The stars of The Baby in the Basket, Elle O’Hara and Michaela Longden, have another film set to release this month that offers a very different vibe from their gothic horror film. Cara, which premiered last August at FrightFest, releases this week on PVOD, diverging significantly from what you might expect.

Typically, a title like Cara could suggest either a quirky comedy or a serious drama; in this case, it is strictly the latter. However, if you’ve seen the trailer or the poster art, you might also feel a sense of familiarity. I certainly felt that way when I first looked at the generic poster last August, seeing a bloodied woman against a grimy green background. I’m no stranger to B-movies, and the reviews that came out of FrightFest were positive overall. But I also couldn’t shake the comparison to Lucky McKee’s May, which has a very similar poster with some added allure. And, given that Cara also addresses mental health issues, I was curious to see if my initial impressions were accurate.

Cara is uniquely unsettling, even while introducing us to our titular character during the opening credits sequence, as a comparison between a cam-girl performance and sexual assault is made in a Saw setting of imprisonment. Quickly, the audience knows Cara is about to tackle some serious subject matter, even if the following scenes don’t necessarily suggest the same temperance, filmed in warmer tones with relatively unassuming dialogue. But as the exposition is revealed, the plot begins to take shape, and it’s a dismal look at the internal struggle of a woman trying to maintain her sanity.

The film deals with a week in the life of a woman in recovery. While the reasons Cara is there in the first place are never made clear, the film infers a great deal about violations she’s suffered, possibly going back as far as her youth. Initially, the titular Cara (O’Hara) is seen with a calm perception. However, specific triggers inflict disconnections from reality. Hewitt employs tonal changes for the viewer to decipher these episodes and inform them that a countdown to self-destruction is occurring.

Beginning with the first shot of Cara in her apartment, Cara’s anxiety builds with a text message from her mother (Julie Hannan), inviting her to visit in an effort to repair their relationship. As the stress is poured on, her recovery group moderator asks to speak with Cara after a session, but paranoia sets in. These departures from her usual routine immediately begin destabilizing Cara, causing her to divert further from the structure she needs. She starts believing everyone around her is plotting to put her back into an abusive psychiatric hospital where she was once chained up and assaulted by the orderlies.

Writer-director Hayden Hewitt plays, rather effortlessly, with Cara’s complex subject matter to craft a provocative thriller. Distinctive and bold for a debut feature. Cara is both an unreliable narrator and an unlikeable character navigating through a seedy underbelly of sex, drugs, and other crimes. Yet, thanks to a superb performance here by O’Hara, the audience remains empathetic to Cara—even after witnessing her viciousness with as little as a cigarette flick. Hewitt treats Cara’s plight intensely but ultimately shows limitations and disconnection in clinical, business-oriented approaches in the recovery system that, while well-meaning, are ultimately not always enough.

While it’s easy to ask the most obvious question: Why would a once committed woman with a history of sexual assault become a cam girl? The connective tissue argues that there’s not much opportunity coming Cara’s way. I assume that resume gets passed over quite a bit. She also seems more comfortable with misogynists and violence-prone people, including a few in her group, as she becomes more unsettled by kind gestures, which seem to obfuscate Cara’s thinking and cause psychosis-fueled daydreams.

Cara is a bit of a slow build, but there’s never a time when the film’s drama-driven parts become uninteresting, probably because there is some audience discernment of the moving pieces and where they’re heading. However, while viewers will try to get ahead of Hewitt, he manages the magic trick of getting us to fixate solely on that part of the reveal while he works to deliver a far more shocking ending.

The movie feels carved from the indie spirit of the ’90s and cusping ’00s independent films that show the sleazy and duplicitous sides of society, which, like mental health, are often the parts no one wants to look at or discuss. Like Requiem for a Dream and early Tarantino films, Cara is gritty and delivers, with a violent ending that even had me holding my hand over my mouth at one point.

Hewitt disguises some subtext into the film about how strong beliefs can wreak havoc on the status quo, incorporating a lively performance by Johnny Vivash’s wildcard character, John “The Nonce” Fisk, as Cara’s wingman in a ritualistic finale. Fisk becomes a disciple to Cara, willing to do whatever it takes to see her plan through. Hewitt could be trying to draw a comparison to the belief systems of the paranoid mind in a much larger context through the film’s finale. Most recovery programs use religious contexts as their backbone, and Cara seeing her actions as righteous seems to play into that.

Overall, Cara is an explosive look into the world of a troubled young woman. The performances are electric, bleeding tension from a thick atmosphere. Though this darkly disturbing film is worth taking a chance on, this genre gem won’t be for everyone. The extreme violence at the end is quite visceral, and though I found the dramatic parts quite compelling, others may not. Regardless, Hewitt’s layered debut is multifaceted and effective, and it starts an interesting dialogue.