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Difficulty[edit]

Under the gameplay settings, there are two difficulty settings of note. The first is labeled difficulty, and the second is hardcore mode. Both options can be changed at any time, although one of the achievements can only be obtained if hardcore mode is enabled starting at Doc Mitchell's house until the end of the game.

The difficulty setting affects the enemy's combat values:

Difficulty Damage to Courier Damage by courier
Very Easy × 0.5 × 2.0
Easy × 0.75 × 1.5
Normal × 1 × 1
Hard × 1.5 × 0.75
Very Hard × 2 × 0.5

The second option, Hardcore mode, affects gameplay by adding survival elements:

  • Stimpacks and radaway no longer operate instantly, but provide their benefit over time.
  • Crippled limbs are no longer healed by resting in any bed. They are recovered by using an "owned" bed, being treated by a doctor or Auto-Doc, or using an item that restors limb condition.
  • Doctor's Bags no longer fully restores all limb conditions at once.
  • Ammunition will count towards weight.
  • Companions are killed when they reach 0 hp rather than falling unconscious.
  • The courier needs to eat, drink and sleep, gaining penalties if the needs are not fufilled. In general, every 33.3 real-time minutes of not drinking water, 83.3 real-time minutes of not eating food, and 2.7 real-time hours of not sleeping will advance the penalty. These are tracked by meters.

Character creation[edit]

Give points for your stats.

After the introduction scene shows the courier shot, he wakes up in the doctor's house. After some speech, you will get a screen showing your character's appearance. Of the choices here, the Sex will have minor impact on gameplay as some characters may react differently to some optional feats described later. There are also presets, and an option to randomize the cosmetic appearance.

Doc Mitchell will then walk you to the Vit-o-Matic tester. Here you will assign base S.P.E.C.I.A.L. points - you have give points to assign, and can obtain extra points if you reduce some of the stats by 1. These attributes affect various game mechanics, as described in S.P.E.C.I.A.L. page. When assigning points, keep in mind that you can increase the attributes later with the Intense Training perk. Additionally,

After the test results, he will bring you to a couch to start a questionnaire. You can safely answer questions according to your preferences - when it's complete, the game presents you with three tagged skills, which you can change. The tagged skills receive a minor starting bonus, and also affects your starting equipment.

The last part is presenting you with a choice of traits. These traits have both a positive and negative effect, influencing how you may play your character. Of the choices, Wild Wasteland causes in-game events in the style of the older Fallout games to appear.

When Doc brings you to the door, characters receive their starting equipment: 4 stimpacks, 18 caps, 6 bobby pins, one weapon, and DLC items. Characters with Lockpick get 6 more bobby pins. By default, a 9mm pistol with 1-30 rounds are given, and one of the skills may either change this or give an alternate weapon. Guns skill gives extra starting ammo, explosives will give 8 sticks of dynamite, Energy Weapons gives a laser pistol and 20 energy cells, Melee weapons adds a straight razor, and unarmed adds boxing gloves.

The last prompt is hardcore difficulty. If enabled, it adds survival elements to the game, making it more challenging, although it's recommended to keep it off for the first playthrough.

Once you exit, you can find Sunny Smiles to start the quest Back in the Saddle for a quick tutorial.

Finally, you will have a chance to change your character after leaving the Goodsprings area, changing your appearance, assigned attributed and tagged skills.

Spoiler

There are multiple ways to gain S.P.E.C.I.A.L. Aside from the intensive training perk, you can also purchase expensive implants in the New Vegas Medical Clinic, or completing the Lonesome Road DLC for an additional attribute point. Some selected traits can also manipulate the SPECIAL scores too, as do some items found later.

The base value of Endurance also affects the number of implants the courier can obtain at the New Vegas medical clinic.