So a friend of mine asked "What would you do to make Outlast harder to play?" And to be honest, I really didn't have to think too much on this. I said:
"Have a female protagonist."
Now he thought I meant "Women are weak, slow and stupid and wouldn't survive in a horror setting like this".
What I meant was "Being a woman and entering an insane asylum with a shit ton of mutated, sexually frustrated, unsound men would be suicide." Half of the inmates who are docile towards you ignore you for reasons. If you were a woman, they might not ignore you. You have men with urges, some masturbate vigorously, some have sex with corpses, some with each other.
On the bright side of things, it would possibly make Eddie's section very very easy. No genital mutilation or anything.