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Nausea Fuel: This film makes few allowances for those that suffer from motion sickness. The vertiginous camerawork and garish red lighting combined with the intense droning soundtrack caused a few people to vomit at the premiere. Low-frequency sound was also used in order to disorientate the audience.
Harsher in Hindsight: Something revealed towards the very end -- namely that Alex was pregnant, makes the events shown at the beginning of the film seem even worse.
The man the camera zooms in just after the extinguisher beating, who smiles? That is La Tenia.
Just the realization that this happens in the real world.
Also, one of the most disturbing things about the rape scene is how methodical Le Tenia is; there is no hurry or uncertainty, he knows exactly what he's doing, as if he's had a lot of practice...