Tome of Madness (5E)

Elena Clement (Order #28577875)

Credits
Authors: Mike Shel
Artists: Bruno Balixa, Jesus Blones, Teresa Guido, Patrik Hell, William Hendershot, Michael Jaecks, James Krause, CJ Marsh,
Mitch Mueller, Anastasia Nicholls, Arrahman Rendi, Daniel Robinett, Tanyaporn Sangsnit, Banu Satrio, Michael Syrigos,
Steve Wood
Editing and Development: Jason Nelson
5E Development: Darrin Drader
Design and Layout: Craig Williams
Legendary Games Team Members: Alex Augunas, Jesse Benner, Clinton J. Boomer, Robert Brookes, Benjamin Bruck, Paris
Crenshaw, Matthew Goodall, Jim Groves, Amanda Hamon Kunz, Thurston Hillman, Tim Hitchcock, Victoria Jaczko, Jenny
Jarzabski, N. Jolly, Jonathan H. Keith, Michael Kortes, Jeff Lee, Nicolas Logue, Will McCardell, Julian Neale, Jason Nelson,
Jen Page, Richard Pett, Tom Phillips, Alistair Rigg, David N. Ross, Amber Scott, Mark Seifter, Tork Shaw, Mike Shel, Loren
Sieg, Neil Spicer, Todd Stewart, Russ Taylor, Greg A. Vaughan, Mike Welham, Linda Zayas-Palmer, and Clark Peterson
Publisher: Jason Nelson
Executive Partner: Neil Spicer
Business Director: Rachel Ventura
Art Director: Richard Kunz
Special Thanks: Erik Mona, Lisa Stevens, James Jacobs, Jason Bulmahn, and the Paizo staff for their excellent Pathfinder
Roleplaying Game Horror Adventures rulebook.
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only portion of this Legendary Games product designated as Open Game Games Logo, Adventure Path Plug-In, Cultic Cryptomancia (5E), as well as all
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Tome of Madness (5E) © 2020, Legendary

Games; Author Mike Shel. Adapted by Darrin
Drader. Legendary Games
ISBN: 9798617380394 524 SW 321st St.
First printing March 2020. Federal Way, WA 98023
Printed in USA. makeyourgamelegendary.com
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What You Will Find Inside
Tome of Madness
Tome of Madness is the definitive source for dealing with maniacal madmen and deranged villains, but also for haunted
heroes and their afflicted allies whose minds have been pushed past the breaking point. This lavishly detailed tome
examines the nature of mental maladies from aphasia and amnesia to phobias, tics, delusions, dyspraxia, and hysterical
blindness. With over three dozen forms of insanity with varying severity and symptoms, you'll find lesser ailments that may
accompany your heroes throughout their lives, as well as devastating delusions that can shatter a character's world.
Tome of Madness goes a step further, with abundant 5E rules for the treatment of madness, including the
use of alchemy and magic (and even occult faith healing) to calm the disturbed mind. Whether insanity
is purely biologic or an element of addiction, brought on by gradual decline or a sudden, sharp break,
you will find a wealth of information for incorporating insanity into your Pathfinder campaign in an in-
depth way that does not degenerate into simple stereotypes but gives your heroes and villains alike some
real depth in their disturbia!
The Legendary Games tradition is to combine rich story and background, innovative layout, beautiful
aesthetics, and excellence in design that is second to none. This product is the latest in that tradition,
and we hope you enjoy using it as much as we enjoyed making it. Game on!
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Table of Contents
Introduction ................................................................................................................ 2
The Nature of Madness ........................................................................................... 2
Threats to Sanity ........................................................................................... 3
Maladies ................................................................................................................ 4
Elements of Maladies ........................................................................................... 6
Specific Maladies ........................................................................................... 7
Maladies for NPCs ...................................................................................................... 19
The Treatment of Madness ........................................................................................... 21
Alchemy ................................................................................................................ 21
Magic ................................................................................................................ 23
Ioun Stones ...................................................................................................... 23
Suggestions for the GM ........................................................................................... 24
Tables
Table 1: Effects of Sanity Threat 4
Table 2: Severity 4
Table 3: Psychopharmacological Mixtures 23
Table 4: Psychotropic Ioun Stones 24

MADNESS: A Word About Mental Illness
AN ALTERNATE While skulking ghouls, magic swords, and treasures
hoards are things of the imagination common to RPGs,
APPROACH mental illness itself is very real. Many people suffer from
such disorders, ranging from mild to debilitating. It isn’t
the purpose of this section to mirror the experience of
The looming specter of madness has been a staple of horror true mental illness with perfect precision, nor is the
films and literature for ages. Witness the murderous narrator intention to make light of conditions with which many
of Poe’s The Tell-Tale Heart, whose hallucinations of his victim’s struggle. The endeavor is to provide verisimilitude
eponymous organ beating beneath the floorboards drive him for the use of madness in the roleplaying experience.
to confess his crime. Or consider the unhinged giggles of This information shouldn’t be considered an accurate
Professor Dexter Stanley as he recounts the attack of a sharp- representation of such afflictions. And of course, anyone
toothed monstrosity that emerges from an ancient crate in in emotional pain is encouraged to seek the assistance of
a chapter of the campy horror anthology Creepshow. And trained mental health professionals.
Lovecraft—heavens save us! If nothing else, Lovecraft’s tales
proclaim that the barrier between rationality and gibbering
lunacy is paper thin, forever threatened by even the smallest Rather than present complex disorders that involve
glimpse of forbidden knowledge. a constellation of symptoms, this chapter describes an
approach involving a variety of specific symptoms of
madness called maladies. A character may suffer from a
Traditionally sanity has been represented in heroic fantasy single malady or many, depending on how profoundly sanity
RPGs as one more resource pool to manage, or madness as has been damaged.
another de-buffing effect shrugged off as easily as poison or
disease. But it can be more. The first question a GM must
answer is what role should madness take in my horror Threats to Sanity
campaign? Is it just one element of many, or is it a central Any creature with an Intelligence score of 3 or higher is
threat endemic to the perilous endeavors your players’ susceptible to developing maladies. This includes creatures
characters undertake? This section seeks to expand the role immune to conditions and damage that affect the mind: while
of madness for GMs and players who wish to make it a vital they are more resistant to the effects of madness, gaining
element of the story, a danger not so easily dismissed. a boost to saves vs. events that threaten the development
of maladies (1 + the creature’s Charisma bonus), they are
nonetheless vulnerable.
THE NATURE OF The GM must be the final arbiter to determine what

MADNESS events and circumstances threaten sanity. The following are
suggested sources.
“Madness” is a broad and imperfect term, with some of Damage to Mental Abilities: any event that causes mental
its manifestations far more severe than others. It’s a blanket damage (hit point loss, spell effects, or trauma at the GM’s
term for the diverse consequences of wear on and damage discretion) risks the development of a malady. Whenever this
to a character’s mental wellness. But damage to a creature’s damage occurs, a Wisdom saving throw is required, with a DC
mental wellness can impact not only the abilities, but often of 15 for minor maladies and 18 for major ones. If a character
the very means by which what is and isn’t real is discerned. The suffers additional mental damage, the Wisdom saving throw
latter is called reality testing: the process of employing reason DC is the same as above +1 for each minor malady and +3
and the five senses to ascertain exactly what’s happening in for each major malady, and is at greater risk of developing
the environment and the proper response. Nearly everything a more serious malady of greater severity (see footnotes for
we do depends on trust in those faculties. While magic can Tables 1, page 4 and 2, page 4).
toy with perceptions, madness truly pulls the rug out from
under a character, for the distortions come from within.
Magic: Spells and spell-like abilities/effects that specifically
target sanity (such as modify memory, feeblemind, or mind blank)

run the risk of leaving permanent mental scars: after being the sanity of those who expose themselves to such dangerous
restored from the spell’s effects, the victim must make an wisdom. In cases for which the description of the tome (or
additional Wisdom saving throw (DC equal to 10 + the spell whatever medium through which a character might receive
level) to avoid developing a malady. the knowledge) doesn’t state a Wisdom saving throw DC, a
determination must be made by the GM.
Divination: Probing the mind of an insane individual
is an enormous risk, potentially inflicting madness on an Trauma: Traumatic experiences have the potential to
incautious diviner. Anyone who employs divination spells cause long-term mental harm. However, the GM must often
that affect the mind, spell-like abilities, or magic items determine what constitutes sufficient trauma to warrant a
duplicating such spells against a target afflicted with one or Wisdom saving throw and its DC.
more maladies must make a Wisdom saving throw to avoid Physical: Physical trauma sufficient to threaten sanity
harm from contact with a disturbed psyche (DC equal to should generally be massive damage, injuries that threaten an
10 + the target’s highest mental ability score). Communing individual’s sense of self, or prodigious pain. For instance, if a
telepathically with a creature suffering from maladies may character sustains damage greater than half her hit points in a
also represent a threat to one’s sanity. single attack or loses an eye or limb in an encounter, or suffers
agony equivalent to a Symbol spell with the pain effect.
Forbidden Knowledge: Certain types of knowledge, often Emotional: Adjudicating the effects of emotional trauma
contained within coveted and forbidden tomes, threatens is trickier. Possible emotional trauma may result from

