This entire album is full of moments like that - when I listen to the title track, I still cringe when she yells "******", but it helps to understand its place in the overall theme.
Agreed. I think the pre-chorus of that song - "You want them to notice the ragged ends of your summer dress; You want them to see you like they see any other girl. They just see a f****t; They hold their breath not to catch the sick." - is one of the most real, gut-punching verses on the album.
I fucking love this album.