If you clip the camera into the ranch house at the start of the game, you can find a copy of the "SILENT HILL RANCH" sign with the text written in Comic Sans. This references an alteration from the Silent Hill HD Collection port of Silent Hill 2 which was widely derided by fans due to the casual and childlike connotations of the font clashing with the bleak atmosphere of the series.

While it's not known to have been explained by the developers, Maria's outfit in the original game bears a near-identical resemblance to one worn by American pop singer Christina Aguilera at the 1999 Teen Choice Awards, which were held in August 1999, two months after the game began development. Further suggesting this connection, Maria is also Aguilera's middle name. Maria's outfit would be redesigned for the game's 2024 remake, but the original outfit still appears during a brief scene where she finds it while raiding a closet and asks James if she would look good in it, to which he hesitantly responds: "Umm... Sure."