Relationship Depth and Associative Stigma of Disability Katherine Nieweglowski, MS Illinois Institute of Technology, 3424 S. State Street, Chicago, IL 60616

Lindsay Sheehan, PhD Illinois Institute of Technology, 3424 S. State Street, Chicago, IL 60616, 312.567.7983

Keywords: disabilities; mental illness; wheelchair use; associative stigma; relationships

Abstract

Family, friends and acquaintances of people with disabilities may be viewed or treated differently by the public due to their association with a stigmatized person. Previous research finds that the public are more willing to engage in relationships with people with physical disability than with mental illness. In addition, attitudes towards associating with people with disabilities has been found to vary by depth of the chosen relationship. The current study sought to examine the connections between relationship depth (friend/romantic partner/acquaintance), disability type (physical/psychiatric) and associative stigma. Adult participants (N=345) were randomly presented with vignettes varying in relationship depth and disability type via an online survey platform. Analyses found no differences in associative stigma between physical and psychiatric disabilities. Participants viewed the vignette actor Rachel as socially warmer when she was a friend or romantic partner of a person with a disability than when she was an acquaintance. Participants rated Rachel as different from themselves when she was romantically involved with the person with disability and were more willing to engage socially with Rachel when she befriended the person with disability rather than when she was a mere acquaintance.


Relationship Depth and Associative Stigma of Disability

Public stigma refers to the negative attitudes and behaviors that society directs towards a particular group or group members (Corrigan & Kosyluk, 2014). This stigma marks these individuals as different from "normal" society and serves to limit rights, opportunities, and social power (Link & Phelan, 2014). Sociologist Erving Goffman (1963) first described three categories of stigma: tribal identity (e.g. race, ethnicity), physical abnormalities of the body, and blemishes of individual character (e.g. mental illness). In this paper, we focus on the latter two categorizations of stigma as applied to people with physical disabilities and psychiatric disabilities.

Bogdan and Taylor (1989) argue that the stigmatization of people with disabilities is accepted because society at large chooses to ignore these individuals. This process of social rejection begins at the early stages of development when children quickly learn to make distinctions between those with disabilities and those without disabilities (Bogdan & Taylor, 1989). Nondisabled individuals are seen as the more favorable category, resulting in those with disabilities being stigmatized throughout the course of their lives (Krahe & Altwasser, 2006). An explanation for this is that persons with disabilities are seen as different. This is often because they are perceived as being unable to live a "normal" life and having to be dependent on others. (Koch, 2001). Such beliefs may also result in people with disabilities being treated differently than their nondisabled peers (Dajani, 2001). For example, people may choose to distance themselves from persons with disabilities because they are not comfortable being around them due to a perceived lack of similarity (Ouelette-Kuntz, Burge, Brown & Arsenault, 2010). According to the stereotype content model, societal groups vary on perceived warmth and competence (Fiske, Cuddy & Glick, 2006; Louvet, Rohmer & Dubois, 2009). For example, those with physical disabilities are generally viewed as high in warmth, but relatively low in competence, whereas those with serious mental illness are seen as lower in both warmth and competence (Fiske, 2012; Fiske, Cuddy, Glick, & Xu, 2002)

Additional research distinguishes the stigma of physical disability from that of psychiatric disability. People with physical disabilities are often viewed as helpless and as an economic burden on society (Livneh, Chan, & Kaya, 2013), causing them to be pitied and subjected to acts of assistance (Braithwaite & Eckstein, 2003). Additionally, physical impairments are sometimes believed to be the result of sinful acts committed in the past (Livneh, 1988; Weiner 1993). Miller and colleagues (2009) suggest that people with physical disabilities may be less stigmatized because they are more likely to receive services and assistance. People with psychiatric disabilities, on the other hand, are often misunderstood and viewed as dangerous, incompetent, or unable to fit into appropriate social roles (Pescosolido, Medina, Martin, & Long, 2013). These public views often lead people with serious mental illness to experience discrimination in employment, housing, and interpersonal relationships (Russinova, Griffin, Bloch, Wewiorksi & Rosoklija, 2011; Corrigan & Kosyluk, 2014).

