Several references to horror stories and movies can be found in the game. In the Point Lookout DLC, a unique knife called the "Toy Knife" can be found alongside a Hockey Mask, referencing Jason Voorhees from the movie series Friday the 13th.

Another reference is found in both the standalone Fallout 3 and in Point Lookout, the first being in a simulation called Tranquility Lane, in which the player can don a clown mask as a kid and begin a killing-spree within the simulation. The second time the mask pops up is in Point Lookout, which is found on top of a skeleton in a bathtub inside a motel room, which itself is adorned with skeletons and blood splattering. This is a reference to Michael Myers from the Halloween movie series, and more specifically his first kill where he wore a clown suit and mask, doing so as a kid.

H.P. Lovecraft references appears in the standalone Fallout 3 too, with the inclusion of the Dunwich Building. The story told through the building via Audio Logs and the apparent obelisk near the end references the Cthulhu Mythos, more specifically the story called The Dunwich Horror, which the very building is named after. The player can also hear the word "Alhazred" from the Obelisk alongside one of the last audio logs, which refers to the fictional author of the Necronomicon, who is named Alhazred. The narrative is extended even further with the inclusion of the Point Lookout DLC, which includes an actual quest line involving a tome named The Krivbeknih and the owner of the book, Obadiah Blackhall. The Krivbeknih is in reference to the number of various books/tomes and artifacts featured predominately in Lovecraftian stories, and the Blackhall family is another reference to The Dunwich Horror, namely that of the Wheatley Family, as well as a possible reference to the central family in The Lurker at the Threshold, which involves an aristocratic man that inherits his family's dark legacies.