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Backstabber is a passive item added in Afterbirth †.
- When tears land on the "back" of enemies, they deal double damage and inflict bleeding.
- Bleeding enemies take damage equal to 10% of their maximum health every 5 seconds.
- BrimstoneTears are replaced by a laser beam that pierces through all enemies and obstacles in its path and deals high damage. Can only be fired after a short charge-up period.: Can still inflict bleeding, as long as Isaac is "behind" the enemy.
- Daddy LonglegsDaddy Long Legs' shadow follows Isaac and stomps on enemies.: Daddy Longlegs can occasionally gain the added damage and bleeding of Backstabber.
- Shooting Familiars: Tears fired by familiars can inflict the effects of Backstabber.
- Punching BagSpawns a Mulligan Familiar that will wander the room randomly. Enemies will attack the Mulligan if it's closer.: Enemies that follow the Punching Bag will be much easier to hit in the back.
- Rubber CementTears bounce off walls, enemies, and environmental objects.: Increases chance to backstab an enemy while standing in front or to the side by the shot bouncing to hit the enemy's back.
- This item might be a reference to Judas's betrayal of Jesus.
- The item may also be a reference to the backstabbing mechanic in other video games, where backstabbing results in increased damage to enemies.