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Angst? What Angst?: Elle... Just... Elle... Sure, she's whiny enough over her mother's uncaring attitude and worried about the townspeople... But her little sister is brutally killed and her mother, who tried to kill her, is also dead, murdered by her maybe-boyfriend. You can actually bring her into the room with her mother's corpse and she will have no reaction, though that's probably a glitch. Perhaps she's still completely in the dark about her family's fate at the end of the game. This gives the ending where she and Alex walk off together an interesting spin. An awkward conversation is about to come up.
The Needlers can be this, especially when first encountered.
The Siams can be really annoying to fight, but thankfully there aren't many of them.
Schisms are easy to fight once you learn to bait them into lunging, but the strategy requires room and patience, both of which drop considerably when they attack in teams.
Fan Disservice: Pretty much a staple of the series. The Nurses obviously qualify, but then there's the female half of the Siams...
Asphyxia. Full stop.
Goddamned Bats: The swarms which exist to attach themselves to Alex and slowly suck his health away.
Narm: The drama mostly succeeds, but "You gotta be shittin' me!" is not something you should say in a game that's trying to create a creepy atmosphere.
Alex Shepherd is in a mostly abandoned town that is riddled with impassible chasms and infested with killer monsters. If he inspects many of the vehicles in the town, he may wonder, "Why hasn't this been towed? It's clearly broken down." Seriously Alex, is that what's on your mind at that moment?
Player Punch: Alex, and therefore the player, is forced to make a decision between performing a Mercy Kill on his mother or allowing her to be ripped apart by the Order's torture device.
Recycled Script: One of the more common complaints is how Josh's death is similar to Mary's death in Silent Hill 2, at least in relation to the protagonist. Of course, unlike James, Alex never intended to kill his brother.
They Changed It, Now It Sucks: The fan reaction to the new combat scheme and "Alex the Military Dude" subplot, though it functionally changes little of the gameplay other than making him more agile than previous Silent Hill characters; even Heather had a "block" move in Silent Hill 3 nobody complained about.
They Wasted a Perfectly Good Plot: The revelation that Alex was never in the military. Having a soldier at the business end of the town's latest venture into the macabre provides all sorts of opportunity for playing with various war-related tropes and character templates. Obviously, none of that is actually possible in the long run.