While this difficulty alone is pretty good, there are a few mods that make it even better. Moreover, the Sole Survivor will be subjected to thirst, hunger, and exhaustion.
This difficulty basically turns the game into a full-on survival experience, with real stakes and no manual or autosave. However, Bethesda didn't want to just stop there, which is why Survival difficulty is an official feature in Fallout 4. From being chased by Deathclaws or getting mauled by ghouls, there's already quite a bit of challenge within the basic, vanilla version of the game itself. The world of Fallout 4 is a pretty grueling one.
