| Achievement | How to unlock
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|---|
| Alchemilla's Finest ( 10 points ) | Defeated one Nurse.
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| Clear the Air ( 10 points ) | Defeated one Smog.
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| Creeper Reaper ( 10 points ) | Defeated one Swarm.
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| Eddie's Legacy ( 10 points ) | Defeated one Feral.
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| Health Junkie ( 50 points ) | Found all serums.
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| Josh's Gallery ( 50 points ) | Found all photos.
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| Kaufmann's Handiwork ( 10 points ) | Found one serum.
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| Lock 'n' Load ( 25 points ) | Found rifle.
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| Lurk No More ( 10 points ) | Defeated one Lurker.
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| Nursery Rhymes ( 50 points ) | Found all the children's drawings.
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| Out of Order ( 10 points ) | Defeated one Order member.
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| Shades of James ( 20 points ) | Defeated one Siam.
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| Sightseeing ( 10 points ) | Found one photo.
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| Split Personality ( 10 points ) | Defeated one Schism.
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| The Old Gods... Haven't left this place ( 100 points ) | Complete game on hard difficulty.
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| To The Point ( 10 points ) | Defeated one Needler.
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| Achievement | How to unlock
|
|---|
| Angela's Choice ( 50 points ) | Alex does not forgive his father.
|
| Blood Donor ( 20 points ) | Defeated Scarlet.
|
| Catch Your Breath ( 20 points ) | Defeated Asphyxia.
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| Compassion ( 50 points ) | Alex could not end his mother's suffering.
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| Forgiveness ( 50 points ) | Alex forgives his father.
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| Head Above Water ( 20 points ) | Defeated Amnion.
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| In Water ( 50 points ) | Achieved Ending 2.
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| Intensive Care ( 50 points ) | Achieved Ending 4.
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| Judgement ( 50 points ) | Achieved Ending 3.
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| Mercy ( 50 points ) | Alex ended his mother's suffering.
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| No Dogs Allowed ( 50 points ) | Achieved Ending 5.
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| Now About Those Drinks ( 25 points ) | Saved Wheeler.
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| Rising Tension ( 25 points ) | Found Circular Saw.
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| Science Fiction ( 25 points ) | Found Laser Pistol.
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| Six Feet Under ( 20 points ) | Defeated Sepulcher.
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| Smile ( 50 points ) | Achieved Ending 1.
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