A store clerk who comes to Silent Hill after getting a letter from his deceased wife, Mary. The plot kicks off when he arrives in town to solve the mystery behind said letter.
- Accent Relapse: When James yells at the twin Pyramid Heads near the end of the game, his voice sounds very English. Sunderland is an English name, so
- Action Survivor: He's a store clerk. He survived Silent Hill. 'Nuff said. Unless you count the In Water ending. Even then, however, the town plays no role in killing him. At least, not directly.
- Classical Anti-Hero: He's sweet, but nervous, unconfident, and emotionally tormented.
- Covert Pervert: The town is using it against him by combining it with his guilt.
- Crusading Widower: His reason for coming to Silent Hill, though his single-minded fixation on his wife's death makes more sense after the player finds out he killed her.
- Dark and Troubled Past: James can't move on from Mary's death. Mostly because he's responsible for it.
- Determinator: He will find where his wife's letter came from, monsters and common sense be damned.
- Despair Event Horizon: The video tape. Both the core motive for what he did in it and quite possibly what sends him careening over the edge in the In Water ending. More specifically, seeing Mary (or at least an image of her) die all over again mid-conversation is what really dooms James' chances of coming to terms with his actions and brings his suicidal tendencies back to the forefront in the In Water ending.
- Driven to Suicide: One possible ending (In Water), and the Book of Lost Memories suggests that it's the real reason he came to Toluca Lake, before the town's influence kicked in.
- Driven to Madness: Implied in the "Maria" ending, where he kills a monster representing Mary and escape Silent Hill to live with Maria, that isn't real, being just a manifestation of his guilt.
- Drowning My Sorrows: When examining a crate of liquor bottles, James goes off on a tangent, during which he admits that he "drinks a fair bit. To get away from the pain, the loneliness..."
- Dull Surprise: From time to time, though he mostly manages the right reactions.
- Heroic BSoD: He slumps to the ground in grief after Maria dies (for the first time), has a smaller BSOD after killing Eddie in self-defense, and later has a much more severe one after remembering that he in fact killed Mary.
- Hidden Heart of Gold: Dealing internally with his guilt he declares he ended Mary through euthanasia, purely because he hated her, how she consumed his life and simply wanted her gone. Mary told him, if this were really true, if this is what he really thought and wanted, then why did he look so sad?
- Idiot Ball: James decides to ask the clearly mentally-unstable and paranoid Eddie if he has gone insane, while Eddie is armed with a gun. To James's credit, he realizes what a bad idea this was immediately afterward and tries to take it back.
- Inferred Survival:
- Downplayed in regards to Mary. James is certain that Mary is dead and remains so for the entire game but her letter gives him hope that she is somehow waiting for him in Silent Hill (even if only spiritually). She's not.
- James himself. It's mentioned in Silent Hill 4 that his father hadn't heard from him after he went to Silent Hill, but that can be supported by all endings in this game.
- Living Emotional Crutch: His character in a nutshell. He can't go on without Mary. It's up to you to interpret these confessions as either love... or lust.
- Love Makes You Crazy: He comes off as more than a little unhinged; his desperation to find Mary leads him to believe that she might somehow miraculously be waiting in Silent Hill (she's not), and his fear of losing her and inability to see her suffer, before that, was so extreme that he killed her.
- Mercy Kill: Whether or not the town (or you) accept this as his motivation for killing Mary depends on your actions throughout the game; in most endings, his desire to end Mary's suffering seems to be genuine and his primary motive, but in the "Maria" ending, it seems more like an excuse he uses to cover up the fact that his primary motive was frustration. It is strongly implied that James himself struggles with severe doubt about whether or not he was in the right, and whether he did it as an altruistic act of love for his wife or for a selfish reason like anger, and that it is this feeling that made him susceptible to Silent Hill's influence.
- Only Sane Man: While the supporting cast appears mostly-there at first glance, James is the one who manages to keep a grip on himself for the longest (albeit through rampant self-delusion).
- Parental Substitute: The "Leave" ending seems to imply that he may become one for Laura.
