Beat the Basement/Cellar without taking damage

Beat the Caves/Catacombs without taking damage

Beat the Depths/Necropolis without taking damage

Beat the Womb/Utero without taking damage

Beat all 20 Challenges

Collect 2 of either Roid Rage, The Virus, Growth Hormones, Experimental Treatment, or Speed Ball

Kill Mom

Kill Mom using the Bible

Kill Mom's Heart 3 times

Kill Mom's Heart 5 times

Kill Mom's Heart 8 times

Kill Mom's Heart 9 times

Kill Mom's Heart 10 times

Kill Mom's Heart 11 times

Kill all 7 sins

You are the best!

Collect all items and unlock all secrets and endings