The document discusses Justine's personal experience with bulimia and how it affected her life and career. It provides information about eating disorders, including definitions and statistics. It offers suggestions for how companies can help employees who may be struggling with an eating disorder, such as addressing performance issues confidentially with HR, providing information on treatment resources and medical leave policies, and ensuring compliance with disability laws. The talk aims to help reduce stigma and support those suffering from these mental health issues.

1. Paying Off
Emotional Debt
Justine Arreche
saltinejustine
Travis CI

2. Hey, I’m Justine.
I’m a UX/UI designer at Travis CI.

3. I’m bulimic.

4. This session will be covering:
• What exactly is an eating disorder?
• My personal struggle with eating disorders and how
they’ve affected my life and career in tech.
• How your company can approach and help an employee
potentially suffering from an eating disorder.

5. What is an eating disorder?
An eating disorder is an unhealthy relationship with food and weight
that interferes with many areas of a person’s life.
One’s thoughts become preoccupied with food, weight or exercise.
A person who struggles with an eating disorder can have unrealistic self-
critical thoughts about body image, and his or her eating habits may
begin to disrupt normal body functions and affect daily activities.
(source: ANAD National Association of Anorexia Nervosa and Associated Disorders)

6. Eating disorders
are more than
about wanting
to be “skinny”.

7. Coping mechanisms
Sense of control
Symptoms of other
underlying issues

8. Anorexia Nervosa
A person with anorexia may have an intense fear of gaining weight
or becoming fat. Someone with anorexia may practice unhealthy
behaviors such as: restricting calories, only eating specific foods
or skipping meals frequently.
(source: ANAD National Association of Anorexia Nervosa and Associated Disorders)

9. Bulimia Nervosa
A person with bulimia may also be intensely afraid of becoming fat or
gaining weight. Someone with bulimia may eat large amounts of food in
a short period of time (binge) and then eliminate the food and calories
(purge). One may induce vomiting, exercise excessively, or use laxatives,
diuretics, or diet pills to purge weight or calories.
(source: ANAD National Association of Anorexia Nervosa and Associated Disorders)

10. Binge Eating Disorder
This disorder involves eating very large amounts of food rapidly (to the
point of feeling sick or uncomfortable). These episodes of bingeing occur
frequently. When binge eating, a person feels like they cannot stop
eating or control what or how much is eaten.
(source: ANAD National Association of Anorexia Nervosa and Associated Disorders)

11. Eating Disorder not otherwise specified (EDNOS)
EDNOS is a feeding or eating disorder that causes significant distress
or impairment, but does not meet the criteria for another feeding or
eating disorder.
(source: ANAD National Association of Anorexia Nervosa and Associated Disorders)

12. Facts about eating
disorders in the
United States

13. 20 million women
10 million men
suffer from a clinically
significant eating disorder
at some time in their life.

14. 1 in 10 people with
eating disorders
receive treatment.
(source: Characteristics and Treatment of Patients with Chronic Eating Disorders, by Dr. Greta
Noordenbox, International Journal of Eating Disorders, Volume 10)

15. Eating disorders are not limited
to age, race or gender.
Anyone can develop an eating
disorder at any time,
though they are more commonly
developed at a young age.

16. An estimated
10-15% of people
with anorexia or
bulimia are male.

17. Among gay men,
nearly 14% appear
to suffer from bulimia
and over 20% appear
to be anorexic.

18. Men are less likely to seek
treatment because of the
perception that eating
disorders are “women’s diseases”

19. Almost 50% of
people with eating
disorders meet the
criteria for depression

20. Mental health issues related to ED’s:
• Depression
• Alcoholism
• Drug abuse
• Obsessive compulsive disorder

21. Why is an eating
disorder so serious?

22. The mortality rate associated
with anorexia is 12 times higher
than the death rate associated
with all other causes of death
for females ages 15-24 yrs.

