Worse Than Death is a 2D action-adventure horror game. Players control an on-screen character, Holly, and navigate a series of side-scrolling levels. Players can walk left and right, or run with a dedicated button (or with a double-tap on mobile devices), which depletes a stamina meter.
The stamina meter refills automatically at different speeds, depending if the player is walking or idle. If the player depletes their stamina completely, Holly enters an exhausted state and can no longer run, and players must wait momentarily before the meter will refill normally.
As well, players interact with environment objects (such as desks and gaps) with a single action button (or a tap on mobile devices) to jump, hide, and perform other context-sensitive actions. These actions must be used to avoid the game's unseen enemies, which patrol certain levels and impede Holly's progress.
The enemies can both hear and see Holly, so if she makes too much noise (because the player chose to run while too close) or is spotted (because the player is in proximity and not hiding), the game enters an alert state, and players must find a hiding spot or escape to another room without being caught.
The game also includes close-up screens in which players solve puzzles or read clues in a first-person perspective. During these scenes, players move a cursor (or tap on mobile devices) to operate dials, switches, and other puzzle objects.
As players progress, they uncover story clues, find items that can be used in the close-up scenes, and complete tasks (such as unlocking a door) that allows them to continue to the next area. The game separates its levels as chapters, with each one taking place at a specific time throughout the story, in a linear fashion.