Survival difficulty is overrated and not hard enough. I though of a simple method of making it even more interesting.

For future DLC's or updates, why not remove the compass, HUD and fast travel? And also add the thirst/hunger/sleep system from NV but this is totally optional.

Also remove the map from the pipboy.

Make it so all headshots without helmets kill you instantly.

Aside of feeling thirsty, hungry and sleepy, you also feel horny.

Bobby pins break twice easier.

Enemies never stop looking for you and they never go lower than cautions on their alert levels if you get to Danger.

Just like you can pickpocket you can also get pickpocketed, and piper pickpockets you a lot.

Deathclaws kill you in 1 hit if you are not wearing power armor, no matter the circunstances.

Enemies can sneak on you as well.

Dogmeat can get rabies and permanently become hostile, but he doesn't lose his essential status.

If the happiness in your settlements is too low, they rebel and start a coup agaisnt you.

You get HIV/AIDS if you romance Cait.

Normal enemies mutate as well like legendary ones.

You can't recover limb damage by waiting, and you need some braces until you can walk and play properly again.

If you don't sleep you will start getting hallucinations making you see fake enemies, the longer you spend without sleep the more fake enemies you will encounter.

Just like you can slice ferals limbs, you can get your limbs removed from your body permanently.

Companions never recover unless you use a stimpack on them. If you leave them knocked down for too long they die.

When you die you can't load your game right away, instead you have to wait 30 seconds to see what the enemies do with your corpse.

Super Mutant Suiciders no longer have an alert sound.

You get addicted to drugs if you try them only once.

The Minutemen can be a potential enemy faction too, and they kidnap your dead spouse for necrophiliac purposes if you mess with them.

If you fail hacking you are locked off the terminal forever, and in all your other characters.

If your radiation gets too high, or if you survive a mininuke but you are near the blast radious, you become a ghoul permanently, unless you have power armor.

When you run out of fusion cores you cant move the power armor at all, and you can potentially get trapped inside.

Limbs on all humans and animals get crippled by 1 hit, with armors 2 hits.

If your charisma is lower than 8, your romanced companions cheat on you.

On the first mission to concord if you run away, the deathclaw eats the minutemen.

The story and factions will progress by itself if you ignore it for too long. If you don't do the main quest for months in the game, the 3 factions will start killing each other, and you can only join the winning one at the end.

If you kill some gunners for no reason they start hunting you down, each time you kill them, they send 1 additional person next time. It goes up to 30 gunners agaisnt you.

Enemies can also hack terminals and unlock robots to attack you.

You can aim at enemy weapons, not to degrade them, but to disarm them. All enemies will aim at your weapons first.

Super mutant hounds never stop tracking and chasing you even if you go inside buildings.

If you wear raider armor everyone will attack you on sight.

Some enemies will assassinate you while you sleep.

Each time you level you also have to pick a drawback or a weakness for your character after you pick the perks, you get a full list that looks exactly the same as the perk list, but it's for drawbacks, whenever you pick a perk you have to pick a drawback or you wan't pick another perk.

You can use your settlers as companions, but if the happiness of the settlement is not high enough, or your charisma is lower than a certain point, they will attack you randomly.

Add an additional line of dialogue only for this mode where curie confesses she has a dike.