Throughout the different worlds, Mariana can find # total alters in the game, each of which give her a different appearance. They each provide different effects and can be used to interact with the different worlds she comes across to varying degree.
Alters
Verdant
(Alters recommended to have before retrieving: none)
Appearance: Mariana becomes plant-like, gaining wood-like skin and green hair. She is decorated in vines and flowers, with a white sundress on.
Passive Effect: Plant.
Action: Bloom pink flowers all over yourself all Mariana to attract.
Location: Found in Old Factory through door opposite the one which leads outside to the Victorian Stairs. Climbing the middle ladder and entering will take you to the isolated balcony with a pink flower. Interacting with this pink flower will give the Verdant alter.
Practical Uses: Plant
Damage
(Alters recommended to have before retrieving: none)
Appearance: Mariana becomes injured, with sickly white skin and light blonde hair. She dons a hospital gown, with bandages covering her head and right eye.
Passive Effect: Injured. Can cause NPCs to be wary of you.
Action: Allows Mariana to use her implanted claw to damage certain objects and kill NPCs.
Location: Found in Hospital deep in one of the rightmost rooms of the dark green corridor. Inside this room is medical equipment and a large experiment tank, containing a white skinned red-eyed creature. Interacting with this creature will give the Damage alter.
Practical Uses: This effect allows Mariana to kill NPCs in certain areas, and causes negative reactions.