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Wealthy children's author Cathryn receives several disturbing calls in her home in London one night; the female voice on the other end, sometimes cutting in on other phone conversations, suggests mockingly that her husband Hugh is having an affair. Hugh comes home, finding Cathryn in distress. Hugh attempts to comfort Cathryn, who witnesses a different man who is behaving as if he were her husband. She screams in horror and backs away, only to see her vision of the figure revert to Hugh.

Hugh attributes Cathryn's outburst to stress and her pregnancy. He decides to take her on a vacation to an isolated cottage in the Irish countryside, where Cathryn can work on her book and take photographs for its illustrations. Upon her arrival, however, Cathryn hears voices saying her name and sees apparitions: While preparing lunch one day, she sees Hugh pass through the kitchen, then transform into her dead lover, Rene. Rene continues to appear to Cathryn around the house, and even speaks with her.

Cathryn's paranoia and visions become increasingly pervasive, and are exacerbated when a neighbor and ex-lover, Marcel, brings his adolescent daughter, Susannah, to visit. Cathryn becomes unable to distinguish Hugh from Rene or Marcel, as the men shift before her eyes. One day, Rene taunts Cathryn, asking her to kill him if she wants rid of him, and hands her a shotgun. She shoots him through the abdomen; Susannah runs into the house and finds Cathryn standing in the den, having shot Hugh's camera to pieces. Cathryn claims that the gun accidentally fired when she was moving it.

Seeking solace, Cathryn goes to a nearby waterfall, where she often sees her doppelgänger staring back at her. After one such occurrence, she returns to the house, where Hugh tells her that he has to leave for business. Cathryn drives him to the train station and returns to the house, where she finds Marcel waiting inside. He begins to undress to have sex with her, but she stabs him through the chest with a kitchen knife. The next morning, she encounters an elderly man walking his dog, and invites him to come inside for coffee, in spite of the fact that Marcel's corpse apparently lies in the living room (which suggests that she regards the "murder" as a hallucination); the old man declines the invitation. Later in the evening, Susannah stops by the house, and remarks that her father was not at home when she awoke that morning. Cathryn is alarmed by this, as it could mean that she really did kill Marcel. She is relieved to hear that Marcel did return drunk after midnight, and invites Susannah in for a cup of tea after reasoning that Marcel cannot be dead on her living room floor. Susannah asks Cathryn if she looked like her when she was young before saying, "I'm going to be exactly like you."

After having tea, Cathryn drives Susannah back home. Marcel comes out of the house and attempts to talk to Cathryn, but she drives away. While on a stretch of road through a desolate field, Cathryn witnesses her doppelgänger again, attempting to wave her down. At the house, she finds that both Rene and Marcel's corpses have reappeared in the living room. Cathryn leaves again, and encounters her doppelgänger at a bend in the road; this time she stops. The doppelgänger begs Cathryn to let her into the car, and the two begin to speak in unison. She then hits the doppelgänger with the car, knocking her off a cliff and into a waterfall below. Cathryn then drives back to her home in London. At her home, she goes to take a shower. While in the bathroom, the door opens, and the doppelgänger walks inside. Cathryn screams in terror, "I killed you," to which the doppelgänger responds serenely, "Not me." Hugh's corpse is then shown lying at the bottom of the falls (meaning that it was him who begged her to let him in the car and was killed when Cathryn, believing that he was her doppelgänger, ran him over the cliff).

Cathryn's hallucinations escalate, leading to acts of violence that blur the line between fantasy and reality, leaving her uncertain of what she has truly done.

The film’s conclusion underscores the tragic ambiguity of Cathryn’s condition—her actions, driven by psychosis, have left her unable to distinguish between truth and delusion. By refusing clear answers, Altman forces viewers to inhabit Cathryn’s fractured reality, making the ending as unsettling as her mental state.