The study's authors, Brian Armor and colleagues, analyzed the data from the CDC's 2006 US-wide survey on "preventive health factors and risk behaviors that are linked to chronic diseases, injuries and preventable infectious diseases in the adult population," comparing rates of intimate-partner violence among disabled and nondisabled women.
They found that women with a disability were significantly more likely than women without a disability to report experiencing some from of intimate partner violence in their lifetime (37.3 percent versus 20.6 percent).Speaking at the American Public Health Association meeting in San Diego, Armor ventured some ideas as to why this is the case:
Women with a disability were more likely to report ever being threatened with violence (28.5 percent vs 15.4 percent) and hit, slapped, pushed, kicked or physically hurt (30.6 percent vs. 15.7 percent) by an intimate partner.
Women with a disability were also much more apt to report a history of unwanted sex by an intimate partner (19.7 percent vs 8.2 percent).
Perhaps, women with disabilities are vulnerable to intimate partner violence because their disability might limit mobility and prevent escape; shelters might not be available or accessible to women with disabilities; the disability might adversely affect communication and thus the ability to alert others or the perpetrator might control or restrict the victim's ability to alert others to the problem.He also hypothesized that disabled women might depend on their abusers for care, and might be more afraid of being left to fend for themselves or institutionalized than of staying with their abusers. Googling around for more information, I found this fact sheet on domestic violence against Australian women with disabilities, this literature review in the Annals of the New York Academy of Sciences, and this Canadian study from this past spring that anticipated Armor's findings of a huge gap in levels of violence directed at disabled vs. nondisabled women, and also identified some characteristics that distinguish violent partners of disabled women.
The fact sheet provided a few more reasons disabled women tend not to seek help, as well as some reasons why they experience so much more violence in the first place:
Social myths - people with disabilities are often dismissed as passive, helpless, child-like, non-sexual* and burdensome. These prejudices tend to make people with disabilities less visible to society, and suggest that abuse, especially sexual abuse, is unlikely.
Learned helplessness - people with disabilities, particularly people with cognitive disabilities or those who have been living in institutions for a long time, are encouraged to be compliant and cooperative. This life history can make it harder for a woman to defend herself against abuse.
Lack of sex education - there is a tendency to deny sex education to people with intellectual disabilities. If a woman with no knowledge of sex is sexually abused, it is harder for her to seek help because she may not understand exactly what is happening to her.
Dependence - the woman may be dependent on her abuser for care because her disability limits her economic and environmental independence.
Misdiagnosis - authorities may misinterpret a cry for help; for example, a woman’s behaviour might be diagnosed as anxiety rather than signs of abuse. In other situations, workers may not be aware that domestic violence also includes financial or emotional abuse, or may not be sensitive to the signs.
The abuser takes control - if the woman seeks help, follow-up may be difficult because the abuser isolates her and prevents her from using the phone or leaving the house.
Several of these are the same reasons nondisabled women often choose not to report their abuse to police --- they're afraid the police won't believe them, their abusers isolate them, they're afraid trying to leave will make things worse (although nondisabled women do not have to fear being institutionalized, they do fear that the abuser will retaliate against them, and possibly kill them), and they may be financially dependent on their abusers. Disabled women just face severer versions of the same things, since they tend to be more isolated, less mobile and less able to live on their own than nondisabled women.
Depending on which study you're reading, you'll come up with different numbers for the proportion of abusers who are also the victims' intimate partners. (Other people likely to be abusers are family members, caregivers, neighbors and health-care professionals). The fact sheet says that 43% of abusers of disabled women are male partners, and another 11% are female partners. The New York Academy of Sciences article cites this 1991 review by the University of Alberta's Dick Sobsey and Tanis Doe, which found a significant portion (44%) of abusers having come into contact with their victims through the disability-support system; they were paid caregivers, psychiatrists, transportation providers, foster parents and other disabled people. (Only 4% of perpetrators in this study were intimate partners).
