The events of Alice: Madness Returns begin where the previous game left off: desperately struggling with her own mind, Alice is now in an establishment for children with psychological problems, and memories of her whole family dying in the fire haunt her. Now another threat - which appears as a giant train - seeks to destroy her Wonderland. Alice will battle through stages to stop the train and find out its true meaning. There are five large chapters in Wonderland, each with different themes and different types of enemies.
It is a single-player game only. Alice's weapons are upgradable three times with new abilities and stronger attacks, by using teeth that she collects on her journey. A total number of roses that stand for Alice's health bar can also be increased by finding and completing special challenges called 'radula rooms' and by solving Cheshire Cat's riddles. There are a lot of hidden objects to find, such as various memories and bottles; collecting them will unlock certain galleries in the game's menu. A New Game+ option with increased difficulty is available once the game is completed.