A man is showing sawing off a woman's head (after she is dead), then picking it up by the hair.
A man breaks into a home and kills a man, then kidnaps his girlfriend. We then see her tied up in painful positions (arms wrenched behind back, etc.) crying and begging to be let go. She is hung up in chains, gagged, tortured and is coerced into slitting the throat of another abducted/tortured girl.
A man ties a woman up and stabs her in the neck very slowly with two needle-like weapons attached to his fingers. The woman's face is very close to the camera and we can see her in agony, choking to death on her own blood behind the clear tape covering the lower half of her face. Graphic and intense.
Throughout the movie, many people describe the brutal killings that were taken place. In gruesome detail, including animal feces being stuck in mouths, intestines being pulled out, genitals being removed or electrocuted, being burned alive, teeth being removed by pliers, women being raped post-mortem. Sometimes there are brief flashes of photos accompanying them. (The list goes on.)
A lot of emotional turmoil is expressed. One profiler mentions that he brought the VHS tapes home and his wife accidentally saw them; she refused to let him touch her again for almost a year. An older profiler mentions quitting his job because he was institutionalized after a mental breakdown because he was the one to cover the case of an eight-year-old girl who was abducted, and it reminded him of his own daughter.
A former abductee of the killer is found eight years after her abduction with an extreme case of stockholm syndrome. She eventually kills herself (offscreen).
In a scene during the film's credits, a woman is told that if she doesn't blink, she won't be killed. As she realizes that any minute she's going to blink, she hyperventilates while screaming at the same time.
It's mentioned that a man murdered and buried dozens of corpses in his backyard, including his landlady, a married couple and a baby.