Introduction

An invisible disability has been defined as a “disability or health condition that is not immediately obvious”. As opposed to visual disabilities that can be recognised through external signs, such as a wheelchair, invisible disabilities lack obvious indicators. This often causes misunderstanding and stigmatisation from peers, making it difficult for the individual to access the required support. Invisible disabilities can impair/impede individuals greatly, with daily activities being much more challenging to complete. Employment and education can be much more difficult to undertake, especially if there is insufficient support from employers and institutions, whilst social interactions are often restricted for those with invisible disabilities. Therefore, it is vital that awareness and understanding of invisible disabilities is increased. This will allow members of the public to be more informed about and have more understanding of those with invisible disabilities, thereby encouraging inclusion. It is crucial in employment and education, for employers or teachers to be able to provide the support needed for an individual to complete their training or education enabling them to go on to earn a living.

Types of invisible disabilities

The term ‘invisible disability’ is assigned to several categories of conditions but within these groupings, there is no specified limit on the number of conditions included. In this article, groups will be used to discuss invisible disabilities with similar backgrounds, processes of development, or symptoms. 

The groupings of invisible disabilities that will be discussed in this article are mental health conditions; chronic pain and fatigue conditions; neurological disorders; cognitive and learning disabilities; and autoimmune diseases.

Mental health conditions 

Examples include:

• Depression
• Bipolar disorder
• Anxiety disorder
• Obsessive-compulsive disorder
• Personality disorder
• Schizophrenia

Historically, mental health disorders have not been acknowledged and validated as disabilities due to a lack of understanding and stigmatisation. However, people’s understanding of mental health has improved greatly over recent years, which is important for helping those suffering from it. The mental health conditions listed above, as well as others, are invisible disabilities because they might not be immediately obvious to an observer but can severely affect people’s daily lives. 

Over the last few decades, disability rates due to mental illness have significantly increased, which is worrying due to its impact on both individuals and society as a whole. The increase could be attributed to better understanding, identification, and hence increased diagnoses. Nevertheless, there is still clearly a significant amount of disability cases attributed to mental illness which is concerning. Long-term impairments from severe mental illness can disrupt several aspects of life, especially education and employment. 

It is important that society accepts mental illness as an invisible disability so that individuals are not judged and can receive the support needed for them to complete their daily tasks and contribute to society. If these individuals do not receive the required support, it could lead to the worsening of their condition as well as inhibiting society as a whole if they cannot carry out their jobs successfully.¹

Chronic pain and fatigue

Examples include:

• Chronic fatigue syndrome (CFS)
• Fibromyalgia (FM)

Chronic pain and fatigue conditions are invisible disabilities that are very difficult for the individual to live with. They are not obvious to other people but can make it very challenging for the sufferer to carry out daily tasks. These individuals need to receive the required support and understanding to live a happy life. 

Considerable personal and occupational disability are associated with chronic fatigue, CFS and FM as well as low employment rates^. Hence, to help these individuals is most important both to ensure they have a high quality of life and to enable them to contribute to society through employment. This means employers need to be understanding and provide support to aid individuals with this type of invisible disability.² 

Neurological disorders

Examples include:

• Alzheimer’s disease
• Cerebrovascular disease
• Epilepsy
• Multiple sclerosis
• Parkinson’s disease³

There is a wide range of neurological disorders that are classed as an invisible disability because they inhibit the individual’s ability to complete their daily activities. Neurological disorders are extremely prevalent within the invisible disability sector, with 13% of disability-adjusted life years being lost due to neurological and psychiatric disorders globally, as stated in the Global Burden of Disease Report.² 

These conditions are particularly burdensome for people in low to middle-income ‘developing’ countries because the individual sufferer could lose employment  – their source of income – as well as having to spend saved money on carers and medical services for example.³ 

Supporting these individuals to ensure they are as healthy as possible is vital but also giving support to help decrease the financial burden due to a lack of employment and expensive healthcare must also be assessed.³ 

Cognitive and learning disabilities

Examples include:

• Attention deficit hyperactivity disorder (ADHD)
• Autism spectrum disorder (ASD)
• Speech and language disorders (e.g. aphasia)
• Dyslexia
• Dyspraxia
• Dementia
• Traumatic brain injury (TBI)⁴

Cognitive and learning disorders include neurodevelopmental disorders, such as ADHD, ASD and dyslexia as well as other conditions, including dementia and TBI. Neurodevelopmental disorders cause academic, personal, social, motor (movement control) or occupational functioning to be disrupted.⁴ 

Cognitive and learning disorders affect the individual’s quality of life significantly, making it challenging to engage in full daily life, especially in an educational or work environment.  

Disorders affecting speech, language and communication are detrimental because they create difficulties which diminish the ability to interact socially and to ‘have a voice’, which is an essential part of having agency and self-determination. To improve communication skills in neurodevelopmental disorders, early intervention is critical, but this is not readily accessible for everyone.⁴

For the conditions that occur later in life such as dementia or a TBI, it is vital the individuals receive the required support and care to be able to maintain the quality of their daily lives.

