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II. Manifestations of Domestic Violence against Women with Disabilities
III. Increasing Safety for Women with Disabilities
Domestic violence was hidden from most of mainstream society and largely ignored by health professionals until the late 1970s (Stark, Flitcraft, and Frazier 1979). As research on domestic violence has developed and programs have been instituted to address the needs of victims, one particularly vulnerable group of women has remained overlooked: women with disabilities (Chenoweth and Cook 2001; McCarthy 1998). The research on the experiences of women with disabilities who are victims of domestic violence is so sparse that little attention has been paid to the impact of culture, beyond gender and ability status (e.g., ethnicity, age, sexual orientation) on those experiences (Hassouneh-Phillips and Curry 2002).
Who are women with disabilities? According to Banks (2003), ‘‘Women who have disabilities represent a very broad spectrum in terms of ability to manage their personal and social affairs’’ (p. xxi). Disabling disorders can be visible (e.g., arthritis, limited mobility, limited vision, deafness) or invisible (cardiac disease, chronic fatigue syndrome, fibromyalgia, pain, traumatic brain injury, learning disability). Having one disability not only does not preclude having others; instead, it increases the probability of having additional challenges. Domestic violence further increases disability.
All women who are victims of intimate partner violence, a large subset of domestic violence, are treated like victims of torture most often associated with war and kidnapping (Beck-Massey 1999). Women with disabilities, on average, endure domestic violence for longer periods than women without disabilities (Coker, Smith, and Fadden 2005; Curry, Hassouneh-Phillips, and Johnston- Silverberg 2001; Li, Ford, and Moore 2000) and are at high risk for being abused by multiple perpetrators (Hassouneh-Phillips and Curry 2002). Beck- Massey (1999) and Curry et al. (2001) found that in addition to vulnerability to the kinds of physical and psychological abuse experienced by most women, women with disabilities are also subjected to specific disability-related types of violence.
Although most examinations of domestic violence focus on a single perpetrator, usually an intimate partner, defined by Tjaden and Thoennes (2000) as ‘‘current and former dates, spouses, and cohabiting partners, with cohabiting meaning living together at least some of the time as a couple’’ (p. 5), the vulnerability experienced by women with disabilities involves a wider variety of perpetrators. Other family members can perpetrate domestic violence on women with disabilities, including parents (Nosek, Foley, et al. 2001), adult children (Bergeron 2005), and siblings (Crawford and Ostrove 2003). As many women with disabilities are dependent on other people for personal assistance, they are at high risk for abuse from the people who provide that assistance (Saxton et al. 2001). Most personal assistance is provided in private, thus increasing the vulnerability of women with disabilities. This is further complicated by the large number of family members, including spouses, who provide personal assistance for women with disabilities (Saxton et al. 2001).
II. Manifestations of Domestic Violence against Women with Disabilities
It is critical to describe domestic violence as it pertains to women with disabilities (Hassouneh- Phillips and Curry 2002). Nosek, Foley, and colleagues (2001) found it expeditious to draw on definitions from others, as they broke domestic violence into the components of emotional abuse, defined as ‘‘being threatened, terrorized, corrupted, or severely rejected, isolated, ignored, or verbally attacked’’ (p. 180); physical abuse, defined as ‘‘any form of violence against her body, such as being hit, kicked, restrained, or deprived of food or water’’ (pp. 180–181); and sexual abuse, defined as ‘‘being forced, threatened, or deceived into sexual activities ranging from looking or touching to intercourse or rape’’ (p. 181). They found that women with disabilities described five types of domestic violence: ‘‘(1) disability-related emotional abuse, (2) disability-related physical abuse, (3) disability-related sexual abuse, (4) abuse related to disability-related settings, and (5) abuse related to helping relationships’’ (p. 182). Saxton and colleagues (2001) also identified financial abuse as a form of disability-related domestic violence. Examples of the types of domestic abuse experienced by women with disabilities include:
Disability-related emotional abuse:
- Actual or threatened abandonment (Nosek, Foley, et al. 2001)
- Isolation (Crawford and Ostrove 2003)
- ‘‘Yelling and screaming, threats of abandonment, violations of privacy, threats to neglect children or pets, and being ignored’’ (Saxton et al. 2001, p. 404)
- Difficulty leaving an identified abusive relationship due to reliance on an abusive spouse for ‘‘financial and/or emotional needs’’ as well as ‘‘most basic needs of mobility and physical access’’ (Saxton et al. 2001, p. 403)
- Power imbalance due to socialization of women with disabilities to be passively compliant and pleasant (Saxton et al. 2001)
- Intolerance and rejection (Nosek, Foley, et al. 2001)
- Refusal to acknowledge disability (Corbett 2003; Nosek, Foley, et al. 2001)
