Extreme Mode changes various gameplay aspects of Granny. These include:
- Granny moving extremely fast (faster than the Player) and cannot be normally outran.
- Forcing Darker Mode and Extra Locks on.
- Removing the opportunity to complete the Painting. (similar to Hard Mode)
- Creaking Floors are much larger, making them completely unavoidable.
- An extra one is added to the Secret Area's Top Floor.
- Adding a set of bars over the passage connecting the Secret Area and the Basement, which blocks it off on the Basement side.
- This makes Extreme mode even harder as this is one of the most popular hiding places.