Kill Mom's Heart 3 times

Collect 2 of either Roid Rage, The Virus, Growth Hormones, Experimental Treatment, or Speed Ball

Kill Mom using the Bible

Beat the Dark Room with Isaac

Beat the Boss Rush

Beat the Chest or Dark Room without taking damage

Beat the Caves/Catacombs without taking damage

Beat the Basement/Cellar without taking damage

Beat the Caves 30 times

Beat the Basement 40 times

Kill Isaac with Eden

Kill Satan with Lazarus