TABLE 1: EFFECTS OF SANITY THREAT witnessing a close ally’s especially gruesome death or an ally
dying due to the character’s negligence or failure (such as a
d% 1, 2
Result 3
failed skill check).
01–05 Character suffers no additional effects.
Mental: Exposure to bizarre dimensions or alien
06–08 Character assumes the frightened condition for mindscapes that violate natural laws can cause great mental
3d4 rounds. strain for those unused to them. A character may normally
09–11 Character rendered unconscious for 3d4 rounds be shaken upon leaving a strange dreamscape, but dying in a
12–15 Character behaves as though under the effects of nightmare plane could cause enough distress to permanently
a confusion spell for 3d4 rounds. damage the psyche. Exposure to particularly powerful haunts
or psychic residue of past atrocities might also warrant a Will
16–18 Insomnia save to avoid developing maladies.
19–22 Kleptomania
23–25 Hypochondriasis Results of Exposure: When exposed to trauma sufficient
26–28 Compulsions to threaten sanity, the traumatized creature must make a
29–31 Phobia, Object Wisdom saving throw (DC equal to 10 + Encounter’s Challenge
Rating, barring special circumstances that would alter the
32–34 Phobia, Activity/Situational
DC). Failure indicates that the creature’s mind was unable
35–37 Despair to withstand the assault and a roll is then required on Table
38–40 Intermittent Explosive Episodes 1. The onset for all maladies is 1d20-1 hours following the
41–43 Alexia affecting episode, a result of 0 meaning onset is immediate.
44–46 Tic, Intentional Vocalization

1
For results greater than 15, an additional roll on Table 2
47–49 Panic Attacks
is required.
50–37 Intentional Tremor
For characters with a pre-existing mild or moderate
2
53–40 Tic, Chronic Vocalization malady, a result in the 6 – 15 range indicates that the existing
56–43 Hysterical Deafness condition has worsened by one step.
59–46 Tic, Chronic Motor
62–49 Hysterical Blindness TABLE 2: SEVERITY
65–52 Delusions, Erotomanic d101 Result2
68–55 Aphasia 1–5 Mild
71–58 Dyspraxia 6–8 Moderate
74–75 Amnesia, Anterograde 9–10 Severe
76–77 Amnesia, Retrograde 1
For maladies with a severity range that doesn’t span the
78–79 Hallucinations, Gustatory full continuum (mild to moderate or moderate to severe),
treat a result outside the range as moderate.
80–81 Hallucinations, Olfactory
82–83 Manic Episodes
84–85 Paranoid Ideation
86–87 Schizophasia MALADIES
88–89 Delirium Below are descriptions of many forms of madness, both
90–91 Akinetopsia neuroses and psychoses. Some of these maladies fall into broader
categories, which are discussed first. Those maladies requiring
92–93 Delusions, Grandiose
creative input from the GM (that is, conditions for which the GM
94–95 Formication must flesh out details) are marked with an asterisk.
96–97 Hallucinations, Auditory
98 Hallucinations, Visual Amnesia: Amnesia is an overarching term for maladies
99 Hallucinations, Command involving problems with retrieving old memories or
developing new ones. Role playing memory loss is
100 Catatonic Stupor

were a cleric.” When the character attempts such a feat and
fails, this can be blamed on the monster’s Wisdom saving
throw or some other extraneous factor. If the player starts
voicing disbelief in the alleged abilities or skills, a Wisdom
saving throw is required to actually disregard the belief in
the moment; otherwise the character insists on employing
this nonexistent ability or skill in circumstances that fit the
exercise thereof.
Two types of delusions are detailed here to afflict PCs,

though several other types exist.
Dementia: Dementia encompasses a number of conditions,

usually the result of brain damage or deterioration. For the
purposes of roleplay, forms of dementia are reimagined
here as episodic to chronic conditions affected by periods
of stress.
Hallucinations: Hallucinations are perceptions in one of

the five senses created by the afflicted character’s own mind.
Their reality is as compelling for the sufferer as any other
sensory perception and are thus very difficult to disregard.
Hallucinations don’t combine sensory modalities; that
is, a hallucination doesn’t have both auditory and visual
components. Of course, a character afflicted with both types
problematic at best: how does one believably pretend not of hallucinations could experience the two simultaneously—
to know something? As a result, the two types of amnesia they would simply not be working in concert.
described here are less severe conditions more amenable for
roleplay. For a more all-encompassing form of amnesia, see Phobias: A phobia is an outsized, recurrent fear of an
Maladies for NPCs below. activity, situation, or object that creates powerful dread in
the sufferer as well as a strong compulsion to avoid it or flee.
Delusions: Delusions are strongly held beliefs for which Naturally anyone would experience fear in circumstances
there is no external reality validating the passion with which met routinely by characters in fantasy RPG—giant vermin,
afflicted individuals hold them. Essentially the creation of demons from the Abyss, stalking undead. For a character
the afflicted’s mind, oftentimes perceptions and information afflicted with a phobia, however, that fear is pathological in
are unwittingly distorted so as to support the irrational its intensity, affecting the ability to face fear and function in
beliefs. an encounter. A phobia might be very specific. For instance,
a pathological fear of vampires. However, this circumscribed
phobia may grow more generalized over time, eventually
Delusions depend mightily on the GM to flesh out and encompassing all corporeal undead. Phobias most often
make real for the player, and this is done in part by providing arise out of traumatic exposure to the feared activity/object/
that player with false information. For instance, if a character situation. Perhaps one’s life was threatened by the phobia’s
survives an encounter with creature that causes mental focus, or the frightening exposure occurred at a crucial stage
damage and ends up with moderate grandiose delusions as a of a character’s formative years.
result, inform the player that the character somehow inherited
new or improved skill bonuses or other abilities somehow
connected to the slain creature: “By slaying this allip you The severity of the phobia determines how difficult it is for
have gained an incredible subtlety and lightness of step (this the character to function in those circumstances. The phobic
translates to Advantage on Stealth checks)”; or “Undead now activity/object/situation conjures up a primordial urge within
fear you. When you encounter any undead creatures of equal the afflicted character to flee—the action is so primitive that
or lower challenge rating, you may turn them as though you it’s conceivable an afflicted individual unnecessarily attacks
allies in the path of retreat in order to escape. When flight is

impossible, the fear paralyzes the sufferer or promotes some
irrational, potentially dangerous reaction. For example, if a
Elements of Maladies
Maladies have the following elements: type, save DC, trigger,
character has a fear of heights (acrophobia), an initial failed duration, and effect.
Wisdom saving throw means that the afflicted individual
simply refuses to walk across the narrow ledge above the
chasm. However, if the afflicted character succeeds on the first
Wisdom saving throw and the crossing requires three rounds,
Type
Maladies are classified as either a neurosis or a psychosis.
failing on the second Wisdom saving throw means the sufferer
becomes paralyzed half way across the gap, or impulsively Neurosis: Also known a “nervous” condition, neuroses are
grabs hold of the ally next to her. As always, the GM must more common mental afflictions that affect an individual’s
adjudicate each situation, keeping these things in mind. emotional state and functioning. Generally more easily
managed than psychotic conditions, neuroses are also more
amenable to control and cure.
Tics: Tics are involuntary nervous movements or
Psychosis: A psychotic condition is a more profound mental
vocalizations that are recurrent and odd to those who witness
disturbance that affects the afflicted individual’s perception
them. As a result, those who interact with a character so afflicted
of reality and/or profoundly impairs functioning. It’s also
tend to assume sufferers are somehow strange, untrustworthy,
generally much more resistant to efforts at control or cure.
or potentially dangerous. Tics are typically caused by mental
trauma or damage done to the brain by substance abuse.
Severity
Due to their involuntary nature tics are difficult to control. Most maladies have a range of severity representing its
Those attempting to suppress such symptoms must devote strength and the nature of its effects. While most forms
all of their focus to the purpose unless aided by alchemical range from mild to severe, some have a narrower continuum.
agents or magical assistance. Attempting to do so is the
equivalent of an attack action and can be continued as long as
the afflicted individual desires, so long as she is able to make Save
Wisdom saving throws each round. Successfully suppressing Listed here is the Wisdom saving throw DC for resisting
a tic reduces it one level of severity, with mild tics rendered the effects of the malady (when possible) and warding off
undetectable. A chronic tic’s effects simply resume at their a worsening of the condition. The entries are listed as DC
normal intensity as soon as the character stops suppressing (mild)/(moderate)/(severe) Wisdom.
it, but with a triggered (intentional) tic there is rebound, and
it becomes chronic for a full 1d4+6 minutes, regardless of
what activity follows. Trigger
A trigger refers to the circumstances wherein a malady
manifests its effects. When a trigger occurs, the afflicted
Terrified individual must make a Will save to avoid manifestation of
Terrified is a new condition affecting those suffering from the malady. Chronic maladies don’t have triggers.
some maladies. A terrified character is so overwhelmed Proximity: Maladies triggered by proximity are those
by fear she becomes physically paralyzed, unable to act in tied to specific objects, locations, or situations (being in a
nearly any way. The character can stutter a single word if she graveyard at night).
can succeed on a DC 20 Wisdom saving throw, but no more. Random: Some maladies are extremely unpredictable,
Even in a dangerous situation, such as crossing a narrow triggered seemingly at random. The character must make
ledge over a precipitous drop, the character freezes in place. a Will save every hour to determine if the malady asserts
If an ally is in an adjacent square, the character must make its effects.
a DC 20 Wisdom saving throw to avoid taking the irrational
action of attempting to grapple the ally. This is true even Stressor: The most common trigger, maladies triggered by
if this could prove potentially fatal for both characters. An stressors are those which manifest during encounters that
ally may attempt to break the character out of the terrified potentially impact the status or well-being of the afflicted
condition through a successful DC 20 Wisdom (Medicine) character or allies. At the outset of the stressor the character
check, but this is the equivalent of an attack action. must make a Will save to determine if the malady asserts its
effects. Stressors include combat, disarming a trap, engaging
in an act requiring a skill check, encountering a haunt, or
other circumstances at the GM’s discretion.

