In the sequel, Alice: Madness Returns, the Queen of Hearts is sought by Alice for assistance in stopping an Infernal Train from tearing apart Wonderland and driving her back into insanity. The Queen claims, when found in the ruins of the Red Kingdom, that Alice is being manipulated by someone other than herself, that this person is trying to erase her memories, particularly about the fire in her childhood, which is tearing her sanity apart. It later turns out that this person is none other than her psychiatrist Dr. Angus Bumby, who has been revealed to have raped Alice's older sister Lizzy and burned down the house with Lizzy and Alice's parents to cover up the crime, and that he is attempting to erase Alice's memories and subject her to prostitution after it. In this sequel, the Red Queen has changed considerably, taking the appearance of a younger Alice, only in a royal dress befitting the Queen of Hearts, with large fleshy claws rather than hands, and her lower body composed of fleshy tentacles that spread throughout the entire castle, which is actually the Queen's body itself. Some argue she is actually based not on Alice herself, but her sister, as she also referred to her as "Lizzy" in the following dialogue, and considering she felt guilty of the death of her family, its possible her subconscious projected her dead sister in the queen she herself killed in the previous game.
