Sociological Focus

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Body Image among Women with Physical

Disabilities: Internalization of Norms and
Reactions to Nonconformity

Diane E. Taub , Patricia L. Fanflik & Penelope A. McLorg

To cite this article: Diane E. Taub , Patricia L. Fanflik & Penelope A. McLorg (2003) Body Image
among Women with Physical Disabilities: Internalization of Norms and Reactions to Nonconformity,
Sociological Focus, 36:2, 159-176, DOI: 10.1080/00380237.2003.10570722

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 BODY IMAGE AMONG WOMEN
WITH PHYSICAL DISABILITIES:
INTERNALIZATION OF NORMS AND
REACTIONS TO NONCONFORMITY*

DIANE E. TAUB SOCIOLOGICAL FOCUS

PATRICIA L. FANFLIK Vol. 36 No. 2:159-176
PENELOPE A. MCLORG May 2003
Southern Illinois University Carbondale

Body norms for women are based on stereotypical gender expectations regarding physical
appearance. Although women in general are exposed to societal standards of the ideal body, women
with physical disabilities encounter unique circumstances in meeting these expectations. Women with
physical disabilities are often stigmatixed because they violate norms of body aesthetics and body
shape. This research examines the extent to which women with physical disabilities internalise body
norms and the reactions these women have to their nonconformity to societal body standards. In-
depth tape-recorded interviews, investigating a variety of social and interpersonal issues, were
conducted with 21 female university students with physical disabilities. Using content analysis, the
researchers examined the interviews for common themes and patterns relating to body image. The
major categories that emerged were (1) awareness of body norms, (2) compliance with body norms,
and (3) reactions to nonconformity to body norms. The study illustrates that women with physical
disabilities have two general reactions to societal expectations of the ideal female body: emotional
responses and stigma management. The lack of questioning of cultural body norms by respondents is
discussed as it relates to the rural, small town study location.

ΜΓ hysical attractiveness and attainment of the ideal body are highly valued in
Western cultures (Cash 1990; Raudenbush and Zellner 1997). Individuals who are
aesthetically pleasing typically receive social rewards and privileges during their daily
interactions (Henderson-King and Henderson-King 1997). Attractive people are often
viewed as possessing such admirable traits as sociability, popularity, happiness, and
confidence (Cash 1990; Fallon 1990). For both males and females, specific qualities of
age and race/ethnicity contribute to the cultural standards of beauty (Cash, Anas, and
Strachan 1997; Molloy and Herzberger 1998). Further, appearance expectations are
related to characteristics of strength, energy, and control over body movements (Abell
and Richards 1996; Cullari, Rohrer, and Bahm 1998; Wendell 1996,1997). Such views
can particularly affect individuals with physical disabilities. In this paper we
illustrate ways that women with physical disabilities respond to body norms, using

Contact Diane E. Taub, Department of Sociology, Southern Illinois University Carbondale, Carbondale, IL
62901-4624. E-mail: dtaub9siu.edu. This research was supported by a University Priorities and
Interdisciplinary Initiative Grant, Southern Illinois University Carbondale Graduate School and Office of
Research Development and Administration, to Elaine M. Blinde and Diane E. Taub. Much appreciation is
extended to Ann Herda-Rapp for her assistance in interviewing, and we gratefully acknowledge the helpful
suggestions and comments of Michelle Hughes Miller.
169
160 SOCIOLOGICAL FOCUS

data from a qualitative study of female college students. To provide a foundation for
our analysis, we review literature on societal views of physical appearance.

SOCIETAL MESSAGES REGARDING PHYSICAL APPEARANCE

Both men and women are affected by the pervasive societal messages regarding
physical appearance (Brodie, Bagley, and Slade 1994). Television and mnganiy» adver-
tisements frequently display body images that reflect a standard that is unattainable
for the vast majority of people (Molloy and Herzberger 1998). Nevertheless, messages
from social interactions and the mass media assign the individual responsibility for
maintaining appearance expectations (Henderson-King and Henderson-King 1997).
Women are more vulnerable to body norms as they are more likely than men to be
judged by their appearance and sexual appeal (Fallon 1990). Cultural pressures thus
encourage females to be overly invested in physical aesthetics (Feingold and Mazzella
1998; Muth and Cash 1997).
Because the ideal body for women stipulates notable thinness, women are at a
greater risk of developing a distorted self-concept (Raudenbush and Zellner 1997). The
degree of satisfaction females feel about their bodies is influenced by the verbal and
nonverbal reactions they receive from others regarding their appearance (Monteath
and McCabe 1997). Body self-perceptions of women also are affected by their attitudes
about appearance, sexuality, health, and physical skills (Cullari et al. 1998; Smart
2001). Further, body dissatisfaction for females increases with weight gain, especially
when they feel the gain occurs in one area of their bodies, for example, on their
stomach, buttocks, or hips (Cash and Henry 1995; Monteath and McCabe 1997).
Overlooked in standards of appearance are variations in body type, height, age, race/
ethnicity, and physical competence. Rather than including diverse characteristics, the
ideal body represents a woman who is young, medium height, slim, nondisabled, and
white (Begum 1992; Monteath and McCabe 1997).