Duration
The length of time the ill effects of a malady last when
triggered. The effects of chronic maladies are always active.
Effect
The effect of a malady is how it alters the afflicted character’s
behavior, perceptions, and experiences when triggered.
While many maladies cause penalties to various checks, they
also produce effects that can directly affect the storyline due
to a character’s altered perceptions and impaired reality
testing. Effects can differ not only by intensity across levels
of severity, but in the way they manifest.
Specific Maladies
AKINETOPSIA (DEMENTIA)
Type: psychosis; Severity mild to severe; Save DC 17/19/21 Wisdom
EFFECTS
Trigger —; Duration chronic
Effect
Mild—The afflicted character suffers a -2 penalty to AC, as
well as Dexterity (Acrobatics) checks and Dexterity saving
throws involving movement (for instance, attempting to
grasp a swinging rope or grabbing a ledge to avoid falling
into a pit). The same -2 penalty applies to any attack roll
in which the target is in motion, or to a Dexterity check
Moderate—As mild, save that subsequent checks are made
to open a lock or disable a device on targets with moving
at -2.
parts.
Severe—As mild, save that subsequent checks are made at -3.
Moderate—As mild, save that the penalty is -3.
Severe— As mild, save that the penalty is -4. DESCRIPTION
A character suffering from alexia is experiencing impairment
DESCRIPTION
in the ability to recognize letters and pictographic writing.
A character suffering akinetopsia, also known as motion As a result, any activity that requires reading, interpreting
blindness, has great difficulty perceiving movement. This symbols, or the like requires a Wisdom saving throw to
has a significant impact on any activity involving hand-eye succeed in addition to any skill checks normally associated
coordination and judging the movement of targets. with the act, which are also performed with a penalty.
ALEXIA (DEMENTIA) AMNESIA, ANTEROGRADE

Type: psychosis; Severity mild to severe; Save DC 12/16/18 Wisdom Type: psychosis; Severity moderate to severe; Save DC 18/20 Wisdom
EFFECTS EFFECTS
Trigger special; Duration chronic Trigger —; Duration chronic
Effect Effect When leveling up, a character suffering from this form
Mild—The afflicted character must make a Wisdom saving of amnesia doesn’t gain any new abilities, skills, or spells.
throw when doing any sort of reading or deciphering of Casters who memorize spells daily must make a Wisdom
symbols, failure indicating that she is unable to decode saving throw in order to commit each spell known before
the text. If the save is successful, any check required with onset of the amnesia to that day’s repertoire.
the reading is made at -1.

DESCRIPTION EFFECTS
This malady affects the afflicted character’s ability to form Trigger proximity or stressor; Duration until the compulsion is
new memories. As a result, at an opportunity to level up she indulged or following 3 consecutive Wisdom saving throws
doesn’t gain the benefit of new skills, spells, and abilities. Effect
Skills, spells, and abilities already known before the onset of Mild—The afflicted character assumes the frightened
the amnesia are unaffected by it, with improvements in those condition (with an additional -1 penalty to Wisdom
abilities determined by level increasing normally. (Perception) checks due to distraction) until the
compulsive behavior is executed, which occupies the
equivalent of an attack action.
AMNESIA, RETROGRADE Moderate—The afflicted character assumes the frightened
Type: psychosis; Severity mild to severe; Save DC 13/16/20 Wisdom condition (with an additional -2 penalty to Wisdom
(Perception) checks) until the compulsive behavior is
EFFECTS
executed, which occupies 2 full rounds.
Trigger —; Duration chronic
Severe—The afflicted character assumes the frightened
Effect
condition (with an additional -4 penalty to Wisdom
Mild—The afflicted individual takes a -2 penalty to all
(Perception) checks) until the compulsive behavior is
Arcana, History, Insight, Medicine, Nature, or Religion
executed, which occupies 4 full rounds.
skill checks. Casters who rely on memory for spells must
make a Wisdom saving throw to avoid spell failure when DESCRIPTION
casting. A compulsion is a repetitive, often nonsensical behavior a
Moderate—As mild, save that the afflicted individual takes a character feels deeply compelled to perform in order to
-3 skill check penalty. reduce a sudden surge of overwhelming anxiety. The time
Severe—As mild, save that the afflicted individual takes a -4 consumed by the behavior, whether a physical act (hand
skill check penalty. washing, touching an object a number of times, making a
series of gestures) or mental act (counting bricks in a wall,
DESCRIPTION repeating a specific phrase mentally), is dependent on the
This malady affects the afflicted character’s ability to retrieve severity of the compulsion.
memories. While the ability to form new memories is
unimpaired, recalling them later is still affected.
CATATONIC STUPOR
Type: psychosis; Severity mild to severe; Save DC 15/17/20
APHASIA (DEMENTIA) Wisdom
Type: psychosis; Severity mild to severe; Save DC 11/13/17 Wisdom EFFECTS
EFFECTS Trigger stressor; Duration varies
Trigger —; Duration chronic Effect
Effect Whenever listening to a speaker who is employing Mild—The afflicted assumes a condition of near
a language other than the afflicted’s native tongue, a immobility for 6d6+4 rounds, during which she is almost
Wisdom saving throw is required to determine if the completely unresponsive to external stimuli, even to the
character is able to comprehend what is said. point of total passivity when being attacked. The sufferer
assumes the Incapacitated condition while catatonic but
DESCRIPTION
may be roused to consciousness by an ally succeeding on
Characters with aphasia have difficulty understanding spoken a DC 17 Wisdom (Medicine) check, though the effort to
language. When listening to a speaker who is employing a do so is an attack action requiring 1d3+1 rounds.
language other than the afflicted individual’s native tongue,
a Wisdom saving throw is necessary to determine if she can Moderate—As mild, save that the episode lasts 2d6+4
comprehend what is spoken. Strangely enough, reading minutes. The sufferer may be roused from the condition
comprehension is unaffected by this malady. by an ally succeeding on a DC 21 Wisdom (Medicine)
check, though the effort itself requires 1d3 minutes.
Severe—As mild, save that the episode lasts 2d6 hours.
*COMPULSIONS The sufferer may be roused from the condition by an
ally succeeding on a DC 24 Wisdom (Medicine) check,
Type: neurosis; Severity mild to severe; Save DC 10/12/14 Wisdom though the effort itself requires 10-30 minutes.

DESCRIPTION Effect
This severe condition of unresponsiveness leaves the Mild—During the episode, all Dexterity saving throws,
sufferer apparently oblivious to all external stimuli, drooling Initiative rolls, skill checks, and saves vs. magic that
and staring off into space, glassy-eyed. The sufferer may affects the mind are made at -2. Casters also have a 20%
be curled into a ball on the ground or remain in the same chance of spell failure and using scrolls is problematic
position for the duration of the episode. The condition is as well, with a 20% chance the spell fails and the item is
almost indistinguishable from unconsciousness, save for wasted.
two odd features. First, catatonic characters assume waxy Moderate—As mild, save that the penalty is -4 and scroll/
flexibility: they can be positioned by another into a pose spell failure is 40%.
which is then held indefinitely. And second, the individual Severe—As mild, save that the penalty is -6 and scroll/spell
may repeat a phrase in a murmuring, barely audible tone. failure is 60%.
Another individual can actually cause a catatonic individual
to repeat a phrase of her choosing by whispering the words DESCRIPTION
several times in the ear of the afflicted and succeeding on a Delirium involves an episode of disturbed consciousness
DC 17 Charisma check. and focus, affecting the sufferer’s thinking, attention, and
memory. An individual experiencing delirium may not
necessarily recognize her impairment during the episode
DELIRIUM unless she succeeds on a DC 20 Wisdom (Perception) check
Type: psychosis; Severity mild to severe; Save DC 13/27/20 Wisdom Note: If a character afflicted with delirium has a mental
ability score reduced to 0, the delirium is permanent until
EFFECTS
the ability score is fully restored.
Trigger stressor; Duration 3d4 rounds

