Alex Shepherd first encounters them in the Grand Hotel's elevator, where five of them attack Alex in succession by breaking through the elevator's walls and attempting to pierce him in the confined space.
Needlers also appear in the spin-off game Silent Hill: Book of Memories.
The monster appears somewhat humanoid with a masculine torso, very synonymous to the normal human, but its arms and legs are replaced with very sharp blades which it uses to walk around, as well as to attack. These blades are grafted onto the severed wrists and ankles of the double-jointed creature. It seems as though the Needler's head had been removed, especially evident as it approaches Alex. However, its sharp-mawed mouth is located between its legs. Very vague traces of eyes and a nose can be detected only by darker regions of the visage. Two breathing holes are present on both sides of the Needler's chest and these holes open and close at a slow rate.
Needlers appear in most areas of the game, whether they tread on the ground, climb out from pipes/holes in the walls, or scale the ceiling. They move quite rapidly and can be detected by the tell-tale clanking of their metallic legs. The beast also makes an unorthodox "chirping" sound in combat, composed of repetitive, quick, and high-pitched vocals.
To avoid injury to Alex, using firearms rather than melee weapons to eliminate Needlers is most successful, especially when they appear in groups. Two to four head shots will be enough to defeat the adversary. Needlers are one of the few monsters that are perfectly capable of dodging or repelling the player's attacks with its blade-like limbs, primarily if the beast is assaulted from the front, which also gives it the opportunity to pin Alex and inflict massive damage, therefore making flank attacks less likely to cause harm to Alex. Needlers express more intelligence than most other monsters in the game, not only with their ability to block, but also by endeavoring to seek shelter when severely injured as it may jump for the ceiling when it senses that its own health is very low, therefore disabling melee combat from its attacker.
If the player chooses to use melee weapons to fight a Needler, it is advised to wait for the enemy to attack and quickly evade to one of its sides and proceed to attack with the player's choice of an axe, crowbar, or knife. It is possible to defeat the Needler with a single axe hit. This can be achieved by walking straight to it, dodging and immediately unleashing a single heavy attack. However, the fire axe's weakness is that it is not as fast as some other choices in Alex's arsenal.
In Silent Hill: Book of Memories, the Needler will block attacks from the front, requiring the player to maneuver behind it to inflict damage.
Its head is located between its legs, a design choice that, when combined with its reclining posture and stirrup-like leg blades, may be intended to viscerally represent labour and childbirth (in the lithotomy position), which is a constant theme in the Silent Hill series, and a particularly emergent theme in Silent Hill: Homecoming. Elaborating on the childbirth reference, since Alex Shepherd had always been second to his brother Joshua, the Needler itself may be a physical manifestation of the way Alex perceives Joshua's birth.
The "needles" themselves may be expressions of the surgical orbitoclasts used in a frontal lobotomy, or simply represent hypodermic needles used to inject psychotropic medications. Alex would be the patient, according to the Doctor's Memo.
The severed head might also foreshadow the manner of Joshua Shepherd's death: a broken neck. In other words, the Needler could represent the truth, gnawing at Alex's subconscious.
The Needler's appearance is vaguely arachnid in nature, which may symbolize Joshua's interest in spiders.
- Defeating a Needler in the Xbox 360 version for the first time will award the player with the achievement "To the Point".
- When using the axe, if Alex successfully performs a combo that ends in a heavy attack, he may pin the weapon into the creature and give it a second swing harder into the ground with the Needler still attached.
- The Needler resembles Mama, who also attacks by crawling and looks similar in stance.