We play a serial killer in this one. The sick sort who likes to do horrible things to his victims until they expire. The "urge" in question refers to an almost sexual attraction that our protagonist develops for his would-be victims; the conflict comes about when he develops an attraction for someone that, contrary to his expectations, does not develop into an urge to kill and destroy.
There are not a lot of choices to be made here. For the most part, it's window dressing. Some of it is about your attitude to events, but I'm not sure that the responses reflect in the following events. Ultimately, you can choose how to end your relationship with this person, but that is about it.
Perhaps it is for the best. I do not think anyone really wants to have Wilfully Horrible Things ascribed to oneself in a serious context, and I imagine that most players would try their best to "escape" this lifestyle as soon as they have the chance. Which would utterly ruin the story that the author wants to tell. In principle, I would like more interactivity, but, given the subject matter, I guess I can't really fault the decision to limit options in such a way.
One quibble: it's established early on that there is some sort of monster in the woods who takes care of any interlopers that might get too close to discovering our protagonist's secret. It seems like an uneasy alliance: the protagonist has never seen this beast, but he knows that it's there; and one of the endings involves letting it handle the problem. This relationship is never explored, though it seems important enough that it really should be. The result is that the monster feels very much like a convenient detail.
Extra-greasy sausages, fried bread and tomato juice.