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So I've started this game, and like every other FPS ever, I auto jumped to the hardest difficulty--Trauma--for the challenge. At the first boss now, and while he's hard, not impossible. But after doing some digging I am seeing that there are some levels not available on Trauma and some are, and I'm pretty damn confused.

I want to play the whole game, really, with as much challenge as I can get (realistically). So which difficulty should I play on? I'm assuming Trauma isn't it, so that does that mean a restart for me?

Thanks a lot for the help. This is an FPS about killing everything, I didn't expect it to become so convoluted!
This question / problem has been solved by bevinatorimage
Trauma is more like the extra-secret bonus difficulty for people who have already beaten the game. The hardest "normal" difficulty is Nightmare, and that's where I'd suggest you start. Trauma is fairly different in that you can't quicksave and there are no souls to pick up. The lack of souls removes one of the really neat aspects of the game, unfortunately. The only real advantage to Trauma is that you can play one extra level that's normally locked, and you get to see the "true" ending. (You miss out on all of the Hell levels, though.) Other than that it's kind of a chore.
Thanks for the clarification. I've heard so many good things about the Hell levels, so I definitely need to play them.
Thanks for this post. I like playing all games on max difficulty and i had no idea what was going on when it wouldn't let me play chapter 5. I kinda wish I could play chapter 5 at max difficulty though. I like how it forced you to play through without saving.
Thanks for this thread. I just bought Painkiller BE for almost nothing, was too easy in Insomnia so i started in Trauma but apparently it's better to first do a "normal" mode, like Nightmare. I guess it's what i'll do.

And thanks to an another thread, i know now all the difficulty levels are unlocked at the beginning due to this BE (Black Edition). I was wondering why i had all this modes available since in the manual there's some things to do explained to get those modes.
Post edited May 24, 2013 by Harest