- Alternate Self Shipping: Fans like to ship Alyssa with her male Split Personality, Bates.
- Alternative Character Interpretation: Does Bates really care about Alyssa, or does he just want to keep her alive because possessing her body is the only way that he can interact with the world? He doesn't seem to have a high opinion of her, but then he doesn't have a high opinion of anybody, and his level of psychopathy varies by adaptation.
- Awesome Music: One thing people seem to agree on is that the music for Ghost Head was quite good, particularly some of the chase themes.
- Catharsis Factor: After struggling with enemies as Alyssa, it can be quite satisfying killing them as Bates.
- Ensemble Dark Horse: Bates and Sho. Both are complete badasses, but the former is also played by Roger Jackson, and he's the only voice actor in the game who does an excellent job.
- Esoteric Happy Ending: In the best ending, Alyssa Hale lives, but her father, the only person she genuinely cares about is dead, alongside her uncle and cousins. Before that, her father also revealed she's the cursed daughter of George Maxwell. Oh, and the zombies have escaped and are running around in the city. While Alex Corey leaves her alone at the street and swears he will take care of the zombies. Subverted in the drama CD, where the whole story makes more sense and is played more realistically.
- Macekre: Ghost Head is set in Osaka, Japan. They try to fit it in California in the localization, despite everything being so Japanese. The references to Japanese folklore were completely removed as well.
- Sequel Difficulty Drop: Outside of the shoved-in bad-endings, with only a handful of exceptions (which never work), every single hiding spot/environmental weapon now works 100 percent of the time and the random Stalker encounters are much more rare than past games.
- Sequelitis: Of the four installments in the Clock Tower series, The Struggle Within is the considered the worst. This was attributed to the game's reliance on Trial-and-Error Gameplay and Guide Dang It!, which wasn't helped by the point-and-click interface being incredibly slow and clunky. The story also drew criticism for being too confusing and lacking explicit details to make sense of it.
- So Bad, It's Good: The Struggle Within is generally seen as this by fans of the Clock Tower series that are willing to forgive its flaws.
- Scrappy Mechanic:
- The game seems as if it was designed without guns in mind. It gets even worse when you play as Alex since the hit boxes to click on the zombies are really fussy to where it is nearly impossible to finish unless you shoot each zombie in order of who walked in before the next. It also drags. The standard gameplay somehow had reduced difficulty overall. The only real difficult part about it is hoping you saved your game before you get locked into any of the bad endings.
- Zombies function entirely differently before and after Bates finds out about their weak point. Beforehand, they will always collapse after being shot; if Bates leaves the room, they're not actually dead dead and will be back up on their feet the moment he reenters the room they were encountered in. Once you find out about the weak point though, Zombies are immortal and can't be killed without shooting said weak point (indicated by the crosshair changing color when aiming at that body part).
- The chase segments are noted as being incredibly tedious compared to past games, as you're unable to do anything while being chased but often you can't lose what's chasing you. This often causes a lot of forced backtracking to something you can use to defeat whatever's chasing you; often for you to only run into another thing that will chase you a few screens after the previous thing that was chasing you was encountered, resulting in the process starting all over again, since hiding/weapon spots, especially in the final chapter are much more scarce compared to the similar environments of the past games.
- The Hint system. Hints in the last game actually gave you fairly reliable clues that, though sometimes a little cryptic, would lead you towards the better endings. The ones in this one...hardly help you at all. Two of them effectively say the same thing, just reworded, none of them really clue you in properly on how to get the better endings, and the final one is simply a useless pick-up that gives no info whatsoever. The player could ignore the hints present in this game and do no worse.
- They Wasted a Perfectly Good Plot:
- As a lot of reviews point out, The Struggle Within is just a rip-off of Resident Evil (although it didn't start out as such - Memorial Pharmaceuticals was innocent, and George Maxwell was the one who released the zombies). The story, however, had potential, but the developers decided to Mind Screw us by letting zombies take over the plot after the first scenario and never fully explaining the backstory.
- Even the Zombies are interesting, functioning similarly to the Regenerators from Resident Evil 4 years later. It could have been interesting to have regular enemies having a constantly changing weak point. However, the mechanics are poorly explained and once they're introduced, the shotgun and machinegun that ignore weak points are introduced soon afterwards.
- A main character with split personalities who play entirely differently, react differently to things, and experience different events in their playthrough is a solid idea that deserved better gameplay/plot than this.
- The Woobie: Alyssa later finds out that her real father is George Maxwell, who went insane due to a lab conspiracy by her adoptive father and uncle to discredit him. Shannon, who is revealed to be her stepsister, has been neglected by her father and hates Alyssa with a burning rage. On top of that, the people she loved and cared for (except for Kathryn) and some people she met (except for Alex and maybe Cook and/or the journalist) are all dead by the end of the game.
YMMV / Clock Tower II: The Struggle Within