Demographic, psychosocial, and personality characteristics of lesbian batterers

Intimate Partner Violence Among Sexual Minority Women: A Scoping Review

Intimate partner violence (IPV) is prevalent among sexual minority women (SMW). However, compared to IPV research with heterosexual women and other LGBTQ+ population groups, SMW are understudied. We conducted a scoping review to examine the current state of knowledge about IPV among SMW, and to identify gaps and directions for future research. A search of Medline, Embase, CINAHL, and PsycINFO databases returned 1,807 papers published between January 2000 and December 2021. After independent reviewers screened these papers for relevance, 99 were included in the final review. Papers were included if they used quantitative methods and reported IPV data on adult SMW separately from other groups. Findings confirmed high rates of IPV among SMW and highlighted groups with particular vulnerabilities, including non-monosexual women and SMW of color. Risk factors for IPV in this population include prior trauma and victimization, psychological and emotional concerns, substance use, and minority stressors. Outcomes include poor mental and physical health. Findings related to the effects of minority stressors on IPV and comparisons across sexual minority groups were inconsistent. Future research should focus on IPV perpetration; mechanisms underlying risk for IPV, including structural-level risk factors; and understanding differences among SMW subgroups.

Intimate Partner Violence in Same-Sex Relationships: Are We Aware of the Implications?

Intimate partner violence (IPV) has been a significant public health problem in same-sex relationships. However, health policies across the globe do not address IPV causing a massive gap in health and economic burden. In the last decade, crucial missing links have been established, and researchers tried to connect the dots of this severe health disparity. This intersectionality has found the impact of race, gender, class, physical ability, and legal framework of IPV in lesbian, gay, and bisexual (LGB) relationships. However, preventive strategies, training programs, and dialogues in the clinical field about IPV are from heteronormative lenses. This particular bias can perpetuate the issue and will remain one of the leading causes of health burden in the LGB population. This article reviews the lacunae in health policies regarding same-sex IPV, highlights its impact on minority mental health, and calls for attention to train health-care professionals regarding the same.

Intimate Partner Violence Perpetration Among Sexual Minority People and Associated Factors: A Systematic Review of Quantitative Studies

Introduction

Intimate partner violence (IPV) among sexual minority people has been underestimated since few decades ago despite its spreading. The current systematic review aims to review and systematize studies on factors associated with IPV perpetration within this population.

Methods

Data search was conducted on EBSCO and PubMed considering articles published until July 2022, and 78 papers were included.

Results

Although methodological limitations can affect the results found, the data demonstrated an association between IPV perpetration and psychological, relational, family of origin-related and sexual minority-specific factors, substance use, and sexual behaviors.

Conclusion

The findings emerged highlight the importance of a multidimensional approach to tackle IPV perpetration among sexual minority people and limit relapses, while increasing individual and relational wellbeing.

Policy Implications

The empirical evidence emerged can contribute to the development of policies and services tailored for sexual minority people victims of IPV, to date still scarce and often ineffective.

Intimate Partner Violence Perpetration Among Sexual Minority People and Associated Factors: A Systematic Review of Quantitative Studies

INTRODUCTION

Intimate partner violence (IPV) among sexual minority people has been underestimated since few decades ago despite its spreading. The current systematic review aims to review and systematize studies on factors associated with IPV perpetration within this population.

METHODS

Data search was conducted on EBSCO and PubMed considering articles published until July 2022, and 78 papers were included.

RESULTS

Although methodological limitations can affect the results found, the data demonstrated an association between IPV perpetration and psychological, relational, family of origin-related and sexual minority-specific factors, substance use, and sexual behaviors.

CONCLUSION

The findings emerged highlight the importance of a multidimensional approach to tackle IPV perpetration among sexual minority people and limit relapses, while increasing individual and relational wellbeing.

POLICY IMPLICATIONS

The empirical evidence emerged can contribute to the development of policies and services tailored for sexual minority people victims of IPV, to date still scarce and often ineffective.

HEGEMONIC MASCULINITY AND VIOLENCE IN GAY COUPLES: A PSYCHOANALYTIC READING

ABSTRACT: The initial purpose of this paper is to analyze the literature on hegemonic masculinity and its intersection with violence in intimate gay couples. As a result, it is identified that hegemonic masculinity is a historical, social and cultural construction that, in order to perpetuate its power over other masculinities “contaminated by the feminine”, employs diverse mechanisms of violence, sometimes imperceptible to those who experience it. Psychoanalytically oriented, a case is analyzed to obtain empirical information and to situate the reality of the phenomenon beyond heteronormative parameters, while offering a methodology to investigate the problem.