- Unrealistic demands on women with disabilities to carry out prescribed family roles (Nabors and Pettee 2003)
- Family prioritization of men’s disabilities over women’s disabilities (Nabors and Pettee 2003)
- Threats of losing custody of or access to children (Beck-Massey 1999; Curry et al. 2001; Olkin 2003)
- Family disavowal of relationship (Crawford and Ostrove 2003; Nosek, Foley, et al. 2001)
- Talking about a deaf woman in her presence by manipulating lighting so that she cannot read lips (Crawford and Ostrove 2003)
Disability-related physical abuse:
- ‘‘By withholding or otherwise preventing the use of orthotic devices or medication, a woman can be rendered helpless’’ (Nosek, Foley, et al. 2001, p. 184; see also Beck-Massey 1999; Curry et al. 2001)
- ‘‘Withholding, immobilizing, or impairing assistive devices or other equipment and withholding or forcing medication’’ (Saxton et al. 2001, p. 405)
- Dismantling of or prevention from using assistive devices (e.g., wheelchairs, hearing aids) (Beck-Massey 1999; Curry et al. 2001)
- Adult children allowing access of known abusive relatives to women with disabilities (Bergeron 2005)
- Family refusal to allow access to personal assistants (Bergeron 2005)
- ‘‘Batterers use the problems women experience (e.g., substance abuse) as abuse strategies (e.g., supplying alcohol or drugs, not allowing women to take medication for mental health issues)’’ (Zweig, Schlichter, and Burt 2002, p. 168)
- Family members’ refusal to develop skills to communicate with a woman with a disability (Corbett 2003)
Disability-related sexual abuse:
- Spousal rape (Nosek, Foley, et al. 2001)
- Threat of physical violence to coerce sexual activity (McCarthy 1998)
- ‘‘The line between appropriate touching as an essential part of the job of providers and inappropriate touching, which could lead to unwanted or ambiguous sexual contact, was not always clearly definable. . . . Bathing and dressing are such intimate activities that it is not surprising that blurry boundaries can create confusion’’ (Saxton et al. 2001, p. 401)
- ‘‘[F]ondling or forcing sexual activity in return for accepting help’’ (Nosek, Foley, et al. 2001, p. 184)
- Confusion between ‘‘helping an individual with sexual activity and participating in sexual activity’’ (Mona 2003, p. 220)
Abuse related to disability-related settings:
- ‘‘Sexual abuse by members of staff in learning disability services is a phenomenon which has happened for many years’’ (McCarthy 1998, p. 548)
- Sexual abuse under the guise of provision of health care (Nosek, Foley, et al. 2001)
- Lack of protection from males in inpatient settings; abuse discounted or excused as ‘‘symptoms’’ of males’ disabilities (McCarthy 1998)
- ‘‘[U]se of seclusion, restraint, and rapid tranquilization with people with developmental disabilities’’ (Sequeira and Halstead 2001, p. 462)
- ‘‘In institutions men routinely pay for, and women routinely accept payment for, sex. . . . Sex is seen as a commodity that can be exchanged and it is a one-way exchange, i.e., the men pay the women, not the other way around’’ (McCarthy 1998, p. 547)
- Therapists’ discounting of impact of disability (Farley 2003; Williams and Upadhyay 2003)
- Therapists’ misattribution of psychological presenting complaints to physical disability (Mukherjee, Reis, and Heller 2003)
- Exposure of nude body to others without permission (Mona, Cameron, and Crawford 2005)
Abuse related to helping relationships:
- ‘‘[R]ough handling, delayed responsiveness of the provider’’ (Mona et al. 2005, p. 238)
- Lack of understanding by police and other helping professionals of the nature of personal assistance relationships, due to societal assumptions that women with disabilities are incompetent (Mona et al. 2005; Saxton et al. 2001)
- Infantilization (Nosek, Foley, et al. 2001; Saxton et al. 2001)
- Attempting to transform a business relationship into a personal friendship (Saxton et al. 2001)
- Disability-related financial abuse:
- ‘‘[T]heft of jewelry, money, and personal belongings; forgery; purchase of personal items when shopping with the participant’s money; and withdrawal of extra money during ATM transactions performed for the woman. A unique form of financial abuse commonly reported was assistants showing up late or not working their full time, but still receiving full compensation’’ (Saxton et al. 2001, p. 405)
- Abuse of durable power of attorney (Bergeron 2005)
- Family refusal to consider financial limitations of women with disabilities (Corbett 2003)
Women with disabilities are often isolated in ways that prevent them from realizing that abusive treatment is not normal (Saxton et al. 2001). Perhaps the greatest threat is that women with disabilities are repeatedly told that they will not be believed if they report abuse (Chang et al. 2003; Nosek, Howland, and Hughes 2001), especially if the perpetrator takes advantage of the woman’s disability to claim that she has misinterpreted or misremembered the abuse (Gilson, DePoy, and Cramer 2001). This is consistent with research indicating that health professionals, police, and legal personnel are slow to respond and engage in considerable victim blaming of women with disabilities (Curry et al. 2001). Even when the women are believed, domestic violence support systems (e.g., shelters) and transportation are seldom accessible to them. Similarly, programs designed to address and support women with disabilities tend to be unprepared to deal with abuse.
