Russell's sign

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Russell's sign
Russell's Sign.png
CausesThe most common causes of Russell’s Sign are bulimia, purging disorder, and anorexia nervosa.
Diagnostic method Russell's Sign can be used as a factor to diagnose bulimia nervosa, purging disorder, or anorexia nervosa
Differential diagnosis Indirect sign of bulimia nervosa, purging disorder, or anorexia nervosa
DeathsWhile 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.

Russell's sign, named after British psychiatrist Gerald Russell, is a sign [1] defined as calluses on the knuckles [2] 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). [3]

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. [2] [4]

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.

Related Research Articles

An eating disorder is a mental disorder defined by abnormal eating behaviors that adversely affect a person's physical or mental health. These behaviors include eating either too much or too little. Types of eating disorders include binge eating disorder, where the patient keeps eating large amounts in a short period of time typically while not being hungry; anorexia nervosa, where the person has an intense fear of gaining weight and restricts food or overexercises to manage this fear; bulimia nervosa, where individuals eat a large quantity (binging) then try to rid themselves of the food (purging); pica, where the patient eats non-food items; rumination syndrome, where the patient regurgitates undigested or minimally digested food; avoidant/restrictive food intake disorder (ARFID), where people have a reduced or selective food intake due to some psychological reasons; and a group of other specified feeding or eating disorders. Anxiety disorders, depression and substance abuse are common among people with eating disorders. These disorders do not include obesity. People often experience comorbidity between an eating disorder and OCD. It is estimated 20–60% of patients with an ED have a history of OCD.

<span class="mw-page-title-main">Bulimia nervosa</span> Type of eating disorder

Bulimia nervosa, also known as simply bulimia, is an eating disorder characterized by binge eating followed by purging or fasting, and excessive concern with body shape and weight. This activity aims to expel the body of calories eaten from the binging phase of the process. Binge eating refers to eating a large amount of food in a short amount of time. Purging refers to the attempts to get rid of the food consumed. This may be done by vomiting or taking laxatives.

Promotion of anorexia is the promotion of behaviors related to the eating disorder anorexia nervosa. It is often referred to simply as pro-ana or ana. The lesser-used term pro-mia refers likewise to bulimia nervosa and is sometimes used interchangeably with pro-ana. Pro-ana groups differ widely in their stances. Most claim that they exist mainly as a non-judgmental environment for anorexics; a place to turn to, to discuss their illness, and to support those who choose to enter recovery. Others deny anorexia nervosa is a mental illness and claim instead that it is a lifestyle choice that should be respected by doctors and family.

Binge eating disorder (BED) is an eating disorder characterized by frequent and recurrent binge eating episodes with associated negative psychological and social problems, but without the compensatory behaviors common to bulimia nervosa, OSFED, or the binge-purge subtype of anorexia nervosa.

Binge eating is a pattern of disordered eating which consists of episodes of uncontrollable eating. It is a common symptom of eating disorders such as binge eating disorder and bulimia nervosa. During such binges, a person rapidly consumes an excessive quantity of food. A diagnosis of binge eating is associated with feelings of loss of control. Binge eating disorder is also linked with being overweight and obesity.

The pharyngeal reflex or gag reflex is a reflex muscular contraction of the back of the throat, evoked by touching the roof of the mouth, back of the tongue, area around the tonsils, uvula, and back of the throat. It, along with other aerodigestive reflexes such as reflexive pharyngeal swallowing, prevents objects in the oral cavity from entering the throat except as part of normal swallowing and helps prevent choking, and is a form of coughing. The pharyngeal reflex is different from the laryngeal spasm, which is a reflex muscular contraction of the vocal cords.

A food addiction or eating addiction is any behavioral addiction characterized primarily by the compulsive consumption of palatable and hyperpalatable food items. Such foods often have high sugar, fat, and salt contents, and markedly activate the reward system in humans and other animals. Those with eating addictions often overconsume such foods despite the adverse consequences associated with their overconsumption.

