At the end of each day, if you haven’t drunk at least 1/2 ounce of water or equivalent per pound of body weight, you must succeed on a DC 10 Constitution saving throw or gain 1 level of exhaustion. The saving throw is made with disadvantage if you are wearing clothing or armor that’s heavy for the climate. If you are traveling at a fast pace instead of a normal or slow pace, you have disadvantage on your saving throws against Dehydration. The DC increases by 2 for every cumulative day until you drink a full day’s requirement of water. At IE 4, you must succeed on a DC 10 Constitution saving throw or experience Hallucinations or Delusions until the IE lowers to 3.

You feel the urge to cough frequently. When you experience the urge, you must succeed on a DC 5 + (IE) Constitution check to stifle the cough. On success, the DC increases by 1 each round until you spend a bonus action coughing or roll a Natural 20, in which case, the urge goes away. When you cough, you have disadvantage on Dexterity (Stealth) checks that require silence.

When you take ten percent or more of your hit points of bludgeoning damage in a single attack to your head, you may roll for concussion: a contested Constitution saving throw against the attacker’s Strength or, if the damage comes from an object not being used as a weapon, use the object’s Armor Class (See chapter 15 of the Basic Rules) as its Strength. If you fail the save, you temporarily experience 1d8 of the following: Pain (Head), Confusion, Gross Motor Control Loss, Anterograde Amnesia, Nausea, Dizziness, Tinnitus, Fatigue, Baseless Emotion (Irritable), Baseless Emotion (Depression), and/or Photosensitivity. Following a long rest, you may attempt another Constitution saving throw. The symptoms remain until you succeed on this saving throw.

You are unconscious and unable to awaken by standard means. When in a coma, you must succeed on death saving throws like other situations when you’re reduced to 0 hit points, but you must make the saving throw daily and succeed or fail 10 times instead of 3.

Some traits of disabilities or illnesses can lead to additional conditions that may be temporary, degenerative or lead to an entirely new set of traits. These complications may be a result of any number of internal or external factors, and depending on the cause, may be healed with applicable healing magic or medicine. If the complication does not indicate a frequency, use the causal trait’s frequency or, lacking a causal trait, choose or roll on the Frequency Table.

Disabilities and Spellcasting

Many traits listed have modifications to spellcasting, especially as it relates to verbal and somatic components. The descriptions mainly relate to wizards, bards, and other casters who keep a spellbook.

Divine casters such as clerics and paladins, as well as warlocks, who receive their magic from a patron, would receive it in such a way that they would be able to cast it. For the sake of game balance, the player and GM should discuss how the spells differ. Some suggestions include:

• Casting time increases as more somatic components are necessary to assist with verbal components (or vice versa).
• Additional material components are needed.
• The range or duration decreases slightly.
• The verbal component is replaced with noisy body movements like clapping, tongue clicks, or rhythmic stomping.

Line of Sight

Some 5th Edition game mechanics, especially spells, rely on line of sight for range. This is problematic for blind and visually impaired characters. Instead, consider the following:

Line of Action: any direct line between the character and a creature they can sense without physical obstruction in that line.

I am not my disability, but it’s not to be ignored either. It’s a part of me; it makes me who I am.

-Ryza Wood]

You experience memories of past trauma (sometimes violent, but not always) as if it’s happening again. The flashbacks are triggered by external stimuli, sometimes predictable, but the specific stimuli can be any number of brief sensory experiences. In this case, the response is triggered seemingly randomly (IE)d4 times per day or when exposed to stimuli known to relate to the traumatic event and lasts for (IE)d6 minutes unless you succeed on a DC 8 + (IE) Constitution saving throw. All spellcasting and ability checks require that you succeed on a concentration check or make the subsequent check with disadvantage, and tasks that normally require a concentration check are made with a −(IE) penalty. If you take damage during the flashback experience that doesn’t make sense within that context, you may make another Constitution saving throw immediately.

Real-world Examples

Post-Traumatic Stress Disorder

Assistive Options

An ally or service animal that recognizes that you’re experiencing a Traumatic Flashback may use a help action to give you advantage on the Constitution saving throw.

