 for the past six years, and I'm actually about to celebrate three years of childless, which is pretty exciting. Conquences, engaging with developers on topics of design. This talk, as PJ mentioned, is going to be a little bit of an accomplishment. What I failed to mention is that I suffer from a linear, general anxiety. Really get excited. I wanted to give a trigger warning. This talk will contain topics on eating disorders, depression, anxiety, substance abuse. Suicide and self-harm. If any of those topics make you uncomfortable, feel free to leave. I won't be offended. If most people are going to stick around, please give this talk your attention and keep an open mind. Some of what I'll be speaking of are facts and figures around eating disorders. Other parts will be my own personal experience with my disorder, as well as the monologues. This talk isn't meant to be a goal for everybody who suffers from eating disorders. It's just my personal experience, and this isn't meant to go over everybody who suffers from them. Some of you might have experienced some of what I'll be talking about. However, I believe probably a bigger majority of this audience are not. What I hope that you'll get out of this talk is a better understanding of what eating disorders are, who they affect, and what it's like to live your life with these disorders. I want you to leave this talk having gained empathy and a bit of understanding of what they're like and the people who struggle through them. I'm sure there's probably a few people in here wondering why I talk about eating disorders at a technical conference. I think that the tech industry has brought a lot better about having discussions relating to mental health. That's pretty fantastic, and I would love to see those conversations continue to grow in popularity. We've heard from people at various events and online media on dealing with burnout, anxiety, and depression, but one topic I never hear about is eating disorders. And I think this is due in part to the fact that while they've brought us better about speaking about mental health, it's still a fairly taboo topic, and these conversations are happening at whiskers between close friends and colleagues. I believe only when we start talking about these mental health topics, health, being the operative word, can we truly start making a difference in our community and in the world. Like to the front on each side, it's all I can see. My abdomen is swollen and in need of relief. Finally, I'm pressure at the back of my throat. The white is not with orange, yellow, and green. Relief has come to the tears we get before. Relief came and went too quickly. No, my weapons regret. I'll never do this again, I tell myself. This makes me feel hollow and empty and the exhaustion sets in. It's a small part of the ritual thinking I've helped during my most recent relapse. I spent two years doing that cycle several times a day. These binges and purges would be carefully managed in my time alone, between work, social engagements, and when I needed to take my prescription medicine. My particular type of disorder is bulimia nervosa, that word comes from the Greek word meaning rather as hunger. Most people I think are probably more familiar with bulimia's counterpart, enterite standard rosa, which stems from the Greek word without appetite. While eating disorders have been around for centuries, mostly among the upper class and the religiously about, the naming conventions for anorexia and bulimia come from a couple of doctors in the late 1800s who had been seeing patients who had symptoms of disorder needed. A British doctor by the name of William Bull presented a paper to the Royal College of Physicians in 1873. The paper was called anorexia hysterica. Around the same time there was also a doctor in France who published an article on anorexia hysterica. Both doctors' naming conventions implied with the use of hyster, which comes from of the womb, that these disorders only affected women. The following year, after the remark cases of eating disorders, the hysterica was dropped in favor of nervosa to show that it was a nervous condition and not a female-only infliction. There are different kinds of eating disorders that are limited to cisgender women. To give you some context about the different medically-recognized disorders that are out there, we're going to go over them. Anorexia nervosa is a person with 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 saving meals frequently. These individuals will be underweight, but usually be unable to see that to be the case. Anorexia nervosa, which is the disorder that I suffer from. These people will also be intensely afraid of gaining weight or becoming fat. However, someone with bulimia will eat large amounts of food in a short period, known as a binge, and then eliminate those food or calories, known as a purge. Purging is different with different bulimas. One might induce vomiting, exercise excessively, use laxatives, diuretics, or diet pills to purge those weight and calories. These individuals will probably be under normal weight or might even