Alice: Madness Returns is a third-person action-adventure game. The player controls Alice for the entirety of the game for running, jumping, dodging and attacking.
In combat, Alice gains a small number of weapons that can be utilized in several ways. Her primary weapon is a vorpal blade, but she can also use a pepper grinder to rapidly hit a target from afar, a teapot cannon to launch an area attack, a hobby horse that can be used for powerful strikes or breaking down fragile walls, and a clockwork bomb that attracts enemies or can be used as counterweight for various puzzles. By collecting teeth that are dropped by foes or found scattered about the levels, the player can upgrade some of these items to more powerful versions. Alice\'s health is tracked by a number of rose petals. Should Alice\'s health fall to zero during game play, the player is forced to start at the most recent checkpoint. Falling off platforms into bottomless pits or dangerous liquids do not damage Alice but restart her at a nearby platform. The game also introduces Hysteria, which can be used when Alice\'s health is very low, and it can only be used for a limited amount of time