No survival is realistic with your inventory being in the ether and all the items just disappearing when you unequip them. Fallout suddenly becomes a high stakes action RPG. You can die in a shot or two, but so can the enemies. It significantly changes weapons, perks and other factors to make enemies less bullet spongey. REST is a mod that balances out the difficulty of survival mode.
REST – Realistic enjoyable survival tweaks It’s a great mod that doesn’t go overboard on the survival mechanics. It accomplishes this by changing a few systems such as limb damage recovery using stimpaks and bandages, infections and how weather influences your wellbeing. Insult to injury is a mod that will make the vanilla Fallout 4 survival mode a bit more hardcore. Top Fallout 4 Mods For a Better Survival Experience