Only started it last night, haven't got very far but it looks impressive enough. I'm a hardcore type gamer who normally plays most games on the hardest difficulty level available for my first playthrough, I started Fallout on Hard, with another two levels available above that because I've been reading that the game is quite unforgiving, nearly Dark Souls difficult, but I may restart on very hard tonight anyway.
The highest I go is Normal difficulty, apart from Fifa where I play on Professional / world class but can get a bit mad sometimes
I don't have the time to play most games more than once so I always pick the most challenging difficulty. I can't stand breezing through a campaign without dying a bunch. I'm a masochist like that plus I've been gaming for so long that I need that extra challenge otherwise I feel like I'm wasting my time.
Restarted last night on very hard, which I don't find particularly difficult myself. Created a female character and when I got to talking with my Mr Handy he called by the name I had given her...Jennifer. Imagine my surprise when that happened. I just read that Bethesda stored 1000 names that would actually be spoken to you in the game if you happen to pick one. That's how good this game is.