- Sympathetic Murderer: He killed his wife after three years of having his life taken over by caring for her and being subject to emotional abuse thanks to her mood swings. Though by that stage of her sickness, James considered it a Mercy Kill. That being said, how sympathetic he is depends upon the player's interpretation and actions; some endings, like "Maria", cast him in a much less sympathetic light than others.
- Tragic Hero: James is a heartbreaking example of this trope since he starts his quest understanding full well how absurd it is it is but carries a small hope that he will succeed. Out of love for his departed wife and blatant disregard for his own life and well-being, James is willing to journey to the depths of hell simply because a letter from Mary said she would be waiting for him. Not only is Mary still dead, but James killed her out of mercy as well as resentment. His entire quest was born from delusion and it is implied in supplemental material that James was at Silent Hill for another reason before the town affected him. Namely, he was planning to kill himself.
- Unreliable Narrator: His wife didn't actually die three years earlier like his narration says...
A disturbed young woman with suicidal tendencies.
- Abusive Parents: Her mother and father. Her father sexually assaulted her on a regular basis. Her mother knew and did nothing to stop it, going so far as to tell Angela she deserved to be abused.
- Broken Bird: Pretty obvious by her second appearance.
- Curtains Match the Window: She has brown eyes to match her brown hair.
- Death Seeker:Angela: Thank you for saving me. But, I wish you hadn't.
- Despair Event Horizon: Crossed it long before she met James.
- Does Not Like Men: Due to being sexually abused by her father, and, in the novelization, her own brother as well. Not that she's especially fond of women, either.
- Don't You Dare Pity Me!: She bristles at James' attempts to comfort her, believing that he can't possibly mean any of it.
- Driven to Suicide: James's final meeting with her in her Otherworld features her ascending a fiery staircase, with the implication she burned herself alive to escape the pain and anxiety lingering from her childhood.
- Evil Is Burning Hot: This is Angela's Otherworld — everything consumed in fire (and extremely disturbing pictures on the walls). Her dialogue suggests she believes she "deserves" hell and thus the town shapes itself to what she imagines hell to be.
- Harmful to Minors: Her past is an example of this.
- Hates Being Touched: Flips out when James even starts to get close to her, even threatening him with a knife at one point. The sexual abuse she suffered might have something to do with that.
- Knife Nut: In her second cutscene, she's admiring a kitchen knife that she later hands to James. The usual subtext of Knife Nuttery is absent, however; Angela doesn't wish violence against others anymore, only herself. Examining the knife often enough in James' inventory will see him Driven to Suicide as well.
- Manslaughter Provocation: She killed her father in self-defense after years of being sexually and physically abused by him.
- Mood-Swinger: Calm, almost ethereal and timid at some points, and then hysterically frightened and angry at the drop of a dime.
- Rape as Backstory: Basically her entire childhood was this, with a helping of victim-blaming from her mother.
- Sympathetic Murderer: She killed her father after being sexually abused by him for years.
- Ungrateful Bastard: Subverted. She is initially hostile to James after he saves her from the monstrous manifestion of her father, but given that she was raped and abused all her life, you can hardly blame her. And she does later thank him, although she says that she wishes he hadn't.
- Womanchild: She exhibits plenty of childish behavior, her abusive childhood having severely stunted her maturity.
- Younger Than They Look: She is actually 19 years old, but her facial features, especially her worn-out, tired eyes, makes her look quite a bit older.
An annoying little girl who seems to have a special hatred for James.
- Bratty Half-Pint: She acts rudely to both James and Eddie. Subverted when it comes to Mary, however; she refers to her very fondly.
- Break the Cutie: She doesn't take the revelation of Mary's death well, especially when she finds out that James was the one who killed her.
- Children Are Innocent: It's implied she's the only one in town who doesn't see it as a nightmarish hellscape, as she's never committed any sins.
- Conveniently an Orphan: The game never mentions what happened to her parents.
- Hair Decorations: She uses a pink scrunchy to hold her hair up.
- Happily Adopted: Implied in the "Leave" ending.
- Invisible to Normals: She's the only one who doesn't see Silent Hill as a monster-infested hellhole.
- Mouthy Kid: Toward James and Eddie. With James at least, it's later implied she knows him from the hospital visits (even if he doesn't remember her), and that there was some preexisting animosity there.
