LGBT people with physical disabilities face unique challenges as compared to their able-bodied peers. Throughout their lives, these individuals are subjected to increased rates of childhood bullying, a lack of proper sexual education as teenagers and difficulties in receiving proper medical care as adults.
"Homophobic, biphobic or transphobic (HBT) bullying is any form of bullying directed toward a person because of their real or perceived sexual orientation or gender identity, or because of their association with people who are LGBT," according to the UK-based Anti-Bullying Alliance.
In a guide for school personnel regarding HBT bullying targeted toward disabled children and kids with special needs, the Anti-Bullying Alliance notes that this population is at an increased risk of HBT bullying compared to their able-bodied peers: two thirds of children with disabilities and special needs have experienced homophobic bullying, for example, compared to 55 percent of the general population. The organization also points to additional research corroborating that a real or perceived physical disability is frequent reason of HBT bullying.
The Anti-Bullying Alliance also points to the lack of sexual education in school directed toward LGBT individuals, and it gets even worse in the case of LGBT individuals with a physical disability.
Dr. Susan Gray, an assistant professor of pediatrics at Harvard Medical School, said it's important that parents of adolescents with physical disabilities make sure their child is receiving proper sexual education.
"Too often adolescents with physical disabilities are told they don't need to be in sex ed, that it doesn't apply to them, but everyone needs that information, and parents need to make sure their kids get that education," Dr. Gray said in a video posted to the Cerebral Palsy Foundation's website.
Not having this conversation in school is a lost opportunity to normalize LGBT behavior, which could prevent or minimize HBT bullying. According to the Anti-Bullying Alliance, "bullying is often directed at the real or perceived differences," therefore we should do everything we can to minimize what is perceived as different. Sexual Education should be for all, with no discrimination of gender, sexual preference or physical ability.
A Focus on Cerebral Palsy
Though much of this analysis is relevant to LGBT people with a range of physical disabilities, some of it pertains specifically to LGBT people with cerebral palsy (CP). CP is primarily associated with childhood — and is the most common motor disability found in children — however there are increasing numbers of individuals with CP surviving longer into adulthood. There is an estimation of at least 500,000 adults with CP in the U.S. alone.
"Cerebral Palsy is a non-progressive disorder resulting from a malformation or injury to a child's brain typically before age four. This results in an imbalance of muscle forces leading to joint contractures, deformities and abnormal movements," Joseph Dutkowsky, M.D., former president of the American Academy of Cerebral Palsy and Developmental Medicine, explained.
Developing Social and Romantic Relationships
A Dutch study among adolescents with CP ranging from 16 to 20 years old revealed that they had significantly less experience in dating and intimate relationships than their age mates. This finding is corroborated by other studies and suggests that individuals with CP may be "late bloomers" when it comes to relationships, but they are surely interested in having relationships just as much as anyone else.
Interestingly, this study also reported that adolescents with CP are less likely to identify as heterosexual than their age mates without CP (90 percent vs. 97 percent in age mates), and were also more likely to explicitly say that they were not sure of their sexual preference (4 percent vs. 1 percent in age mates).
Another Dutch study showed that establishing a healthy network of friends is an important pathway for individuals with disabilities to develop romantic relationships. According to Dr. Dutkowsky, one way to develop this network is by helping people with Cerebral Palsy to participate in arts, also as a way to "give them the opportunity to fully express themselves and grow into their own life".
Another challenge that individuals with CP face is finding specialized medical care, particularly as adults, as many health professionals specialized in CP focus on treating only children. The Weinberg Family Cerebral Palsy Center is one of the few clinical facilities to provide specialized health care throughout the entire lifespan for individuals with CP. Tracy Pickar is a social worker at the Weinberg Center, and echoes some of the concerns elicited by these studies.
"I've heard from some our patients that due to social isolation they may have delayed sexual experiences," Pickar said. She also noted that general medical providers "are so focused on medical issues that no one talks to the patients about their sexual health needs."
Given the increasing number of individuals with physical disabilities living into adulthood, issues associated with growing up, such as establishing healthy relationships, are becoming more prominent. As practitioners, it is important for us to work with young adults with physical disabilities to help them develop healthy pathways for relationships.
While arts-related activities have always been a safe haven for the LGBT community, it might be even more important for individuals who also have a physical disability, in order to help them establish healthy relationships and to be able to fully express themselves. Encouraging their participation in arts might be one of the best long-term interventions for their mental health that families and friends could ever do.
It is also imperative that LGBT individuals with physical disabilities receive proper sexual education while in school just as anyone else. Sex is a reality for everyone, regardless of gender, sexual orientation or physical ability, therefore everyone deserves to be well educated about this topic.
Daniel Linhares, M.D., is an assistant professor of psychiatry at Columbia University Medical Center and is specialized in providing holistic psychiatric care to medically complex patients. Dr. Linhares' expertise is in psychiatric care of the medically ill, LGBT psychiatry and psychodynamic psychotherapy.