There are several descriptions of the ways the main character was neglected and berated by her mother when she was young. The mom herself talks about being beaten with a belt when she was young by her own mother.
One of the members of the VFR tells a story about a babysitter killing her children. It is not described in detail, but the trauma is mentioned a few times throughout the book.
The main character's mother is described as a narcissist. She is repeatedly cruel to both the main character and her granddaughters and there are several flashback scenes where the main character describes her life growing up.
There is one major NB character who Ella, even before she meets them, comments that she cannot tell their gender or "if they conform to one". Everyone is respectful of this character's pronouns.
The Violence is a disease that causes people to black out and kill others brutally. The Violence is not technically a mental illness, but could stand in for one.
The people at the incarceration center for the Violence are tranquilized when they begin to storm (have an attack of the Violence). This is described in an email but not explicitly seen.
The main character, Chelsea, flinches when people touch her or loom over her because of her past experiences with abuse. She describes being sensitive to being choked, even by jewelry.
The main character is choked by her husband numerous times. There is also a scene where the main character is crushed under a dogpile while restraining a person with the Violence. She is ultimately fine, but it is a claustrophobic scene until she calms down.
When a person at the VFR comes down with the Violence, several characters dogpile her to subdue her. The main character is at the bottom of the pile and describes how heavy the weight is on top of her.
The main character's mother is described as "kidnapping" her granddaughters. The girls are left there by their mom to keep them safe. They are not taken forcefully.
Briefly, after being barred from her grandmother's neighborhood, Ella is homeless and lives our of her car and abandoned houses until she is reunited with her mother.
Multiple animals are killed throughout the book including the main character's dog, two cats who are abandoned by their owner, and more cats who are killed by people with The Violence.
One of the main plots of the book is the main character's participation in the Violence Fighting Ring (VFR), which is like WWE for people with the disease. Both men and women fight in the ring, but no one is ever actually hurt.
David, the main character's husband, exhibits alcoholic tendencies but is never explicitly identified as an alcoholic. The head of the VFR, Harlan, mentions once, in passing, that he met another character when he was in rehab.
The driving point of the book is the abusive relationship between the main character and her husband. Most of the women in the book are in some type of abusive relationship.
Pet dogs and cats are killed by their owners who have The Violence, and two cats are left to die after their owner dies. Their bodies are described in detail.