Wonderland syndrome” (AIWS): a hallucinogen persisting perception disorder (HPPD) case report. Isr J Psychiatry Relat Sci 2015; 52: 67– 69. 25841113

Authors
Blom, J. D.
Affiliations
Leiden University (NL)
Corresponding author
Blom, Jan Dirk
ORCID
Blom, Jan Dirk
Venue
Neurology Clinical Practice
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2016-06
Volume
6
Issue
3
Pages
259-270
ISSN
  • 2163-0402 (ISSN-L)
  • 2163-0933
DOI
10.1212/cpj.0000000000000251
PMC
PMC4909520
OpenAlex
W2338302713
Cited by
143
References
40
Citations by year
2026: 14 · 2025: 24 · 2024: 16 · 2023: 20 · 2022: 12 · 2021: 13 · 2020: 14 · 2019: 8 · 2018: 12 · 2017: 8 · 2016: 1
FWCI
1.02
Type
journal article
Language
en
Open access
Licence
cc-by-nc-nd
Locations
  • Neurology Clinical Practice (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • Leiden Repository (Leiden University) (submittedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion, cc-by-nc-nd)
Topics
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Hallucinations in medical conditions
  • Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
  • Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
Keywords
Alice in Wonderland syndrome, body schema, time perception, etiology, encephalitis, neurological disorders, adolescents, diagnosis, treatment

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review