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Here's the fun part: when Isaac takes damage, he cries even harder than usual and gets a Tears Up, because crying out in pain from taking damage tears open the stitches. All the item does initially is stitch Isaac's mouth shut, which is pretty tame by this game's standards. It Hurts, while not as horribly disfiguring as some of the other item options, tends to give players sympathy pains whenever it's picked up.Hell, its effect is to make any enemies in a short range gain a fear effect, making it nightmare fuel In-Universe. Silly name aside, the item causes Isaac to turn blood-red, and gives him a screaming face with hellish pupils. An honorable mention for the most nightmarish item is "2Spooky".It also has a chance of making Isaac's head explode upon taking damage, spawning friendly spiders and freeing it to jump at enemies, which is actually less horrifying to look at. It's a little spider familiar that wedges itself into Isaac's face, with its legs poking out of his eye sockets. The new items naturally do not skimp on the Body Horror, but the absolute crowner is probably The Intruder.When he wakes up, he's still in the basement. Issac's mother wakes up from the dead, causing Isaac to panic, and wakes up. Ending 1x, the ending unlocked for beating The Witness.If you thought the orignal music for Sheol and Dark Room was creepy, listen to Mudeth's Shadowdance and Morphine.The Fridge Horror implication that The Witness represents the fact that Isaac, after killing his mom, was mentally scarred by not just having to kill his own mother to survive, but that she spent her last moment of life staring at him in silent judgement for it.In the versus screen, The Witness's boss portrait has it looming over Isaac, instead of the "facing Isaac from the side" view of every single other boss.It's implied to be an undead Mama Grudy that witnessed Isaac killing his mother. The Final Boss of the Corpse, The Witness.It really puts the Scarred Womb to shame. Doubles as Nausea Fuel, even by this game's standards. And let's not even get started on the music that plays, which feels like something out of a Creepypasta. As a result, the entire level is dead and rotting, and is teeming with enemies that are either rotting away (with visible skeletons) or feasting on the decaying meat. It's the Womb chapter, but after the destruction of Mom's heart. Once you hear this music, you have no choice but to get into the new floor, Corpse.It's almost as if the game is telling you "you've made a horrible, horrible mistake" not completely unfounded, since you just killed your mother, and this is a grave reminder that she's dead. It sounds like Lavender Town, HILL Act 1, and the Reverse Song of Healing all rolled into one. The music that plays after killing Mom's Heart in the Mausoleum, " Spinning Intensifies ".