EXPERIENCES OF WOMEN WITH PHYSICAL DISABILITIES

Although women in general are influenced by body norms, women with physical
disabilities encounter unique circumstances in attempting to conform to these ideals
(Asch and Fine 1988, 1997; Stone 1995). In particular, the use of accommodating
devices such as wheelchairs, braces, and crutches counters appearance expectations
(Asch and Fine 1997; Begum 1992). In Bogle and Shaul (1981), accommodating
devices are described as "metal . . . hard, cold, angular, and usually ugly" (p. 93).
Incorporating these devices as an aspect of a woman's physical self may affect her
development of a positive body concept (Stone 1995). In addition, movement restric-
tions and the body shape of women with physical disabilities complicate their con-
formity to ideal body aesthetics (Frank 2000).
Daily interactions for women with physical disabilities can be impeded when
able-bodied individuals believe these women are not complying with appearance
expectations (Smart 2001; Thomson 1997). Deviation from such cultural norms may
result in their being viewed as "defects and undesirable" (Begum 1992, p. 77), as well
as asexual, unfeminine, and childlike (Healey 1993; Lakoff 1989; Lloyd 1992).
Thomson's work (1997) suggested that the body of a woman with a physical disability
BODY IMAGE AMONG WOMEN WITH PHYSICAL DISABILITIES 161

is regarded as a "grotesque spectacle" and as an "icon of deviance" (p. 285). Further,

Wendell (1997) argued that in a culture that values control over one's body, a
disability "symbolizes failure" and reflects a body appearance that able-bodied
individuals "are trying to avoid, forget, and ignore" (pp. 268-269). Rather than being
considered as possessing a variety of personal qualities, women with physical disabili­
ties are frequently defined by others only in terms of their body attributes (Asch and
Fine 1988,1997; Henderson, Bedini, and Hecht 1994). Such a focus on the functional
limitations of the body characterizes the stigma-based medical model. A newer and
competing model, the social or identity politics model, emphasizes differences in the
body and the transformation of appearance norms (Barton 1998; Darling 2001).
As with their able-bodied counterparts, many women with physical disabilities
internalize cultural expectations of body aesthetics (Bogle and Shaul 1981; Stone
1995; Wendell 1996,1997). Because of disparaging reactions to their disability, women
with physical disabilities often believe their bodies are a "source of pain, guilt, and
embarrassment" (Begum 1992, p. 77). Such self-perceptions perpetuate feelings of
inferiority, a poor body self-concept, and avoidance of social interactions (Rybarczyk et
al. 1995; Smart 2001). This emphasis on appearance has promoted an increase in the
incidence and prevalence of eating disorders for women with physical disabilities
(Gross, Ireys, and Kinsman 2000).
Goffman (1963) suggested that women who do not embody appearance stand­
ards possess a stigma, or discrediting attribute. Stigma derives from cultural expecta­
tions and reflects the norms and values of individuals in the dominant group. The
"spoiled" identity of the stigmatized person emerges from the negative reactions of
"normals" to the possessor of the discrediting attribute (Darling 2001; Goffman 1963).
Stigmatized individuals need to create and defend a claim to a legitimate status
(Elliott et al. 1990). The techniques used to manage a stigma primarily depend on the
degree to which the attribute is apparent to others. Goffman (1963) differentiated
between individuals with a visible or perceivable stigma, the discredited, and those
whose duTerentnese is not easily identifiable, the discreditable. Individuals with a
discredited stigma attempt to manage the tension involved in social interactions,
while discreditable persons strive to control information that may expose their stigma
(Barnes, Mercer, and Shakespeare 1999; Goffman 1963). For women with physical
disabilities, the degree to which they need to manage the tension during social
encounters is dependent upon how much their disability is perceived as varying from
appearance expectations (Darling 2001; Gerschick 2000; Stone 1995; Thomson 1997).
To conform to body norms, women with physical disabilitiee may attempt to
conceal their disability (Henderson et al. 1994; Peters 1993; Stone 1995). Some women
participate in weight lifting and wheelchair racing with the express purpose of
improving their appearance and mobility (Bogle and Shaul 1981). Others may focus on
educational and career pursuits when they believe they cannot attain the standard of
feminine beauty (Asch and Fine 1997; Begum 1992). Lastly, some women with
physical disabilities choose to resist both gender and disability standards by rejecting
expectations of beauty and frailty (Gerschick 2000).
162 SOCIOLOGICAL FOCUS

LIMITATIONS OF PRIOR STUDIES

Although the number of publications concerning women with physical dis­

abilities has recently increased, there is a shortage of research focusing on their lived
experiences (Gill 1996; Lisi 1993; Morris 1993). In articles and books that focus on
women with physical disabilities, commentaries and theoretical discussions appear,
instead of sentiments voiced by the women themselves (Asch and Fine 1988). Most
studies do not incorporate interview data about the daily lives of women with physical
disabilities (for exceptions, see Frank 2000; Henderson et al. 1994). No research, to
the authors' knowledge, has explored responses of these women who live in rural,
small towns. Such settings may present particular challenges because of their physical
barriers to mobility and the generally limited cultural and social diversity of
individuals who live in these areas.
In addition, gender studies addressing cultural expectations for women have
excluded women with physical disabilities (Asch and Fine 1988; Morris 1993;
Thomson 1997; Wendell 1996, 1997). The topic of body image, for example, has been
researched extensively (e.g., Cash 1990; Cullari et al. 1998; Feingold and Mazzella
1998). However, most studies about body image have not included women with
physical disabilities (for exceptions, see Henderson et al. 1994; Rybarczyk et al. 1995).
The inadequate investigation of issues pertinent to women with physical disabilities
contributes to their marginalization and deviant labeling. Excluding women with
physical disabilities from research denies their experiences as active participants in
social life.
This study extends prior work on the able-bodied ideal by examining how
women with physical disabilities interpret body norms and respond to their variations
from the ideal body. Given the restricted ability of these women to meet the societal
emphasie on the ideal body, the manner in which they negotiate their body image is of
particular interest. Including women with physical disabilities in research that
examinee body image can illuminate their unique experiences and challenge the
normative conception of the ideal female body. The purpose of this research is to
investigate awareness of the ideal body, internalization of body standards, and
reactions to nonconformity to appearance expectations among women with physical
disabilities. This study differs from other research about women with physical
disabilities in that interview data were collected from women with a range of physical
disabilities who live in a rural, small town.