- Only Sane Man: In the sense that she doesn't see the monsters that the others do.
- Skip of Innocence: When she's not bolting away from James, she tends to skip around without a care in the world.
- Unwitting Instigator of Doom: She does at least two things that inconvenience or endanger the playernote , and she really has no idea how badly her actions are affecting them because she doesn't seem to see the monsters that the others see.
A beautiful woman who bears a striking resemblance to James's late wife.
- Alas, Poor Villain: The only thing she can do before James kills her off is repeat his name over and over again.
- Anti-Villain: All she really wants is for James to love her. And in fact, it's all she lives for.
- Big Bad Duumvirate: With Pyramid Head, as they represent different manifestations of James's guilt.
- Butterfly of Death and Rebirth: She has one tattooed on her hip. Possibly a symbol of her being Mary's "replacement".
- Death Is Cheap: She dies many times throughout the game, but reappears later quite alive and usually without so much as a Hand Wave. This is, of course, exactly what she is intended to do.
- Despair Event Horizon: Upon discovering her true purpose at the end of "Born from a Wish", she seriously considers suicide for a long moment. Of course, she decides against it (and given how many times she's brought back during the course of the main game, pulling the trigger likely wouldn't have worked anyway).
- Fate Worse than Death: Her very existence.
- Final Boss: She can be this in three out of four endings.
- Multicolored Hair: She has blonde hair with pink highlights.
- Mood-Swinger: She frequently switches moods between nice, mean, or clingy and fearful, mirroring Mary's behaviour after being diagnosed with a terminal illness.
- Ms. Fanservice: She dresses in a low-cut skirt and a top that slightly bares her midriff. And this is practically enforced, too, because she is the incarnation of James' sexual frustration while Mary was bedridden.
- One-Winged Angel: She reveals her true, monstrous form in most of the endings.
- Replacement Goldfish: Is very much one for Mary, and she's not happy with this fact. Fully becomes one in the "Maria" Ending, complete with Incurable Cough of Death.
- Tragic Monster: The Born from a Wish bonus prequel scenario reveals that when she was first "created", Maria was actually a pretty nice person, just like Mary. However, her experiences in Silent Hill eventually turn her into a willing minion of the town's forces, with the goal of seducing and tormenting James.
- Tulpa: She's James's guilt incarnated.
- Victoria's Secret Compartment: She keeps a key there, along with one in her boot and one in her skirt.
- Voiced by: David Schaufele (original), Liam O'Brien (HD)
A seemingly harmless young man whose many, many issues only serve to remind the player that James isn't exactly the epitome of sainthood, either.
- All Are Equal in Death: A big part of the reason he takes to shooting everyone who gets in his way.
- All There in the Manual: The game's never entirely clear about Eddie's crimes, but the Book of Lost Memories reveals that the "he" who "had it coming" was a bully. Eddie shot and killed the bully's dog in a fit of rage, and then shot the bully in the leg before fleeing.
- Ax-Crazy: In his final showdown with James, laughing about how easy it is to kill and coming at him with a gun.
- Berserk Button: Once he's gone crazy, do not ask him if he's gone crazy.
- Beware the Nice Ones: Eddie starts off as the friendliest character in the game. This also happened before the game even started, but, like James and Angela, he didn't remember it at first.
- Climax Boss: His boss fight accompanies The Reveal of Silent Hill as a Genius Loci, his death is an emotional turning point for James, and immediately after is the Lakeview Hotel.
- Driven to Madness: The anxiety and obsession with the murders he possibly committed, along with Silent Hill likely throwing it at him, ends up with Eddie becoming mentally insane, as he even tries to kill James later in the game.
- Dumb Is Good: Tragically averted. Eddie's slowness and immaturity are what exacerbated his problems, by leaving him unable to deal with his inner torment in any kind of constructive way.
- Evil Is Deathly Cold: Eddie's Otherworld resembles a frozen meat locker.
- Expy: The creators have confirmed him to be based off of Private Pyle, being an overweight, somewhat slow young man who was constantly bullied for his weight until he snaps and goes on a rampage with a gun.
- Fat Bastard: He is one of these, he just doesn't remember yet.