*DELUSION, EROTOMANIC this skill or ability, she insists on employing it unless she
verbalizes disbelief and succeeds on a Wisdom saving
Type: psychosis; Severity mild to severe; Save none (see below)
throw. Needless to say, such delusions can place the afflicted
EFFECTS individual and her allies in potentially deadly situations. The
Trigger —; Duration chronic GM is responsible for tailoring the delusional belief to the
Effect circumstances in which the malady formed.
Mild—The afflicted insists on taking the lead in any
diplomatic effort, negotiation, or bluff attempt unless
an ally can dissuade her successfully—this requires a DESPAIR
Persuasion check (DC equals 4 + the afflicted character’s
Type: neurosis; Severity mild to severe; Save DC 10/12/15 Wisdom
Charisma score). The character makes all social skill
checks at a -2 penalty. EFFECTS
Moderate—As mild, save that the Persuasion check DC Trigger —; Duration 24 hours
to dissuade the afflicted is 6 + the afflicted character’s Effect
Charisma score. Mild—The afflicted character suffers a -1 penalty to all
saving throws, Initiative checks, and Charisma-based
Severe— As mild, save that the Persuasion check DC to
skill checks. However, a natural cynicism makes the
dissuade the afflicted is 8 + the afflicted character’s
afflicted character less susceptible to
Charisma score.
deception, gaining a +1 bonus to
DESCRIPTION Wisdom (Perception) checks made
A character with erotomanic delusions mistakenly believes to determine motive.
that she possesses overwhelming charm and is thus Moderate—As mild, save that
especially persuasive and irresistible to others. As a result, in the penalty is increased to -2.
situations calling for inducement and diplomacy, she insists Also, when confronted by an
on being the group’s representative. In truth, the character’s obvious danger, the character
arrogance and overconfidence actually impairs such must make a Wisdom saving
interactions. Characters with erotomanic delusions can throw or succumb to self-
cause rather uncomfortable situations to escalate to outright destructive impulses to seek
hostilities by disregarding social norms. For instance, it out. In a combat situation
boldly approaching a person of considerably higher this means getting in the front
social standing in violation of etiquette or even local laws lines and fighting recklessly,
might result in unwanted attention or rebuke. Such a resulting in a -2 penalty to
character is also likely to suggest negotiation AC. Allies may attempt to
or diplomacy in circumstances where grapple the character: this
the level of hostility wisely provides a renewed save
counsels otherwise. opportunity to resist the
harmful impulse.
Severe—As moderate,
*DELUSIONS, GRANDIOSE save that the penalty
Type: psychosis; Severity mild to severe; Save DC 15/28/20 is increased to -3. In
Wisdom addition to recklessness
in danger, following an
EFFECTS
intense encounter (such
Trigger —; Duration chronic as a combat encounter
Effect The afflicted believes that she possesses special lasting more than 2
powers and abilities and insists on exercising those rounds), the afflicted
powers when an opportunity presents itself unless character must make a
disbelief is verbalized and a Wisdom saving throw is made. Wisdom saving throw
DESCRIPTION each round or deal 1d8
A character with grandiose delusions mistakenly believes points of damage plus Strength modifier to
that she has powers or abilities not truly possessed. When self with any item at hand. Grappling by allies
an opportunity occurs in which the character might exercise provides an additional save attempt, the episode of self-
harm lasts 2d4+2 rounds otherwise.
10

DESCRIPTION Severe—As moderate, save that the penalty is -4 (-8 for
A character suffering from despair experiences despondency Charisma-based skill checks) and the episode lasts 4d4
and ennui that significantly impacts functioning, perhaps rounds. Furthermore, during an episode, the afflicted
even sapping the will to live. Each morning the afflicted suffers 1d2 points of damage per round from her
character must make a Wisdom saving throw or suffer the attempts to root out the hallucinatory vermin, and 1
effects of despair for a full day. point of bleed damage from the severe abrasions and
lacerations caused by the scratching until these wounds
can be tended or a period matching the episode has
DYSPRAXIA (DEMENTIA) passed. There is also a 10% chance during an episode that
the afflicted inadvertently cuts an artery, causing 1d4+3
Type: psychosis; Severity mild to severe; Save DC 11/13/17 Wisdom points of piercing damage a round until the wound is
EFFECTS healed or the afflicted dies.
Trigger special; Duration varies DESCRIPTION
Effect Whenever a character attempts to employ speech,
A character experiences tactile hallucinations, the unnerving
a Wisdom saving throw is required to determine if
sensation of bugs or worms crawling beneath the surface
what comes out is unintelligible gibberish. This would
of her skin. So real is this sensation that in extreme cases
prevent the casting of spells with verbal components.
a character will abrade and cut her own flesh to get at the
DESCRIPTION insidious vermin thought to lurk within.
A character afflicted with dyspraxia has difficulty articulating
speech, rendering them essentially mute when the malady
asserts itself. If a character wishes to speak for any reason, *HALLUCINATIONS, AUDITORY
a Wisdom saving throw is required. Failure indicates that Type: psychosis; Severity mild to severe; Save DC 13/17/20 Wisdom
the afflicted may not attempt to do anything involving
EFFECTS
speech for 1d4 rounds, after which another Wisdom saving
throw is possible. Strangely enough, a bard’s ability to Trigger special; Duration varies
sing is unimpaired by this malady, though any other verbal Effect
performance (such as comedy or oratory) is. Mild—The character suffers a -1 penalty to all Initiative and
Wisdom (Perception) checks, as well as any other activity
that requires focused attention (such as disabling a trap
FORMICATION or casting a spell).
Moderate—As mild, save that the penalty is -2 and once
per hour the afflicted must make a Wisdom saving
EFFECTS throw to resist the urge to shout for the voices to “shut
Trigger stressor; Duration varies up” or otherwise argue back, which can make for rather
Effect awkward social situations.
Mild—When triggered and the Wisdom saving throw is Severe—As moderate, save that rather than resist an urge
failed, a character with formication begins scratching to yell back at the voices, the afflicted instead carries on
roughly at her flesh. The distraction and emotional a conversation with these imagined voices, whispered
strain of the experience causes the afflicted to suffer a if the character knows she’s in the presence of others.
-1 penalty to all skill checks, attack and damage rolls, Furthermore, when others are speaking, the voices inform
Initiative checks, and double that for all Charisma-based the afflicted that the speaker is somehow untrustworthy
skill checks. Even when the formication isn’t active, or lying, making all Deception or Persuasion checks with
Charisma-based checks are still made at -1 if the afflicted such a character more difficult (-3 penalty).
individual’s abrasions from chronic scratching are
visible. The episode lasts 2d4 rounds. DESCRIPTION
Moderate—As mild, save that the penalty is -2 (-4 for Auditory hallucinations are sounds or voices that have the
Charisma-based skill checks) and the episode lasts 3d4 quality of reality and are experienced outside the afflicted
rounds. Furthermore, during and after an episode, the individual’s head, as any other sound is experienced. These
afflicted suffers 1 point of piercing damage from the hallucinations vary widely in what triggers them, as well as their
severe abrasions and lacerations caused by the scratching duration and nature, based on severity. Note that the GM must
until the wounds can be tended or a period matching the employ creativity in describing the hallucinations, drawing
episode’s length has passed. from a theme or specific threats the PCs have discussed facing.
11

Mild: The afflicted hears vague, muffled whispering with DESCRIPTION
great frequency that she cannot comprehend, resulting A subtype of auditory hallucination, a character experiencing
in chronic distraction. command hallucinations hears insistent, compelling voices
Moderate: The afflicted hears voices carrying on a directing them to violent acts,either to harm another or themselves
demeaning, negative running commentary on her (equal chance). The afflicted may try to resist the command with
behavior. a Wisdom saving throw, breaking the hallucination, but leaving
Severe: As moderate, save that in addition to the negative the creature frightened for 1d4+2 rounds.
commentary, the voices also verbalize paranoid thoughts
about any other persons who are speaking (including
allies), suggesting that they are untrustworthy or lying. *HALLUCINATIONS, GUSTATORY
Wisdom
EFFECTS
Trigger stressor; Duration 2d6+3 rounds
Effect
Mild—The afflicted experiences a powerfully unpleasant
psychogenic taste and is poisoned for the duration of
the hallucination.
Moderate/Severe—As mild, save that each round the afflicted
must make a Constitution saving throw equal to the
Wisdom DC to prevent themselves from vomiting and
assuming the poisoned condition for that round.
DESCRIPTION
During times of stress, the afflicted individual’s mouth
experiences a flooding of some extremely repellent
taste, poisoning her and potentially leading to bouts of
debilitating nausea.
*HALLUCINATIONS, OLFACTORY
Type: psychosis; Severity mild to moderate; Save DC 15/20
Wisdom
EFFECTS
Trigger random and stressor; Duration 2d6+3 rounds
Effect
Mild—The afflicted experiences a powerfully unpleasant
psychogenic odor and as a result is poisoned for the
HALLUCINATIONS, COMMAND duration of the hallucination and otherwise takes an
additional -1 penalty to Wisdom (Perception) checks.
Creatures who rely on scent for tracking are unable to
EFFECTS employ this skill when experiencing these hallucinations.
Trigger stressor; Duration until resisted, the character restrained, Moderate—As mild, save that each round the afflicted must
or 2 consecutive saves are made make a Constitution saving throw equal to the Wisdom
Effect Compelled by authoritative voices, the afflicted DC to prevent themselves from becoming poisoned for
creature must make a Wisdom saving throw or either that round.
self-inflicts 1d8 damage per round with whatever is at
hand or physically attacks the nearest creature (including DESCRIPTION
a familiar) until 2 consecutive Wisdom saving throws are During times of stress and also seemingly at random, the
made or restrained by allies. afflicted individual experiences an extremely unpleasant
odor—rotting flesh, offal, ammonia, burning hair, vomit,
12