<span class="mw-page-title-main">Rumination syndrome</span> Medical condition

Rumination syndrome, or merycism, is a chronic motility disorder characterized by effortless regurgitation of most meals following consumption, due to the involuntary contraction of the muscles around the abdomen. There is no retching, nausea, heartburn, odour, or abdominal pain associated with the regurgitation as there is with typical vomiting, and the regurgitated food is undigested. The disorder has been historically documented as affecting only infants, young children, and people with cognitive disabilities . It is increasingly being diagnosed in a greater number of otherwise healthy adolescents and adults, though there is a lack of awareness of the condition by doctors, patients, and the general public.

Gerald Francis Morris Russell was a British psychiatrist. In 1979 he published one of the first descriptions of bulimia nervosa, and Russell's sign has been named after him.

<span class="mw-page-title-main">Relative energy deficiency in sport</span> Syndrome of disordered eating, oligomenorrhoea and osteopenia

Relative energy deficiency in sport (RED-S) is a syndrome in which disordered eating, amenorrhoea/oligomenorrhoea, and decreased bone mineral density are present. It is caused by eating too little food to support the amount of energy being expended by an athlete, often at the urging of a coach or other authority figure who believes that athletes are more likely to win competitions when they have an extremely lean body type. RED-S is a serious illness with lifelong health consequences and can potentially be fatal.

<span class="mw-page-title-main">Vomiting</span> Involuntary, forceful expulsion of stomach contents, typically via the mouth

Vomiting is the involuntary, forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose.

Purging disorder is an eating disorder characterized by the DSM-5 as self-induced vomiting, or misuse of laxatives, diuretics, or enemas to forcefully evacuate matter from the body. Purging disorder differs from bulimia nervosa (BN) because individuals do not consume a large amount of food before they purge. In current diagnostic systems, purging disorder is a form of other specified feeding or eating disorder. Research indicates that purging disorder, while not rare, is not as commonly found as anorexia nervosa or bulimia nervosa. This syndrome is associated with clinically significant levels of distress, and that it appears to be distinct from bulimia nervosa on measures of hunger and ability to control food intake. Some of the signs of purging disorder are frequent trips to the bathroom directly after a meal, frequent use of laxatives, and obsession over one's appearance and weight. Other signs include swollen cheeks, popped blood vessels in the eyes, and clear teeth which are all signs of excessive vomiting.

<span class="mw-page-title-main">Nausea</span> Medical symptom or condition

Nausea is a diffuse sensation of unease and discomfort, sometimes perceived as an urge to vomit. While not painful, it can be a debilitating symptom if prolonged and has been described as placing discomfort on the chest, abdomen, or back of the throat.

Painful bruising syndrome, also known as autoerythrocyte sensitization, Gardner–Diamond syndrome, and psychogenic purpura, is an idiopathic trauma-induced condition seen in young to middle-aged women who sometimes manifest personality disorders. It is characterized by a distinctive localized purpuric reaction occurring primarily on the legs, face and trunk, with recurring painful ecchymoses variably accompanied by syncope, nausea, vomiting, gastrointestinal and intracranial bleeding. Patients with this condition can experience frequent painful bruising around joints and muscles. Because of the rarity of the disorder, there are few methods of support in place for patients.

Maudsley family therapy also known as family-based treatment or Maudsley approach, is a family therapy for the treatment of anorexia nervosa devised by Christopher Dare and colleagues at the Maudsley Hospital in London. A comparison of family to individual therapy was conducted with eighty anorexia patients. The study showed family therapy to be the more effective approach in patients under 18 and within 3 years of the onset of their illness. Subsequent research confirmed the efficacy of family-based treatment for teens with anorexia nervosa. Family-based treatment has been adapted for bulimia nervosa and showed promising results in a randomized controlled trial comparing it to supportive individual therapy.

<span class="mw-page-title-main">Anorexia nervosa</span> Type of eating disorder

Anorexia nervosa (AN), often referred to simply as anorexia, is an eating disorder characterized by food restriction, body image disturbance, fear of gaining weight, and an overpowering desire to be thin.

