Barriers to Adjusting to Disability: Physical, Social, and Psychological Factors

Adjusting to a disability is rarely a straightforward process. It demands far more than physical adaptation – it requires navigating a complex web of environmental obstacles, internal psychological battles, shifting social dynamics, and real financial strain. For many people, it is not the disability itself that presents the greatest challenge, but the layered barriers that society, circumstances, and even one’s own mind can place in the way of successful adjustment. Understanding these barriers is the first step toward addressing them.

Physical and structural barriers
Psychological factors: self-efficacy and locus of control
Self-efficacy
Locus of control
Social support: a critical buffer
The unique role of friends
Economic challenges
Psychological control and collective coping
Stigma and societal attitudes
What shapes adjustment: the bigger picture

Physical and structural barriers

The most visible obstacles to adjustment are physical ones – inaccessible buildings, the absence of ramps, poorly designed public transport, and built environments that simply were not designed with disability in mind. Research published by the National Academies confirms that when functional limitations exist, social participation is only possible when adequate environmental support is present. When that support is absent, the gap between what a person can do and what the environment allows creates a barrier that restricts participation in work, leisure, and daily life.

Structural barriers, however, extend well beyond ramps and doorways. The World Health Organization has identified discriminatory policies and practices – including forced medical treatments and institutionalisation without consent – as significant structural impediments to adjustment. These experiences strip away personal autonomy, which is a foundational element of any successful life transition. According to a review in Frontiers in Psychology, society’s unwillingness to remove environmental barriers frequently imposes disability on individuals rather than the impairment doing so on its own – a central insight of the social model of disability. Each inaccessible space or discriminatory policy sends a message of exclusion that compounds the psychological difficulty of adjustment.

Psychological factors: self-efficacy and locus of control

While external barriers are clearly visible, the internal psychological landscape can be equally – if not more – influential. Two constructs are particularly significant here: self-efficacy and locus of control.

Self-efficacy

Self-efficacy refers to a person’s belief in their own ability to manage specific situations or accomplish tasks effectively. Research by Amtmann and colleagues (2012) found a significant association between self-efficacy and physical and social functioning in people with disabilities, and identified lower self-efficacy as a meaningful predictor of depression. When someone acquiring a disability believes they can learn to use assistive technology, navigate social environments, or advocate for their own needs, that belief becomes a powerful driver of proactive coping. Conversely, low self-efficacy is associated with avoidance, helplessness, and poorer psychosocial outcomes.

Locus of control

Locus of control describes whether a person believes they have agency over events in their life (internal locus) or whether they see outcomes as determined by external forces (external locus). Studies on disability and life satisfaction have consistently found that an internal locus of control is associated with better adjustment outcomes. People with an internal locus are more likely to seek rehabilitation services, develop problem-solving strategies, and modify their environments proactively. Those with an external locus are more prone to passivity and psychological distress. A systematic review in Behaviour Research and Therapy confirms that individuals with high self-efficacy and an adaptive locus of control are significantly more likely to approach difficult circumstances as challenges rather than threats to be avoided.

Human beings are inherently social, and this becomes especially apparent during major life transitions. A systematic review in BMC Public Health covering decades of research confirms that favourable social relationships have consistently positive effects on mental health and wellbeing in people with physical disabilities. King and colleagues (2000) demonstrated a clear link between robust social support and both lower stress levels and improved overall wellbeing during disability adjustment.

Social support functions through multiple mechanisms. It provides practical assistance – help with transport, daily tasks, or navigating healthcare systems. It offers emotional comfort through empathy and encouragement. And it provides a sense of belonging at a time when identity is undergoing profound change. Jensen and colleagues (2014) found that social support reduces depression across all ages and disability diagnoses, with those lacking adequate support significantly more vulnerable to isolation and withdrawal from society.

The unique role of friends

An important nuance in the literature is that friends and family play qualitatively different roles in adjustment. Family relationships can become complicated by changed dynamics, caregiver burden, and feelings of guilt. Friends, by contrast, often maintain a more consistent form of emotional support. Research by Silverman and colleagues (2017) found that friends – particularly those who share similar disability experiences – can provide uniquely valuable emotional and informational support that buffers the impact of functional impairment on wellbeing. Jensen et al.’s (2014) work similarly highlighted that friends are often the more potent source of emotional support during the adjustment process. This does not mean family support is unimportant; rather, it highlights the value of maintaining diverse social networks during adjustment.

It is equally important to note that not all support is helpful. Well-meaning but overprotective behaviour, pity, or excessive assistance can undermine autonomy and self-efficacy – turning a potential resource into an inadvertent barrier.

