What Is Russell's Sign?

M.C. Huguelet

Russell’s sign is a term used to describe the scarring and calluses that often build up on the lower knuckles of a bulimic individual from inserting the fingers into the mouth to stimulate vomiting. The term is named for the British psychiatrist who first described bulimia in a medical publication in the 1970s. It is important to note that not every bulimic individual develops Russell’s sign, and that skin damage around the knuckles does not always indicate bulimia. Consequently, the presence or absence of Russell’s sign alone cannot be used to determine whether an individual suffers from bulimia.

Some bulimic individuals are able to stimulate vomiting without using their hands.
Some bulimic individuals are able to stimulate vomiting without using their hands.

The term Russell’s sign refers to skin damage, such as scarring and calluses, that develops on and around the lower knuckles of a bulimic individual’s hand. This damage occurs when the fingers are placed in the mouth to induce vomiting. As the fingers are used to stimulate the gag reflex at the back of the throat, the knuckles often collide with the upper teeth. Depending on the length of time that an individual has suffered from bulimia and whether that individual is currently engaging in purging, her knuckles may show a mix of old scarring and fresh scrapes or cuts.

Someone with Russell's sign is likely bulimic.
Someone with Russell's sign is likely bulimic.

In 1979, a British psychiatrist named Gerald Russell became the first physician to publish a professional report on bulimia. His report noted a number of symptoms that often accompany this condition. Among these symptoms was skin damage around the lower knuckles. Following Russell’s report, this bulimia-related skin damage was termed Russell’s sign.

Bulimia can have serious physical and emotional consequences.
Bulimia can have serious physical and emotional consequences.

It is important to note that the occurrence or lack of Russell’s sign is not considered sufficient evidence to prove or refute a case of bulimia. This is because some bulimic individuals are able to stimulate vomiting without using their hands and consequently do not sustain damage to their knuckles. Further, damage to the hands can often be caused by some other source. In this case, falsely presuming that an individual is bulimic can lead to hurt feelings and damaged relationships. While Russell’s sign may be an indicator of bulimia, the condition can be diagnosed only after a physician has examined the individual in question and determined that she purges herself of food via vomiting, excessive exercise, or some other means.

Russell's sign is indicative of scarring and calluses on a person's lower knuckles.
Russell's sign is indicative of scarring and calluses on a person's lower knuckles.
Bulimia is the most common eating disorder in women with type 1 diabetes.
Bulimia is the most common eating disorder in women with type 1 diabetes.
Individuals suffering from extreme cases of bulimia may require hospitalization and the use of a feeding tube.
Individuals suffering from extreme cases of bulimia may require hospitalization and the use of a feeding tube.
Bulimia can damage tooth enamel.
Bulimia can damage tooth enamel.

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