Discrimination leads people with disabilities to be excluded from meaningful social opportunities (Harley, Mpofu, Scanlan, Umeasiegbu & Mpofu, 2015). While other factors (i.e. limited social skills) may be involved, stigma-induced social isolation presents a substantial barrier for people with disabilities who are seeking romantic partners or other close relationships (Howland & Rintala, 2001). People with mental illness, for example, report major relationship losses involving spouses, partners, and friends, as well as a lack of belonging (Baker & Procter, 2015). Social isolation poses a significant threat to recovery from psychiatric disability (Davidson et al., 2004) and has even been associated with additional health problems and higher mortality in those with physical disabilities (Nosek, Hughes, Swedlund, Taylor & Swank, 2003). Research demonstrates that attitudes toward disability vary depending on social context, with the formation of dating and marriage relationships with people with disabilities being seen as less favorable than less intimate working relationships (Hergenrather & Rhodes, 2007). When the friends, family members, or acquaintances of people with disabilities themselves experience stigma-by-association, they may be less willing to interact with the person, further risking social isolation and social exclusion of people with disabilities (Mak & Cheung, 2008).

The current research examines how nondisabled individuals are affected when they associate with the stigmatized group—otherwise referred to as "associative stigma." Goffman (1963) observed that families, friends and acquaintances of stigmatized individuals were socially tainted by their interactions with such individuals through what he called "courtesy stigma," now more commonly termed "stigma by association" or associative stigma. Family members and other acquaintances might be seen as causing the stigmatized condition, as failing to sufficiently help the person recover from the condition, or as weak for helping or befriending the person (Corrigan & Miller, 2004).

Associative Stigma for Psychiatric Conditions

Much of the literature on the associative stigma of mental illness, or psychiatric disability, centers on families and mental health workers. Nurses working in psychiatric departments are seen as less skillful, dynamic, and logical. They are also seen as more dependent, disinterested and judgmental as compared to other nurses (Halter, 2008). Family members of persons with mental illness report experiences of negative treatment, social exclusion, blame, and not being taken seriously (van der Sanden, Stutterheimer, Pryor, Kok & Bos, 2014). Parents receive more blame and responsibility for the illness while children and siblings are seen as different and deviant by others (van der Sanden, Bos, Stutterheimer, Pryor & Kok, 2015). Corrigan & Miller (2004) found that siblings and spouses were blamed for not assuring that their relative adhere to treatment plans. Spouses of people with psychiatric disability reported thoughts that their loved one would be better off dead, and some even exhibited suicidal thoughts of their own as a result of the association (Ostman & Kjellin, 2002).

Van der Sanden and colleagues (2013) conducted a cross-sectional analysis on a sample of individuals who had a relative with mental illness. Those family members with greater awareness of negative public attitudes towards their mentally ill relative felt the impact of associative stigma more acutely (van der Sanden, Stutterheim, Pryor & Kok, 2013). Family members who experienced associative stigma also felt more psychological distress and reduced closeness with family members. Associative stigma mediated the relationship between perceived public stigma and closeness, suggesting a model whereby family member awareness of public stigma makes families more susceptible to feeling associative stigma and causes them to distance themselves from their relative (van der Sanden, et al., 2013).

Associative Stigma for Physical Conditions

Only limited research exists on associative stigma for people with physical disability. A study of associative stigma by Goldstein and Johnson (1997) demonstrated that partners of individuals with a physical disability are often viewed in a more "positive" way than those who had a partner with a psychiatric disability, including being subject to sympathy, and considered more nurturing and trustworthy (Goldstein & Johnston, 1997). Although these are positive attributes, they nonetheless reflect patronizing attitudes towards people with disabilities, highlighting needs of the "disabled" to be dependent on others and being "lucky enough" to have someone to care for them.

