Community RemixInsane ModeDifficulty
This is a gamemode that can be selected on the character menu.

Isaac's heart cap is reduced to 6 hearts.
All heart pickups that would be full hearts are now halved.
Regular rooms and treasure rooms have a chance to be Hexed.
Bomb pickups have a chance to be replaced with a Troll Bomb when touched.
Pacers and Gushers leave red creep on the floor.

Beating Mom's Heart on Insane mode will reward Isaac with an Insane Pin, which will be displayed in the character menu on top of the post-it note for the character it has been beat with. It will also unlock that character's Insane mode unlock.

Beating Mom's Heart as any character will also unlock Insane Pendant and Shrunken Head.
Unlock: Defeat Mom's Heart 5 times.
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