Economic challenges

Financial hardship is one of the most pervasive and least discussed barriers to disability adjustment. Disability frequently brings with it a cascade of economic pressures: increased medical and rehabilitation costs, reduced earning capacity, and persistent employment discrimination.

The Century Foundation reports that working-age adults with disabilities face poverty rates roughly twice as high as those without disabilities, and were paid significantly less on average than non-disabled peers – a gap driven by widespread ableism and structural employment barriers. The U.S. Bureau of Labor Statistics found that among non-employed people with disabilities, nearly half reported at least one significant barrier to employment, with their own disability, lack of training, and inaccessible workplaces cited most frequently. A scoping review in BMC Public Health examining low- and middle-income countries found that unemployment rates for people with disabilities in these settings can reach as high as 60-90%, reflecting how deeply economic exclusion is shaped by broader systemic and political contexts.

The psychological impact of financial insecurity compounds these challenges significantly. When a person is preoccupied with meeting basic needs or managing debt, the cognitive and emotional resources required for adjustment – developing new skills, building resilience, engaging in rehabilitation – are severely diminished. Economic stress does not exist in isolation; it ripples through entire family systems, straining relationships and creating secondary barriers to adjustment.

Psychological control and collective coping

A related but distinct concept in disability adjustment is psychological control – the belief that one has the ability to manage stress and exert influence over challenging situations. Taylor and colleagues (1991), as discussed in the National Academies literature, identified the belief in one’s capacity to manage stress as a key promoter of resilience in the face of disabling conditions. People who hold this belief are more likely to use active, adaptive coping strategies, which in turn lead to better functional outcomes.

However, psychological control need not be purely individual. Hou and Wan’s (2012) research introduced the concept of collective control – the belief that significant others, such as family members, close friends, or healthcare providers, can help manage stress and challenges collaboratively. This is particularly relevant in collectivist cultural contexts, where individual and group identities are closely intertwined. Collective control recognises that adjustment does not happen in isolation. When the people around someone with a disability work together effectively – coordinating care, pooling resources, and offering different types of support – outcomes are meaningfully better than when adjustment is attempted alone.

Critically, collective control works best when it complements rather than replaces individual agency. Research on the psychological impact of disability consistently shows that environments supporting both personal agency and collaborative support produce the strongest adjustment outcomes. When collective support becomes excessive or controlling, it risks undermining the very self-efficacy it is meant to reinforce.

Stigma and societal attitudes

Running through all of these barriers – physical, psychological, social, and economic – is the persistent force of stigma. As Babik and Gardner (2021) note in Frontiers in Psychology, negative societal attitudes toward disability lead to social exclusion and disempowerment, and societies that fail to challenge these attitudes make adjustment exponentially harder. Research in the journal Society and Mental Health found that perceived interpersonal discrimination worsens the psychological consequences of disability, with working-age adults particularly vulnerable because functional impairment at this life stage violates social norms around independence and productivity.

EBSCO’s Research Starters on the psychological impact of disability describe how stigma can reduce a person to a “sick role” – defined by dependency and charity rather than capability and contribution – a dynamic that actively corrodes self-worth and impedes adjustment. Combating stigma requires coordinated effort from communities, institutions, media, and policy alike.

What shapes adjustment: the bigger picture

What emerges from the research is that adjustment to disability is shaped far less by the nature or severity of the impairment than by the surrounding conditions. The Rocky Mountain ADA Center highlights that how a person adjusts is more closely linked to who they were before the disability – their psychological resources, social connections, and financial stability – than to the impairment itself. Physical accessibility, supportive relationships, financial security, psychological resilience, and freedom from discrimination are not merely helpful additions; they are structural prerequisites for meaningful adjustment.

Kriofske Mainella and Smedema (2019), writing for Oxford University Press, emphasise that coping and adaptation are inherently multidimensional processes, shaped by the person’s own psychology, the stressors associated with the disability, and a wide range of contextual factors. No single intervention – whether psychological, social, or structural – is sufficient on its own. Effective support requires addressing all of these dimensions in coordination.

What do you think? If financial security and social support are more predictive of successful adjustment than the severity of a disability itself, what does that say about where society’s efforts should be focused? And how might the balance between individual psychological control and collective support look different across various cultural contexts?

How useful was this post?

Click on a star to rate it!

Average rating 5 / 5. Vote count: 3

No votes so far! Be the first to rate this post.

References

PDF 📄

Table of Contents

Physical and structural barriers 🔗

Psychological factors: self-efficacy and locus of control 🔗

Self-efficacy 🔗

Locus of control 🔗

Social support: a critical buffer 🔗

The unique role of friends 🔗

Economic challenges 🔗

Psychological control and collective coping 🔗

Stigma and societal attitudes 🔗

What shapes adjustment: the bigger picture 🔗