- Philip Seymour Hoffman as Caden Cotard
- Samantha Morton as Hazel
- Michelle Williams as Claire Elizabeth Keen
- Catherine Keener as Adele Lack
- Emily Watson as Tammy
- Dianne Wiest as Ellen Bascomb / Millicent Weems
- Jennifer Jason Leigh as Maria
- Hope Davis as Madeleine Gravis
- Tom Noonan as Sammy Barnathan
- Sadie Goldstein as Olive Cotard
- Robin Weigert as adult Olive
- Deirdre O'Connell as Mrs. Bascomb
- Jerry Adler as Caden's father
- Lynn Cohen as Caden's mother
- Josh Pais as Ophthalmologist
- Daniel London as Tom
- Stephen Adly Guirgis as Davis
- Amy Wright as Burning House Realtor
- Paul Sparks as Derek
- John Rothman as Dentist
- Frank Wood as Evaluative Services Doctor
- Elizabeth Marvel as Warehouse Realtor
- Daisy Tahan as Ariel
- Cliff Carpenter as Old Man
- Amy Spanger as Soap Actress Nurse
- Nick Wyman as Soap Actor Doctor
- Dan Ziskie as Leg Tremor Doctor
- Rosemary Murphy as Frances
- Alvin Epstein as Man with Nosebleed
- Tim Guinee as Needleman Actor
- Joe Lisi as Maurice
- Alice Drummond as Actress Playing Frances
- Michael Higgins as Actor Playing Man With Nosebleed
- Christopher Evan Welch as Pastor
- Peter Friedman as Emergency Room Doctor
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