If the player uses a shotgun, enemies may be heavily damaged to the point of losing parts of their limbs. Additionally, several members of The Left Behind have prosthetic limbs due to injuries they gained during combat.
Most of the criminals are minorities, and the game uses common stereotypes like Muslim "terrorists," sex traffickers, etc. A nightclub mission was added on June 12, which is the anniversary of Pulse (probably a homophobic dog whistle).
Some parts of several missions can be quite claustrophobic, which can directly inhibit the player's movement and weapon use. The mission Rust Belt involves clearing a series of tunnels used by a cartel.
In commander mode, members of your team can quit as the pressure mounts to a point of instability. Further, several suspects are undergoing extreme mental breaks, particularly in A Lethal Obsession.
While the game is largely grounded in reality, there are some slight supernatural undertones in a few levels. Most notably, in Rust Belt, glowing eyes can be seen in the distance in the underground lake.
Ends of the Earth takes place in a residence by the coast, and you can choose to enter from the beach. Rust Belt features a large, underground lake at the end of the level. Hide and Seek takes place at a port. Two Coast Guard-focused DLC levels, Mirage at Sea and Leviathan, take place on a yacht and an oil rig respectively.
A major part of commander mode is attempting to mitigate the stress faced by your team. If it becomes too intense, members may have to leave. Additionally, the Left Behind is a terrorist organization made up of veterans, several of whom have stated PTSD.
Some of the robbers and civilians in the first level are black, as is one of your teammates by default. While not forced, it's possible one of them will be the first to go.
One of the missions is raiding a 'talent agency' for a human trafficking/child pornography ring. Parents you encounter there are selling their children for cash.
You raid recruitment center for a human trafficking ring where parents sell children for cash. You also encounter a child overdosing on drugs, for a start.
Some of the criminal organizations and more sympathetic suspects are implied or stated to be participating in crime as a desperate measure, due to factors outside of their control.
While there's no physical spiders, a large, realistic depiction of one is used as the symbol of a mysterious criminal group seen in Twisted Nerve and Hide and Seek.
One or two levels has mannequins to turn up the creep factor. DLC mission 3 Letter Triad has several human-like statues dotting the map, and when you're not expecting them you'll almost instinctively tend to shoot them.
The player and other protagonists are police officers in a game centered on police actions. The game rewards the player for adhering to procedure and arresting suspects without killing them.
Some suspects may be held in a jail cell at the police station following the completion of certain missions. Visiting them is entirely optional, and there aren't any interactions with them.
Neon Tomb takes place at a night club during a DJ's live performance. The room where it was being held contains bright flashing lights; you need to get on the stage in order to turn the flashing lights and music off.
Alt-right dog-whistles, most prominently a pillbox in the game with the words "Redpill" and "NOGGINJOGGERS" labeled (later removed). At the Dorms level, players forcibly evict homeless people taking shelter from a hurricane.