Basically take the original game and move some things around.

User Rating: 8 | The Suffering: Ties That Bind PS2
Well this game has a special place in my heart because it takes place in Baltimore (which looks just a crappy as it does in the game). I enjoyed the fact that this game literally seems to just pick up where the other one left off and that they added a bit more to the mystic of what the creatures really are and where they truly came form. As before the graphics, Sound and gameplay were all great and the horror element is still there. Some great improvements were the fact you could not choose between being good or evil and when you transformed it showed your alignment. This game felt just as difficult as the original and also seemed to have some spots that I really just had to walk away from. Some of the things in this game that I didn't like were some areas were to dark and I had the brightness turned all the way up. Some enemies were very glitchy and wouldn't attack you at all even if you were all up in their faces. Aside from that if you loved the first one your going to love this one. 8/10

Little side note the ending in my opinion sucked but hey what can you do.