- Catharsis Factor: After playing most of the series as powerless protagonists, it's very satisfying for Silent Hill players to gun down the monsters here with unlimited ammo pistols.
- Funny Moments: The UFO ending, a continued tradition in the Silent Hill series.
- Goddamned Bats: Bat-birds, nonetheless. And roaches. And leeches. And they often follow Pyramid Head around.
- Heartwarming Moments: The Good Ending, accompanying probably the first and only time in the series where it's clear that the heroes totally won over the town and its horrors, even saving the souls of some of its early victims.
- Nintendo Hard: Monsters travel in packs, they like cheap hits, healing items are rare and don't heal very much, and as in the other games, one hit by Pyramid Head is an almost certain Game Over. Also, the game is one of the longest, if not the longest, rail shooter ever compared to another arcade games.
- Tear Jerker: The Bad Ending. "Why didn't you rescue me?"
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