Year : 2021  |  Volume : 63  |  Issue : 2  |  Page : 200--201

Russell's sign in obsessive–compulsive disorder

Praveen Rikhari, Ashutosh Kumar 
 Department of Psychiatry, Sarojini Naidu Medical College, Agra, Uttar Pradesh, India

Correspondence Address:
Praveen Rikhari
Department of Psychiatry, Sarojini Naidu Medical College, Agra, Uttar Pradesh

How to cite this article:
Rikhari P, Kumar A. Russell's sign in obsessive–compulsive disorder.Indian J Psychiatry 2021;63:200-201

How to cite this URL:
Rikhari P, Kumar A. Russell's sign in obsessive–compulsive disorder. Indian J Psychiatry [serial online] 2021 [cited 2021 Jun 15 ];63:200-201
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Obsessive–compulsive disorder (OCD) is characterized by obsessional thoughts and compulsive behaviors. Russell's sign refers to traumatic callosities on knuckles and dorsum of hand in patients with eating disorders that may become permanent and hyperpigmented.[1] Here, we discuss Russell's sign in a patient with OCD.

Mrs. A, a 35-year-old homemaker presented with repetitive thoughts of contamination for the past 2 years. She also had repetitive thoughts of phlegm being stuck in throat. She reported these thoughts to be her own and tried to resist them but could not. In response to these thoughts, she bathed, washed her hands, clothes, and other household items multiple times, consuming a significant time. She also did a peculiar ritual of trying to clean her throat with hand before meals, for usually an hour to get rid of the thoughts of perceived phlegm in throat. The patient often tried to check these behaviors but developed anxiety and restlessness if she did not commit to them. The patient considered these thoughts and acts as irrational and excessive; she also reported sleep disturbance, decreased appetite, significant distress, and functional impairment. She did not have any obsessions and compulsions concerning bodily appearance, weight, or food. There was no restriction of food intake secondary to fear of gaining weight or disturbances in body shapes, no binge eating episode, or any behavior to prevent weight gain (use of laxatives, diuretics, fasting, or excessive exercising) including self-induced vomiting.

General examination revealed multiple callosities with hyperpigmentation over right knuckles with no other skin lesions [Figure 1]. Systemic examination was unremarkable except for her being underweight (body mass index [BMI] – 17.3). Hemogram and biochemical parameters were within normal range. Dermatology opinion confirmed the skin lesions as callosities while otorhinolaryngology opinion ruled out any pathology in throat. Score on Yale–Brown Obsessive–Compulsive Scale (Y-BOCS) scale was 14 each for obsession and compulsion items. The patient was diagnosed as OCD with good insight. She was prescribed fluvoxamine, clomipramine, aripiprazole, and clonazepam dosed according to clinical response. After 6 months, a significant improvement occurred with decrease in Y-BOCS score to 8 each for obsession and compulsion items, and throat cleaning shortened to 15–20 min/day. Her BMI also became normal (18.7).{Figure 1}

Russell's sign is associated with eating disorders and has been otherwise described only in persistent delusional disorder.[2] This is probably the first report of Russell's sign in OCD. It emphasizes that we should be watchful of any physical sign and its association may be completely different from the illness, with which they are usually described.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.


1Strumia R. Dermatologic signs in patients with eating disorders. Am J Clin Dermatol 2005;6:165-73.
2Manoharan SV, Behere RV, Praharaj SK, Kongasseri S, Sharma PS. Russell's sign in persistent delusional disorder: A case report. J Neuropsychiatry Clin Neurosci 2014;26:E4-5.