Breaking the Silence: First Documented Case of Sibling Sexual Abuse in Bangladesh

Abstract

Sibling sexual abuse (SSA) involves non-consensual or coercive sexual acts between siblings and is often overlooked, especially in conservative societies such as Bangladesh. This article reports the first documented case of SSA in Bangladesh, involving a 17-year-old boy who repeatedly sexually abused his 14-year-old brother over a year through threats and coercion. The abuse was discovered by their mother. The elder brother showed signs of sexual addiction and anxiety, while the younger developed major depressive disorder with suicidal thoughts. Both received antidepressant medication and cognitive behavioral therapy (CBT), leading to improvement. The case reveals key risk factors such as a single-parent family, poor supervision, early sexual exposure, and limited privacy. It highlights the profound psychological effects of SSA on both victims and perpetrators, as well as the cultural stigma that hinders disclosure and intervention. The study calls for greater awareness, culturally sensitive mental health services, and the establishment of protective frameworks. It urges health professionals, educators, and policymakers to treat SSA as a public health concern, ensuring early detection, appropriate intervention, and long-term support for affected families.

Highlights

• First documented case of SSA in Bangladesh

• Abuse occurred in a low-supervision, single-parent household

• Both the victims and the perpetrator both developed significant mental health issues

• Early sexual exposure linked to later abusive behavior in the elder sibling

• CBT and medication were effective for both victim’s and abuser’s recovery

Introduction

Sibling sexual abuse (SSA) is described as inappropriate sexual conduct between two or more siblings that is not driven by developmental or appropriate curiosity. ¹ According to Caffaro, it is defined as sexual practices initiated by one sibling (brother or sister) against another (brother or sister) without the other’s consent, or when there is a power imbalance between the children. ² SSA can take many different forms over an extended period, including penetrative sexual activities, intimate physical contact, and non-physical forms such as voyeurism. ³ Sibling sexual behavior that deviates from developmental norms is likely to be harmful to the children involved. ⁴ Although the prevalence of SSA in the general population remains unclear due to inconsistent definitions and methodological challenges in studies, it is estimated that SSA is at least five times more frequent than parent-child incest. ⁵

Survivors may choose not to disclose SSA for various reasons, including fear of punishment, feelings of guilt, or concerns about credibility. ⁶ They may also fear their sibling, fail to recognize the abuse as aggression, wish to protect their parents or sibling from trouble, or simply prefer that no one knows about it. ⁸ Furthermore, SSA is the least commonly reported type of sexual abuse, possibly because parents and caregivers often believe it to be safe, consensual, or even a normal part of childhood sexual experiences. ²

However, SSA has traumatic effects that can result in severe and long-lasting psychological, emotional, and physical consequences. Childhood sexual abuse is associated with mental health issues, significant functional impairments, and a substantially reduced quality of life in adulthood. ⁷ Despite evidence that SSA is more prevalent than parent-child incest, there is a striking lack of documented cases from South Asian and Muslim-majority countries, including Bangladesh. Cultural taboos surrounding sexuality, family honor, and masculinity significantly limit disclosure and clinical reporting. This case is reported to address this critical gap in the literature, to highlight the psychiatric consequences of SSA in both victim and perpetrator, and to inform culturally sensitive prevention and intervention strategies in low-resource settings.

Case Report

A 17-year-old boy visited the psychiatric outpatient department with complaints of porn addiction and excessive masturbation for the past six months. He also reported experiencing excessive sexual fantasies and difficulty concentrating on his studies. He was raised in a conservative family in a suburban area. The boy has a younger brother, aged 14, and both were raised by their single mother, who works full-time. The elder brother confessed to having sexual intercourse with his younger brother for a year, initially using force. He threatened to harm his younger brother if he refused or disclosed the abuse to their mother. These sexual encounters occurred while their mother was at work or visiting relatives. One night, their mother witnessed the brothers engaging in sexual activities, after which she separated and began monitoring them closely. Subsequently, the elder brother developed an addiction to pornography and masturbation, which negatively affected his academic performance.

On further inquiry, the elder brother disclosed that his first sexual encounter occurred at the age of 10 with a 13-year-old girl who was staying in their home to help with household chores. They engaged in sexual activity out of curiosity for about two years until the girl left the home. He later had infrequent sexual encounters with two cousins and, more recently, with his younger brother. The elder brother had a bisexual orientation.

