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* FiveSecondForeshadowing: Dr. Weaver tells a young Madison that she won't have to fear anything from Gabriel, specifically because he's been given a heavy sedative which is the reason Madison herself is feeling a bit sleepy. Minutes later, [[spoiler:his nature as an extreme parasitic twin attached to Madison's back is revealed.]]
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** [[spoiler: "It's all in my head. ''[[AccidentalTruth It's all in my head.]]''"]]
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** Hints at Gabriel's true nature are scattered before TheReveal; in particular, when he picks up [[spoiler:the trophy to kill Dr. Weaver, his hands, and the fact that they're oriented backwards, are center-frame]].
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** Hints at Gabriel's true nature are scattered before TheReveal; in particular, when he picks up [[spoiler:the trophy to kill Dr. Weaver, his hands, and the fact that they're oriented backwards, are center-frame]].center-frame. Detective Moss also notes after examining the scene of Derek's murder that the perpetrator's hands were "upside down".]]
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* HopeSpot: Zigzagged and inverted in the climax. [[spoiler:As Gabriel closes in to kill Sydney and his and Madison's birth mother Serena, Sydney desperately calls to Madison to try to get her to fight back and regain control of her body. After Sydney's words get through to her, we see Madison begin to strain and start to move her limbs back from Gabriel's configuration, leading the viewer to think that Sydney's appeal worked. But then it seems to either fail or succeed only too late, and Gabriel shoots Sydney in the head and then shoots Serena before gloating to Madison. But ''then'' the scenery around him melts away, revealing that Madison ''has'' taken control back and has trapped Gabriel in a mental prison just like he did to her, only leading him to think that he won for a moment.]]
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* HopeSpot: Zigzagged and inverted in the climax. [[spoiler:As Gabriel closes in to kill Sydney and his and Madison's birth mother Serena, Sydney desperately calls to Madison to try to get her to fight back and regain control of her body. After Sydney's words get through to her, we see Madison begin to strain and start to move her limbs back from Gabriel's configuration, leading the viewer to think that Sydney's appeal worked. But then it seems to either fail or succeed only too late, and Gabriel shoots Sydney in the head and then shoots smothers Serena before gloating to Madison. But ''then'' the scenery around him melts away, revealing that Madison ''has'' taken control back and has trapped Gabriel in a mental prison just like he did to her, only leading him to think that he won for a moment.]]
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* TheEndOrIsIt / SequelHook: [[spoiler:Madison traps Gabriel back inside her mind, but he promises he will find a way to take control again.]] In the final shot, [[spoiler:a lamp starts to flicker, signaling that he is already working on it.]] Director James Wan has said that [[https://www.darkhorizons.com/james-wan-on-malignant-2-possibility/ while he didn't make the movie with the intent of launching a franchise, he would certainly be open to making a sequel]].
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* TheEndOrIsIt / SequelHook: TheEndOrIsIt: [[spoiler:Madison traps Gabriel back inside her mind, but he promises he will find a way to take control again.]] In the final shot, [[spoiler:a lamp starts to flicker, signaling that he is already working on it.]] Director James Wan has said that [[https://www.darkhorizons.com/james-wan-on-malignant-2-possibility/ while he didn't make the movie with the intent of launching a franchise, he would certainly be open to making a sequel]].
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* HopeSpot: Zigzagged and inverted in the climax. [[spoiler:As Gabriel closes in to kill Sydney and his and Madison's birth mother Serena, Sydney desperately calls to Madison to try to get her to fight back and regain control of her body. After Sydney's words get through to her, we see Madison begin to strain and start to move her limbs back from Gabriel's configuration, leading the viewer to think that Sydney's appeal worked. But then it seems to either fail or succeed only too late, and Gabriel shoots Sydney in the head and then shoots Serena before gloating to Madison. But ''then'' the scenery around him melts away, revealing that Madison ''has'' taken control back and has trapped Gabriel in a mental prison just like he did to her, only leading him to think that he won for a moment.]]
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* BullyingADragon: A group of holding cell prisoners decide to harass and pummel Madison the moment she enters police company, unaware that [[spoiler:she has a homicidal monster dwelling inside her body. Cue a massacre.]]
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* MuggingTheMonster: A group of holding cell prisoners decide to harass and pummel Madison the moment she enters police company, unaware that [[spoiler:she has a homicidal monster dwelling inside her body. Cue a massacre.]]
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* ParasiticHorror: Gabriel is a parasitic twin.
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* ParasiticHorror: Gabriel is a parasitic [[spoiler:parasitic twin.]]
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* ThroughTheEyesOfMadness: [[spoiler:Madison sees what Gabriel wants her to, preventing both her and the viewer from knowing the killer is her own body being piloted backwards.]]
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* ThroughTheEyesOfMadness: [[spoiler:Madison sees what Gabriel wants her to, preventing both her and the viewer from knowing the killer is her own body being piloted backwards.]]
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* ElectronicTelepathy: One of Gabriel's abilities.
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* {{Technopath}}: One of Gabriel's abilities.
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* RuleOfThree: The "Where is My Mind," cover is used three times, after a particular revelation - When Madison tells Sydney she's adopted, when the kidnapped woman wakes up, and when [[spoiler: the kidnapped woman crashes through the floor, into Madison's living room.]]
