->''"I know I've said it before, but fuck this place."''
-->-- '''Miles Upshur'''

This game has a [[{{Pun}} frighteningly]] large amount of things to be scared of. Whether it's due to seeing piles of intestines and gore, or running away from the crazed inmates, there's something here to scare everyone.

* This game's graphics provide plenty to be afraid of. The detail put into the blood and gore is good. Unfortunately, [[SceneryGorn it's a little too good at points]], to where just standing around and looking is sure to make you [[NauseaFuel queasy]].
* Many of the other inmates are [=NPCs=], that have already [[SanitySlippage gone far past the point of no return, mentally]], sitting by themselves and [[MadnessMantra whispering random gibberish]], each of them with FacialHorror all their own. What's worse? Some of them attack you. Most don't. [[ParanoiaFuel You'll never know which one's which until it's too late]].
* Early on in the game, you are met with the lovely sight of [[spoiler:a [[ILoveTheDead necrophiliac]] inmate having his way with a beheaded body]] in the form of an effective JumpScare. And, when he sees you, he calls ''you'' the sicko. Rest assured, this scene has left quite the impact on a number of players.
* One of the inmates is trying to clean another... [[{{Gorn}} in a bath tub full of blood]], [[DissonantSerenity softly whispering to him]] like a newborn baby. ''Shudder.''
* When Miles is thrown down a few floors later in the game, he lands on top of a pile of LudicrousGibs, [[OhCrap slowly coming to the realization of what he's on]].
* The huge inmate, Chris Walker, is enough to make any player scared to look around the corner. [[EstablishingCharacterMoment The first time we see him]], he calls Miles a "little pig" and throws him through a window. Getting caught by him later will likely result in Miles's head getting literally ripped off from his shoulders. [[spoiler: It makes [[AlwaysABiggerFish the Walrider's]] [[CurbStompBattle effortless killing of him]] all the more scary.]]
* ThoseTwoBadGuys, who stand naked in front of Miles, calmly talk about how they'd love to kill him slowly and take various parts of him. This doesn't become that big of a deal until [[spoiler:you have to escape from both of them]].
* The ColdBloodedTorture scene is skin-crawlingly sickening. [[spoiler:The FauxAffablyEvil Doctor Trager straps Miles to a wheelchair, teases him with a way out, then brings him into a disgusting lab. The [[SarcasmMode good doctor]] proceeds to [[{{Fingore}} cut off a finger on each of Miles's hands]], even punching Miles to keep him from passing out. Once Trager leaves, presumably to find something else to torture Miles with, Miles manages to get himself free, only to [[VomitIndiscretionShot violently throw up immediately after.]]]]
** It becomes worse with a dash of FridgeHorror: [[spoiler:it's [[http://images.wikia.com/outlast/images/9/9e/12.png implied]] that after the fingers he was going to go for the [[GroinAttack groin]] and [[TongueTrauma tongue]] next, had Miles not escaped.]]
* Being discovered by the enemies makes things really fast and intense as it becomes a game of cat and mouse. It's scary because you have no idea where you are going, where's safe to hide, and where the items are.
* A mix of this and TearJerker. The, surprisingly comprehensible, inmate you find [[spoiler: in the burning room]] late in the game. He just sounds [[DespairEventHorizon so defeated]] as everything around him has gone to hell. Him [[spoiler: attacking you a little later in the game]] implied that he was about to lose his sanity.
* Chris Walker's [[spoiler:death.]] The player should feel relieved that he's off their back, but [[spoiler:just watching how the Walrider kills him is just as disturbing as the others. First, Walker is thrown around like a rag doll but then he's pulled into the air vent and diced up by the fan.]] And the worst part: that could have happened to Miles! In a disturbing way, this was a VillainousRescue.
* One of the rooms in the sewers is a massive underground reservoir, so large it renders the camera's IR pretty much useless. Far on the other side, you see a little speck of light. The sheer size of the reservoir is foreboding in itself, but it's not long before you hear the clinking of Chris Walker's chains. And the echos in the room make it nearly impossible to find out which direction the sound's coming from, forcing you to walk through chest-deep water towards the light and pray that he doesn't find you. [[spoiler:Walker only appears once you jump to the exit ladder, making the buildup that much worse.]]
* In one room, you find a guy in a straight jacket, gagged and blinded. He follows you. Slowly, not saying or doing anything, but no matter where you go in the room, he just FOLLOWS you. It is really unnerving.
* Finally, the ending itself is nightmare fuel that crosses into Tearjerker territory: [[spoiler: Everything Miles suffered through meant absolutely nothing. Miles is dead, nobody will ever know the truth about Murkoff, all eyewitness testimony is silenced, the camera with the only evidence of the truth is lost forever, and now, worst of all, Wallrider is free to roam the world horribly killing anyone and everyone it pleases and nobody will know where it even came from or how to stop it.]]