Publisher Knopf censored the American translation, removing a section involving underage male prostitution, as it was considered too taboo for U. S.

The narrator of Grotesque is unnamed and forever lives under the shadow of her younger-by-a-year sister Yuriko, who is unimaginably beautiful and the center of all attention.

Then the narrator comes in possession of their personal journals and her life is entwined with theirs to the point of meeting and adopting Yuriko's handsome but blind son, Yurio.

Fordham, the reviewer in The Times, writes that the book is about women struggling to be taken seriously by men, and their consequent retreat into "coldness, violence and dehumanisation".

[3] The reviewer for The Telegraph, however, sees the theme in terms of Japanese society and culture, writing that "Grotesque is not so much a crime novel as a brilliant, subversive character study.

Kirino's real concerns are social, not criminal; her true villain is 'the classist society so firmly embedded in Japan' which pushes her protagonists along the road to prostitution".