When Henry first enters the Hospital world, one views a cut scene showing the mysterious trench coat man chopping up a cadaver. If one looks closely at the body, one can see that it is Claudia, the creepy priestess from Silent Hill 3. This might have a deeper meaning to it. That or the Silent Hill creators just threw it in to mess with player's minds.

Sometimes if you look out of Henry's windows, you may see a hot air baloon in the sky that has the Silent Hill 3 bunny rabbit from the amusement park as its design. You will also see the bunny as a stuffed animal if you look through the hole in the apartment where you can see Eileen's room.

Whenever you walk around in Henry's apartment, go to his bedroom and look out of his window. If you notice, you will see a billboard that says "Bar Ashfield" on it and right below it as a phone number. Then go to his phone next to his bed and dial: 555 – 3750. It will play a little creepy call makes Henry feel disturbed.

Whenever you enter a new room and get the loading screens with the weird symbols, move the left analog stick around and watch as they move across the screen.

Throughout the latter part of the game, your apartment will become possessed and/or haunted. If you took the Shabby Doll that the mysterious man gave you inside of the Apartment World, Ghosts will slowly come into your apartment. No matter what, however, your apartment will become possessed from time to time. You must eliminate these possessions by lighting Holy Candles near the possessed item, or equipping a Saint Medallion once you go near it.

• 21 Sacraments: Ignore Eileen and your room.
• Eileen's Death: Ignore Eileen but take care of your room.
• Escape: Take care of both Eileen and your. room.
• Mother: Take care of Eileen but not your room.

You just have to complete the game once on any difficulty and then save the file on a slot to your memory card to start “A Brand New Fear" file.

To get the Chainsaw melee weapon, you must complete the game once, and the Chainsaw will become available at Jasper's rock in the first visit to the Forest World.

• Eileen : After you beat the game and start a new game in A brand new fear mode get the nurse’s costume in Room 303 and beat the game. It will now be available.
• Lingerie Cynthia : To check Cynthia out in some sexy, sexy lingerie, you must complete the game four times. You must be truly dedicated to bosoms if you'd like to see this outfit.

There are four endings in Silent Hill 4: The Room: Escape (the good ending), Mother, Eileen's Death, and the 21 Sacraments (the bad ending). Ironically enough, the worst ending is the most interesting, and the best is the least interesting. To get Escape, you must take good care of Eileen and your room. For Mother, make sure Eileen is okay but disregard your room. For Eileen's Death, disregard Eileen's safety/sanity but take care of your room. For the 21 Sacraments, don't bother with either of them.

To unlock Full Weapon Mode, score a 100 rank in One Weapon Mode. Full Weapon Mode is the exact opposite of One Weapon Mode.

• Finish the game once
• Obtain at least 9 stars
• The machine gun is found in the Apartment world in Room 102.

To unlock One Weapon Mode, you must complete the game with a nearly perfect 100 rank score. You can only choose one weapon in this mode, sans Pistol.