Have you ever hurt yourself, just to see what it felt like? How about cut yourself? No? Of course not. That's something people who hate themselves do, a form of self-punishment that leaves a physical reminder of the inner pain that prompted the act in the first place. Or so we are told. I can tell you from personal experience that it's not that simple – people harm themselves for a variety of reasons and not all of them can be written off as symptoms of mental anguish. Many of you reading this may have at least dabbled without even realising. Ever picked a scab or pressed on a bruise? Why would you do that if it causes pain or slows the healing process? And have you ever lost a filling or broken a tooth and had to wait for an appointment to get it fixed? Think back, did you just try your best to ignore it or did you repeatedly prod it with your tongue or a finger? Did it hurt? Even if it did, I'll lay good money that you still prodded it again. And again. And what about that niggling hangnail that kept catching on clothing? Did you carefully remove it with nail scissors or did you bite it off? I'll bet it felt good when you got it. If none of this means anything to you then you are going to have some major problems with Dans ma peau, and even if it does you may well find yourself out of your depth.

The destructive nature of sexual obsession was most famously and bewitchingly explored by David Cronenberg in his mesmerising adaptation of J.G. Ballard's Crash, whose protagonists achieved sexual fulfillment by exposing themselves to the possibility of violent death and disfigurement. The film was surrounded by controversy and prompted howls of outrage from the right wing press, who completely failed to understand (or simply refused to deal with) the subtextual thrust of the piece. But where Crash was a communal affair, the journey taken in Dans ma peau is very much a solitary one.

The story revolves around Esther, an upwardly mobile professional woman in a stable relationship that nonetheless takes second place to her work. Attending a party one evening, she wanders into the garden and takes a fall, injuring her leg to a degree that necessitates a hospital visit. Even at this early stage, director Marina de Van throws a curve ball when the fall is passed off as a minor incident and Esther only realises just how badly she has been hurt some time later when she notices the trail of blood she is leaving. Her initial reaction is one of horrified disbelief – a natural one to such a bad gash – but her surprise raises a question re-enforced by the doctor who treats her wound. The injury should have caused her considerable pain, but until the discovery of the blood trail she had remained blissfully unaware of the damage done to her leg. So after discovering the injury she goes straight to hospital, right? No. Instead she hides the wound and – on her own suggestion – goes on to a bar for one last drink with her companions before seeking medical attention.

It's at the hospital that the first real pointers become evident, with her reaction to the treatment an unusual mix of curiosity and mild arousal. From this point on she develops an increasing fascination with the wound. This climaxes, so to speak, when she sneaks out of her office and into a store room to physically attack it with a metal door hinge, taking things a step further by inflicting a new wound with a physicality that suggests that this is no mere scratch, emphasised by a wince-inducing sound effect and a perfectly timed edit (or, perhaps more appropriately, cut).

This is a turning point for the audience, the moment you will either go with de Van or tune out. The majority of those I spoke to after our cinema screening were willing (albeit squeamishly) to follow where the film was leading them, and I'm guessing this had less to do with their own history of self harm than the metaphoric level on which the film was by then working. Esther's discovery is one that she finds compelling but remains secretive about. The whole store room incident, despite the violence of her action, has masturbatory overtones that all but the most prudish (who, let's face it, would not even be in the cinema for a film like this) should instantly recognise and possibly even directly relate to. Thus when Esther confesses to her friend what she has done, sharing her discovery with someone who may at least sympathise if not understand, her friend's negative reaction prompts an immediate about-face. Esther very quickly realises that this is something that she cannot share, something that others will negatively judge her by. Later, at a poolside social gathering, a group of male colleagues playfully attempt to disrobe her to throw her into the water and her reaction is one of screaming panic, as they come perilously close to exposing her dark secret. Her frantic pleas to her friend to stop them fall on the deaf ears of disapproval, and from this point on their friendship is effectively over.

The obsessive, damaging relationship metaphor is at its most devastating in the film's supremely uncomfortable and uncompromising centrepiece. Following a corporate dinner at which Esther begins to completely lose control of her obsession (brilliantly realised through an increasingly claustrophobic use of close-ups, editing and overlapping sound effects), she flees to a nearby hotel for what is essentially an urgently driven and fiercely passionate sexual liaison, not with another man or woman but with her own flesh, an encounter realised with her teeth and a stolen dinner knife. There is no musical accompaniment to this sequence, no attempt to impose a surrealistic tone, the gentle moans of sex replaced by the sounds of biting, chewing and cutting. It is a scene of quite extraordinary intimacy and disturbing reality, and one that proved too much for a good part of the audience at our cinema screening, who turned their heads away and mumbled into their handkerchiefs. Or so I was told. I, you see, could not take my eyes of the screen for a second. Only afterwards did I question what that said about my own reading of what had just occurred.

