Narrated by a young author, Vanya, who has just released his first novel which bears an obvious resemblance to Dostoyevsky's own first novel, Poor Folk, it consists of two gradually converging subplots. One deals with Vanya's close friend and former love object, Natasha, who has left her family to live with her new lover, Alyosha. Alyosha is the saintly but dimwitted son of Prince Valkovsky, who hopes to gain financially by marrying Alyosha off to an heiress, Katya. Valkovsky's cruel machinations to break up Alyosha and Natasha make him one of the most memorable "predatory types" (like Stavrogin in The Possessed) that Dostoyevsky created. The other branch of the plot deals with the approximately 13-year-old orphan Nellie, whom Vanya saves from an abusive household by taking her into his apartment, and whose deceased mother's story in some ways parallels that of Natasha. It's unusual to see a well-developed character as young as Nellie in a Dostoyevsky novel, but Nellie may be one of his most moving creations, and she in particular shows the influence of Dickens (Dostoyevsky is known to have read Dickens during the Siberian exile; this novel was conceived near the end of this exile. In turn Japanese director Akira Kurosawa adapted Nellie's story in his 1965 film, Red Beard).

One of the most important themes throughout Dostoyevsky's work is the expiative value of suffering, and The Insulted and Injured, with its tragically moving plot and characters, develops that theme.