The Iron Heart toggles a mode that prevents natural life regeneration, consumption of Recovery Potions, and increases damage taken depending on how much maximum health the player has.
The Defiled Rune disables the player's flight time and allows enemies to critically hit the player, in exchange raising the drop rates of certain items to 5%.
Revengeance Mode and Death Mode are difficulty settings intended to be much more challenging than Expert Mode, introducing mechanics such as the Rage Meter and Adrenaline Meter, and new boss mechanics.
Several of these items toggle unique difficulty modes: The bag contains weapons for each class in the game, as well as Death and the Defiled Rune.
The player starts out with several items: the Starter Bag, Iron Heart and Revengeance.