Horror RPGs have a history of some really interesting designs.
Call of Cthulhu is pretty basic, though seeing that sanity score inevitably drop down is nerving. VtM's deliberate choice to make succeeding too much be a bad thing is really evocative. But those are both pretty typical rpg mechanics. It can get so much more interesting.
Dread using a Jenga tower to create an organic tension and release cycle is absolutely fascinating. I've not played it, but I'd love to, with the right group.
10 Candles tells the players upfront you will die; this is a story about how that happens. That sets such a strong tone from the outset. A scene gradually becoming more and more hopeless as you lose dice creates a similar tension and release cycle to Dread, and physically extinguishing the candles as you go adds to the atmosphere and clearly shows your progress towards the end. Physically burning off your character traits as you call upon them is icing on the cake.
All this to say: in the world of horror RPGs, Paizo has a lot to live up to. I wish them luck, but it's not an easy job!