23. Eating disorders
have the highest
mortality rate of
any mental illness

24. Rough estimated mortality rates
per eating disorder category
4% Anorexia
3.9% Bulimia
5.2% EDNOS

25. Effects eating disorders take on the body
Anorexia
• Monthly menstruation stops
• Breathing, pulse and blood
pressure rates drop
• Anemia
• Loss of bone mineral density
• Irregular heart rhythms/
heart failure
Bulimia
• Monthly menstruation stops
• Mild anemia
• Extreme heartburn
• Electrolyte imbalance that can
lead to cardiac arrest
• Ruptured stomach
• Erosion of teeth enamel
• Kidney and Liver damage
• Internal bleeding
• Gallbladder eruption

26. But there is treatment
• Individual psychotherapy
• Group therapy
• Medication
(to relieve paralyzing depression and anxiety)
• Nutritional counseling
• Hospitalization
(for weight gain, suicide watch or stabilization of healthy eating habits)

27. Now, this is
my story.

28. At 19 I was diagnosed
and treated by the
Cleveland Clinic
for bulimia.

29. At 20, I had my
first relapse.

30. At 25 I was sexually
assaulted and began
my 2 year relapse.

31. At first I just
stopped eating.

32. I was so far into my
depression that I felt
nothing but saddness
and disappointment.

33. I hid my bulimia from
everyone. Eating was
really the only thing I
could do to be happy
for even 5 minutes.

34. Excessive anxiety
steered me into
heavy drinking.

35. The amount of
emotional debt I had
acquired had almost
left me paralized

36. My inability to
preform my role at
the company and my
poor behavior cost
me my job.

37. Then I moved to
Germany, cutting
all ties from Ohio
and anyone who
knew me.

38. But it was just the
same thing only in a
city where it was even
easier to get away
with my secret.

39. This past November
I made a 911 call after
I had collapsed and
couldn’t breathe.

40. Recovery has been extremely difficult but
I didn’t want to die.

41. How can you help
someone you know
or suspect is
struggling with
an eating disorder?

42. DISCLAIMER: This is not legal advice. I am not a lawyer and
you should always seek legal council and get in touch with
your human resources department before speaking with an
employee on this topic.

43. Avoid making
assumptions.
Rapid weight gain or loss doesn’t necessarily
mean that person has an eating disorder.

44. People who are suffering from eating disorders can often
preform their job duties normally on a day to day basis.
But some cannot.

45. An eating disorder can severely alter a
person’s behavior and mentality making
it difficult for them focus on job tasks.
This will ultimately interfere with the
productivity of that individual, your
team and your projects.

46. Team members talking about an
individual behind their backs will
ultimately harm team morale.

47. It is never appropriate to discuss another person’s
health issues in the office.

48. If you have concerns with
the health of an employee or
teammate, address your concerns
with HR or senior management.

49. How will you know?
• The employee will outright tell you
• Outward Symptoms
• Colleagues become concerned and inform management

50. Legal issues to
keep in mind

51. Anytime a manager or team leader
knows about confidential health
information it puts the company
at risk of future accusations of
discrimination or unfair termination
due to the person’s health concerns.

52. Additionally if something
unfortunate should occur as
a direct result of that person’s
illness and no action was taken,
the manager or employer could
be accused of negligence.

53. This doesn’t mean be afraid to get involved

54. How to approach
someone with an
eating disorder

55. If your company does not
have an HR representative
this meeting should be with
the most senior manager

56. Address work
deficiencies such
as forgetfulness,
errors, and
performance.

57. Address observations
We suspect you’re anorexic because you’re way too skinny
You appear to have lost a significant amount of weight
recently. Are you doing okay?

58. Follow up your concerns with
helpful resources and options.
Remind them of the health benefits
your company’s health plan offers.

59. Provide information about the
Family and Medical Leave Act
(FMLA) if they would like to
enter treatment.

60. Be clear that you want to support them
and want them to be in great health.

61. Honor professional
boundaries.
Remember that you are not a counselor

62. Instead of counseling,
try researching eating
disorder treatment
in the area

63. Acquaint yourself with
company health benefits.
What kind of medical and mental health
benefits do you provide?

64. If the person has explicitly denied
the presence of an eating disorder,
simply say you wish to help them
seek a physician or clinic to help
them with their health concerns.

65. Remind your employee that accessing these
benefits is completely confidential.

66. Once a team member has disclosed
having and eating disorder,
The Americans with Disabilities
Act protects that person from
discrimination based on the disease.

67. ADA law also requtires
employers to make
accommodations for
people with disabilities.

68. Such accommodations include:
• Flexible leave time for doctor’s appointments
• Flexible scheduling to accommodate for medication
• Make job performance expectations clear and meet
regularly with a supervisor or manager for feedback

69. ADA law also allows for individuals
to take up to 90 days off work to
seek treatment.
These 90 days do not need to
be consecutive.

70. What should you
as a company do to
ensure the mental
health of all your
employees?

71. Make mental health of all your
employees a priority and a promise.

72. Thank You
Justine Arreche
saltinejustine
Travis CI