be overweight, but also might experience the inability to accurately assess their weight or health. In 2013, there was the addition of a binge eating disorder to the diagnostic decisions of a manual on mental disorders. This disorder was characterized by individuals who eat large amounts of food rapidly to point feeling sick or uncomfortable. These episodes of binging occur frequently, and people who are engaging in these binges often feel that they cannot stop and control how much food. Finally, the DSM-5 has a section known as Eating Disorders Not Otherwise Specified. It's kind of a catch-all for symptoms of disorders that don't fall into the previous three categories. Prior to 2013, binge eating disorder was also listed in the ENOS category. While eating disorders are often medically characterized by the individual's habits of disorder eating, that's not their only symptom. Eating disorders are often triggered and influenced by external events such as mental fatalities like stress, anxiety, trauma, depression. Eating disorders for many individuals has side-effects of underlying mental health issues and are used as coping mechanisms giving those who are suffering a feeling of control when life might go otherwise out of control. I was diagnosed with bulimia when I was 19. My parents discovered I was losing weight and curing food and admitted me to an outpatient program for people with eating disorders with a gluten line. I had some tests done on me at the time and they found my body was extremely dehydrated and long on electrolytes. It's just pretty common amongst believe-ins. But as a young person without a long-standing history of curing, it was thought that I was a good candidate for recovery. I completed my six-week outpatient program and mostly managed to stay on track for about a year before my first relapse during college. That relapse was fairly short-lived and mostly onset by my general stress living out home for the first time in the dorm. There were a couple of take-ups long the next five years, but I managed to live a fairly normal life as normal as anybody could do in a commanding art degree candidate. Then, in January 2013, I was sexually assaulted at a tech conference during my longest and most recent relapse. In some ways, I find some solids to know that I'm not alone, as sad as that might sound. In the United States alone, 20 million women and 10 million men suffer from a clinically significant eating disorder at some point in their life. That means about 10% of the United States population will feel like I feel. 30 million people. And that's just one of them. Eating disorders are fairly non-discriminatory. Geneticist environmental factors and personality traits all work together to create the risk of developing one. They are not limited to age, race, or gender. Anyone can develop one at any point in their life, though they are more commonly developed at a yearly age by young girls. That said, an estimated 10 to 15% of people with anorexia and bulimia are male. Among gay men, nearly 14% suffer from bulimia and 20% from anorexia. Transgendered individuals are the highest risk of the entire LGBTQ community to develop an eating disorder. Each morning I confront the scale. 128.5 is not the 128.0 I wanted. 35 pounds gone. That's not enough. I'm still hurt, and I'm still angry. A few glasses of wine for breakfast still won't make me happy. The lines, the drinking, the crying. I'm constantly tired. Maybe tomorrow. If I don't eat today, maybe tomorrow. 128.0. I spent two years constantly anxious in the past. I began cutting again in late night in the past of anger and confusion. It seemed like my world was falling in on me and my life was spiraling out of control. In an attempt to manage my extreme feelings of self-patriot and my increasing social anxiety, I began to drink heavily. Most people, same for a couple of friends, had no idea how drunk and compressed I was ever yet. During this time, I somehow managed to move to Germany. Secretly I hoped I could leave my problems behind in Ohio and create a new life for myself in Berlin. But as it turns out, your problems have no problem finding you abroad, Berlin certainly isn't the city to try and bury them in. Not a lot, which was a blessing and a curse. I could structure my day in a way that worked for me. Unfortunately, it also left me with a lot of time. Being janky and encouraging multiple hours a day, I spent my life within the confines of my kitchen and my bathroom. All that time on the counter for left me with a lot of lies and excuses. And that's the feeling that I hate the most during the whole period. Living one life, but managing extreme conditions of another. Many of the people suffering from eating disorder will struggle with other mental health issues. In the brain, there are several shared neurotransmitters that are believed to be involved in both eating and substance abuse disorders. In regards to substance abuse, about 50% of individuals with eating disorder will be abusing alcohol under drugs. And that times greater than the U.S. general population statistics. For men with binge eating