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Modifiers can be applied in the process of starting a new save file. Modifiers are unlocked by playing the game and accomplishing the requirements of the modifier in question. Multiple modifiers can be active simultaneously.

Modifier Requirement Effect
Hellspawn
Hellspawn

(YOLO!)

Beat the game on any difficulty Every checkpoint is replaced with a heart and Vi starts with 400% health
Doomed
Doomed Unlocked from the start Vi dies in one hit
Purified
Purified Unlock all weapons All weapons are unlocked from the beginning of the run
Turbo
Turbo

(Gotta go fast!)

Beat the game on Mortal difficulty or higher The game runs at 125% speed
Boss Rush Beat the game All bosses are playable through a list much like the one of Darkheim Watch. The bosses are separate and the order of the bosses fought can be chosen freely
Mirror icon
Mirrored Unlocked from the start The game is mirrored while the controls stay the way they were. Text in dialogue boxes is also mirrored, so it is not very wise to pick this if you want to read the story dialogue. To clarify, the game flips horizontally, as in left gets switched with right and does not get turned upside down.

Modifiers get a separate note as an icon on the leaderboards.