After successfully completing a run, you'll be able to choose a different Background for your character. These will affect the gameplay of your run, generally by providing a benefit at the cost of an extra challenge or limitation. Most of these are unlocked by completing a successful run with the previous Background, though a few can be unlocked through other means.
World of Horror[edit]
"At the beginning, no one had any idea what we were up against."
Unlocked by: Available from the start.
The default Background. Has no advantages or disadvantages.
Medical History[edit]
"Brittle bones run in your family and you've spent each summer in a cast."
Unlocked by: Complete a run with the World of Horror Background.
You start the game with the Discharge Summary treatment and a Medical Kit item, but each instance of damage taken can cause a random injury.
Hunted by the Cult[edit]
"You've managed to run from them once, but the cult is tireless..."
Unlocked by: Complete a run with the Medical History Background.
Doom is reduced by an additional 1% upon finishing a mystery, but you now have a chance of running into the Cultist Hunter A and Cultist Hunter B enemies, and the "Hunted" General event may also occur.
The Seventh Curse[edit]
"Your family was cursed. Everyone around you will die..."
Unlocked by: Complete a run with the Hunted by the Cult Background.
You start with +4 additional Funds, but you cannot recruit any human allies. The Hermit and dog allies are exempt from this, as well as Kana, who is required to finish Eerie Episode of Evolving Eels.
Ill-Fated[edit]
"You were born under a bad moon..."
Unlocked by: Complete a run with the The Seventh Curse Background.
You start with 133 experience, but all event skill checks will automatically fail.
Knight-Errant[edit]
"Only I can save our town..."
Unlocked by: Discard 3 Books in one run.
You start with the Inspiring Novel item, but finishing a mystery with a sub-A ending will incur a 6% Doom penalty.
Scars[edit]
"I've made it through hell and back, you won't break me now."
Unlocked by: Complete a run with the Knight-Errant Background.
You take -1 less damage in combat, but your maximum Stamina and Reason are reduced by -3.
Curious Birthmark[edit]
"Doctor, if it looks 'fine', please explain to me, why is it changing its shape?"
Unlocked by: Complete a run with the Scars Background.
You start with the Old Coin item, but each instance of damage taken can cause a random curse.
Eldritch Parasite[edit]
"Something is... growing inside me"
Unlocked by: Complete a run with the Curious Birthmark Background.
You start with +20 additional maximum Stamina and Reason, but cannot recover Stamina or Reason by any means.
Exquisite Taste[edit]
"Only a few places are good enough for me."
Unlocked by: Complete a run with the Eldritch Parasite Background.
Only one additional action is available per location for this run.
Fatalist[edit]
"It's... pointless, I can't change my fate..."
Unlocked by: Complete a run with the Exquisite Taste Background.
Mysteries must be completed in the order presented for this run.
Commoner[edit]
"I was supposed to die."
Unlocked by: As Yashiro Kawaji, complete a run on True Believer difficulty with Cthac-Atorasu as your chosen Old God.
Experience cannot be gained for this run.