Unlocked by: Unlocking the boss 'It Lives' and the character Eve and 1 or 6 pips dice rooms to reroll your items (Missing No.

It is also advisable to use either D4,D100,Missing No. Finding a good active item (ex: Krampus' Head) will be very beneficial, as well as passive item like Lump of coal (the range of tears will increase as they orbit) or Dark Matter for the Fear Status. It will be difficult to target enemies, but it will be easier to hit enemies with tears facing away from them. Strategy: You start as Isaac with the items: Iron Bar, Soy Milk, The Small Rock and Tiny Planet. With Petrified Poop you will have a higher chance of pickups from poop, usually coins to help buy from the shop. It is advised to use Flush! when they are a large amount of enemies. E Coli with allow you to run into enemy that don't hurt you on contact (ex: Gray flies, Mulligans and Hosts). The items you are given at the start will given you a high firing, but low range shot of tears, which require you to be close to your enemies, so try to find Range Up items or try to find Brimstone (good synergy with Number One). Strategy: You start as Isaac with the items:Butt Bombs, E Coli, Flush!, Number One and Petrified Poop. Turning up the Gamma options can make Curse of the Darkness less of a problem. Your goal is to beat the boss 'Mom.' Your best bet is to take it slow and keep track of your health either by memory or paper and be careful about taking Devil Deals and the Blood Donation Machine. You can still go to treasure rooms, but there are no shops. Strategy: You start with Isaac (without the D6) and is the same as regular run, but you have permanent Curse of the Darkness (always dark) and Curse of the Unknown (can't see your health). Each challenge has a theme to it and unless otherwise stated most challenges don't have Treasure Rooms, but most contain Shops. To unlock this achievement you must complete the 20 challenges found in the game.

Binding of isaac rebirth achievements