Certain stimuli cause a feeling of panic resulting in Heart Palpitations, sweating, and other responses, and because of the feelings you associate with that stimulus, you try to avoid it. If Frequency is Triggered, choose or roll on the Phobia table, or choose another event or stimulus. While this trait is triggered by stress or some other stimulus, the stimulus could be a memory that surfaces suddenly or caused by an unexpected or unknown source. In this case, the response is triggered seemingly randomly (IE)d4 times per day and during any remotely stressful situation and lasts for (IE)d6 minutes unless you succeed on a DC 8 + (IE) Constitution saving throw. All spell casting and ability checks require that you succeed on a concentration check or make the subsequent check with a −(IE) penalty, and tasks that normally require a concentration check are made with a −(IE) penalty. If you have multiple traits, you may choose Startle Amplification, Dizziness, Phobia, Nausea, Cramps, or Tremors as one or more of them, triggered by the panic attack.

Real-world Examples

Obsessive-Compulsive Disorder, Panic Disorder

Assistive Options

The combination of calming activities, exercise, getting enough sleep, and avoiding alcohol, caffeine, and smoking, when used consistently together for at least three consecutive days, reduce the IE by 1.

You have an overactive stress response, causing you to have a fight-flight-freeze reaction to non-threatening situations. This response is triggered seemingly randomly (IE)d4 times per day and during any remotely stressful situation, including being awakened suddenly. If you are a barbarian, when this response is triggered, you must succeed on a DC 10 + (IE) Wisdom saving throw or begin to Rage involuntarily, using up one of your daily Rages. You have a +(IE) bonus to Charisma (Intimidation) checks but a −(IE) penalty on Charisma (Persuasion) checks. Because of your heightened awareness, you also have +1 bonus on initiative rolls. If you have multiple traits, you may choose Rash as one of them.

Real-world Examples

Post-Traumatic Stress Disorder, Anxiety

Assistive Options

Several behavior changes can have a positive cumulative benefit. Upon keeping three of the following for seven days, the IE decreases by 1 as long as you maintain them: spend an hour each day on a calming activity such as meditating, exercising, and staying in contact with at least two trusted people. If you change which of those you’re doing, at least three must stay the same, or you lose the benefit for seven days.

You feel the need to use repetitive physical stimulation (stimming) for (IE)d4 rounds to manage your emotions. Stimming can manifest as hand flapping or finger movements, rocking, unusual posture, watching a repetitive movement, making or listening to a song or noise repeatedly, manipulating a fidget device, or mouthing inedible objects or your own appendages. Aside from drawing negative attention from those who don’t understand this behavior, inability to stim can lead to emotional dysregulation. When needing to stim, if unable, you must succeed on a DC 3 + (IE) Wisdom check to fight the urge each round, the DC increasing cumulatively by (IE) each round until you meet your stimming needs. Failure to resist the urge causes a −(IE) penalty on all ability checks until you meet your stimming needs.

At IE 4, stimming may be self-injurious, such as hand-biting (succeed on a DC 5 Constitution saving throw or develop Infection), eye-poking (succeed on a DC 5 Constitution saving throw or develop Infection. On a critical failure, develop Refractive Difference), or head-banging (1 bludgeoning damage every 1d4 rounds).

Real-world Examples

Autism, Sensory Processing Disorder, Rett Syndrome, Fragile X Syndrome, Prader-Willi Syndrome, Attention Deficit Hyperactivity Disorder, Tourette Syndrome, Schizophrenia, Fronto-Temporal Dementia, Alzheimer’s Dementia

Assistive Options

While stimming is normally harmless and in fact helpful, if it gets in the way of achieving your goals or is self-injurious, some helpful options may include attempting to avoid the causal stimulus, which is not always possible. You may also attempt proactively stimming if expecting a triggering situation, which reduces the length needed later by 1d4 rounds and gives a +1 bonus to the Constitution saving throw to resist. Wearing a helmet or other protective gear that still allows you to get the needed stimulation but reduces or eliminates the resulting injury may also be possible for self-injurious stimming. Fidget items and chewelry sometimes provide a safe alternative to some injurious movements.