Sexual and Gender Minority Intimate Partner Violence and Childhood Violence Exposure

Limited research on female-assigned-at-birth sexual and gender minorities (FAB SGM) suggests that their risk of psychological, physical, and sexual intimate partner violence (IPV) victimization and perpetration may be linked to childhood violence exposure (CVE), such as experiencing child abuse, or witnessing sibling or interparental abuse. That said, there is a dearth of research in this population examining whether there is typically a violence type match between CVE and IPV (e.g., physical CVE predicting physical IPV), a gender match between those involved in CVE and later IPV (e.g., witnessing the abuse of female parents predicting IPV among women), or an increase in IPV risk commensurate with the number of different CVE types experienced. Addressing these gaps, this article draws on the baseline survey data of FAB400, a merged cohort accelerated longitudinal study of 488 FAB SGM adolescents and young adults. Analyses focused on the subsample of 457 participants with prior intimate relationship experience. Findings revealed that each assessed form of CVE-parental verbal abuse victimization, parental physical maltreatment victimization, childhood sexual abuse victimization, witnessing sibling abuse, and witnessing interparental violence-predicted risk of IPV perpetration and victimization, without evidence of violence type match. Witnessing interparental violence was associated with IPV irrespective of the abused parent's gender. In addition, exposure to a greater number of forms of CVE was associated with an increased risk of all types of IPV victimization and perpetration. Results offer preliminary evidence that the intergenerational transmission of violence is an applicable framework for FAB SGM, and as such this should be considered when screening and intervening for childhood, family, and partner violence in this population. Suggestions for future directions are discussed.

Do Trust and Sexual Intimacy Mediate Attachment's Pathway Toward Sexual Violence Occurring in Same Sex Romantic Relationships?

This study tested a serial mediation model examining how dyadic trust and sexual intimacy mediate the relationship between insecure romantic attachment and perpetrated sexual violence occurring between same sex intimate partners (sexual SSIPV). A community sample of adults (N = 310; 203 women, 107 men) involved in a committed (6 months or longer) same sex romantic relationship completed an encrypted online questionnaire package which included psychometric measures designed to assess the aforementioned variables. Controlling for gender effects, analyses conducted using bootstrapping procedures supported full mediation pathways for both attachment anxiety and attachment avoidance. That is, attachment anxiety and avoidance were both directly associated to the perpetration of sexual SSIPV, and these relationships were both fully mediated by dyadic trust and sexual intimacy, in that respective order.

Patterns of Intimate Partner Violence Victimization and Perpetration Among Sexual Minority Women: A Latent Class Analysis

This study explored patterns of intimate partner violence (IPV) victimization and perpetration in 150 sexual minority women (SMW): 25.3% had been sexually victimized, 34% physically victimized, 76% psychologically victimized, and 29.3% suffered an IPV-related injury. A latent class analysis found four behavioral patterns: (1) minor-only psychological perpetration and victimization; (2) no IPV; (3) minor-severe psychological, physical assault, and injury victimization, and minor-only psychological, physical, and injury perpetration; and (4) severe psychological, sexual, physical assault, and injury victimization and perpetration. Individuals who experienced and/or perpetrated all types experienced the greatest heterosexism at work, school, and in other contexts.

Discrepant Drinking and Partner Violence Perpetration Over Time in Lesbians' Relationships

Discrepant drinking (i.e., differences in alcohol use) and perpetration of intimate partner violence in same-sex female couples were examined. Self-identified lesbian participants were recruited from market research firms and reported on their own and their partner's alcohol use and their own perpetration of psychological aggression and physical violence at baseline, then 6 and 12 months later. Cross-lagged panel analyses revealed that discrepant drinking predicted participants' subsequent perpetration of psychological aggression but not physical violence. Both psychological aggression and physical aggression predicted subsequent discrepant drinking. Consistent with findings in heterosexual couples, differences in alcohol use appear to be a risk factor for relationship aggression.

