Let’s imagine Patient X. She is a 10-year-old girl with a family history of migraines. One night in bed, she looked at her fingers to find they stretched half a mile long; she stood up and screamed that she was growing taller and taller, eventually filling the entire room. The next night, Patient X claimed she had shrunk so much, her body was small enough to fit inside a dollhouse. When her mother was only a few feet away, she begged her not to leave as it appeared she was rapidly receding into the distance. On occasion, she reported feeling her leg sinking into the ground, and seeing her foot plunging into the carpet. Her mother has noticed she complains time moves painfully slowly, and she often describes the world “as if everything is at the wrong end of a telescope”.

Patient X is probably suffering from Alice in Wonderland Syndrome – a neurological condition characterised by altered perception and distortion of sensory modalities, typically affecting body parts and the sizes of external objects. These body image illusions most famously involve distortions of the size, mass or shape of the patient’s own body, or its position in space. Patients might also have a distorted perception of time, touch or sound.

The syndrome is named after the resemblance of its symptoms to the fluctuations in size and shape that plague the main character in Lewis Carroll's 1865 novel, Alice in Wonderland. In the novel, Alice undergoes dramatic changes in size, including shrinking to 10 inches and growing to the size of a room. The observed medical symptoms resemble this precisely. One patient described how an attack gradually builds up and “you feel like the room is shrinking in on you and that your body’s becoming larger”. Patients complain of being unable to live normally if the chair and desk at work seem enormous, and crossing the road becomes dangerous if they cannot judge the size or distance of approaching cars.   

The condition primarily affects children, and is thought to have a strong genetic link. Migraines and epilepsy are closely associated with the condition, as is infection with the Epstein-Barr virus, which can cause glandular fever. For around half of diagnosed cases, no cause is identified. The episodes of distorted perception that patients experience are typically of short duration (under an hour) and variable frequency (up to several times a day), occurring unpredictably. Thankfully, the majority of children ‘outgrow’ these symptoms over time – it is much rarer to experience the syndrome as an adult.

Interestingly, Lewis Carroll himself suffered from migraines, leading some scholars to speculate that he suffered from the syndrome. When British psychiatrist John Todd first described the condition in the Canadian Medical Association Journal in 1955, he noted that Carroll mentioning his migraines in his diary “arouses the suspicion that Alice trod the paths and byways of a Wonderland well known to her creator”.