Silent Hill 4: The Room is a mystical action-horror game with a third-person view and puzzle elements. The goal of the game is to help the character Henry Townsend escape from his apartment. Gameplay centers on an apartment, which is shown from a first-person perspective and contains a single save point. Other areas of the game can be accessed through holes formed in the apartment. In the first half of the game, the room restores Henry's health, but in the second half the room is filled with ghosts, draining his health.
In the main levels, the player uses a regular third-person view. The player has a limited inventory of items, which can be managed by leaving unwanted items in a chest in the room. Silent Hill 4 places an emphasis on combat during gameplay, with an almost complete absence of complex puzzles in favor of simple hidden object tasks. Unlike previous games in the series, separate difficulty settings for combat and puzzles are not available; In the second half of the game, Henry is accompanied and assisted in battle by his neighbor Eileen Galvin. She cannot die while she is with Henry, although if she takes damage she becomes possessed, which also happens if she is given a firearm. The damage Eileen takes in the game determines whether or not she dies during the final boss fight, directly affecting the ending achieved.