Research suggests that relationship depth may be an important factor in associative stigma. Pryor and colleagues (2012) prompted participants to view photos of an overweight individual participating in social gatherings. The other people in the photos were either described as being family members of the individual, or not related to the individual at all. When the associated persons were unrelated to the overweight individual, implicit, or less conscious, negative attitudes against overweight individuals moderated levels of associative stigma (Pryor, Reeder & Monroe, 2012). When the associated persons were depicted as family members, however, associative stigma was moderated by explicit, or more conscious, negative attitudes of being overweight (Pryor et al., 2012). This suggests that, as relationships become more serious, the associate experiences increased, and more overt, forms of associative stigma from the public.

Family relationships seem qualitatively different from those in other spheres. That is, family members are seemingly obligated to interact with their disabled relative, whereas friends and significant others make a conscious decision to do so. A survey of college students further explored the role of relationship depth by examining willingness to engage in a relationship with a disabled individual (Miller, Chen, Glover-Graf & Kranz, 2009). The Relationships and Disability (RAD) scale measured student willingness across relationship types (i.e. acquaintances, friendships, dating relationships, and marriage/partnerships), disability types (i.e. physical, cognitive, chronic health, psychiatric, sensory), and severity of disability (i.e. mild, moderate, and significant) (Miller et al., 2009). The results showed that people are more likely to be acquaintances or friends with individuals who have mild to moderate disabilities—especially if they are physical, sensory or chronic health conditions. Participants were least willing to date or marry someone who possessed either a cognitive or psychiatric impairment. This may be because psychiatric and cognitive disabilities are less understood due to being either inaccurately or inadequately portrayed in the media and society at large (Miller et al., 2009).

The current study expands on the research of Miller and colleagues (2009) by exploring the connections between relationship depth and associative stigma in the non-student population. Exploration of associative stigma in a non-student sample is of critical importance to further research because it will help generalize the results to a broader population of people, thus gathering insight into attitudes towards disabilities in a less controlled environment. This study uses validated stigma measures to examine two disabling conditions (i.e. psychiatric disability and physical disability). The three relationship conditions include acquaintance, friend, and romantic partner, allowing exploration of associative sigma outside of the family, or when relationships with disabled individuals are more voluntary. (H1) We expected that associative stigma would increase as the relationship depth, or association, with the disabled person increases. In accordance with the research described above, (H2) we also predict that associative stigma will be greater overall for psychiatric disability than physical disability.

Method

Participants

Research participants residing in the United States were recruited through Amazon Mechanical Turk (MTurk), an online network used to, among other purposes, gather research data. MTurk is widely used in the U.S., and its workers represent income distributions and age ranges similar to the U.S. population (Paolacci et al., 2010; Buhrmester, Kwang & Gosling, 2011; Ross et al., 2010). MTurk samples have superior diversity compared to other common methods of data collection (Buhrmester et al., 2011; Goodman, Cryder & Cheema, 2013; Rouse, 2015) and while MTurk samples are somewhat less likely to give sufficient attention to study materials this drawback can be ameliorated through appropriate data screening practices (Goodman et al., 2013).

A total of 399 individuals responded to the solicitation on MTurk about "attitudes on disability." Of these, 14 participants were dismissed from the survey after failing two levels of vignette comprehension checks (described more fully in methods section). Twenty-eight participants provided insufficient data to include in the analyses and data from another 26 participants were excluded because they failed specified vignette comprehension questions. Data from 12 participants were excluded for incorrect responses on one or more embedded quality control questions, leaving an overall sample of 345 participants.

Table 1 summarizes the sample demographics, of which 55.7% were male with a mean age of 33.4 years (SD = 9.90). Participants were primarily Caucasian/white (85.5%) and about 7% identified as being of Hispanic or Latino origin. Our sample identified largely as heterosexual/straight (87.8%) with most participants being single/never married (40%). Level of education varied with the majority of the sample having an Associate's degree/some college (40.9%). More than half the sample worked full-time (57.7%) and household incomes ranged from $0-$25,000 (29.9%) to $75,000 or higher (23.2%). Nearly 10 percent (9.9%) of participants reported having a serious mental illness and 2.9% reported currently using a wheelchair.

