This game, is absolutely, totally, unforgivingly brutal.
From the word go you're thrown into the mayhem that is a Necromorph outbreak, the scenes are gory, if Isaac isn't causing some (Massively) gruesome damage to necromorphs, they're causing some (even more massively) gruesome damage to him.
Superb graphics, combined with a terrifying story line and soundtrack that will always have you looking behind you (to find you have a necromorph about to rip your head off) and quaking in your seat.
The new necromorphs you'll see in this game are VERY smart, they'll hide, charge at you at stupid speeds, or explode to simply sever your limbs straight off.
Even when you accidentally cause a blast door to open up a vacuum (and consequently cause you to lose your arms if you don't react fast enough) will cause a scare.
I would advise people planning to buy this to make sure they play the first one before picking up this, as the fmv showing what previously happened isn't great.
Also, play this with others watching, it's very easy to miss necro's coming at you.
Totally sold with this game.