There is very little data available on adult sibling incest. I imagine it goes on far more than psychologists or the general public suppose. Interestingly, it is a common sexual fantasy of both men and women.
Two potential difficulties come to mind. The first is that it would tend to turn the two people inward. Such a relationship would tend to isolate them from others, as they presumably would not want to reveal their relationship to friends, co-workers, or family. They probably would not choose to go out on public "dates" in their hometown. And this sort of isolation would naturally limit the range of social and psychological stimulation they would receive from the outside world.
The second difficulty is similar to any sexual relationship that takes place within another context of closeness-- for example, people working in the same office, on the same sports team, etc. The sexual relationship can start affecting the other, functional relationships, or vice versa. If one party chooses to discontinue the sexual relationship against the other's wishes, and the other contacts remain the same, this can be awkward or even terribly unpleasant. In the case of siblings, the now ex-couple will still have to interact as members of the same family, which again could be terribly unpleasant.
This is not to say that such a relationship would necessarily be "sick" or disastrous. You did, however, ask about potential problems.
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