Partner abuse and its association with emotional distress: A study exploring LGBTI relationships

This study examines partner abuse in LBGTI relationships, with focus on the associations with emotional distress and protective factors. Two hundred and eighty-seven participants took part. Partner abuse (victimisation) comprised three factors; conflict orientated aggression; hostile ignorance and control of communication; and social control and possessiveness (including threats to possessions). Perpetration factors were similar. Significant differences across sexuality or gender were limited to the perpetration of abuse relating to suspicion and possessiveness, where men were more likely to report this than the other gender groups, and women were less likely to report this. Of those reporting abuse in their current relationship, over half reported experiencing abuse in a primary relationship previously, with 60% reporting exposure to abuse as a child. Partner abuse in their current relationship predicted current levels of increased emotional distress, with reduced satisfaction with the current relationship having an indirect impact on this association. Resilience traits were not a predictor or mediator. The results demonstrate the similarity in abuse across LGBTI communities despite the diversity of genders, sexualities and experiences within these groups. The results are discussed with regard to directions for future research and implications for practice.

Interpersonal dysfunction in personality disorders: A meta-analytic review

Personality disorders are defined in the current psychiatric diagnostic system as pervasive, inflexible, and stable patterns of thinking, feeling, behaving, and interacting with others. Questions regarding the validity and reliability of the current personality disorder diagnoses prompted a reconceptualization of personality pathology in the most recent edition of the psychiatric diagnostic manual, in an appendix of emerging models for future study. To evaluate the construct and discriminant validity of the current personality disorder diagnoses, we conducted a quantitative synthesis of the existing empirical research on associations between personality disorders and interpersonal functioning, defined using the interpersonal circumplex model (comprising orthogonal dimensions of agency and communion), as well as functioning in specific relationship domains (parent-child, family, peer, romantic). A comprehensive literature search yielded 127 published and unpublished studies, comprising 2,579 effect sizes. Average effect sizes from 120 separate meta-analyses, corrected for sampling error and measurement unreliability, and aggregated using a random-effects model, indicated that each personality disorder showed a distinct profile of interpersonal style consistent with its characteristic pattern of symptomatic dysfunction; specific relationship domains affected and strength of associations varied for each personality disorder. Overall, results support the construct and discriminant validity of the personality disorders in the current diagnostic manual, as well as the proposed conceptualization that disturbances in self and interpersonal functioning constitute the core of personality pathology. Importantly, however, contradicting both the current and proposed conceptualizations, there was not evidence for pervasive dysfunction across interpersonal situations and relationships. (PsycINFO Database Record

Barriers to Help Seeking for Lesbian, Gay, Bisexual, Transgender, and Queer Survivors of Intimate Partner Violence

Intimate partner violence (IPV) is a pervasive and devastating social problem that is estimated to occur in one of every four opposite-sex relationships and at least one of every five same-sex romantic relationships. These estimates may not represent violence against those who identify as transgender or genderqueer, and very little comprehensive research has been conducted on IPV within these populations. One statewide study on IPV found rates of IPV were as high as one of every two transgender individuals. In order to cope with the effects of abuse or leave an abusive partner, many lesbian, gay, bisexual, transgender, and genderqueer (LGBTQ) IPV survivors seek support from others. However, LGBTQ IPV survivors may experience unique difficulties related to their sexual orientation and gender identity when seeking assistance. This article reviews the literature on LGBTQ IPV and suggests three major barriers to help-seeking exist for LGBTQ IPV survivors: a limited understanding of the problem of LGBTQ IPV, stigma, and systemic inequities. The significance and consequences of each barrier are discussed, and suggestions for future research, policy, and practice are provided.

Borderline personality disorder traits and sexuality: Bridging a gap in the literature

Extant research connecting borderline personality disorder (BPD) to sexuality is sparse. The current study aimed to expand the limited body of research on borderline personality traits and human sexuality, and to shed light on the personality features that contribute specifically to sexual sensation seeking, sexual compulsivity, and sexual risk-taking behaviours. Undergraduate students (n=955) completed an online questionnaire containing scales assessing BPD symptoms (affective instability, identity disturbance, negative relationships, and self-harm), sexual sensation seeking, sexual compulsivity, and sexual risk-taking. Multiple linear regression analyses were conducted and revealed no significant gender X symptom interaction predictors. Results did indicate links between specific BPD symptoms and specific sexuality variables. Total sexual compulsivity and compulsive sexual control behaviours were positively predicted by all four BPD symptoms, whereas compulsive sexual violence was predicted by all symptoms except for identity disturbance. Sexual sensation seeking was positively predicted by negative relationships and self-harm. Sexual risk taking was not significantly predicted by any BPD symptoms. These findings improve our understanding of how individuals with borderline personality traits experience romantic and sexual relationships, and may inform the future development of therapeutic interventions.