Table 1: Sample Demographics— Mean, standard deviation, and range are provided for age of participants along with percentage for gender, Latino/Hispanic origin, race, sexual orientation, marital status, education level, employment status and household income. Table reads from left to right with subcategories under the main headings.
Variable (N=345)Percentage; M(SD)
Age
Years33.4 (9.90)
Range (in years)19-70
Gender
Male55.7
Female44.1
Other0.3
Latino/Hispanic Origin
Yes7.0
No93.0
Race
Caucasian/White85.5
Black/African7.0
Asian7.3
Other2.8
Sexual Orientation
Heterosexual/Straight87.8
Lesbian/Gay3.2
Other/No Answer9.0
Marital Status
Single/Never Married40.0
Married34.2
Long-Term Relationship20.3
Separated/Divorced/Widowed5.5
Educational Level
High School Diploma or less13.7
Some College40.9
Bachelor's Degree 36.2
Graduate Degree9.3
Employment Status
Full-Time57.7
Part-Time17.1
Retired2.3
Attending School8.1
Unemployed9.9
Other9.5
Household Income
$0-$25,00029.9
$25,001-$49,99930.1
$50,000-$74,99916.8
$75,000 +23.2

Procedure

The survey protocol was approved by the institutional review board at the Illinois Institute of Technology and data was collected in June of 2015. The survey took approximately 8 minutes to complete and each individual received $0.96 for completing the study. After consenting and being screened for legal age (18 years), participants answered demographic questions and were randomized to one of six vignettes crossing relationship depth (acquaintance, friend, or romantic partner) with disability condition (serious mental illness or wheelchair use). In the vignette, Jacob is a college student with an illness or disability, and Rachel is a college student who has some form of a relationship with Jacob. The conditions were manipulated as follows (See Appendix A for full scripts of all six vignette conditions):

Jacob and Rachel are college students at a major university in Chicago. They live in the same building and have become close friends over the past year. Jacob suffers from a serious mental illness, which adds extra stress and interferes with his college experience. Both of them are good students and devote their time to various extracurricular activities.

In line with recent recommendations (Goodman et al., 2013), after reading the vignette, participants were presented with a comprehension question to ensure full understanding of the scenario and attention to task. The question asked participants to choose the answers that were true according to the vignette (i.e. "Jacob and Rachel live in the same building" and "Jacob has an illness/disability."). If the comprehension check answers were initially answered incorrectly, participants were routed back to the vignette and given another opportunity to read and answer the comprehension question. If comprehension check answers were incorrect a second time, participants were thanked for their time and routed from the survey. Those who completed the comprehension check were prompted to complete several brief measures of stigma difference, and two familiarity scales. Another cheater question was included in the Social Distance Scale (SDS) to make sure participants were fully attending to the measures (i.e. "If you are reading this, you will choose 'probably willing.'"). Twelve participants were excluded from the study for failing this cheater question.

Measures

Difference.

Measures of difference have been utilized for research on stigma because stigmatized people are placed into categories that separate "us" from "them" (Corrigan, Bink, Fokuo & Schmidt, 2015). This type of scale may be less subject to social desirability and thus more sensitive to less overt stigmatizing attitudes (Corrigan et al., 2015). Participants were administered the Difference Scale (Corrigan et al., 2015) in order to rate Rachel on three levels of difference (i.e. unlike me or like me; not similar to me or similar to me; and not comparable to me or comparable to me). Each item was scored on a 9-point visual analogue scale and internal consistency for the current study was high (α = .973). Difference scores ranged from 3 to 27 with higher scores indicating less difference and lower stigma.

Social Distance.

