Russell's sign

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|image = Russell's Sign.png

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|causes = The most common causes of Russell’s sign are bulimia, purging disorder, and anorexia nervosa.

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|diagnosis = Russell's sign can be used as a factor to diagnose bulimia nervosa, purging disorder, or anorexia nervosa

|differential = Indirect sign of bulimia nervosa, purging disorder, or anorexia nervosa

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|deaths = While Russell’s sign in of itself has not caused any deaths, it is a sign of potentially deadly disorders such as bulimia nervosa, purging disorder, and anorexia nervosa.

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Russell's sign, named after British psychiatrist Gerald Russell, is a sign{{cite journal |vauthors=Tyler I, Birmingham CL |title=The interrater reliability of physical signs in patients with eating disorders |journal=Int J Eat Disord |volume=30 |issue=3 |pages=343–5 |date=November 2001 |pmid=11767717 |doi=10.1002/eat.1094 }} defined as calluses on the knuckles{{cite journal |author=Strumia R |title=Dermatologic signs in patients with eating disorders |journal=Am J Clin Dermatol |volume=6 |issue=3 |pages=165–73 |year=2005 |pmid=15943493 |doi=10.2165/00128071-200506030-00003 |s2cid=42761798 |url=https://dx.doi.org/10.2165/00128071-200506030-00003 |archive-url=https://archive.today/20130209123017/http://content.wkhealth.com/linkback/openurl?issn=1175-0561&volume=6&issue=3&spage=165 |url-status=dead |archive-date=2013-02-09 |url-access=subscription }} or back of the hand due to repeated self-induced vomiting over long periods of time. The condition generally arises from the patient's knuckles making contact with the incisor teeth during the act of inducing the gag reflex at the back of the throat with their finger(s).{{cite journal | last=Glorio | first=Roberto | last2=Allevato | first2=Miguel | last3=De Pablo | first3=Ana | last4=Abbruzzese | first4=Mario | last5=Carmona | first5=Luz | last6=Savarin | first6=Mario | last7=Ibarra | first7=Monica | last8=Busso | first8=Corina | last9=Mordoh | first9=Ana | last10=Llopis | first10=Carolina | last11=Haas | first11=Roxana | last12=Bello | first12=Mabel | last13=Woscoff | first13=Alberto | title=Prevalence of cutaneous manifestations in 200 patients with eating disorders | journal=International Journal of Dermatology | volume=39 | issue=5 | date=2000 | issn=0011-9059 | doi=10.1046/j.1365-4362.2000.00924.x |pmid=10849124 | pages=348–353}}

This type of scarring is considered one of the physical indicators of a mental illness, and Russell's sign is primarily found in patients with an eating disorder such as bulimia nervosa, purging disorder, or anorexia nervosa. It is almost always associated with eating disorders and is the most characteristic skin condition indicative of purging.{{cite journal|doi=10.1176/appi.neuropsych.13060127 |title=Russell's Sign in Persistent Delusional Disorder: A Case Report |date=2014 |last1=Manoharan |first1=Senthil Vel Rajan Rajaram |last2=Behere |first2=Rishikesh V. |last3=Praharaj |first3=Samir Kumar |last4=Kongasseri |first4=Sreejayan |last5=Sharma |first5=P.S.V.N. |journal=The Journal of Neuropsychiatry and Clinical Neurosciences |volume=26 |issue=3 |pages=E4–E5 |pmid=25093783 }}

People who are capable of "handsfree purging", or the induction of vomiting by the willful opening of the esophageal sphincter in a manner similar to belching, while contracting the stomach muscles, do not have Russell's sign. People who use a fork, spoon, or foreign object to stimulate the gag reflex may not display Russell's sign.