etcetera. Once per hour and at the beginning of any stressor, HYPOCHONDRIASIS
the afflicted must make a Wisdom saving throw or experience
the hallucination and suffer its effects.
EFFECTS
Trigger proximity; Duration Until indulged or 2 consecutive
*HALLUCINATIONS, VISUAL Wisdom saving throws
Effect
Mild—The afflicted character assumes the poisoned
Wisdom
condition and seeks out healing or aid for imagined or
EFFECTS exaggerated injuries or illness.
Trigger varies; Duration varies Moderate—As mild, save that the character is poisoned and
Effect suffers disadvantage on all saving throws.
Mild—Once per hour or during times of stress the afflicted
Severe—The afflicted character assumes the stunned
must make a Wisdom saving throw or experience
condition and seeks out healing or aid.
vague, peripheral hallucinations. Due to this unnerving
distraction, the afflicted suffers a -2 penalty to all DESCRIPTION
Perception, and Initiative checks. Concentration may be This malady exaggerates an afflicted character’s concern
broken at the GM’s discretion. for health and well-being. Unless a Will save is made,
Moderate—As mild, save that during times of stress whenever the character witnesses another with an injury
the hallucination is front and center and takes on a or illness requiring treatment, or hears discussion of some
threatening demeanor. The character feels compelled disease, she experiences deep distress until aid is received
to focus attacks on this non-existent creature until it comparable to what the injury or disease would normally
vanishes 2d4+2 rounds later. If the PC verbalizes disbelief, require. This includes any healing measure such as lesser
a Wisdom saving throw is required to successfully restoration, channeling of positive energy, protection from
ignore the hallucination, which dissipates 1d4+1 rounds poison, greater restoration, or the like. The afflicted can be
later. Note that real creatures in close proximity of the temporarily mollified by a lesser measure (say, cure wounds),
hallucination may be inadvertently harmed by the but 1d4 rounds later another Wisdom saving throw must be
afflicted individual’s attacks. made or the distress returns.
Severe—As moderate, save that the terror generated by
this more vivid and “real” hallucination is such that the
afflicted also assumes the frightened condition during HYSTERICAL BLINDNESS
the hallucination’s existence. Type: neurosis; Severity mild to severe; Save DC 10/12/15 Wisdom
DESCRIPTION EFFECTS
A character with visual hallucinations sees things that have Trigger stressor; Duration varies
the appearance of reality but are in fact creations of the Effect
mind. These hallucinations vary widely in appearance, and Mild—The afflicted character assumes the blinded
thus the GM must employ creativity in describing them, condition for 1d6+4 rounds or until 2 consecutive
drawing from a theme or specific threats the PCs have faced Wisdom saving throws are made, whichever comes first.
or anticipate facing. Moderate—As mild, save that the character is blinded for
Mild: The afflicted experiences passing forms or shadows 1d4+6 minutes or until 3 consecutive Wisdom saving
in the periphery of her vision, both at random and throws are made.
during episodes of significant stress. These work Severe— As mild, save that the character is blinded for 1d4+1
best if the GM first asks the player for a Wisdom hours or until 3 consecutive Wisdom saving throws are
(Perception) check, reporting the hallucination as a made.
real thing.
DESCRIPTION
Moderate & Severe: The afflicted experiences random
peripheral hallucinations (as above), but also witnesses Sufferers of this malady experience psychogenic blindness
a threatening form advancing menacingly upon her under stressful circumstances. While there is no physiological
during times of stress. reason for this loss of vision, there is no practical difference
between this condition and actual blindness.
13

INSOMNIA
EFFECTS
Trigger special; Duration Until the character has a full night’s
undisturbed sleep
Effect
Mild—Unless the afflicted makes her Wisdom saving
throw, she doesn’t benefit from some of a long rest’s
restorative effects (such as natural healing of hp). During
the following day the character suffers -1 penalty to all
Intelligence-based skill checks, Initiative checks, and
Wisdom saving throws. Spells normally recovered during
sleep have a 10% chance of failure when cast. After 3
consecutive days of such disturbed sleep the condition
escalates to moderate.
Moderate—As mild, save that the penalties increase to -2
and include all skill checks and spell failure increases to
20%. There is also a 10% chance during stressful events
the afflicted experiences mild visual hallucinations. After
3 consecutive days of such disturbed sleep the condition
escalates to severe.
Severe—As mild, save that the penalties increase to -3 and
the chance of spell failure is 30%. There is also a 25%
chance during stressful events the afflicted experiences
moderate visual hallucinations. After 3 consecutive days
of such disturbed sleep the afflicted begins suffering
2d10 points of damage during each restless night.
DESCRIPTION
HYSTERICAL DEAFNESS Insomnia is disturbed sleep during which the sufferer
Type: neurosis; Severity mild to severe; Save DC 10/12/15 Wisdom doesn’t benefit from the full recuperative effects of a night’s
rest. Indeed, what sleep the afflicted catches is plagued by
EFFECTS bizarre and disturbing nightmares.
Trigger stressor; Duration varies
Effect
Mild—The afflicted character assumes the deafened INTENTIONAL TREMOR
condition for 1d6+4 rounds or until 2 consecutive
Wisdom saving throws are made, whichever comes first. Type: neurosis; Severity mild to severe; Save DC 11/14/17 Wisdom
Moderate—As mild, save that the character is deafened for EFFECTS
1d4+6 minutes or until 3 consecutive Wisdom saving Trigger special; Duration 2—5 rounds after the triggering
throws are made. behavior ends
Severe— As mild, save that the character is deafened for Effect
1d4+1 hours or until 3 consecutive Wisdom saving throws Mild—The afflicted character suffers a -2 penalty on all
are made. Dexterity-based skill checks.
Moderate—As mild, though penalties to skill checks are
DESCRIPTION -3, and the character suffers a -2 penalty to all ranged
Sufferers of this malady experience psychogenic deafness attacks. There is also a 20% chance of spell failure when
under stressful circumstances unless a Wisdom saving throw casting spells with somatic components.
is made. While there is no physiological reason for this loss Severe—As mild, though penalties to skill checks are -4, the
of hearing, there is no practical difference between this ranged attack penalty is -4, and the chance of spell failure
condition and actual deafness. when casting spells with somatic components is 50%.
14

DESCRIPTION Effect
Intentional tremors are focused in the hands of the afflicted, Mild—The afflicted assumes the poisoned condition.
similar to chronic tics, save that the tremulousness is triggered Moderate—As mild, save that the afflicted also assumes the
by activities involving planned actions. If a character intends frightened condition.
to employ some Dexterity-based skill, cast a spell, or make a
DESCRIPTION
ranged attack, she must also make a Wisdom saving throw or
the effects of the tremor emerge. Intentional tremors cannot This malady involves a powerful compulsion to steal objects
be suppressed once triggered. Rather, they cease 1d4+1 rounds of little or no worth to the afflicted character that is alleviated
after the character abandons or completes the triggering act. for a time if the unbidden impulse is indulged. The sufferer
feels an equally strong desire to keep a stolen object,
regardless of its value. In time the collection of meaningless
INTERMITTENT EXPLOSIVE EPISODES pilfered belongs becomes quite sizable.

EFFECTS MANIC EPISODES
Trigger stressor; Duration varies Type: psychosis; Severity mild to severe; Save DC 13/18/21 Wisdom
Effect
EFFECTS
Mild—The afflicted becomes filled with unreasoning fury
for 1d2+1 rounds. The effect is similar to a barbarian’s Trigger random; Duration 2d12 hours
rage, with the following adjustments: 1) the afflicted has Effect
no control over the episode’s termination; 2) the character Mild—The afflicted character gains a +2 bonus to Initiative
gains a +2 bonus to Strength; 3) there is no Wisdom saving checks and is immune to the exhausted condition.
throw bonus; and 4) when the episode is over the afflicted However, due to the reckless impulsiveness and impaired
character is exhausted for a number of rounds equal to judgment, the character also suffers a -2 penalty to AC
twice the length of the episode’s duration. The number of and all Charisma-based checks. In combat a save must
rounds the episode lasted are deducted from the rounds be made for the afflicted to resist an urge to fight in the
the character can employ the rage ability. Also, all Charisma- front lines.
based checks are made at -2.
Moderate—As mild, save that the fury lasts 1d4+3 rounds and
the bonus to Strength and Constitution is +3 and the social
skill penalty is -2. Also, each round in a combat situation
there’s a 25% chance that the afflicted character unknowingly
strikes out at the nearest ally rather than an enemy.
Severe—As moderate, save that the fury lasts 2d4+4 rounds,
the social skill penalty is -4, and there is a 40% chance
each round the afflicted character unknowingly strikes
out at the nearest ally rather than an enemy.
DESCRIPTION
This malady afflicts the sufferer with unpredictable episodes
of uncontrolled fury. During a combat situation such
episodes may actually aid in the encounter, though the
afflicted may unwittingly harm an ally instead. Of course, any
sort of social interaction can certainly spin out of control if
an afflicted individual experiences an episode.
KLEPTOMANIA
Type: neurosis; Severity mild to moderate; Save DC 10/12 Wisdom
EFFECTS
Trigger proximity; Duration Until indulged or 2 consecutive
Wisdom saving throws
15