Based on the percentage of offenders that are associated with specialized services, it would be reasonable to expect risk to increase by an additional 78% due to exposure to the "disabilities service system" alone. The extent of this elevation of risk would be adequate to explain most of the findings of increased incidence (of rape and molestation) among individuals with disabilities. (emphasis mine)
Most of these offenders were never charged; the victims pressed charges in 22% of cases, and of those, only 8% (36% of the 22% who were charged) were convicted. Most often, the victims chose not to report the incident, believing the risk of retaliation or of being cut off from needed services far outweighed the slim chance at conviction, although there were also a few cases where police or prosecutors refused to press charges.
Another worrying finding from Sobsey and Doe is the role of tranquilizing medication in abuse by caregivers:
It is frightening and ironic that the victims' reports that we analyzed included several cases of victims who developed non-compliant or inappropriate behavior as a response to their abuse, and were placed on intrusive behavior-management programs or tranquilizers to suppress their behavior before the true cause was determined.
They also identify two factors --- inhibitions that normally prevent people from sexually abusing one another as often as they might which are missing from the institutional settings where most of their incidents occurred --- contributing to this increased likelihood of abuse. The lack of scrutiny and oversight of most of these places, due to their isolation and tendency to be understaffed, allows abusive caregivers to abuse with impunity, and the overall societal tendency to devalue disabled people both makes the victims less willing to come forward and other caregivers whom they might tell less likely to believe them.
Appearing in the same issue of Sexuality and Disability as Sobsey and Doe's article is an analysis of the dynamics of institutional sexual abuse by Maureen Crossmaker. She corroborates a lot of the things I've quoted elsewhere in this post: common beliefs about mentally ill people and cognitively or developmentally disabled people predispose people away from seeing them as fully human and possessing rights; residents in institutions are dependent on staff for their survival and well-being, and taught to be compliant and passive; institutions are isolated, insular and intensely hierarchical, which conditions breed sexual abuse**; and victims who complain of abuse are often dismissed as psychotic or incompetent and drugged into submission.
More recent studies, like the Medical Science Monitor article, say the most common source of violence in the lives of disabled women is intimate relationships (which constitute the biggest threat to nondisabled women as well). Both Sexuality and Disability articles I cited focus on institutionalized mentally-ill and developmentally-disabled populations, which would explain the larger share of abuses committed by healthcare workers in those samples.
The above-linked article compared survey data from disabled and nondisabled women asked about their (heterosexual) relationships, looking for relationships between their answers and the level of violence in the relationship, and for differences in factors influencing relationship violence for disabled vs. nondisabled women. They found three factors that were common to both groups of women: their male partners, if violent, tended to be possessive, sexually jealous and espouse "patriarchal dominance."*** Only for the nondisabled women was heavy drinking associated very strongly with violence, and, though the correlation between the three shared factors and violence was stronger for them, the disabled women were more likely to have partners who met those criteria. Patriarchal dominance was the characteristic that was most common in partners of disabled women; those men espoused patriarchal dominance at a rate 2-3 times that of nondisabled women's partners.
*This myth was certainly in evidence in the Ashley X case --- one of the reasons her parents gave for stunting her growth and removing her breast buds was that they thought Ashley would be safe from rape if she didn't look like a woman. Obviously, the myth of the asexual PWD works in tandem with the myth that rape is about sexual attraction --- much like the myth that fat women don't get raped.
**These characteristics also go a long way toward explaining the epidemic levels of rape in prison. The one difference I can see between them is that people outside the prison system are generally aware of prison rape and accept it, while people do not seem to be aware of rape in psychiatric institutions and assisted-living facilities.
***The surveys included one question meant to assay for each of these traits: the possessiveness and jealousy questions were fairly self-evident --- asking directly if the women's partners were jealous, or if they wanted to know where the women were all the time --- but the "patriarchal dominance" question asked if the men controlled the finances and didn't allow the women access to them. That is certainly an instance of patriarchal dominance, but I am not sure it's particularly universal. Maybe it is among men with that high a level of male-supremacist thinking.