many characters' ages are ambiguous, which makes this difficult to gauge. an adult character chastises and beats an underage character, although not explicitly sexual, the scene is sexually charged.
the way the series portrays "madness" resembles stereotypes of the mentally ill. the "mad" characters express satisfaction and pleasure in hurting other people.
the residents of gensokyo are "driven mad" by an unknown cause throughout the series. the madness is depicted similarly to horror-movie mental illness, causing them to attack and hurt other people. a character that was severely bullied and harassed and traumatized by it is depicted torturing other characters as a result of that trauma.
the series centers around a genocide charged and justified by religion. the victims of the genocide are seen as impure within the religion and therefore acceptable to be harmed.