METHODOLOGY

SAMPLE

Female students with physical disabilities were recruited through personal

contacts of the interviewer and the disability support office at a rural midwestern
university. This school, with an enrollment of approximately 22,000 students, is
located in a small town surrounded by farmlands, orchards, and a national forest. The
rural area presents mobility barriers such as inadequate public transportation and
absent or poorly maintained sidewalks. A total of 21 women agreed to participate in
an interview study that examined social and interpersonal issues pertaining to women
BODY IMAGE AMONG WOMEN WITH PHYSICAL DISABILITIES 163

with physical disabilities. The age range for respondents was 19 to 56 years with a
median age of 35. Nineteen individuals were white; one participant was African
American; and the other respondent was Asian. While 7 individuals had congenital
disabilities, 14 participants had an acquired disability. The length of time with an
acquired disability spanned 2 to 38 years, with an average duration of 14 years.
Disabilities of respondents included mobility impairment (n = 6), post polio (re = 3),
spinal cord injury (re = 2), muscular dystrophy (re = 2), cerebral palsy (re = 2), multiple
sclerosis (re = 1), a cardiac condition (re = 1), spina bifida (re = 1), fibromyalgia, a
condition characterized by chronic musculoskeletal pain (re = 1), achondroplasia, a
condition characterized by delayed bone growth and short stature (re = 1), and
osteogenesis imperfecta, or brittle bone disease (n = 1). Seven individuals did not
require movement accommodations; however, they had limited mobility and often
limped or walked very slowly. Seven of the women utilized wheelchairs, and one
respondent used an ankle brace. The remaining six individuals used a combination of
at least two accommodating devices, such as ankle, leg, and back braces, crutches,
wheelchair, cane, scooter, and walker.

DATA COLLECTION

Individuals were asked to participate in a tape-recorded interview with a female

sociology graduate assistant who was trained in research methodology. Two women
who were contacted declined to be interviewed. Eighteen of the 21 interviews occurred
in a private university office, and the other interviews were conducted at off-campus
locations. The length of time for an interview ranged from 40 minutes to two hours;
the average duration was one hour, 10 minutes. Each of the women chose a fictitious
name to promote confidentiality and to protect her identity during the interview and
subsequent transcription.
This research was one aspect of a larger project exploring interpersonal and
academic issues pertaining to college women with physical and visual disabilities. The
current study centered on interview responses from women with physical disabilities,
with a focus on the internalization of body norms and self-perceptions of the body.
Interviews were tape-recorded to allow uninterrupted data gathering and to facilitate
accurate information. A semi-structured interview schedule consisted of open-ended
questions. The first areas of inquiry centered on demographic information and the
history and nature of the student's disability. Respondents also were asked about
their overall perceptions of the ideal female body and how others reacted toward their
bodies. Questions sought to determine the degree to which a disability influenced the
respondents' body image and whether perceptions of their bodies had changed during
their lifetimes. In addition, respondents were asked how societal portrayal of women's
bodies affected their body self-perceptions. Other topics explored stereotypes regard­
ing the ideal female body and the degree of their internalization of body norms. Final
interview questions centered on whether any strategies were used to achieve societal
standards of the ideal female body.
Probing techniques were used during the interviews to encourage women to
elaborate on and clarify their responses. For example, participants were asked to die-
cues further any reactions or feelings that may have emerged in response to a certain
question. After each interview, the interviewer tape-recorded general impressions of
164 SOCIOLOGICAL FOCUS

the respondent, a description of the woman's disability, additional comments made by

the respondent, and any nonverbal behavior exhibited before, during, and after the
interview.

DATA ANALYSIS

Verbatim transcriptions of the 21 tape-recorded interviews were completed and

then proofed for accuracy. Interview responses totaled 463 pages of single-spaced text,
with an average of 22 pages per respondent. The interview transcripts were independ-
ently analyzed by the first and second authors using content analysis, a research
technique designed to reduce large amounts of data into more discrete, identifiable
sections. All transcribed material was coded to identify themes, patterns, and concepts
related to body image and disability. Open coding, or the process of dividing the data
into a set of broad categories, was used (Baker 1999; Berg 1998; Strauss and Corbin
1998). Each interview response was inspected for coding placement and later arranged
by a major theme. Awareness of body norms for women as described by women with
physical disabilities was the first main category that emerged from the content
analysis. The second main category indicated by this analysis was compliance with
body norms by women with physical disabilities, and the third was various reactions
of women with physical disabilities to their nonconformity to body norms.
To identify possible subcategories, the same investigators further examined the
main categories using axial coding, which divides broad categories into subcategories
(Baker 1999; Berg 1998; Strauss and Corbin 1998). The resulting subcategories were
more specific and refined than the main categories. The researchers identified emo-
tional responses and stigma management as subcategories of participants' non-
conformity to body norms.
Summary sheets for each category were constructed so that transcribed material
could be organized. All relevant interview comments were arranged according to their
category placement and included on the respective sheet. To determine intercoder
reliability, the first and second authors independently examined the transcribed
material. Each interview response was evaluated for the development of categories
and eventual placement into categories and subcategories. Comparison of category
development and data assignment indicated a high rate of agreement between the
researchers. Differences in data interpretation concerned placement of a few interview
passages, and after discussion the researchers reached a consensus.