- From Nobody to Nightmare: Began as a fat, disgusting piece of shit, as he describes it, ended as a paranoid murderer.
- Jumping Off the Slippery Slope: He starts out as a bullying victim who eventually snapped and crippled his tormentor after killing his dog and then ran away to Silent Hill out of guilt and fear of the consequences. He ends up as an unrepentant, trigger-happy murderer who forces James to kill him in self-defense.
- Kick the Dog: Or is it Shoot the Dog? Anyway, he did that (and from his remarks, it wasn't a nice death for the dog) before kneecapping the dog's owner (who'd bullied Eddie in the past) and fleeing to Silent Hill.
- Manchild: Eddie has a very childlike personality and fashion sense, and he's implied to be somewhat mentally slow.
- Motive Rant: He gives one to James once he's gone completely over the edge.
- Nice Guy: Subverted with a vengeance. Eddie seems like an affable if slow young man, but as the game progresses further, James finds out that Eddie isn't quite the nice guy he presents himself as.
- Nice Hat: A silly-looking baseball cap.
- Not So Different: Invoked during his Motive Rant.Eddie: Don't get all holy on me, James. This town called you too. You and me are the same. We're not like other people.
- Older Than They Look: He seems younger than his 23 years of age. His strangely juvenile fashion sense doesn't help.
- Revolvers Are Just Better: Carries one around with him. He used it to kill a dog, kneecap a bully, and tries to kill James with it.
- Sanity Slippage: It happens throughout the game and before he came to Silent Hill.
- Serial Killer: Sort of. James discovers the corpses of lots of people killed by Eddie — although it is implied that these "people" are Eddie's monsters. According to Masahiro Ito, Eddie never actually killed anyone except the bully's dog. His dialogue in-game indicates that he did shoot the bully, though...in the kneecap, crippling the latter.
- Vomit Discretion Shot: When James first meets him, Eddie is violently vomiting into a toilet.
- Wouldn't Hurt a Child: He'll kill anyone he sees for calling him fat or crazy without thinking twice about it. When Laura calls him a "gutless fatso," however, he's mildly annoyed at worst and even seems kind of amused, not even motioning for his weapon and eating his pizza in peace. Since this happens before he goes full psycho (at this point, he hasn't killed any people outside of Silent Hill, and maybe not even inside of it), it's kind of ambiguous.
- Voiced by: Monica Horgan (original), Mary Elizabeth McGlynn (HD)
James' beautiful wife, who tragically died three years ago of a terminal illness. Didn't she?
- All Take and No Give: She admits in her goodbye letter that her relationship with James had become this by the final stage of her illness, unable to pay him back for all of the time, money, and emotional burden he put into caring for her and instead lashing out at him while begging him to stay.
- Anti-Villain: In the Maria Ending.
- Final Boss: In one of the endings, at least.
- Ill Woman: She died of a terminal illness years before the game... or so the players are led to believe. In actuality, she was killed around a week before James' arrival in the town.
- Incurable Cough of Death: Though this isn't the only sign of her illness — she also developed a very unpleasant-looking rash and became too weak to stand up.
- The Lost Lenore: James is literally incapable of moving on from her emotionally even in the "Maria" ending, where he chooses a facsimile of her. Only in the "Leave" ending does he seem to be able to truly move on.
- Mood-Swinger: In some of her flashbacks, though being afraid to die and in constant pain can do that. James later says that, though his killing her at her request was an act of mercy, there was an element of anger in it that he's ashamed of, and that the town's feeding on.
- One-Winged Angel: She takes on a monstrous form in the "Maria" ending.
- Parental Substitute: To Laura.
- Posthumous Character: She's only ever seen in James' photo of her, and depending on which ending you get, as a vision or a boss.
- Soap Opera Disease: Whatever her terminal illness is supposed to be, it is extremely vaguely defined.
- Woman Scorned: If you're on track for the "Maria" ending, an image of her is the final boss you face instead of Maria.
An enigmatic shut-in that Maria encounters in the "Born From a Wish" sub-scenario. He refuses to see her directly, only communicating through doorways.
- Dead All Along: Ernest finally agrees to let Maria into his study, but when she opens the door, the room turns out to be empty.
