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- Ambiguous Gender / Viewer Gender Confusion: Oreko and possibly Sabitsuki. The Kaibutsu are generally hard to figure out as well, (excluding the pigtails one and the Sabitsuki lookalike).
- Demonic Spiders: The Kaibutsu, which are pale white-haired figures resembling schoolchildren with bleeding faces. Usually they simply wander around, minding their own business, but then if you smack them with the steel pipe, they become enraged and chase you. And then they teleport you to inescapable areas. Some of them don't need to be smacked to be enraged, since they already are. Luckily, you can avoid them by using the ghost effect, but touching them still teleports you away.
- Ear Worm: Many of the songs, but especially Shinsoku Neko's music.
- Ensemble Darkhorse: Quite a few obscure characters, such as Oreko who only serves to give you the Diving Helmet effect, Smile and Sister (his little sister) and even the Kaibutsu. Sabitsuki herself is very popular, not unlike Madotsuki and Urotsuki (Yume 2kki) of the other games.
- Fridge Horror: As you continue through the game... Things start to connect in horrifying ways.
- Just what are the Kaibutsu? And why does one kind look very suspiciously like Sabitsuki?
- Goddamn Bats: The red demons. Though they only appear in one part of the game - specifically, the Womb Level near to where you get the Viscera effect - they nastily disable your effects, not to mention there are a lot of them in said area. In the endgame, though, they become even worse. They slowly wear Sabitsuki down, move erratically, and have an annoying habit of speeding up when they have a clear path to Sabitsuki. Oh, and they're just about everywhere at this point in the game. On the other hand, they make certain spots that normally had Kaibutsu easier as they replace a lot of them, meaning Sabi can just tank the damage and move on. EXCEPT IF YOU TOUCH TOO MANY YOU EXPLODE IN A BLOODY MESS.
- Except Rust's corrupted school event, where they LITERALLY replace the Kaibutsu.
- Nightmare Fuel: The very definition of this trope. Oh boy, where to start...?
- A video of it - Oh wait, this isn't bad at all!...Wait...oh..shi-
- Everything about the Children's Hospital, especially the music.
- Squick: Some theories speculate that the Sugar Hole's cake is made out of human flesh.
- Tear Jerker: Some parts of the game are just plain depressing.