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  • Angst Aversion: This is a very dark and depressing game, so it's very likely to fall into this.
  • Big-Lipped Alligator Moment: The Joe Davis sequence. Even if you've played Downfall (2009), it doesn't make sense.
  • Complete Monster: While all Parasites are undoubtedly evil, the first and last Parasites stand out even more:
    • Dr. Xavier Zelmann, aka Doctor X, is Susan's psychiatrist. A seemingly good-hearted man who cares for his patients, Xavier is in fact a Soft-Spoken Sadist who uses his job as a way to finding lone, vulnerable women for him to take down to the hospital's abandoned basement and kill; one of his victims being his own co-worker Liz, whom he impaled on a wall with a metal rod through her neck. After killing his victims, he uses their bodies to recreate Renaissance art pieces and puts them on display in his own twisted gallery. When Susan finds Xavier after he stabbed her multiple times, he is torturing a woman tied to a chair, and dancing blindfolded so he can better hear her screams, which he associates to a song and "poetry without words". Despite only being the first Parasite, he manages to be one of the worst.
    • Adam, also known by his online pseudonym The Eye of Adam, is the fifth Parasite and the one whose presence is felt throughout almost the entire game. A spiteful, wheelchair-bound young man with grandiose delusions, Adam surfs around internet forums so he can find depressed people and give them ways to commit suicide. Prior to the events of the game, Adam got in contact with Mitzi's boyfriend, Jack, who suffered from depression after discovering his girlfriend's brain cancer, and convinced him into locking himself inside his car and inhale hydrogen sulfide. Having implanted a device which would release poisonous gas in his apartment, he activates it in an attempt to stop Susan and Mitzi, killing his own father in the process, despite everything the latter had done for him. Inside his flammable, gas-filled room, Adam tries to coerce Mitzi into shooting him, knowing this would end with the room exploding. Adam was not only Susan's polar opposite, but he also served as an example of the evils a simple troll can do if given the chance.
  • Fridge Brilliance: It only makes sense that the Parasites flock around Susan: she lives in a rough part of the town, she has no friends, her entire family is dead by the beginning of the game, she is unemployed, her few neighbors would be happy to see her gone, so nobody is going to miss her and look for her. She is also very weak emotionally, making it easy to win her trust. She is a perfect target for any Serial Killer.
    • Although Liz being Dead All Along does come as quite a shock, it starts to make sense when one replays her chapter. None of the nurses are ever seen talking about her or to her, the doctor who Liz calls over when Susan wakes up never speaks to Liz or looks at her, and the only other person who knows anything about her is Doctor X.
      • You can ask the nurse at the front desk about Liz. Her response is that she doesn't know a Liz, but that she can't be expected to keep track of all the nurses that work there. It's a great piece of dialogue that fits perfectly with her overworked persona, and doesn't tip the player off at all that Liz is dead. Well, not until later.
  • Fridge Logic: Everything about the Joe Davis sequence. Did he and Susan have a shared hallucination? Was Susan somehow transported into his inner world? Were they in some sort of alternate reality? What was that?
    • Susan did the same thing with Ann Burton's hallucination of the spider heart in Chapter 2, although she needed drugs to do it.
  • Harsher in Hindsight:
    • Susan gets a hilarious one-liner about social media early on in the game. By the ending, she is making the world a better place by doing exactly what she ridiculed.
    Susan: Why would I want to go online to tell people I'm having a shitty day?
    • Susan's hatred of flowers was pretty prominent, but one could assume it was just because she wasn't a huge fan of them. However, we discover in later chapters that Susan's baby died from a rare pollen allergy, triggered by the flowers Susan's stalker had given her.
  • Hilarious in Hindsight: The reveal that Doctor X is a serial killer can be kind of funny if you've played Downfall, since it's pretty much the opposite of Doctor Z from that game, who seemed insane and obsessed with dead bodies when you meet him, but is actually a good guy and Joe was just hallucinating.
  • Les Yay: Defied when Susan has a bath while talking to Mitzi. One dialogue choice has Susan only willing to let Mitzi in the bathroom if she promises she's not gay and doesn't stare at her chest the whole time.
  • Nightmare Retardant: Although the buildup to it is extremely suspenseful and creepy, what with the recreations of famous paintings using the corpses of women and the distant screaming of his victim, the actual reveal of the First Parasite can be this due to the somewhat clunky animation of him punching his victim and "dancing".
    • Susan's immortality can be this. For as frightening as the Parasites and Joe Davis can be, you're always aware that because Susan is immortal none of them can really DO anything to her beyond incapacitate her for a short time.
  • Obvious Beta:
    • You cannot overwrite saves, and there is a hard limit of 50 saves, in a game where Save Scumming is absolutely vital if you want the best outcomes.
    • There's also a large number of visible bugs, such as voice clips mismatching subtitles completely, or softlocking at times.
  • Viewer Gender Confusion: Or, rather, Listener Gender Confusion: the pest control guy's wife. Being voiced by a man doesn't help, either.
  • Wangst: Susan is guilty of this at the start, but it's very quickly justified by the fact that she has genuine depression. By the end of the game, she's starting to overcome it.
  • The Woobie: Every single sympathetic character really, really needs a hug.
    • Jerkass Woobie: Susan's ex-husband, Eric. Despite his excessive jealously and general bad behavior, it's hard to not fell bad for him when he commits suicide after their infant daughter dies.

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