Autometamorphopsia

A special case of metamorphopsia regarding a violation of self-perception, that is, directly of the size and shape of one’s own body as a whole or its individual parts, is called autometamorphopsia. This pathology is not an independent disease and is considered within the framework of depersonalization syndrome as one of its manifestations. It develops with various disorders of the central nervous system.

An autometamorphopsia can be total when the perception of one’s entire body is distorted, or partial, partial, when the distortions concern any part of the body. Western clinicians call this phenomenon Alice’s syndrome in Wonderland or Todd’s syndrome, by the name of a psychiatrist from Great Britain who owns the name.

Epidemiology

Autometamorphopsia is only a manifestation of a violation of self-awareness in many diseases, therefore, accurate statistics on the frequency of cases of this pathology is unknown. It is described in detail, therefore it is often found. In children, it is not possible to diagnose with confidence such a disorder in the perception of their own body. In adolescents, autometamorphopsia of a purely stressful origin also practically does not occur. Therefore, early manifestations of a “body pattern disorder” are considered signs of serious illness — schizophrenia, epilepsy, or psychedelic abuse. The debut of most cases of autometamorphopsia occurs before 30 years, which in general coincides with the age of manifestation of the bulk of cases of mental illness.

There is no epidemiological evidence for Alice’s syndrome in Wonderland in the general population. Although it is usually assumed that the syndrome is rare, clinical trials among patients with migraines show that the prevalence rate in this group can be about 15%. [1],  [2] In adolescents crossover study in 1480  [3] it was found that the prevalence micropsia and / or macropsia the lifetime is 5.6% for men and 6.2% for women. A cross-sectional study  [4] of 297 people with an average age of 25.7 years found a lifetime prevalence of 30.3% for teleopsy, 18.5% for dysmorphopsia, 15.1% for macropsy, and 14.1% for micropsy.

Causes of the avtometamorfopsii

Unlike metamorphopsia, which may be due to visual defects, isolated autometamorphopsia, which concerns only the distortion of the physical parameters of one’s own body (other objects are perceived correctly), is a disorder of higher nervous activity and one of the manifestations of depersonalization syndrome, which is also extremely rare as an independent disease. Basically, distorted perception of his own body diagrams inherent schizophrenics, epileptics, people suffering from migraine (during seizures)  [5],  [6],  [7] disturbing, phobia, depression, obsessive-compulsive disorder, organic lesions of the cerebral structures (acute disseminated encephalomyelitis)  [8] , and even vegetative dystonia (I heard this explanation in my life at least once, probably all). The exact reason for the development of autometamorphopsia, as well as the diseases that cause this mental phenomenon, is under study. And it is definitely not the only one, since a disorder of perception of the scheme of one's own body is observed with many violations of mental status.

Risk factors are numerous. In addition to neurological deficits and mental illnesses, they include acute severe infectious diseases with a complicated course; head injuries; encephalitis; [9] chronic metabolic disorders and hormonal imbalance; addictions to alcohol, drugs, computer games, dysfunctional conditions in the family, etc.

Stress can provoke a violation of self-perception, and sometimes insignificant. Especially when it is superimposed on chronic lack of sleep, physical overstrain, immunosuppression after an illness. Individuals who are prone to lengthy deliberation and analysis of negative events and their role in them, are suspicious, touchy, overstated, non-contact and unsure of themselves, the risk of developing autometamorphopsia is significantly higher than that of mentally stable individuals.

There are usually several factors, and another stress on the background of mental exhaustion gives impetus to the development of this disorder.

