The Suffering: Ties That Bind is the sequel to The Suffering, and picks up after the ending of that game. Players who have a game save of the different endings of The Suffering can decide with which morality to start with, starting with a different morality changes the dialogue and intro of the game. Ties That Bind features a number of gameplay changes from the original The Suffering.
The player controls Torque, a man who has been sent to Abbott State Penitentiary on Carnate Island, Maryland. He has been convicted and sentenced to death for murdering his ex-wife and two children, although he claims to have blacked out at the time this happened and cannot remember anything.
The night Torque arrives, there is a powerful earthquake, which releases an army of monsters upon the facility. Torque's cell door breaks and he is freed from captivity. Starting from his cell, Torque traverses the prison in an attempt to escape Carnate Island alive.
