Appearance Anomalies – Complete Guide

Appearance Anomalies – Complete Guide

Appearance anomalies are physical deformations visible on the patient when you look at them directly in person. They do not show up on the polaroid photo or CCTV feed — you must physically inspect the patient at their bed or in the treatment area to spot them.

Once you confirm an appearance anomaly, the correct response is to close the shutter immediately to trap the anomaly and keep it contained.

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Quick Reference Table

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Detailed Breakdown

1. Twitching

The patient's limbs jerk and spasm in an unnatural, glitchy way. The movement can be subtle at first glance — you may need to observe for 4–5 seconds before the twitching becomes obvious.

• Difficulty: Medium
• Detection tip: Stand still and watch the patient's arms and legs. Normal patients are still; an anomalous one will have visible, rhythmic jerking motions.
• Common mistake: Glancing too quickly and missing it. Take your time during the appearance check phase.

2. Three Eyes

A third, bright red eye appears on the patient's forehead or between their existing eyes. This is one of the easiest anomalies to spot because the red eye stands out dramatically against the patient's normal coloring.

• Difficulty: Easy
• Detection tip: A quick glance at the face is usually sufficient.
• Common mistake: None — this anomaly is very hard to miss.

3. Hollow Face

The patient has empty, pitch-black holes where their eyes should be. There are no eyeballs, no light reflection — just dark voids in the face.

• Difficulty: Easy
• Detection tip: The complete absence of eyes is immediately noticeable. The hollow sockets contrast sharply with a normal face.

4. Wide Eyes & Creepy Smile

The patient's eyes are stretched unnaturally wide and their mouth is locked into an exaggerated, unsettling grin. The facial proportions are distorted in a way that no normal patient would display.

• Difficulty: Easy
• Detection tip: The oversized eyes and fixed smile are immediately off-putting and easy to identify.

5. Human Teeth

The patient has normal-looking human teeth inside a mouth that clearly belongs to an animal. The teeth are flat, white, and uniform — completely wrong for the species you are treating.

• Difficulty: Easy
• Detection tip: Look at the patient's mouth. Human-style incisors and molars on an animal patient are a dead giveaway.

6. Mismatched Eyes & Sharp Teeth

The patient has asymmetric eyes — they may differ in color, size, or shape — combined with visibly sharp, pointed teeth resembling fangs.

• Difficulty: Medium
• Detection tip: This anomaly requires a closer look. Check both eyes individually and compare them. The sharp teeth confirm the anomaly once you spot the eye asymmetry.

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Detection Strategy

Step-by-Step Screening

1. Approach the patient and look directly at their face.
2. Scan the face first — check for Three Eyes, Hollow Face, Wide Eyes, or Creepy Smile (all Easy).
3. Check the mouth — look for Human Teeth or Sharp Teeth.
4. Observe the body for 4–5 seconds — watch for Twitching.
5. Compare both eyes — look for Mismatched Eyes.
6. If anything looks wrong, close the shutter immediately.

Pro Tips

• Take your time on Medium anomalies. Twitching and Mismatched Eyes can be missed if you rush.
• Use the flashlight if the room is dark — better lighting makes facial details easier to read.
• Don't rely on the polaroid or CCTV for these anomalies. Appearance anomalies are only visible in person.

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What Happens If You Miss One

Leaving an appearance anomaly unchecked can lead to the anomaly spreading, increased Sanity drain, and potentially more dangerous events spawning in the hospital. Always prioritize a thorough in-person check.

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Sources: Community wiki research, in-game testing, IGN/TechWiser anomaly breakdowns.