Incest features prominently as a theme.

Dead women are seen topless or nude after being murdered and possibly raped.

Two scenes of attempted rape, one with breast nudity.

A dead woman's breasts are fondled.

A man attempts to seduce a teenage boy by placing his hand on the boy's thigh; the boy reacts by punching him in the face, then fleeing.

A woman is raped. Another man discovers it as it's happening, and attacks the rapist.

This movie is extremely realistic and disturbing. Proceed with caution, because it will remain with you long after you have stopped watching.

The violence is highly sadistic and disturbing due to its realistic and non-stylized portrayal.

The movie does actually not show more than perhaps 15 minutes of violence, but the dark, filthy tone and the theme makes the impact much stronger.

Henry and Otis watches on TV, a video they have shot, in which they murder a family. Not bloody but intense. The mother is also sexually abused.

Two homeless men attacks and kills another homeless man, while being filmed by Henry and Otis.

The opening scenes show various bodies killed in different ways - shot, strangled, cut, etc.

A man is tackled and punched several times before being stabbed; the man who punched him smashes a tv on the man's head and tells another to plug it in; the other man complies and steam and sparks spit out of the machine.

A man is shot multiple times (some blood).

Two prostitutes are killed by strangulation and breaking of the neck.

A man is punched in the face as he attempts to seduce a teenage boy.

10 uses of 'fuck'. References to shit.

The characters are frequently seen drinking alcohol and smoking cigarettes.

Otis is a drug dealer and supplies a high school boy with a bag of weed.

The kills aren't that gory but very realistic.

Henry himself is an extremely disturbing character, which goes without saying as he's a spree killer.

It is insinuated that Becky is abused by her husband, but he dies not appear in the film.

Modern day MPAA rating R for strong disturbing violence including grisly images, brutal killings, rape, graphic nudity and for language and drug use.

More than one character talks about being victimized as children.