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Once you start to unlock certain stuff, builds get more and more powerfull/unfair too as difficulty ramps up.
You slowly unlock everything with each Mirror Level you beat, Beating DM 0 should get you the skull selection box and the item one comes soon after.
As for what Random said, there is a mod that some content creators use that improves the passives to also include more powerful items, skulls and quintessences. Without it you can only choose 2 Basic or Rare Skulls and 2 Basic Items.
I still wish there was a way to get 2 random skulls at the beginning as well on hard mode since I find it super hard to not just pick Water / Bomber all the time since it's my favorite combo.