In the slim genre of horror films about female anxiety, there is Rosemary’s Baby, brimming over with angst about just what is cooking inside Rosemary Woodhouse’s womb. And there is the afterbirth saga of Scottish director Lynne Ramsay’s We Need to Talk About Kevin, which hinges on a mother’s horror of doing everything right by your child and ending up, nevertheless, with a very, very bad seed.

Within the genre of maternal horror, We Need to Talk About Kevin is a doozy. It speaks to the worst human fear imaginable: that evil lurks, not in the outside world, but right at home. If you can suspend disbelief long enough to imagine Tilda Swinton and John C. Reilly as husband and wife, Ramsay’s (Ratcatcher, Morvern Callar) film delivers a sustained gut punch of profound anxiety about parenthood. The film’s nonlinear structure plunges viewers into the head-swimming grief that defines Eva Khatchadourian (Swinton).

Something terrible has happened that has left Eva alone, her family nowhere to be seen, in a house someone has vandalized with red paint. She takes a job in a tacky strip mall travel agency, but the other employees keep their distance. Walking down the street one day, a woman slaps Eva across the face. As the film flashes back, signs are given that her teenage son Kevin (Ezra Miller) has done something truly monstrous. Slowly, terrible details emerge.

At the center of this disquiet is an uncommon-in-film, but more-common-in-life scenario of a woman ambivalent about her maternity. In a scene that conveys the quiet nightmare of swimming against the tide and realizing your ambitions may run counter to the norm, a bevy of ridiculously fecund, half-dressed pregnant women mill around a locker room like romantic sprites. Eva sits, fully clothed and looking distinctly uncomfortable in this happy sea of expectant flesh. That uneasiness about motherhood never seems to leave her. Maybe, just maybe, some women (and men) weren’t meant to have children, no matter what biology tells us. Her ambivalence is not unreasonable: When something goes wrong with a child, we always blame the mother.

Once Eva gives birth, her child appears to have been pickled in her anxiety. As an infant, he wails unceasingly. As a toddler, Kevin (played by Rock Duer) glares at his mother with eyeball daggers. His pitch-black shark eyes resemble his mother’s — blank and terrifying. Both seem unable to relate to each other. Eva’s alienation only intensifies when Franklin (Reilly) insists they move to the suburbs, and Eva seems increasingly entrapped and alone in a large modern home in an eerily quiet neighborhood. Eva is a city girl and the move suggests a further destabilization in her life beyond the birth of her first child.

At an age when most boys are picking up baseballs, a preteen Kevin (now played by Jasper Newell) still sports a diaper, an emblem of his calculated defiance. He sends his mother into convulsions of disgust when he makes her clean up his freshly soiled Pampers. A peculiarly horrifying monster, Kevin is a button pusher who knows how to inflict guilt and manipulate his parents to serve his own agenda. Occasionally, little glimmers of hope emerge in tiny blasts of tenderness, like when Kevin comes down with the flu and, for the first time, allows his mother to cuddle and tend to him. But such moments are all the more cruel because they are so fleeting. Before long, Kevin is back to treating his mother like his worst enemy.

And she’s the only one who sees it. Franklin is happily, stupidly oblivious to the war of wills raging between mother and child and is an apologist for his son’s every transgression. Kevin is all smiles and sunshine in Franklin’s presence but seems to save his psychological warfare for mommy dearest. And what is simply unnerving in a child is terrifying in a teenager. Teenage Kevin has blossomed into a wholesale sociopath mainlining a steady diet of sugar and stewing in a toxic hatred for his mother, his angelic little sister, and the world.

At its worst, We Need to Talk About Kevin is stylized and occasionally too hip for its own good, with its avant-garde mother prowling the suburbs in chic black attire and her cool, irreverent son. The film exudes a brand of artificiality that can make much of it go down hard. Where is the Khatchadourians’ family? Their friends? With a story this compelling and thought-provoking, why gild the lily by situating this family in what looks like an airless, theatrical world set off from any reality we might recognize? And yet, We Need to Talk About Kevin still manages to convey something real and troubling about the banal monstrosity that can grow and thrive even within a normal home. The film’s essential question concerns what could have been done to prevent Kevin from doing what he did. Or was he just born evil?

We Need to Talk About Kevin plays at the Charleston Film Festival on March 2 and 3 at 9 p.m.