"Choke" is sick, twisted, perverted, irreverent, sacrilegious, distasteful and possibly every thing else under the sun you can think of to describe the film.

It's also surprisingly poignant and thoughtful at times — especially in a couple of scenes when you least it expect it to be.

That's sort of expected, though, since this darkly comic, highly dysfunctional tale was based on a book by author Chuck Palahniuk, whose works also inspired the similarly love-it-or-hate-it feature "Fight Club."

Obviously, this is not the sort of thing that's for all audiences — or many of them at all. But if nothing else, it's worthwhile because it features yet another fascinating Sam Rockwell performance.

He stars as Victor Mancini, who dropped out of medical school to look after his mother, Ida (Anjelica Huston), a victim of early-adult senility.

However, Victor is unable to take care of her by himself, so he's put her into a nursing home. Besides, he has his own nagging disorder to deal with — an addiction to sexual activities.

Unfortunately, his attempts at overcoming that addiction have gone horribly awry. And they threaten to wreck a possible relationship with his mother's new doctor, Paige Marshall (Kelly Macdonald).

If that wasn't a crazy enough premise, the subplot that actually gives the film its title actually refers to a "scam" Victor has going. (The character tries to choke himself to death in restaurants and then he bilks the person who saves him.)

Maintaining the good balance between light and dark story and character elements clearly challenges screenwriter/director Clark Gregg. So, he's lucky to have this good ensemble cast.

Rockwell makes Victor surprisingly likable, despite the character's rather repellent personality. Huston has a similarly tricky role, and in support, Brad William Henke impresses as Victor's slow but sweet-natured best friend.

"Choke" is rated R for crude sexual and scatological humor (references, sight gags and other suggestive jokes and references), crude sexual language (profanity and frank sex talk), simulated sex and other sexual contact, female nudity, derogatory slurs and language, brief drug content and references (various pharmaceuticals), and some violence (including vehicular mayhem). Running time: 92 minutes.