Mental Help Seeking for Voyeuristic Disorder After 25 Years in Bangladesh: A Case Report

Introduction

Paraphilic disorders, including voyeurism, remain poorly documented because of stigma and are rarely addressed in health professionals’ training, which might hamper treatment. ¹ Voyeuristic disorder is a paraphilic disorder where the person derives recurrent sexual arousal from observing an unsuspecting person who is naked, undressing, or engaged in sexual activity, persisting for at least six months. ² It is estimated to be one of the most prevalent paraphilic disorders, and it becomes a chronic phenomenon due to the delay and difficulty of diagnosis. One study estimated the prevalence of voyeuristic disorder at 12% in men and 4% in women; this suggested potential under-diagnosis. ² Bangladesh is a lower-middle-income country where more than 90% of the residents are Muslim. In Bangladesh, discussions of sexual behavior remain heavily stigmatized, and mental health services are limited; more than 90% treatment gaps are present. ³ In this context, this report presents a case of voyeuristic disorder from Bangladesh.

Case Presentation

Mr. B is a 48-year-old married male residing in a rural area of Bangladesh. He came to a psychiatric outpatient department due to repeated and uncontrollable voyeuristic behavior, ongoing for the last 25 years. He worked as a day laborer and had no formal psychiatric history or substance use other than betel leaf. The patient reported that he achieves sexual gratification from observing real-life sexual activities of neighboring couples without their knowledge. Since observing real-life sexual activities is difficult, he tried pornographic material, however his arousal only developed for real-life sexual activities. Occasionally, he masturbates during these episodes. He described a compulsive urge to leave his home at night to observe others. His wife was aware of his behavior and had repeatedly confronted and scolded him. He had been caught engaging in voyeuristic behavior on more than three occasions by community members. No formal legal punishment was imposed previously, however the most recent incident resulted in physical assault by the affected couple, prompting him to seek psychiatric help.

When asked specifically about possible childhood sexual abuse or early sexual trauma, the patient reported no recollection of such experiences. A mental status examination revealed intact orientation, insight into the problematic nature of his behavior, and no evidence of psychosis, mood disorder, or cognitive impairment. There was no history suggestive of mania, substance misuse, or neurological illness. The patient was started on fluoxetine hydrochloride 20 mg once daily in the morning, olanzapine 5 mg once daily at night, and was requested to regularly follow up. At the one-month follow-up, he reported complete abstinence from voyeuristic behavior during the treatment period.

Discussion

This case highlights an extraordinary delay of approximately 25 years in help-seeking, underscoring the long-standing, untreated course of voyeuristic disorder in a conservative, low-resource setting, and its psychosocial consequences. It shows how paraphilic disorders like voyeurism may remain hidden for decades in conservative and low-resource settings until social confrontation or physical harm forces individuals to seek psychiatric care.

The long duration of symptoms of this case (almost 25 years), is unique compared with previous studies, even though voyeuristic disorder often continues for many years. ⁴ This might occur because individuals with potentially harmful sexual interests frequently avoid seeking help due to profound shame, fear of social stigma, and concerns about legal consequences. One study found that only approximately 20% of individuals with such interests attempted to discuss their sexual interests with anyone prior to arrest. ⁵

The social and cultural context of Bangladesh likely played a central role in delaying diagnosis and treatment. In addition to strong stigma surrounding sexual behaviors outside marital norms, mental illness itself remains highly stigmatized, and discussions of paraphilic interests are also taboo.^6,7 As a result, individuals may suppress symptoms, avoid mental health services, and only present after severe social, legal, or physical consequences occur. The physical assault the patient experienced shortly before seeking treatment shows the real-life dangers of untreated voyeuristic behavior. These risks affect not only the people being observed but also the individual engaging in the behavior. This highlights the importance of early psychiatric identification and treatment, both to prevent harm and to address the public health and legal consequences associated with the disorder.

Limitations

Several limitations must be acknowledged. The absence of standardized psychometric scales to assess symptom severity, compulsivity, or treatment response limits the objectivity of outcome evaluation. Follow-up was relatively short, and long-term maintenance of symptom remission or relapse risk could not be assessed. Information was largely based on self-report, which may be influenced by recall bias.

Conclusion

The case report demonstrated that voyeuristic disorder exists in Bangladesh and may remain undetected for decades due to stigma, lack of awareness, and limited mental health services. Early recognition and culturally appropriate psychiatric intervention, including pharmacological treatment, may prevent serious social, legal, and physical consequences. Further research, including case series and epidemiological studies, is urgently needed to better understand the prevalence, clinical patterns, and optimal management strategies for paraphilic disorders in South Asian and other conservative societies.