Stigma has often been measured via self-reported social distance. Social distance measures are a proxy of behavior that evaluate willingness to engage in social contact with the target person (Corrigan, Edwards, Green, Diwan & Penn, 2001a; Ouellette-Kuntz et al.,2010). We will utilize this as a measurement of stigma amongst people associated with persons with disabilities. Willingness to associate with Rachel was measured with the 7-item Social Distance Scale (SDS) (Corrigan, Green, Lundin, Kubiak & Penn, 2001b; Link, Cullen, Frank & Wozniak, 1987). Items were measured on a 4-point Likert scale (0 = definitely willing, 3 = definitely unwilling) and internal consistency for the current study was adequate (α = .837). Social distance scores ranged from 0 to 21, with higher scores indicating more stigma.

Warmth & Competence.

The stereotype content model proposed by Fiske and colleagues (2002) outlines stigma as categorized by levels of perceived warmth and competence. Warmth is determined by whether the out-group has good intentions towards the in-group, and competence is determined by whether or not they can fulfill these intentions (Fiske, Cuddy, Glick & Xu, 2002; Fiske, 2012). Stigmatized groups are generally viewed as less warm and less competent compared to the in-group (Fiske et al., 2002). Level of warmth of Rachel was measured across 4 items (i.e. how tolerant, warm, honest, and nice) and level of competence was measured across 4 items (i.e. how competent, independent, intelligent, and confident) (Fiske et al., 2002). All eight items were scored on a 5-point Likert scale (1 = not at all, 5 = completely). Internal consistencies for warmth (α = .906) and competence (α = .864) were determined for the current study. Levels of warmth and competence each ranged from 8 to 20 with higher scores indicating less stigma.

Analytic Procedure

All analyses were performed in SPSS 22. Pearson product-moment correlations were computed between study variables. A series of two-way ANOVAs were conducted to investigate any significant main effects or interactions between relationship depth and disability type. Post-hoc tests examined specific differences between groups.

Results

A series of bivariate correlations were conducted between study measures and demographics as summarized in Table 2. Stigma measures were moderately correlated, with the exception of warmth and competence, which were highly correlated (r = .79). Gender was positively correlated with difference, r =.227, p<.001, and negatively correlated with social distance, r = -.141, p<.01. That is, male participants were slightly more likely to see Rachel (the associate of person with a disability) as different from them and were also more likely to desire social distance from her. Males also viewed Rachel as less competent than did female participants. These results were not distinguished by disability type.

Table 2: Bivariate Correlations between Measures and Demographics—Measures and demographics are numbered down the first column, followed by row headers corresponding to that number to indicate correlations. Level of significance identified by number of asterisks.
12345
1. Gender
2. Age.11*
3. Difference .23**-.01
4. Social Distance -.14**-.04-.28**
5. Warmth.10-.02.27**-.46**
6. Competence.18**.02.31**-.47**.79**

*Significant at .05 level; **Significant at .01 level

One-way ANOVAs were used to examine differences in stigma on relationship depth and disability type. No significant interactions were found between relationship depth condition and disability type across any of the measures, and no significant main effects were found for disability type. However, significant main effects were observed for relationship depth across three measures including: difference, social distance, and warmth. These results were determined by merging the sample regardless of disability condition assigned in the vignette. The means and standard deviations of these results are summarized in Table 3.

Table 3: Means, Standard Deviations and ANOVA Results by Relationship

Depth and Measure (N=345)—Measures are identified in the first column, and aligned with the three relationship conditions in the second column (i.e. acquaintance, friend, romantic partner). This is followed by mean, standard deviation, F score, p values, and partial eta.
MeasureRelationship DepthMSDF (df1, df2)pPartial eta
DifferenceAcquaintance18.0315.21
Friend18.4714.928.08 (2,344).000.05
Romantic Partner15.7926.06
Social DistanceAcquaintance6.5313.03
Friend4.9723.257.09 (2,344).001.04
Romantic Partner 5.763.10
WarmthAcquaintance14.9212.54
Friend16.1422.617.10 (2,344).001.04
Romantic Partner15.7822.47
CompetenceAcquaintance15.062.28
Friend15.452.32.84 (2,344).430.01
Romantic Partner15.242.17

Note: Means with different superscripts differ significantly (p<.01).

