Reportedly, this installment was originally envisioned as a spinoff of the main game series. The gameplay is very different from the previous three installments. The player is based in Henry's apartment, from which Henry can manage his now limited item inventory and which contains the only save point in the game. Henry also does not have a portable radio, but has one in his apartment which serves a similar purpose. A first person perspective is also used in the apartment, a first for Silent Hill. However the familiar third person view, is used when in "the dream world" (silent hill) after crawling through the hole in your bathroom.
In previous games, the main character would happen upon a flashlight that they would use to guide themselves through dark areas. This installment doesn't feature any particularly pitch black areas as the others did, so the flashlight is not required in this game.
Combat has also been significantly altered. While the player is now able to "charge" an attack, allowing its power to build before the attack is launched, there are no "safe" areas (monsters are able to follow Henry from area to area) and the ghosts in the game are unkillable and will constantly bedevil Henry in the subway section and elsewhere. Even Henry's apartment, seemingly set in the "real" world, becomes increasingly haunted and dangerous throughout the game.