Moderate—As mild, save that the bonus and penalties are
+3/-3.
Severe— As mild, save that the bonus and penalties are +4/-4.
DESCRIPTION
A period of increased energy, poor impulse control, and
impaired judgment lasting 2-24 hours. Checks for an episode
are made three times a day (morning, noon, and night).
PANIC ATTACKS
EFFECTS
Trigger proximity (cued) or random (uncued); Duration until the
afflicted character makes 3 consecutive saves or 15 minutes passes
Effect
Mild—The afflicted character assumes the frightened
condition. If the character rolls a natural 1 on any Wisdom
saving throw, the episode escalates to moderate and the
15-minute time is reset. The episode is followed by a
period of exhaustion equal to the time the panic attack
lasted. (A character with cued attacks also has a 5% chance
every waking hour to experience an uncued attack.)
Moderate—The afflicted character assumes the frightened
condition and attempts to flee the trigger situation/
location. If unable to flee, the character assumes the
incapacitated condition. If the character rolls a natural
1 on any Wisdom saving throw, the episode escalates
to severe and the 15-minute time is reset. The episode
is followed by a period of exhaustion equal to the time are cued by the verbalized speculations. When a character
the panic attack lasted. (A character with cued attacks experiences a panic attack, rather than informing her of
[see below] also has a 10% chance every waking hour to that fact, describe the symptoms, noting a trigger only if the
experience an uncued attack.) attacks are cued: “As soon as you enter the crowded bazaar,
Severe—The afflicted character assumes the incapacitated your heart begins pounding, you feel a stabbing pain in your
condition. If the character rolls a natural 1 on one of chest, you’re short of breath, and sweating profusely.” Panic
the Wisdom saving throws, the character assumes the attacks are the only malady that can shift severity within a
paralyzed condition for 3d4 rounds. The episode is single episode.
followed by a period of exhaustion equal to the time the Cued: A sudden episode of extreme anxiety that seems to
panic attack lasted. (A character with cued attacks also come in response to some specific disconcerting, frightening,
has a 15% chance every waking hour to experience an or stressful situation. When exposed to the fear cue, the
uncued attack.) character must make a Wisdom saving throw to avoid entering
a panic episode. Once the panic attack has commenced, the
DESCRIPTION
afflicted individual must make 3 successful Wisdom saving
Panic attacks are potentially debilitating episodes of throws to get the overwhelming anxiety under control. The
overwhelmingly intense anxiety. Attacks are either cued— episode is followed by a period of exhaustion.
seemingly elicited by specific situations—or uncued,
Uncued: A sudden episode of extreme anxiety that seems to
seeming to come out of nowhere. Unless an encounter
have no apparent cause. The episode is otherwise identical to
indicates otherwise, a character’s first panic attack is always
cued attacks. A person with uncued panic attacks must make
uncued. Monitor if the player enquires about what caused
a Wisdom saving throw every waking hour to determine if an
the episode: was it this or that cue that caused it? If the
attack commences.
character then fails a Wisdom saving throw, all future attacks
16

*PARANOID IDEATION DESCRIPTION
Type: psychosis; Severity mild to severe; Save DC 10/16/20 Wisdom A character with an activity/situational phobia has an
outsized fear of an activity (examples: being alone, crossing
EFFECTS
bridges, swimming) or situation/place (caves, cemeteries,
Trigger —; Duration chronic darkness, enclosed spaces, heights) which affects the ability
Effect to function when exposed and creates a powerful urge to
Mild—The afflicted makes all Charisma-based checks at avoid or otherwise flee the feared activity or situation.
-2 and must succeed at a Wisdom saving throw to allow
anyone to use a help action or offer any assistance to
the character (including healing). Persons attempting PHOBIA, OBJECT
Deception or Persuasion with a character suffering
paranoia do so at a -2 penalty as well. Type: neurosis; Severity mild to severe; Save DC 10/12/15 Wisdom
Moderate—As mild, save that the penalty is -3. EFFECTS
Severe—As mild, save that the penalty is -4. The penalty Trigger proximity; Duration 1d2 rounds after the character is no
extends to simple social niceties as well, gruffly refusing longer in the presence of the phobic object
polite offers to buy the afflicted a drink, for instance. Effect
Furthermore, a character with paranoia always takes up Mild—While in the presence of the phobic object, a
the rear of a party, not wishing to have anyone at her back. character assumes the frightened condition and must
make a Wisdom saving throw each round to resist the
DESCRIPTION impulse to flee or otherwise avoid the object (for instance,
A character afflicted with paranoid thoughts suspects that others putting others between herself and the object);
have malevolent intentions, even in contravention of rational Moderate—As mild, save that the duration lasts 1d4 rounds
evidence. Such a character is generally experienced by others as after the character is no longer in the presence of the
gruff and unfriendly, affecting Charisma-based checks. phobic object, and a result of 3 or less on saving throws
means that instead of fleeing/avoiding, the character
assumes the incapacitated condition until the object is
PHOBIA , ACTIVITY/SITUATIONAL no longer present or its perceived threat is eliminated.
Type: neurosis; Save DC 9/12/16 Wisdom Severe—As moderate, except that any saving throw below 10
EFFECTS results in the character assuming the incapacitated condition.
Trigger proximity; Duration 1d2 rounds after the character is no DESCRIPTION
longer in the phobic activity/situation An outsized fear of a character/class of characters (examples:
Effect ghosts/incorporeal undead, snakes/all reptiles) or things
Mild—The character assumes the frightened condition. (holy symbols, mirrors) which results in impairment and a
In order to operate in the feared activity/situation (for strong urge to avoid or otherwise flee the feared object.
instance, a claustrophobic individual crawling through a
narrow tunnel), the afflicted must make a Wisdom saving
throw each round the activity/situation requires. If the SCHIZOPHASIA
character fails the first roll she then refuses to enter the
activity/situation (additional attempts are possible on Type: psychosis; Severity mild to severe; Save DC 17/18/20 Wisdom
subsequent rounds). However, if a save is failed after the EFFECTS
activity/situation is entered, the afflicted assumes the Trigger stressor; Duration varies
incapacitated condition until a Wisdom saving throw is Effect
made, returning to the poisoned condition. Mild—The afflicted character speaks an uncontrollable and
Moderate—As mild, save that the duration of the frightened incoherent flood of words. Any attempted Stealth check
condition lasts and additional 2d4 rounds after the is automatically failed. The episode lasts 2d4+2 rounds.
character is no longer in the phobic activity/situation. Moderate—As mild, save that the episode lasts 3d4+3 rounds.
Severe—As moderate, except that the afflicted character Severe— As mild, save that the episode lasts 4d4+4 rounds..
is unable to enter the feared activity/situation, doing
whatever possible to avoid it or flee at top speed. If DESCRIPTION
flight is impossible, the afflicted assumes the paralyzed A character afflicted with this malady speaks an
condition until extricated by allies. uncontrollable babble of words that make no sense to any
listeners as words and phrases are joined together without
17

any logical meaning. During these episodes the afflicted is Moderate—As mild, though penalties to skill checks are -4
unable to communicate verbally with anyone and cannot cast (-2 for an ally’s checks). There is also a 20% chance of spell
spells with verbal components. failure when casting spells with somatic components.
The tics are also more easily noticed by others (DC 8
Perception).
TIC, CHRONIC MOTOR Severe— As moderate, though penalties to skill checks
Type: neurosis; Severity mild to severe; Save DC 10/13/18 Wisdom are -6 (-4 for an ally’s checks) and the chance of spell
failure when casting spells with somatic components is
EFFECTS
50%. The tics are noticed by others on a DC 5 Wisdom
Trigger —; Duration chronic (Perception) check.
Effect
Mild—The afflicted character suffers a -2 penalty on all DESCRIPTION
Dexterity-based skill checks. If the tic is detected by Rapid, recurrent involuntary movements that are noticed by
others (DC 10 Wisdom (Perception) check), the afflicted others depending on their severity. The tics are both facial
also suffers a -2 penalty on Charisma-based skill checks. (eye twitches, head jerking, mouth grimaces) and involve
Furthermore, an ally’s Charisma-based checks are other bodily movements such as trembling hands. A nearly
made at -1 if the afflicted character is within sight of constant malady, an afflicted character may make an effort to
the interaction and a known associate of the teammate suppress the tic, an immediate action requiring a Wisdom
attempting the check. saving throw each round.
18

TIC, CHRONIC VOCALIZATION
Maladies for NPCs
Some forms of madness can’t be easily role played and are far
EFFECTS
too disruptive to a story’s narrative flow. Unless a GM wishes
Trigger —; Duration chronic to build an entire adventure or campaign around them,
Effect such maladies are better suited for NPCs and can be used as
Mild—The afflicted character suffers a -2 penalty on all interesting tools for building and twisting a plot.
Charisma-based skill checks and Stealth checks. An ally’s
Charisma-based checks are made at -1 if the afflicted
character is within sight of the interaction and is a
AMNESIA, GLOBAL
known associate of the teammate attempting the check.
Type: psychosis; Severity severe; Save none
Moderate—As mild, though penalties to checks are -3 (-2
for an ally’s checks). There is also a 20% chance of spell EFFECTS
failure for spells with verbal components. This extends to Trigger —; Duration permanent or until healed
the employment of magic items with verbal components Effect
(such as scrolls). Mild—Loss of memory (see below).
Severe—As moderate, though check penalties are at -4 Moderate—As mild, plus -2 to all Nature and Religion
(-3 for an ally’s check). Spell failure 50% for spells with checks.
verbal components. Severe—As moderate, save the check penalty is -3.
DESCRIPTION DESCRIPTION
A rapid, recurrent involuntary vocalization such as throat A character suffering from amnesia cannot remember
clearing, hoots, laughing, or other nonsense noises the things: name, skills, and past are all equal mysteries. She can
afflicted character has great difficulty controlling. The build new memories, but any memories that existed before
vocalizations occur at random intervals on a nearly constant becoming an amnesiac are suppressed.
basis. Chronic vocalization tics may be suppressed each
Worse, the amnesiac loses all class abilities, feats, and
round, requiring a Wisdom saving throw.
proficiency bonuses for skills for as long as the amnesia lasts.
She retains her proficiency bonus for attacks, and base saving
throw bonuses. Total experience points and hit dice (and hit
TIC, INTENTIONAL VOCALIZATION points) remain unchanged, but everything else is gone until
Type: neurosis; Severity mild to severe; Save DC 10/13/16 Wisdom the amnesia is cured. If a character gains a class level while
EFFECTS suffering from amnesia, she may use any abilities gained by that
Trigger special; Duration 2—5 rounds after the end of the class level normally. If the class level gained was of a class the
stressor character already possessed levels in, she gains the abilities of a
1st-level character of that class, even though she is technically of
EFFECT a higher level in that class. If the amnesia is later cured, all the
Mild—The afflicted character suffers a -2 penalty on all full abilities of this class are regained, including those gained
Charisma-based skill checks and Stealth checks, as well from any levels taken while suffering from amnesia.
as voice-related Performance skills.
Moderate—As mild, though penalties to checks are -3.
There is also a 20% chance of spell failure for spells with DISSOCIATED IDENTITIES
verbal components. Type: psychosis; Severity moderate to severe; Save DC 19/21 Wisdom
Severe—As moderate, though check penalties are at -4. Spell EFFECTS
failure 50% for spells with verbal components.
Trigger special; Duration permanent or until healed
DESCRIPTION Effect
A rapid, recurrent involuntary vocalization the character Moderate—The afflicted possesses 1d4+1 distinct personalities.
experiences when employing speech. When a stressor presents itself a Wisdom saving throw is
necessary to prevent shifting to another identity.
Severe—As moderate, save that the afflicted possesses
1d6+2 distinct personalities, at least two of which are of
diametrically opposed beliefs and motivations.
19

