Silent Hill: Origins is the fifth installment in the Silent Hill survival horror series, and a prequel to the original game. As in the previous entries, the player move back and forth between nightmare and real versions of the town, gathering items used to solve puzzles and open up new areas. Monsters of various types provide obstacles and, in series tradition, are mostly disturbingly twisted versions of humanity. The main character can fight with his bare fists or use melee weapons. Unlike previous games in the series, melee weapons break after a time. There are also one-shot items that can be thrown and several guns. There is no HUD, but the edge of the screen turns red when the protagonist is near death.

Silent Hill: Origins takes place several years before the events of the first game. Travis Grady, a trucker who suffers from visions that are somehow familiar to him, is running late for a delivery one night. He decides to make up for lost time by taking a detour through Silent Hill on his way to Brahms. On the outskirts of Silent Hill, a cloaked figure darts into the road in front of him. Travis slams on the brakes and exits his truck to check on their condition, without know where he is putting himself.