Intimate Partner Violence in Self-Identified Lesbians: A Systematic Review of Its Prevalence and Correlates

This article presents the first systematic review on intimate partner violence (IPV) in self-identified lesbians in same-sex couples. Studies published from January 1990 to December 2013 were analyzed. Of the 687 studies reviewed, 59 were preselected, of which 14 studies were selected that met the inclusion and methodological quality criteria. A summary is presented of the characteristics of the studies, the participants, the prevalence of IPV victimization and perpetration, and its correlates. All the studies were carried out in the United States and used a nonprobabilistic sampling method. The majority of participants were White with a high educational level. The results indicate that all the forms of violence occur, but the most prevalent is emotional/psychological violence. The correlates positively associated with IPV are certain personality characteristics, fusion, previous IPV experience, a family history of violence, and alcohol consumption. This review finds significant limitations in the analyzed literature. Methodological recommendations are made for future studies.

Relationship Quality and Domestic Violence in Women's Same-Sex Relationships: The Role of Minority Stress

Despite a large body of literature addressing relationship quality and domestic violence in women's same-sex relationships, few studies have empirically examined how stress specific to living as a lesbian or bisexual woman might correlate with these relationship variables. Degree of outness, internalized homophobia, lifetime and recent experiences of discrimination, butch/femme identity, relationship quality, and lifetime and recent experiences of domestic violence were assessed in a sample of 272 predominantly European American lesbian and bisexual women. Lesbian and bisexual women were found to be comparable on most relationship variables. In bivariate analyses, minority stress variables (internalized homophobia and discrimination) were associated with lower relationship quality and both domestic violence perpetration and victimization. Outness and butch/femme identity were largely unrelated to relationship variables. Path analysis revealed that relationship quality fully mediated the relationship between internalized homophobia and recent domestic violence.

Borderline personality disorder and violence in the UK population: categorical and dimensional trait assessment

BACKGROUND

Borderline personality disorder (BPD) is characterised by difficulties with impulse control and affective dysregulation. It is unclear whether BPD contributes to the perpetration of violence or whether this is explained by comorbidity. We explored independent associations between categorical and dimensional representations of BPD and violence in the general population, and differential associations from individual BPD criteria.

METHODS

We used a representative combined sample of 14,753 men and women from two British national surveys of adults (≥16 years). BPD was assessed using the Structured Clinical Interview II- Questionnaire. We measured self-reported violent behaviour in the past 5 years, including severity, victims and locations of incidents. Associations for binary, dimensional and trait-level exposures were performed using weighted logistic regression, adjusted for demography and comorbid psychopathology.

RESULTS

Categorical diagnosis of BPD was associated only with intimate partner violence (IPV). Associations with serious violence leading to injuries and repetitive violence were better explained by comorbid substance misuse, anxiety and antisocial personality disorder (ASPD). However, anger and impulsivity BPD items were independently associated with most violent outcomes including severity, repetition and injury; suicidal behaviours and affective instability were not associated with violence. Both trait-level and severity-dimensional analyses showed that BPD symptoms might impact males and females differently in terms of violence.

CONCLUSIONS

For individuals diagnosed BPD, violence is better explained by comorbidity. However, BPD individual traits show different pathways to violence at the population level. Gender differences in BPD traits and their severity indicate distinct, underlying mechanisms towards violence. BPD and traits should be evaluated in perpetrators of IPV.