- The Voice: During the course of the game, we never see his face.
- Voice with an Internet Connection: Well, more like "Voice With A Demonic-Forces-Controlling-The-Town Connection." After she helps him, he reveals he knows Maria's purpose and gives her the info to nudge her toward meeting James. (With genuinely helpful intent, so she won't be lost and alone anymore.)
A strange man-like figure with a giant headpiece that hounds James and Maria.
- Advancing Boss of Doom: The encounter with him in the basement of the hospital.
- Anti-Villain: In the end, his only real goal is to make sure that James discovers the truth about Mary's death. He even helps him out along the way a few times, such as by draining the water in a flooded apartment basement and giving him access to a previously locked room. He's still plenty hostile towards him, though, and if one is to follow the interpretation of him found here, he's certainly malicious as well.
- BFS: Despite being called the "Great Knife", it's more than large enough to be considered a sword. The weapon which, interestingly, can be picked up by James.
- Being Watched: James' first encounter with it is unsettling, to say the least. Pyramid Head does what he does best: wordlessly observing James from a safe distance.
- Big Bad Duumvirate: With Maria, as they represent different manifestations of James's guilt.
- Bizarre Alien Senses: When James hides in a closet from him, Pyramid Head fumbles with his helmet briefly, then seems to "scan" the area with an outstretched, fused hand. It's unknown if he is using this to search for James or not, but it's still quite unsettling.
- Blade on a Stick: He also carries a spear, which is more light-weight (and subsequently less iconic). He uses this if you take the Great Knife from him, and also in some fixed encounters (such as the chase sequence in the hospital).
- Blindfolded Vision: The helmet does not have eye holes, but he can see just fine. (Assuming there even are eyes under it.)
- Blood Is the New Black: Positively sticky with the blood of the things he's maimed.
- It's telling that the first Pyramid Head that the blood on him is a dull rusty color—as in dried blood. When James faces two at once near the end, the second one has a brighter red—as in fresh blood. This is after James killed Eddie, so at this point James has two killings on his conscience, including Mary's death the week before.
- Body Horror: Very, very subtle, but there. The underside of his helmet is made of flesh, not metal, meaning that Pyramid Heads's head is shaped like his helmet.
- Breakout Villain: His popularity has made him something of a "mascot" for the franchise, appearing in multiple games and both movies, something the developers never intended.
- Buffy Speak: James calls him Red Pyramid Thing.
- The Cameo: In Origins, Homecoming, and Downpour.
- Chained by Fashion: Occasionally seen struggling with his oblong helmet, such as when James unloads his pistol at him in a cutscene, though PH's reaction is more irritation at being thrown off-balance than pain.
- Combat Tentacles: If he manages to grab you, he'll lift you up and stab you with his "tongue" that'll come out from a small hole on his helmet.
- Cool Mask: His pyramid-shaped helmet. Though not exactly a pyramid per se, since it has 7 sides. In fact, it may not even be a mask, given how it's fused to him. For all intents and purposes, the pyramid is his face.
- Driven to Suicide: After James comes to the realization that he no longer needs them to fulfill his desire for punishment, the two Pyramid Heads skewer themselves on their own spears.
- Dual Boss: Before the final boss fight. One wears a red helmet, the other brown.
- Enemy Without: Subtle, but he shares the same general size and build as James. Whenever Pyramid Head thrusts his spear in the final bout, their grunts are identical, too.
- Fitting, since Pyramid Head is the physical manifestation of James' guilt. However, his appearances in later games seems to embody of all of his victims.
- The Heavy: It'd be a stretch to call him the Big Bad, but he drives most of the plot by chasing James around Silent Hill and seems to be the town's primary avatar.
- Hopeless Boss Fight: The first encounter and the final encounter with him end when they end, not when you kill him.
- Humanoid Abomination: Humanoid, certainly — arms, legs, torso, head — but he is an aspect of Silent Hill and James' mind, not an independent being.
- I Have Many Names: The Executioner, Red Pyramid, and The Bogeyman.
- Iconic Item: The Great Knife.
- Immune to Bullets: The helmet gets in the way — as well as James's inability to aim at his exposed body or legs instead. Expect to hear a lot of "ping pings" before this thing is over.
