To the Editor:
The vast majority of micropsia cases in PubMed literature are attributed to organic pathology. In clinical practice, there are many cases without any relevant organic findings.
In dissociative disorders, there are distortions of perceptions as well as self experience and memory, while reality testing remains adequate. The Dissociative Experiences Scale (DES) is a patient-administered self-rating scale that can be easily used without special education (1). In psychiatric practice, we have come across three patients with micropsia as a prominent symptom. A 40-year-old woman reported seeing things, especially cars, smaller than they were, and was afraid that she would be run over by one; a 22-year-old woman suffering from micropsia felt that the walls around her were tumbling down; and a 51-year-old railroad worker occasionally saw trains as small as toy trains. Their DES scores (31.4, 30.4, and 51.0) were far above normal range (0–20/100), and each of them received the diagnosis of a dissociative disorder in a structured psychiatric examination. A strong correlation between micropsia and DES score was also found in a nonclinical sample of 297 subjects (2).
We suggest that neuro-ophthalmologists consider that micropsia may be a manifestation of a dissociative disorder. The DES can be used to screen for dissociative disorders in psychiatric examinations.
Tapio Lipsanen, MD
Jyrki Korkeila, MD, PhD
Simo Saarijärvi, MD, PhD
Hannu Lauerma, MD, PhD
1. Steinberg M, Rounsaville B, Cicchetti D. Detection of dissociative disorders in psychiatric patients by a screening instrument and a structured diagnostic interview. Am J Psychiatry 1991; 148:1050–4.
2. Lipsanen T, Lauerma H, Peltola P, Kaet al. Visual distortions and dissociation. J Nerv Ment Dis 1999; 187:109–12.