Analyses showed that Rachel, the person associated with Jacob (person with disability), was found to be significantly different across all three relationship depth conditions, F(2, 345) =8.01, p<.01. Simple main effects analysis showed that Rachel was seen as significantly more different when she was romantically involved with Jacob (p < .01) compared to when she was an acquaintance (p <.01) or friend (p <.005). Regardless of whether Jacob had a mental illness or used a wheelchair, Rachel was more different (stigmatized) when she was a romantic partner than when she was an acquaintance or friend.

Significant main effects were also found for relationship depth on measures of social distance, F(2, 345)=7.02, p<.005. Analyses showed that participants were more willing to engage socially with Rachel when she was a friend (p<.005) to Jacob rather than an acquaintance (p <.005). Social distance means were lowest for friend (x=11.98), next lowest for romantic partner (x = 12.76) and highest for acquaintance (x=13.53). Significant differences were not found between being a friend or romantic partner (p = .182), or being an acquaintance or romantic partner (p = .184).

Lastly, significant main effects were found for relationship depth on measures of warmth, F(2,345)=7.03, p<.005. Analyses showed that Rachel was seen as significantly more warm when she was a friend (p < .005) or romantic partner (p <.05) to Jacob compared to when she was an acquaintance (p < .005). Regardless of whether Jacob had a mental illness or used a wheelchair, Rachel was seen as significantly warmer when she as a friend or romantic partner to Jacob than when she was a mere acquaintance.

Discussion

This study examined the associative stigma and non-familial relationship depth for people with disabilities. Consistent with past research on the public stigma of mental illness (Martin, Pescosolido, Olafsdottir & McLeod, 2007), male respondents were more stigmatizing than female respondents. Surprisingly, and contrary to past research (Miller et al., 2009), there were no differences between associative stigma of psychiatric disability and physical disability. This could be explained by the fact that both actors in the vignette (Rachel and Jacob) were portrayed primarily as typical college students, perhaps suggesting that the disability was relatively mild, minimizing the associative stigma differences previously found in comparisons of mental and physical illness (e.g. an internal narrative of a participant may be, "He's in college, so he must not be a total wacko"). It can also be argued that Rachel and Jacob were portrayed as more than typical college students because not every college student is involved in extracurricular activities. This detail may infer to the participant that Jacob's disability is not as limiting as suggested. Lack of differences might also be due to the fact that stigma measures chosen for this study were not sensitive enough to distinguish qualitative differences between physical and mental health stigma. That is, stereotypes especially salient for mental illness but not for physical disabilities, such as the stereotype of dangerousness, were not explicitly measured in the study. While we intentionally selected stigma measures that would apply more generally to both types (physical and mental) of disability, this may have limited the ability to detect specific differences between the two.

The warmth and competence scale has been used to measure stigma in gender (Fiske, 2010), criminal history (Young & Powell, 2015), physical disability (Kittson, Gainforth, Edwards, Bolkowry & Latimer-Cheung, 2013), and mental illness (Iles, Seate & Waks, 2016; Sadler, Kaye & Vaughn, 2015).We expected that participants would see the associate as having a higher level of warmth for befriending a person with a disability, but subsequently anticipated that participants might question her competence (e.g., "I guess she just can't do any better"). There were also no distinctions in competence between disability conditions in our study. In general, people with mental illness and physical disability have both been viewed as incompetent. However, the fact that both Rachel and Jacob were depicted as college students who did fairly well in school and participated in extracurricular activities may have been reflected in the high competence ratings. Rachel, the associate in our vignette, was viewed by participants as having greater warmth when she was a friend or romantic partner to Jacob. This finding is consistent with stereotypes of people with disability as needing help and, in this situation, Rachel is conforming to the role as helper or caregiver.

