The actions you do, the way you speak to the different people you meet. These interactions will have a much more fluid transition into the story upon up intriguing possibilities.
Monsters are now fully motion-captured (ala the Silent Hill movie) and all new beasts are set to make their debut. One such creature, Siam, is a fusion of a male and female body. What’s left is a pulsating, overtly sexual enemy. Monsters will now have visible effects on them. So if an enemy has busting pustules or bleeding mouths, it will be animated, in real time and will be effected by Alex's attacks.
Some of the enemies are humanoid in nature, favorites such as the nurses, will indeed return, however the variety of creatures is said to be quite large.
(Side Note: In the Silent Hill games, the "enemies" are usually physical manifestations of the protagonists mind.
It can even be argued that the "monsters" they see aren’t even real or that perhaps what a character see's as a monstrosity might in fact be human after all)
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