This study described the factors that contribute to engagement patterns of college students with the hidden health-related disability of orthostatic intolerance. Specifically, it used a qualitative methodology and collective-case study design to explore the categories of campus physical, institutional, academic and social engagement from a student perspective. Guided by theories from college student development, student engagement, and identity development in both disabled and non-students with a disability, the research also examined student self-disclosure, self-advocacy, and identity. The data collection method consisted of two in-depth interviews with five undergraduate college students over one semester and participant observation of each student in their college setting over several on-campus site sessions. Findings from the study indicate that these students encountered a number of barriers affecting all categories of engagement. Themes included lack of student centeredness, roommate difficulties, rigid institutional and classroom policies, curriculum pressure, financial penalties, lack of understanding of hidden disability, perception of lack of legitimacy of the disorder among administrators, faculties and peers, social isolation, conflicting values from peer regarding parties and alcohol use, and limited physical energy to engage on all levels. Factors that played an important role in student engagement included self-disclosure, self-advocacy, integration of disability identity, and positive faculty interactions. Although this study is exploratory, it makes clear that students with hidden disabilities need assistance from higher education officials, high school counselors, and health care professions in order to have a successful campus engagement experience. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]