What are 'Bulimia Hands'?

Schedule a Consult
woman in yellow sweater holding a mug hiding her bulimia hands

Bulimia Nervosa 

Bulimia nervosa involves recurrent episodes of binge eating, where an individual consumes large amounts of food in a short period, followed by compensatory behaviors to prevent weight gain. These behaviors can include self-induced vomiting, excessive exercise, fasting, or the misuse of laxatives or diuretics.

According to the National Eating Disorders Association, bulimia nervosa is a prevalent issue that impacts a significant portion of the population. At any given point in time, 1.0% of young women will meet the diagnostic criteria for bulimia nervosa. Signs and symptoms can sometimes be difficult to identify and can go unnoticed.

One of the lesser-known symptoms is ‘bulimia hands,’ a term used to describe the physical changes that occur in the hands of individuals who frequently engage in self-induced vomiting as a purging behavior. This symptom is typically referred to as Russell’s sign. 

Russell’s Sign/Bulimia Hands

Russell's sign, or bulimia hands, is a physical manifestation commonly observed in individuals with bulimia nervosa. The condition is named after British psychiatrist Sir Russell Brain, who first described the phenomenon in the 1950s. The primary cause of Russell's sign is the repeated contact of the fingers or hands with the teeth and throat during the act of self-induced vomiting, which is a common symptom of bulimia nervosa. 

Russell's sign is not always indicative of bulimia nervosa, as individuals may purge without causing physical damage to their hands. Other purging methods, such as laxative abuse or excessive exercise, may also be present in individuals with bulimia nervosa. This highlights the importance of conducting a comprehensive assessment for an accurate diagnosis.

Effects of Frequent Purging on Hands

  • Calluses and Scars: Frequent self-induced vomiting can cause calluses or scars to form on the knuckles and the back of the hand due to the repeated friction and pressure applied to the skin.
  • Swelling: Swelling in the hands may occur as a result of inflammation and irritation caused by frequent purging. This inflammation can also lead to a reduced range of motion in the fingers and joints.
  • Discoloration: Repeated exposure to stomach acid during vomiting can cause the skin on the hands to become discolored, taking on a yellowish or reddish hue. This discoloration may be more pronounced in areas where the skin is damaged, such as calluses or scars.

How Serious is Russell's Sign?

While Russell's sign may appear to be relatively minor physical manifestations of bulimia nervosa, the presence could signify more severe underlying issues. It is crucial to take these signs seriously, as they can indicate ongoing self-induced vomiting and the presence of a potentially life-threatening eating disorder. These symptoms can serve as essential indicators that someone may need help and support in overcoming bulimia nervosa.

Bulimia nervosa is often linked to other mental health disorders, with 80% of sufferers experiencing at least one other psychiatric illness. Russell's sign is not only a physical indicator of damage but also reflects the emotional and psychological struggles that people with bulimia may face due to issues such as self-esteem and emotional regulation.

Other Signs and Symptoms of Bulimia Nervosa

Bulimia nervosa can cause severe long-term effects on an individual's physical and mental health. Apart from Russell's sign, individuals with bulimia may also exhibit other symptoms:

  • Dental issues such as tooth erosion, cavities, gum disease, and bad breath
  • Swollen salivary glands: bulimia cheeks
  • Skin problems such as dryness, acne, and yellowish complexion
  • Hair thinning or loss
  • Inflamed throat
  • Brittle and discolored nails
  • Gastrointestinal issues
  • Severe dehydration

Treatment for Bulimia Nervosa

Russell's sign is a physical manifestation of the damage caused by bulimia nervosa. Seeking professional help and receiving a comprehensive approach to treatment, which includes psychotherapy, nutritional counseling, and medication, can reduce the impact of this eating disorder on both physical and emotional well-being. 

Our approach at the Kahm Center for Eating Disorders prioritizes a comprehensive treatment for bulimia nervosa, which may include the utilization of techniques such as metabolic testing and body composition analysis. If you or someone you know is struggling with bulimia nervosa or any other eating disorder, please don't hesitate to reach out to the Kahm Center for help and support. Contact us today to learn more about our bulimia nervosa treatment.

Clinically Reviewed By

nick kahm reviewer

Nick Kahm, PhD


Nick Kahm, a former philosophy faculty member at St. Michael's College in Colchester, VT, transitioned from academia to running the Kahm Clinic with his mother. He started the clinic to train dietitians in using Metabolic Testing and Body Composition Analysis for helping people with eating disorders. Now, he is enthusiastic about expanding eating disorder treatment through the Kahm Center for Eating Disorders in Vermont.

Looking for treatment?

We're Here to Help!
Call for Assessment