The differential diagnoses of anorexia nervosa (AN) includes various types of medical and psychological conditions, which may be misdiagnosed as AN. In some cases, these conditions may be comorbid with AN because the misdiagnosis of AN is not uncommon. For example, a case of achalasia was misdiagnosed as AN and the patient spent two months confined to a psychiatric hospital. A reason for the differential diagnoses that surround AN arise mainly because, like other disorders, it is primarily, albeit defensively and adaptive for, the individual concerned. Anorexia Nervosa is a psychological disorder characterized by extremely reduced intake of food. People with anorexia nervosa tend to have a low self-image and an inaccurate perception of their body.

Cognitive behavioral therapy (CBT) is derived from both the cognitive and behavioral schools of psychology and focuses on the alteration of thoughts and actions with the goal of treating various disorders. The cognitive behavioral treatment of eating disorders emphasizes on the minimization of negative thoughts about body image and the act of eating, and attempts to alter negative and harmful behaviors that are involved in and perpetuate eating disorders. It also encourages the ability to tolerate negative thoughts and feelings as well as the ability to think about food and body perception in a multi-dimensional way. The emphasis is not only placed on altering cognition, but also on tangible practices like making goals and being rewarded for meeting those goals. CBT is a "time-limited and focused approach" which means that it is important for the patients of this type of therapy to have particular issues that they want to address when they begin treatment. CBT has also proven to be one of the most effective treatments for eating disorders.

Drunkorexia is a colloquialism for anorexia or bulimia combined with an alcohol use disorder. The term is generally used to denote the utilization of extreme weight control methods to compensate for planned binge drinking. Research on the combination of an eating disorder and binge drinking has primarily focused on college-aged women, though the phenomenon has also been noted among young men. Studies suggest that individuals engage in this combination of self-imposed malnutrition and binge drinking to avoid weight gain from alcohol, to save money for purchasing alcohol, and to facilitate alcohol intoxication.

Oral manifestations of systematic disease are signs and symptoms of disease occurring elsewhere in the body detected in the oral cavity and oral secretions. High blood sugar can be detected by sampling saliva. Saliva sampling may be a non-invasive way to detect changes in the gut microbiome and changes in systemic disease. Another example is tertiary syphilis, where changes to teeth can occur. Syphilis infection can be associated with longitudinal furrows of the tongue.

References

  1. Tyler I, Birmingham CL (November 2001). "The interrater reliability of physical signs in patients with eating disorders". Int J Eat Disord. 30 (3): 343–5. doi:10.1002/eat.1094. PMID   11767717.
  2. 1 2 Strumia R (2005). "Dermatologic signs in patients with eating disorders". Am J Clin Dermatol. 6 (3): 165–73. doi:10.2165/00128071-200506030-00003. PMID   15943493. S2CID   42761798. Archived from the original on 2013-02-09.
  3. Glorio, Roberto; Allevato, Miguel; De Pablo, Ana; Abbruzzese, Mario; Carmona, Luz; Savarin, Mario; Ibarra, Monica; Busso, Corina; Mordoh, Ana; Llopis, Carolina; Haas, Roxana; Bello, Mabel; Woscoff, Alberto (2000). "Prevalence of cutaneous manifestations in 200 patients with eating disorders". International Journal of Dermatology. 39 (5): 348–353. doi:10.1046/j.1365-4362.2000.00924.x. ISSN   0011-9059. PMID   10849124.
  4. Manoharan, Senthil Vel Rajan Rajaram; Behere, Rishikesh V.; Praharaj, Samir Kumar; Kongasseri, Sreejayan; Sharma, P.S.V.N. (2014). "Russell's Sign in Persistent Delusional Disorder: A Case Report". The Journal of Neuropsychiatry and Clinical Neurosciences. 26 (3): E4–E5. doi:10.1176/appi.neuropsych.13060127. PMID   25093783.