Vulnerability for abuse is a product of the complex interaction of individual, intrapersonal, and societal/institutional factors.16 Certain characteristics of perpetrators and victims have been identified in retrospective studies of domestic violence. A review of research on risk factors for male to female domestic violence17 identified younger age, less education, unemployment, pregnancy, childhood victimization, and mental illness as being associated with victimization. Some of these factors are known to be disproportionately characteristic of women with disabilities. Population statistics show their high rates of unemployment and poverty, lower education levels, and very high prevalence of depression.4 Abuse has been associated with depression and stress among women with disabilities in several of our recent studies.18-21
In one study of women with physical disabilities, those who screened positive for abuse within the past year were younger, more educated, less mobile, more socially isolated, and had higher levels of depression.21 Longitudinal studies are needed to determine if variables such as social isolation and depression are risk factors for abuse or are merely correlated with it.
Other factors possibly contributing to increased vulnerability include the combined cultural devaluation of women and persons with disabilities,22 often compounded by age-related devaluation,23overprotection, and internalized societal expectations. Women with disabilities may have had fewer opportunities to learn sexual likes and dislikes and to set pleasing boundaries, perceiving celibacy or violent sexual encounters as their only choices, believing no loving person would be attracted to them.24 They are often perceived to be powerless and physically helpless.25
Although women with severe disabilities face many barriers to the expression of their sexuality and, statistically, they are less likely to be married and more likely to live alone, many people mistakenly assume that all women with disabilities do not date, do not live with significant others, do not marry, do not have children, and do not desire such relationships, especially if they exhibit visible signs of disability such as disfigurement or use of a wheelchair. The assumption follows that an abnormal appearance makes such women undesirable to potential perpetrators of sexual assault. Findings from studies conducted at our Center do not support these assumptions.12,25-26 Out of nearly 500 women with physically disabling conditions (e.g., spinal cord injury, cerebral palsy), 87 percent reported they had at least one serious romantic relationship or marriage, and more than half currently were involved in an intimate relationship. Level of sexual activity was found to be unrelated to the severity of the disability.27
Vulnerability associated with the need for personal assistance and the problem of social isolation deserves special attention. The large majority of women who have significant functional limitations depend on family for personal assistance, since assistance from outside the family is often expensive and not very reliable. In the event that the person providing the assistance is the perpetrator of abuse, the disabled woman may perceive that this is her only option and that abuse is the price she must pay for survival. As in the case study above, abusive actions by someone providing assistance may not be perceived as abusive by the uninformed observer. Several studies confirm a high prevalence of disability-related abuse perpetrated by personal assistants who were either intimate partners or hired attendants and provide evidence of its serious implications.13,28-32 CDC has identified social isolation as a key factor that must be addressed in delivering violence-prevention interventions to underserved communities.33 Each of the four types of isolation--geographic, economic, political, and social--is compounded by having a disability, thus elevating vulnerability for violence.
Based on excerpts from Nosek, M.A., Hughes, R.B., Taylor, H.B., Howland, C.A. (2004) Violence against women with disabilities: The role of physicians in filling the treatment gap. In: S.L. Welner and F. Haseltine (Eds.) Welner's Guide to Care of Women with Disabilities.(pp. 333-345) Lippincott, Williams & Wilkins, Philadelphia.
4. National Center for Health Statistics. Healthy women with disabilities: Analysis of the 1994-1995 National Health Interview Survey: Series 10 Report [forward by F. Chevarley, J. Thierry, M. Nosek, C. Gill] (in preparation). 2002.
12. Nosek MA, Howland CA, Rintala DH, Young ME, Chanpong GF. National study of women with physical disabilities: Final report. Sex Disabil 2001; 19(1):5-39.
13. Sobsey D, Doe T. Patterns of sexual abuse and assault. Sex Disabil, 1991; 9, 243-260.
14. Sobsey D. Violence and abuse in the lives of people with disabilities: The end of silent acceptance? Baltimore, MD: Paul H. Brookes Publishing Co., 1994.
15. Nosek, M. A., Walter, L. J., Young, M. E., & Howland, C. A. Lifelong patterns of abuse experienced by women with physical disabilities (submitted). J Interp Viol, 2003.
16. Hamby SL, Koss MP. Violence against women: Risk factors, consequences, and prevalence. In Liebschutz, J.M., Frayne, S.M., & Saxe, G.N. Violence against women: A physicians guide to identification and management. Philadelphia: American College of Physicians, 2003, 3-38.
17. Schumacher JA, Feldbau-Kohn S, Smith-Slep A, Heyman RE. Risk factors for male-to-female partner physical abuse. Aggr & Viol Beh, 2001, 6, 281-352.
18. Hughes RB, Swedlund N, Petersen N, Nosek MA. Depression and women with spinal cord injury. Topics in Spinal Cord Injury Rehabilitation, 2001, 7, 16-24.
19. Hughes RB, Taylor HB, Robinson-Whelen S, Nosek MA. Perceived stress and women with physical disabilities (submitted). Rehab Psych.
20. Hughes RB, Taylor HB, Shelton ML, Nosek MA. Dynamics of violence against women with disabilities: A qualitative study (in preparation).
21. Nosek MA, Taylor HB, Hughes RB, Taylor WP. Demographic, disability, and psychosocial characteristics of abused women with disabilities (in preparation).
22. Belsky J. Child maltreatment: An ecological integration. American Psychologist, 1980, 35, 320-335.
23. Kreigsman KH, Bregman S. Women with disabilities at midlife: [Special issue: Transition and disability over the life span]. Rehab Counsel Bull, 1985, 29, 112-122.
24. Womendez C, Schneiderman K. Escaping from abuse: Unique issues for women with disabilities. Sex & Disab, 1991, 9, 273-280.
25. Howland CA, Rintala DH. Dating behaviors of women with physical disabilities. Sex Disabil 2001; 19(1):41-70.
26. Rintala DH, Howland CA, Nosek MA, Bennett JL, Young ME, Foley CC et al. Dating issues for women with physical disabilities. Sexuality & Disability, 1997, 15(4):219-242.
27. Nosek MA, Rintala DH, Young ME, Howland CA, Foley CC, Rossi D et al. Sexual functioning among women with physical disabilities. Arch Phys Med Rehabil 1996; 77(2):107-115.
28. Curry M., Hassouneh-Phillips D, Johnston-Silverberg A. Abuse of women with disabilities: An ecological model and review. Violence Against Women, 2001, 7, 60-79.
29. Powers LE, Curry MA, Oschwald M, Maley S, Saxton M, Eckels K. Barriers and strategies in addressing abuse: A survey of disabled women's experiences. J Rehab, 2002, 68(1):4-13.
30. Saxton M, Curry MA, Powers LE, Maley S, Eckels K, Gross J. "Bring my scooter so I can leave you": A study of disabled women handling abuse by personal assistance providers. Violence Against Women, 2001, 7, 393-417.
31. Hassouneh-Phillips D, Curry MA. Abuse of women with disabilities: State of the science. Rehabilitation Counseling Bulletin, 2002, 45, 96-104.
32. Hughes RB, Taylor HB, Shelton ML, Nosek MA. Dynamics of violence against women with disabilities: A qualitative study (in preparation). 2003.
33. Centers for Disease Control and Prevention. Webcast: Sexual violence prevention: Building leadership and commitment to underserved communities. Accessed April 3, 2003.