Steam Achivements
| Name | How to Unlock |
| The Radioactive Spider | Complete the Basement |
| Monstro's Tooth | Defeat all the bosses in the Basment over multiple playthroughs. |
| The Spelunker | Complete the Caves |
| Lil Chubby | Defeat all the bosses in the Caves over multiple playthroughs. |
| I Killed Mom! | Defeat Mom at the end of the Depths. |
| Loki's Horns | Defeat all the bosses in the Depths over multiple playthroughs. |
| The Rock | Break 50 rocks over multiple playthroughs. |
| The Bean | Destroy 50 piles of poo over multiple playthroughs. |
| Mom's Pill Bottle | Used the Blood Donation Machine 20 times over multiple playthroughs |
| The Gamekid | Enter into 10 diffrent arcades over multiple playthroughs. |
| The Common Cold | Collect any two of these items in one playthrough: Roid Rage, The Vrius and Growth Hormones. |
| Mr. Mega | Destroy 30 Blue Rocks over multiple playthroughs. |
| The Book of Sins | Defeat all of the seven deadly sins over multiple playthroughs. |
| Mom's Contact | Get Mom's Eye before getting any other mom item in a playthrough. |
| The Parasite | Collect any two of these items in one playthrough: Bob's Rotten Head, Dead Cat, Max's Head and Tammy's Head. |
| The Necronomicon | Use the Death tarot card four times over multiple playthroughs. |
| The Halo | Kill Mom or Mom's Heart with the Bible. |
| The Bandage | Kill four Horsemen of the Apocalypse in one playthrough. |
| The Shears | Die 100 times. |
| Maggy's Wig | Have atleast 7 heary containers in one playthrough. |
| Cain's Eyepatch | Have 55 or more cents at one point during a playthrough. |
| Judas' Fez | Defeat Mom's Heart. |
| Eve's Dead Bird | Make two deals with the devil in one playthrough. |
| ??? | Defeat Mom's Heart 9 times and It Lives once. (After beating Mom's Heart 9 times it gets replaced with It Lives for the rest of the game unless you delete your data.) |
| My Head Hurts... | Defeat Steven. |
| I need a hug... | Defeat C.H.A.D.. |
| I Have Sticker Fingers... | Defeat Gish. |
| The Noose | Defeat Mom's Heart 2 times. |
| The Nail | Defeat Mom's Heart 3 times. |
| The Quarter | Defeat Mom's Heart 4 times. |
| The Fetus | Defeat Mom's Heart 5 times. |
| Everything's Terrible | Defeat Mom's Heart 6 times. |
| The Wafer | Defeat Mom's Heart 7 times. |
| Money = Power | Defeat Mom's Heart 8 times. |
| It Lives | Defeat Mom's Heart 9 times. |
| The Cross | Beat the Womb with Maggy. |
| The Bag | Beat the Womb with Cain. |
| The Robo-Baby | Beat the Womb with Judas. |
| The Razor Blade | Beat the Womb with Eve. |
| The D6 | Beat the Womb with ???. |
| Golden God | Collect every secret and item in the game, if you collected Lump of Coal you need all but 1 item to unlock. (No item or seceret from Wrath of the Lambs counts towards this.) |
| Basment Boy | Complete the Basement without taking any damage. |
| Spelunker Boy | Complete the Caves without taking any damage. |
| Dark Boy | Complete the Depths without taking any damage. |
| Mama's Boy | Complete the Womb without taking any damage. |
| Mom's Knife | Defeat Saten with Isaac. |
| The Guardian Angel | Defeat Saten with Maggy. |
| The Bomb Bag | Defeat Saten with Cain |
| The Monster Manual | Defeat Saten with Judas. |
| The Demon Baby | Defeat Saten with Eve. |
| Forget Me Now | Defeat Saten with ???. |
| A Gift From Krampus | Defeat Krampus in the devil room. |
| Wrath of the Lamb (DLC) Achievements | |
| Samson | Skip two treasure rooms and beat Mom in a single playthrough. |
| Blood Lust | Defeat either Mom's Heart or It Lives with Samson. |
| Blood Rights | Defeat Saten with Samson. |
| The D20 | Defeat Isaac (Catherdral Version) with Isaac. |
| The Celtic Cross | Defeat Isaac with Maggy. |
| Abel | Defeat Isaac with Cain. |
| The Curved Horn | Defeat Isaac with Judas. |
| The Sacrificial Knife | Defeat Isaac with Eve. |
| The Raibow Baby | Defeat Isaac with ???. |
| The Bloody Penny | Defeat Isaac with Samson. |
| The Candle | Complete Challenge 1: Beat Mom while having the Curse of Darkness throughout the challenge. |
| The Lucky Toe | Complete Challenge 2: Beat Mom while starting the game with bad luck. |
| The Burnt Penny | Complete Challenge 3: Beat Mom while having the Curse of the Labyrinth. |
| Guppys Tail | Complete Challenge 4: Beat mom with Dead Cat (You have 1 heart container, any container you gain you will lose on death and you have 9 lives.). |
| The Fish Head | Complete Challenge 5: Beat Mom's Heart or It Lives while starting the game with The Mulligan and Infestation. |
| Mega Fetus | Complete Challenge 6: Beat Mom's Heart or It Lives while starting the game with Dr. Fetus and Doctor's Remote. |
| Super SMB Fan | Complete Challenge 7: Defeat Mom's Heart or It Lives while starting the game with a Level 4 Meat Boy (Go to Meat Cube for more details). |
| The Spider Butt | Complete Challenge 8: Defeat Mom's Heart or It lives while stating the game with Mutant Spider and Spider's Bite. |
| The Counterfeit Coin | Complete Challenge 9: Beat Saten while starting the game with The Halo and The Holy Grail. |
| Dad's Key | Beat ??? in the Chest. |
| Guppy's Hairball | Turn into Guppy. (You must obtain 3 of these 4 items in a playthorugh to turn into him: Guppy's Paw, Guppy's Head, Guppy's Tail and Dead Cat.) |
| The Polaroid | Complete the Cathedral by beating Isaac six times. (This can be done with the same character all six times or three of them twice ect...) |
| Daddys Love | Complete Challenge 10: Beat Isaac in the Cathedral with no starting items or item rooms. |
| Platinum God | Get all items and secrets from both the original game and Wrath of the Lambs DLC. If you have ghost baby you need one less item. |
| Isaacs Head | Beat ??? in the Chest with Isaac. |
| Maggys Faith | Beat ??? in the Chest with Maggy. |
| Cains Eye | Beat ??? in the Chest with Cain. |
| Juads' Tounge | Beat ??? in the Chest with Judas. |
| Eves Bird Foot | Beat ??? in the Chest with Eve. |
| ???s Soul | Beat ??? in the Chest with ???. |
| Samsons Lock | Beat ??? in the Chest with Samson |
| The Left Hand | Beat Ultra Pride. |