Participants viewed Rachel as different from themselves only when she was romantically involved with Jacob. This suggests that social norms may be permissive enough to allow friendships with people with disabilities, but draw the line when it comes to romantic partnerships. This is supported by a literature review of the attitudes toward persons with disabilities. Acceptance from the public is greater when persons with disabilities are perceived as casual friends and employees. However, when perceived as potential dating or marriage partners, the negative reactions and discomfort towards persons with disabilities significantly decreases levels of acceptance (Brodwin & Frederick, 2010; DeLoach, 1994). Other research shows that students perceive their classmates with disabilities as less likely to be dating (Robillard & Fitchen, 1983), which could also contribute to viewing Rachel as different from others if she were Jacob's romantic partner.

The decision to assign the disability condition to the male in the vignette and make the female the associate may also influence these findings. According to past research, males with disabilities find that females seek them out for friendships rather than romantic relationships in order to feel safe and avoid sexual pressure (Hergenrather & Rhodes, 2007; Shakespeare, 1999; Tepper, 1999). Female participants in our study may have found Rachel less favorable when she was a romantic partner for similar reasons. A study consisting of male and female university students measured the degree of comfort that students without disabilities had toward their disabled peers. Results showed that male students expressed greater interest in sexual activities with disabled students than did females (Robillard & Fitchen, 1983). Thus, our male participants may have viewed the associate more favorably as a romantic partner if he were Jacob instead of Rachel. It should be noted, however, that the Robillard and Fitchen (1983) study is the most recent that could be located regarding perceptions of students with disabilities and dating. Future research should continue to examine the effects of gender on associative stigma related to students with disabilities so that more recent findings may inform the literature.

In regards to social distance, participants were more willing to socially interact with Rachel when she was Jacob's friend than when she was merely an acquaintance, with no significant differences in social distance between being a friend and romantic partner or between romantic partner and acquaintance. These findings suggest that research participants endorsed a "close, but not too close" mentality for people with disabilities. This is, while they were accepting of Rachel's friendship with Jacob, being a romantic partner may have been beyond their comfort level. In our vignette, the romantic partner condition was characterized by Rachel and Jacob dating. Other literature suggests that people are more uncomfortable being in a dating relationship than they are being married to someone with a disability (Hergenrather & Rhodes, 2007). In evaluating the factor structure of the Disability Social Relations Generalized Disability (DSRGD) scale, the authors found that factors related to dating had lower means of acceptance overall compared to marriage and work relationships. Additional comments from participants also suggested that engaging in a sexual relationship with someone who has a disability is more acceptable in a fully committed relationship (e.g. marriage, civil unions) (Hergenrather & Rhodes, 2007).

Results of this study indicate that individuals who become intimate with people with disabilities could be seen as different and subject to associative stigma. Alternately, the public stigma could dissuade members of the public from forming social relationships with people with disabilities. This may lead to social isolation, and limit social power if people hesitate to interact with people with disabilities. Research has demonstrated that negative attitudes toward students with disabilities pose barriers when it comes to inclusivity in schools, and the perceptions of nondisabled students toward students with disabilities may impede participation in the community as well (de Boer, Pijl & Minnaert, 2012). More research can be done to further explore how attitudes influence social isolation in higher education and non-educational settings.

Limitations

The present study does have notable limitations. First, we did not designate a control group to include a vignette of Jacob without a disability. If included, this comparison to the two disability conditions could shed more light on the existence of associative stigma towards disabilities in general. Future research should consider introducing Jacob without a disability first and then measuring associative stigma responses after the disability is introduced. Our sample is also not fully representative of the overall U.S. population. For example, our participants identified as over 80% Caucasian while the U.S. population is comprised of 72.4% of individuals identifying as Caucasian or white (U.S. Census Bureau, 2010). While our results are valuable, it should be noted that they may be affected by the lack of representation from minority group views on stigma and disability.