Domestic Violence Perpetrator Programs: A Proposal for Evidence-Based Standards in the United States

In the United States, the judicial system response to violence between intimate partners, or intimate partner violence (IPV), typically mandates that adjudicated perpetrators complete a batterer intervention program (BIP). The social science data has found that these programs, on the whole, are only minimally effective in reducing rates of IPV. The authors examined the social science literature on the characteristics and efficacy of BIPs. More than 400 studies were considered, including a sweeping, recently conducted survey of BIP directors across the United States and Canada. Results of this review indicate that the limitations of BIPs are due, in large part, to the limitations of current state standards regulating these programs and, furthermore, that these standards are not grounded in the body of empirical research evidence or best practices. The authors, all of whom have considerable expertise in the area of domestic violence perpetrator treatment, conducted an exhaustive investigation of the following key intervention areas: overall effectiveness of BIPs; length of treatment/length of group sessions; number of group participants and number of facilitators; group format and curriculum; assessment protocol and instruments; victim contact; modality of treatment; differential treatment; working with female perpetrators; working with perpetrators in racial and ethnic minority groups; working with lesbian, gay, bisexual, and transgender (LGBT) perpetrators; perpetrator treatment and practitioner–client relationships; and required practitioner education and training. Recommendations for evidence-based national BIP standards were made based on findings from this review.

Borderline personality disorder and related constructs as risk factors for intimate partner violence perpetration

In this manuscript we systematically reviewed 29 articles from 2010 to 2014 that addressed the association between borderline personality disorder (BPD) and intimate partner violence (IPV) perpetration, with particular attention paid to the role of perpetrator sex. Our primary objective was to provide a summary of (1) the operationalization and measurement of BPD and IPV, (2) mechanisms of the BPD-IPV association, and (3)the current understanding of the role of perpetrator sex related to BPD and IPV. We observed three distinct operational definitions of BPD which are measured in a variety of ways. IPV measurement tends to be more consistent. Further, emotion perception, impulsivity, attachment, and substance use are proposed mechanisms to explain the BPD IPV relation. The findings regarding potential perpetrator sex differences in the BPD-IPV association are mixed. Finally, we also provide recommendations for future research and clinical practice.

Sarantakos's Research on Same-Sex Parenting in Australia and New Zealand: Importance, Substance, and Corroboration with Research from the United States

Sarantakos (1996a) compared teacher ratings and other outcomes for the children of heterosexual married, heterosexual cohabiting, and homosexual parents and reported numerous significant, substantial differences. Few scholars have taken the effect sizes of his results into account or have considered his larger program of research. Sarantakos's research yielded many interesting findings with respect to children's academic performance, sexual orientation, use of alcohol and drugs, sexual deviance, and gender identity with respect to parents' parenting values, relationship stability, conflict, monogamy, and religiosity or moral values, many of which have been corroborated by U.S. or British research. In addition, the methodological quality of his research appears to be at least above average, especially for research done 20 or more years ago. He appears to have been unbiased with respect to same-sex families. His results disseminated via multiple publications should be taken into account in literature reviews concerning same-sex parenting.

Same-Sex Domestic Violence: Prevalence, Unique Aspects, and Clinical Implications

Domestic violence is a significant public health issue. Prevalence rates for same-sex domestic violence vary because of methodological issues related to recruitment and definitions of sexual orientation. However, such prevalence rates are currently considered to be similar to slightly greater than other-sex prevalence rates. Research has identified differences between same-sex domestic violence and other-sex domestic violence, including internalized and externalized stressors associated with being a sexual minority that interact with domestic violence to create or exacerbate vulnerabilities, higher risk for complex trauma experiences, and difficulties accessing services. This review provides a critical review of the literature, focusing upon empirical findings regarding same-sex domestic violence.

Profile of Female Perpetrators of Intimate Partner Violence in an Offender Population: Implications for Treatment

Despite evidence that the incidence of female-to-male intimate partner violence (IPV) in the general population is as high as that of male-to-female intimate violence, until recently little attention has been devoted to understanding women perpetrators of partner violence or to the design of programs to address their violence. This study explored the characteristics of female perpetrators of IPV in an offender population and examined the context, consequences, and motives for their aggression. There were 897 women serving a federal sentence in the Correctional Service of Canada at the time of data extraction, of whom 15% (n = 135) had a history of IPV. Results indicated that these offenders were most often classified as moderate criminal risk and high criminogenic need. Most had been victims of severe abuse during their youth and in adult relationships. Women’s motives for violence were diverse. Although most women had a history of mutual violence with their partners, 64% were the primary perpetrators in at least 1 incident. Violence in self-defense or in defense of their children were the least frequently coded categories. Similar to a comparison group of male offenders, the Spousal Assault Risk Assessment tool indicated that the most common risk factors associated with women’s IPV included past physical assault against intimate partners, substance abuse, and employment problems. These findings reinforce the need for a correctional programming targeting the diverse circumstances and motivations of women who are violent against their partners.

