"Invisible" disabilities : identity management and well-being in college students

The present study aimed to quantify relationships between internal and external identity management and well-being in individuals with two types of invisible disabilities: learning disabilities and a history of mental health problems. Participants were 111 college students (ages 18-52; 64% women) recruited via email lists who self-identified as having an invisible disability. Participants completed surveys measuring levels of internal identification with disability, outness about the disability, self-esteem, and self-determination. Correlational analysis revealed significant relationships between dis-identification with disability and both self-esteem and selfdetermination in students with invisible disabilities (p < .001, p = .006, respectively). The results highlight the stigmatizing effects of diagnostic labels for students with invisible disabilities and the need for a multidimensional scale to measure identification with disability. INVISIBLE DISABILITIES IN COLLEGE STUDENTS 3 “Invisible” Disabilities: Identity Management and Well-Being in College Students The term “invisible disabilities” can refer to a wide range of cognitive, neurological, and emotional dysfunctions and/or disorders. For the purposes of the present study we define an invisible disability as a mental health problem or a learning disability. Persons with invisible disabilities represent a significant minority of the U.S. population (Kring, Davison, Neale, & Johnson, 2007) and these people are often in need of counseling, accommodations, and other services. However, too little is known about how best to develop and deliver these services. People with invisible disabilities face an additional challenge in gaining access to such support in that their disabilities often go unnoticed, and the legitimacy of the limitations they experience are often not fully recognized by others. Learning about the unique challenges that people with invisible disabilities face, and how the integration of these experiences into their identity affects their well-being, is vital to the improvement of services for this population. Receiving a diagnosis of a learning disability or mental health problem places an individual within a group that is both invisible and stigmatized, and the negative implications of this categorization warrant specific attention from psychologists. Society places a high value on mental abilities and thus, labeling disruptions in cognitive and emotional functioning broadly devalues the person receiving the label (Olney & Kim, 2001). Based on this idea, it is possible that if a person‟s mental abilities indicate his or her value as a person, then people with learning disabilities or mental health problems can suffer as a result of being perceived as fundamentally defective, unintelligent, or “crazy. ” Link, Struening, Neese-Todd, Asmussen, and Phelan (2001) demonstrated a connection between perceived societal stigma regarding mental illness and fear of rejection and low self-esteem in people with such diagnoses. Heyman (1990) showed that the formation of a positive self-concept in children with learning disabilties is strongly dependent on INVISIBLE DISABILITIES IN COLLEGE STUDENTS 4 acceptance and support within children‟s environments. Without acceptance and support, these children may generalize their academic difficulties to other areas of competence, resulting in lower self-esteem. Clearly, the misunderstanding of invisible disabilities has wide implications for how one is viewed by society, which in turn affects how one views oneself. The purpose of the present study is to expand previous research on issues of identity management and well-being in order to provide new and useful information to service providers and counselors for their work in supporting individuals with invisible disabilities. Prior research on identity management in people with disabilities has not fully addressed the complexity of how an individual integrates a disability into his or her identity. Such research has focused broadly on many types of disabilities (Olney & Kim, 2001), or narrowly on specific diagnoses (Anderson, Asher, Clark, Orrick, & Quaison, 1979); it also tends to have been primarily qualitative and exploratory (Olney & Kim, 2001; Anctil, Ishikawa, & Scott, 2008). In the present study, we seek to address gaps in the research by uniquely combining three approaches. Firstly, we strike a middle ground between broad and narrow by studying multiple kinds of disabilities while at the same time only focusing on those which share a very important feature— invisibility to the general population. Secondly, we examine multiple issues this population faces; these include both internal and external identity management, and how these relate to certain aspects of well-being. And thirdly, we collect and analyze survey data in an attempt to quantify the relationships between these variables. Although we recognize the universality of some of the struggles experienced by people with disabilities (e.g., issues of identity formation and management, as well as the matter of how to live a fulfilling life of which disability is a part) these particular concerns are unique and nuanced in people with invisible disabilities. Some of the issues presented by living with an invisible disability include both external and internal INVISIBLE DISABILITIES IN COLLEGE STUDENTS 5 identity management and the relationships these have with certain aspects of well-being, particularly self-esteem and self-determination. Internal and External Identity Management The integration of a disability into identity is a highly complex process with multiple dimensions. Olney and Kim (2001) conducted a qualitative study involving focus groups in which they explored the formation of identity in relation to disability in college students with cognitive disabilities. The disabilities of the majority of participants were invisible in nature and included neurological disorders (e.g., ADHD, traumatic brain injury), learning disabilities (e.g., dyslexia, perceptual disabilities) and mental health problems (e.g., depression, anxiety disorder). One dimension of identity formation and integration that Olney and Kim focus on is identity management. Based on their analysis they suggest this dimension has two subthemes: selfdisclosure of one‟s disability to other people and the meaning disability has for oneself and within one‟s own life. In the present study, we explore these two subthemes and refer to them as external and internal identity management. External identity management can be examined by measuring the degree to which a person is “out” about his or her disability (that is, how much a person self-discloses to others about the disability). Internal identity management relates to how much individuals identify or dis-identify with their disabilities personally. External identity management: Outness with regards to disability. An aspect of external identity management that is unique to individuals with invisible disabilities is the degree to which a person is out about his or her disability (Olney & Kim, 2001; Pachankis, 2007; Quinn, Kahng, & Crocker, 2004). “Outness” refers to the extent to which individuals disclose the existence of, or openly talk about, their learning disability or mental health problem with people in their lives. Since invisible disabilities are not readily recognizable to other people, individuals INVISIBLE DISABILITIES IN COLLEGE STUDENTS 6 with invisible disabilities have a greater degree of choice in deciding the extent to which they reveal their disabilities than those with visible disabilities. Disclosure of a disability to other people is often a significant decision for many individuals with learning disabilities and mental health problems because of the stigmas attached to such labels. Olney and Kim (2001) found that for participants in their study, this decision depended largely on the degree of comfort and closeness experienced in relationships with others. Participants in this study reported fears that disclosure would lead others to perceive them one-dimensionally in terms of their disability, and others noted that they found needing medications or accommodations to be especially stigmatizing. These concerns were not unjustified as participants reported real consequences for revealing their disabilities. Such consequences included discrimination, responses that were patronizing, or responses that minimized the significance of the challenges posed by the disability (Olney & Kim, 2001). This provides evidence that revealing identification with a stigmatized group can have negative consequences regarding the way one is perceived and treated by others. Revealing a history of mental illness can have consequences for individuals in another way by increasing susceptibility to stereotype threat (Quinn et al., 2004). Stereotype threat occurs when negative stereotypes regarding the intellectual capabilities of a stigmatized group exist and are made salient in a certain situation, and the members that identify with that group demonstrate a decrease in performance on measures of intellectual ability. Quinn et al. examined how participants with a history of mental health problems responded to a situation of stereotype threat in which they revealed their mental health histories just prior to taking a test. The results suggest that revealing the stigmatized identity of having a mental health problem can have an adverse effect on test performance. This effect becomes even stronger when the test is described INVISIBLE DISABILITIES IN COLLEGE STUDENTS 7 as diagnostic of one‟s abilities because this increases the salience of one‟s mental health problem. These findings provide further evidence that revealing identification with a stigmatized group can have negative psychological consequences. While there is evidence that revealing a stigma may have significant negative consequences, Pachanki