- Impaled with Extreme Prejudice: A favored attack when he uses a spear. Also a favorite method of suicide.
- Institutional Apparel: Wears a grimy white smock. In later incarnations, he is shirtless.
- Judge, Jury, and Executioner: Implied to be one by artwork in the museum. And he follows through by executing Maria and tormenting James. A second one appears after James kills Eddie in the meat locker.
- The Juggernaut: Win, lose, or draw, it's because he wishes it.
- Malevolent Masked Man: Well, helmet, but still fits it to a T. Except he's not a man.
- Monster Lord: He emits louder radio static than most other monsters, and they appear to hold him in esteem. He has a lot in common with SH3's Valtiel, and the "original" Pyramid Heads (hood-wearing members of the Circle) were members of the Valtiel sect. While not quite in the same league, they're near the top of Silent Hill's hierarchy.
- Lean and Mean: Despite later installments portraying him as imposingly muscular, the one here is surprisingly scrawny. Rather like James...
- Lightning Bruiser: He's positively cat-like when the story calls for it, even capable of moving fast while underwater. On the harder difficulties, you can and should stock up plenty of ammunition to slow his advances, especially in the hospital chase.
- The One Guy: He's the only masculine presence amongst this game's otherwise superficially feminine monsters.
- One-Hit Kill: He has a number of moves and attacks that could kill you in one hit. The most prominent is his overhead slash using his Great Knife.
- The player can do the overhead slash as well when he acquires the weapon. It does massive damage to anything it hits, but it won't always guarantee a death blow, especially towards bosses. Hitting Pyramid Head with his own weapon would only stun him for a while.
- Rape Is a Special Kind of Evil: A personification of the concept — not rape, but rape as a crime with no possible absolution and deserving of specific and extremely harsh punishment.
- Recurring Character: Appeared in most games both in the franchise and outside games 12 at least, two movies, and five comics that's quite an impressive streak.
- Rule of Symbolism: Represents James' guilt over killing Mary as well as his sexual frustration and his anger.
- Series Mascot: He has become the franchise's mascot. Appearing in many game installments, spin-offs, and cameos, and guest appearances in other games and even from other source materials like comics and the movies. He also has a number of knockoffs like Origin's Butcher and Downpour's Bogeyman.
- Small Role, Big Impact: His appearance in Homecoming is minor, but it's significant, as Adam is punishing himself, and in one of the endings, he turns Alex into one of him.
- Sinister Geometry: Hence the name. From the front, he resembles some kind of hooded executioner or Grand Wizard of the KKK.
- Sinister Scraping Sound: The sound of the Great Knife scraping across the Otherworld's rusty metal floors is a sign that Pyramid Head is coming.
- Sleeves Are for Wimps: Gloves aren't, though.
- Sword Drag: Pyramid Head often drags his Great Knife behind him when he walks. The damn thing is huge and heavy.
- Threshold Guardians: It's the job of the Pyramid Heads to lead James toward the truth.
- The Voiceless: He never speaks. He only makes muffled noises.
- Weapon of Choice: Most often his signature weapon, the Great Knife, though he does carry a simple spear from time to time.
- Especially when you steal the Great Knife from him. You can acquire his weapon in a room later in the game. Getting it will make Pyramid Head resort to the spear instead the next time you meet him, which makes him fasternote and gain a longer attack reach. Oops. Still, he does use the spear at times even before you can take the Great Knife, such as the hospital basement chase sequence with Maria.
Bizarre, feminine figures whose arms are trapped inside a straight jacket made of skin.
- Armless Biped: More or less a case of this, thanks to it's straight jacket.
- The Blank: Like many other monsters in the game, they have no visible facial features.
- Body Horror: They're faceless, meaty, twitching things with a fleshy straight jacket and what appear to be platform shoes encased in skin.
- Fan Disservice: Their legs are long and shapely, and they appear to wear a thong exposing feminine buttocks... Said thong is made of diseased-looking skin that encases the entire upper half of the creature.
- The Goomba: They're pretty weak, and are, for better or for worse, the most common enemies you'll find in the game.
- Hollywood Acid: They emit a brown mist from [slits in their chests that causes a fair amount of damage.
