Risk Factors


Factors Associated with Violence Against Women with Disabilities


In a sample of 415 predominantly minority women with physical disabilities recruited from private and public specialty outpatient clinics, we examined experiences of physical, sexual, and disability-related abuse within the past year and its associations with demographic, disability, and psychosocial characteristics. Logistic regression analyses identified 27 percent of the variance and indicated that women with disabilities who were younger, more educated, less mobile, more socially isolated, and who had higher levels of depression may have a higher likelihood of having experienced abuse in the past year. This model correctly identified 84 percent of the abused women with disabilities.

It is understandable that women who are less able to function physically, either because of impairment or lack of assistive devices, would be less able to escape abusive situations and more likely to maintain dependence on an abusive caregiver, who may also be her husband. Similarly, being younger, experiencing greater social isolation, and having higher levels of depression have been shown in other studies to have a strong association with the experience of abuse.

The counterintuitive element in these findings, however, is the direction of the association of education with abuse experiences. We found that more women who were better educated had experienced abuse within the past year than women who were less educated. This is the opposite of the results of studies reviewed by Schumacher, Feldbau-Kohn, Smith-Slep, and Heyman (2001), where less education was strongly associated with the experience of domestic violence. We suspect that the finding of significance for higher education levels in our study might be a statistical artifact. In the pre-regression correlation analyses, education was unrelated to experiencing abuse, but it was related to other correlated variables. In the first regression analysis, education still did not significantly correlate with abuse; however, because it improved the sensitivity of the model, it was retained in subsequent analyses. Additionally, an inordinately high proportion of our sample, nearly half, had post-secondary education. A sample with a more representative distribution in the various educational categories might well yield different results.

If, however, we choose to accept the veracity of this finding, there are several possible explanations. Women with some post-secondary education may be able to communicate their experiences in a more articulate manner and may be more willing to discuss them with a stranger for the purpose of research. Since data were gathered in face-to-face interviews, the intimidation and stigmatization factors may have been intensified for women with less education. Similar to other groups of women in this country, our sample undoubtedly reflected the melting pot of America with its myriad of cultural and socioeconomic disparities and differences that influence the status of women, including the value and amount of women's educational attainment.

Anthropologists have found that cultural mores dictate the acceptability of violence such as "wife beating" (Crowell & Burgess, 1996), and we know from our clinical experience that those mores can exert intergenerational influence on immigrants. The combination of those factors may help to explain the educational difference uncovered in our findings in that, with greater education, women may be more likely to engage in political and feminist activism wherein they would learn about the nature, causes, and consequences of violence against women.

Although no known studies have examined the relation of education level with knowledge of violence and abuse, it may be that women with more education are more cognizant of abusive behaviors and better able to recognize and label their own experiences as abusive. Questions surrounding issues of disclosure and the understanding of abuse, including the effect of differences in language and culture, demand further investigation.

The only disability variable that proved significant in these analyses was mobility. Whether the measure of mobility is a proxy for overall severity of impairment, disability type, the need for personal assistance, or the adequacy of environmental resources warrants further examination. Are women with physical disabilities more vulnerable for abuse than women in general? Is their vulnerability compounded by disability itself and/or their barriers to escaping and getting help? It will take longitudinal, randomized controlled studies comparing the vulnerabilities for abuse among women with disabilities and women without disabilities to answer these questions.

Based on excerpts from Nosek MA, Hughes RB, Taylor HB, Taylor P (submitted). Disability, psychosocial, and demographic characteristics of abused women with physical disabilities. Violence Against Women.


Violence as a Risk Factor for Secondary Conditions in Women with Disabilities


Recent investigations of prevention of secondary conditions resulting from disability have not recognized the negative effects of abuse on physical, psychological, and social health. There is a substantial body of literature documenting the consequences of abuse, but there has been virtually no examination of how these consequences interact with a pre-existing disability.

Violence against women, both with and without disabilities, results in homicide (Kellerman & Mercy, 1992), suicide (Browne & Finkelhor, 1986), temporary and permanent disability (Murphy, 1993), emotional problems (Ratican, 1992), medical complaints (Faria & Belohlavek, 1984; Courtois & Watts, 1982; Cunningham, Pearce & Pearce, 1988), drug and alcohol abuse (Faria & Belohlavek, 1984; Finkelhor et al., 1986; Briere & Zaidi, 1989) and sexual dysfunction (Ratican, 1992).

Ratican (1992) described the identifying symptoms of sexual abuse survivors. These survivors may present with symptoms of depression, including self-destructive and suicidal ideation (Browne & Finkelhor, 1986), chronic anxiety and tension (Briere & Runtz, 1988), anxiety attacks and phobias, as well as sleep and appetite disturbance. Many survivors also have more medical complaints, including pelvic pain (Cunningham et al., 1988), headaches, backaches, skin disorders, and genitourinary problems (Faria & Belohlavek, 1984; Courtois & Watts, 1982) It is important to note that many of these conditions are more prevalent among people with disabilities, making it more likely for physicians to attribute causation to the disability and to fail to pursue abuse as a possible cause.

Survivors also experience exaggerated feelings of guilt and shame, negatively affecting their self-esteem and enhancing feelings of worthlessness (Bradshaw, 1989). These feelings often result in poor body image, leading to obesity or eating disorders (Courtois & Watts, 1982; Gordy, 1983; Kearney-Cooke, 1988). Self-destructive behavior, self mutilation, drug abuse, and alcoholism occur more frequently than among non-abused women (Faria & Belohlavek,1984; Finkelhor et al., 1986; Briere & Zaidi, 1989).

A history of abuse may have serious effects on a woman's relationship and sexuality issues, engendering feelings of passivity, powerlessness, lack of trust, and isolation. Left untreated, sexual abuse may lead to sexual dysfunction, flashbacks, promiscuity, and more serious psychological sequelae including repressed memories and dissociation (Ratican, 1992).

Based on excerpts from Nosek, M.A., Howland, C.A., Hughes, R.B. (2001) The investigation of abuse and women with disabilities: Going beyond assumptions. Violence Against Women, 7 (4) 477- 499.




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