- hardcoe setting (to make healing slower)
- Easy or Normal difficulty (to make enemies' heads less impervious to harm)
- Small Frame trait (to make it easier for me to get crippled limbs)
- Endurance kept at 1 (for least hit points possible)
- Survival skill kept very low (to make healing from food harder, and to make eating/drinking more frequent)
Note that I'm talking about point/perk allocation and settings you can adjust on a console, not rules you actively ignore or disallow yourself from recognizing during play. While it would certainly make things more challenging to ignore fast travel, refuse to get addictions healed by doctors, or pretend like my weight limit is actually significantly lower than it actually is, these aren't things you can limit within the rules and systems of the game, so I'm not bothering with them. I'm perfectly happy selecting sub-par weapons, armor, and stats for roleplaying purposes, but for some reason, I feel like it ends up actually being less immersive if I have to fastidiously monitor whether I'm breaking my arbitrarily-created rules (which I've tried on more than one character and then quit out of boredom). I know I'm not the only player who works like this, so I'd really appreciate if we could focus this thread on how to make a playthrough that works based on options within the rules of the unmodded game, and not get bogged down with a discussion about making up your own rules for roleplaying purposes, which has already seen plenty of heated debate in other threads (like http://www.gamesas.com/index.php?/topic/1141389-who-was-the-courier-that-passed/page__hl__gamers__st__40).
So, any other suggestions for a "realistically dangerous" playthrough?