Oh my god.
YES
Insanity calls.

Ever since you were young, you had a poor sense of reality, usually watching old holotapes and listening to radios of the past, with your family murdered infront of your own eyes, you have stopped beleiving in all sense of reality, you see the wasteland as a beautiful forest and utpoia.
People seem to like you more easily, making you gain karma, good or bad easily. you also see creatures in a more horrifying light, making you less able to fire perfect shots in normal gameplay, and vats, you also get a Overhaul of every, single dialog option.
Death's door.

you have lost the ability of living to the age of 80! you grow slightly older everyday, foes hit harder, hardcore mode is on the hardest difficulty, and it's forever on! also, if you die even once? your save will become corrupted, and will become deleted.
Beloved and heroic

No matter what faction you are, you have become loved, by everyone, and everything, but if you even harm a single innocent soul? everyone will try to murder you.EVERY.ONE.