Sarah uses narrative elements and characterizations that also occur in the short stories of "The Heart Is Deceitful Above All Things" (2001). But unlike "The Heart" or "Harold's End" (2004), Sarah is rich in humor and more fabulistic in its characters and situations. These qualities temper the harsh themes this novel shares with the other JT LeRoy books: abuse, exploitation, abandonment, betrayal, loss. Like them, it also explores the dynamics of identity and gender and employs the plot situation of having one's hidden life exposed and the shaming, hostility, and violence that ensue. Poet and critic Stephen Burt called Sarah "a work of art" and "a book about the risks and thrills of false identity," which derives its power "from the glee with which it refuses realism: multiple subjects (sexual trauma, coming out, rural poverty) that American fiction usually depicts with flat-footed seriousness instead come together for a Technicolor romp."