There are many sharp objects in the game. In a side mission a character previously apart of the main storyline is found in bloody bathtub after slitting her wrists. Suicide and self harm are mentioned in the game a couple of times as well.
there is an option in a flashback sequence for Silverhand to become physical with one of his girlfriends. the option involves him grabbing a fistful of the woman's hair and forcing eye contact.
There is a lot of drug usuage and mentioned in the game. Although, V is also given the opportunity to refuse all substances offered throughout the game.
One mission shows, through a braindance, how cows are inhumanely kept, with a fully enclosed head covering and chemicals pumped in. It’s pretty messed up.
No actual snakes, but there is a decent amount of imagery of them in tattoos, graffiti, etc. There are a couple of lizards - if this is an issue for you, steer clear of the nomad lifepath, although the scene is over fast.
There is a side mission where V and a cop named River are hunting after a serial killer. The killer lures and targets young boys specifically. There is no SA involved, but V does find some of the victims hooked up to machines that pump them full of horomones like cattle. Definitely tread lightly if grooming is a trigger for you as some of the killer's tactics involve grooming to lure the boys.
One of the main story characters is a "doll" who ends up being tortured and sexually abused by the owner of the place she works at. It is not shown, but it is referenced.
There is a BD of someone being eletrocuted to death and they are forcibly strapped to a table. Silverhand also gets restrained after Saburo Arasaka takes him in for interogation.
numerous characters have extreme cybernetic body modifications that results their bodies and heads looking distorted and "wrong". these characters are very prominently featured in the game and it's main storyline.
A major character has their head crushed in one ending, and something similar happens to another major character in another. These are both characters who you are likely to care about. The former scene is reasonably shocking. You can also blow off the heads of enemy NPC's with headshots from some weapons.
there is a scene in a side mission called "they won't go when i go" where someone is very graphically hung from a crucifix and you have to watch the die to complete the mission. there is an option to skip this part of the mission.
not displayed beyond verbal descriptions or gesturing, but in a side mission called "burning desire" character's penis implant malfunctions resulting to his genitals being burned. you have to transport him to a doctor, while listening him scream in pain.
There are many overdose mentions and drug usage is mentioned/shown frequently throughout the game. V does have the option to decline everytime they are offered drugs or alcohol though.
yeah like all the fucking time like deadass youll see random npcs puking everywhere and this is excluding missions then you have to account for your own character just puking whenever the fuck (in first person might i add). on top of that you got hacks or whatever that make your enemies puke too. on the corpo path the very first thing your character even does is puke. if you dont like seeing people vomit dont play this game lol
Cops are overall portrayed in a negative light, but there are a few who the player is supposed to sympathise with, including a major (but avoidable) character. Although he is a "good" cop, he is unhappy with the way the police force is functioning and (depending on your choices) later leaves the force.
There is a gig which has you rescuing a patient from a mental institution. The institution is abusive towards its patients. This is an optional short mission which is not tied to any main quests. Its name is "Cuckoo's Nest".
While it is not a mental institution, but there is a scene in one ending where a character is repeatedly tested to assess brain damage. This scene is deliberately uncomfortable and repetitive and the character can no longer trust their own brain, even though they personally haven't noticed many symptoms.
One ending involves a long, stressful stay in a hospital room where the player character is treated inhumanly. You can also visit "ripperdoc" clinics to be operated on, but they don't look like traditional hospital settings.
While V and Johnny are not apart of a system, a character describes V as having "two personalities" which may be triggering. Soon after this character also attempts to demonize Johnny for attempting an equivalent of fronting.
In the DLC Phantom Liberty there is a quest where a man claims to not be at fault for the gruesome murders he committed because they were done in a dissociative episode. This is very quickly revealed to all be an act.
He is not stated to have DID, only that he has unspecified "blackouts."
a bit debatable if it would count as abuse, but in a mission called "the hunt", there are text records in the NCPD laboratory facility that discusses dubious sounding treatments being done to autistic children.
In the side quest, Dream On, it is revealed toward the end that the mayoral candidate and his wife have been watched for some time in their own home (including their bedroom) by their own security contract.
There's a small easter egg which has Johnny acknowledge a package that says "For Mr. Wick", nodding to his actor's previous roles. There is also a building called Fourth Wall Studios.
in mission called "the hunt" the second largest room in the NCPD laboratory facility has an orange transparent liquid filled capsule that holds a live unborn fetus inside it.
there is a loud and very prominent side character standing near Misty's shop who often goes on conspiracy theory rants that clearly draw inspiration from antisemitic conspiracy theories
Gender is really well handled and customizable in this game (aside from pronouns which come with the body you choose) in my experience. You can easily make your character GNC or trans and no one treats it as odd or funny or anything like that. There is at least one canonical trans woman and she's just a regular woman with trans flags on some of her stuff.
I disagree with the previous poster. This game allows players to explicitly choose both the sex and gender of their character, making both cis and trans characters a possibility. The in-universe setting is a capitalist dystopia where all manner of vice is publicly embraced, and sex of all varieties is grotesquely commodified. As a whole the environment is supposed to be uncomfortable and exploitative, but I would not say that game itself is as the genre is meant to highlight injustice and inequality. That the game provides for cis, trans, straight, homosexual, and lesbian protagonists to exist in a normalized way is pretty remarkable, and it goes one step further and provides romanceable NPCs for each option. I legitimately do not understand how this can be viewed negatively.
Rich characters in this setting are able to afford treatments which allow them to remain young, creating a few cases of large age gaps. One of these characters is romanceable for the player character, who is 27. He is at least 75, but it doesn't show in his appearance or behaviour. By making certain choices, the player character can also end up kissing and almost having sex with a woman of a similar age, but the situation is complex and there is no actual relationship between her and the player character. A more minor character also has a relationship with a man in his 90s under similar circumstances.
there are various buddhist monks, and some talk about their beliefs. the quest "Sinnerman" involves the recration of the crucifixtion of Christ, where V can nail Joshua to the cross. the quest "Sinnerman" is heavy on the religious side and V engages in discussion about faith with Joshua, a family, Rachel and Johnny Silverhand.
You will be involved in a car crash early on. There are no fatalities and the characters involved were already wounded beforehand, so it's hard to tell what damage it does. Also, driving is so hard in this game that you're probably going to crash at times anyway, lol.
You cause a plane crash in one part of the main questline, although it's a futuristic flying vehicle, not a plane. Steps are taken to ensure the crash doesn't kill anyone, and it seems that there are no fatalities in the crash itself, but a lot of death follows.
you can find various drowned people, in the game, Meredith Stout for example can be found in such a way as a result of a specific path for the quest "the pickup"
also in "pyramid song" V has a seizure underwater, but is saved by Judy