Laura, a graduate student, seeks a session with Dr. Rose Cotter, a therapist who works at a mental health facility, after she witnesses her professor commit suicide. Laura tells Rose that, recently, she has seen an apparition who, rather than looking sick and dreary, takes the form of people with a grin on their face. Laura worries that she's going to be murdered by this ghostly visitor, who threatens her on a regular basis. Some time later, Laura falls to the ground and starts screaming. Rose shouts for help and then watches Laura get back up, smiling. In this account, Laura slit her throat and died with a shard of broken porcelain inside of her. Meanwhile, Rose saw her psychiatric patient Carl go by yelling that she would also be going in time. Once she requests that medical personnel come restrain the patient for his erratic behaviour, he instantly becomes asleep and stays this way for the duration of the time Rose spends on shift. Due to the young nurse's emotional distress from the work day, Rose's supervisor grants her a week of paid time off.
The hallucinations persist throughout the next few days, making Rose appear crazy and threatening to all around her, including her fiancé Trevor and sister Holly. Rose's gift had been changed to her dead cat during her nephew's birthday celebration, frightening the kids. She stumbles onto a glass table after spotting a party hostess grinning at her and causes chaos to break out. She sees Dr. Madeline Northcott, a former therapist, who says that her issues are a result of her upbringing with a mentally ill and violent mother, whose overdose death she witnessed as a young child. Despite Rose's growing suspicions that she may be under some type of otherworldly curse, Trevor refuses to take her word for it.
Rose visits Laura's professor's widow Victoria after discovering that he was smiling at Laura before he passed away and discovers that he got more unstable after seeing a woman commit herself a few days before. Rose requests that her ex-boyfriend Joel, a police detective, review police files. They discover multiple instances when someone watched a suicide, then committed themselves a few days later in front of another person who carried on the trend.
Rose tries to explain the matter to Holly when she visits her, but it only causes further friction. The intensity of the hallucinations is increasing. Joel phones her and tells her that he learned all the witnesses committed themselves within a week, leading him to realise Rose is actually cursed. Robert Talley was an exception, as he killed someone else instead. When Rose and Joel visit Robert in jail, he explains that the entity feeds on trauma and that the only way to get rid of it is to execute a victim in front of a witness in such a way as to inflict severe psychological distress, which will then transfer the entity to them. Rose rejects the proposal fiercely and walks away.
The demon, disguised as Madeline, confronts her at home and gleefully informs her that time is running out. When Morgan suddenly starts to lose his face, Rose rashly drives to her hospital with a knife and has a hallucination of killing Carl in front of him so she can give the entity to him. She abruptly recovers and quickly drives off, but not before Morgan notices the knife. He informs the police out of concern for the potential threat she might pose.
Rose travels to her abandoned family house because she believes that if she stays alone, she won't be able to pass the entity. It is revealed that when Rose was a youngster, she had frightfully disregarded her mother's cries for aid after she overdosed and unintentionally abandoned her to die. Rose then confronts the entity that takes the form of her mother. Rose is attacked by the thing, but she kills it by setting it ablaze and escapes the flaming house. She drives to Joel's apartment after that, and he consoles her there. Rose discovers that all that has happened to her since walking into her old house has been a hallucination when Joel begins to smile.
The real Joel soon arrives after tracking Rose's phone. Rose rushes hysterically inside the house to lock Joel out since she is afraid he is either the entity or its next victim, only to discover that she has mistakenly locked herself in with the still-alive entity. The being approaches the now-dejected Rose and rips off its own skin to expose its actual nature: a gigantic, skinless humanoid with numerous misaligned sets of jaws nested inside of a massive, grinning mouth. The thing enters Rose's body through her mouth as she is absolutely paralysed from shock after viewing this. When Joel smashes down the front door, Rose sets herself on fire while grinning and transfers the entity to him.
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