- Marionette Motion
- Rule of Symbolism: Their restrained appearance and penchant for spitting bile reflects the game's theme of disease and suffocation of an emotional and literal kind.
Unnerving creatures resembling store mannequins... But with a second pair of legs where arms and a head would go.
- Fan Disservice: Like the Lying Figures, the creature's body is sexually suggestive, but is arranged in a completely alien way, having two pairs of long, feminine legs and no arms or head, nor anywhere for arms or a head to go.
- Marionette Motion
- Nothing Is Scarier: You can often find them posing deathly still in dark hallways. The radio static doesn't even pick up on their presence.
Bubble Head Nurse
Shambling, twitchy, female figures wearing sexy outfits that lurk in the dark of Brookhaven Hospital.
- The Blank: Subverted; while their heads are bulbous and bone-white, they have small mouths full of dirty, bloodied teeth.
- Butter Face: Close to it, at least.
- Fan Disservice: Their faces and jerky movements remove anything remotely sexy about them.
- Naughty Nurse Outfit: Quite possibly the least sexy example of this trope ever.
- Rule of Symbolism: They're some of the most blatantly sexual monsters in the game, and reflect the darker parts of James' psyche.
Surreal, abstract creatures resembling masses of flesh inside bed frames suspended from the ceiling. They attack James when Laura locks James inside a hospital room.
- Body Horror: Their flesh is uneven and tumorous, and their skin is sac-like.
- Freud Was Right: Their name comes from the perfectly circular opening between their legs from which a pair of lips protrude.
- Murderous Thighs: Of a sort, They mainly attack by wrapping their burnt-looking legs around James' neck to strangle him.
- Our Monsters Are Weird: Even by the standards of the game, the Flesh Lips are particularly surreal, their bed frames and yonic lips perhaps resembling an abstraction of Mary in her sickbed and James' sexual urges during her disease.
Long-armed, brachiating monsters that swing beneath the metal gratings opening into yawning darkness.
- Combat Tentacles: They can shoot out sharp, tongue-like organs from their arms to stab James' feet.
- Creepily Long Arms: They hang below the floor by their apelike arms.
- Mind Screw: Their very environment. They live beneath rusty grating floors where there would normally be grass or concrete.
A repulsive creature resembling two squirming figures atop a bed, covered in a taut layer of rancid skin. Implied to be a distorted manifestation of Angela Orosco's sexually abusive father.
- Abusive Parents: Not the creature itself, but what it represents. Angela's cries of "Daddy, please, no!" confirm the nature of the beast.
- Body Horror: The creature appears as though it's skin stretches and melds onto a bed frame, while the two figures underneath are fused together. There's also the massive mouth on the bottom of it's body.
- Belly Mouth: It can cover James' face with the large, vertical slit along the length of its underbelly.
- Degraded Boss: Smaller, weaker versions of it are found later in the hotel.
- Freud Was Right: The thing is obscene; the two figures making up its body look to be mid-intercourse, with a larger, more muscular one dominating a smaller one. The room it is encountered in is also suspect, being fleshy and lined with holes in the walls through which pistons thrust.
- Harmful to Minors: Its very nature is this.
- Limp and Livid: It has a stance vaguely similar to this.
- No-Holds-Barred Beatdown: On the receiving end of this from Angela, who kicks it repeatedly before throwing a TV on it.
Maria's true form and the true final boss of the game.
- Butterfly of Death and Rebirth: She vomits clouds of moths, and as a manifestation of Silent Hill, is a newer, younger, sexier version of Mary... Well, was.
- Combat Tentacles: She has a long, black, pointed tongue that can wrap around James' neck to strangle him.
- Macabre Moth Motif: Fitting with Maria's butterfly tattoo, the monster releases swarms of black, biting moths to distract James while she moves in.
- Madness Mantra: She can only endlessly repeat "James" before the final blow is struck. Fitting, as her entire existence revolves around James.
- One-Winged Angel: Being the monstrous and more powerful form of a supposedly human woman.
- Tragic Monster: As Maria, she never wanted to be James' mental tormentor. She was constructed by the town to fulfill that purpose, but (at least initially) had some amount of autonomy and feeling.