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I'm Too Young To Die - easy mode, for wusses.
Hurt Me Plenty - normal mode, for players new to Doom or shooters.
Ultra Violence - hard mode, for old-school Doom players (I'm playing it on this mode atm)
Nightmare - really hard mode, for true Doom veterans, said to be damn hard
Ultra Nightmare - ultra-mega hard mode, for sadomasochists or psychopaths with a death wish. It has permadeath, so you get only ONE shot at completing the campaign.
To be honest, I've no idea, and I doubt there are many that do, since I imagine that only a small number of players will have finished the game by this point.
The enemies don't spawn indefinitely (that would ruin gore nests, lockdowns and such) or the weird Doom 3 thing. Normal health packs and armor scraps only add like +1 and an Imp fireball is 50 dmg done. It's just balls-out hard.
I just met the first really big enemy. Beat him after about fifteen goes, dropped through a portal, and he's back. With barely any effective ammo I got no chance.
I am sick of dying and it's ruined Doom along with other stuff I ain't so keen on. Like since when was Doom a platformer; excuse me while I vomit scaling the tower.
They just deal more damage and are more agressive. Enemies spend more time attacking and throwing fireballs vs aiming or getting to a new position.