Pathogenesis

The pathogenesis of disorganization of self-perception is considered as a violation of neurochemical balance in the cells of the brain. Symptoms of autometamorphopsia are associated with functional and structural abnormalities in the perceptual system. [10]

Most symptoms of autometamorphopsia are associated with clusters of neurons that selectively respond to specific types of sensory signals (for vision, especially in areas of the cortex V1-V5). For example, extrasystatic visual cortex region V4 selectively responds to color, while region V5 responds to movement. Both areas also respond to shape and depth, but bilateral loss of V4 function leads to achromatopsia (inability to see color), and bilateral loss of V5 leads to akinetopsia (inability to see movement). The inability to visually perceive vertical lines (plagiopsia) or lines at a different angle is explained by the loss of the function of orientation columns, which are grouped by horizontal layers of the visual cortex. [11]

A violation of serotonergic, dopaminergic, GABA-ergic regulation is assumed. There are various hypotheses for the development of autometamorphopsia, but the processes taking place in the brain are still beyond full understanding. The visual perception of one’s own body, provoked by a number of the above factors, disrupts the internal idea of the structural organization of the body and / or its dynamic characteristics, independent of the will of the individual. The disorder occurs at the very first stage of higher nervous activity. An object, in this case, the body or part of it, is correctly identified, that is, the sensory organs correctly reflect its qualitative characteristic, and the quantitative one - shape, size, location distort, and a holistic view is already formed incorrectly. Depersonalization, one of the manifestations of which is autometamorphopsia - the rejection of one's own body, is recognized as a protective reaction of the exhausted nervous system to mental trauma. The manifestation occurs suddenly immediately after stress and in some cases the condition can stabilize on its own. Often patients understand that their perception is impaired, but this does not depend on the will of the individual, and if the pathology is long, then the patient develops a persistent belief in his physical disability over time.

Symptoms of the avtometamorfopsii

The first signs appear suddenly after acute or chronic stress - suddenly the feeling of self completely changes or such changes occur periodically. Patients note that the period preceding the onset of symptoms is characterized by a high level of anxiety and emotional stress, most patients experience a feeling of change in their own body, going to bed. Alienation from your body, as a rule, does not happen, sensations are sharp and distinct, they attract attention. Although in some cases, patients note alienation, the body is felt as if from the outside, as a stranger.

Total autometamorphopsia is manifested by the perception of a proportional increase (macropsy) or decrease (micropsy) of the sizes of all parts of the body, while their shape is usually perceived correctly. The degree of increase (decrease) can be different, sometimes the patient has a feeling of a huge body. It seems so big that the patient is afraid to enter a spacious room so as not to get stuck. The apparent decrease can cause the patient, for example, fear of drowning in a puddle. The body is perceived as distant and turned into a point. In some cases, such metamorphoses of perception are hardly noticeable.

Partial (partial) autometamorphopsia is more common than total. Any part of the body may seem altered. The most common violations have their own names.

Macromilia is a sensation of big hands. Both arms or parts thereof, such as palms or fingers, may be perceived as enlarged. Asleep, the patient feels how huge his hands are. The effect of "big hands" can be symmetrical or one-sided. Micromilia is a sensation of small hands, sometimes quite microscopic.

In addition, it happens that one part of the body, for example, the left hand, seems to be enlarged, and the other, the right - is reduced. This condition is called contrast autometamorphopsia.

The feeling of one’s legs as large and / or thick is called macropedia, respectively, a decrease is called micropedia.

Often, distorted sensations affect the head - macro- and microcephalopsia. Any organ or its part can be perceived incorrectly: tongue, nose, ears, neck, chest, stomach, genitals, and so on.

An unconscious internal concept of the shape of the body or its parts (autodysmorphopsia), their position (bodily allesthesia), and dynamic characteristics may be disturbed. [12]

Autodysmorphopsia manifests itself in the fact that rounded parts of the body, for example, the head, are perceived as triangular, rectangular square, abnormally long or short, curved, spherical, etc. [13]

With corporal allesthesia, the feet may appear to be inverted toes, the back to the front and the knees to the back.

The idea of the width of steps, the intensity of gestures, and the speed of movement may be disturbed. The nature of the movements can be perceived distorted, for example, cramps - like rotational movements, smoothness seems to be intermittent.

Sometimes all parts of the body seem fragmented - the head or hands, separated from the body, eyes - popping out of their orbits (somatopsychic dissociation). The whole body can be represented as composed of individual elements, as a constructor. At the same time, the patient is worried about his integrity and is afraid that it will crumble. K. Jaspers called this condition "a symptom of a dissociated self."

