What does the presence of calluses on the knuckles indicate in a patient with bulimia nervosa?

The presence of calluses on the knuckles in a patient with bulimia nervosa is indicative of self-induced vomiting, commonly referred to as Russell's sign. This phenomenon occurs when individuals use their hands to induce vomiting, causing repeated trauma to the skin on the backs of the hands and knuckles. The friction and pressure from this behavior can lead to thickened areas of skin, or calluses, developing in these locations.

Understanding this sign is important in clinical practice, as it serves as a physical manifestation of the underlying eating disorder and highlights the behavior associated with the condition. In the context of bulimia nervosa, attention to such signs can assist healthcare professionals in identifying patients who may be struggling with the condition, even if they do not openly disclose their behaviors.

Other options like malnutrition, excessive hand washing, and gastroesophageal reflux do not explain the specific development of calluses on the knuckles in this context. While malnutrition may be a consequence of bulimia nervosa, it is not specifically linked to the formation of calluses. Excessive hand washing can cause skin changes but typically results in a different pattern, and gastroesophageal reflux, while a potential complication of bulimia, would not create calluses on the knuckles