This post contains not only frank discussion of the first episode of HBO’s adaptation of the novel Sharp Objects, but also a subject matter that some may find triggering.

Anyone who has either read Gillian Flynn’s 2006 debut novel or any of the in-depth coverage of the HBO adaptation leading up to Sunday night’s premiere would be prepared for the reveal, in the episode’s final seconds, of protagonist Camille Preaker stripped down to expose the years of self-harm she’s done to her body. As the episode closes out, the camera focuses in on one word etched on actress Amy Adams’s forearm, which lends its name to the episode: “Vanish.” In the latest installment of Vanity Fair’s Still Watching podcast, Richard Lawson and Joanna Robinson break down the reveal as well as all the other twists and turns of this week’s premiere episode.

There’s plenty of shocking material in Sharp Objects—one wouldn’t expect any less from Flynn, the creator of Gone Girl. But in an era of Peak TV that constantly pushes the envelope when it comes to on-screen sex and violence, most TV audiences are fairly inured to depictions of murder and sexual assault. Sharp Objects is airing in the same Sunday night HBO slot as the unceasingly brutal Game of Thrones, but procedural-esque murder scenes and dragon-based violence likely won’t deliver the same jolt as that single word cut into Camille’s skin. Audiences aren’t that used to seeing such unflinching depictions of cutting. In fact, viewers who saw the episode premiere at ATX in Austin last month audibly gasped at the sight.

The truth of Camille’s history with self-harm doesn’t appear in the book until midway through Chapter Four. Up until then, readers might have taken Camille Preaker for a classic hard-boiled murder-mystery protagonist with an addiction to alcohol. In her book and in Camille’s voice, Flynn wrote: “I am a cutter, you see. Also a snipper, a slicer, a carver, a jabber. I am a very special case. I have a purpose. My skin, you see, screams. It’s covered with words—cook, cupcake, kitty, curls—as if a knife-wielding first-grader learned to write on my flesh.”

It’s possible, in this age of spoilers, social media, and a book that’s more than a decade old, that Flynn and show-runner Marti Noxon felt they couldn’t keep either Camille’s self-harm or the dual identity of her sister Amma (Eliza Scanlen) a secret past the premiere. The Amma twist also comes a little later in Flynn’s original story. After the credits rolled on the premiere, HBO flashed the following advisory: