* The Grim Reaper spirit. His ''modus operandus'' of carving numbers into his victims' heads. He can also "''kill''" other spirits.
** There's also his traveling through walls, floors and carpets.
** Worse, the menu screen for the director's cut has the Grim Reaper ''[[TheFourthWallWillNotProtectYou coming right at the screen towards you]]''! [[SarcasmMode Sweet dreams]], fellow viewers!
* The finale in which Frank has to evade [[spoiler:Patricia, who's armed with a shotgun]] as he constantly shifts between the present and the past hospital, bearing witness to the horrible massacre that happened many years ago, often from the perspective of the people being slaughtered.
* "I'm in the mood for vivisection!" "Me too! Me too!" (they're referring to vivisection with a ''pick ax''!)
* The AndIMustScream implications of a spirit missing both chances to move on. You are stuck in this plane of existence until you just fall apart. The Judge has been around for quite a while, and showed no signs he was about to [[IncrediblyLamePun give up the ghost]] anytime soon. And if no one around has had near-death trauma, then the only people who can hear you are other ghosts, who are equally stranded.
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