Autoimmune diseases

Examples include:

• Chron’s disease
• Lupus
• Postural Tachycardia Syndrome (PoTS)

Autoimmune diseases are chronic conditions that occur due to the immune system not recognising its self-antigens ( the person’s immune system ‘perceives’ certain tissues of the body as an ‘external threat’, rather than recognising them as ‘self’, and attempts to destroy them. These conditions can be very debilitating, making it difficult to engage in daily activities and participate fully in society.⁵ 

The use of biological therapies has led to great advancements in treating and managing some of these conditions, such as Chron’s.⁶ However, many autoimmune diseases are still not fully understood or managed well. Individuals suffering from these diseases need to be well supported to assist them in accessing employment and education. 

Lots of the treatment for these conditions involves “switching off” the immune system, which makes the sufferer vulnerable to other diseases. Therefore the appropriate supportive measures are needed to allow them to interact with their peers in spite of the risks using precautions such as facemasks. This is essential for their mental health and was highlighted during the COVID-19 pandemic and has been emphasised since.¹⁰

Misunderstanding and stigma 

Many of the obstacles experienced by people suffering from invisible disabilities arise because of others' lack of understanding or appreciation for such disabilities. As a result, there is no appropriate support and assistance available to enable them to thrive in society. 

The primary stigma around invisible disabilities is that a lack of visible symptoms can lead to disbelief from peers and rejection of acknowledgement of there being an issue, causing feelings of isolation and frustration for those with invisible disabilities. Furthermore, sufferers may not want to disclose their condition because society often has negative stereotypes about disabilities, which can impact various aspects of life including personal relationships and social interactions. These misunderstandings and stigmas need to be countered by awareness-raising through education to allow people with invisible disabilities to feel welcomed and supported in society.^7,8 

Lack of accommodations

The failure to accommodate and support people with invisible disabilities is detrimental to their lives and must be reviewed. 

Most workplaces and schools are not well-prepared to make the right accommodations for an individual with an invisible disability. , which can make it awkward for people to request specific support. This can, in turn, make it difficult for the individual to be productive in their work and can create higher levels of stress and disadvantage. 

Public facilities and services may also lack appropriate design for those with invisible disabilities; thus, independence for such individuals becomes elusive, as they have to struggle to get what they need from the resources provided.⁸ 

Mental health implications

One of the most severe consequences of having an invisible disability is its impact on mental health. Regularly and repeatedly having to manage symptoms and decide when to disclose the condition can be stressful and increase anxiety levels, which further worsens the underlying condition. Not only that but living with an invisible disability can take a toll on self-esteem and identity for a person who has to go through those struggles and endure misconceptions and misunderstanding from others. Often, people try to pass as not having a disability so they are not discriminated against.^7,8 

Legislation and policies 

Although it is very challenging for those with invisible disabilities due to the health implications and stigmatisation, legislation and policies have been put into place to support them. Most counties have legislation and regulations to protect the rights of persons with disabilities. In the UK there is the Equality Act 2010, which makes workplace discrimination of any kind towards people with disabilities illegal.⁹

Strategies for support and inclusion

Awareness and education

One of the most important elements in supporting people with invisible disabilities is creating awareness and information to educate the general population. Public education initiatives can help significantly to address stigmas and ensure that people better understand invisible disabilities.⁹

Educational programs can make the environment more inclusive by teaching students (and employees) about the need to recognise and accommodate people with invisible disabilities.^7,8,9

Workplace accommodations/adjustments

Offering flexible work hours alongside remote work options can help individuals with invisible disabilities manage their symptoms and maintain productivity. Equipping them with tools and software that are designed specifically to aid in tackling particular challenges, such as providing ergonomic workstations, can make a difference in how enabled they are to do their job.^8,10 

Personal coping strategies

Teaching self-advocacy skills to those with invisible disabilities could be very useful. It will empower individuals to communicate their needs effectively, helping them secure the support they require. Moreover, they need to build a support network to provide emotional and practical assistance.^11,12

Summary

An invisible disability has been defined as a “disability or health condition that is not immediately obvious”. Invisible disabilities can be categorised into groupings such as: mental health conditions; chronic pain and fatigue conditions; neurological disorders; cognitive and learning disabilities; and autoimmune diseases. Invisible disabilities are very challenging to manage and can make it extremely difficult for an individual to carry out their daily activities. Because there is insufficient information and education about them, those experiencing them do not receive the support they need to have the highest quality of life possible. Improving education and information will assist with providing the appropriate accommodations in employment or education, as well as removing stigma. Future work still needs to be done to ensure these individuals receive the support needed to completely remove the discrimination and challenges linked with invisible disabilities.