On mental state examination, the elder brother appeared anxious and reported intense sexual fantasies and urges. He was prescribed fluoxetine 20 mg per day, and cognitive behavioral therapy (CBT) sessions were initiated with the goals of developing healthier choices, reducing his sexual urges, and coping with his preoccupation with sexual addiction.

The younger brother, on the other hand, was exhibiting symptoms of depression. He refused to attend school, became socially isolated, and spent most of his time in his room. On mental state examination, he appeared depressed and expressed suicidal ideation. After a thorough psychiatric evaluation, he was diagnosed with major depressive disorder. He was prescribed escitalopram 10 mg per day and was also provided with CBT to address his symptoms and trauma.

At follow-up after six-weeks of pharmacological treatment and ongoing CBT, the younger brother’s depressive symptoms had significantly improved, suicidal ideation had resolved, and he was able to return to school and resume normal social interactions.

Discussion

SSA is a major public health issue with significant social and psychological consequences that affect the entire community. Studies conducted globally have identified several risk factors associated with SSA, including low socioeconomic and educational levels, divided families, closed social structures, extramarital affairs, poor sexual boundaries within the home, and a lack of supervision. ⁸

In the case discussed, the abuse occurred within a lower-middle-income family with separated parents, where the siblings were raised by their mother. The incident took place in a restricted, religious social environment, indicating a constrained and possibly repressive atmosphere. Additionally, there was no educational environment that could adequately address the children’s intellectual or emotional needs. A lack of supervision and unrestricted internet access can expose children to inappropriate content such as pornography and sexual misconduct. Risk factors such as sharing rooms or beds, spending unsupervised time together, especially at night, and older siblings caring for younger ones can increase the likelihood of SSA. ⁹ In this particular case, most of the abuse occurred while the mother was at work or visiting relatives, leaving the children unsupervised. The siblings also shared the same room. Research has shown that adolescents who abuse their younger siblings are five times more likely to have experienced sexual abuse themselves.^8,9 In the present case, the elder brother had a known history of childhood sexual abuse.

SSA can have severe short-term effects such as physical injuries, emotional disturbances, post-traumatic stress symptoms, and sexually transmitted infections. Long-term consequences may include depression, low self-esteem, substance abuse, eating disorders, and overwhelming feelings of guilt. ⁷ Victims may also face physical violence and trust issues in relationships later in life. Moreover, male-to-male SSA is linked with future challenges in sexual adjustment and intimacy for adult men.

Disclosure of SSA is particularly difficult in culturally conservative countries such as Bangladesh, where strong taboos around sexuality, honor, and family reputation discourage open conversations about sexual violence. ¹⁰ Victims may be silenced by fear of stigma, blame, or retaliation, while families often prioritize preserving social image over seeking justice or treatment. This culture of silence delays intervention, intensifies trauma, and prevents both victims and offenders from receiving necessary psychological support and rehabilitation. Following such incidents, it is crucial to take practical steps to ensure the safety and well-being of all children involved. This may include evaluating whether the siblings can continue to live together or maintain contact. A home safety plan should establish clear boundaries and monitoring protocols in sensitive areas such as bedrooms, bathrooms, play settings, and sibling roles.

However, in sexually conservative societies such as Bangladesh, prevention of SSA requires culturally sensitive, multi-level strategies. At the family level, parental education regarding healthy sexual boundaries, supervision, and age-appropriate sexual education is essential. At the community level, schools and religious institutions can play a role in disseminating child protection awareness while respecting cultural norms. At the policy level, strengthening child mental health services, confidential reporting mechanisms, and training healthcare professionals to recognize intrafamilial sexual abuse are critical steps. Public health initiatives addressing safe internet use and protecting children from premature sexual exposure are particularly relevant in low-resource settings.

Limitation

The sexual orientation of the younger brother could not be explored properly.

Conclusion

This is the first clinically documented case report of SSA from Bangladesh identified through a review of available national and international medical literature. Very few SSA instances have been documented in the literature worldwide, leaving this problem mainly unexplored in the field of psychiatry.‎ To support and appropriately respond to disclosures of SSA, all health and social care professionals need to be aware of this issue. It is possible to reduce the long-term harm and aid in the healing process by listening to them and providing a protective interdisciplinary response.

Supplemental Material

Supplemental material for this article is available online.