There are tarantula-like creatures that skitter around at points and act as collectibles for the player to collect. There is also a massive spider-like creature that pursues the player during the second and third chapters.
There are slimy humanoid creatures that are depicted with their pale buttocks showing and no visible genitals. It is presented in a very loose and surreal way.
It depends on your interpretation due to the surreal tone of the game. There are certainly scenes of children being killed but the finale casts ambiguity as to whether or not they are actually “dead”.
The final act is a prolonged war sequence reminiscent of battles from World War 1. During which, the gore and graphic violence become much more prominent. 90% of the game’s most graphic content takes place in the final 20% of the game.
The two main characters use a crowbar to pry out a large creatures eyeball and then sever the optic nerve. It is shown in graphic detail and is on screen for a prolonged period of time.
One commonly fought antagonist are children made of sand who crumble to dust upon being struck by the main character(s). The finale of the game also concludes the violent capture and imprisonment of a child.
Animal abuse is a central theme of the game. Dead animals such as pigs, seagulls, sheep and rabbits are featured prominently throughout the entire game.
Rabbits are prominently featured across the game and are used to reinforce one of the game’s central themes of animal cruelty. In one sequence, the main character(s) enter a theater that is showing a film depicting a rabbit being beheaded. The footage plays on loop and is seen at multiple points throughout the chapter.
This happens several times to one of the two main characters. In one particularly graphic and surreal sequence, a main character regurgitates an entire sheep that is the same size as them.