RESULTS

AWABENE88 OF BODY NORMS

The women with physical disabilities who were interviewed for this study hold
beliefe similar to those of their able-bodied counterparts regarding societal standards
of the ideal female body. Respondents, regardless of age or whether they had a con-
genital or acquired disability, indicated their belief that the body of the ideal woman is
lean. Responses referring to the muscularity of an ideal body included "not mis-
shapen," "firm," "looks stronger, has muscle tone," "not full-figured," "perfect little
bodies," "muscular definition," and "good athletic shape, toned op, looks like a model."
BODY IMAGE AMONG WOMEN WITH PHYSICAL DISABILITIES 165

Vicky, a 37-year-old woman with muscle degeneration from muscular dystrophy,

commented that an ideal body reflects "someone who does a lot of aerobics and
immmi»ffl her muscles."
In their descriptions, these women, regardless of age or type of disability,
characterized the ideal body as lacking fat, using phrases such as "less flabby,"
"anorexically thin," "skinny, not fat," "nice thin waist, nice hips," "not really grossly
overweight,* and "thin, not [having] cellulite." Discussing her impressions of the ideal
female body, Holly, a 23-year-old woman with partial paralysis from spina bifida,
stated that the ideal body "is probably a size six, doesn't have a very high percentage
of body fat, tall and slim." Laura, a 56-year-old woman with a mobility impairment,
suggested that "society wants thinner, a nice body is fit and within an appropriate
range of fat composition and muscle composition." Only two women mentioned
qualities of the ideal body not based on appearance. These comments reflected the
beliefs that the ideal body is healthy and functional.

COMPLIANCE WITH BODY NORMS

Even though these women with physical disabilities are aware of body norms,
they believe they cannot achieve the ideal body type because of how they think they
look and move. While participants acknowledged that nearly all women encounter
difficulties meeting societal appearance standards, women with physical disabilities
are unique in the ways that they attempt to attain the ideal body. Respondents,
regardless of type of disability, stated that their lack of compliance with body norms is
related to their accommodating devices (e.g., wheelchairs, braces, crutches, and
scooters), restricted physical movement, and atypical body appearance.
These women indicated that attempts to comply with a lean physique are
hindered by the appearance and effects of accommodating devices. Their comments
linked lack of compliance with body norms to accommodating devices: "I'm heavier,
society's more thin. Since I'm in a wheelchair . . . I'm the opposite of the whole total
picture;" "the back brace, it's an albatross. I mean it's there; you can't miss it;" and
"it's hard to lose weight when you're a female in a wheelchair... you don't get a lot of
activity." Casey, a 45-year-old woman with a mobility impairment, reflected on how
her body image has changed since being in a wheelchair after a falling accident 12
years ago. Prior to this incident, Casey enjoyed an active lifestyle that included roller-
skating, aerobics, and swimming. Distraught about her inability to exercise to lose
weight, Casey commented, "For someone who was very athletic and very active most
of their life — to be in a position where your body won't allow you to do whatever you
want, ifs very frustrating and very demeaning."
Debbie, a 24-year-old woman with cerebral palsy, stated that self-perceptions of
her body are related to the use of both a wheelchair and braces. She indicated that one
effect of cerebral palsy is that she has minimal control of her arm, leg, and trunk
muscles.

When you're sitting down moat of the time, your metabolism isn't a· great, and you work harder to
stay thinner or «tay more normal looking.... I wore brace« on my lege . . . and I need to go on my
walker and walk down the hall and my braces would just clink together, so that aflecta your body
image. You think you're more weird looking.
166 SOCIOLOGICAL FOCUS

Women who do not use accommodating devices reported they could not achieve
the ideal body because of their restricted physical mobility. Respondents who were
older than 30 years were more likely than younger women to indicate that physical
limitations hindered their attempts to comply with body norms. As two such women
noted, "Sometimes I hate my body because I can't get out of bed." "How are you
supposed to stay in shape if you hurt all the t i m e . . . . It's something that's on my mind
sometimes throughout the day that my body doesn't work like I would like it to." With
the onset of muscular dystrophy, Vicky became troubled over her inability to meet
appearance expectations. While striving for a lean body, she admitted to being
hindered by chronic fatigue and a lack of muscle strength. April, a 41-year-old woman
with a spinal cord injury resulting from an automobile accident five years ago,
discussed how her "activity level has changed from sports-oriented affairs to more
cultural activities." Describing how she compares her body to those of other women
her age, she remarked, "I'm not holding my own. . . . I can't run the steps anymore. I
think I could, even at my age, if I didn't have the hip pain, the back pain, afraid of
falling . . . it preoccupies my mind and body."
Other respondents expressed the belief that they cannot attain the ideal body
because of their atypical appearance. However, they continue to strive toward societal
expectations regarding the body. Women younger than 30 years of age were more
likely than women who were older to mention an atypical body appearance as an
explanation for their lack of compliance with body norms. Describing how she feels
about her body, Linda, a 25-year-old woman with osteogenesis imperfecta, stated, "I'm
about the size of a 3-year-old . . . my body proportions — I'm not shapely. . . . I don't
have the perfect shape. . . . I don't like my shoulders, probably because I don't really
have any." In a discussion about the appearance of her disability, Josephine, a 19-
year-old woman with post polio, stated that she cannot meet societal standards
because "both my legs don't look the same and it's different looking."

REACTIONS TO NONCONFORMITY TO BODY NORMS

These women with physical disabilities reported that they are aware of body
norms for women. However, they feel it is difficult for them to comply with such
appearance standards. In their discussions about body norms, these women indicated
two general reactions to their nonconformity to an ideal body: emotional responses
and stigma management.

