Altered is a demanding-yet-meditative puzzle game where must get your character to the end of the level. It's unique because to get there, you change your physical characteristics (extending, elongating, splitting into two, or attaching yourself to objects in the level). It's difficult levels combined with its soothing atmosphere add to create a uniquely thoughtful experience, where crafting strategies and thinking ahead are essential.

In each level, there is a tile you need to get to, that is blocked by gaps or by objects. You use your character's abilities to make it to the end. This involves extending your body to make it across a gap or by moving items onto buttons, or even attaching yourself to found items.

There are four characters you play as across the 80+ levels; you start as The Norn who can extend his arms in each of the four cardinal directions, allowing you to move across gaps and push blocks along, either to push buttons or fill in holes. Getting a good understanding of the abilities of each character you play as is essential for beating the levels and crafting the strategies necessary for success.

It's a unique game that puts a spin on the puzzle genre, by allowing you to change your characters as well as the levels they inhabit, and offers a chance for outside-the-box thinking to flourish and rewards forethought and experimentation.