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Survival adds needs, food, water, rest ect, you can become exhausted, dehydrated ect, and you can only save in beds (from what I've heard) so it does add more. Though I've heard of people having issues with survival mode, disabled CC, not being able to change back to regular difficulties ect. a lot of people use CC (Console Command) for getting around in game bugs such as clipping, a quest that fails to complete despite having completed all objectives ect.
I love doing everything in the game, but I hate becoming so OP that I steamroll through the content.
The Realistic Needs mod for me was the best way I experienced Skyrim
Lead Belly is still useless since you can find the resources to easily utilise the Chemist perk and Solar Powered will remove the rads anyway.
Lead Belly is indeed useless because it is super easy to grow nonradioactive food, to cook nonradioactive meat, and lead belly doesn't fix the biggest problem with drinking dirty water, specifically the overly high chance of getting a negative symptom from the dirty water. The rads from food and dirty water are fairly negligible.
I really don't recommend Survivor because it doesn't really add any difficulty but does make the game more annoying due the lack of saving. Any time your game crashes or you encounter a bug you just lost an hour of playtime, and it will happen extremely frequently. The enemies aren't really any more difficult once you get a few levels under your belt, but the danger from crashing never goes away and that's the only danger you can't control.