When He broke the third seal, I heard the third living creature saying, “Come.” I looked, and behold, a black horse; and he who sat on it had a pair of scales in his hand. And I heard something like a voice in the center of the four living creatures saying, “A quart of wheat for a denarius, and three quarts of barley for a denarius; and do not damage the oil and the wine.” –Revelations 6:5-6
| The Basement|
| Ball of Bandages|
|Defeating Mom for the first time|
•If the player is to the left or right of Famine, he will commence charging across the screen.
•He can also spawn up to two Pooters to assist him during the fight, and he will not spawn any more until one of the two Pooters are killed.
•When Famine takes a sufficient amount of damage, his body and horse will explode into gore while his head remains. Famine's head behaves similarly to a Horf, firing triple shots at the player periodically.
Blue: Much more aggressive, though cannot summon Pooters. Will shoot six tears radially and will frequently charge the player regardless if they're near him. In Phase 2 he will shoot out a large amount of tears, akin to Monstro's attack.
- Famine is one of the Four Horsemen of the Apocalypse mentioned in the Bible.
- Famine appeared in the original Binding of Isaac.
- A famine is the scarcity of food over a large area.
- Which can explain Famine's emaciated appearance.