DESCRIPTION PSYCHOGENIC FUGUE
This complex condition involves the presence of multiple, Type: psychosis; Severity moderate to severe; Save DC 18/20
separate identities within a single individual. In addition to Wisdom
an original, “core” personality, are a number of other distinct
EFFECTS
personalities that have evolved over time. These separate selves,
including the core personality, are generally unaware of one Trigger —; Duration varies
another’s existence. The identities potentially possess different Effect
ages, classes/levels, alignments, mental ability scores, and sexual Moderate—The afflicted has no memory for her previous
orientation, but may also vary in terms of the afflicted character’s life, including her name, relationships, or experiences.
perception of her own race and gender (note that the character A new identity has been assumed, alignment may have
doesn’t gain racial abilities/benefits if she isn’t truly a member been altered (see below), and divine casters may in fact
of that race). be devoted to a new deity or philosophy. Class abilities
and skills are all intact. If confronted by someone or
Note that not all of the identities need be heroic: a frightened
something from the past, a successful Wisdom saving
child, brooding farmer, curmudgeonly old woman, and any
throw indicates that the afflicted has a recollection
other mundane personality are all possibilities. The NPC in
of the thing or person, but generally dismisses this
many ways can be treated as a multiclassed character, with hit
as a remembrance of a story once heard. However, 3
points, Attack Bonus, and the like whatever they would be if the
consecutive recollections (read: Wisdom saving throws)
NPC were a regular multiclassed character. However, she cannot
of the past break the fugue. The flood of past memories
switch between class abilities at will. Rather, the switch between
leaves the afflicted frightened for a full 24 hours and she
personalities is often random or driven by circumstances. For
suffers from the effects of moderate retrograde amnesia
instance, combat brings the paladin half-elf to the fore, while
for 2d4+3 days before memory is fully restored. This may
entering a dark room brings forth the frightened child.
also be healed by traditional methods. When the fugue is
broken the character retains any class levels or abilities
gained while afflicted with the malady.
Severe—As moderate, save that the afflicted has no conscious
memory of past class abilities or skills. However, if a
stressful circumstance presents itself where such an
ability/skill would be useful, the afflicted may reflexively
employ it if a Wisdom saving throw is made and the
ability/skill would have required no prior preparation
(such as memorizing a spell). Strangely, the afflicted
cannot deliberately employ this same ability/skill
afterwards. It’s not uncommon for a creature suffering
from this severe fugue to adopt a new profession entirely.
This malady is permanent until healed.
DESCRIPTION
A person who has undergone a psychogenic fugue has lost
their personal identity and assumed a new one. Most often
the afflicted has set up a life far from home, with a new name,
perhaps even a new alignment, though it’s most common for
evil persons to assume a neutral or good alignment rather
than the reverse. A false past has taken the place of the
afflicted’s true memories. These constructed recollections
are vague at best, though this fogginess of distant memory
is not experienced as strange by the afflicted. A psychogenic
fugue is most often the result of a significant trauma.
20

THE TREATMENT OF
MADNESS
Determining how well maladies are understood in various
locales in the campaign world is another GM consideration.
Mental illness has a long history in our own world of
poor understanding, superstitious misconceptions, and
barbaric treatment methods. It stands to reason that in
fantasy worlds the plight of those afflicted with madness is
no better. Some cultures may believe that maladies signify
possession by evil spirits, that the sufferer has somehow
been touched by the gods, or the illness is somehow a sign
of feeblemindedness, low moral character, or connected
to phases of the moon and lycanthropy. Asylums can
range from humane refuges where only moderately
effective attempts (at best) are made to assuage the
symptoms of maladies, to brutal institutions where Divinity: Read Thoughts, and other characters may use
grossly ineffective and harmful “treatments” are practiced. similar abilities to determine if a target is afflicted with
Even worse, the mad may be exploited by evil individuals as maladies, and can further discern the number and general
easily manipulated followers, patsies on whom to pin blame nature of these afflictions (neuroses or psychoses, but not the
for their own crimes, or guinea pigs for unthinkably cruel specific maladies). Spells such as detect thoughts can likewise
experimentation. detect the presence and severity of maladies.
The text below outlines efficacious means of addressing However, maladies actually disrupt and confuse the alignment
maladies. However, these methods may not be common aura. Any effect allowing a creature to read the Alignment of
knowledge in all places adventurers find themselves. Indeed, an afflicted character is more difficult: there is a 50% chance
discovering an effective cure for madness can itself be the that it will return an incorrect result. Roll a d4 to determine the
subject of a grand, wide ranging quest. reader’s possible error: 1 = reader makes an error on both the
good/evil and law/chaos axis; 2 = reader makes an error on the
good/evil axis; 3 = reader makes an error on the law/chaos axis; 4
Healers = reader correctly recognizes she has failed.
Characters with a Proficiency Bonus in Medicine can
perform a Help Action when afflicted individuals with
neurotic conditions attempt Wisdom saving throws related Potions
to their maladies, giving them Advantage. The character must Some magic users have made a study of madness that enables
be level seven or higher to do the same for those suffering them to concoct agents which can, for a limited time, assuage
from psychotic conditions. Anyone with Proficiency in Heal the deleterious effects of neuroses and psychoses, while less
may attempt to soothe a character afflicted with an active scrupulous sorts can concoct brews that mimic their effects.
neurotic condition, though they must succeed on a check This involves a new discovery called psychopharmacology.
equal to the malady’s Wisdom saving throw DC + 1/2 the Psychopharmacology: A magic user is able to create medicinal
afflicted’s Charisma score. This is an Attack Action requiring mixtures to temporarily alleviate the effects of neurotic and
1d4 rounds, with success reducing the severity by one step psychotic maladies. These mixtures can be purged from
(mild conditions are suppressed). The palliative effect lasts the system (including any negative effects) by successfully
for 2d8 rounds if the condition is chronic, or until another employing protection from poison.
triggering event occurs. Furthermore, the study of madness has given these magic
users a +1 bonus when attempting a Wisdom (Medicine)
check or performing a Help Action for an ally afflicted with
Auras and Madness a malady’s ill effects. Non-good magic users may also create
Madness has an impact on some auras, as detected by detect maddening agents, which imbue those who ingest them with
magic and similar magic and abilities. A Paladin can employ the symptoms of madness.
their Divine Sense Ability, Clerics can use their Channel
21

BENEFICENT PHYSIC (ANTI-NEUROTIC) If a character suffers from more than one psychosis or also
Potion, very rare suffers from neurotic conditions, the potion has its palliative
A potion to help those afflicted with neurotic maladies, a effects on all the conditions accordingly.
beneficent physic provides Advantage to Wisdom saving Those who ingest an infusion who aren’t suffering from
throws related to neurotic conditions. It lasts for 1d4 hours a malady gain no benefit, suffer double the side effects for
before wearing off. the agent’s duration, and are immediately nauseous,
A beneficent physic has no benefit against psychotic symptoms. giving them the incapacitated condition for
Those who ingest a physic that aren’t suffering from a 1d6 minutes unless they succeed on a DC 17
malady gain the benefits associated with calm emotions, Constitution, in which case they become
but this lasts only 1d4+3 rounds before wearing off. poisoned. A natural 1 results in the paralyzed
condition for the period of incapacitation.
CALMING ELIXIR (ANTI-NEUROTIC)