disorder, 57% suffer from a long life struggle with substance abuse. Although alcohol is my encounter, it's a common substance abuse among those of eating and other mental health issues. Both eating disorders and substance abuse can be used as avoidance-based coping techniques. Obviously, these are ineffective and will give you more harm than good, leaving emotions under drugs and potentially escalating issues in personal lives as well as the workplace. This is particularly problematic in the tech industry of working in cultures of the North and it's mainly used as our source of interactions with our colleagues. In addition to those individuals struggling with substance abuse, about 50% of people with an eating disorder will also suffer from depression. The cycle between bulimia and depression is constant and one influence is the other and it's difficult to adjust to either disorder. Purging is used to respond to and control depression. However, the act of purging is in and of itself will leave the bulimia to feel more depressed. That combination with malnutrition caused by self-spiritation will harm an individual's physical as well as mental health. As an example, poor nutrition may harm the body's ability to be stripped of them, which can lead to mood disorders and contribute to depression, and treat either without a positive change in diet. Among patients with anorexia, 33% to 50% have a comorbid mood disorder, such as obsessive compulsive disorder and social phobia. Those statistics are even higher among patients with bulimia, with at least 50% suffering from a comorbid mood disorder like depression, and over a half struggling with a comorbid mood anxiety disorder. One intently mix will also have a comorbid substance and reduce disorder like alcohol abuse. Additionally, those with eating disorders may begin to abuse over-the-counter drugs like sleeping pills and limespits. Many will develop addictions to illegal drugs, hallucinogens, and prescription medicines. All of these statistics and numbers, they boil into one serious problem. Eating disorders have the highest mortality rate of any mental illness. Every 62 minutes, at least one person dies from a comorbid mood disorder. Anorexics and abnormally low heart rate and low blood pressure will bring risk of heart failure, while security and hydration can risk kidney failure. For females between 15 to 24 years old, the mortality rate associated with the illness is 12 times higher than that of the death rate of any other cause of death. For bulimics, the constant binge purge cycles affect the entire digestive system and can lead to electrolyte chemical imbalances. Those imbalances can affect the heart and other major organ functions. Electrolyte imbalances can lead to irregular heart rates and potentially even heart failure and death. Additionally, those risk of gastric rupture can create a binge in while frequent vomiting can rupture the esophagus. Who's the shortness of breath? My assumption is it's nothing. But the sharp pain continues. Trying to find breath again. Trying again. Changing positions on the furniture and then the floor. The breathlessness persists. I check my phone but my credit is at zero. I'm afraid I'm going to die alone in this home. I die when I'm one alone. I spend two years constantly anxious and depressed. So where were we? Hey, I was classing on the floor the last time we fought. So that day was November 25th, 2014. I remember a lot of that day pretty clearly up until that point. I was visiting my family in Ohio, Thanksgiving was rapidly approaching. I was in charge of making the whole meal this year and spending my morning making vegetable stock for my shepherd's pie. Like any other day when I was home alone, I had already been encouraged a couple times. But then I started to experience sharp pain in my chest leaving me with the inability to breathe. I situated and resituated myself in different positions all over the house trying to find a position that would allow me to regain comfortable breathing. But I couldn't find it. After a while, I started to pen it. Then I reached for my phone and called my partner who was also visiting the US with me. Unfortunately, my prepaid phone service was out of order and I sent a frantic eye message to him to come to the house as quickly as he could. Realizing I couldn't make a call and still struggling to breathe, I dialed 911. Paramedics came to the house and took me to the emergency room. I don't remember a lot after dialing the emergency number. One thing I do remember is that they said my vegetable stock smelled pretty good and that's probably the only constant from that day. From the emergency room after running tests, giving me potassium and fluids and letting me regain breathing, I was able to go home. It was that day I realized how much harm I was doing to my body, to my organs, to my mind. When my life felt like it was collapsing, in reality, my body was beginning to shut down. Despite all my suicidal thoughts, my depression and my anxiety, a switch went off in my mind. I really didn't want to die. Not from this. I was equipped with