Emotional Responses

These women with physical disabilities manifest negative emotional responses

because they perceive that their bodies do not meet societal expectations regarding the
ideal body for women. Respondents, regardless of the type of disability, stated that
anger and discontentment are the most common emotional reactions arising from
their attempts to conform to body norms.
The first emotional response toward not meeting expectations of the ideal body
by women with physical disabilities was anger, either at themselves or at the
normative restrictions. In both cases, participants still felt obligated to comply with
societal standards. Describing how she feels about the appearance ideal for women,
BODY IMAGE AMONG WOMEN WITH PHYSICAL DISABILITIES 167

Perry, a 27-year-old woman with cerebral palsy, said, "I get really mad, and that just
makes me want to try all those diets even more." She believes the ideal body is
becoming increasingly "bone-thin" and that her body is "completely deformed . . . a
giant zigzag." Perry, who has been continually irritated about her weight gain over
the past 10 years, remarked, "I don't like my body. . . . I don't want to go through life
overweight the whole time . . . I just want to be thinner."
The pressure to be slim is so intense that several respondents constantly try to
lose weight. Mary, a 25-year-old woman with achondroplasia, has perpetually used fad
diets. Reflecting resentment of body standards, she stated, "I get mad; they're trying
to make us think that we have to look like that and that's ridiculous. I just think
that's wrong." Similar to other respondents, Mary considers her body to be "different
than other people's" and dislikes the portrayal of the ideal female body in magazines
and on television. Although Mary expressed her anger over societal images, she still
insisted, "I wish I was a little skinnier. I wish I could lose weight."
Casey becomes angry about not meeting societal standards because she can no
longer maintain the ideal slim and fit body she had before her accident. In fact, she
noted, "Being overweight bothers me a lot worse than the back injury." In the past,
Casey had engaged in a regular exercise regime, whereas now she is sedentary.

I get really disgusted because, naturally, when you can't exercise or be athletic anymore, you start
putting on weight. And I'd say I'm going to lose this, I'm going to exercise. I'm going to get rid of it.
And I would exercise every day or three days a week for maybe one week or two, and then I would
end up sick and down and back in pain again.

The second emotional reaction of women with physical disabilities toward not
achieving the ideal body is discontentment. Throughout the interviews, the respond­
ents' comments about body size and shape revealed feelings of inadequacy about their
bodies and low self-esteem. Women who were older than 30 years of age were more
likely than younger women to mention feelings of discontentment over not attaining
an ideal body. When discussing how she cannot meet societal expectations of body
norms, April stated that having a disability negatively affects her self-image,
especially as a woman. She said, "[the disability] interferes with your ability to feel
your femininity, your motherhood, what I feel makes a woman a woman. Yes, I feel
like it violates or [that] it does interfere with [being a woman]." Marsha, a 41-year-old
woman with a mobility impairment, described how feelings about her body have
changed after her car accident. She now walks with a distinct limp and believes her
body is incapable of meeting both physical demands and appearance expectations.

I feel bad; it doesn't work anymore. I feel my body's bad; I have a negative perception of i t I don't
have the type of body that society classifies as desirable which makes me feel undesirable . . . so,
yeah, I feel bad. I don't fit the standard norm. I guese I have a hard time being okay with the way I
am.

Vicky discussed how negative self-perceptions about her body affected her inter­
actions with other individuals. Avoiding social situations, she believes her disability
"really sent my self-esteem way down, and I'd stay in the house all week long for
months." Similar to Vicky, Sara, a 41-year-old woman with post polio, described her
apprehension at forming relationships or appearing in public. Believing she is judged
168 SOCIOLOGICAL FOCUS

by her appearance, Sara considers herself to be shy and "distant . . . afraid to get
close." Sara commented on how she particularly disliked going to the mall:

I always felt like a zombie ii bow I used to describe it to myself. I need to hate if we would go
■hopping and there waa full-length mirrors, or whenever yon had to eee yourself paaa by. I waa just
really repulsed by seeing how I walked or how I looked and how I must look to other people. I never
accepted it well.

Responding to whether her weight gain has adversely affected her self-image,
Holly admitted, "I've been wanting to lose weight for a long time, and nothing has
completely worked. The more it [weight] goes on, the worse I feel." While attempting
to meet societal standards, she acknowledged that "the ideal body and my [body]...
just don't go together, and that frustrates me and that bothers me. And I don't like it."

Stigma Manageaient

A second response toward not meeting expectations of the ideal body is stigma
management, techniques used in an effort to control negative reactions or conse­
quences from a discrediting attribute (Goffman 1963). These women with physical
disabilities engage in strategies that offset unfavorable perceptions by others that
their bodies vary from societal standards. As all the respondents have a disability that
is immediately apparent, these women exhibit a discredited stigma. This group of
women, who internalize body norms, attempt to manage tension by minimising
disparaging responses to their body shape and size. The most commonly used stigma
management strategies relate to concealment of their disability, deflection of attention
from their disability, and normalization of their disability.
Women with physical disabilities make efforts to bide or disguise their dis­
ability. Concealment strategies include self-segregation, passing, and use of disidenti-
fiers (Elliott et al. 1990; Goffman 1963). These women do not use the technique of self-
segregation because removal from social interactions with able-bodied individuals is
impractical. Similarly, passing, a means by which individuals attempt to manage
undisclosed discrediting information about themselves, is not evident from the
responses of these women. The strategy of passing is not chosen primarily because the
physical disability of all respondents is easily noticed. The degree to which individuals
can pass is dependent upon the visibility, obtrusiveness, and centrality of their stigma
(Elliott et al. 1990; Goffinan 1963).
These women with physical disabilities employ disidentifiers to separate them­
selves from visible attributes and other aspects most negatively related to a physical
disability (Goffinan 1963). Disidentifiers are used as a strategy of concealment: The
body is consciously monitored or altered in an attempt to conform to appropriate body
norms. Acts of concealment for respondents involve the strategic placement of their
body and clothing deliberately chosen to hide their disability.
Respondents with acquired disabilities report using the technique of conceal­
ment more often than women with congenital disabilities. For example, Megan, a 28-
year-old woman who sustained a spinal cord injury five years ago, attempts to die-
guise her disability during social events by purposefully placing her wheelchair away
from her. Megan explained that she engages in this behavior "to feel like more part of
things. You're not separated by this big piece of equipment." She feels hindered by
BODY IMAGE AMONG WOMEN WITH PHYSICAL DISABILITIES 169

stereotypes that able-bodied individuals hold about people in wheelchairs. Megan

hopes that by biding her wheelchair, she will be viewed as an individual and not just
"a crippled body." Also striving to hide her disability, Debbie tries to conceal the
epaetiäty of her muscles by maximizing the time she spends seated and limiting how
much she lets people see.
When I'm sitting down, I feel normal.... I just think I'm sitting in a chair. When I'm transferring
somewhere, when I'm on my walker because I don't have straight knees . . . I know how I look. It's
not a» normal.

