One-fourth of U.S. adults have a disability, defined as a condition of the body or mind that limits certain activities and leads to participation restrictions due to incompatibility between the condition and the environment.1,2 This definition encompasses a range of disabilities, including physical, learning, and mental health impairments. Individuals with disabilities disproportionally experience discrimination in daily life,3,4 which contributes to higher levels of depression and anxiety among this population.5, 6, 7 Disability stigma encompasses a range of experiences, including microaggressions and interpersonal discrimination.5,8,9 Ableist microaggressions can include denial of personal identity and disability experience, denial of privacy, helplessness, spread effect (e.g., one disability affects all capacities), patronization, second-class citizenship, and desexualization.5 Interpersonal discrimination reflects stigmatizing behaviors which occur during social interactions.10 Among people with disabilities, experiencing more ableist microaggressions and interpersonal discrimination is associated with multiple negative outcomes, including poorer physical and mental health.5, 6, 7,11,12

Much research has examined visibility, the extent to which a disability is apparent to others during a simple interaction, as an important dimension on which disabilities vary.13 People with visible disabilities report not only more experiences with disability-related microaggressions and greater symptoms of depression and anxiety,7 but also increased discrimination, perhaps due to the lack of concealability and unexpected physical appearance perceived by others.14,15 However, beyond visibility, few features of disabilities have been examined that potentially contribute to stigma and mental health outcomes.

Dynamicity may be a critical dimension of disability but has been relatively understudied to date. Classifications and theories of disability have recognized that impairments can fluctuate over time,16,17 and empirical work indicates substantial variability in mobility impairments in older adults over time.18 Additionally, women experiencing more sporadic rather than consistent symptoms report feeling excluded when unable to attend social events for extended periods due to their disability, and youth with Juvenile Idiopathic Arthritis report feeling frustrated and hurt by others’ lack of understanding and empathy towards the fluctuating nature of their arthritis.6,19 Chronic illnesses and mental health conditions may be particularly dynamic because symptoms often shift with time and can affect functional skills and quality of life.19, 20 In contrast, learning disabilities and intellectual disability might be more static, reflecting a relatively stable, predictable level of impairment.21,22 Despite acknowledgement in the literature that impairments change in outward appearance, no research we are aware of has attempted to quantitatively assess dynamicity among disabled individuals. Thus, little is known about the association of dynamic disability with experiences with stigma and mental health.

Given how disability visibility relates to discrimination and microaggressions, dynamicity of a disability may have similar associations with these outcomes. Consistent with anecdotal experiences,23 fluctuations in support needs and accommodation use may increase the number of stigmatizing experiences one encounters. For example, fluctuation in symptom severity may lead to intrusive questions regarding one's impairment.6 As discrimination and stigma are robustly associated with higher rates of depression and anxiety,24 these stigmatizing experiences likely lead to mental health consequences. Given visibility's established associations with stigma, it is important to examine whether dynamicity independently relates to stigmatizing experiences. However, dynamicity and visibility may also interact with one another because individuals may face more stigma if their symptom fluctuation impacts disability visibility (e.g. using a mobility aid some, but not all of the time).