One of the most important concepts to remember is that adjustment to adventitious disability is not a function of the severity of the disability per se. The predisability personality of the individual is the most important factor in how they will adjust to their new situation. Individuals well adjusted before will likely cope with a disability far more successfully than those who were not.

As an example, consider two individuals, each of whom sustain a facial disfigurement. If one has narcissistic personality difficulties, that individual may have a much harder time accepting their changed appearance, even though their disfigurement is less severe than that of the other.

For a second example, consider a person who has struggled with a low level of dysthymia for many years. A physical disability added to their life situation may exacerbate that condition, interfering with their ability to cope with the disability.

In general, how well a person has coped with past adversity in their life is the best predictor of how they will cope with any new problem.

Remember that there is no such thing as disability/personality types. There is no Epileptic Personality, no Paraplegic Personality, no Amputee Personality, or the like. There are individuals with disabilities who have their own unique personalities, stressors and coping styles.

The support system of individuals is another critical factor in how well they will cope with serious adversity. How significant others respond to them and the new situation will be a major factor in everything that follows. An absent or weak support system will potentially compound adjustment difficulties, and a strong support system will generally facilitate adjustment. Significant others include the spouse, children whether juvenile or adult, siblings, friends and employer. Each can help or hinder the individual's adjustment to disability.

A number of different stage models have been described, but it is best to remember that adjustment to disability is not a linear process where the person spends so much time in one stage, graduates, and moves onto the next. They can slip back and forth between them, principally spending most of their time in one stage and then another. Hopefully, they progress to a final stage where they accept (i.e., realistically plan and effectively cope with) their disability.

Attitude and Value Changes

It is fairly common for people to place a high value on personal appearance and physical fitness. To the extent that self-esteem is tied to what might be called, "the body beautiful," adjusting to a changed appearance or physical limitations will be impaired. Attention to fitness and appearance should not be neglected, but they should also not be an important basis for self-esteem.

Having a disability involves certain losses of function or efficiency, and if a person compares how they are now with how they were before, a sense of loss will be experienced. Some of this is very natural and even necessary, but to dwell on comparative values, either with the predisability state or by comparing oneself to others not having disabilities, is not conducive to adjustment. For example, it may take three times as long to prepare a meal, four times as long to dress in the morning, and only some of former house cleaning activities may be possible. Individuals with disabilities need to give credit to themselves for what they have learned to accomplish in the face of their limitations, striving to maximize their own functional capacities ... and taking pride in those accomplishments.

When a person has a disability certain activities they could do in the past may no longer be possible. They must not, however, allow the legitimate limitations of their disability to spread to life areas that need not be involved. A person losing an arm, for example, may no longer be able to play golf. But this does not mean they have to stop seeing their golf partners, should not drive the cart and putt, or meet them in the clubhouse afterwards. If they formerly walked courses following professional matches they can still engage in that activity. To rid oneself of everything related to golf spreads the disability to areas of life that need not become involved.

As another example, a person in a wheelchair may lose certain activities, but not likely being able to go to church. If they stop going to their church because they don't want friends to see them in a wheelchair, the effects of the disability have spread to an area of their life they do not naturally impair.

When past activities can no longer be engaged in as a result of disability, a hole is created in the person's life that needs to be filled. They have lost something reinforcing to them, and must find another activity to replace it. If new activities and interests are not found, a deeper sense of loss will be experienced. Successfully adjusting to a disability involves finding these new values and activities, and making them a new part of one's life. Disabilities tend to reduce strength, physical capacities, mobility and/or endurance, and more sedentary activities are often less restricted and the easiest for many to add.

A secondary gain is a [problematic] benefit that comes to an individual as a result of having a disability. In rehabilitation, the term is usually reserved for [problematic] gains that interfere with an individual's personal adjustment or rehabilitation program. Being able to go to the front of a line at Disney World or use handicapped parking spaces are technically secondary gains, but they are nonproblematic and not what this term is intended to address.

Secondary gains from disability that may, for some individuals, interfere with personal adjustment or rehabilitation include: (1) financial compensation or the expectation of receiving such compensation, (2) release from unpleasant family, household, work and/or other responsibilities, (3) increased attention and/or solicitous behavior from significant others, and (4) medications that reduce anxiety and/or create feelings of euphoria. Secondary gains may spread disability effects beyond areas they naturally impair.

This is the study of how physique, the body, and physiological processes influence the psychological functioning of the individual. The somatopsychological relationship is the opposite of the psychosomatic relationship, the latter being how psychological processes (such as stress) affect the body. Disability and atypical physique are somato conditions that can affect the experiences, development and psychology of individuals.

Disabilities may be adventitious (occurring at anytime over the long course of life), congenital, or developmental. A congenital disability is one existing since birth. Most developmental disabilities have existed since birth, but many are not recognized until there is a failure to reach developmental expectations of a certain age. Common childhood disabilities seen by Rehabilitation Counselors in adolescence or early adulthood include autism, cerebral palsy, deafness, and mental retardation.

From a psychosocial perspective, the child with a disability needs to have their special needs met without being overly protected. The problem of not having special needs met and over protection are the same ... absent or delayed development. Such delays may be intellectual, educational, or emotional.

Many years ago children with significant disabilities were characteristically given homebound instruction. While this very questionably met their educational needs, it did not provide the developmental experiences of other children and adolescents. These developmental experiences are often very difficult for young people with disabilities, but they are not easy for anyone, and they are the only tried and true road to mature adulthood. Mainstreaming in the schools is intended to provide not only an education, but normal developmental experiences necessary for the transition, with or without a handicap, into mature adult life.