Potion, very rare MADDENING AGENT
Potion, very rare
An alchemical remedy for reducing the effects
of neurotic maladies, a calming elixir lasts A potion made to mimic the effects of
for 2d4 hours before wearing off and during a malady, but disguised to fool the
this time decreases the severity of neurotic unwary. Failure to properly deduce
conditions by a number of steps (severe its effect by taste (DC 17 Wisdom
becomes moderate; moderate becomes mild, (Perception) check) leads to the
and it suppresses the effects of a mild condition mistaken notion that it is some sort of
altogether). However, these potions also produce healing potion. There are six agent varieties,
a side effect of sedation, causing a -1 penalty to each inducing the severe form of the
Initiative rolls for each step reduced (see Table one of the following maladies for 4d6+2
3, page 23). The effects of ingesting additional rounds: chronic motor tic, command
calming elixirs while another is already in an hallucinations, formication, manic
individual’s system are cumulative, but so are the episode, retrograde amnesia, visual
side effects. If a character suffers from more than hallucinations. The active symptoms
one neurosis, the potion has its palliative effects of the malady occur 1d4 rounds after
on all the conditions accordingly. imbibing the potion. Those who ingest a
potion who already suffer from the malady it
A calming elixir has no effect on psychotic symptoms.
mimics must make a DC 17 Constitution saving
Those who ingest an elixir that aren’t suffering from a
throw or enter a severe catatonic
malady gain +1 to Wisdom saving throws per step of
stupor (as the malady) for the
malady reduction, but the side effects are doubled.
potion’s duration. A maddening
agent should be treated as a poison
for all other purposes.
FOCALIZING INFUSION (ANTI-PSYCHOTIC)
Potion, rare
A potion for reducing the effects of psychotic maladies, a TRANQUILIZING TINCTURE (ANTI-PSYCHOTIC)
focalizing infusion lasts for 2d4 hours before wearing off and Potion, rare
during this time decreases the severity of the psychotic
A potion for those afflicted with psychotic maladies, a
condition by a number of steps (severe becomes moderate;
tranquilizing tincture provides a bonus to Wisdom saving throws
moderate becomes mild, and it suppresses the effects of a
related to psychotic conditions, lasting for 1d4 hours before
mild condition altogether). However, these infusions also
wearing off. Tinctures have a sedating effect, however, affecting
produce sedation, causing a -2 penalty to Initiative rolls and
Initiative and Dexterity saving throws of imbibers. A tranquilizing
Dexterity-based checks for each step reduced (see Table 3, page
tincture’s benefits are doubled for those who only have neurotic
23). A focalizing infusion can also affect neurotic conditions (as
symptoms. However, so are the side effects. Those who ingest
calming elixirs), but are generally less desirable due to their
a tincture that aren’t suffering from a malady gain the benefits
more serious side effects. The effects of ingesting additional
associated with calm emotions, but this lasts only 1d6+8 rounds
focalizing infusion potions while another is already in an
before wearing off.
individual’s system are cumulative, but so are the side effects.
22

TABLE 3: PSYCHOPHARMACOLOGICAL MIXTURES
Class Type Effect Side Effects
Beneficent Physic Onyx Wis saves for neurosis None
made at +1
Beneficent Physic Pearl Wis saves for neurosis None
made at +2
Beneficent Physic Topaz Wis saves for neurosis None
made at +3
Calming Elixir Copper Effects of neurosis reduced -1 to Initiative
one step
Calming Elixir Silver Effects of neurosis reduced -2 to Initiative
two steps
Calming Elixir Gold Effects of neurosis reduced -3 to Initiative
three steps
Focalizing Infusion Copper Effects of malady reduced -2 to Initiative, Dex-based checks
one step
Focalizing Infusion Silver Effects of malady reduced -4 to Initiative, Dex-based checks
two steps
Focalizing Infusion Gold Effects of malady reduced -6 to Initiative, Dex-based checks
three steps
Maddening Agent Yellow Chronic motor tic None
Maddening Agent Red Manic episode None
Maddening Agent Green Formication None
Maddening Agent Clear Retrograde amnesia None
Maddening Agent Purple Visual hallucinations None
Maddening Agent Blue Command hallucinations None
Tranquilizing Tincture Onyx Wis saves for psychosis -1 to Initiative and Dex saves
made at +1
Tranquilizing Tincture Pearl Wis saves for psychosis -2 to Initiative and Dex saves
made at +2
Tranquilizing Tincture Topaz Wis saves for psychosis -3 to Initiative and Dex saves
made at +3
Magic Any spell/spell-like effect causing the charmed condition (such as

hypnotic pattern): The deleterious effects of neurotic conditions
The following describes the effects of certain spells and
spell-like abilities on maladies. are suspended while an afflicted creature is charmed, though
the effects of the fascinated condition remain. When the
Greater restoration, heal, or wish: Immediately cures a target charmed state ends, the afflicted gains a new saving throw
of all the maladies from which it suffers. vs. the malady’s effects unless those effects are episodic, in
Lesser Restoration and remove curse cast one after another: which case the episode is terminated.
Reduces a single moderate or severe malady by one step but
has no effect on mild maladies. The caster may target a specific
malady as long as she is aware how many maladies afflict the Ioun Stones
target. Lesser restoration has no effect on maladies whatsoever. Some ioun stones channel the balancing qualities of the
Calm emotions: Afflicted creatures under the active relatively inexpensive hematite gem into an effective palliative,
employment of the spell gain Advantage to saves made vs. even a cure for maladies. Utilizing the gem’s latent power to
the effects of neurotic maladies and psychotic maladies. transform negative into positive energies, there are 6 varieties
23

of these psychotropic devices. However, the magicks involved TABLE 4: PSYCHOTROPIC IOUN STONES
in these gems are so incredibly delicate and complex that
there is a 1% that a psychotropic ioun stone is cursed. Shape Effect
Rhomboid Reduces a single moderate or severe
neurotic malady one step or suppresses a
mild neurotic malady
PSYCHOTROPIC IOUN STONE PRICE VARIES
Wondrous Item, rare Sphere Provides a +1 bonus to Wisdom saving
throws related to all afflicting maladies
These specialized ioun stones are always made of pieces of a
relatively low-value gem: hematite. Star Reduces a single moderate or severe
psychotic malady one step or suppresses a
Hematite ellipsoid ioun stones shield the user from
mild psychotic malady
contracting maladies. When an event indicates the user
would normally contract a malady, the stone absorbs the Spindle Suppresses a single psychotic malady
malady. A single stone can absorb 24 points of psychic weight. Ellipsoid Prevents user from contracting maladies1
The weight of a single malady is determined by whether it’s Prism Absorbs existing maladies1
a neurosis or psychosis (neurosis = 1 point, psychosis = 3
points) and its severity (mild = 1 point, moderate = 2 points,
1
See item description for details
severe = 3 points). For example, a mild neurosis has a psychic
resist contracting a malady are made at a -5 penalty, and saves
weight of 2, while a moderate psychosis has a weight of 5.
vs. the effects of existing maladies are made at -2. Despite
Once a stone has absorbed its limit, it burns out and loses
these deleterious effects, the user is deluded into believing
its metallic sheen, forever useless. If a stone doesn’t have
that the stone is effective and cannot be convinced otherwise.
sufficient remaining storage to absorb a malady, it either
burns out and the malady afflicts the user as it normally
would (80% chance) or causes the stone to explode in a 20-
foot radius (20% chance). Every creature within the blast Decompensation
radius must make a DC 20 Wisdom saving throw to avoid Without treatment, maladies naturally worsen over time,
contracting a malady (roll d100+12 on Table 1, page 4). Pre- a process referred to as decompensation. When a character
existing maladies are unaffected by the hematite ellipsoid. contracts a malady and forgoes any treatment for a full
month (treatment being defined as anything which reduces a
Hematite prism ioun stones permanently absorb existing malady by one or more steps, even temporarily), the afflicted
maladies in those users already suffering from them, up to must make a Wisdom saving throw for each malady suffered
a total psychic weight of 18. Should to determine if the condition(s) worsen by one step. If a failed
the user have maladies save indicates that an already severe condition worsens, a new
that exceed the stone’s malady develops (roll on Table 1, page 4, ignoring results of
remaining capacity, the conditions already suffered).
result is the same as
those for a hematite
ellipsoid noted above.
Determining the
remaining capacity
in one of these stones
Suggestions for the GM
requires detect magic How deeply players are immersed in the game world is
and a DC 21 Arcana check. greatly influenced by the skill of the GM. This is doubly true
for effective introduction of the elements of madness. The
following are a few suggestions for creating verisimilitude.
CURSED PSYCHOTROPIC IOUN STONE
Wondrous Item, Very Rare First and foremost, don’t treat maladies as simple de-buffs
These ioun stones are superficially indistinguishable from impacting die rolls. Players are much more likely to find
their functional counterparts: hematite ioun stones crafted elements of madness challenging and immersive if the GM
to combat madness. Regardless of the type of psychotropic isn’t artlessly naming a malady outright: “You have paranoid
stone intended, all such cursed stones have the same effect. ideation.” Remember, the GM is the source of nearly all
When placed in orbit around the user’s head, they instead information in the game. Therefore, where madness is
increase vulnerability to maladies and their effects. Saves to concerned the GM acts as the primary source of mistaken and
24

untrustworthy information generated by maladies afflicting
a character: the distortions are presented as fact. This can
be accomplished with subtlety and cleverness during the
course of game play. For instance, an event occurs triggering
the manifestation of an afflicted character’s paranoia. The
GM asks for a Wisdom (Perception) check from the afflicted
character, though the roll is really the PC’s Wisdom against
the paranoia. If the check is failed, a note is passed to the
player: Your ally is in league with the vampires you hunt.
Once a player begins to suspect that a character is afflicted

with some form of madness, resist naming it. Keeping
players in the dark about a malady’s nature and mechanics
mimics the confusion of an afflicted soul. If a character
has hypochondriasis, ask for frequent Constitution saving
throws, making a notation behind your screen without
comment; with mild hallucinations, ask for frequent
Wisdom (Perception) checks followed by an off-handed,
“It was probably nothing.” Creating tension in a party of
characters suffering from madness really can be as simple
as asking for various checks and saves without apparent
reason. Players are left guessing what is real or the result of
madness by interspersing legitimate episodes of genuine
peril mirroring the characters’ maladies. For instance, allies
may grow complacent about a character’s repeated false
alarms that are the product of mild visual hallucinations,
until they are coincidentally attacked by a shadow or some
other incorporeal undead.
Familiarity with the maladies afflicting characters is

essential. Consider how these afflictions could impact on
the encounters ahead and plan accordingly. Madness should
have an impact on the story being told. Finding ways to weave
the manifestation of maladies into a game’s events greatly
enhances players’ experiences.
25

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