A Visceral Attack in Bloodborne is similar to a riposte from the Souls series. There are 2 main steps to initiate a visceral attack:

  1. Interrupt enemy's attack with a well-timed firearm shot (by clicking L2 with a firearm equipped); the enemy will then kneel down for a short period of time.
  2. Move up to the vulnerable enemy and tap R1; if you were quick enough, you should perform a visceral attack.

You can also perform a backstab-visceral attack by

  1. Moving behind an enemy and charging up an attack to stun them (holding down R2),
  2. Then moving up to them and tapping R1.

However, note that if you wait too long, the enemy will recover before you can perform a visceral attack. In addition, you cannot perform a visceral attack on certain enemies, although you can on certain bosses (e.g. Father Gascoigne).

You can read a detailed article on visceral attacks here.

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