- Dead bodies still twitching, still bleeding, still talking, asking you "What the fuck are you looking at?" Made worse by the fact that this is one possible symptom of real PTSD - seeing dead bodies that aren't really there.
- Lucky (if you can call it that), since the past events leading up to Jacket waking up in the hospital, have been him dreaming the past events he has experienced. Although not all of it was a dream.
- The finishing moves for the bosses is no slouch, either. The first boss has you gouging his eyes out. The second one consists of you hitting his head so hard with a golf club that only a quarter of his head is left. The third boss has you beating him up horribly and then setting him on fire.
- While you're finishing the third boss (despite his desperate pleas to be spared), the cutscene keeps "skipping" forward as the screen keeps flashing to static (which is similar to what happens in one of the intermission shop visits, where you get the first creepy vision, a sign of Sanity Slippage). Combined with you losing control of your protagonist, it feels like at this point he is literally unable to stop himself from brutally killing people and isn't even fully aware of what he is doing.
- Really, the entire game (and it's sequel). Yes, it's fun. Yes, it's challenging. But what the Hitman is doing is violently, relentlessly and ruthlessly killing hundreds of people. He may be completely crazy, he may be a psychopath, or he may be forced into it against his will... but he's still an extremely violent mass murderer killing at the behest of a mysterious voice on his answering machine.
- The really disturbing part comes when you realize he's not responsible for the mayhem. You are
- You're blazing through a level, smashing skulls, blowing people away with shotgun blasts and slashing throats... and then finally as soon as the last body drops, the music stops abruptly leaving you standing alone in an ocean of dead bodies, all with a low humming noise filling your ears. It hits hard because when you play the game you have little time to be thoughtful and tactical and by the time it wears off you realize the chaos and horror you've committed.
- It's not always easy to tell if an enemy is simply stunned when they're surrounded by a whole lot of actually-dead bodies due to how chaotic the carnage gets. It can be very startling to think you've killed everyone in your vicinity only to have a stunned enemy get back up and quickly blow your brains out right when you're expecting to be "safe".
- Speaking of jump scares, in one level opening a door to a certain room gets you blown up without warning. And then there's the level where a SWAT team comes in while you're in the building, and you have to make your way out. The SWAT members are difficult (if not impossible) to kill as well, heightening the tension.
- In light of the newest PAYDAY 2 DLC, the mere thought of Jacket hanging with the crew. Have a rephrasing: a band of heisters (who includes John Wick) are recruiting someone whose modus operandi is killing everyone in the vicinity (which is how you progress in the stages). No need to say that hostages won't last...
- The song Crush by El Huervo, that plays after you clear out a building. Walking out of it while seeing all the carnage you've caused is really quite...unconfortable.
Nightmare Fuel / Hotline Miami
This page will be full of SPOILERS, you have been warned. For the sequel, see Hotline Miami 2: Wrong Number.