This is the hardest difficulty in the game and its available from the start. Also you can start a New Game+ after your easy or normal playthrough.WHEN STARTING A NEW GAME+ YOUR SKILLS WILL BE RESET BUT YOUR XP AMOUNT WILL BE RETURNED BACK TO YOU. SO YOU WILL HAVE TO RE-BUY ALL THE SKILLS AGAIN. On this difficulty you will want to stay in motion as much as possible. The Butterfly Sword will be your main weapon of choice. So buying the blade abilities will help you out. Try to conserve ammo, not as much on your pistols, but for your SMGs, Assault, Shotgun & Grenade Launcher. This will help you when you get to the Panda Bear fights or main boss fights. You will also lose your limbs a lot quicker and more often, usually your head most of the times. So get really good at attaching your body quickly and using up on the to move away from the Grand-babies or else..
Note: Difficult achievements are stackable. Skills will only be available on what ever playthrough you bought all the abilities on, THEY DO NOT CARRY OVER TO A NEW GAME+! When you start a New Game+ all your XP is carried over, and will only be able to buy the stander abilities you get when you start a new game. So all abilities will have to be bought again as you progress in the story.