Other respondents attempt to engage in concealment by wearing certain

clothing that minimizes the appearance of their disability. Sammy, a 35-year-old
woman with fibromyalgia, wears baggy running pants to disguise her stiffness and
limited joint flexibility. In further discussion about her clothing selection, Sammy
indicated that she "would love to wear a pair of jeans" but refuses because her joints
"would swell up real bad." Laura selectively chooses clothing accessories for her
position as a teaching assistant. Discussing how she disguises her disability to
promote a professional appearance, Laura indicated, "I finally decided I might as well
just learn to camouflage." She wears a long full skirt and flat or comfortable shoes
during her daily activities.

If I go to a party, 111 wear heels and stay off my feet all day long and walk in very slowly and wait
till nobody's looking and lean on something or slowly sit down. Act like I don't have a problem, BO
that I can look good.

These women with physical disabilities discussed a second type of stigma

management, deflection, the effort to accentuate other aspects of themselves (Goffman
1963). Stigmatized individuals may engage in deflection when the technique of
concealment is not feasible (Elliott et al. 1990). Further, certain individuals possess
the assets (e.g., appearance or financial) that permit the strategy of deflection. Rather
than attempting to wear clothes that conceal their disability, respondents use clothing
and other personal adornments to draw attention to less discrediting attributes.
In a discussion regarding body perceptions, Linda described how her appearance
is especially important. Not being able to hide her disability because of her small
stature, she attempts to focus on other personal attributes. Linda said, "I work on
looking good, dressing to show off the features that are good.... My body concept has
never made me not care about the way I dress. I have always tried to look good."
Elizabeth, a 44-year-old woman with a cardiac condition, described how choice of
clothing is used to divert attention from her slow gait and limited mobility. She
explained, "I try to look nice. I have a nice wardrobe and try to look nice when I go
out."
While striving to shift focus from her disability, Rebecca, a 37-year-old woman
with post polio, said, "You may end up dressing in such a way that will make you fit in
with the others [able-bodied] even when that is not you." She indicated that she must
use leg braces because of the weakening of her muscles. Describing how she wears
dresses that are not comfortable, Rebecca disclosed that "you have to look as much
like them as you can." In addition to careful wardrobe selection, Rebecca concentrates
on the application of her make-up, because, she said, "I consider my only real asset to
170 SOCIOLOGICAL FOCUS

be my eyes. I know I have nice eyes. I emphasize them too much, to try and draw
attention away from everything else."
As the third form of stigma management, normalization is a strategy that
attempts to redefine the stigma and reeducate "normals." Stigmatized individuals
may engage in normalization when the strategies of concealment and deflection are
not practical (Elliott et al. 1990). Thus, women with physical disabilities may choose
to confront the stigma directly. The optimal outcome of normalization is a condition in
which the discrediting attribute loses its stigmatizing quality. Although not widely
used among respondents, attempts at redefinition generally emphasize the positive
attributes of the bodies of women with physical disabilities, while reeducation consists
of the women informing others that body norms should be a non-issue. These women
with physical disabilities engage in normalization in an effort to manage the stigma of
not complying with societal standards regarding the ideal body for women.
Respondents who are older than 30 years and have an acquired disability are most
likely to employ techniques of normalization. Strategies of normalization include
being resigned to the appearance of their body and feigning disinterest in the pursuit
of an ideal body.
Some respondents stated that they have learned to adjust to not meeting
appearance expectations. Sally, a 50-year-old woman with a mobility impairment,
believes that self-perceptions of her body have changed since the onset of Lyme
Disease three years ago. She is now more cognizant of her body as she realizes the
physical effects of her disability. Sally commented, "I'm still happy with myself. . .
sometimes I compare myself to ads and stuff.... I don't like to get down on myself but
I want to be realistic."
Like Sally, Josephine expressed resignation about her physical appearance. In
contrast to when she was a child and self-conscious about wearing a leg brace,
Josephine no longer tries to conceal her disability and is more reconciled to the
appearance of her body. She stated, "I like my body. I don't think everybody should be
like that [the ideal]. It's not healthy. I'm not out to please everybody anymore."
However, when discussing societal portrayal of women's bodies, Josephine acknow­
ledged that she adheres to body norms. As she has become older, Josephine realizes
she will never achieve "a 10 body" and that her body "doesn't fit up to most average
women's bodies, society's average women." Further, she "feels the pressures of being
the ideal thing," [but] "sometimes I just don't care."
Among these participants, feigned disinterest, or outward expressions that body
appearance does not concern them, is the second type of normalization strategy
employed. Some respondents state that they simply do not care if they meet body
expectations, while others contend that body standards are not of interest to them
because they know they cannot embody the ideal. In a discussion regarding how
comfortable she is about her body, Janet, a 35-year-old woman with multiple sclerosis,
revealed that surgery to correct her limited sight resulted in "a droopy cheek and an
eye that turns out." However, she believes that "beauty comes from within and . . . I'm
doing the best that I can, to make use of what I've got." Janet nevertheless maintain«
that body self-perceptions may affect how other individuals treat her. "If you feel
crummy about your looks... the way you are, other people aren't going to treat you as
well."
BODY IMAGE AMONG WOMEN WITH PHYSICAL DISABILITIES 171

