- Severe
- You're able to interact with strangers which might lead to small missions, some of these individuals are criminals or mentally unhinged. And might try to kill or harm you. In some cases, they'll relentlessly chase you nonstop throughout the entire game. This can all be very unsettling.
- The main story is extremely depressing and sad at times.
- A gang known as the Skinner Brothers roam the lands of Tall Trees. They are the most violent characters in the game. They skin, scalp, burn, gut and slaughter innocent civilians. You don't see any of these occurring, except scalping. (It is a random encounter, you are intended to save the victim) When you raid their camps, they will have decapitated bodies hung from trees, buckets of organs and scalps hanging in their tents.
- In some Chance encounters, a person or a couple is being attacked/mugged. If you fail the encounter one of them will die and you will lose honor. The other person cries out in anguish. Very realistic voice acting.
- Strong violence sometimes
- Chapter 6 is very depressing
- An easter egg reference to the "Klu Klux Klan" is made. You are supposed to shoot and kill them. You gain "honor points" which is the games version of XP for doing so.
- At night in the game, there is a shed that can be found and at a certain point a pentagram will randomly show up. While there is a story behind this, it requires much digging and research, so to the average person it will be nothing more than a random pentagram. This is not a major part of the game at all.
- Some chance encounters can be disturbing.
- The player can sometimes be randomly assaulted by grizzly bears out of nowhere if they're in the Northwestern parts of the map, often resulting in a jumpscare. Due to this, players should be cautious when entering these regions, especially if they're hunting bears or other dangerous animals, such as wolves and cougars.
- Hunting grizzly bears can be anxiety-inducing for the player (especially for those who are less experienced) since you usually don't know where it is until it has already spotted you first. The bear's roars are also very startling and most likely indicate it is about to charge at you, if not already.
- Some missions and free roam have heavy topics and can be extremely depressing.
- Some gangs such as night folk, skinner brothers, and the murfree brood actively dismember, dissect, and castrate civilians. Very gory and grotesque.
- Rated R for Strong Graphic/Bloody Violence Throughout, Grisly Images, Language, Brief Sexuality, Some Nudity and Drug Material.
- The character Micah Bell is a complete psychopath, and the things he does are very nasty and unpleasant. However, most of his actions can only be heard, not shown.
- In an optional side mission, Arthur is able to track down a serial killer. You hear about terible things that he has done through out the mission.
- The scene where arthur dies is one of the saddest moments in video game history.
- The final mission is very emotional. Arthur will have a fight with a knife or fists with the main villain Micah. In the end, Arthur either lays and watches the sunset while he dies, or gets shot in the face. Very depressing.
- As the game progresses, you learn that Arthur has tuberculosis, and at times can be seen coughing up blood. The condition worsens as you progress, such as bloodshot eyes, and being weaker than usual. The game ends with Arthur dying.
- A elderly woman who is a taxidermist can be found at some point in the game after a lot of progressing. She walks you around her very large collection of stuffed animals, posed in various poses. She also states that she had tried it on humans, but "animals were better."