While there are countless conditions that can result in disability, understanding just a few key characteristics can tell us a lot about how people might experience disability and how others will react to them. Below are eight cross-cutting dimensions of disability, described in a new chapter of the Handbook of Prejudice, Stereotyping, and Discrimination (Tran et al., 2024).
A woman wearing a colorful dress stands with a sticker-covered rollator.
Source: Gritchelle Fallesgon/Disabled and Here/CC BY 4.0
- Disability type. Categorized by the major functions affected, disability types include mobility, communication, intellectual, cognitive, chronic health, sensory, mental health disabilities, and many more. Some types are more commonly associated with our stereotype of what a disability is, such as mobility, sensory, and intellectual disabilities. For example, the symbol on disabled parking spots and bathrooms depicts a wheelchair user. The public may less readily recognize other disabilities—these include invisible disabilities, chronic health conditions, rare disorders, and mental health conditions. People with non-stereotypical disabilities may receive less support and more invalidation. They may also be less inclined to identify as disabled themselves.
- Time of onset. Disability is perhaps the only minority group one can be born into or one can join at any point in life. Research indicates that individuals with congenital disabilities or who acquire them in early childhood may have an adaptive advantage (Bogart, 2020). These individuals go through their initial development with their disability, learning to navigate the social and physical world alongside their disability. In contrast, those who acquire disabilities often face the challenge of relearning how to function. They may experience grief over the change in their abilities, identity, and how others perceive them (Adler et al., 2021). Evidence shows that those with congenital or early onset disabilities tend to have a stronger disability self-concept, which includes disability identity and self-efficacy, which is, in turn, associated with higher life satisfaction (Bogart, 2014).
- Observability. The degree to which a disability is noticeable shapes the kind of ableism individuals may encounter. (I prefer to use the term “observable” instead of “visible” to avoid an ableist focus on one sensory domain and also to acknowledge that some disabilities may be observed through channels other than sight (e.g., a speech disorder). The majority of disabilities are non-observable, including chronic health and mental health conditions. While such disabilities allow individuals to “pass” as nondisabled and potentially avoid overt ableism, people with non-observable disabilities may face disbelief from others, including healthcare professionals, due to the absence of visible signs. On the other hand, observable disabilities—such as amputated limbs, facial differences, or the use of assistive devices—can attract stares, questions, and more blatant forms of ableism. Thus, ableism impacts both those with invisible and visible disabilities, though in different ways: subtle as opposed to overt.
- Course. The course of a disability describes how it evolves over time. Disabilities can be temporary, like a broken bone, or chronic, lasting more than six months. Chronic disabilities may become more severe over time (progressive), be life-limiting (terminal), relapse and remit (episodic), or remain stable. Stable conditions, such as an amputated limb, are unlikely to change, making adaptation more straightforward (Bogart & Dermody, 2020). In contrast, progressive, terminal, and episodic conditions involve uncertainty about the future and require constant adjustment to fluctuating symptoms. Episodic conditions, characterized by unpredictable flare-ups and remissions, can make it challenging for others to understand the fluctuating nature of the disability. Individuals with such conditions may be perceived as unreliable, facing accusations of exaggerating their symptoms, or “faking” their disability.
- Prevalence. Whether a condition is common or rare interacts with social and structural factors to shape the experience of disability. In the United States, a disorder is considered rare if it affects fewer than 200,000 people. There are over 10,000 different rare disorders. Collectively, rare disorders affect approximately 1 in 10 Americans, making the experience of having a rare disorder quite common. Examples of rare disorders include narcolepsy, Ehlers-Danlos syndrome, spinocerebellar ataxia, and blood cancers. Many healthcare providers lack adequate information about rare disorders, leading to an average diagnostic delay of seven to nine years (Bogart & Irvin, 2017). This results in long diagnostic odysseys filled with uncertainty and misdiagnosis (Bogart et al., 2022). People with rare disorders may struggle to find support groups or connect with others who share their condition. When seeking support from family, friends, and healthcare providers, they often face misunderstanding or disbelief about their symptoms. These factors contribute to a lower health-related quality of life for people with rare disorders. They experience higher levels of anxiety and depression compared to the general population and those with more prevalent disorders (Bogart et al., 2022).
- Functional impairment. Referring to limitations in an individual’s ability to perform daily activities or participate in society, functional impairment is strongly influenced by physical and social barriers. For example, whether a wheelchair user lives in an accessible community plays a large role in whether they experience functional limitations.
- Fatigue. Conditions involving fatigue, such as Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), have been historically contested and difficult to treat due to their invisible nature. A hallmark of ME/CFS is post-exertional malaise, where symptoms worsen after exertion and do not improve with rest. The lack of objective biomarkers and the reliance on self-reported experiences can create barriers to accessing appropriate healthcare and support.
- Pain. A particularly challenging dimension, pain is a complex and often invisible experience. Individuals may struggle to have their pain taken seriously, and may be mislabeled as drug-seekers, leading to inadequate pain management. Chronic pain can significantly impact mental health, daily functioning, and overall well-being.
To illustrate these dimensions, imagine two adults, Anna and Ameer, each with a mobility disability. Anna was diagnosed with cerebral palsy at birth, and her condition is expected to be relatively stable over time. Thanks to a supportive family and access to good healthcare, Anna learned how to use a manual wheelchair at a young age. Her physical therapist helped her family adapt their home to be accessible. Anna has been part of a cerebral palsy organization in her state since she was a child, which has helped her develop a positive disability identity. One of Anna’s biggest challenges is landing a full-time job. She often gets invited to interviews, but when employers see her wheelchair, they seem to patronize her and question her abilities.
Ameer began showing symptoms of muscle weakness as an adult. After years of doctors appointments, tests, and ineffective treatments, he was finally diagnosed with Kennedy disease, a rare disorder resulting in progressive weakness. Ameer feels like he has lost his identity and his former life. He needs to move to a different home or modify the one he has to be accessible, but it is hard to predict what his accessibility needs will be as his disease progresses. His symptoms wax and wane, especially as he tries new experimental treatments; sometimes he can walk, other times he uses a manual wheelchair. The fluctuating nature of his disability means he needs a flexible work schedule and the ability to work from home sometimes, but his employer is unfamiliar with Kennedy disease and has refused these accommodations.
While Anna and Ameer both have mobility disabilities, they vary in the dimensions of time of onset, observability, course, and prevalence. These examples highlight how social factors intersect with dimensions of disability, shaping individuals’ experiences.