some of the tools I had for my six-week program and started working from that day forward with the help of my partner. I've worked every day since then and I've been having a better version of myself. In those two years with my relapse from Lilliania, I lost a lot of friends. I lost a meaningful relationship. I lost a job. I lost the trust of my new colleagues for work. Not to mention the heaps of money an hour and it's wasted on the binge per cycle. It's been a lot to clean up after. And that's what I call paying off emotional debt. That phrase was said many years ago by a friend and former colleague Lillian Bursin. He told me that all the lies, all of the stress and all of the anxiety would eventually accumulate in one big mess that eventually I'd need to work off. That emotional debt, much like technical debt, must be dealt with. In some ways, speaking about this publicly is a point of a back of recovery. I've spent a lot of time thinking about how I did rock bottom. The lies and the substance abuse. I really have become the worst version of myself and I never want to be like that again. I know there's a good chance that I'll relapse again. But my mental business, that I talk about this with others, raise awareness, help others. It'll be harder for me to relapse. People will sleep. People will notice. Recovery and treatment is different for all people. However, only one in ten people with an eating disorder will receive it. In men, those numbers are even lower because of the state-of-the-art eating disorders are a women's issue. In the rest of the tech community, as individuals, as contracts and data organizers, as team leads, and company leadership, it's important for us not only to understand the issues that have affected our colleagues and friends, but to be advocates for and support those with mental health issues. As individuals and as an industry, working to make tech more inclusive and safe-place, eating disorders, unfortunately, aren't really a part of this. As individuals, you have a voice. You can be an advocate for and to support those with eating disorders. As members of an organization or as a committee, you can speak up to today's concerns. Making sure that your org is a safe space for those who are suffering. You can be a voice. When you hear people making remarks on what another person is eating, when you see people making comments on the appearance of others, remind people that eating disorders are deadly. Remind people that it's not effectiveness. Remind people to be amplified. Organized meals are a great place for us to make an effort to ensure inclusive aid to not only those with eating disorders, but all mental health issues. It's popular to have companies provide on-site meals and snacks. Managerial meals provided in-house to your employees don't have to leave the office. It's bad for all mental health. Those programs we develop to take pressure off of workers to a lot of them think about the problems they're solving at work but not the problem of what's for lunch. But taking a break from the computer screen isn't as effective if you're still spending the office. Taking longs, changing locations, removing yourself for an hour might mean you're not cranking out workers quickly, but it also means you have the opportunity to step away from talking physically as well as mentally. Regardless of the meals that are provided, whether in the office or at the event, you're putting people in a position where they no longer have options. You're taking away their ability to decide what the life they eat. Generally when I put this situation where workers providing even lunch are generally anxious, resentful, and will typically skip it all together. Now of course, everyone with an eating disorder will be different and handle these situations to the best of their abilities. We are all responsible for our own actions. However, given the shame of the taboo that surrounds not only mental health issues but especially eating disorders, it's difficult for people to voice concerns about eating situations. For example, last year my company was preparing to go on a team retreat to beautiful Barcelona, Spain. And as I was getting my things in order to leave, scheduled for the offside arrives in my inbox. Upon scanning the events at the time table, I see group cooking session as a team building activity. Immediately I was hit with a panic attack. Though I've made a lot of progress in my recovery, to this day I was still extremely controlling while buying when I eat. And now I see I've been thrown into a scenario where I'm going to be expected to cook food strangers. What was I going to do? To my knowledge, all of the events were mandatory. Could I approach the person who created the schedule and say I won't be able to attend? Or will I miss the fun? Will people notice what I'm missing? Can I take the money with me and find other food alternatives through the evening? Would that be considered a boycott of the event? These are the things running through my mind as I cried and I prevailed. Ultimately what I ended up doing was attending the event. What that resulted