Similarly, Laney has "learned to live with her body" and believes that "what's
inside a person . . . is more important than physical looks or physical movement."
Laney, 45, has ruptured discs and developed bone spurs from a car accident six years
ago. She reflected on how she has "gained about 80 pounds and . . . can't do exercises
to take the weight off because of the hernia and the back injury." Rather than striving
for a slender physique, Laney believes that "the most important thing is the mind and
what you do and how you help people." However, she admitted, "I don't think 111 ever
be satisfied with my body again, even with a weight loss."
Other women profess to be indifferent to appearance norms because they
acknowledge that they cannot meet body standards. However, the women revealed
that they do believe the norms are relevant. Respondents attributed their inability to
achieve an ideal body to their disability. Rose, a 31-year-old woman with muscular
dystrophy, indicated that not achieving an ideal body "doesn't really bother me that
much because I know I'll never be like them." Although she stated that she is not
troubled by appearance expectations, Rose believes she "has gotten fatter" and admits
she has to "worry a lot more about being skinny."
Kat, a 20-year-old woman with a congenital mobility impairment, insisted that
she is "more settled with it [her body], more used to it. It's like, 'this is the way it is.
We'll deal with it.' There ain't much you can do about it, so . . . I've never thought
about it really." However, Kat stated that she should lose weight. Kat appears to
ignore societal pressures and be accepting of her body; nonetheless, she remains
aware of the pressure to conform to body expectations.

DISCUSSION

Cultural standards regarding appearance influence the vast majority of women.

In this paper, data from qualitative interviews with 21 college women with physical
disabilities illustrate this theme. Traits relating to the ideal female body are
attractiveness, strength, and thinness (Cash et al. 1997; Fallen 1990; Feingold and
Mazzella 1998). Women whose bodies vary from the societal norm may be held
responsible for a lack of compliance with appearance standards (Smart 2001; Stone
1995). In discussing the ideal body, respondents stated overwhelmingly that the most
desirable female body is one that is lean and lacks fat. Although these women with
physical disabilities strive to adhere to body norms, they indicated that their attain­
ment of societal appearance expectations is difficult. The use of accommodating
devices, restricted physical movement, and atypical body appearance hinder their
efforts to present a slim physique and socially acceptable body.
In general, women with physical disabilities adopt various strategies in response
to their nonconformity to body norms (Bogle and Shaul 1981; Peters 1993; Stone
1995). Respondents choose emotional responses and stigma management to deal with
their variation from appearance expectations. These reactions demonstrate that the
women maintain responsibility for not abiding by body norms. Regarding their non-
compliance with appearance expectations, respondents become angry and discontent,
conceal their disability, deflect attention from their disability, and normalize then-
disability. Concealment, deflection, and normalization are employed as stigma
management strategies in an effort to display a body that is affirmed by others (Elliott
et al. 1990).
172 SOCIOLOGICAL FOCUS

Goffman (1963) asserted that stigmatized individuals internalize the same

cultural beliefs as the person who labels them. Marginalized individuals therefore use
a variety of strategies to create outward images of themselves that counter their
devalued status, as well as to lessen and redefine their discrediting attribute. These
women with physical disabilities use purposeful placement of the body, deliberate
choice of clothing, accentuation of other aspects of themselves, resignation to their
body appearance, and feigning disinterest in the pursuit of an ideal body.
Unfortunately, because of small sample size, factors that differentiate the subgroups
that choose certain strategies over others could not be determined.
For women with physical disabilities, one response to nonconformity to body
norms could be to examine the validity of these norms and their obligation to comply
with such stringent standards. However, these women did not demonstrate this
strategy. The majority of respondents may not question body norms because of their
rural and small town experience, lack of social support, older age, and acquired type of
disability. Most of the women have lived significant portions of their lives in small,
rural communities in the Midwest. Living in such traditional and conservative
settings encourages a high degree of adherence to cultural norms (Bushy 1990;
Johnson 1999). Respondents may thus internalize body expectations without question
and develop strategies to achieve the ideal female body rather than to examine the
relevance of appearance norms and their compliance with such standards.
Regarding social support, women with physical disabilities, unlike many other
marginalized individuals, generally do not have frequent social interactions with other
members of their group (Asch and Fine 1997; Morris 1993). In the current sample,
women with physical disabilities similarly tended to be isolated from other women
with physical disabilities. Although the local university has a disability support office,
respondents indicated that this office primarily serves the academic needs of students.
These women stated that few social events, outside of participation in sports, are
sponsored by offices on campus for women with physical disabilities. Respondents
further commented that their social activities primarily occurred with able-bodied
women. Such interactional patterns correspond with those reported in other works
involving the social contacts of women with physical disabilities (Smart 2001). These
restricted social experiences may reinforce the adherence of women with physical
disabilities to appearance expectations, as able-bodied women are likely to believe
that such cultural norms should be emulated and are worth pursuing (Cash 1990;
Fallon 1990).
Respondents also did not know many women with physical disabilities who
challenged societal standards or demonstrated contentment with their body appear­
ance. In general, few role models or advisory relationships exist for women with physi­
cal disabilities (Lisi 1993; Smart 2001). Similar to other women with physical
disabilities, respondents did not have many opportunities to bond with a mentor.
Thus, disability consciousness and critical thinking about appearance expectations are
less likely to occur (Deegan 1985).
In terms of age, approximately two thirds of these women with physical dis­
abilities are older than 30 years; thus, compliance with body norme might be higher
than in a sample of younger women (Cash et al. 1997; Fallon 1990; Tiggemann 1992).
Respondents who are older may feel additional pressure to comply with societal
expectations due to the normative component of youthful appearance and vitality
BODY IMAGE AMONG WOMEN WITH PHYSICAL DISABILITIES 173