Since the body diagram means the totality of unconscious information about the structural organization of the body, incorrect manifestations of the localization of sensations, for example, pain or tactile, the placement of emotions, for example, fear, in the throat or lower abdomen (Minor symptom) are also referred to as manifestations of autometamorphopsia.

Patients perceive manifestations painfully. In most cases, the phenomena of autometamorphopsia are accompanied by other psychopathological symptoms: anxiety, unreasonable fears (drowning in a puddle or spreading across the floor), panic attacks, depression, social isolation. In case of serious diseases, their symptoms are present: epileptic seizures, peremptory voices, obsessions, automatisms, ritual acts, etc.

Sometimes, in mild cases, it is possible to correct the distorted idea of the parameters of the body by looking in the mirror. At the same time, a person is convinced that everything is in order.

The duration of the symptoms of AIWS is generally from a few minutes to 26 days; However, symptoms may persist for 2 years or even for life. [14] An essential detail is that after visual fixation on an object, metamorphopsies can sometimes occur in the interval from seconds to minutes. After this time delay, objects are perceived in a distorted way, but during the delay, the perception process is not disturbed. In historical literature, this phenomenon is explained as a sign of cerebral asthenopia (that is, unusual fatigue of the perceptual system).

Complications and consequences

Autometamorphopsia can be a sign of a serious disease, so with prolonged troubles of this kind, you should definitely consult your doctor. Since this condition is often just a symptom of more significant mental disorders, it is known that in the initial stages, any disease is much better treatable. The consequence of ignoring the symptoms of the disease is its progress and, ultimately, the emergence of resistance to treatment, aggravation of the disease, loss of independence, and sometimes premature death.

Autometamorphopsia, not associated with a progressive mental illness, is not always self-stopping. In the initial stages, patients are critical of their condition, but its unnaturalness creates the prerequisites for constant reflection, a person thinks he is losing his mind. Obsessions, severe neurosis, depression may develop. Patients prefer isolation, lose social connections, self-esteem, neglect their official and family responsibilities, as complacency, distractions often become dependent on psychoactive substances. There is a high probability of committing illegal or suicidal acts.

Diagnostics of the avtometamorfopsii

Patient complaints usually come down to the fact that they suddenly have strange sensations of disproportion of their body or its parts: it seems prohibitively large or small, and in this connection new inconveniences appear: they are afraid to go out because small ones will crush them; to enter the room - they are stuck because they are large; go to bed because huge hands will crush them, etc. Basically, patients emphasize that they understand - the sensations are apparent.

The doctor asks the patient in detail what preceded the onset of symptoms, how he is sick, whether something like this happened to him earlier, how often he drinks, whether he takes any medications, or if he has other dependencies. The family history, stress tolerance, and cognitive abilities of the patient are analyzed. Since autometamorphopsia is one of the manifestations of depersonalization, the patient is asked to undergo specific tests.

In addition, a general health examination is prescribed - clinical blood and urine tests, an endocrinologist’s consultation and tests for blood glucose, thyroid hormones can be prescribed. If a patient is suspected of abusing psychedelics, a urine test is prescribed to detect traces of psychoactive substances and a narcologist is advised.

Hardware studies (MRI, EEG, ultrasound) are prescribed to rule out or confirm the organic causes for the occurrence of symptoms of a perceptual disorder. This is especially true with a late debut, the absence of factors provoking it, symptoms of neurosis, depression, previous craniocerebral trauma.

Differential diagnosis

Differential diagnosis and the establishment of a final diagnosis is carried out according to surveys. A diazepam test may be prescribed.

Autometamorphopsia is differentiated with other disturbances in perception - hallucinations and illusions. The object of hallucinations is imaginary, but naturally fits into the environment. The patient has no criticism regarding his feelings. With illusions, a really existing object is taken for something completely different. With autometamorphopsia, the object is real and recognizable, but its characteristics are transformed in the patient’s mind. Patients mainly understand the absurdity of their sensations.

Like autometamorphopsia, functional hallucinations occur when there is a real object. Real irritants provoke their occurrence, for example, imaginary sounds, smells, tactile sensations appear in parallel to the sound of wind, the sound of pouring water or the sound of train wheels. The patient perceives both real sounds and imaginary phenomena at the same time, they coexist in his mind, and when the stimulus ceases, they immediately disappear.

