Alex has some form of social anxiety
Like most fangame protagonists, Alex refuses to leave their room. This extends further than merely interacting with others in public. The anxiety may be so intense, it actively prevents Alex from communicating with others. During the Telephone event, Alex drops to their knees when the phone begins to ring. This shows that even the thought of talking to another person is enough to debilitate Alex. Alex appears to overcome this fear in the Good Ending.
Loneliness and escapism through video games
Alex may have soft spot for the NPCs in the Friendly Town because they are from a game Alex would play by themselves because they didn't have friends. With the Cleaver effect, Alex is capable of killing most of the dream world inhabitants without hesitation, with few exceptions. One such group of exceptions are the Friendly Town inhabitants. In the real world, Alex is seen to own a television set and a television. There is only one cable, the power cable, that runs from the wall to the TV, with the other plug powering a nearby game console. At the end of the Dark Maze, an NPC takes you to a room with a television, displaying a game. This is a game that Alex has familiarity with; it appears in Alex’s dreams, and they are very hesitant to bring harm to its residents. If you do succeed in killing a resident, you are immediately kicked out of the game world and observed by a shadow creature. This creature represents the lingering feelings of loneliness and depression Alex feels, which is why they collapse after some time.
Alex has gender dysphoria
This theory stems from the fact that Alex can receive the same effect from two different locations in the same area. In the School, Alex can either get the Egg effect from either the boy’s bathroom or the girl’s bathroom. An "egg" is a term used to describe a person who has not realized they are transgender yet. The fact that the Egg effect can be obtained from either bathroom can be interpreted to mean Alex may identify as both genders, or neither. The shark in Alex’s room appears to be a Blåhaj, a stuffed animal with close ties to transgender culture. Alex’s social anxiety may even be tied to their gender dysphoria, as equipping the Egg effect in the Dark School results in the inhabitants becoming hostile towards Alex, suggesting that Alex fears the reaction they may elicit from coming out.
Alex has depression fueled by alcoholism
As the player collects more effects in the dream world, they will see Alex’s apartment becoming more and more cluttered. The trash in question consists mostly of what appears to be beer bottles and cans. As the amount of trash in the apartment increases over the course of the game, we can assume that time is passing between each effect collected. Alcohol is a known depressant, and heavy sleeping is a symptom of depression. This depression could stem from any number of sources, from Alex’s social anxiety, loneliness, etc.
Alex has Filipino heritage
Many aspects of Alex’s subconscious are Filipino in origin. The Tikbalang, Manananggal, Sirena, and Witch effects are all Filipino mythical creatures, while the kalabaw is the Filipino name for the water buffalo. The houses in the Cursed Village appear to be stilt houses, common traditional Filipino structures built to weather floods and typhoons. This knowledge implies that Alex has a sound understanding of various cultural and lifestyle aspects of living in the Philippines.