Our results may have also been impacted if we included elements of intersectionality to the subjects in the vignettes. Our vignettes, for instance, did not specify the ethnicities of Rachel and Jacob. Greenwell and Hough (2008) identify that there is a "double discrimination" that occurs when a person with a disability is also part of another stigmatized group. For example, African Americans with disabilities may experience greater stigma because they are also part of a racial minority. If Jacob or Rachel were described as African American college students, this may have increased levels of associative stigma toward Rachel. Future research should explore such elements of intersectionality including variations of other ethnicities, races, and sexual orientations.

While we took measures to ensure that data collected on Mturk was sound, data collected via Mturk has been criticized for having questionable validity (Goodman et al., 2013) and research participants may have lacked sufficient attention to the task. Social desirability, or the tendency for research participants to give socially acceptable answers is common problem for stigma research (Michaels & Corrigan, 2013) and may be of particular concern for Mturk participants (Antin & Shaw, 2012). While the Difference measure used in this study was designed to reduce the effects of social desirability, other types of measures such as implicit bias tasks might have more robust results in terms of stigma. It should also be noted that the Difference measure had a very high reliability (a=0.937), which could have resulted from the redundancy of items (like me, similar to me, comparable to me). Finally, the eta-squared effect sizes for this study were in the "small" range, meaning that differences, while statistically significant might not have significant consequences in everyday life of people with disabilities.

Implications

This study provides findings on disability-related associative stigma. However, our measures of stigma are merely attitudes and proxies of actual behavior. Actual differences in public behavior toward associates of people with disabilities would provide the strongest evidence for the impact of associative stigma. Those impacted by associative stigma, including people with disabilities and their friends and partners, provide valuable insight into personal preference and experiences. Associates of people with disabilities might also internalize the stigma, or self-stigmatize (Mak & Kowk, 2010). That is, they endorse the public beliefs that it is shameful to form relationships with people with disabilities.

Associative stigma against peers and partners may also be internalized by the individual with the disability, thus negatively affecting their sexual identity. Rehabilitation counselors, and other service providers, should consider how this may impact the person's self-stigma and willingness to engage in romantic relationships with nondisabled peers. This may in turn influence theories of asexuality, or the belief that people with disabilities are not capable of engaging in intimacy. In practice, counselors should also consider effects of associative stigma as a factor related to disability adjustment in a college setting. One way that this can be remediated is by promoting disability awareness on campus and encouraging contact with people with disabilities through inclusive policies. Future research should examine how the associates and persons with disabilities are personally impacted and develop additional ways to alleviate the stigma in theory, policy, and practice.

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Appendix A: Relationship Vignettes

Psychiatric Disability Condition

Acquaintance

Jacob and Rachel are college students at a major university in Chicago. They live in the same building and have spoken in passing a few times over the past year. Jacob suffers from a serious mental illness, which adds extra stress and interferes with his college experience. Both of them are good students and devote their time to various extracurricular activities.

Friend

Jacob and Rachel are college students at a major university in Chicago. They live in the same building and have become close friends over the past year. Jacob suffers from a serious mental illness, which adds extra stress and interferes with his college experience. Both of them are good students and devote their time to various extracurricular activities.

Romantic Partner

Jacob and Rachel are college students at a major university in Chicago. They live in the same building and have been dating exclusively for the past year. Jacob suffers from a serious mental illness, which adds extra stress and interferes with his college experience. Both of them are good students and devote their time to various extracurricular activities.

Physical Disability Condition

Acquaintance

Jacob and Rachel are college students at a major university in Chicago. They live in the same building and have spoken in passing a few times over the past year. Jacob uses a wheelchair, which adds extra stress and interferes with his college experience. Both of them are good students and devote their time to various extracurricular activities.

Friend

Jacob and Rachel are college students at a major university in Chicago. They live in the same building and have become close friends over the past year. Jacob uses a wheelchair, which adds extra stress and interferes with his college experience. Both of them are good students and devote their time to various extracurricular activities.

Romantic Partner

Jacob and Rachel are college students at a major university in Chicago. They live in the same building and have been dating exclusively for the past year. Jacob uses a wheelchair, which adds extra stress and interferes with his college experience. Both of them are good students and devote their time to various extracurricular activities.

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