This is probably one of Konami's most scary game out of the series. As well as their finest
Monsters: each monster has something about that will horrify you deeply one way or another. Like the dogs who have split heads or the little things that crawl around on the ground and try to eat you. Some of the nurses in this game will have guns so when you get to that part kill them as fast as you can or they might shoot you.
Settings: The settings are disgusting and yet at the same time very pretty. As most gamers of this know the way the settings work. It'll start out bright and normal looking with a few weird things to it. Then suddenly it'll become dark and the walls will become either covered in blood, fire, and rust. There will be objects that won't belong there or things there that will make you question what it is in the first place. The settings are one of my personal favorites in this game.
Sounds and Effects: there will be points in the game when your stuck in the dark and you hear something in there with you or your radio goes off. This creates much tension to the player of not wanting to know whats in there with you. The lighting in this game is just as wonderful and perfect as it has been in the other games. In fact Silent Hill is most known for its masterful lighting effects and disturbing content.
Story: The story picks you up about 17 years after the first game (correct me if i'm wrong about that). Where you are Heather a teenage girl who suddenly finds herself in a world of hellish nightmares. With many mysteries added throughout the game, this will be one of things that will keep you playing as you'll want to find out what Heather has to do with all of this. The story is another one of Silent Hill's strong points as this series doesn't focus on action, but disturbing you and giving you a storyline you may not understand at first.