in was another panic attack and me excusing myself from the building. It was a pretty embarrassing experience and I wish I'd skipped it all together. If your company is made up of just 20 people, statistically speaking at least two of your employees will be eating disorders on my meal-ups. If your event will have 210 eats, you're looking at least 20 of them with eating disorders. So while this seems like a small minority, in reality it's more common than anything. Instead of offering a variety of unhealthy food options for your meet-ups and conferences, consider offering whole-food options instead. Ditch the cupcakes and offer something healthy for the afternoon snack. Cater from your local Mediterranean or Thai restaurants for your meet-ups. This family benefits those with eating disorders who rely on healthy food options. Healthy options will help all of your attendees feel satisfied and alert. One of the best conferences to handle the what's for lunch was 2015's Madison Breeding. Upon registration, each attendee was given an honorable cash to be spent on a lunch. This kind of program essentially empowers people to make their own food decisions. I didn't have to be put in a situation where I had to hunt down a server to get a specially requested meal. I wasn't put in an offered position where I was uncomfortable providing food buffet. I was even lucky enough to have been traveling with a co-worker who was aware and sensitive to my eating disorder. So we buddied up with a few fellow attendees that I was totally comfortable with. These examples, they work great for events. But what can companies do to ensure their employees are being treated well with eating disorders? Much like any other health benefit, mental health should be a priority for your company. As medically-recognized mental illness, eating disorders qualified for the Americans with Disabilities Act. As managing directors or company leadership, you should familiarize yourself with the medical benefit of mental health benefits. You absolutely should be. Mental health disorders that affect more women than men. So including women in these discussions will ensure that their voices are heard and those disorders are most likely to be covered. Once you've recouped yourself with plans and information to support those with mental health issues, ensure that those practices and information are transparent to everyone. That way, everybody is able to take advantage of their benefits. At Travis, we have some pretty transparent discussions with policy regarding mental health. For example, taking the mental health that is not current as one of our men for your 28 vacation days. We're not questioning the legitimacy of our mental health days. We simply want to see each other well. Happy Builders produce a better product than overall. Additionally, we've started a mental health channel in our company, Slack, where we're able to discuss issues we're having, support fellow builders, and share mental health resources. While we're very lucky at Travis to have a small company of supportive colleagues, I know that mental health doesn't exist everywhere and it won't work in all cases. But if I take the lighter down and find the middle of the mental breakdown, I can simply take the day off, hatch up on reruns above the vampire slayer and deep press. But even if we don't provide a safe space for your employees to talk amongst each other about mental health, I strongly recommend you recommend to have questions asked as to policy regarding mental health days. Just as important as physical health. Whether someone has the flu or having an anxiety attack, if they can't work, just give them time to recover. You'll have happier employees for it. At this in the air, the tinkling of silverware meaning a dish, a toast, an appetizer, a may, a dessert. I don't know if the toilet's a private and it doesn't matter. No regret. Just good company, kindred life there and upon memory. This feels right. Eating disorders like all mental health issues are serious and should be treated as such. I encourage all of you to get thinking about how we can support those with mental health issues. Start a conversation with your office. With your friends. Invite people to speak at your events. As I said earlier, I'm part of an initiative called the problem that sends speakers, such as myself, to events to talk about bringing life to mental health topics. If possible, get in touch with prompt and invite someone to speak at your events event. Continuing these conversations is how we make a positive impact in our industry and how we treat mental health. What this all means, whether you're someone who's suffering or just another individual working in this community, we have one goal and we need to share this industry. Think less about technology itself and more about the people building it. Happy people build better software. For people with eating and other mental health disorders and the subsequent issues that generally have happened in them, we need to promise to look after each other. We can't build anything amazing and we can't take away from each other.