(Abell and Richards 1996; Feingold and Mazzella 1998). Interestingly, this age-related
motivation may be ameliorated if these women have a feminist orientation. Such a
finding was noted by Tiggemann and Stevens (1999), who reported that when women
between the ages of 30 and 49 internalize a feminist ideology, their self-esteem is less
associated with their adherence to body norms. Respondents who were older than 30
were more likely than younger women to express discontentment in not achieving the
ideal body and to indicate that restricted physical movement hinders their ability to
comply. Demonstrating some concern for compliance with body norms, the younger
participants in this study were more likely than older women to indicate that they
could not attain the ideal body because of atypical appearance.
Women with physical disabilities are more likely to adhere to body expectations
if their disability is acquired than congenital (Smart 2001). The high degree of
reported efforts at stigma management demonstrated in this study could have
occurred because two thirds of the women had acquired a disability as an adult, with
the average duration of having a disability being 14 years. For women who have
acquired a disability, compliance with appearance norms can be more salient as their
bodies become objects of increased scrutiny. A negative body image for these women
might be reinforced by the stereotypes conveyed throughout their able-bodied lives
about women with physical disabilities (Smart 2001).
With an acquired disability, women become new members of a stigmatized group
and learn to manage any discrepancies between their former and new bodies (Wendell
1997). Women with acquired disabilities therefore may adhere to body standards to
divert attention from their disability. In contrast, women with congenital disabilities
might be more likely to accept their body shape and appearance as they place less
importance on the achievement of appearance standards. Compared to women with
acquired disabilities, women with congenital disabilities are more reconciled to their
bodies because they have experienced fewer identity transformations regarding their
appearance and physical abilities (Smart 2001).
Findings from these women with physical disabilities demonstrate their
adherence to the medical model, a view in which the disability is individualized and
defined in biological and medical terms. Such a framework highlights the functional
limitations of the body and the responsibility of the individual to make personal
accommodations and to develop coping strategies (Barton 1998; Darling 2001; Linton
1998). Although the disability is the defining characteristic of women with physical
disabilities, their devalued status is generalized to the entire person (Barnes et al.
1999). In following the medical model, respondents hold self-perceptions that focus on
their body deviations and lack of adherence to body norms. Thus, these women react
to stigmatization by being nonresistant and indicating a need for some appearance
modification and adjustment.
This stigma-based medical model is counter to the social or identity politics
model (Anspach 1979; Barton 1998; Darling 2001). In the latter model, emphasis is
placed on social, political, and cultural obstacles that limit opportunities and choices
for women with physical disabilities. An alternative set of societal values and stand­
ards is enacted in attempts to remove such barriers. Rather than embodying
stigmatized identities, women with physical disabilities take a proactive stance to
eliminate biased societal expectations regarding appearance. The focus shifts from
changing women with physical disabilities to transforming societal structures and
174 SOCIOLOGICAL FOCUS

norms (Anspach 1979; Barton 1998; Darling 2001). Thus, appearance norms become
the object of social change in which body choice and differentness are highlighted.
Such new standards alter social interactions with women with physical disabilities
and, subsequently, their body self-perceptions.
The failure of these women with physical disabilities to adhere to the social
model may relate to their rural, midwestern background. Consistent with living in a
traditional and conservative environment, respondents readily internalized appear-
ance expectations and took responsibility for complying with these standards. That
community resources for accommodation are likely to be less common may also
reinforce the women's perception that it is they who must accommodate, not their
environment. The women interviewed indicated a lack of social interactions with other
women with physical disabilities; thus, they do not appear to have developed a
disability consciousness. For respondents, current body norms often emphasize a
disability status in which their disability is labeled as their most salient charac-
teristic. Findings that these women adhere to the medical model counter current
literature that shows a paradigm shift to increasing use of a social model.
Overall, the objectification of women with physical disabilities contributes to
their feeling of worthlessness and negative self-image (Begum 1992; Deegan 1985). By
internalizing societal definitions regarding the body, respondents disassociate
themselves from their disabled identity (Bogle and Shaul 1981; Stone 1995; Wendell
1996, 1997). As body norms highlight strength, attractiveness, and physical compe-
tence, the devalued status of a disability is reinforced and ableism is encouraged
(Lakoff 1989; Lisi 1993; Lloyd 1992). However, resistance to body standards at the
individual, group, and structural levels could promote cultural beliefs that disability
reflects diversity and variation (Wendell 1996, 1997). With a redefinition of disability,
differences in body appearance become valuable rather than deviant or resulting from
individual failure (Frank 2000; Thomson 1997).

Diane E. Taub is a professor of sociology and associate dean of the College of Liberal Arts at Southern Illinois
University Carbondale. She holds cross-appointments in the Department of Psychology, Women's Studies, and
the Department of Family and Community Medicine, School of Medicine. Her research focuses on eating
disorders and individuals with physical disabilities.

Patricia L. Fanflik is currently a senior research analyst, Office of Research and Evaluation, at the American
Prosecutors Research Institute in Alexandria, Virginia. Her research interests include domestic violence, gun
control policies, and workplace violence involving prosecutors.

Penelope A. McLorg is an adjunct assistant professor of anthropology at Southern Illinois University

Carbondale. As a biological anthropologist, she specializes in human biological variability and biomedical
anthropology, with concentrations in aging and women's health. Current research interests include aging, body
composition, and glucose metabolism among nonwesternized Maya women in rural Yucatan, Mexico.

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