Unsurprisingly, in a game that involves hiding from a giggling, insane murderer who is hunting you down in a darkened environment, there's quite a lot of things to be paranoid about, which also overlaps with Paranoia Fuel.
- That Saiko can be around any corner, outside the door of the room you're in, right behind you, or literally on your back at any moment. The only clues for these instances are her shadow in the moonlight, her glowing red eyes in the dark, lights in a classroom turning off, her knife at your throat, or randomly hearing her laughter. This can quickly lead to turning around every second just to make sure she isn't there, sometimes treating you to the sight of her seconds away from slashing you. Her behavior is custom-tailored to invoke this, as she's likely to spend time closely following you and staying out of your sight while you're turning.
- Extreme Yangire carries the extra paranoia of having to constantly keep track and worry about where two killers are at the same time and hoping you aren't being cordoned into a trap between the two of them.
The theme song when Saiko is pursuing is a warbled version of the "Entry of the Gladiators" circus theme and speeds up as she gets closer, but if Elissu is the pursuer, then the Creepy Circus Music is reversed. Update 2.2 jacks it up with both Saiko and Elissu now wielding machetes in both hands and having a demonic sounding voice. Oh, and the moon is now bloodshot red. Luckily, this mode bumps your health up to 200 as opposed to the normal 100, and you will absolutely need it.- Elissu's surprise entry can also be a shock for anyone not familiar with what the photograph does.
- Elissu's surprise entry
- If the Steam Cards are any indication, Saiko will eventually die of blood loss due to her self-inflicted wounds, but even death won't stop her from coming back as a ghostly abomination◊ whose limbs have been impaled with glass shards.
- This seems to be canon as Nightmare Saiko is a hallucination formed from Akira's guilt of witnessing her death and being unable to do anything about it. She appears in his mind as a disheveled and bloodied revenant. In the game's menu, her neck appears to be twitching as well, highlighting her undead status.
- Nightmare will also be the hardest of all modes. It will be as dark as, if not darker than Yangire Mode. The subtitles are rendered black so you have a harder time knowing which mode Saiko is in, and she's invisible at times with the only way to see her is the bloody footprints she leaves behind her and the brief moments she returns to visibility when she interacts with something. The game will also shift between "memories and realities" of previous modes to confuse the player and show that Akira has developed PTSD by experiencing flashbacks of the events that led to Saiko's death.
- This animated short reveals that Akira felt repulsed at Saiko's excessive clinginess, even causing him to run away in fear when he spots her in the boys' bathroom. Said short also reveals Saiko's obsession of Akira has become unhealthy to the point she even turned her entire bedroom into a Stalker Shrine. Shinji also unintentionally wonders if Saiko would resort to forced kidnapping and murder even if she's told to stop it, but Akira dismisses that as nonsense.
- The Immortal Senpai achievement's image shows Akira sporting bat-like wings, horns, and a devilish Slasher Smile.
- The God of RNG achievement's image shows Akira dressed up similar to Yangire Saiko◊ (including red facepaint, a bowtie, and bunny ears). He also has the same Red Eyes, Take Warning as Yangire Saiko and an unnerving Glasgow Grin that makes him look like The Joker.
- The Halloween Edition spin-off is just as creepy as Yangire Mode, albeit for an entirely different reason. Saiko in this game is a zombie that has to be put back together via finding her missing body parts, including her heart. She's as helpful as she normally is in her 'passive' state...except instead of going psycho and trying to stab you, she'll quickly start wondering if you taste any good. Oh, and did we forget to mention Akira has to deal with a second girl trying to kill him?