Risk and protective factors of same-sex intimate partner violence in Hong Kong

Numerous studies have assessed risk and protective factors for intimate partner violence (IPV) among heterosexual couples around the globe. Nevertheless, few have addressed the same issue among same-sex couples, especially in cultures where same-sex intimate relationships have gained little acceptance. This exploratory study evaluated the substantial risk and protective factors for same-sex IPV based on gender-neutral theories. Three hundred and six Hong Kong residents who have been in a same-sex romantic relationship completed a web-based questionnaire. Logistic regression analyses indicated that relationship conflict and poor anger management were risk factors both of psychological and physical perpetration. Dominance and substance abuse were respectively associated with psychological aggression and physical battering despite their small effect sizes. Psychological aggression was also found to mediate the relationship between conflict and physical assault, and that between anger management and physical assault. Interventions related to the array of risk and protective factors were discussed and recommended.

Service providers' reactions to intimate partner violence as a function of victim sexual orientation and type of abuse

In this online vignette study, a national sample of domestic violence shelter service providers (N = 282) completed a 10-item questionnaire about a woman experiencing intimate partner violence (IPV). Scenarios varied in terms of couple sexual orientation (heterosexual or lesbian) and type of abuse (physical or nonphysical). Results indicate that although participants did not overtly discriminate against a woman in a lesbian relationship, they were less likely to perceive her as a victim, and their acceptance of a lesbian as a client was more dependent on their comfort with her than was the case for a woman in a heterosexual relationship. Type of abuse, as expected, had a main effect on many questions, with physical abuse taken more seriously than nonphysical abuse. Scores on the Attitudes Toward Lesbians subscale (Herek) were unrelated to responses. Implications for service providers are discussed.

Empirical research about same-sex intimate partner violence: a methodological review

This article presents a systematic review of empirical research examining intimate partner violence among same-sex couples. Seventeen studies that met the inclusion criteria were rated using a 15-item evaluation questionnaire. The results indicated that the existing body of research examining same-sex intimate partner violence demonstrates some common methodological strengths and limitations. The authors conclude with a list of recommendations for future research based on the results of this study.

Personality disorders and violence

PURPOSE OF REVIEW

To review the most recent literature on the relationship between personality disorders and violent behavior. The review does not aim to address the issue of a possible etiological connection between previously being the victim of violent acts and later developing a personality disorder.

RECENT FINDINGS

Recent data suggest that personality disorders, especially antisocial and borderline, are strongly related to the manifestation of violent acts. Substance abuse is another strong factor which could act either independently or additively. Biological factors seem to constitute a risk factor for violent behavior independently of personality. Although intelligence does not seem to be related to violence, some patients may manifest specific cognitive deficits. The ethical and legal questions posed by the above correlations are difficult to answer, and research has not yet provided enough data on this issue.

SUMMARY

The most recent data support the relationship between antisocial personality and violence, especially when substance abuse is also present, although the presence of confounding factors in the diagnostic criteria suggest caution in the interpretation of the literature.

Health care barriers and same-sex intimate partner violence: a review of the literature

Minority groups experience barriers to accessing and receiving health care. Sexual minorities, which include gay men and lesbians, have no specific defining physical characteristics and are not as easy to identify as other minority groups. Consequently, their unique health care disparities are frequently overlooked. Myths and facts regarding the common barriers to health care, including those specific to same sex intimate partner violence, are explored.

Substance use and social identity in the lesbian community

Although the study results report discrepancies in the rates of substance abuse in the lesbian community, the general consensus in the field of gay and lesbian studies is that these individuals, as a whole, have a higher rate of substance use. For this study, data were collected via the Internet on the use of drugs and alcohol, level of self-esteem, and degree of social identity in the lesbian community. A correlation analysis was used to determine if negative social identity within the lesbian community leads to low self-esteem that is reflected in higher rates of substance abuse. Though a positive relationship between social identity and self-esteem was determined, no significant correlation between negative social identity, low self-esteem, and substance use was determined. However, it is important to consider that respondents with higher levels of self-esteem reported more frequent use of specific drugs. That outcome in itself is an implication for further investigation.