From this point on, Esther is caught in a spiral of self-destruction, a violent love affair with her own flesh that only she cannot see is destroying her. By the time we reach the climactic sequence, which de Van presents in unsettlingly stylised form (aware that she can neither top the hotel scene nor explicitly show what Esther is doing to herself without completely losing her audience), you can pretty much select your own metaphor: abusive relationships, sado-masochism, the deadening effect of the corporate world, incest, drug addiction... There are plenty more to choose from and all of them work, because despite the seemingly disassociative nature of Esther's obsession, there are too many familiar touchstones along the way for us to stay at arm's length. We may not understand why she does what she does, but to a certain degree many of us have been there too or know someone who has, whether it be a destructive or unhealthy relationship that only we were unable to see the harm in or a dependence on drugs, alcohol or even cigarettes that feels fine while indulging but is slowly tearing away at the body inside. When Esther cuts a square off skin and tries to preserve it, the relationship analogy is impossible to ignore – not properly cared for it withers and dies, becoming a treasured memento, mournfully pressed against her breast like a deceased child. It is no doubt these subtextual readings that prompted a female friend after our screening to say: "What she was doing was really horrible, but it a funny sort of way I knew where she was coming from. Does that make sense?" To me it did. Perfectly.

De Van's real trump card is in casting herself in the lead role. This is no cost-cutting compromise but a bold and very deliberate decision that effectively eliminates any potential barrier between directorial vision and performer interpretation, and removes any worrying doubts that might arise about what the director put her lead actor through. De Van is a compelling screen presence, not beautiful in the classic sense but still strikingly attractive, but it's her confidence and unwavering commitment to the role that really sells it. If the film itself is a million miles from a Hollywood product, then de Van's performance is likewise divorced from its mainstream counterpart. There is no ego at work here, no manufactured image to project, no self-censorship and seemingly no fear. Whether trailing a camera over her own naked and injured body in the shower or exploring the elasticity of her skin while sitting in the bath, de Van's matter-of-fact and sometimes unflattering presentation of her own flesh is at the same time both surprising and yet crucial to why the film is so damned effective, as is the almost brutal physicality that she brings to key scenes. This is most obviously visible in the sequences of self mutilation, which she throws herself into with a such conviction that it never for a second feels like a performance – indeed, there are times (particularly the hotel scene) when the audience is very much put in the position of voyeur, which makes the scenes themselves all the more troubling to watch.

Dans ma peau is dangerous cinema in all that is positive in that term. Taken literally, it's a horror story about the exploration and destruction of flesh and a discovery of emotional feeling through physical pain, but if also viewed on a metaphorical level, as it inevitably must be, this is one of the most charged and confrontational films of the past couple of years. In one extraordinary piece of writing, directing and acting, Marina de Van – previously best known in the UK for her screenplay collaborations with François Ozon and her role in Ozon's delerious Sitcom – takes us to darker places than even the celebrated Crash dared. As fellow reviewer Lord Summerisle remarked as we left the cinema, "Cronenberg must be really jealous."

Framed at 1.85:1 and anamorphically enhanced, this is a solid transfer that just lacks that vibrancy that would mark it as perfect, though this could well be down to the original film elements. The toned down colour palette is well reproduced, and sharpness and contrast are fine. There is some grain evident throughout, but it is never a problem.

There are three soundtrack options, something that has become something of a Tartan standard of late: 2 channel stereo, plus Dolby and DTS 5.1 surround. Both 5.1 tracks are fuller and more expansive than the stereo, though this is not a film that will prompt the subwoofer to blow the windows across the lawn, even during the early party sequence. Both the 5.1 and DTS mixes are very front-weighted, though the cutting and biting is reproduced with disturbing clarity.

It should be noted that you cannot switch between the audio tracks using the 'audio' button on your DVD remote – due to the specific requirements of the commentary track (see below) this has to be done in the Setup menu.

The only substantial extra here has to be the director's commentary, which is in French with English subtitles. As this means replacing the in-film subtitles with those for the commentary, this option cannot be accessed via the 'audio' control on the remote and has to be switched on in the Setup menu on the main intro screen. This is a busy commentary – de Van barely pauses for breath – but she does tend to discuss character actions and intentions in a way that, while confirming some things merely hinted at in the film itself, does not expand to any great degree on what you should be able to work out for yourself. There is little information on the technical aspects of filming, which I would like to have known more about. What does come through is that de Van sees this as a story a woman in psychosis, and no mention is made of the film's many possible connotative readings.

Also included is a Theatrical Trailer (1:35), which in non-anamorphic 1.85:1 and subtitled. The inter-titles confirm this is a French rather than a UK trailer.

Also included is a trailer reel for other recent and upcoming Tartan releases.

Dans ma peau is never going to find a large audience – when we screened it at the cinema we had the smallest attendance of the season, many of our regulars unable to even deal with the subject matter, let alone the brutally realistic handling. But this is great outsider cinema in every respect – daring, provocative, utterly committed to its vision and disturbing in all the ways that the modern American horror film is not. If you are seriously squeamish then you are going to have a major problem sitting through this, but if you're prepared to go where the multi-talented de Van wants to take you then I can promise that this is a journey you will not forget in a hurry. I raise my glass to Marina. I've got you... under my skin...