Violence Silent Hill is extremely violent, with visceral gore and bloodshed. It is one of the most obvious examples of body horror in video games; most of the monsters are horrifically deformed versions of humans.
Scary Imagery Silent Hill is pretty terrifying—its creators have defined it as psychological horror with a focus on the fear of the unknown. The atmosphere is incredibly disturbing, there are multiple jump scares, and its creatures are typically horrifically deformed versions of humanity. It is insinuated that many of the protagonists are suffering from mental illness, delusions, or hallucinations.
Sex & Nudity Some female characters and female-presenting monsters (the "Nurses") have fairly low-cut tops—they are manifestations of a protagonist’s sexual frustration. Aside from the nurses, most enemies do not appear to wear clothing, but are removed enough from humanity that the nudity does not seem explicit. Think Ken doll without shorts.
Sexuality and sexual frustration is a theme in many of the games, for various reasons and with various outcomes. Sexual abuse is also heavily insinuated in several of the games, though it tends to have occurred in the past. Several monsters also present sexual themes, including the Abstract Daddy (a deformed bed), the Nurses, and the Two-Back. Silent Hill’s sexual content, though it is not generally explicit, is an extremely disturbing and negative representation of sexuality.
Strong Language Strong language is used throughout the games.
Substance Use Characters drink alcohol on several occasions.