Hard mode changes the gameplay compared to Normal in some ways to make it more difficult.
When playing in hard mode, a small red pentagram () appears on the HUD, below the consumables.
- Rooms contain more advanced enemies and in a higher number.
- Causes champions to spawn more often; however, they award fewer pickups.
- You are 65% less likely to receive hearts after completing a room.
- Only champion bosses can drop red hearts; normal bosses will not.
- You are more likely to be cursed on each floor.
- You are more likely to receive a harder version of a floor (e.g. Necropolis or Dank Depths instead of The Depths).
- Prior to update 1.03, the reduced drop-rate affected all Pickups (not just Red Hearts).
- GodheadIncreases damage and range while reducing tears and shot speed. Grants homing tears and tears gain a damaging halo.'s unlock requirements were extended in the Afterbirth DLC (and further extended in the Afterbirth+ DLC) due to the addition of more completion marks, but it can still be unlocked in the base game using the same method.