Russell’s sign is a physical indicator that may occur in people who engage in self-induced vomiting. People with Russell’s sign may have calluses, abrasions, or scars on the knuckles or back of their hands.

Russell’s sign is a physical symptom found in some people with eating disorders, such as bulimia nervosa. The abrasions can occur when someone repeatedly uses the fingers to induce vomiting, causing the skin on the knuckles to rub against the teeth.

However, other activities that cause friction against the back of the hand or knuckles can also lead to these calluses. Russell’s sign does not always indicate an eating disorder.

This article looks at the conditions that may cause Russell’s sign, including their symptoms and treatment, when to speak with a doctor, and how to get support with an eating disorder.

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When a person inserts their fingers into their mouth and throat to trigger their gag reflex to induce vomiting, the skin on the knuckles or back of the hand rubs against the teeth.

Over time, this repeated action can cause damage to the skin, resulting in the formation of calluses, abrasions, or scars, collectively referred to as Russell’s sign.

People with bulimia nervosa often engage in episodes of compulsive eating, followed by compensatory behaviors, such as:

Learn more about bulimia nervosa.


The repeated act of self-induced vomiting can lead to the development of Russell’s sign. Other symptoms of bulimia nervosa may include:

  • eating large amounts of food in a short period
  • dental problems, including enamel erosion
  • feelings of guilt, shame, or anxiety after eating
  • hiding food or eating in secret
  • mood swings or depression
  • noticeable fluctuations in weight
  • obsession with food, dieting, or exercise
  • preoccupation with body shape and weight
  • stomach cramps or other gastrointestinal problems
  • swelling of the cheeks or jaw area
  • dizziness or fainting due to dehydration


Treatment options for bulimia nervosa typically aim to help stop binging and purging behaviors, including the following:

  • Psychotherapy: Cognitive behavioral therapy (CBT) may benefit people with bulimia nervosa by helping them understand and change unhealthy eating behaviors and negative body image.
  • Medication: Antidepressants, such as fluoxetine (Prozac), may help manage symptoms.
  • Nutritional counseling: A registered dietitian can help develop a healthy eating plan and promote a new, healthier relationship with food.
  • Hospitalization: In people with severe cases or significant medical complications, hospitalization may be necessary.

People with the binge-purge subtype of anorexia nervosa may engage in self-induced vomiting or other compensatory behaviors after eating. This can also lead to the development of Russell’s sign.

Learn more about anorexia nervosa.


Symptoms of anorexia nervosa may include the following:


According to a 2021 review article, current treatment approaches for anorexia nervosa may include:

  • Psychotherapy: Family-based therapy (FBT) is often the first-line treatment for adolescents with anorexia nervosa. Individual therapy, such as CBT, may be more appropriate for adults.
  • Medication: There is currently no medication approved by the Food and Drug Administration (FDA) for anorexia nervosa. However, some medications, including antidepressants, may help manage associated symptoms, such as anxiety or depression.

Some people with anorexia nervosa may require hospitalization if their symptoms are severe.

Russell’s sign can indicate eating disorders, particularly bulimia nervosa and the binge-purge subtype of anorexia nervosa, as it often results from the repeated action of self-induced vomiting.

However, someone can have calluses or abrasions on their knuckles from other activities or conditions that cause repeated friction on the hands, such as certain types of manual labor or martial arts training.

While Russell’s sign is a strong indicator of self-induced vomiting and may raise suspicion of an eating disorder, it is not definitive proof. A thorough assessment by a healthcare professional is necessary for an accurate diagnosis.

People should speak with a doctor if they notice they experience symptoms of an eating disorder. Early intervention is crucial for successful treatment and recovery.

Eating disorders are complex mental health conditions that often require a multidisciplinary approach to treatment.

However, to treat Russell’s sign, doctors may suggest the following:

  • soaking affected areas in warm water to soften the skin
  • gently file calluses with a pumice stone
  • apply moisturizer and lotion
  • stop activities that cause friction on the hands and knuckles

In the United States, there are several organizations and places where people can seek support for eating disorders:

  • National Eating Disorders Association (NEDA): NEDA provides support services, resources, and information on treatment options.
  • Eating Disorder Hope: This organization offers recovery tools, information, and resources for those experiencing eating disorders. They also offer online support groups.
  • National Association of Anorexia Nervosa and Associated Disorders (ANAD): ANAD offers support groups, recovery mentors, and other resources for people and families affected by eating disorders.
  • This is a searchable database of treatment facilities provided by the Substance Abuse and Mental Health Services Administration (SAMHSA).

People should speak with a healthcare professional for personalized advice and treatment options. A doctor may be able to suggest local support groups and other resources.

Supporting someone with an eating disorder

It can be challenging for people with eating disorders to seek help or even acknowledge they have a problem. The following methods may help people offer support to someone with an eating disorder:

  • Getting educated: People should learn as much as possible about eating disorders. People can offer better support when they understand the challenges a loved one is facing.
  • Listening without judgment: Be a supportive listener and avoid making judgmental or critical comments about their appearance or eating habits.
  • Expressing concerns: Express concerns honestly and kindly. Focus on their feelings and behaviors rather than their appearance.
  • Encouraging professional help: Encourage them to seek help from a healthcare professional or support group. Offer to help them find a treatment center or accompany them to an appointment.
  • Being patient: Recovery from an eating disorder is a long process, and there will be ups and downs. Be patient and offer support throughout their journey.

Not everyone with an eating disorder will develop Russell’s sign, and its presence does not definitively confirm an eating disorder.

However, Russell’s sign can indicate self-induced vomiting and may raise suspicion of an eating disorder, such as bulimia nervosa.

A thorough assessment by a healthcare professional is necessary for an accurate diagnosis and prompt treatment, which may include therapy or medications.