What does difficulty do?

[Cruellinnet]

I'm trying to figure out what the changes between difficulty settings are. Does increasing it give the enemies more health? Are they more resistant to things? Do the cult followers get hungry or sick easier at higher difficulties?

Or is it all combat?

[Argonisgema]

from my overall experience higher difficulty have the enemies have more health but not by much.
From what other in the forums mentioned, drops may also be effected like you may just overall get less but again from my experience its not much of an issue.

As for followers i don't think they are effected with getting sick or hungry more easily , i'm two playthroughs in a on the highest difficulty they seem to get hungry and get sick at the same rate as my last playthrough on normal so overall the higher difficulties aren't hard by much if at all.

[Toni 'Bō' Jones]

To add to that - on Extreme Hard difficulty you start with only one heart (2 hits and you'rte done), which at the beginning might be a lil overwhelming.

[Cruellinnet]

alright, thank you!

[CyberShadow]

Setting	Easy	Medium	Hard	ExtraHard
PrimaryDifficulty	Easy	Medium	Hard	ExtraHard
SecondaryDifficulty	Easy / Medium / Hard	Easy / Medium / Hard	Easy / Medium / Hard	Easy / Medium / Hard
HealthDropsMultiplier	2 / 1.5 / 1.25	1.2 / 1 / 0.9	1	1
ChanceOfNegatingDeath	0.4 / 0.4 / 0.2	0.2 / 0 / 0	0	0
PlayerDamageMultiplier	1.5 / 1.25 / 1.25	1	1	1
InvincibleTimeMultiplier	2.5 / 2 / 1.5	1.25 / 1 / 1	0.85 / 0.75 / 0.65	0.65 / 0.5 / 0.4
EnemyHealthMultiplier	0.5	1	1.25	1.5
EnemyRoundsScoreOffset	-3 / -2 / -1	-1 / 0 / 0	0 / 0 / 1	0 / 2 / 3
LuckMultiplier	4 / 3 / 2	2 / 1.5 / 1.3	1.2 / 1 / 0.8	0.8 / 0.75 / 0.6
DungeonRoomMultiplier	0.75 / 1 / 1	1	1 / 1.1 / 1.2	1.2 / 1.3 / 1.3
DeathPeneltyPercentage	15	25	30	50
EscapedPeneltyPercentage	10	15	20	25
DripMultiplier	0.6 / 0.7 / 0.8	0.9 / 1 / 1.1	1 / 1.1 / 1.2	1.4 / 1.5 / 1.6
HungerDepletionMultiplier	0.5 / 0.6 / 0.7	0.8 / 1 / 1.1	1 / 1.1 / 1.2	1.4 / 1.5 / 1.6
IllnessDepletionMultiplier	0.5 / 0.6 / 0.7	0.8 / 1 / 1.1	1.15 / 1.25 / 1.5	1.85 / 2 / 2.25
DissenterDepletionMultiplier	0.5 / 0.6 / 0.7	0.8 / 1 / 1.1	1.15 / 1.25 / 1.5	1.85 / 2 / 2.25
TimeBetweenDissentingMultiplier	0.5 / 0.6 / 0.7	0.8 / 1 / 1.1	1.15 / 1.25 / 1.5	1.6 / 1.5 / 1.7
TimeBetweenDeathMultiplier	0.5 / 0.6 / 0.7	0.8 / 1 / 1.1	1.15 / 1.25 / 1.5	1.6 / 1.5 / 1.7
TimeBetweenIllnessMultiplier	0.5 / 0.6 / 0.7	0.8 / 1 / 1.1	1.15 / 1.25 / 1.5	1.6 / 1.5 / 1.7
TimeBetweenOldAgeMultiplier	0.5 / 0.6 / 0.7	0.8 / 1 / 1.1	1.15 / 1.25 / 1.5	1.6 / 1.5 / 1.7

When there's more than one value per difficulty, the game picks one according to your skill level, which it measures as the ratio of damage done vs. damage taken.