LISA: The Painful

LISA: The Painful - Definitive Edition is the miserable, hilarious RPG of your wildest nightmares. Undertake a relentless journey through the post-apocalyptic wasteland of Olathe. Beneath its charming exterior is a world full of disgust and moral desolation, where you will learn what kind of person you are by being FORCED to make choices that permanently affect the gameplay. Make sacrifices to keep your party members alive, whether it's taking a beating for them, losing limbs, or some other inhuman torture. In this world, you will learn that being selfish and heartless is the only way to survive...
The Definitive Edition brings new content and nightmares to the game with HD graphics, 120 FPS mode, new party member campfire conversations, updated battle systems, new border art overlays, new music, music player (including music from LISA: The First), Painless (Story) mode, and new secrets to explore.
100+ unique character battles.
Visible character sacrifices that affect your stats and attacks (removing arms, eyes, scratches).
Recruit up to 30 party members in towns and camps.
Make ruthless choices that permanently affect towns, characters, and lives.
Participate in white-knuckle shopping cart races, extreme weight lifting, and other minigames.
Bet your party members on Russian Roulette for huge profit, but permanently lose them if they die.
Listen to your favorite tracks in the music player, which also includes music from LISA: The First.
Discover countless secrets hidden throughout Olathe.
Play Painful mode for an extra challenge and unique enemies, or Painless mode for a story-focused experience.
A life-ruining gaming experience.

The developers describe the content like this: depictions of mature language, violence, gore, sexual assault/non-consensual sex, drugs, alcohol abuse, and suicide.