In discussing women with disabilities as victims of domestic violence, it is important to consider the violence itself as a source of disability (Plichta 2004). Curry et al. (2001) and Campbell and Kendall- Tackett (2005) indicated that domestic violence could also exacerbate disabling health conditions (see also Zlotnick, Johnson, and Kohn 2006). Three major disabling consequences of domestic violence are traumatic brain injury (Ackerman and Banks 2003; Coker et al. 2005), severe depression leading to suicide (Curry et al. 2001), and pain (Kendall- Tackett, Marshall, and Ness 2003). Plichta’s (2004) review reveals that older women report chronic ill-health effects from intimate partner violence, even after the abuse has ended.
Women with disabilities experience increased vulnerability in part due to conflicting social stereotypes. Some ‘‘asexual’’ stereotypes portray women with disabilities as unattractive, undesirable, and desperate for relationships (Beck-Massey 1999; Crawford and Ostrove 2003; Dotson, Stinson, and Christian 2003; Li et al. 2000; Mona et al. 2005; Olkin 2003), whereas other ‘‘oversexed’’ stereotypes involve exaggerated attractiveness to the point of exploitation (Elman 1997; Fiduccia 1999). Farley (2003) explained that the most hidden intimate partner violence against women with disabilities occurs within prostitution, where injury is inflicted with impunity. The injured women are trapped in ongoing dangerous situations and do not receive health treatment for disabling physical and psychological injuries; this is consistent with research by Plichta (2004), who found that women in abusive relationships had unmet health care needs. Prostituted women, in particular, are unlikely to receive legal or medical assistance (Farley 2003; Zweig et al. 2002). Some pornography suggests that inflicting disabling injury on women with disabilities is acceptable and includes recommendations on how to injure women (Elman 1997); women in prostitution who encounter consumers of such pornography are at very high risk of being killed.
III. Increasing Safety for Women with Disabilities
It is critical to consider ways to facilitate safety for women with disabilities who are in abusive relationships. An overwhelming sense of vulnerability can interfere with women with disabilities who might consider independent living (Hendey and Pascall 1998) or leaving abusive relationships (Olkin 2003). Beck-Massey (1999) suggested being alert for signs of abuse (both individual and in the interactions of a couple), sensitive listening, and individually considered recommendations for increased safety. Chang and colleagues (2003) noted that safety planning is particularly complex for women with disabilities who are being abused by people on whom they are physically dependent; they recommended developing creative ways to let others know that help is needed and having extra medical supplies and assistive devices available.
Some environments appear to be relatively safe for women with disabilities. Albaugh and Nauta (2005) found that college women with disabilities reported receiving ‘‘less psychological aggression and coercion’’ (p. 303) than college women without disabilities or health concerns. Implementation of the Americans with Disabilities Act may increase opportunities for women with disabilities to experience the relatively safe college environment.
Participants in the Saxton et al. (2001) focus groups recommended the following as techniques to minimize the potential of abuse from people providing personal assistance: (a) rigorous screening in the recruitment, interviewing, and hiring phases; (b) checking references, including a criminal background check with the police; (c) drawing up a written contract; (d) authorizing payment; (e) scheduling and following through with regular supervision meetings for direct feedback on how the job is going; (f) making time for the provider to discuss concerns; and (g) never firing a provider in anger (Saxton et al. 2001, p. 410).
Coble (2001) provided recommendations for the hiring of personal assistants, including development of a hiring process and being specific about tasks to be handled and the preferred manner in which they should be accomplished (e.g., order of assistance with dressing, management of laundry). In order to facilitate cooperation of personal assistants, Coble emphasized the importance of clear communication, assertiveness, empathy, careful listening, and focusing on ‘‘only the immediate issue of concern’’ (p. 8). In addition, Coble (2001) noted that relationships between women with disabilities and personal assistants could be enhanced with psychotherapy using ‘‘a combination of education, conflict resolution and enhancing communication skills’’ (p. 8).
There is a strong need to increase the accessibility of shelters for women with disabilities (Beck-Massey 1999). The necessary accommodations vary considerably due to the wide variety of disabilities experienced by women. Zweig and colleagues (2002) noted that women with substance-related or mental disabilities face multiple barriers to receiving assistance in escaping from domestic violence. Shelters struggle with severe financial limitations that serve as barriers to developing accommodations necessary to serve women with disabilities who are attempting to leave abusive situations (Chang et al. 2003). Some shelters have started to coordinate services with other agencies (Chang et al. 2003), but the reality is that such coordination seldom meets the needs of the broad range of disabilities experienced by women.
There is a need for much more research to fully understand the extent and variety of domestic violence experienced by women with disabilities. However, enough vulnerabilities have been documented so that programs can be instituted to start to meet the needs of and enhance safety for women with disabilities. Information about domestic violence ought to be made available in multiple formats accessible to women with disabilities. Services for women with disabilities must include awareness of, education about, and the ability to screen for domestic violence, just as domestic violence services must be prepared to serve women with disabilities. Education of health professionals and law enforcement personnel must include the specific challenges faced by women with disabilities; such education must directly address and confront stereotypes about women with disabilities. Future research should include attention to a broad range of issues, including ethnicity, age, sexual orientation, religion, socioeconomic status, and types of disability, to ensure that culturally accessible and relevant services are developed and maintained.
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