The Road - Cormac McCarthy. Except I haven't been able to finish it. I know the story, through watching the film, but the imagery in the book is so much more depressing and powerfully disturbing. When I watched the film I felt it for at least a week afterwards. I was getting that feeling each time I'd go to pick up the book of a night. I really want to read it completely, but I just can't work myself up to it.
That’s my answer as well. The book is just so bleak. I read it over a decade ago, and I have thought about re-reading it, but can’t bring myself to do it. It is a really good read though.
It's difficult to choose as a horror fan because there are books that hit differently for vastly different reasons. I think Exquisite Corpse by Poppy Z. Brite might be the one that eeked me out the most so far though. It was a thoroughly enjoyable book, but it was practically a meet-cute romcom with serial killers as the main characters. Loved it. Probably won't read it again lol.
I haven't read this since high school so I don't remember much. It was required reading at the time. Now it's probably banned. It deserves a reread. There was one line that described how one of the prisoners had to put his own father's body into the crematory oven. It's probably been 20 years since I read it, but the horror of that image has stuck with me.
The Real Story and Lord Foul's Bane by Stephen Donaldson. The man is so utterly casual about rape as plot progression that it leaves me with serious questions about the author.
I don't read a ton of horror, but It by Stephen King was deeply disturbing to me. Not just because of the monster or the graphic child sex (yes, really), but because the entire book was basically a reflection of my own childhood until shit started getting horror-y. White, middle class, suburban New England gets turned into a huge bloody world.
I would have to say American Psycho was pretty fucked up and I don’t think I see it mentioned yet. Way more intense than the movie because it’s a much deeper character study. But man that Patrick Bateman has some fucking crazy thoughts
Cadaver Exquisito, known as Tender is the Flesh in English. I read it in the original Spanish.
It's about a future where a virus infects all animals and so they have to be culled. But people still want to eat meat, so they begin farming humans.
It's basically just standard factory farming stuff, but when it's from the point of view of humans you see how horrific some of it is. It makes you think a lot about how animals are treated in agriculture.
The Painted Bird by Jerzy Kosiński, I went in the book knowing nothing about the book. It is from a young Jewish boy's point of view during the second world war. Enough said.
In honor of Cormac McCarthy, Blood Meridian is pretty fucked up, I like it better than The Road (although excellent as well) because it's just more verbose.
I read "The Diary of a Young Girl" by Anne Frank when I was about the same age. It disturbed me beyond measure, to learn what humans can do to each other. (Still I found hope in seeing people were also willing to help.)
Same topic (but from a much older woman): Margot Friedländer's memoir "Versuche, dein Leben zu machen" ("Try to make your life").