Treatment of the avtometamorfopsii

Autometamorphopsia, which suddenly appeared on the background of a traumatic situation as an isolated neurotic syndrome, that is, regular recurrent bouts of distorted perception or constant disorder, usually leads people into confusion. There are thoughts about the loss of reason. What to do? Can I do it myself? After all, I do not want to immediately use heavy artillery - psychotropic drugs. Information about their side effects is not inspiring.

Given that we are talking about the manifestation of depersonalization syndrome, you need to take similar measures. If the patient feels the desire and strength to get rid of the disorder on his own, then, without delay, you need to get down to business (How to get rid of depersonalization yourself?).

Topical treatment for mTMS (repetitive transcranial magnetic stimulation) can have a global therapeutic effect in Alice’s syndrome in wonderland and verbal auditory hallucinations. [15]

In complex cases, resort to medical treatment. It is carried out only as directed and under medical supervision, self-medication is strictly excluded, since psychotropic drugs cause a lot of side effects, addiction and withdrawal syndrome (drug therapy of depersonalization). You can resort to homeopathic treatment. The drugs used in the alternative direction of medicine are non-toxic, and correctly prescribed treatment can be very effective. However, it also needs to be carried out under the supervision of a specialist.

A good effect is psychotherapy. It is used both independently and in combination with medication. The therapist can give recommendations on the use of certain methods of working on yourself at home. In general, without the desire and efforts of the patient himself, he will not be able to cope with the problem. 

In cases where the cause of autometamorphopsia was a mental or somatic pathology, it is necessary to treat the underlying disease. When it is cured, or in cases of schizophrenia or epilepsy, when a stable remission is achieved, the symptoms of the disorder of the body pattern disappear, and usually the first.

Alice's Wonderland Syndrome (AIWS) does not have a proven effective treatment, but treatment programs for the possible causes of this disease are used to alleviate the condition. Chronic cases of AIWS are completely untreatable. A person suffering from a disorder may have distortions and hallucinations several times during the day. Fairly, a person can be scared, excited and panicked. These manifestations are not harmful or dangerous, and, in all likelihood, will disappear over time.

Cases of AIWS have been described using montelukast,  [16] a mast cell stabilizer. Moreover, the association of AIWS with Lyme disease, [17] mononucleosis  [18] and H1N1 influenza infection is known . [19],  [20] Further studies on this association has not yet been excluded.

In general, a treatment plan consists of migraine prophylaxis (anticonvulsants, antidepressants, calcium channel blockers, and beta blockers). Following a diet regimen for migraines provides tremendous relief.

Complete remission was achieved in 46.7% of all patients, and partial or temporary remission in 11.3%. In chronic conditions such as epilepsy and migraine, complete remission has been achieved very rarely. [21]

Prevention

To prevent the occurrence of violations of self-perception, as well as to prevent relapse, it is recommended to analyze and adjust your attitude to the world, requests, optimize goals and objectives in accordance with real possibilities. To bring more positive things into your life, find something for yourself to your liking, increase physical activity. It has been established that physical activity promotes the production of endogenous antidepressants. It will be useful to take a course of rational psychotherapy. At the same time, no one canceled the benefits of a balanced diet and the absence of harmful addictions.

In some cases, when a mental disorder was caused by the use of psychoactive substances, it is necessary to change the circle of communication and, if possible, the place of residence.

Forecast

Autometamorphopsia as a neurotic post-stress disorder is prognostically favorable. People who have taken measures to get rid of pathological manifestations, almost immediately have every chance to quickly cope with the situation. The prognosis almost always depends on the desire and efforts of the patient himself.

In advanced cases, autometamorphopsia can be difficult to cure, in some cases, the disorder becomes chronic relapsing in nature and complications develop against its background. However, it is worth noting that with autometamorphopsies of neurotic origin, significant personality changes are not observed.

If a body circuit disorder is observed in the symptom complex of schizophrenia, epilepsy, organic brain pathologies, etc., then the prospects for recovery depend on the prognosis of the underlying disease.